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

{"title":"Defining minimum work priorities in emergency general surgery in a national cohort.","authors":"Tom V McIntyre, Paul F Ridgway","doi":"10.1016/j.surge.2024.08.005","DOIUrl":"https://doi.org/10.1016/j.surge.2024.08.005","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency general surgery is typically delivered in addition to routine elective care. Models such as acute surgical assessment units and reduced elective working have been explored to reduce the conflict between these competing demands. We aim to identify the models used, the cohorts of patients seen, and the staffing levels in each system.</p><p><strong>Methods: </strong>Data on general surgery activities were obtained from the National Quality Assurance and Improvement System (NQAIS) and previously published data. The mode of delivery of acute services in other countries was collated from national surgical bodies and published position statements.</p><p><strong>Results: </strong>National on-call services are supra-elective or parallel to elective streams with little dedicated on-call. Internationally, many similar countries are moving to separate acute and elective care to ensure both are performing optimally. Staff in Model 3 hospitals are frequently on call with variable but small operative numbers but represent a combination of high and low acuity. These consultants need a wider breadth of surgical skills than Model 4 hospitals due to a lack of local specialists.</p><p><strong>Conclusion: </strong>The majority of national hospitals still work a traditional on-call model, with limited adoption of separate on-call and elective workstreams. Preserving the elective workload is likely to require separation of these priorities, which is difficult with current staffing levels. The use of Acute Surgical Assessment Units (ASAUs) within emergency surgical networks may improve patient outcomes by regionalising the delivery of higher acuity care.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The formidable challenges faced by surgeons in war zones","authors":"Rand Y. Omari","doi":"10.1016/j.surge.2024.08.003","DOIUrl":"10.1016/j.surge.2024.08.003","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Page e188"},"PeriodicalIF":2.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty and the incidence of surgical site infection after total hip or knee arthroplasty: A meta-analysis","authors":"Guangjiang Wu ,&nbsp;Can Cui ,&nbsp;Qingkun Song","doi":"10.1016/j.surge.2024.07.008","DOIUrl":"10.1016/j.surge.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infection (SSI) remains a critical postoperative complication after total hip and knee arthroplasty (THA and TKA). Frailty, a condition characterized by decreased physiological reserve and increased vulnerability to stressors, may influence the risk of SSI in these patients. This meta-analysis aims to evaluate the association between frailty and the incidence of SSI following THA or TKA.</div></div><div><h3>Methods</h3><div>A systematic search of databases including PubMed, EMBASE, Web of Science, Wanfang, and CNKI was conducted to identify relevant studies. Data were extracted and pooled using a random-effects model to calculate the overall risk ratio (RR) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>A total of ten studies comprising 1,036,787 patients met the inclusion criteria. The meta-analysis revealed that frail patients undergoing THA or TKA had a significantly higher risk of developing SSI compared to non-frail patients (RR = 1.64, 95 % CI: 1.39–1.93, p &lt; 0.001, I² = 66 %). Subgroup analyses indicated that the type of arthroplasty (hip vs. knee) and the method of frailty assessment did not significantly alter the association. Further subgroup analysis suggested that frailty was significantly associated with a higher incidence of deep SSI including joint infection (RR = 1.77, 95 % CI: 1.27–1.48, p &lt; 0.001), but not the incidence of superficial SSI (RR = 1.57, 95 % CI: 0.45–5.42, p = 0.48). The association between frailty and SSI remains in subgroup of multivariate studies only (RR = 1.56, 95 % CI: 1.34 to 1.80, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Frailty is a potential predictor of SSI following TKA/THA.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages e221-e229"},"PeriodicalIF":2.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The journey of female surgeons in the arab region: A scoping review","authors":"Amani N. Alansari ,&nbsp;Nour W. Alhussaini ,&nbsp;Usra Elshaikh ,&nbsp;Raed M. Al-Zoubi","doi":"10.1016/j.surge.2024.07.009","DOIUrl":"10.1016/j.surge.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><p>In the Arab region, there's a dearth of research on female surgeons' experiences and challenges. To address this gap, a scoping review aims to map existing literature. It seeks to understand the hurdles faced by female surgeons in Arab countries and examine any gender biases in public preferences for surgeons. No previous reviews were conducted on female surgeons in the Arab region. By identifying systemic barriers, the review aims to promote inclusivity and support for female surgeons in the Arab medical community.</p></div><div><h3>Methods</h3><p>A scoping review was performed and reported using the PRISMA extension for scoping reviews. Five databases were searched which include PubMed, Web of Science, Scopus, Embase, and ProQuest. The search strategy included three main strings that are “Women” AND “Surgeons” AND “Arab Country”. A priori-identified spreadsheet was used for data extraction.</p></div><div><h3>Results</h3><p>A total number of 23 studies were included in this review. The findings were categorized under several headings, such as the general public's preferred gender of surgeon and well-being, challenges, and experiences of female surgeons as well as career perspectives, choices, and satisfaction.</p></div><div><h3>Conclusions</h3><p>This scoping review explores experiences and challenges faced by female surgeons in the Arab region, emphasizing the need to address systemic barriers and promote inclusivity.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Pages 307-318"},"PeriodicalIF":2.3,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X24000805/pdfft?md5=b6be17c1af2e8f765d6e0525857eaea1&pid=1-s2.0-S1479666X24000805-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the transition from print to electronic journals through the lens of sustainability","authors":"","doi":"10.1016/j.surge.2023.12.003","DOIUrl":"10.1016/j.surge.2023.12.003","url":null,"abstract":"<div><p>This paper presents a comparative analysis of the sustainability aspects between print and electronic journals. A narrative synthesis is presented under the three key areas of environmental impact, social impact, and impact on research practices. Over the past decades, the gradual transition from print to electronic media has facilitated greater global access to academic research, reshaped research methodologies through innovative tools and systems, and arguably, reduced the ecological footprint of academia.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 209-211"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139510516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waste management in the operating theatre","authors":"","doi":"10.1016/j.surge.2024.06.004","DOIUrl":"10.1016/j.surge.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Poor clinical waste management<span> and its effect on the environment is an increasingly recognised concern for global healthcare systems. Approximately two thirds of waste produced in healthcare is from the operating theatre. In the Republic of Ireland, an estimated 580,977 tonnes of hazardous waste<span> was produced in 2019. The cost of incineration of this hazardous waste is approximately €2,125 per tonne and €935 per tonne for sterilisation. Pollution from incineration is substantial and harmful.</span></span></p></div><div><h3>Methods</h3><p>A literature review was performed on the topic of hospital waste management, specifically looking at the Republic of Ireland. A comparison could then be drawn between Ireland, Europe and the United States of America. Observation of our current operating theatre environment and practices were carried out.</p></div><div><h3>Discussion</h3><p>An increased focus towards sustainability and reusable equipment means that there is potentially a decreased amount of waste for disposal, but an increase in the process of sterilisation. Approximately 66% of healthcare related waste is inappropriately contaminated, meaning that significant savings are possible if correct segregation and recycling were to occur. An increase in the amount of bins, identification labels above bins and education of staff results in an increased likelihood of successful segregation of waste. Clear and concise hospital guidelines of what is considered hazardous versus non-hazardous waste will decrease the amount of inappropriately disposed items.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 248-252"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable orthopaedic surgery: Initiatives to improve our environmental, social and economic impact","authors":"","doi":"10.1016/j.surge.2023.06.005","DOIUrl":"10.1016/j.surge.2023.06.005","url":null,"abstract":"<div><p>In response to appeals from the WHO and The Lancet, a collaborative statement from over 200 medical journals was published in September 2021, advising international governments to combat the “catastrophic harm to health” from climate change. Healthcare, specifically surgery, constitutes a major contributor to environmental harm that remains unaddressed. This article provides practical guidance that can be instituted at a departmental, hospital and national level to institute transformative, sustainable efforts into practice. We also aim to provoke healthcare leaders to discuss policy-making with respect to this issue and highlight the necessity for sustainability to become a core domain of quality improvement.</p><p><span>The average orthopaedic service produces 60% more waste than any other surgical specialty. Fortunately, simple measures such as a comprehensive education programme can decrease waste disposal costs by 20-fold. Other simple and effective “green” measures include integrating carbon literacy into surgical training, prioritising </span>regional anaesthesia<span> and conducting recycling audits. Furthermore, industry must take accountability and be incentivised to limit the use of single-item packaging and single-use items. National policymakers should consider the benefits of reusable implants, reusable surgical drapes and refurbishing crutches as these are proven cost and climate-effective interventions. It is crucial to establish a local sustainability committee to maintain these interventions and to bridge the gap between clinicians, industry and policymakers.</span></p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 215-220"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9836651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does reusable mean green? Comparison of the environmental impact of reusable operating room bed covers and lift sheets versus single-use","authors":"","doi":"10.1016/j.surge.2024.05.003","DOIUrl":"10.1016/j.surge.2024.05.003","url":null,"abstract":"<div><h3>Introduction</h3><p>As hospitals strive to reduce their environmental footprint, there is an ongoing debate over the environmental implications of reusable versus disposable linens in operating rooms (ORs). This research aimed to compare the environmental impact of reusable versus single-use OR bed covers and lift sheets using life cycle assessment (LCA) methodology.</p></div><div><h3>Methods</h3><p>LCA is an established tool with rigorous methodology that uses science-based processes to measure environmental impact. This study compared the impacts of three independent system scenarios at a single large academic hospital: reusable bed covers with 50 laundry cycles and subsequent landfill disposal (System 1), single-use bed covers with waste landfill disposal (System 2), and single-use bed covers with waste disposal using incineration (System 3).</p></div><div><h3>Results</h3><p>The total carbon footprint of System 1 for 50 uses was 19.83 ​kg carbon dioxide equivalents (CO₂-eq). System 2 generated 64.99 ​kg CO₂-eq. For System 3, the total carbon footprint was 108.98 ​kg CO₂-eq. The raw material extraction for all the material to produce an equivalent 50 single-use OR bed cover kits was tenfold more carbon-intensive than the reusable bed cover. Laundering one reusable OR bed cover 50 times was more carbon intensive (12.12 ​kg CO2-eq) than landfill disposal of 50 single-use OR bed covers (2.52 ​kg CO2-eq).</p></div><div><h3>Discussion</h3><p>Our analysis demonstrates that one reusable fabric-based OR bed cover laundered 50 times, despite the carbon and water-intensive laundering process, exhibits a markedly lower carbon footprint than its single-use counterparts. The net difference is 45.16 ​kg CO2-eq, equivalent to driving 115 miles in an average gasoline-powered passenger vehicle. This stark contrast underscores the efficacy of adopting reusable solutions to mitigate environmental impact within healthcare facilities.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 236-241"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X24000581/pdfft?md5=80777cfcba3a43430e967d8046b277c9&pid=1-s2.0-S1479666X24000581-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs","authors":"","doi":"10.1016/j.surge.2024.04.007","DOIUrl":"10.1016/j.surge.2024.04.007","url":null,"abstract":"<div><h3>Background and purpose</h3><p><span><span>The rise in hip and knee </span>arthroplasty for </span>osteoarthritis<span> requires addressing healthcare system pollution to support Ireland's climate change<span> goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices.</span></span></p></div><div><h3>Methods</h3><p><span>The study was conducted at National Orthopaedic<span> Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty<span>. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO</span></span></span>₂e) and disposal costs were calculated.</p></div><div><h3>Results</h3><p>In a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 ​kgCO₂e per case, revision hips 23.50 ​kgCO₂e, primary knees 15.82 ​kgCO₂e, and primary hips 14.64 ​kgCO₂e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 ​at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO₂e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed.</p></div><div><h3>Conclusion</h3><p><span>The research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower </span>sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 221-226"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon footprint of tonsillectomy","authors":"","doi":"10.1016/j.surge.2024.06.001","DOIUrl":"10.1016/j.surge.2024.06.001","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Healthcare is responsible for 5.4% of greenhouse gas emissions in the UK. Emissions in surgery is a relatively unexplored area; in particular, this hasn't yet been looked at as a whole in ENT in the UK. The purpose of the study was to quantify the amount of greenhouse gas (GHG) emission from a tonsillectomy and assess the proportion of each source's contribution.</p></div><div><h3>Methods</h3><p>Operational data from tonsillectomies performed at a large university teaching hospital in the UK were gathered and converted to global warming potential using established conversion factors and data from existing healthcare-focused carbon footprint studies. The domains considered were waste, pharmaceuticals, surgical instrument decontamination, transportation, consumables use and utilities. This study used a process-based carbon footprint approach based on the “Greenhouse Gas Protocol: Product Life Cycle Accounting and Reporting Standard”.</p></div><div><h3>Main findings</h3><p>The carbon footprint of a typical case was 41 kgCO2e which is equivalent to driving a car for approximately 150 miles. Consumables were responsible for 17% of this; 14% came from transport, 5.4% from decontamination, 4.8% from pharmaceuticals and 4% from waste. However, the largest GHG was from utilities, of which heating, ventilation and air conditioning was the overwhelming contributor.</p></div><div><h3>Conclusions</h3><p>While the largest sources of GHG emissions require hospital-wide initiatives, there are aspects of consumables and waste streams we can improve on in ENT surgery. These include the use of disposable vs reusable instruments as well as increased availability and use of recycling waste streams in theatres. Additionally, this study provides a template that can be applied to other ENT procedures.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 242-247"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X24000593/pdfft?md5=4ae74be8dfdd79b4d00f274c6ae45e3e&pid=1-s2.0-S1479666X24000593-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}