Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 40.350
Filtrar
1.
Orv Hetil ; 162(16): 623-628, 2021 04 07.
Artigo em Húngaro | MEDLINE | ID: mdl-33830933

RESUMO

Összefoglaló. Bevezetés: Az emberi sziklacsont a halántékcsont része, egy bonyolult és változatos anatómiai felépítésu struktúra. A sziklacsonton végzett beavatkozások elott, a mutéti szövodmények megelozése érdekében, nélkülözhetetlen a biztos anatómiai tudás és kézügyesség megszerzése, valamint az egyes mutéti lépések és mozdulatok begyakorlása. A VOXEL-MAN Tempo 3D fül-orr-gégészeti szimulátor a virtuális valóság és a robotika alkalmazásával nyújt gyakorlási lehetoséget. Célkituzés: A Szegedi Tudományegyetem 2019-ben VOXEL-MAN fül-orr-gégészeti szimulátort helyezett üzembe az Orvosi Készségfejlesztési Központban. A cikk fül-orr-gégész szakorvos szerzoi a VOXEL-MAN Tempo szimulátor megismerését követoen bemutatják a készüléket, és megfogalmazzák a szimulátorral végzett beavatkozásokkal szemben támasztott igényüket. Módszer: A szerzok a megfogalmazott szempontoknak megfeleloen értékelik a VOXEL-MAN Tempo szimulátort, és meghatározzák, milyen szerepet szánnak neki a gyakorlati képzésben. Eredmények: A szimulátor virtuálisan, mégis valósághuen mutatja meg a sziklacsont anatómiai viszonyait, a fontos anatómiai struktúrák valós térbeli elhelyezkedését és egymástól, illetve a sebészi eszköztol mért távolságát. A rendszer lehetové teszi a fülmutétek valósághu elvégzését (kétkezes csontmunka fúróval és szívóval, vérzés szimulálása) taktilis visszacsatolással. Az egy- vagy kétkezes feladatokkal fejleszthetjük a sebészi készségeket. A fülmutétek csontmunkája reprodukálható módon elvégezheto valódi beteg halántékcsontjáról készített rutin, nagy felbontású komputertomográfiás vizsgálat anyagából. Következtetés: Tapasztalataink alapján a szimulátor kiválóan alkalmas az egyes mutéti lépesek begyakorlására. A jövoben fontos szerepet szánunk a virtuális rendszernek a fül-orr-gégészeti graduális és a fülsebészeti posztgraduális képzésben. Orv Hetil. 2021; 162(16): 623-628. INTRODUCTION: The pars petrosa of the human temporal bone is a structure of complex and diverse anatomy. Prior to surgical interventions, in order to prevent surgical complications, it is essential to acquire sound anatomical knowledge and dexterity as well as to practice each surgical step and movement. The VOXEL-MAN Tempo 3D simulator uses virtual reality and robotics to provide an opportunity to practice. OBJECTIVE: In 2019, the University of Szeged installed a VOXEL-MAN Virtual Reality simulator at the Medical Skills Development Center. After learning about the VOXEL-MAN Tempo simulator, the authors present the device and articulate their need for interventions with the simulator. METHOD: The VOXEL-MAN Tempo simulator is evaluated according to the formulated criteria and the role assigned to it in the practical training is determined. RESULTS: The simulator shows the anatomical structure of the temporal bone virtually, yet realistically, the real spatial location of the important anatomical structures and their distance from each other and from the surgical instrument. The system allows ear surgery to be performed realistically (two-handed bone work with a drill and suction) with tactile (vibration) and visual (bleeding) feedback. One can improve surgical skills with one- or two-handed tasks. Bone work in ear surgeries can be performed in a reproducible manner from routine, high-resolution computer tomography of the temporal bone of a real patient. CONCLUSION: With reference to our experience, the simulator is excellent for practicing each surgical step. In the future, we intend to use this virtual system in undergraduate and postgraduate training in otolaryngology. Orv Hetil. 2021; 162(16): 623-628.


Assuntos
Período Pré-Operatório , Procedimentos Cirúrgicos Operatórios , Osso Temporal/cirurgia , Realidade Virtual , Humanos
3.
Ann R Coll Surg Engl ; 103(3): 145-150, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645280

RESUMO

INTRODUCTION: The relation between type of ventilation used in the operating theatre and surgical site infection has drawn considerable attention. It has been reported that there is a possible relationship between the type of ventilation used in the operation theatre and surgical site infection. This meta-analysis was performed to evaluate this relationship. METHODS: Through a systematic literature search up to May 2020, 14 studies describing 590,121 operations, 328,183 were performed under laminar airflow ventilation and 2,611,938 were performed under conventional ventilation. Studies were identified that reported relationships between type of ventilation with its different categories and surgical site infection (10 studies were related to surgical site infection in total hip replacement, 7 in total knee arthroplasties and 3 in different abdominal and open vascular surgery). Odds ratios with 95% confidence intervals were calculated comparing surgical site infection prevalence and type of theatre ventilation using the dichotomous method with a random or fixed-effect model. FINDINGS: No significant difference was found between surgery performed under laminar airflow ventilation and conventional ventilation in total hip replacement (OR 1.23; 95% CI 0.97-1.56, p = 0.09), total knee arthroplasties (OR 1.14; 95% CI 0.62-2.09, p = 0.67) or different abdominal and open vascular surgery (OR 0.75; 95% CI 0.43-1.33, p = 0.33). The impact of the type of theatre ventilation may have no influence on surgical site infection as a tool for decreasing its occurrence. CONCLUSIONS: Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation since it has a much higher cost compared with conventional ventilation.


Assuntos
Salas Cirúrgicas , Procedimentos Cirúrgicos Operatórios , Infecção da Ferida Cirúrgica/epidemiologia , Ventilação/estatística & dados numéricos , Artroplastia de Quadril , Artroplastia do Joelho , Ambiente Controlado , Humanos , Procedimentos Cirúrgicos Vasculares , Ventilação/métodos
6.
Medicine (Baltimore) ; 100(10): e25119, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725909

RESUMO

ABSTRACT: The purpose of the present study was to investigate the efficacy of perioperative oral managements (POMs) on perioperative nutritional conditions in patients undergoing surgery with general anesthesia. Medical records were retrospectively reviewed and the effects of POMs were investigated based on a large number of cases using a multicenter analysis. The profile of serum albumin levels was assessed and compared between patients with and without POMs using the multivariate analysis. Seventeen Eleven thousand and one hundred sixty patients (4,873 males and 6,287 females) were reviewed. Of these, 2710 patients (24.3%) had undergone POMs. The results of a multivariate analysis revealed the significant positive effect of POMs on perioperative serum albumin level (change between at admission and discharge, (Estimate: 0.022, standard error: 0.012, P < .0001). Patient gender, age, surgical site, performance status, the American Society of Anesthesiologists (ASA) physical status classification, operation time, amount of blood loss, and serum albumin level at admission were also significant predictors. Adjusted multivariate analysis of the effects of POMs on perioperative change of serum albumin level in all subjects reveled the significance of POMs intervention (estimate: 0.022, standard error: 0.012, P < .0001). These results suggest that POMs exerts significant positive effects on perioperative serum albumin levels in patients underwent surgery under general anesthesia.


Assuntos
Anestesia Geral/efeitos adversos , Higiene Bucal , Assistência Perioperatória/métodos , Albumina Sérica Humana/análise , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica Humana/imunologia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 100(12): e24776, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761639

RESUMO

BACKGROUND: Postoperative complications after abdominal surgery are high, and there is no reliable intervention program to prevent them. Some studies have pointed out that early postoperative activities have advantages in preventing the occurrence of complications, but lack of evidence-based basis. The purpose of this study is to systematically evaluate the effect of nursing intervention is guiding early postoperative activities on the rapid recovery of patients undergoing abdominal surgery. METHODS: China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database and Chinese Biomedical Database, PubMed, Embase, Web of Science and the Cochrane Library will be searched by computer, and a randomized controlled study is conducted on early participation in exercise programs after abdominal surgery from the establishment of the database to January 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers, and the included literature is analyzed by Meta using RevMan5.3 software. RESULTS: This study will evaluate the effect of nursing intervention is guiding early postoperative activities on the rapid rehabilitation of patients undergoing abdominal surgery through the indexes of postoperative quality of life score, the incidence of complications, mortality, length of stay and so on. CONCLUSION: This study will provide reliable evidence-based basis for establishing a reasonable and effective postoperative activity guidance program for patients undergoing abdominal surgery. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/59MD4.


Assuntos
Abdome/cirurgia , Cuidados de Enfermagem/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/reabilitação , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Metanálise como Assunto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Revisões Sistemáticas como Assunto , Fatores de Tempo , Resultado do Tratamento
8.
Ann R Coll Surg Engl ; 103(3): 151-154, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645287

RESUMO

INTRODUCTION: Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the spread of infectious airborne particles. We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19. METHODS: A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Search terms included "COVID-19", "theatre ventilation", "laminar", "turbulent" and "negative pressure". FINDINGS: Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surgery. Following previous viral outbreaks, some centres have introduced negative pressure ventilation in an attempt to decrease exposure of airborne pathogens to staff and surrounding areas. This has again been suggested during the COVID-19 pandemic. A limited number of studies show some positive results for the use of negative pressure ventilation systems and reduction in spread of pathogens; however, cost, accessibility and duration of conversion remain an unexplored issue. Overall, there is insufficient evidence to advocate large scale conversion at this time. Nevertheless, it may be useful for each centre to have its own negative pressure room available for AGPs and high risk patients.


Assuntos
Filtros de Ar , Ambiente Controlado , Salas Cirúrgicas , Isoladores de Pacientes , Procedimentos Cirúrgicos Operatórios/métodos , Ventilação/métodos , /transmissão , Humanos , Procedimentos Ortopédicos , Infecção da Ferida Cirúrgica/prevenção & controle
9.
BMC Surg ; 21(1): 114, 2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676462

RESUMO

BACKGROUND: There is limited evidence to clarify the specific relationship between preoperative estimated glomerular filtration rate (preop-eGFR) and postoperative 30-day mortality in Asian patients undergoing non-cardiac and non-neuron surgery. We aimed to investigate details of this relationship. METHODS: We reanalyzed a retrospective analysis of the clinical records of 90,785 surgical patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. The main outcome was postoperative 30-day mortality. RESULTS: The average age of these recruited patients was 53.96 ± 16.88 years, of which approximately 51.64% were female. The mean of preop-eGFR distribution was 84.45 ± 38.56 mL/min/1.73 m2. Multivariate logistic regression analysis indicated that preop-eGFR was independently associated with 30-day mortality (adjusted odds ratio: 0.992; 95% confidence interval [CI] 0.990-0.995; P < 0.001). A U-shaped relationship was detected between preop-eGFR and 30-day mortality with an inflection point of 98.688 (P for log likelihood ratio test < 0.001). The effect sizes and confidence intervals on the right and left sides of the inflection point were 1.013 (1.007 to 1.019) [P < 0.0001] and 0.984 (0.981 to 0.987) [P < 0.0001], respectively. Preoperative comorbidities such as congestive heart failure (CHF), type 1 diabetes, ischemic heart disease (IHD), and anemia were associated with the odds ratio of preop-eGFR to 30-day mortality (interaction P < 0.05). DISCUSSION: The relationship between preop-eGFR and 30-day mortality is U-shaped. The recommended preop-eGFR at which the rate of the 30-day mortality was lowest was 98.688 mL/min/1.73 m2.


Assuntos
Taxa de Filtração Glomerular , Procedimentos Cirúrgicos Operatórios , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Singapura/epidemiologia , Procedimentos Cirúrgicos Operatórios/mortalidade
10.
World J Emerg Surg ; 16(1): 9, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685484

RESUMO

BACKGROUND: SARS-CoV-2 infection has spread worldwide, and the pathogenic mechanism is still under investigation. The presence of a huge inflammatory response, defined as "cytokine storm," is being studied in order to understand what might be the prognostic factors implicated in the progression of the infection, with ferritin being one of such markers. The role of ferritin as a marker of inflammation is already known, and whether it changes differently between COVID and non-COVID patients still remains unclear. The aim of this retrospective analysis is to understand whether the inflammatory process in these two types is different. METHODS: In this retrospective analysis, we compared 17 patients affected by SARS-CoV-2, who had been admitted between February and April 2020 (group A) along with 30 patients admitted for acute surgical disease with SARS-CoV-2 negative swab (group B). A further subgroup of Covid negative patients with leukocytosis was compared to group A. RESULTS: In group A, the median (interquartile range) serum ferritin was 674 (1284) ng/mL, and it was double the cutoff (300 ng/mL) in 9 out of 17 (52%). The median (IQR) value of ferritin level in the total blood samples of group B was 231, and in the subgroup with leucocytosis, 149 (145). Group A showed a significantly higher ferritin median level compared to the entire group B (two-tailed Mann-Whitney test, p < 0.0001) as well as to the subgroup with leucocytosis (p < 0.0014). CONCLUSIONS: The role of iron metabolism appears to be directly involved in COVID infection. On the other hand, in the acute inflammation of patients admitted for surgery, and probably in other common phlogistic processes, iron modifications appear to be self-limited. However, our finding suggests the use of ferritin as a marker for COVID infection.


Assuntos
/métodos , /fisiopatologia , Ferritinas/sangue , Inflamação/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , /cirurgia , Estudos de Casos e Controles , Emergências , Feminino , Humanos , Inflamação/sangue , Inflamação/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios
12.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653868

RESUMO

We describe a case of retrovesical liposarcoma in a male patient with concurrent COVID-19. A 50-year-old man had lower urinary tract symptoms and dull pain along his right gluteus. Due to COVID-19 infection, management was delayed. During self-isolation, the patient developed urinary retention and his pain level was an eight on the Visual Analogue Scale. A urinary catheter and an epidural catheter were inserted without any difficulty. Abdominal-pelvic MRI revealed a retrovesical mass suspected of liposarcoma with clear borders from surrounding organs. Following two consecutive negative SARS-CoV-2 PCR tests, we proceeded with surgery. Histopathology was dedifferentiated liposarcoma. Postoperatively, the patient suffered reactivation of COVID-19, and he was eventually discharged after two consecutive negative results on the PCR test on Post Operative Day (POD)-10. Retrovesical dedifferentiated liposarcoma is rare and considered as high-grade liposarcoma. Although surgery may exacerbate COVID-19 infection, surgical resection of symptomatic high-grade sarcoma is prioritised and performed as soon as no infection detected.


Assuntos
/diagnóstico , Lipossarcoma , Sintomas do Trato Urinário Inferior , Neoplasias Pélvicas , Procedimentos Cirúrgicos Operatórios/métodos , Retenção Urinária , /terapia , Quimiorradioterapia Adjuvante/métodos , Dissecação/métodos , Humanos , Lipossarcoma/patologia , Lipossarcoma/fisiopatologia , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/fisiopatologia , Tempo para o Tratamento , Resultado do Tratamento , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia
13.
Ann R Coll Surg Engl ; 103(3): 173-179, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33557703

RESUMO

INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Neoplasias/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/métodos , Derivação Arteriovenosa Cirúrgica , Cateterismo Cardíaco , Assistência à Saúde/organização & administração , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Histerectomia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reino Unido/epidemiologia , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
14.
JAMA Netw Open ; 4(2): e2036315, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33533930

RESUMO

Importance: Adhesion-related complications (ARCs), including small-bowel obstruction, are common complications of intra-abdominal surgery. Statins, which have antifibrotic pleiotropic effects, inhibit adhesion formation in murine models but have not been assessed in humans. Objective: To assess whether statin use at the time of intra-abdominal surgery is associated with a reduction in ARCs. Design, Setting, and Participants: These 2 separate retrospective cohort studies (The Health Improvement Network [THIN] and Optum's Clinformatics Data Mart [Optum]) compared adults receiving statins with those not receiving statins at the time of intra-abdominal surgery. Individuals undergoing intra-abdominal surgery from January 1, 1996, to December 31, 2013, in the United Kingdom and from January 1, 2000, to December 31, 2016, in the US were included in the study. Those with obstructive events before surgery or a history of inflammatory bowel disease were excluded. Data analysis was performed from September 1, 2012, to November 24, 2020. Exposure: The primary exposure was statin use at the time of surgery. Main Outcomes and Measures: The primary outcome was ARCs, defined as small-bowel obstruction or need for adhesiolysis, occurring after surgery. Sensitivity analyses included statin use preceding but not concurrent with surgery, fibrate use, and angiotensin-converting enzyme inhibitor use. All analyses were adjusted for age, sex, and conditions associated with microvascular disease, such as hypertension, hyperlipidemia, obesity, and tobacco use; surgical approach and site; and diagnosis of a malignant tumor. Results: A total of 148 601 individuals met the inclusion criteria for THIN (mean [SD] age, 49.6 [17.7] years; 70.1% female) and 1 188 217 for Optum (mean [SD] age, 48.2 [16.4] years; 72.6% female). A total of 2060 participants (1.4%) experienced an ARC in THIN and 54 136 (4.6%) in Optum. Statin use at the time of surgery was associated with decreased risk of ARCs (THIN: adjusted hazard ratio [HR], 0.81; 95% CI, 0.71-0.92; Optum: adjusted HR, 0.92; 95% CI, 0.90-0.95). Similar associations were appreciated between statins and small-bowel obstruction (THIN: adjusted HR, 0.80; 95% CI, 0.70-0.92; Optum: adjusted HR, 0.88; 95% CI, 0.85-0.91). Conclusions and Relevance: This study's findings suggest that, among individuals in 2 separate cohorts undergoing intra-abdominal surgery, statin use may be associated with a reduced risk of postoperative ARCs. Statins may represent an inexpensive, well-tolerated pharmacologic option for preventing ARCs.


Assuntos
Abdome/cirurgia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Obstrução Intestinal/epidemiologia , Intestino Delgado , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios , Aderências Teciduais/epidemiologia , Adulto , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Modelos de Riscos Proporcionais , Fatores de Proteção , Estudos Retrospectivos , Aderências Teciduais/cirurgia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Urológicos , Procedimentos Cirúrgicos Vasculares
16.
Ann R Coll Surg Engl ; 103(2): 96-103, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559543

RESUMO

INTRODUCTION: Adaptation is vital to ensure successful healthcare recovery during the COVID-19 pandemic. Hand trauma represents the most common acute emergency department presentation internationally. This study prospectively evaluates the COVID-19 related patient risk, when undergoing management within one of the largest specialist tertiary referral centres in Europe, which rapidly implemented national COVID-19 safety guidelines. MATERIALS AND METHODS: A prospective cohort study was undertaken in all patients referred to the integrated hand trauma service, during the UK COVID-19 pandemic peak (April-May 2020); all were evaluated for 30-day COVID-19 related death. Random selection was undertaken for patients with hand trauma who either underwent non-operative (control group) or operative (surgery group) management; these groups were prospectively followed-up within a controlled cohort study design and telephoned at 30 days following first intervention (control group) or postoperatively (surgery group). RESULTS: Of 731 referred patients (566 operations), there were no COVID-19 related deaths. Both groups were matched for sex, age, ethnicity, body mass index, comorbidities, smoking, preoperative/first assessment COVID-19 symptoms, pre- and postoperative/first assessment isolation and positive COVID-19 contact (p > 0.050). There were no differences in high service satisfaction (10/10 compared with 10/10; p = 0.067) and treatment outcome (10/10 compared with 10/10; p = 0.961) scores, postoperative/first assessment symptoms (1%, 1/100 compared with 0.8%, 2/250; p = 1.000) or proportion of positive tests (7.1%, 1/14 compared with 2.2%, 2/92; p = 0.349), between the control (n = 100) and surgery (n = 250) groups. CONCLUSION: These data support continued and safe service provision and no increased risk to patients who require surgical management. Such findings are vital for healthcare providers when considering service adaptations to reinstate patient treatment.


Assuntos
/epidemiologia , Infecção Hospitalar/epidemiologia , Traumatismos da Mão/terapia , Procedimentos Cirúrgicos Operatórios , Adulto , Idoso , Amputação Traumática/terapia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Fraturas Ósseas/terapia , Traumatismos da Mão/epidemiologia , Articulação da Mão , Humanos , Luxações Articulares/terapia , Lacerações/terapia , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Satisfação do Paciente , Traumatismos dos Nervos Periféricos/terapia , Traumatismos dos Tendões/terapia , Centros de Atenção Terciária , Resultado do Tratamento , Reino Unido/epidemiologia
17.
BMC Surg ; 21(1): 75, 2021 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-33549063

RESUMO

BACKGROUND: Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons' manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees. METHODS: A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees. Although four open conventional knots with four throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with two cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively. RESULTS: Twenty-four instructors (PGY6-PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7 N) than in instructors (49.9 ± 34.4 N, P = 0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P < 0.001). Knot slippage (31.8 ± 17.7 N) was significantly worse than suture rupture (89.9 ± 22.2 N, P < 0.001) in tensile strength. CONCLUSIONS: Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.


Assuntos
Ortopedia/educação , Estudantes de Medicina , Cirurgiões , Procedimentos Cirúrgicos Operatórios/métodos , Técnicas de Sutura , Suturas , Resistência à Tração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Operatórios/educação
19.
J Perioper Pract ; 31(3): 108-113, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33557712

RESUMO

INTRODUCTION: The Surgical Care Practitioner is a medical associate profession role, working to an advanced level, undertaken by registered nurses, operating department practitioners or physiotherapists, on completion of a Royal College of Surgeons accredited course. The COVID-19 pandemic has led to all heath care professionals needing to adapt to help support the health care system as it tackles its effect. AIM: Audit of roles undertaken by Surgical Care Practitioners during the COVID-19 pandemic in the context of Royal College of Surgeons (2014) Curriculum to review the utilisation of this medical associate profession role. METHOD: The online questionnaire service, SurveyMonkey®, was used to collect data on the activities being undertaken by the Surgical Care Practitioner during the COVID-19 pandemic. RESULTS: Eighty Surgical Care Practitioners from across seven different surgical specialties within the United Kingdom completed the online survey. Nearly half stated that they remained mostly working in their substantive role, just less than a third helped in critical care units, with the remaining redeployed in equal shares to emergency departments or assisting on wards with nurses and as part of medical teams. A brief description of their activities was also recorded. CONCLUSION: This audit has demonstrated the versatility of the Surgical Care Practitioner and ability to adapt during the pandemic.


Assuntos
/epidemiologia , Competência Clínica , Profissionais de Enfermagem/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Necessidades e Demandas de Serviços de Saúde , Humanos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido
20.
Int J Qual Health Care ; 33(Supplement_1): 51-55, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33432983

RESUMO

BACKGROUND: In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy. METHODS: The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organizational structures. The adaptations made and the expertise acquired have the potential for triggering deeper learning and to create enduring improvements in the routine identification and management of infections relating to surgery. RESULTS: This paper aims to illustrate how adopting a human factors and ergonomics perspective can provide insights into how clinical work systems have been adapted and reconfigured in order to keep patients and staff safe. CONCLUSION: For achieving sustainable change in IPCS practices in surgery during COVID-19 and beyond we need to enhance organizational learning potentials.


Assuntos
Controle de Infecções/métodos , Procedimentos Cirúrgicos Operatórios/normas , Antibacterianos/uso terapêutico , Infecção Hospitalar/prevenção & controle , Monitoramento Epidemiológico , Ergonomia/métodos , Higiene das Mãos , Humanos , Controle de Infecções/normas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...