Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 898
Filtrar
1.
J Surg Res ; 257: 333-343, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892128

RESUMO

BACKGROUND: To improve surgical performance, image-guided (IG) technologies are increasingly introduced. Yet, it is unknown which oncological procedures yield most value from these technologies. This study aimed to select the most promising IG technology per oncologic indication. METHODS: An Analytic Hierarchical Process was used to evaluate three IG technologies: navigation, optical imaging, and augmented reality, in five oncologic indications compared with usual care. Sixteen decision criteria were selected. The relative importance of the criteria and the expected performance of the technologies were evaluated among surgeons. The combination of these scores gives the expected value per technology. RESULTS: On criteria level, sparing critical tissue (9%-18%) and reducing the risk of local recurrence (11%-27%) were most important. Navigation was preferred in three indications-removal of lymph nodes (42%), liver (47%), and rectal tumors (33%). In removing rectal tumors, optical imaging was equally preferred (34%). In removing breast and tongue tumors, no technology was clearly preferred. CONCLUSIONS: In selecting IG technologies, especially optical and navigation technologies are expected to add value in addition to usual care. Further development of those technologies for the preferred indications seems valuable. Multi-attribute analysis showed to be useful in prioritization of conducting clinical studies and steer research and development initiatives.


Assuntos
Neoplasias/cirurgia , Cirurgia Assistida por Computador/estatística & dados numéricos , Humanos , Cirurgiões/psicologia , Cirurgia Assistida por Computador/métodos
2.
J Surg Res ; 257: A1-A11, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32768197

RESUMO

The issue of burnout among surgical trainees became evident during our work on the FIRST Trial. In studying the issue, we found that burnout symptoms occurred in a relatively large proportion of surgical trainees, and burnout was associated with significant risks of having thoughts of leaving the residency program or having suicidal thoughts. The SECOND Trial seeks to reduce trainee wellbeing and mistreatment by leveraging approaches used in healthcare quality performance improvement (e.g., comparative reports, toolkits, collaboration). Importantly, the epidemic of surgical trainee wellbeing issues have worsened (i.e., fanning the burnout fire) given our misconceptions about generational differences, our delayed adaptations to shifts in healthcare, and even some of our good intentions. However, there are several things we can do to improve the situation: (1) embrace the change that comes with each generation; (2) appreciate, respect, and enjoy our trainees; (3) teach residents constructively, leaving yelling and bullying behind; (4) embrace the concept of wellness for ourselves and each other; (5) provide meaningful feedback and mentorship; and (6) give each other the benefit of the doubt (e.g., principle of charity). Despite these issues, academic surgery remains the best job in the world, and the strength of our profession, leaders, and colleagues will see us through these challenges. The Association for Academic Surgery will help lead the way on these important issues.


Assuntos
Esgotamento Profissional/epidemiologia , Cirurgiões/educação , Cirurgiões/psicologia , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Cirurgia Geral/educação , Humanos , Internato e Residência/métodos , Internato e Residência/tendências , Sociedades Médicas , Cirurgiões/tendências , Ensino/psicologia , Ensino/tendências
3.
J Surg Res ; 257: 221-226, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32858323

RESUMO

BACKGROUND: The Accreditation Council for Graduate Medical Education has defined six core competencies (CCs) that every successful physician should possess. However, the assessment of CC achievement among trainees is difficult. This project was designed to prospectively evaluate the impact of resident identification of CC as a component of morbidity review on error identification and standard of care (SOC) assessments. The platform was assessed for its reliability as a measure of resident critical analysis of complication causality across postgraduate year (PGY). MATERIALS AND METHODS: A total of 1945 general surgery cases with complications were assessed for error identification and SOC management between January 1, 2016, and December 31, 2018. CC identification was additionally assessed between January 1, 2019, and December 31, 2019, and included 708 general surgery cases. Data were evaluated for error assessments and overall SOC management. PGY4 and 5 residents were compared for number of cases and complications reviewed, severity, error causation, and CC relevance. RESULTS: Study groups were equivalent by Clavien-Dindo scores. Error identification significantly increased in all categories: diagnostic (P < 0.001), technical (P < 0.05), judgment (P < 0.001), system (P < 0.001), and communication (P < 0.001). Overall SOC assessments validated by a supervising surgical quality officer were unchanged. An increased exposure to cases with severe complications, error causation, and CC relevance was noted across PGY. CONCLUSIONS: The addition of CC assessment into morbidity review appears to improve the critical thinking of evaluating residents by increasing the identification of management errors. Used as an element of prospective self-assessment, teaching residents to identify CC principles in cases with complications may assist in learner progression toward clinical competence and critical thinking.


Assuntos
Educação Baseada em Competências/métodos , Cirurgia Geral/educação , Complicações Pós-Operatórias/prevenção & controle , Autoavaliação , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Competência Clínica , Seguimentos , Humanos , Internato e Residência , Erros Médicos/efeitos adversos , Erros Médicos/prevenção & controle , Dano ao Paciente/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Cirurgiões/psicologia , Procedimentos Cirúrgicos Operatórios/educação
4.
J Surg Res ; 257: 317-325, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889330

RESUMO

BACKGROUND: Onlay mesh repair (OMR) has proven to be a widely used, simple, and effective technique for treatment and prevention of hernia occurrence. Despite established benefits, there is still a lack of widespread adoption. In this study, we present the Dual Tacker Device (DTD), an enabling technology that directly addresses the limitations to the adoption of OMR, saving surgical time and effort and making OMR more reproducible across a wide range of patients. METHODS: The DTD mesh fixation system is a semiautomated, hand-held, disposable, multipoint onlay mechanical mesh fixation system that is able to rapidly and uniformly tension and fixate mesh for both hernia treatment and prevention. A cadaveric porcine model was used as a pilot test conducted during a 2 day session to assess the usability of the device and to show that the DTD provided equivalent or superior biomechanical support compared with the standard of care (hand-sewn, OptiFix). RESULTS: Our study included 37 cadaveric porcine incisional closure abdominal wall models. These were divided into four groups: DTD-mediated OMR (n = 14), hand-sewn OMR (n = 7), OptiFix OMR (n = 9), and suture-only repair (no mesh) (n = 7). Eight surgical residents performed device-mediated and hand-sewn OMR. Average time to completion was fastest in the DTD cohort (45.6s) with a statistically significant difference compared with the hand-sewn cohort (343.1s, P < 0.01). No difference in tensile strength was noted between DTD (195.32N), hand-sewn (200.48N), and OptiFix (163.23N). Discreet hand movements were smallest in the DTD (29N) and significant (P < 0.01) when compared with hand-sewn (202N) and OptiFix (35N). CONCLUSIONS: The use of the DTD is not only feasible, but demonstrated improvement in time to completion and economy of movement over current standard of care. While more testing is needed and planned, compared with conventional approaches, the DTD represents a robust proof of principle with promising implications for clinical feasibility and adoptability.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia Ventral/cirurgia , Herniorrafia/instrumentação , Telas Cirúrgicas , Técnicas de Sutura/instrumentação , Animais , Fenômenos Biomecânicos , Cadáver , Ergonomia , Estudos de Viabilidade , Hérnia Ventral/etiologia , Hérnia Ventral/prevenção & controle , Herniorrafia/métodos , Humanos , Modelos Animais , Duração da Cirurgia , Projetos Piloto , Cirurgiões/psicologia , Suínos , Resistência à Tração
5.
Semin Vasc Surg ; 33(3-4): 34-35, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308593

RESUMO

As a junior colleague of Dr. D. E. Strandness, Jr., for almost 30 years, I had the unique professional opportunity to witness the development of duplex ultrasonography at the University of Washington. "Gene" as he liked to be called, was a surgeon with a persistent curiosity about vascular disease. He led the multidisciplinary team that developed the technique of duplex ultrasound, measured its diagnostic accuracy, and performed research studies to reduce stroke due to carotid bifurcation atherosclerosis. My reflections on the legacy of Dr. Strandness are offered with gratitude for the curiosity "bug" he nurtured in me, which continues today.


Assuntos
Atitude do Pessoal de Saúde , Pesquisa Biomédica/história , Comportamento Exploratório , Cirurgiões/história , Ultrassonografia Doppler Dupla/história , Procedimentos Cirúrgicos Vasculares/história , Educação Médica/história , História do Século XX , História do Século XXI , Humanos , Cirurgiões/psicologia , Procedimentos Cirúrgicos Vasculares/educação
6.
Saudi Med J ; 41(12): 1344-1349, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33294893

RESUMO

OBJECTIVES: To evaluate the impact of coronavirus-19 (COVID-19) pandemic and its consequences on general surgery residents. Methods: Cross-sectional, survey based study including surgical residents in Kingdom of Saudi Arabia and Kingdom of Bahrain. RESULTS: Surgical trainees who participated in our survey (n=234) were young (mean age 28), single (53.8%), and males (65.8%). Approximately half (50.4%) have been deployed to cover the staff shortage in intensive care units (ICUs) or emergency departments (EDs). Half of our trainees (117) scored positive in the screening tool of generalized anxiety disorder (GAD). There was a significant association between experiencing anxiety and male gender (p=0.055), level of training (p=0.002), deployment to cover ICUs (p=0.050), testing positive for COVID-19 (p=0.054) and having an infected family member (p=0.004). CONCLUSION: Coronavirus-19 pandemic has a serious effect on all healthcare workers and surgical residents have experienced a considerable amount of stress. Accordingly, this psychological burden should be appropriately addressed in organizations planning strategies. We suggest formulating guidelines to help surgical trainees to continue their learning process with least psychological burden.


Assuntos
/psicologia , Cirurgia Geral/educação , Internato e Residência , Estresse Ocupacional/etiologia , Resiliência Psicológica , Cirurgiões/psicologia , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , Barein/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Estresse Ocupacional/diagnóstico , Estresse Ocupacional/epidemiologia , Pandemias , Arábia Saudita/epidemiologia , Cirurgiões/educação
7.
JAMA Netw Open ; 3(11): e2023684, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33211106

RESUMO

Importance: Despite availability of evidence-based guidelines for surgery, many patients receive guideline-discordant care. Reasons for this are largely unknown. For example, evidence-based guidelines recommend a minimally invasive approach for persons with bilateral or recurrent unilateral inguinal hernias. Benefits are also noted for primary unilateral inguinal hernia. However, findings from previous quantitative research indicate that only 26% of patients receive this treatment and only 42% of surgeons offer a minimally invasive approach, even for recurrent or bilateral hernias. Objective: To explore factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care. Design, Setting, and Participants: Qualitative study performed as part of a larger explanatory sequential mixed methods design. Purposive sampling was used to recruit 21 practicing surgeons from a large statewide quality collaborative who were diverse with regard to practice type, geographic location, and surgical specialty. Qualitative interviews consisted of a clinical vignette, followed by semi-structured interview questions. Through thematic analysis using qualitive data analysis software, patterns within the data were located, analyzed, and identified. All data were collected between April 24 and July 31, 2018. Exposure: Clinical vignette as part of the qualitative interviews. Main Outcomes and Measures: Capture of surgical approaches and factors motivating decision-making for inguinal hernia repair. Results: Of the 21 participating surgeons, 17 (81%) were men, 18 (86%) were White, and all were 35 years of age or older. Data revealed 3 dominant themes: surgeon preference and autonomy (eg, favoring one approach over the other), access and resources (eg, availability of robot), and patient characteristics (eg, age, comorbidities). Conclusions and Relevance: Decision-making for the approach to inguinal hernia repair is largely influenced by surgeon preference and access to resources rather than patient factors. Although a one-size-fits-all approach is not recommended, the operative approach should ideally be informed by patient factors, including hernia characteristics. Addressing surgeon preference and available resources with a clinician-facing decision aid may provide an opportunity to optimize care for patients undergoing inguinal hernia repair.


Assuntos
Fidelidade a Diretrizes , Hérnia Inguinal/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Pesquisa Qualitativa , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos
8.
Plast Reconstr Surg ; 146(6): 1419-1431, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234982

RESUMO

BACKGROUND: Online reviews play a significant role in influencing a patient's choice of a plastic surgeon. The purpose of this article is to help the practicing plastic surgeon understand reviews and review websites. METHODS: A review of both the medical literature and online blogs was performed to identify the most current information pertinent to plastic surgeons. RESULTS: Negative reviews can impact a potential patient's decision on where to seek plastic surgery, and the best way to dilute that impact is to attract good reviews. Good reviews result from running an excellent practice, and patient surveys can help identify and address problems. The qualities of each of the seven online patient review websites are summarized, along with practice advice on how to attract reviews and how to deal with fake, fraudulent, and negative reviews. CONCLUSIONS: Reviews impact plastic surgeons, whether or not they are aware of what patients are saying about them online. This article helps plastic surgeons become familiar with how to use reviews for practice growth and how to protect their online reputation.


Assuntos
Internet/estatística & dados numéricos , Marketing de Serviços de Saúde/métodos , Preferência do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/economia , Cirurgia Plástica/economia , Comportamento de Escolha , Competência Clínica/estatística & dados numéricos , Humanos , Marketing de Serviços de Saúde/estatística & dados numéricos , Preferência do Paciente/psicologia , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Procedimentos Cirúrgicos Reconstrutivos/psicologia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/economia , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos
9.
Plast Reconstr Surg ; 146(5): 673e-679e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33136968

RESUMO

BACKGROUND: Physicians, especially plastic surgeons, are underrepresented in hospital leadership. As such, the steps an aspiring plastic surgeon should take toward assuming a high-level administrative role remain unclear. The authors aim to profile the chief executive officers and surgeons-in-chief at top-ranked U.S. hospitals with the goal of better characterizing the attributes of institutional leaders. METHODS: Chief executive officers and surgeons-in-chief at top-ranking hospitals in the 2019 to 2020 U.S. News and World Report "Best Hospitals Honor Roll" were included in this study. For each leader, sex, title, degrees, years of experience, total number of publications, practice specialty (for physician leaders), and previous leadership roles in national societies were reviewed. Descriptive statistical analyses were performed. RESULTS: A total of 99 leadership positions at 66 institutions were included. Of these, 67 were chief executive officers and 32 were surgeons-in-chief. Overall, 28 of 67 chief executive officers (42 percent) were physicians-23 nonsurgeons and five surgeons. Of all surgeon executives, only two were plastic surgeons, and both were surgeons-in-chief. The "average" physician-chief executive officer had 24 years of experience, no M.B.A., over 100 publications, zero to one fellowship, and was involved in national leadership. There was no difference in professional qualifications (defined as years of experience, business training, number of publications and fellowships, and leadership positions) between nonsurgeon- and surgeon-chief executive officers, or between plastic surgeons and other surgeons in leadership positions. CONCLUSIONS: Despite possessing adequate qualifications, plastic surgeons are underrepresented in American health care institutional leadership roles. Aspiring plastic surgeon leaders should lean on their peer credibility and experience delivering patient-centered care to succeed in leadership roles.


Assuntos
Diretores de Hospitais/estatística & dados numéricos , Liderança , Diretores Médicos/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos , Humanos , Motivação , Cirurgiões/psicologia , Cirurgia Plástica/psicologia , Estados Unidos
10.
Am Surg ; 86(11): 1462-1466, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33213199

RESUMO

Surgeons routinely provide palliative care, but often the technical procedure needed for the palliative intervention is beyond our training and comfort zone. This case is an example of surgical palliative care that utilizes image-guided techniques to provide optimal care. A frail elderly patient with multiple comorbidities who had been hospitalized for other diseases was diagnosed with acute acalculous cholecystitis. General surgery and gastroenterology were initially consulted, and the patient was referred to interventional radiology for a percutaneous cholecystostomy. The procedure was technically successful, and the patient's clinical status improved. A few days later, a follow-up cholecystogram showed a decompressed gallbladder, patent cystic duct, a common bile duct free of stones, and dilute contrast in the duodenum. After 2 weeks, the fistula tract was interrogated and found to be intact. The cholecystostomy tube was removed without incident. This case is presented as a call to action for surgeons to learn the skills required to place percutaneous cholecystostomies themselves and to add it to their surgical armamentarium.


Assuntos
Colecistite Acalculosa/cirurgia , Colecistostomia/métodos , Drenagem , Cirurgiões , Colecistite Acalculosa/complicações , Colecistite Acalculosa/terapia , Doença Aguda , Idoso , Colecistostomia/efeitos adversos , Drenagem/métodos , Humanos , Cuidados Paliativos/métodos , Cirurgiões/educação , Cirurgiões/psicologia
12.
JAMA Netw Open ; 3(10): e2019843, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33030551

RESUMO

Importance: Gender differences in interprofessional conflict may exist and precipitate differential achievement, wellness, and attrition in medicine. Objective: Although substantial attention and research has been directed toward improving gender equity in surgery and addressing overall physician wellness, research on the role of interprofessional conflict has been limited. The objective of this study was to understand scenarios driving interprofessional conflict involving women surgeons, the implications of the conflict on personal, professional, and patient outcomes, and how women surgeons navigate conflict adjudication. Design, Setting, and Participants: A qualitative approach was used to explore the nature, implications, and ways of navigating interprofessional workplace conflict experienced by women surgeons. The setting was a national sample of US women surgeons. Purposive and snowball sampling were used to recruit women surgeons in training or practice from annual surgical society meetings. Participants were eligible if they were currently in a surgical training program or surgical practice. Nearly all participants had experienced at least 1 workplace conflict with a nonphysician staff member resulting in a formal write-up. Exposures: A workplace conflict was defined as any conflict resulting in the nonphysician staff member taking action such as confronting the woman surgeon, reporting the event to supervisors, or filing a formal report. Main Outcomes and Measures: Interviews were conducted between February 19, 2019, and June 21, 2019. Recordings were transcribed and deidentified. Inductive thematic analysis was used to examine data in relation to the research questions. Results: Thirty US women surgeons (8 [27%] age 25-34 years, 16 [53%] age 35-44 years, 5 [17%] age 45-54 years, and 1 [3%] age 55-64 years) of varying surgical specialties were interviewed. Conflicts were often reported as due to a breakdown in communication or from performance-related disputes. Participants perceived personal and professional implications including self-doubt, depression, frustration, anxiety, loss of sleep, reputational harms, and delays to advancement. Participants also described potential patient safety implications primarily due to decreased communication resulting from some surgeons being hesitant to engage in subsequent interactions. Participants described a variety of navigation strategies including relationship management, rapport building, and social capital. The success of these processes tended to vary by individual circumstances, including the details of the conflict, practice setting, level of support of leadership, and individual personality of the surgeon. Conclusions and Relevance: This qualitative study highlights women surgeons' experiences with interprofessional workplace conflict. Interprofessional culture building, broader dissemination of implicit bias training, and transparent and equitable adjudication systems are potential strategies for avoiding or mitigating the implications of these conflicts.


Assuntos
Conflito Psicológico , Relações Interprofissionais , Médicas/psicologia , Cirurgiões/psicologia , Local de Trabalho/psicologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Humanos , Satisfação no Emprego , Pessoa de Meia-Idade , Padrões de Prática Médica , Pesquisa Qualitativa , Estados Unidos
13.
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
15.
Acad Med ; 95(10): 1529-1538, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006870

RESUMO

Though overt sexism is decreasing, women now experience subtle, often unconscious, gender bias as microaggressions. The authors sought to explore the prevalence and impact of the sexist microaggressions female surgeons experience, using a sequential exploratory mixed methods approach (January 2018-April 2018), to identify opportunities for education and prevention. First, all resident, fellow, and attending female surgeons at the University of New Mexico Health Sciences Center (UNM HSC) were invited to participate in focus groups conducted by experienced moderators using a semistructured interview guide based on the 7 Sexist Microaggressions Experiences and Stress Scale (Sexist MESS) domains. Qualitative analysis was performed using line-by-line manual coding to identify themes aligned with the Sexist MESS domains as well as other gender bias experiences of female surgeons. Next, a survey was sent to all resident, fellow, and attending female surgeons at the UNM HSC, which included the Sexist MESS questionnaire and questions related to surgeon-specific experiences of gender bias that the authors developed based on major thematic categories from the focus groups.Four focus groups of 23 female surgeons were conducted, revealing 4 themes: exclusion, increased effort, adaptation, and resilience to workplace slights. The survey response rate was 64% (65/101 surgeons). Across Sexist MESS domains, the frequency and severity of microaggressions was higher for trainees than attendings. The variables of non-White race/ethnicity, having children under 18, and fellowship training generally did not demonstrate statistical significance. This exploratory study adds to the growing body of evidence that gender bias in surgery continues and frequently manifests as microaggressions. Trainees reported the highest rates and severity of microaggressions and bias experiences. Further research should investigate how to address microaggressions, the experiences of male surgeons, the perspectives of medical students and groups who were reported as often perpetuating gender bias, and the efficacy of possible interventions.


Assuntos
Médicas/psicologia , Sexismo/psicologia , Cirurgiões/psicologia , Local de Trabalho/psicologia , Adulto , Agressão/psicologia , Bullying/psicologia , Feminino , Grupos Focais , Humanos , New Mexico , Pesquisa Qualitativa , Inquéritos e Questionários
16.
Niger J Clin Pract ; 23(10): 1368-1374, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047692

RESUMO

Background: For the benefits of less postoperative pain, early recovery and discharge, and better cosmesis, laparoscopic surgery is rapidly gaining acceptance amongst surgeons as a better alternative to traditional open procedures. In January 2015, bookings for laparoscopic surgery became a more regular feature on our operation list. Aims: We reported the indications, management outcome, and challenges in patients who had laparoscopic surgery in our institution. This is to document the trends in our surgical practice. Methodology: This is a descriptive study of 137 patients who had laparoscopic surgery for general surgical indications in our institution over a period of 5 years. Patients data as collected from the records department were evaluated for demographic characteristics, medical comorbidities, type of procedures done, and perioperative outcome. Data analysis was performed using Statistical Package for Social Sciences (SPSS). Results: A total of 137 Patients had laparoscopic general surgery between January 2015 and December 2019. There were 48 males and 89 females with a male-to-female ratio of 1:1.9. The mean age of the patients was 38.8 ± 3.4 years (range 16-87 years). Laparoscopic cholecystectomy (35%) and laparoscopic appendicectomy (29.9%) were the most common procedures performed. Five (3.7%) cases were converted to open surgery. Superficial surgical site infection (5.8%) following laparoscopic appendicectomy was the most common postoperative complication. There was no 30-day postoperative mortality. Conclusion: Laparoscopic surgery is safe and can be applied to wide variety of general surgical conditions in developing countries. Minimal postoperative morbidity of laparoscopy is a major benefit to the patients.


Assuntos
Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Cirurgiões/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nigéria , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
17.
PLoS One ; 15(10): e0240433, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33048961

RESUMO

BACKGROUND: Good patient information has shown to improve surgical outcomes. In this study we explore what kind of pre-surgical information patients need and if the provision of a 360˚ video of a surgical procedure can be of added value to the information provided by the hospital. METHODS: An explorative qualitative study using semi-structured interviews on information needs was conducted among 17 inguinal hernia patients to gain more insight in the patients' present surgical information needs. Patients either were planned to receive or already had received a surgical procedure. Questions were asked about the current information provision and, after being shown a 360˚ video of the surgery, whether this would be of added value. RESULTS: Of the total group of 17 patients (mean age 56, interquartile range 45-64) 16 were male and one was female. Most had no previous experience with virtual reality (14/17), already had undergone a surgical procedure (11/17). Patient information needs were all about "seeing" which can be viewed from three different perspectives [1] being seen as a unique person in the treatment process, [2] being seen as a partner, and [3] seeing is understanding. Patients wanted the contact with the doctor to be more personal, with the possibility to see the anesthetist in person, the surgeon to see their wound in the recovery phase, and to receive personal answers to questions about their specific situation. Patients found the 360-video not fearsome, and believed that visual content could be beneficial as it appeals more to their imagination than written or oral information and increases their understanding. It also provided them with a better understanding of their treatment options, their pre-, peri-, and post-surgical procedures and identification of the cause of post-operative side effects. CONCLUSION: To address patients' information needs, complementary tools or services are needed that increase personal contact as well as tailor it to individual patient's needs. Even though video-apps are a partial alternative, hospitals should still offer patients the possibility of having face-to-face meetings with physicians as this is highly valued by patients and leads to increased trust in physicians' performance.


Assuntos
Hérnia Inguinal/cirurgia , Sistemas de Informação Hospitalar/normas , Disseminação de Informação/métodos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Participação do Paciente , Gravação em Vídeo/métodos , Tomada de Decisões , Feminino , Hérnia Inguinal/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Pesquisa Qualitativa , Cirurgiões/psicologia , Confiança
18.
JAMA Netw Open ; 3(9): e2015916, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32930778

RESUMO

Importance: Although evidence-based guidelines designed to minimize health care variation and promote effective care are widely accepted, creating guidelines alone does not often lead to the desired practice change. Such knowledge-to-practice gaps are well-recognized in the management of patients with abdominal wall hernia, where wide variation in patient selection and operative approach likely contributes to suboptimal patient outcomes. To create sustainable, scalable, and widespread adherence to evidence-based guidelines, it is imperative to better understand individual surgeon motivations and behaviors associated with surgical decision-making. Objective: To evaluate the systematic application of the Theoretical Domains Framework (TDF) to explore motivations and behaviors associated with surgical decision-making in abdominal wall hernia practice to help inform the future design of theory-based interventions for desired practice and behavior change. Design, Setting, and Participants: This qualitative study used purposive sampling to recruit 21 practicing surgeons at community and academic hospitals from 5 health regions across Michigan. It used interviews consisting of clinical vignettes for highly controversial situations in abdominal wall hernia repair, followed by semistructured interview questions based on the domains of the TDF to gain nuance into motivating factors associated with surgical practice. Patterns within the data were located, analyzed, and identified through thematic analysis using software. All data were collected between May and July 2018, and data analysis was performed from August 2018 to July 2019. Main Outcomes and Measures: Factors associated with decisions on the surgical approach to abdominal wall hernia repair were assessed using TDF. Results: Seventeen (81%) of the 21 participants were men, with a median (interquartile range) age of 47 (45-54) years. Of the 14 TDF domains, 5 were found to be most associated with decisions on the surgical approach to abdominal wall hernia repair for surgeons in Michigan: knowledge, beliefs about consequences, social or professional role and identity, environmental context and resources, and social influences. Mapping of the findings to the sources of behavior identified the potential intervention functions and policy categories that could be targeted for intervention. The intervention functions found to be most relevant included education, persuasion, modeling, incentivization, and environmental restructuring. Conclusions and Relevance: Using the TDF, this study found that the primary factors associated with individual practice were opinion leaders, practice conformity, and reputational concerns. These findings are important because they challenge traditional dogma, which relies mainly on dissemination of published evidence, education, and technical skills acquisition to achieve evidence-based practice. Such knowledge allows for the development of sustainable, theory-based interventions for adherence to evidence-based guidelines.


Assuntos
Hérnia Abdominal/cirurgia , Cirurgiões/psicologia , Adulto , Idoso , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa , Cirurgiões/estatística & dados numéricos
19.
Acta Biomed ; 91(3): e2020043, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921736

RESUMO

The Sars-Cov2 Pandemic in Italy gave rise in Piacenza, northern Emilia, to one of the most extensive contagions ever recorded in Italy, the area being hit from the beginning of February, with all its dramatic force and enormous impact in terms of human lives, upsetting social lives. Piacenza is only few kilometers away from what was unexpectedly identified as the first known outbreak in the Western world, registered in Codogno, a small town in the province of Lodi, where the first verified Italian case of the infection Covid- 19 was isolated.Due to the advancement of the contagion and the exponential increase of Covid cases which required hospitalization all the surgical wards of our Hospital, except for the Emergency Surgery of the Hospital's central hub "Guglielmo da Saliceto" of Piacenza, were converted into Covid wards with various degrees of management care on behalf of the personnel, as also the operating theatres became new ICU units. Consequently, the professional life habits of the surgeons in general have radically changed: the surgeons have been working for about 70% of their working hours in internist support activities for the management of Covid-correlated pneumonia patients.Since then however, many questions have arisen during our daily reflections regarding the need for future planning of our surgery procedures: how much longer can we delay the planning of our selected surgery? Which epidemiological parameters, and other, should we identify in order to start up selected general surgery?For how long can selected surgery be deferred without compromising outcomes and mid to long term mortality in oncological patients in our province, considering also the diagnostic-therapeutic delays in these exceptional months of the Covid era?


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Hábitos , Pandemias , Pneumonia Viral/epidemiologia , Cirurgiões/psicologia , Infecções por Coronavirus/psicologia , Humanos , Itália/epidemiologia , Pneumonia Viral/psicologia
20.
PLoS One ; 15(9): e0238759, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898179

RESUMO

OBJECTIVES: The purpose of this study was to assess the impact of the COVID-19 pandemic on orthopedic and trauma surgery in private practices and hospitals in Germany. DESIGN: In this cross-sectional study, an online-based anonymous survey was conducted from April 2th to April 16th 2020. SETTING: The survey was conducted among 15.0000 of 18.000 orthopedic and trauma surgeons in Germany, both in private practices and hospitals. PARTICIPANTS: All members of the German Society of Orthopedic and Trauma Surgery (DGOU) and the Professional Association for Orthopedic and Trauma Surgery (BVOU). were invited by e-mail to participate in the survey. MAIN OUTCOME MEASURES: Out of 50 questions 42 were designed to enquire a certain dimension of the pandemic impact and contribute to one of six indices, namely "Preparedness", "Resources", "Reduction", "Informedness", "Concern", and "Depletion". Data was analyzed in multiple stepwise regression, aiming to identify those factors that independently influenced the indices. RESULTS: 858 orthopedic and trauma surgeons participated in the survey throughout Germany. In the multiple regression analysis, being employed at a hospital was identified as an independent positive predictor in the indices for "Preparedness", "Resources", and "Informedness" and an independent negative predictor regarding "Depletion". Self-employment was found to be an independent positive predictor of the financial index "Depletion". Female surgeons were identified as an independent variable for a higher level of "Concern". CONCLUSIONS: The study confirms a distinct impact of the COVID-19 pandemic on orthopedic and trauma surgery in Germany. The containment measures are largely considered appropriate despite severe financial constraints. A substantial lack of personal protective equipment (PPE) is reported. The multiple regression analysis shows that self-employed surgeons are more affected by this shortage as well as by the financial consequences than surgeons working in hospitals. WHAT ARE THE NEW FINDINGS: The COVID-19 pandemic has a profound impact on orthopedic and trauma surgery as an unrelated specialty. Self-employed surgeons are affected especially by a shortage of PPE and financial consequences. HOW MIGHT IT IMPACT ON CLINICAL PRACTICE IN THE NEAR FUTURE: Political and financial support can now be applied more focused to subgroups in the field of orthopedics and trauma surgery with an increased demand for support. A special emphasis should be set on the support of self-employed surgeons which are a more affected by the shortage of PPE and financial consequences than surgeons working in hospitals.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Cirurgiões/psicologia , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Estudos Transversais , Assistência à Saúde , Feminino , Alemanha , Hospitais , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/virologia , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA