Guía práctica para el uso de registros visuales en la era del Reglamento General de Protección de Datos de la Unión Europea / Use of visual media in the era of European Union's General Data Protection Regulation: A practice-oriented guideline

El nuevo Reglamento General de Protección de Datos de la Unión Europea (más comúnmente conocido por sus siglas en inglés como «GDPR») conforma un nuevo marco para la protección de datos común para la Unión Europea. Es por ello que los profesionales del ámbito sanitario deben revisar cómo recopilan y comparten datos para garantizar que estos cumplan con todos los estándares. El propósito de este artículo es concienciar sobre el Reglamento General de Protección de Datos de la Unión Europea y proporcionar una guía práctica que ayude a evitar problemas legales en la redacción de artículos o la preparación de comunicaciones científicas que requieran compartir datos personales y visuales. Para hacer esto, se han analizado las más comunes situaciones donde es necesario recoger y utilizar datos personales y visuales, para finalmente dar una serie de respuestas y recomendaciones para todos los escenarios descritos. (AU)

With the European Union's new General Data Protection Regulation, commonly known as “GDPR”, as the new framework for data protection across the European Union, doctors will need to review how they collect and share personal data to ensure they meet the standards. The aim of this article is to raise awareness on the General Data Protection Regulation, and to provide an easy guideline to steer free from legal problems at the time of drafting papers, presenting lectures and sharing personal data and visual media in particular. To do so, we have analysed the most common situations where personal data, and above all visual media, can be collected, giving clear-cut answers and recommendations for all the scenarios. (AU)

Use of visual media in the era of European Union's General Data Protection Regulation: A practice-oriented guideline.

With the European Union's new General Data Protection Regulation, commonly known as 'GDPR', as the new framework for data protection across the European Union (EU), doctors will need to review how they collect and share personal data to ensure they meet the standards. The aim of this article is to raise awareness on the GDPR, and to provide an easy guideline to steer free from legal problems at the time of drafting papers, presenting lectures and sharing personal data and visual media in particular. To do so, we have analysed the most common situations where personal data, and above all visual media, can be collected, giving clear-cut answers and recommendations for all the scenarios.

International cooperation group of emergency surgery during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams' adoption of recommendations during the pandemic. METHODS: Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. RESULTS: One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. CONCLUSION: Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.

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

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.

Correction to: Surgeon-performed point-of-care ultrasound for acute cholecystitis: indications and limitations: a European Society for Trauma and Emergency Surgery (ESTES) consensus statement.

Unfortunately, the author Luca Ponchietti was omitted in the original publication. Please find the correct author list here.

Not only FAST The MUSEC® experience in training surgeons.

For a long time surgeons have been discussing the need to improve their skills in the use of ultrasound (US). However in the recent years it has become evident the importancxe for general aklnd trauma surgeons treating critically-ill patients to learn basic and advanced US. The two last editions (9th and 10th) of the ATLS manual have officially included FAST and e-FAST in the primary assessment of trauma patients, making this tool an essential skill for surgeons. In the acute care setting FAST, e-FAST and other applications have gained a pivotal, evidence-based role in this fields. Nevertheless, surgeons are rarely performing US exams by themselves, losing a major decision-making tool. The Modular Ultrasound ESTES Course (MUSEC®) was developed to provide both fundamental and advanced US training for surgeons in trauma and acute care settings. We are strongly convinced, in the light of the results from both the surveys carried out and the customer satisfaction tests administered to all the participants in the MUSEC courses, that US courses such as these should be part of the general surgery residency programs. KEY WORDS: e-FAST, MUSEC Ultrasound in Emergency Department, Ultrasound Training Trauma Patients.

Thromboprophylaxis in Elderly Surgical Patients: Current State and Future Considerations.

Venous thromboembolism is the number one cause of preventable death for hospital inpatients. Aging general surgical patients are especially susceptible to DVT/PE and this risk increases in the presence of other comorbidities prevalent in the elderly. However, it is often unrecognised and undertreated. Various risk scores classify patients in low, moderate and high risk categories. Current guidelines for thromboprophylaxis advocate combination of mechanical methods in the form of elastic stockings or intermittent pneumatic leg compression and pharmacological agents such as low molecular weight heparins and oral anticoagulants. Increased bleeding risk is a concern in this population and the method of prophylaxis needs to be adjusted as a result. Decreased renal function also influences the choice and dosage of medication. The required duration of prophylaxis is unclear but can range from one week to more than a month depending on the underlying pathology and individual risk assessment.

Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery: A Systematic Review.

Background: Geriatric surgery is rising and projected to continue at a greater rate. There is already concern about the poor outcomes for the emergency surgery in elderly. How to manage the available resources to improve outcomes in this group of patients is an important object of debate. OBJECTIVES: We aimed to determine the feasibility and safety of applying ERAS pathways to emergency elderly surgical patients. METHOD: Two searches were undertaken for ERAS protocols in elderly patients and emergency surgery, in order to gather evidence in relation to ERAS in geriatric emergency patients. Primary outcomes were postoperative complications, mortality, hospital length of stay and readmission rates. Results: Eighteen studies were included. The majority of patients were older than 70. Elderly patients had fewer postoperative complications and a reduced hospitalization with ERAS compared to conventional care. Emergency surgical patients also had fewer postoperative complications with ERAS compared to conventional care. Hospital stay was reduced in 2 out of 3 studies for emergency surgery. Conclusions: ERAS can be safely applied to elderly and emergency patients with a reduction in postoperative complications, hospitalization and readmission rates. There is evidence to suggest that ERAS is feasible and beneficial for geriatric emergency patients.

The Future of Emergency Surgery.

Introduction: Over the past three decades, there has been a recognised need for emergency surgery (ES). Studies of ES have demonstrated variation in patient outcomes depending on admission time or day. ES as a subspecialty is still under consideration in Europe despite being recognised as such in the US. This article reviews this need and addresses the issues required to develop ES as a separate surgical subspecialty in Europe. METHOD: A survey on ES was developed by the Educational Committee of the European Society for Trauma and Emergency Surgery (ESTES) and sent to all ESTES members with 102 responses received. Results: Of the responses, 93.1% had completed training. 75.3% of respondents report that ES should be a recognised subspecialty and 79% report that ES is capable of offering a rewarding career. 90% report that ES should have dedicated post-graduate training programme with 69.8% in agreement that dedicated emergency surgeons have improved outcomes following ES. CONCLUSION: Developing ES as a subspecialty in Europe would improve patient outcomes and facilitate resource allocation. This advancement is, however, still in its infancy and its evolution would require overhaul of our current European system, training methods and understanding of the role of emergency surgeons in ES.

Apps in Trauma and Emergency Surgery.

Background: As physicians, Mobile smartphones, laptops and tablets are now an integral part of our day to day activities including personal communications as well as our routine clinical practice. Methods: A digital survey was designed to explore the usage of mobile smartphones and the associated apps among surgeons in Trauma and Emergency departments. It was sent to 850 members of the European Society for Trauma and Emergency Surgery. Results: A total of 91 responses were received with 60.4% aged between 35 and 54 years. Only 24.1%of respondents found the available apps extremely useful in their practice, however 75.9% of participants agreed on not being able to identify a certain good application to rely on. CONCLUSION: Despite the widespread use of smartphones among doctors of different grades and specialties, there is a preference shown towards the use of instant messenger apps and the use of the camera for clinical photos. The usefulness of current available apps appears to be limited due to the absence of a regulating body to check the validity of data and peer review the contents of apps leaving a huge responsibility on the individual doctor using the app to rely on its results.

Enhanced Recovery after Emergency Surgery: A Systematic Review.

OBJECTIVE: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS). METHODS: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate. RESULTS: The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care. Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance. CONCLUSIONS: The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.

Transverse colon herniation through the foramen of Winslow presenting with unusual CT findings.

Bowel herniation through the foramen of Winslow is among the rarest of internal hernias, accounting for less than 0.8%. In its origin, a pivotal role is played by some anatomic variations, or anomalies such as the increased mobility of the right transverse colon, and maybe the exceedingly large bore of the foramen itself. The first case of hernia through the foramen of Winslow was reported by Blandin in 1834. Since then, no more that 200 new cases have been described. Diagnosis usually is established during surgery while treating a bowel obstruction. Only in an exceedingly small group of patients is diagnosis achieved preoperatively on the basis of radiological findings. We describe a preoperatively diagnosed case of transverse colon herniation through the foramen of Winslow, showing a portal vein narrowing and periportal lymphedema at computed tomography (CT). To the best of our knowledge, only a few cases of preoperative CT diagnosis of Winslow foramen hernia have been described in the past. None had the above-mentioned CT findings.