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Kawa N, Araji T, Kaafarani H, Adra SW. A Narrative Review on Intraoperative Adverse Events: Risks, Prevention, and Mitigation. J Surg Res 2024; 295:468-476. [PMID: 38070261 DOI: 10.1016/j.jss.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/16/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Adverse events from surgical interventions are common. They can occur at various stages of surgical care, and they carry a heavy burden on the different parties involved. While extensive research and efforts have been made to better understand the etiologies of postoperative complications, more research on intraoperative adverse events (iAEs) remains to be done. METHODS In this article, we reviewed the literature looking at iAEs to discuss their risk factors, their implications on surgical care, and the current efforts to mitigate and manage them. RESULTS Risk factors for iAEs are diverse and are dictated by patient-related risk factors, the nature and complexity of the procedures, the surgeon's experience, and the work environment of the operating room. The implications of iAEs vary according to their severity and include increased rates of 30-day postoperative morbidity and mortality, increased length of hospital stay and readmission, increased care cost, and a second victim emotional toll on the operating surgeon. CONCLUSIONS While transparent reporting of iAEs remains a challenge, many efforts are using new measures not only to report iAEs but also to provide better surveillance, prevention, and mitigation strategies to reduce their overall adverse impact.
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Affiliation(s)
- Nisrine Kawa
- Department of Dermatology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York City, New York
| | - Tarek Araji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haytham Kaafarani
- Division of Trauma, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Emergency Surgery and Critical Care, Boston, Massachusetts
| | - Souheil W Adra
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Shen XF, Li L, Ma H, Liu J, Jin LW, Li X, Wang JS, Gao G. Influence of resilience on depression among nurses in clean operating departments: The mediating effect of life satisfaction. World J Psychiatry 2023; 13:698-706. [PMID: 37771646 PMCID: PMC10523204 DOI: 10.5498/wjp.v13.i9.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND A clean operating room is an important part of surgical and critical treatment in hospitals. The workload is substantial, the pace is rapid, and the working environment is intense; therefore, nurses who work in clean operating rooms are constantly challenged, which can lead to anxiety, depression, and other mental health issues. Life satisfaction and resilience are important factors that ensure mental health. Therefore, exploring the mediating role of life satisfaction in the influence of resilience on depression among nurses in clean operating rooms can help improve nursing services and teamwork. AIM To explore the mediating effect of satisfaction on the influence of resilience on depression among nurses in a clean operating department. METHODS From April to November 2022, 196 nurses from the Department of Clean Operating at Harbin Medical University Cancer Hospital participated in this study. Participants were selected using convenience sampling. Participants' gender, age, marital status, position, length of service, personal monthly income, daily working hours, employment status, and professional title were collected, and the Connor-Davidson resilience scale, satisfaction with life scale, and self-rating depression scale were used to evaluate resilience, life satisfaction, and depression. The researchers conducted professional training in advance, introduced the research methods to the participants before the investigation, and explained the study's significance and purpose. Surveys were distributed and collected on-site. Each questionnaire took 30 min to complete. RESULTS The average scores for life satisfaction, resilience, and depression were 3.13 (± 0.28), 4.09 (± 0.78), and 56.21 (± 8.70), respectively. The correlation between resilience and depression was negative (r = -0.829, P < 0.01). Life satisfaction was positively related to resilience (r = 0.855, P < 0.01) and negatively related to depression (r = -0.778, P < 0.01). The relationship between resilience and depression was partially mediated by life satisfaction. The value of the mediating effect was -6.853 (26.68% of the total effect). CONCLUSION Life satisfaction partially mediates the link between resilience and depression among nurses in clean operating departments.
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Affiliation(s)
- Xue-Fei Shen
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Li Li
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Hong Ma
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Jing Liu
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Li-Wei Jin
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Xue Li
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Jia-Shu Wang
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Ge Gao
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
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Kalywis AL, Samuel R, Scholtes F, Reuter G, Stienen MN, Seifritz E, Surbeck W. Distribution of Psychological Instability Among Surgeons. World Neurosurg 2023; 175:e531-e541. [PMID: 37028482 DOI: 10.1016/j.wneu.2023.03.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND High emotional instability (i.e., neuroticism) is associated with poor mental health. Conversely, traumatic experiences may increase neuroticism. Stressful experiences such as complications are common in the surgical profession, with neurosurgeons being particularly affected. We compared the personality trait neuroticism between physicians in a prospective cross-sectional study. METHODS We used an online survey using the Ten-Item Personality Inventory, an internationally validated measure of the 5-factor model of personality dimensions. It was distributed to board-certified physicians, residents, and medical students in several European countries and Canada (n = 5148). Multivariate linear regression was used to model differences between surgeons, nonsurgeons, and specialties with occasional surgical interventions with respect to neuroticism, adjusting for sex, age, age squared, and their interactions, then testing equality of parameters of adjusted predictions separately and jointly using Wald tests. RESULTS With an expected variability within disciplines, average levels of neuroticism are lower in surgeons than nonsurgeons, especially in the first part of their career. However, the course of neuroticism across age follows a quadratic pattern, that is, an increase after the initial decrease. The acceleration of neuroticism with age is specifically significant in surgeons. Levels of neuroticism are lowest towards mid-career, but exhibit a strong secondary increase towards the end of the surgeon's career. This pattern seems driven by neurosurgeons. CONCLUSIONS Despite initially lower levels of neuroticism, surgeons suffer a stronger increase of neuroticism together with age. Because, beyond well-being, neuroticism influences professional performance and health care systems costs, explanatory studies are mandatory to enlighten causes of this burden.
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Affiliation(s)
- Anna L Kalywis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland; Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Robin Samuel
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Felix Scholtes
- Department of Neuroanatomy, Faculty of Medicine, Université de Liège, Liège, Belgium
| | - Gilles Reuter
- Department of Neurosurgery, Faculty of Medicine, Université de Liège, Liège, Belgium
| | - Martin N Stienen
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Werner Surbeck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.
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Øyri SF, Søreide K, Søreide E, Tjomsland O. Learning from experience: a qualitative study of surgeons' perspectives on reporting and dealing with serious adverse events. BMJ Open Qual 2023; 12:bmjoq-2023-002368. [PMID: 37286299 DOI: 10.1136/bmjoq-2023-002368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION In surgery, serious adverse events have effects on the patient journey, the patient outcome and may constitute a burden to the surgeon involved. This study aims to investigate facilitators and barriers to transparency around, reporting of and learning from serious adverse events among surgeons. METHODS Based on a qualitative study design, we recruited 15 surgeons (4 females and 11 males) with 4 different surgical subspecialties from four Norwegian university hospitals. The participants underwent individual semistructured interviews and data were analysed according to principles of inductive qualitative content analysis. RESULTS AND DISCUSSION We identified four overarching themes. All surgeons reported having experienced serious adverse events, describing these as part of 'the nature of surgery'. Most surgeons reported that established strategies failed to combine facilitation of learning with taking care of the involved surgeons. Transparency about serious adverse events was by some felt as an extra burden, fearing that openness on technical-related errors could affect their future career negatively. Positive implications of transparency were linked with factors such as minimising the surgeon's feeling of personal burden with positive impact on individual and collective learning. A lack of facilitation of individual and structural transparency factors could entail 'collateral damage'. Our participants suggested that both the younger generation of surgeons in general, and the increasing number of women in surgical professions, might contribute to 'maturing' the culture of transparency. CONCLUSION AND IMPLICATIONS This study suggests that transparency associated with serious adverse events is hampered by concerns at both personal and professional levels among surgeons. These results emphasise the importance of improved systemic learning and the need for structural changes; it is crucial to increase the focus on education and training curriculums and offer advice on coping strategies and establish arenas for safe discussions after serious adverse events.
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Affiliation(s)
- Sina Furnes Øyri
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Stavanger University Hospital, Stavanger, Norway
- SHARE Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- SAFER Surgery, Surgical Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Eldar Søreide
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Ole Tjomsland
- South-Eastern Norway Regional Health Authority, Oslo, Norway
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Le HD, Wolinska JM, Baertschiger RM, Himidan SA. Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery. Eur J Pediatr Surg 2023; 33:181-190. [PMID: 36948212 DOI: 10.1055/s-0043-1767830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the "second victim," results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.
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Affiliation(s)
- Hau D Le
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Justyna M Wolinska
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharifa A Himidan
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, Humber River Hospital, Toronto, Ontario, Canada
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6
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Drudi LM, D'Oria M, Bath J, Van Nispen J, Smeds MR. Postoperative complications and their association with post-traumatic stress disorder in academic vascular surgeons. J Vasc Surg 2023; 77:899-905.e1. [PMID: 36402248 DOI: 10.1016/j.jvs.2022.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Postoperative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons. METHODS An anonymous electronic survey was sent to all vascular surgery program directors in North America with a request to disseminate to their faculty. The survey captured data on demographics and practice type and used imbedded validated measures to determine emotional responses to postoperative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Multivariable logistic regression analysis was performed for all covariates found significant on univariate analysis, and those deemed clinically relevant. RESULTS The survey was distributed to 267 faculty at 128 institutions in the United States and 10 institutions in Canada and completed by 65 participants (response rate, 32%). Twenty of 65 (31%) identified as female, and the total group had a mean age of 47 ± 10.2 years. Most respondents (43/65; 66%) reported a major complication within 3 months of the survey, with the majority of respondents (45/65; 69%) reporting the outcome of patient mortality. Of respondents, 20 of 65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year, with 12 of 65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to criticize/blame themselves following the complication (P = .0028); less likely to identify the complication as "expected" (P = .048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs 20%; P = .008). Regarding support following major complications, most respondents (57/65; 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and a sense of honor (66%). Gender differences persisted on multivariate analysis (P = .016). CONCLUSIONS Emotional responses following major postoperative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly following complications that are unexpected or in cases in which the cause of the complication was due to a perceived or actual surgical mistake. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described and under-recognized. Gender-related differences may exist, and most surgeons desire a support network of respected peers with whom to discuss complications.
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Affiliation(s)
- Laura M Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Carrefour de l'Innovation, Centre de Rechercher du CHUM, Montreal, Quebec, Canada
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Jonathan Bath
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Johan Van Nispen
- Division of Vascular Surgery, St. Louis University, St. Louis, MO
| | - Matthew R Smeds
- Division of Vascular Surgery, St. Louis University, St. Louis, MO.
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Møller KE, Sørensen JL, Topperzer MK, Koerner C, Ottesen B, Rosendahl M, Grantcharov T, Strandbygaard J. Implementation of an Innovative Technology Called the OR Black Box: A Feasibility Study. Surg Innov 2023; 30:64-72. [PMID: 36112770 PMCID: PMC9925891 DOI: 10.1177/15533506221106258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. The operating room (OR) Black Box is an innovative technology that captures and compiles extensive real-time data from the OR, allowing identification and analysis of factors that influence intraoperative procedures and performances - ultimately improving patient safety. Implementation of this kind of technology is still an emerging research area and prone to face challenges. Methods. Observational study running from May 2017 to May 2021 conducted at Copenhagen University Hospital - Rigshospitalet, Denmark, involving 152 OR staff and 306 patients. Feasibility of the OR Black Box was assessed in accordance with Bowen's framework with 8 focus areas. Results. The OR Black Box had a high level of acceptability among stakeholders with 100% participation from management, 93% from OR staff, and 98% from patients. The implementation process improved over time, and an average of 80% of the surgeries conducted were captured. The practical aspects such as numerous formal and informal meetings, ethical and legal approval, recruitment of patients were acceptable, albeit time-consuming. The OR Black Box was adopted without any changes in scheduled surgery program, but capturing hours were adjusted to match the surgery program and relocation of OR staff declining to provide consent was possible. Conclusions. Implementation of the OR Black Box was feasible yet challenging. Management, nearly all staff, and patients embraced the initiative; however, ongoing evaluation, information meetings, and commitment from stakeholders are required and crucial to sustain momentum, continue implementation and expansion. Ideas from this study can be useful in the implementation of similar initiatives.
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Affiliation(s)
- Kjestine Emilie Møller
- Department of Gynecology and
Obstetrics, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark,Kjestine Emilie Møller, Department of
Gynecology and Obstetrics, Juliane Marie Centre, Copenhagen University Hospital
– Rigshospitalet, Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jette Led Sørensen
- Juliane Marie Centre, Children’s
Hospital Copenhagen, Copenhagen University Hospital –
Rigshospitalet and University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine,
Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
| | - Martha Krogh Topperzer
- Juliane Marie Centre, Children’s
Hospital Copenhagen, Copenhagen University Hospital –
Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Christian Koerner
- Department of Improvement and
Digitalization, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark
| | - Bent Ottesen
- Juliane Marie Centre, Children’s
Hospital Copenhagen, Copenhagen University Hospital –
Rigshospitalet and University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine,
Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
| | - Mikkel Rosendahl
- Department of Gynecology and
Obstetrics, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark
| | - Teodor Grantcharov
- Department of General Surgery, University of Toronto, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
| | - Jeanett Strandbygaard
- Department of Gynecology and
Obstetrics, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine,
Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
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Rivard SJ, Kemp MT, Sandhu G, Heximer AC, Hughes T, Byrnes ME. "Why would you want to do that?"Surgical Interns Reflect on Discouragement From Entering Surgical Fields. JOURNAL OF SURGICAL EDUCATION 2022; 79:1150-1158. [PMID: 35662535 DOI: 10.1016/j.jsurg.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Decreasing numbers of medical students are choosing to pursue surgical careers. This study highlights individual experiences of surgical interns receiving discouragement from pursuing surgery as a career. METHODS We interviewed 24 incoming surgical interns from 7 institutions and 7 surgical subspecialties about their experiences with discouragement from surgery. RESULTS All surgical interns discussed experiencing discouragement from pursuing surgery as a career. Family, friends, the general public, and medical professionals, including surgeons, served as sources of discouragement. Reasons for discouragement fell into 3 main themes: The Surgeon and Surgical Culture, The Sacrifices, and The Sexism. Despite its pervasiveness, participants reconciled the discouragement received. DISCUSSION Discouragement from surgery is pervasive and centered around surgeon stereotypes and perceptions of surgical culture, significant personal sacrifices required, and traditional gender-related expectations. These results highlight the importance of individual surgeons' comments on student experience and can be used to improve the perception of surgery amongst prospective interns.
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Affiliation(s)
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Tasha Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mary E Byrnes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Guy IA, Kerstein RL, Brennan PA. How to WHO: lessons from aviation in checklists and debriefs. Ann R Coll Surg Engl 2022; 104:510-516. [PMID: 34846195 PMCID: PMC9246552 DOI: 10.1308/rcsann.2021.0234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) surgical safety checklist (SSC) has had an overall positive impact; however, it has not completely prevented adverse events and compliance with the checklist varies. The aviation industry is considered to have better engagement with their safety checklists, reporting not only safety improvements, but also a cultural shift in their checklist philosophy over recent years. METHODS We explored the personal attitudes of pilots working in the aviation industry to identify principles of an effective checklist philosophy that could be transposed to the healthcare setting to empower more effective, consistent and ultimately successful implementation of the WHO SSC. A questionnaire was developed by the authors. Three airline pilots were interviewed via telephone, and asked questions regarding the logistics of and attitudes to checklists in the aviation industry. RESULTS Several key factors for successful checklist implementation were identified. These include regular training and education on human factors and the checklist's purpose, and institution of an atmosphere that is receptive, engaged and welcoming. Much can be learned from the aviation industry, where not only has the incidence of adverse events decreased, but the attitudes of people working in the industry have also transformed. CONCLUSION The WHO SSC is an invaluable tool used in healthcare settings worldwide. However, it is not a standalone commodity. To be effective, it necessitates steadfast engagement from the team members involved in its implementation. Human and checklist must work in partnership, using each other's strengths and fallibilities, to optimise outcomes and prevent risks to patient safety.
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Affiliation(s)
- IA Guy
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - RL Kerstein
- Oxford University Hospitals NHS Foundation Trust, UK
| | - PA Brennan
- Portsmouth Hospitals University NHS Trust, UK
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10
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Akyol C, Celik SU, Koc MA, Bayindir DS, Gocer MA, Karakurt B, Kaya M, Kekec SN, Simsek FA. The Impact of Patient Deaths on General Surgeons’ Psychosocial Well-Being and Surgical Practices. Front Surg 2022; 9:898274. [PMID: 35574543 PMCID: PMC9096651 DOI: 10.3389/fsurg.2022.898274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient deaths are an unavoidable occurrence in surgical practice. Although these events have negative effects on patients and their families, they can also have a profound adverse impact on surgeons who are unprepared for these deep emotional experiences. This study aims to investigate the impact of patient deaths on general surgeons’ psychosocial well-being and surgical practices. Methods A national cross-sectional survey of a 30-item questionnaire was conducted. The survey evaluated the surgeons’ demographics, professional and practice characteristics, and the impact of patient deaths on their emotional well-being, professional career, and social life. Results Four hundred eighty participants completed the survey. One-third of the participants reported that patient deaths affected their emotional well-being, 23.3% reported that patient deaths affected their social life, and 34.2% reported that patient deaths affected their professional career. Surgeons who reported suffering from the emotional impact of death exhibited no differences in terms of place of practice, academic title, surgical experience, work hours, or annual surgical volume. Middle-aged surgeons (p = 0.004), females (p = 0.041), and surgeons who reported feeling burned out (p < 0.001) were more likely to be affected by patient loss. Feelings of sadness, worry, and stress were most reported. A total of 18.1% of the participants indicated that they considered taking a break after patient death, and 11.9% thought they would abandon their surgical career. Conclusions The findings of this study suggest that patient death affects surgeons’ psychosocial well-being and surgical practices. Greater awareness and effort are required at the personal, institutional, and organizational level to provide effective support, helping surgeons to cope with the emotional burden of patient deaths.
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Affiliation(s)
- Cihangir Akyol
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
- Correspondence: Cihangir Akyol Suleyman Utku Celik
| | - Suleyman Utku Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey
- Correspondence: Cihangir Akyol Suleyman Utku Celik
| | - Mehmet Ali Koc
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Duygu Sezen Bayindir
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Ali Gocer
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Buket Karakurt
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kaya
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Sena Nur Kekec
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Furkan Aydin Simsek
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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11
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Bhattacharya K, Bhattacharya N. Surgeon’s guilt after postoperative complication. POLISH JOURNAL OF SURGERY 2022; 94:45-48. [DOI: 10.5604/01.3001.0015.6986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surgery is an art, surgical dilemmas are not mathematical problems with rigid, straight cut solutions and the human mind/body is not a perfect science. In such a scenario, unexpected, sudden complications can happen during surgery. While better diagnostic and advanced techniques in surgery, have minimised surgical errors to a great extent, with the risk of post-operative death being as low as 3.6% now, still when complications due occur, the surgeon faces a huge backlash not only from the patient relatives, but from his peers, the hospital management, the social and print media. The surgeon also fears violent retribution, not just consumer issues but a threat of arrest and legal battles. All these make a surgeon the “second victim” in the event of a post-operative complication, leading to changes in practice behaviour, emotional turmoil and even serious mental issues like depression and suicide. In this era of instant judgement by a largely unregulated social media, it is urgently required to address this issue and provide appropriate strength/support to the surgical fraternity.
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12
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Serou N, Husband AK, Forrest SP, Slight RD, Slight SP. Support for Healthcare Professionals After Surgical Patient Safety Incidents: A Qualitative Descriptive Study in 5 Teaching Hospitals. J Patient Saf 2021; 17:335-340. [PMID: 33881807 DOI: 10.1097/pts.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patient safety incidents can have a profound effect on healthcare professionals, with some experiencing emotional and psychological distress. This study explored the support medical and nonmedical operating room staff received after being involved in a surgical patient safety incident(s) in 5 UK teaching hospitals. METHODS An invitation letter and information sheet were e-mailed to all medical and nonmedical operating room staff (N = 927) across the 5 sites. Semistructured interviews were arranged with a range of different healthcare professionals working in operating rooms across a wide variety of surgical specialities. Interviews were audio recorded, transcribed verbatim, and analyzed using an inductive thematic approach. RESULTS We conducted 45 interviews with medical and nonmedical operating room staff, who emphasized the importance of receiving personalized support soon after the incident. Operating room staff described how the first "go to" people were their peers and reported feeling comforted when their peers empathized with their own experience(s). Other participants found it very difficult to seek support, perceiving it as a sign of weakness. Although family members played an important role in supporting second victims, some participants felt unable to discuss the incident with them, fearing that they might not understand. CONCLUSIONS There should be clear support structures in place for operating room staff who have been involved in surgical incidents. Health organizations need to offer timely support to frontline staff after these incidents. Senior clinicians should be proactive in offering support to junior colleagues and empathize with their own experiences, thus shifting the competitive culture to one of openness and support.
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Affiliation(s)
| | - Andy K Husband
- From the School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
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The effect of surgical complications on ENT trainees. The Journal of Laryngology & Otology 2021; 135:293-296. [PMID: 33769237 DOI: 10.1017/s0022215121000797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The 'second victim phenomenon' is a term attributed to the traumatic effect a medical error can have on healthcare professionals. Patient safety incidents have been shown to occur in as many as one in seven patients in hospital. These incidents cause significant, potentially devastating, trauma to patients and their relatives, and can have deep and long-lasting effects on the health professionals involved. These incidents can have a negative impact on doctors' emotional wellbeing; their professional practice in relation to this impact has not been extensively investigated in surgical trainees. METHOD A survey of UK otolaryngology trainees was conducted to investigate the effects of complications and medical errors on trainees, and examine how these are discussed within departments. RESULTS AND CONCLUSION The findings suggest that further training is required and would be warmly received by otolaryngology trainees as part of higher surgical training.
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Serou N, Sahota LM, Husband AK, Forrest SP, Slight RD, Slight SP. Learning from safety incidents in high-reliability organizations: a systematic review of learning tools that could be adapted and used in healthcare. Int J Qual Health Care 2021; 33:mzab046. [PMID: 33729493 PMCID: PMC8271183 DOI: 10.1093/intqhc/mzab046] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE A high-reliability organization (HRO) is an organization that has sustained almost error-free performance, despite operating in hazardous conditions where the consequences of errors could be catastrophic. A number of tools and initiatives have been used within HROs to learn from safety incidents, some of which have the potential to be adapted and used in healthcare. We conducted a systematic review to identify any learning tools deemed to be effective that could be adapted and used by multidisciplinary teams in healthcare following a patient safety incident. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses for Protocols reporting guidelines and was registered with the PROSPERO (CRD42017071528). A search of databases was carried out in January 2021, from the date of their commencement. We conducted a search on electronic databases such as Web of Science, Science Direct, MEDLINE in Process Jan 1950-present, EMBASE Jan 1974-present, CINAHL 1982-present, PsycINFO 1967-present, Scopus and Google Scholar. We also searched the grey literature including reports from government agencies, relevant doctoral dissertations and conference proceedings. A customized data extraction form was used to capture pertinent information from included studies and Critical Appraisal Skills Programme tool to appraise on their quality. RESULTS A total of 5921 articles were identified, with 964 duplicate articles removed and 4932 excluded at the title (4055), abstract (510) and full-text (367) stages. Twenty-five articles were included in the review. Learning tools identified included debriefing, simulation, crew resource management and reporting systems to disseminate safety messages. Debriefing involved deconstructing incidents using reflective questions, whilst simulation training involved asking staff to relive the event again by performing the task(s) in a role-play scenario. Crew resource management is a set of training procedures that focus on communication, leadership and decision-making. Sophisticated incident-reporting systems provide valuable information on hazards and were widely recommended as a way of disseminating key safety messages following safety incidents. These learning tools were found to have a positive impact on learning if conducted soon after the incident with efficient facilitation. CONCLUSION Healthcare organizations should find ways to adapt to the learning tools or initiatives used in HROs following safety incidents. It is challenging to recommend any specific one as all learning tools have shown considerable promise. However, the way these tools or initiatives are implemented is critical, and so further work is needed to explore how to successfully embed them into healthcare organizations so that everyone at every level of the organization embraces them.
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Affiliation(s)
- Naresh Serou
- School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, Tyne and Wear NE1 7RU, UK
- Operating Theatres, Singleton Hospital, Swansea Bay University Health Board, Swansea SA2 8QA, Wales, UK
- Swansea Medical School, Swansea University, Swansea SA2 8QA , Wales, UK
| | - Lauren M Sahota
- School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, Tyne and Wear NE1 7RU, UK
| | - Andy K Husband
- School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, Tyne and Wear NE1 7RU, UK
| | - Simon P Forrest
- Department of Sociology, Durham University, Durham DH1 1SZ, UK
| | - Robert D Slight
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, Tyne and Wear NE1 7RU, UK
- Department of Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne, Tyne and Wear NE7 7DN, UK
| | - Sarah P Slight
- School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, Tyne and Wear NE1 7RU, UK
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, Tyne and Wear NE1 7RU, UK
- Department of Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne, Tyne and Wear NE7 7DN, UK
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Serou N, Slight SP, Husband AK, Forrest SP, Slight RD. Surgical incidents and their impact on operating theatre staff: qualitative study. BJS Open 2020; 5:6043604. [PMID: 33688942 PMCID: PMC7944493 DOI: 10.1093/bjsopen/zraa007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background Surgical incidents can have significant effects on both patients and health professionals, including emotional distress and depression. The aim of this study was to explore the personal and professional impacts of surgical incidents on operating theatre staff. Methods Face-to-face semistructured interviews were conducted with a range of different healthcare professionals working in operating theatres, including surgeons and anaesthetists, operating department practitioners, and theatre nurses, and across different surgical specialties at five different hospitals. All interviews were audio recorded, transcribed verbatim, and analysed using an inductive thematic approach, which involved reading and re-reading the transcripts, assigning preliminary codes, and searching for patterns and themes within the codes, with the aid of NVivo 12 software. These emerging themes were discussed with the wider research team to gain their input. Results Some 45 interviews were conducted, generally lasting between 30 and 75 min. Three overarching themes emerged: personal and professional impact; impact of the investigation process; and positive consequences or impact. Participants recalled experiencing negative emotions following surgical incidents that depended on the severity of the incident, patient outcomes, and the support that staff received. A culture of blame, inadequate support, and lack of a clear and transparent investigative process appeared to worsen impact. Conclusion The study indicated that more support is needed for operating theatre staff involved in surgical incidents. Greater transparency and better information during the investigation of such incidents for staff are still needed.
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Affiliation(s)
- N Serou
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Operating Theatres, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea Medical School, Swansea University, Swansea, UK
| | - S P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A K Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - S P Forrest
- Department of Sociology, Durham University, Durham, UK
| | - R D Slight
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Acevedo E, Kuo LE. The Economics of Patient Surgical Safety. Surg Clin North Am 2020; 101:135-148. [PMID: 33212074 DOI: 10.1016/j.suc.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adverse surgical events are a major cause of morbidity, mortality, and disability worldwide. Serious reportable events, such as wrong site surgery, retained foreign bodies, and surgical fires, are preventable adverse events that have significant consequences. These "never events" are costly to the patient, health care systems, and society and have led to many efforts to reduce their occurrence. However, these costly events still occur, and more research is needed to obtain a better understanding of their causes and how to prevent them.
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Affiliation(s)
- Edwin Acevedo
- Temple University Lewis Katz School of Medicine, 3401 North. Broad Street, Philadelphia, PA 19140, USA. https://twitter.com/iamaceMD
| | - Lindsay E Kuo
- Temple University Lewis Katz School of Medicine, 3401 North Broad Street Parkinson Pavilion, 4th, Fl, Philadelphia, PA 19140, USA.
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Biggs S, Waggett HB, Shabbir J. Impact of surgical complications on the operating surgeon. Colorectal Dis 2020; 22:1169-1174. [PMID: 32065472 DOI: 10.1111/codi.15021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023]
Abstract
AIM The involvement of surgeons in major adverse outcomes can have a negative impact on their personal and professional lives, as well as on patient outcomes. Healthcare professionals involved in such incidents have been referred to as 'second victims'. We designed an online survey to study the impact of operative complications on surgeons' professional and personal lives. METHOD An online survey of general, gastrointestinal, hepato-pancreato-biliary and vascular surgeons was conducted using the Twitter feed of the Association of Coloproctology of Great Britain and Ireland, the Association of Surgeons of Great Britain and Ireland and the European Society of Coloproctology over an 8-week period. RESULTS Questionnaires were completed by 82 participants. Ninety-one per cent of respondents were consultant surgeons, 37% with more than 15 years' experience. Eighty-three per cent were colorectal surgeons. The majority of surgeons (95%) reported that their practice had been affected as a result of serious complications and 54% suggested that it had had a negative impact on their family life. Fifty-five per cent of respondents mentioned lack of support in their institution for healthcare professionals involved in adverse outcomes and an existing blame culture. Suggestions for improvement included mentoring (41%), counselling (38%), openness (66%), peer support groups (52%) and human factors training (32%). CONCLUSION This survey highlights that the majority of surgeons involved in serious complications are adversely affected. Those involved in the running of surgical services need to improve support for surgeons in the aftermath of such events.
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Affiliation(s)
- S Biggs
- Department of Colorectal Surgery, University Hospitals Bristol NHS Trust, Bristol, UK
| | - H B Waggett
- Department of Colorectal Surgery, University Hospitals Bristol NHS Trust, Bristol, UK
| | - J Shabbir
- Department of Colorectal Surgery, University Hospitals Bristol NHS Trust, Bristol, UK
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Tang S, Zhang J, Mei TT, Guo HQ, Wei XH, Zhang WY, Liu YL, Liang S, Fan ZP, Ma LX, Lin W, Liu YR, Qiu LX, Yu HB. Association of PNPLA3 rs738409 G/C gene polymorphism with nonalcoholic fatty liver disease in children: a meta-analysis. BMC MEDICAL GENETICS 2020; 21:163. [PMID: 32811452 PMCID: PMC7433068 DOI: 10.1186/s12881-020-01098-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. Current studies have shown that PNPLA3 (Patatin-like phospholipase domain containing 3) rs738409 G/C gene polymorphism is associated with adult nonalcoholic fatty liver disease [1, 2].But there is no consensus on the relationship between PNPLA3 rs738409 G/C gene polymorphism and children NAFLD due to differences in population samples. To this end, a meta-analysis of published research is conducted to comprehensively assess the relationship between PNPLA3 gene polymorphism and NAFLD in children. Methods We searched MEDLINE, PubMed, EMBASE, and CENTRAL databases from inception to May 2019. Case-control studies assessing the relationship between PNPLA3 rs738409 G/C gene polymorphism with non-alcoholic fatty liver disease in children were selected according to inclusion and exclusion criteria. Random effects model was used to quantify the association between the PNPLA3 rs738409 G/C gene polymorphism and the susceptibility of children’s NAFLD. Fixed effects model was used to quantify the relationship between the PNPLA3 rs738409 G/C gene polymorphism and the severity of NAFLD in children. The Stata 12.0 software was employed for data analysis. Results A total of nine case-control studies were included in this meta-analysis containing data of 1173 children with NAFLD and 1792 healthy controls. Five studies compared NAFLD children and non-NAFLD healthy populations. Statistical analysis showed that PNPLA3 gene polymorphism was significantly associated with children’s NAFLD in the allele contrast, dominant, recessive and over dominant models (G vs C,OR = 3.343, 95% CI = 1.524–7.334; GG + GC vs CC,OR = 3.157, 95% CI = 1.446–6.892;GG vs GC + CC,OR = 5.692, 95% CI = 1.941–16.689; GG + CC vs GC,OR = 2.756, 95% CI = 1.729–4.392). Four case-control studies compared Children with nonalcoholic fatty liver (NAFL) and children with nonalcoholic steatohepatitis (NASH). The results showed that the PNPLA3 gene polymorphism was also significantly associated with the severity of NAFLD in children in recessive gene model (GG vs GC + CC,OR = 14.43, 95% CI = 5.985–34.997); The Egger’s test revealed no significant publication bias. Conclusions Meta-analysis showed that PNPLA3 gene polymorphism was significantly associated with susceptibility and severity of NAFLD in children.
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Affiliation(s)
- Shan Tang
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Jing Zhang
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Ting Ting Mei
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Hai Qing Guo
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Xin Huan Wei
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wen Yan Zhang
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Ya Li Liu
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Shan Liang
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Zuo Peng Fan
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Li Xia Ma
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wei Lin
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Yi Rong Liu
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Li Xia Qiu
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Hai Bin Yu
- Department of Hepatitis C and Drug-Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China.
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Tebala GD. Is there a standard reaction of surgeons to surgical complications? Study on an interesting historical case. Med Hypotheses 2020; 144:110006. [PMID: 32585465 DOI: 10.1016/j.mehy.2020.110006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Abstract
The surgeon has been recognised as the "second victim" of a surgical complication and the long term psychological impact of a surgical adverse event has been demonstrated. However, the immediate and early psychological response to a surgical complication has not been properly investigated. In this manuscript we analyse a well-known historical case of a surgical complication and discuss the early reaction of the surgeon. Sir Anthony Eden, UK Prime Minister in the '50s, underwent a cholecystectomy for gallstones, but the operation complicated with a biliary fistula causing jaundice and sepsis. The reaction of the surgeon followed a precise three-stage pattern that can be identified in almost every case of surgical complication. Initially he denied the complication, with a simplistic attitude, but subsequently he felt overwhelmed by the environmental pressure and gave up. The early psychological response of a surgeon to a surgical complication usually follows the three phases of "denial", "desperation" and "action or get-away". In the denial phase the surgeon tries to reassure him or herself by diminishing the real burden of the complication and to demonstrate self-confidence. After few days, when it is evident that the complication is more severe than expected, the surgeon changes completely his or her attitude and becomes more and more depressed and anxious. The reaction to phase 2 will determine the subsequent phase 3, where the surgeon would choose between a positive and proactive attitude or getting-away, thus disengaging from the complicated patient. Acknowledging these three phases would help team leaders and colleagues to recognise the need for a supportive, friendly and blame-free environment and to act timely to help the surgeon to overcome the negative impact on his or her personality and career.
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Affiliation(s)
- Giovanni D Tebala
- Consultant Colorectal and Emergency Surgeon, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
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Boyle FM, Allen J, Rey-Conde T, North JB. Learning from regret. Br J Surg 2020; 107:422-431. [PMID: 32077094 DOI: 10.1002/bjs.11452] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Death after surgery is infrequent but can be devastating for the surgeon. Surgeons may experience intense emotional reactions after a patient's death, reflecting on their part in the death and the patient's loss of life. Excessive rumination or feelings of regret may have lasting negative consequences, but these reactions may also facilitate learning for future decision-making. This qualitative study analysed surgeons' reflections on what might have been done differently before a patient's death and explored non-technical (cognitive and interpersonal) aspects of care as potential targets for improvement. METHODS In Australia's Queensland Audit of Surgical Mortality, surgeons reflect on factors surrounding the death of patients in their care and respond to the open-ended question: in retrospect, would you have done anything differently? Framework analysis was applied to surgeons' responses to identify themes relating to non-technical aspects of care. RESULTS Responses from 1214 surgeons were analysed. Two main themes were identified. Dilemmas and difficult decisions confirmed the uncertainty, complexity and situational pressures that often precede a surgical death; regret and empathy for patients featured in some responses. In the second main theme, communication matters, surgeons cited better communication, with patients, families, colleagues and at handover, as a source of reflective change to improve decision-making and reduce regret. CONCLUSION Surgical decision-making involves uncertainty, and regret may occur after a patient's death. Enhancing the quality of communication with patients and peers in comprehensive assessment of the surgical patient may mitigate postdecision regret among surgeons.
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Affiliation(s)
- F M Boyle
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
| | - J Allen
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
| | - T Rey-Conde
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
| | - J B North
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
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Association of TM6SF2 rs58542926 T/C gene polymorphism with hepatocellular carcinoma: a meta-analysis. BMC Cancer 2019; 19:1128. [PMID: 31752753 PMCID: PMC6868855 DOI: 10.1186/s12885-019-6173-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) is the sixth-most common malignancy worldwide. Multiple previous studies have assessed the relationship between TM6SF2 gene polymorphism and the risk of developing HCC, with discrepant conclusions reached. To assess the association of TM6SF2 rs58542926 T/C gene polymorphism with liver cancer, we performed the current meta-analysis. Methods This study queried the MEDLINE, PubMed, EMBASE, and CENTRAL databases from inception to April 2019. Case-control studies assessing the relationship between TM6SF2 rs5854292 locus polymorphism and liver cancer were selected according to inclusion and exclusion criteria. The Stata 12.0 software was employed for data analysis. Results A total of 5 articles, encompassing 6873 patients, met inclusion criteria and were included in the meta-analysis. Statistical analysis showed that the TM6SF2 gene polymorphism was significantly associated with liver cancer in the allele contrast, dominant, recessive and over dominant models (T vs C, OR = 1.621, 95%CI 1.379–1.905; CT + TT vs CC. OR = 1.541, 95%CI 1.351–1.758; TT vs CT + CC, OR = 2.897, 95%CI 1.690–4.966; CC + TT vs TC, OR = 0.693, 95%CI 0.576–0.834). The Egger’s test revealed no significant publication bias. Conclusion The present findings suggest a significant association of TM6SF2 gene polymorphism with HCC risk in the entire population studied.
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