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1.
J Surg Res ; 257: 379-388, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892134

RESUMO

BACKGROUND: The impact of surgical volume on outcomes in Hirschsprung's disease (HD) remains uninvestigated. We aimed to determine whether higher surgeon and hospital-level HD operative volumes are associated with improved surgical outcomes following primary surgery for neonatal HD. MATERIALS AND METHODS: Neonates who underwent either an ostomy or pull-through (PT) procedure for HD before 60 d of life and a PT procedure by age 1 y were identified in the Pediatric Health Information System (PHIS). Index admissions from January 2000 to September 2012 across 41 tertiary childrens hospitals were included. Surgeon and hospital-level HD operative volume were defined as the average annual number of PT procedures performed for HD in the 2 y preceding each included case. We examined the relationship between operative volumes and all-cause readmission, readmission for Hirschsprung's associated enterocolitis (HAEC), and rates of reoperation within 30 d and 2 y. RESULTS: A total of 1268 infants were included. There were 218 patients (17.2%) readmitted to the hospital within 30 d and 540 (42.6%) within 2 y. A total of 119 patients (9.4%) had HAEC-related readmission within 30 d, and 271 (21.4%) had HAEC-related readmission within 2 y. A total of 57 patients (4.5%) had a reoperation within 30 d and 129 (10.2%) within 2 y. In risk-adjusted analyses, there were no significant associations between either surgeon or hospital HD operative volumes and readmission/reoperation rates within 30 d or 2 y. CONCLUSIONS: Neither surgeon nor hospital PT volumes were significantly associated with readmission or reoperation rates for infants with Hirschsprung's disease. Future work is needed to evaluate whether operative volumes are associated with functional outcomes following PT for HD.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Doença de Hirschsprung/cirurgia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
2.
Clin Sports Med ; 40(1): 213-220, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187611

RESUMO

As the COVID-19 (Coronavirus disease 2019) pandemic continues, the paradigm of treatment continues to rapidly evolve, especially for sports medicine surgeons, because treatment before the pandemic was considered predominantly elective. This article provides subjective and objective data on the changes implicated by the COVID-19 pandemic with regard to the interactions and practices of sports medicine surgeons. This perspective also considers the potential impact on the patients and athletes treated by sports medicine surgeons. This article discusses the impact of the COVID-19 pandemic on sports medicine and provides thoughts on how the landscape of the field may continue to change.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Medicina Esportiva/métodos , Cirurgiões/estatística & dados numéricos , Humanos
3.
Can J Surg ; 63(5): E454-E459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107817

RESUMO

SUMMARY: Small surgical residency programs like plastic surgery can be challenging environments to accommodate parental leave. This study aimed to report the experiences, attitudes and perceived support of Canadian plastic surgery residents, recent graduates and staff surgeons with respect to pregnancy and parenting during training. Residents and staff surgeons were invited via email to participate in an online survey. The results presented here explore experiences of pregnancy and parental leave of current plastic surgery residents and staff surgeons. Residents' and staff surgeons' perceptions of program director support, policies, negative comments and the impact of parental leave on the workload of others were also explored. Although the findings suggest that there may be improvements in the support of program directors, there continues to be a negative attitude in surgical culture toward pregnancy during residency. The perceived confusion of respondents with respect to programspecific policies emphasizes the need for open conversations and standardization of parental leave.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência/estatística & dados numéricos , Licença Parental/estatística & dados numéricos , Gravidez/psicologia , Cirurgia Plástica/educação , Adulto , Canadá , Feminino , Humanos , Internato e Residência/organização & administração , Masculino , Pessoa de Meia-Idade , Diretores Médicos/psicologia , Políticas , Gravidez/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/psicologia , Cirurgia Plástica/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
4.
Isr J Health Policy Res ; 9(1): 59, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126921

RESUMO

INTRODUCTION: Israel ranks very high globally in performing bariatric surgery (BS) per capita. In the first phase of the COVID-19 pandemic the bariatric surgeons' community faced many concerns and challenges, especially in light of a decree issued by the Ministry of Health (MOH) on March 22nd, to ban all elective surgery in public hospitals. The aim of this study is to portray the practices and attitudes of Israeli bariatric surgeons in the first phase of the pandemic. METHODS: Anonymous web-based questionnaire sent to all active bariatric surgeons in Israel. Statistical analysis was performed using SAS software package. RESULTS: 53 out of 63 (84%) active surgeons responded to the survey. 18% practice in the public sector only, 4% in the private sector only and 78% in both sectors. 76% practice BS for more than 10 years and 68% perform more than 100 procedures a year. Almost all the surgeons (98%) experienced a tremendous decrease in operations. Nevertheless, there were substantial differences by sectors. In the public sector, 86% of the surgeons ceased to operate while 14% did not comply with the government's decree. In the public sector 69% of the surgeons were instructed by the administrators to stop operating. The majority of surgeons who continued to operate (77%) changed nothing in the indications or contra-indications for surgery. Among the surgeons who opted to refrain from operating on special sub-groups, the most frequent reasons were pulmonary disease (82%), age above 60 (64%), Ischemic heart disease (55%) and living in heavily affected communities. Roughly only half (57%) of the surgeons implemented changes in informed consent and operating room (OR) measures, contrary to guidelines and recommendations by leading professional societies. When asked about future conditions for reestablishing elective procedures, the reply frequencies were as follows: no special measures - 40%; PCR negativity - 27%; IgG positivity - 15%; waiting until the end of the pandemic- 9%. CONCLUSIONS: We showed in this nation-wide survey that the variance between surgeons, regarding present and future reactions to the COVID-19 pandemic, is high. There were substantial differences between the private and the public sectors. Although the instructions given by the MOH for the public sector were quite clear, the compliance by surgeons and administrators was far from complete. The administrators in the public sector, but more so in the private sector were ambiguous in instructing staff, leading surgeons to a more "personal non-structured" practice in the first phase of the pandemic. These facts must be considered by regulators, administrators and surgeons when planning for reestablishing elective BS or in case a second wave of the pandemic is on its way.


Assuntos
Atitude , Bariatria , Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Pandemias , Pneumonia Viral , Padrões de Prática Médica , Cirurgiões/estatística & dados numéricos , Adulto , Betacoronavirus , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Setor Privado , Setor Público , Inquéritos e Questionários
5.
Can J Surg ; 63(5): E396-E408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009899

RESUMO

BACKGROUND: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. METHODS: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. RESULTS: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. CONCLUSION: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Padrões de Prática Médica/estatística & dados numéricos , Âmbito da Prática/tendências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Canadá , Competência Clínica/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Feminino , Cirurgia Geral/economia , Cirurgia Geral/educação , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/economia , Padrões de Prática Médica/tendências , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Cirurgiões/economia , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/educação
7.
Obstet Gynecol ; 136(5): 942-949, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030877

RESUMO

OBJECTIVE: To use the Messick validity framework for a simulation-based assessment of vaginal hysterectomy skills. METHODS: Video recordings of physicians at different levels of training and experience performing vaginal hysterectomy on a high-fidelity vaginal surgery model were objectively assessed using a modified 10-item Vaginal Surgical Skills Index, a one-item global scale of overall performance, and a pass-fail criterion. Participants included obstetrics and gynecology trainees and faculty from five institutions. Video recordings were independently assessed by expert surgeons blinded to the identities of the study participants. RESULTS: Fifty surgeons (11 faculty, 39 trainees) were assessed. Experience level correlated strongly with both the modified Vaginal Surgical Skills Index and global scale score, with more experienced participants receiving higher scores (Pearson r=0.81, P<.001; Pearson r=0.74, P<.001). Likewise, surgical experience was also moderately correlated with the modified Vaginal Surgical Skills Index and global scale score (Pearson r=0.55, P<.001; Pearson r=0.58, P<.001). The internal consistency of the modified Vaginal Surgical Skills Index was excellent (Cronbach's alpha=0.97). Interrater reliability of the modified Vaginal Surgical Skills Index and global scale score, as measured by the intraclass correlation coefficient, was moderate to good (0.49-0.95; 0.50-0.87). Using the receiver operating characteristic curve and the pass-fail criterion, a modified Vaginal Surgical Skills Index cutoff score of 27 was found to most accurately (area under the curve 0.951, 95% CI 0.917-0.983) differentiate competent from noncompetent surgeons. CONCLUSION: We demonstrated validity evidence for using a high-fidelity vaginal surgery model with the modified Vaginal Surgical Skills Index or global scale score to assess vaginal hysterectomy skills.


Assuntos
Competência Clínica/estatística & dados numéricos , Avaliação Educacional/normas , Histerectomia Vaginal/educação , Treinamento por Simulação , Cirurgiões/estatística & dados numéricos , Adulto , Feminino , Ginecologia/educação , Humanos , Masculino , Obstetrícia/educação , Reprodutibilidade dos Testes , Cirurgiões/educação
9.
Am Surg ; 86(8): 1010-1014, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32997952

RESUMO

INTRODUCTION: Failure to perform adequate fasciotomy for a presumed or diagnosed compartment syndrome after revascularization of an acutely ischemic limb is a potential cause of preventable limb loss. When required, outcomes are best when fasciotomy is conducted with the initial vascular repair. Despite over 100 years of experience with fasciotomy, the actual indications for its performance among acute care and trauma surgeons performing vascular repairs are unclear. The hypothesis of this study was that there are many principles of fasciotomy that are uniformly accepted by surgeons and that consensus guidelines could be developed. METHODS: A 20-question survey on fasciotomy practice patterns was distributed to trauma and acute care surgeons of a major surgical society which had approved distribution. RESULTS: The response to the survey was 160/1066 (15 %). 92.5% of respondents were fellowship trained in trauma and acute care surgery, and 74.9% had been in practice for fewer than 10 years. Most respondents (71.9%) stated that they would be influenced to perform a preliminary fasciotomy (fasciotomy conducted prior to planned exploration and arterial repair) based upon specific signs and symptoms consistent with compartment syndrome-including massive swelling (55.6%), elevated compartment pressures (52.5%), delay in transfer >6 hours (47.5%), or obvious distal ischemia (33.1%). 20.6% responded that they would conduct exploration and repair first, regardless of these considerations. Prophylactic fasciotomies (fasciotomy without overt signs of compartment syndrome) would be performed by respondents in the setting of the tense compartment (87.5%), ischemic time >6 hours (88.1%), measurement of elevated compartment pressures (66.9%), and in the setting of large volume resuscitation requirements (31.3%). 69.4% of respondents selectively measure compartment pressures, with nearly three-fourths utilizing a Stryker needle device (72.5%). The most common sequence of repairs following superficial femoral artery injury with a >6-hour limb ischemia was cited as the initial insertion of a shunt, followed by fasciotomy, then vein harvest, and finally interposition repair. CONCLUSIONS: While there is some general consensus on indications for fasciotomy, there is marked heterogeneity in surgeons' opinions on the precise indications in selected scenarios. This is particularly surprising in light of the long history with fasciotomy in association with major arterial repairs and strongly suggests the need for a consensus conference and/or meta-analysis to guide further care.


Assuntos
Artérias/lesões , Síndromes Compartimentais/cirurgia , Fasciotomia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/complicações , Artérias/cirurgia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/prevenção & controle , Fasciotomia/métodos , Humanos , Inquéritos e Questionários , Traumatologia , Estados Unidos , Lesões do Sistema Vascular/cirurgia
11.
Surgery ; 168(3): 355-362, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32741622

RESUMO

BACKGROUND: To interview extraordinary women who have made recent significant contributions to the field of colorectal surgery. DESIGN: The authors asked some of the many extraordinary women who have made significant contributions to the field of colorectal surgery to answer several questions. These women were selected from many potential candidates based upon their extraordinary recent contributions to the field of colorectal surgery. These thought leaders were asked about their contributions to colorectal surgery, their mentors, whether they had any women as role models, and, lastly, what they would tell their younger selves. The study was structured to recognize these women for their remarkable recent contributions to colorectal surgery, and we wished to encourage women to pursue leadership in colorectal surgery including the allied fields of colorectal pathology and colorectal imaging. Furthermore, the authors hoped to inspire male colorectal surgeons to actively mentor and help the career development of women colorectal surgeons. The potential limitations of the study include the fact that there are many more well-deserving women who could have been included in the sample survey but, because of space constraints, were not invited. CONCLUSION: Women in colorectal surgery and in the allied specialties of colorectal pathology and colorectal radiology have made many recent major significant contributions to colorectal surgery. The expectation is that the volume and frequency of such contributions as well as the number of women making these contributions should further significantly increase with time.


Assuntos
Cirurgia Colorretal/organização & administração , Liderança , Mentores , Médicas/psicologia , Cirurgiões/psicologia , Escolha da Profissão , Cirurgia Colorretal/estatística & dados numéricos , Cirurgia Colorretal/tendências , Feminino , Humanos , Masculino , Médicas/estatística & dados numéricos , Médicas/tendências , Cirurgiões/estatística & dados numéricos , Cirurgiões/tendências
13.
BMJ ; 370: m2588, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32732322

RESUMO

OBJECTIVE: To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices. DESIGN: Retrospective observational study. SETTING: US national survey of physician salaries, 2014-18. PARTICIPANTS: 18 802 physicians from 9848 group practices (categorized according to proportion of male physicians ≤50%, >50-75%, >75-90%, and >90%). MAIN OUTCOME MEASURES: Sex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography. RESULTS: Among 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£29 663; €32 621) (95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P=0.03 for difference). Similar findings were observed among surgical specialists (n=3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P=0.06 for difference). Among primary care physicians (n=3829), sex differences in income were not related to the proportion of male physicians in a practice. CONCLUSIONS: Among both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.


Assuntos
Prática de Grupo/organização & administração , Prática de Grupo/estatística & dados numéricos , Renda/estatística & dados numéricos , Médicos/economia , Médicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Médicas/economia , Médicas/estatística & dados numéricos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Cirurgiões/economia , Cirurgiões/estatística & dados numéricos , Estados Unidos
14.
Spine (Phila Pa 1976) ; 45(18): 1285-1292, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32756270

RESUMO

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: The aim of this study was to investigate the impact of COVID-19 pandemic on the clinical practices of spine surgeons within the Asia Pacific region. SUMMARY OF BACKGROUND DATA: COVID-19 pandemic had changed spine surgeons' clinical practices and their concerns toward personal and family risk of infection. METHODS: This cross-sectional survey was carried out from May 4, 2020 to June 4, 2020. The questionnaire was administered using REDCAP. The online questionnaire includes four sections. First section includes surgeon's demographics, background, type of clinical practice, and status of pandemic in their country. Second section includes volume and the type of spine surgery practice before the COVID pandemic. Third section includes changes of clinical practice during the pandemic and the last section was regarding their concern on COVID transmission. RESULTS: Total of 222 respondents from 19 countries completed the questionnaire. During the pandemic, 92.3% of the respondents felt their clinical practice was affected. 58.5% respondents reported reduced outpatient clinic hours and 74.6% respondents reported reduced operation theatre hours due to the enforcement by the hospital administration. The mean reduction of clinic volume for all countries was 48.1%. There was a significant reduction in the number of surgeries performed in Japan, Malaysia, India, Philippines, and South Korea. This was due to reduced patient load. More than 60% of respondents were worried being infected by COVID-19 virus and >68% were worried of transmission to their family members. CONCLUSION: COVID-19 pandemic has significantly affected the clinical and surgical practice of spine surgeons in the Asia Pacific region. Clinics were closed or the practice hours reduced. Similarly, surgical theaters were closed, reduced, or limited to semi-emergency and emergency surgeries. Spine surgeons were moderately concerned of contracting COVID-19 during their clinical practice but were extremely concerned to transmit this disease to their family members. LEVEL OF EVIDENCE: 4.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Coluna Vertebral/cirurgia , Cirurgiões , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Ásia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Estudos Transversais , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos
15.
J Laryngol Otol ; 134(8): 665-669, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32758319

RESUMO

BACKGROUND: ENT surgeons are likely to be at high risk of coronavirus disease 2019 exposure. METHODS: A national registry of UK ENT surgeons with suspected or confirmed coronavirus disease 2019 was created with the support of ENT UK. Voluntary entry was made by either the affected individual or a colleague, using a web-based platform. RESULTS: A four-month data collection period is reported, comprising 73 individuals. Coronavirus disease 2019 was test-confirmed in 35 respondents (47.9 per cent). There was a need for hospitalisation in two cases (2.7 per cent) and tragically one individual died. Symptom onset peaked in March. The majority suspected their exposure to have been in the workplace, with a significant proportion attributing their disease to a lack of personal protective equipment at a time before formal guidance had been introduced. CONCLUSION: The registry suggests that a significant number of ENT clinicians in the UK have contracted coronavirus disease 2019, and supports the need for tailored personal protective equipment guidance and service planning.


Assuntos
Infecções por Coronavirus/transmissão , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Otolaringologia/estatística & dados numéricos , Pneumonia Viral/transmissão , Cirurgiões/estatística & dados numéricos , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Pessoa de Meia-Idade , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sistema de Registros , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido/epidemiologia , Local de Trabalho/normas , Local de Trabalho/estatística & dados numéricos
16.
Plast Reconstr Surg ; 146(2): 371-379, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740590

RESUMO

BACKGROUND: As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. METHODS: Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. RESULTS: Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. CONCLUSIONS: This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.


Assuntos
Fissura Palatina/cirurgia , Medicina Baseada em Evidências/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/legislação & jurisprudência , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/legislação & jurisprudência , Cirurgia Plástica/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
17.
Plast Reconstr Surg ; 146(2): 413-422, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740599

RESUMO

BACKGROUND: As social media have become pervasive in contemporary society, plastic surgery content has become commonplace. Two of the most engaging and popular platforms are Instagram and Twitter, and much research has been performed with respect to Twitter. Currently, there are no studies comparing and contrasting the two platforms. The aim of this study was to robustly sample plastic surgery posts on Twitter and Instagram to quantitatively and qualitatively evaluate platform content differences. METHODS: The hashtag #PlasticSurgery was systematically queried twice per day, for 30 consecutive days, on Twitter and Instagram. Account type, specific media content, possible patient-identifying information, content analysis, and post engagement were assessed. Post volume and engagement between Instagram and Twitter posts were compared. Post characteristics garnering high engagement from each platform were also evaluated. RESULTS: A total of 3867 Twitter posts and 5098 Instagram posts were included in this analysis. Daily total post volume for the 1-month duration of the study was significantly higher on Instagram compared with Twitter. Overall post engagement was significantly higher on Instagram compared with Twitter. Plastic surgeons and plastic surgery clinics represented the majority of accounts posting on both platforms with #PlasticSurgery. Identifiable patient features were much more prevalent on Instagram. The majority of Instagram posts were promotional in nature, outcome-based, or unrelated to plastic surgery. Alternatively, tweets were predominantly educational in nature. CONCLUSIONS: For physicians to harness the power of social media in plastic surgery, we need to understand how these media are currently being used and how different platforms compare to one another. This study has highlighted the inherent similarities and differences between these two highly popular platforms.


Assuntos
Marketing de Serviços de Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/economia , Mídias Sociais/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Estudos Transversais , Humanos , Marketing de Serviços de Saúde/métodos , Preferência do Paciente , Estudos Prospectivos , Mídias Sociais/economia , Cirurgiões/economia
18.
Int Forum Allergy Rhinol ; 10(11): 1201-1208, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32735062

RESUMO

BACKGROUND: It has become clear that healthcare workers are at high risk, and otolaryngology has been theorized to be among the highest risk specialties for coronavirus disease 2019 (COVID-19). The purpose of this study was to detail the international impact of COVID-19 among otolaryngologists, and to identify instructional cases. METHODS: Country representatives of the Young Otolaryngologists-International Federation of Otolaryngologic Societies (YO-IFOS) surveyed otolaryngologists through various channels. Nationwide surveys were distributed in 19 countries. The gray literature and social media channels were searched to identify reported deaths of otolaryngologists from COVID-19. RESULTS: A total of 361 otolaryngologists were identified to have had COVID-19, and data for 325 surgeons was available for analysis. The age range was 25 to 84 years, with one-half under the age of 44 years. There were 24 deaths in the study period, with 83% over age 55 years. Source of infection was likely clinical activity in 175 (54%) cases. Prolonged exposure to a colleague was the source for 37 (11%) surgeons. Six instructional cases were identified where infections occurred during the performance of aerosol-generating operations (tracheostomy, mastoidectomy, epistaxis control, dacryocystorhinostomy, and translabyrinthine resection). In 3 of these cases, multiple operating room attendees were infected, and in 2, the surgeon succumbed to complications of COVID-19. CONCLUSION: The etiology of reported cases within the otolaryngology community appear to stem equally from clinical activity and community spread. Multiple procedures performed by otolaryngologists are aerosol-generating procedures (AGPs) and great care should be taken to protect the surgical team before, during, and after these operations.


Assuntos
Infecções por Coronavirus/epidemiologia , Otorrinolaringologistas/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Sistema de Registros/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Adulto , Aerossóis , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Inquéritos e Questionários
19.
J Laryngol Otol ; 134(8): 739-743, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32718359

RESUMO

OBJECTIVE: Mastoidectomy is considered an aerosol-generating procedure. This study examined the effect of wearing personal protective equipment on the view achieved using the operating microscope. METHODS: ENT surgeons assessed the area of a calibrated target visible through an operating microscope whilst wearing a range of personal protective equipment, with prescription glasses when required. The distance between the surgeon's eye and the microscope was measured in each personal protective equipment condition. RESULTS: Eleven surgeons participated. The distance from the eye to the microscope inversely correlated with the diameter and area visible (p < 0.001). The median area visible while wearing the filtering facepiece code 3 mask and full-face visor was 4 per cent (range, 4-16 per cent). CONCLUSION: The full-face visor is incompatible with the operating microscope. Solutions offering adequate eye protection for aerosol-generating procedures that require the microscope, including mastoidectomy, are urgently needed. Low-profile safety goggles should have a working distance of less than 20 mm and be compatible with prescription lenses.


Assuntos
Mastoidectomia/instrumentação , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Equipamento de Proteção Individual/efeitos adversos , Aerossóis , Betacoronavirus/isolamento & purificação , Líquidos Corporais/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Controle de Infecções/métodos , Mastoidectomia/tendências , Microscopia/instrumentação , Microcirurgia/tendências , Otorrinolaringologistas/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Cirurgiões/estatística & dados numéricos
20.
J Urol ; 204(6): 1326-1332, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32614254

RESUMO

PURPOSE: We sought to determine the number of cases to achieve competency and proficiency in tubularized incised plate technique for distal hypospadias repair using cumulative sum analysis. MATERIALS AND METHODS: From 2001 to 2015 we reviewed all distal tubularized incised plate repairs performed by a single surgeon since independent practice. Data for 450 consecutive cases included age, meatal location, presence of curvature, operative time, occurrence of complications and followup duration. A cumulative sum analysis cohort chart was used to determine trends in complication rate and operative time during the evaluation period. In order to account for surgical experience with time, the highest peak, plateau, and down trends in operative time and complication rate were identified on the plot and set as the transition points between learning (phase 1), competence (phase 2) and proficiency (phase 3). RESULTS: Based on the cumulative sum analysis learning curve, the competence phase with plateau of operative time and complication rate commences beyond the 127th case, and the proficiency phase with notable decline in operative time and complication rate was noted beyond the 234th case. When comparing case characteristics and surgical outcomes between phases and learning curve, the proficiency phase involved younger patients and more severe degree of distal hypospadias being repaired using the tubularized incised plate approach with fewer complications related to meatal stenosis and fewer cosmetic complications. CONCLUSIONS: In our study competency in distal hypospadias tubularized incised plate repair was reached beyond the 127th case, while proficiency was attained beyond the 234th case.


Assuntos
Hipospadia/cirurgia , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Competência Clínica , Seguimentos , Humanos , Lactente , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/educação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Cirurgiões/educação , Resultado do Tratamento , Uretra/anormalidades , Uretra/cirurgia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/educação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
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