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Background: The COVID-19 pandemic has affected health care workers in unprecedented ways. Surgical residents at baseline have higher prevalence of burnout and depression, and now face unique challenges related to the pandemic. This study sought to evaluate the psychological impact of COVID-19 on surgical residents. Methods: An online survey was distributed to surgical residents between June 2020 and January 2021. It covered multiple domains: demographics, socioeconomic factors, clinical experience, educational experience, and psychological outcomes. The Mayo Clinic Resident Well-Being Index (RWBI) was used as a validated measure of resident mental health. Analysis was done with logistic regression. Results: A total of 31 residents responded to the survey, corresponding to a 36.0% response rate. Respondents were from general surgery (n = 21), orthopedic surgery (n = 5), otolaryngology (n = 2), urology (n = 2) and vascular surgery (n = 1) training programs. Seventeen (54.8%) respondents were female, 24 (77.4%) were senior residents and 21 (67.7%) were in a relationship. Residents were concerned about infecting family members (71.0%) and about personal protective equipment (PPE) supply (54.8%). Most residents (64.5%) were satisfied or very satisfied with their operative experience, but only 41.9% were happy with educational activities. Despite measures that were put in place to support the wellness of residents, 57.1% reported feeling burnt out and 46.4% depressed. Residents who were concerned about PPE supply were found to have 6.67 (95% confidence interval [CI] 1.24-35.71, p = 0.027) times the odds of depression than those who were not. The median RWBI was 2.5, slightly higher than the United States National Resident Survey median of 2. There were 10.7% of residents who had an at-risk score of 5 or more, compared with the US National 20.25%. Conclusion: The pandemic had a considerable impact on the psychological well-being of surgical residents. Continued investigation into mental health risk and protective factors is needed to improve future response of residency programs to unexpected stressors.
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Healthcare represents 19.7% of the gross national product, making it one of the largest expenses for all U.S. companies. It crowds out investment for growth and is generally considered unsustainable. And the biggest cost is hospitals. Every manager has a vested interest in lowering the cost of care and increasing the viability of hospitals in their community. More than 10% of U.S. hospitals are at immediate risk of closing because of financial losses and lack of financial reserves. Over 70% of 900 hospitals surveyed reported a decrease in operating revenue over the last year. The COVID-19 pandemic provided momentum toward developing alternative deliveries of care, including virtual health, home, and outpatient care. This has created a rapid, massive shift away from hospital-based care. Perhaps the greatest risk is the largest opportunity-to find solutions to this financial crisis in the rapidly changing revenue dynamic of subspecialties, with musculoskeletal care being the prime example. Alternative sites of care and innovative care delivery are being financed by capital market investment. One solution to this crisis is for hospitals to collaborate with capital market-backed companies creating a novel business model.
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Objectives: We aimed to reduce surgical site infections in Camarines Norte Provincial Hospital, Philippines, (1) by establishing SSI surveillance in the surgical departments, (2) by implementing quality improvement processes, and (3) by developing and implementing an SSI prevention care bundle. Methods: In partnership with Americares, SSI surveillance based on CDC criteria was instituted for all surgeries, excluding orthopedic surgeries. Staff were trained in applying quality-improvement methodology, infection prevention and control, and SSI prevention. A care bundle based on the WHO evidence-based interventions for SSI prevention was designed. Interventions included preoperative bathing, surgical hand preparation, intraoperative surgical-site preparation using 2% chlorhexidine isopropanol solution, and postoperative wound management. The model for improvement methodology was used to implement these changes for 12 months from May 2020 to May 2021. Results: In total, 718 surgeries were followed for SSI surveillance, with an average of 58 surgical patients per month in 2020, which increased to 90 patients per month in 2021. In 2020, the SSI incidence rate was 1.76%, and this rate increased 38.64% to 2.44% in 2021. A statistically significant increase in knowledge of 5.29 points (95% CI, 4.91–5.67) among 150 participants undergoing SSI training between pretest (+6.46) and posttest (+ 11.76) was achieved. SSI care-bundle checklists were used for 80% of eligible surgical patients by 2021. Compliance with the SSI care-bundle checklist increased from 0 to 87.69% (n = 718) by October 2021, subsequently decreasing by 2.75% by December 2021. Conclusions: A quality-improvement process embedded in routine surgical care can be a building block for reducing SSIs. However, we did not achieve an overall decrease in SSIs, likely due to increased reporting of SSIs through improved SSI surveillance. However, important gains were achieved in improved healthcare worker knowledge and practice through the implementation of an SSI care bundle. Fluctuations in checklist compliance reflected COVID-19 surges.
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In brief TED talk-style presentations on topics ranging from climate change, artificial intelligence (AI) and telemedicine, to the COVID-19 pandemic and emergence of corporate medicine, the radiologists shared their predictions of how these developments could change medical imaging technology and practice during the next five years. Given the expansion of telemedicine, the growth of radiologic consultation, and the emergence of new and improved diagnostic modalities-such as hybrid PET-MRI, photon-counting CT, new nuclear medicine radiotracers, and theranostics-as well as minimally invasive imaging-guided procedures and implementation of AI, Dr Morrison predicted the role of radiologists eventually will go beyond simply supplying and interpreting the images. The Carol D and Henry P Pendergrass Professor, chair of the radiology and radiological science department, and a professor of biomedical engineering at Vanderbilt University Medical Center and School of Medicine in Nashville, Tennessee, addressed the imminent dangers of climate change and radiology's role in both contributing to and helping alleviate those dangers. [...]what was once meant to protect physicians will become a major threat to radiologists over the next several years, says Mark E Schweitzer, MD, vice president of health affairs at Wayne State University in Detroit, Michigan.
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Background: The Coronavirus pandemic has resulted in an extreme challenge for humanity in recent times, like the challenges faced during World War II. Its origin has been pointed out, and the speculation made on its source directly points towards Wuhan in China. Since then, it has spread across the globe. The pandemic has resulted in more than one million deaths, which is a considerable challenge for humanity. Objective: With the pandemic of COVID-19, prevention of patient infection is crucial. This research focused on the orthopedic operating room nursing model effect based on evidence-based nursing and PDCA (Plan-Do-Check-act) cycle during the COVID-19 outbreak. Materials and Methods: From February 2020 to May 2020, 146 patients were admitted and received orthopedic surgery at Xuanwu Chunshu Hospital, Beijing, China, these admissions were grouped into control and intervention groups, which was based on the treatment provided. Satisfaction, time to bed and hospitalization, postoperative incision infection, and the occurrence of deep venous thrombosis of lower extremities, pain degree score, surgical treatment effect, anxiety, and depression scores were compared for all the admissions between the control and intervention groups. Results: In the control group, nursing satisfaction was less than in the intervention group. The time of getting out of bed and hospitalization was less in the intervention group;The total incidence of postoperative incision infection and lower limb deep vein thrombosis in the intervention group decreased. In the first postoperative day, the pain level in the intervention group was less than the control group. The effectiveness rate in the observation group is higher than that of the control group. Anxiety and depression scores of both groups tended to decrease with time and there was an interactive effect between grouping and time, where these differences were found to be statistically significant (P-value<0.05). Conclusion: The clinical application of the orthopedics operating room nursing model based on evidence-based nursing and PDCA cycle is remarkable and worth implementing during the COVID-19 outbreak.
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This study aimed to identify patient characteristics that predict long-term opioid use after an orthopedic or neurosurgery procedure. Long-term opioid use was defined as opioid use for 90 or more days following the surgical procedure. A retrospective analysis was conducted of orthopedic and neurosurgery patients 18 years and older from 01/01/2011 through 12/31/2017 (n = 12,301). Characteristics included age, sex, race, length of hospital stay, body mass index, surgical procedure specialty, presence of opioid use before and after surgery, and opioid use 90 days or more after surgery. A multiple logistic regression model was used to model characteristics predictive of long-term use of opioids. In this cohort, 32.0% of patients had prescriptions for opioids 90 or more days after surgery. Statistically significant risk factors for long-term opioid use were being Caucasian, younger (18-25 years age group) or older than age 45 and being obese. People who were African American or Black, in the 25-45 years age group, underweight, and used opioids before surgery were less likely to use opioids 90 days after surgery. Nurse anesthetist awareness of predictive characteristics of long-term opioid use can lead to alternative options to prevent opioid abuse.
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BACKGROUND: Vascular injuries during inguinal hernia repair are rarely reported. Especially in children, we have little information about vascular management. CASE REPORT: In this article, we present a 6-year-old girl with right iliac vein ligation during inguinal hernia repair who was referred to our center and managed at the day of surgery. We recommended prior surgeon to order therapeutic heparin in dispatch time. The patient was treated with primary anastomosis of iliac vein and was admitted to pediatric intensive care unit (PICU). On the day following the operation, she had minimal dyspnea with low oxygen saturation and the investigations revealed pulmonary micro-embolization. Blood flow in lower extremity was normal and after a few days, she was discharged with good health and oral anticoagulation. CONCLUSION: Any unusual bleeding at the time of inguinal hernia repair should be considered as major vascular injury by the surgeon, and to prevent more injuries, minimum attempt must be performed to control the bleeding.
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ObjectivesThe aim of this study was to confirm our clinical impression that a significant number of surgical patients, otherwise presenting without specific COVID-19 complaints, were initially overdiagnosed with COVID-19, leading towards treatment delays and potential harm in cases which require emergency surgery. We wanted to investigate the significance and magnitude of these ‘overdiagnosis’ cases and when possible, quantify the effects with follow up on patients’ two-week morbidity and mortality and length of hospital stay.MethodPatient data was collected from 25 March – 10 April 2020 in three general hospitals in the city of Makassar, Indonesia. The inclusion criteria were patients that were candidates for urgent or emergency surgical operation, without typical COVID-19 complaints but with chest X-rays, blood result or rapid antibody tests that otherwise pointed towards COVID-19 infection. Data was also collected from the involved healthcare providers on the treatment timelines for these patients. These were later matched to later nasopharyngeal swab PCR results on whether these patients actually had confirmed COVID-19 infection, and matched with their length of hospital stay, as well as morbidity and mortality after two weeks, compared to surgical patients during the same period without COVID-19 suspicions.Results• Data of 6 digestive surgery, 5 neurosurgery & plastic reconstruction, 3 orthopedic surgery and 2 vascular surgery patients were collected. All patients had abnormal chest X-ray findings, 7 patients showed lymphocytosis and increased NLR ratio, and 4 patients had positive total antibody rapid test. • 3 patients were later confirmed with COVID-19 infection • On average patients suffered 5.2 h delay due before they underwent surgery • Patients were 2x more likely to have to undergo transfer to another hospital • On average patients stayed for 2.3 days longer in hospital • 2-week morbidity from this cohort is comparable to the cohort without COVID-19 suspicions • Two neurosurgery patients (one with post-operative hematoma and one with post-operative meningitis) and one digestive surgery patient (from sepsis) died in the first 2 weeks. 1 patient with confirmed COVID-19 infection are now already discharged and two others are still being treated and currently in good condition.ConclusionsStringent measures in diagnosing all possible COVID-19 infections are necessary to protect healthcare workers and facility, including all other patients. However, lack of accurate testing method that could give rapid results may allow patients to be overdiagnosed with COVID, which may create harm in patients who needed rapid intervention. Our study found that surgical patients that presented with abnormal chest X-ray findings, all categorized as suspected infections, suffered an average of 5.2 hours delay in receiving surgery, were 2x more likely to have to undergo hospital transfers, and stayed 2.3 days longer on average. Morbidity seems comparable to non-suspected patients. 3 cases of post-operative deaths occured in this group. Only 3 patients later had confirmed COVID-19 infection. This highlights the possible indirect harm caused by overdiagnosis during the COVID-19 pandemic, precipitated by stringent needs for safety and the lack of rapid, accurate testing.
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Hollett expresses her excitement and pride attending the international conference of the Operating Room Nurses Association of Canada (ORNAC) in the US. She cannot describe her feelings interacting with her perioperative nurses in person. She says that the experience was refreshing and she feels like she's returning home with a new perspective and a renewed energy for her representation of ORNAC. Here, she announces the upcoming conference of ORNAC in 2023 in Quebec City which will coincide with the association's ruby anniversary.
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Background: Centralized examinations are key to competency-based curricula as they are carried out by neutral assessors who are not involved in teaching the learner and allow for evaluation of trainees against their peers. The COVID-19 pandemic has limited the ability to gather to perform in-person evaluations. We sought to assess the effectiveness and end-user experience of virtual centralized Objective Structured Clinical Examination (OSCE) for basic orthopedic surgery modules. Methods: A virtual evaluation process including assessor training followed by online OSCE for basic orthopaedic surgery modules (arthroplasty and trauma) were developed. Surveys were used to assess the effectiveness of the assessor training and the overall examination environment. Results: All 14 assessors completed the post-training survey and agreed that the training session was useful and should be repeated prior to all virtual centralized examinations. Seventy-four percent of residents (n = 17) responded to the survey. Most trainees (59%) recommend that some, but not all, examinations be conducted virtually. The online platform generally did not alter trainees' preparation, comfort levels, stress levels prior to or during the examination, or ability to demonstrate their skills. Technical difficulties were rare, though when they did occur, the trainees perceived it to negatively impact their score. Conclusion: Most residents wished for increased frequency of formative examinations, which is in keeping with the Competence by Design education framework. Given the minimal perceived difference between the virtual and in-person assessment environments, and with the added convenience of virtual examinations, the virtual platform may be a useful tool to facilitate increased frequency of formative assessments for any learner.
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Background: The COVID-19 third wave in Ontario from April to June 2021 led to a province-wide cancellation of elective surgeries and the development of policies to minimize in-person patient encounters. We aimed to assess the educational impact of the third wave on the orthopedic surgical trainees in a competency-based program. Methods: Qualitative post-third-wave surveys were distributed to residents in postgraduate years (PGY) 1-4 in a competency-based orthopedic training program in Ontario (n = 48). Results: Thirty-one residents (64.5%) responded to the survey. Overall average work hours per week were reduced from 79.3 to 73.3 hours among the junior residents (n = 16) and from 79.7 to 72.5 hours among the senior residents (n = 15). More than half of the residents saw their overall patient encounter volume either decrease or significantly decrease. More senior residents (66.7%, n = 10) reported significant decreases in their operating volume than the junior residents (43.8%, n = 7). Five senior residents (33.3%) and 6 junior residents (37.5%) did not receive credits for their rotation. Of those residents, 4 senior residents (80%) and 2 junior residents (33.3%) perceived that they achieved all expected competencies to pass the rotation. Conclusion: Several residents, especially residents in PGY3 and PGY4, perceived that they achieved the necessary competencies to progress to the next level of training despite seeing reduced work hours, decreased patient encounters, and reduced operating volume during the COVID-19 third wave in Ontario. Further studies on identifying and managing discrepancies pertaining to assessment of residents' performance and faculty's perception of their competence in orthopedic surgery training may be warranted.