Antiseptic versus non-antiseptic solutions for preventing infection in acute traumatic wounds: a systematic review.

OBJECTIVE: To compare the effectiveness of antiseptic solutions to that of non-antiseptic solutions in reducing wound infection rate, reducing bacterial load and improving wound healing. METHOD: We searched PubMed MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest Medical Database and medRxiv for randomised controlled trials (RCTs) comparing antiseptic solutions with non-antiseptic solutions in simple, uncomplicated acute traumatic wounds. Qualitative data synthesis was employed. Risk of bias was assessed and GRADE assessment was used to evaluate quality of evidence. RESULTS: In this systematic review, four studies with a total of 875 participants were included, of which two studies showed a significant reduction of wound infection rate using povidone-iodine (p=0.001 and p=0.03). The use of non-antiseptic solutions significantly increased bacterial load on acute traumatic wounds (p=0.0001). The quality of evidence was very low. No studies reported on wound healing outcome. CONCLUSION: No robust conclusions can be implemented in clinical practice. Future studies are needed to compare the use of antiseptic and non-antiseptic solutions in acute traumatic wounds.

Virtual suturing skills learning: role of verbal versus written feedback in surgery rotation clerkship.

OBJECTIVE: Onsite clinical skills learning is interrupted during the SARS-CoV-2 pandemic. This study aimed to compare the effectiveness of verbal versus written feedback in virtual suturing skills learning. DESIGN: Participants were randomly divided into two groups, one with verbal feedback and written feedback on the other. Each was instructed to perform a simple interrupted suture which was assessed both before (pre-test) and after (post-test) feedback was given. Both groups were given the same duration of time to learn from the feedback they received. SETTING: Students undergoing clinical rotation in Department of Surgery at School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia. PARTICIPANTS: The eligibility of the participants are students who enrolled on virtual learning in the surgery rotation and have consented to the research and those who own basic surgical equipment at home. A total of 199 participants were enrolled, with 17 (8.55%) participants dropping out. RESULTS: Out of 182 participants, 66 (36.3%) were males and 116 (63.7%) were females. The group receiving verbal intervention showed a significant difference both in suturing skills checklist (Pre-test [M = 4.11, SD = 0.61] and post-test [M = 4.73, SD = 0.37]; t(85) = -10.63, p = 0.000) and Global Rating Scale (GRS) assessment (pre-test [M = 3.83, SD = 1.06] and post-test [M = 4.56, SD = 0.64]; t(86) = -8.10, p = 0.000). In the same way, the group receiving written intervention also showed a significant mean pre-test and pos-test difference in both assessment tools (Checklist assessment [Z = -7.93, p = 0.000]; GRS assessment pre-test [M = 3.42, SD = 0.73] and post-test [M = 4.20, SD = 0.83]; t(105) = -9.62, p = 0.000). Both verbal and written feedback had a large effect (effect size >0.8). CONCLUSIONS: Both verbal and written feedback provide a significant result in improving suturing skills in a virtual learning setting which may provide a solution to online clinical skills training.

Case report: Complex perianal fistula treated with fistula laser closure (FILAC) and suction catheter.

INTRODUCTION AND IMPORTANCE: A patient presented with complex perianal fistula treated with fistula laser closure (FILAC) combined with suction catheters. CASE PRESENTATION: Male, 29 years old, presented in our department, presented with complex perianal fistula with a history of fistulectomy and tight seton for 6 months in another health facility. Intraoperative findings were a tract of 4,5 cm long, 4 external openings, and 1 internal opening. Definitive treatment of Fistula Laser Closure (FILAC) with 13-watt power laser diode produces by BIOLITEC German. CONCLUSION: The patient recovers within 6 months. Promising results have been shown by combining FILAC and suction catheter for complex perianal fistula.

Professional identity formation of medical teachers in a non-Western setting.

INTRODUCTION: Understanding and supporting professional identity formation (PIF) among medical teachers has become increasingly important in faculty development programs. In this study, we explored medical teachers' PIF in Indonesia. METHODS: We conducted a qualitative descriptive study using focus group discussions (FGDs) at four medical schools in Indonesia. Basic science and clinical teachers from four different schools were selected to participate. Data were transcribed, coded, and analysed to develop themes and subthemes. RESULTS: Seventeen FGDs were completed, involving 60 basic science and 59 clinical teachers. Four major themes regarding the formation of medical teachers' professional identity emerged: an internal dialogue between intrinsic values and external influences, empowerment through early socialization, experiential workplace learning, and envisioning the future. The PIF process was similar for basic science and clinical teachers. CONCLUSION: Our findings suggested that PIF among medical teachers in a non-Western setting is a continuous and dynamic process that is shaped by key socialization factors (e.g. role models, workplace learning, peer support), with significant influences from religious beliefs, family values, and societal recognition. Faculty development programs should consider the dynamic and continuous nature of PIF among medical teachers and encourage clinicians and basic scientists to explore their values and beliefs, realize their goals, and envision their future.

Bowel necrosis in patient with severe case of COVID-19: a case report.

BACKGROUND: In patients who are critically ill with COVID-19, multiple extrapulmonary manifestations of the disease have been observed, including gastrointestinal manifestations. CASE PRESENTATION: We present a case of a 65 year old man with severe COVID-19 pneumonia that developed hypercoagulation and peritonitis. Emergent laparotomy was performed and we found bowel necrosis in two sites. CONCLUSIONS: Although rare, the presentation of COVID-19 with bowel necrosis requires emergency treatments, and it has high mortality rate.

Parents' Knowledge, Attitude and Behaviour toward Cleft Lips and Cleft palate in Kencana Hospital, Serang, Banten.

INTRODUCTION: Cleft lips (CL) and cleft palate (CP) are common congenital diseases caused by gene mutation in embriology development of the lips and mouth at 4 weeks of gestation. CL and CP can cause several problems such as difficulty in eating, speaking, abnormality in teeth and mouth development and ear iritation. Adequate treatment is needed to improve patients' quality of life. MATERIAL AND METHOD: This cross sectional study take samples purposively from all parents who joined in cleft charity surgery in Kencana Hospital, Serang, Banten on October 24th 2018. This study identify parents' knowledge, attitude and behaviour towards CL and CP and analyzed the relationship of parents' knowledge and attitude towards CL and CP. Statistical analysis used in this study is Fisher method. RESULT: Ten patients undergo labioplasty surgery, 1 patient undergo labioplasty revision, 5 patients undergo palatoplasty surgery and 10 patients undergo labioandpalatoplasty surgery. The majority of parents' education background have income < 3,5 million a month 84.6% (22 people), do not have any social insurance 88.5% (23 people) and joined in because of they cannot pay for medical treatment 96,2% (25 people). 6.2% (25 people) have under knowledge, 69.2% (18 people) have good attitude and 84.6% (22 people) have good behaviour toward CL and CP. There is no significant relationship between parents' knowledge and attitude toward CL and CP P value = 1,00 (P > 0,05). DISCUSSION: Parent's under knowledge is caused by their low educational background and inaccurate information and education provided by medical professional. But, they had a good attitude and behaviour toward CL and CP because they had initiative to look for medical help and treat their children same as other normal one. Although they received inaccurate information and education about cleft disease, all parents looked for medical help and did what they were told by medical professionals. CONCLUSION: The majority of parents in this study have under knowledge about cleft lips and cleft palate but they are still looking for medical help to treat their children. This charity significantly helps parents whose children have cleft lips, with or without cleft palate, to get treated in that area.