Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

Objective: Medical error is an inevitable part of modern healthcare, with a potential harmful impact for the patient and the surgeon. The phenomenon of negative personal responses for healthcare workers in the aftermath of adverse events is described as the "second casualty" and can involve significant physical and psychological distress. We present results from a cross-sectional survey of surgeons and their experience in the aftermath of adverse events or complications.

Subjects and methods: Following ethical approval an anonymous online survey was distributed to all training and consultant surgeons in the Republic of Ireland. Data collected included basic demographics, personal response to an adverse event, coping strategies, contributing factors and perception of potential support structures.

Results: A total of 110 responses were received representing surgeons with a broad range of experience and specialty. Eighty-nine percent (n = 98) of surgeons described negative psychological symptoms in the aftermath of adverse events. The predominant responses were anxiety, guilt and low mood. Sixty-seven percent (n = 74) reported that their training did not prepare them for the personal impact of events but found informal peer and family support to be beneficial and were open to the implementation of formal support structures.

Conclusion: Surgeons suffer in the aftermath of negative outcomes and feel unprepared to manage the personal consequences. Institutions and representative bodies must step forward to change culture and develop supports for surgeons in the aftermath of adverse events and complications.

Introduction: Surgery is a cognitive discipline whose practitioners characteristically use technology during operations for patients. With accelerating technological innovation throughout society and healthcare, we sought to develop a shared position for Irish surgery via a commissioned work programme by the Royal College of Surgeons in Ireland.

Methods: Using Stanford design principles, representative clinical specialty and academic leads and higher trainee representatives across 15 specialties were surveyed regarding sentiments, perspectives and concerns regarding now and near future technology in clinical practice, career considerations and training/education. Selected participants proceeded to semi-structured interview as deeper dive including use-case exemplar development with narrative thematic analysis.

Results: New technologies matter to surgeons and surgical practice for patients as evidenced by the high level of engagement and rich perspectives provided. However there is concern, particularly among academic groups, that Irish Surgery could be better positioned for the opportunities inherent in new technologies and better prepared strategically regarding stakeholder (surgical units, healthcare institutions, universities and especially management, health service executive and government) alignment. Investment levels are felt to be insufficient to maximally leverage new technology effectively including training investment where new ways of learning are needed as technologies such as artificial intelligence and data and analytics become more important to surgical practice beyond the current prioritisation of robotics and biomaterials.

Conclusion: While there is high engagement, clear ambition and confidence with role of new technologies in the now and near future of Irish Surgery, there is opportunity to demonstrate leadership and synergise stake holders for better healthcare.

Background: The framing effect has been demonstrated in a variety of settings. This study aimed to determine whether framing of complication risk in total hip arthroplasty (THA) and long-term patient satisfaction rates in total knee arthroplasty (TKA) influences patient decision-making and 'worry' using hypothetical vignettes.

Methods: Two cross-sectional survey studies were undertaken, one based on a THA vignette and one based on a TKA vignette. Participants were randomized into a positive-framing or negative-framing group and asked to read the vignette. They were then asked to indicate whether they would proceed with surgery, and to self-report their degree of 'worry' about surgery. For the THA vignette, the positive-framing group was informed '98 % of people will have no major complications' while the negative-framing group was informed that '2 % of people will have a major complication'. For the TKA vignette, the positive-framing group was informed '80/100 of people will be happy … once they have recovered' and the negative-framing group was informed '20/100 people will be unhappy … once they have recovered'. The vignettes were otherwise identical. The primary outcome was the decision to proceed with surgery. The secondary outcome was self-reported 'worry' about surgery.

Results: For the THA vignette (622 individuals) 294/310 (95 %) indicated they would proceed with surgery in the positive-framing group while 275/312 (88 %) indicated they would proceed with surgery in the negative-framing group (p = 0.0037). For the TKA vignette (623 individuals), 302/311 (97.1 %) indicated they would proceed with surgery in the positive-framing group and 280/312 (89.7 %) indicated they would proceed with surgery in the negative-framing group (p = 0.0003). Self-reported 'worry' differed based on positive or negative framing in both surveys.

Conclusions: Framing of complication risk and long-term outcomes influences patient decision-making and 'worry' in a THA and TKA vignette. This has implications for shared decision-making and informed consent.

Background: Fungating breast wounds cause significant complications and morbidity to patients. Wound care is of paramount importance in optimising care and alleviating suffering for patients with malignant breast wounds. Currently, routinely implemented objective assessment tools for fungating breast wound treatment outcomes are non-existent, and institutional practice varies.

Aims: This review aims to evaluate current evidence regarding various wound care methodologies for fungating breast tumours on their effectiveness at targeting established fungating wound-specific complications: malodour, pain, exudates, bleeding, wound characteristics, emotional and quality-of-life outcomes.

Data sources: We conducted a systematic review of four databases (PubMed, Embase, Scopus, The Cochrane Library) and hand-search of bibliographies of relevant reviews, in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines.

Results: The search strategy yielded 1319 articles, of which, 8 studies involving 188 patients were included in the review. Studies examined the effects of wound care products such as but not limited to calcium alginate, hydrocellular dressing and metronidazole and looked at outcomes such as bleeding (6), malodour (5), exudates (3), pain (4), wound size/length (2), emotion (3) and quality-of-life (1).

Conclusion: There is a wide variety of options for wound care which is able to target the various complications of fungating breast wounds. Certain wound care methods are effective in alleviating patient morbidity. However, key barriers toward establishing evidenced-based management of patients with fungating breast wounds were identified in the paucity of studies, lack of standardisation of interventions and objective outcome measures.