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Kim S, Sebastian M, Cooper M. Anaesthesia for primary bone sarcoma. BJA Educ 2024; 24:288-295. [PMID: 39099752 PMCID: PMC11293499 DOI: 10.1016/j.bjae.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- S.C.P. Kim
- Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - M.P. Sebastian
- Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - M.A. Cooper
- Royal National Orthopaedic Hospital NHS Trust, London, UK
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Futterman ID, Conroy EM, Chudnoff S, Alagkiozidis I, Minkoff H. Complex obstetrical surgery: building a team and defining roles. Am J Obstet Gynecol MFM 2024; 6:101421. [PMID: 38969176 DOI: 10.1016/j.ajogmf.2024.101421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/23/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
As the number of placenta accreta spectrum cases continues to rise, the gap in surgical skills in labor and delivery units becomes more apparent. Recent scholarly work has highlighted the diminishing advanced surgical skills among obstetrician-gynecologists, particularly among new graduates. Therefore, it has become a practice in many institutions to refer complex cesarean deliveries and obstetrical hysterectomies to subspecialists, specifically gynecologic oncologists. Hence, in this commentary, we propose a process through which key personnel within departments of obstetrics and gynecology are identified and their appropriate level of involvement in cases of complex obstetrical surgery is delineated. In doing so, we describe the surgical skills expected from each provider level so that the cesarean delivery complexity level can be matched with specific surgical expertise. Through this process, an obstetrician-led complex obstetrical surgery team is formed. Ultimately, the goal of this process is 2-fold; first, to return cases with higher levels of surgical complexity back to obstetricians and, second, to reduce the surgical back-up burden from gynecology subspecialists such as gynecologic oncologists.
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Affiliation(s)
- Itamar D Futterman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Futterman and Minkoff); Division of Complex Obstetrical Surgery, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Futterman and Conroy).
| | - Erin M Conroy
- Division of Complex Obstetrical Surgery, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Futterman and Conroy); Hospitalist Division, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Conroy)
| | - Scott Chudnoff
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Chudnoff)
| | - Ioannis Alagkiozidis
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Alagkiozidis)
| | - Howard Minkoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Futterman and Minkoff); Department of Obstetrics and Gynecology and School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY (Minkoff)
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Serna J, Furie K, Wong SE, Swarup I, Zhang AL, Diab M. The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates. Arthrosc Sports Med Rehabil 2024; 6:100929. [PMID: 39006788 PMCID: PMC11240039 DOI: 10.1016/j.asmr.2024.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/16/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To analyze the annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as postoperative outcomes, including ipsilateral reoperations. Methods International Classification of Diseases, Ninth and Tenth Revision, codes were used to query the PearlDiver Mariner database from January 2010 through January 2022 to identify patients aged 10 to 59 years who had a presenting diagnosis of HD and subsequently underwent (1) HA; (2) PAO; or (3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days after HA). We analyzed annual rates for each treatment, as well as rates of postoperative emergency visits, readmissions, and 5-year ipsilateral secondary operations (determined via Kaplan-Meier analysis). Results There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the greatest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, whereas PAO peaked in 2019. For HA, PAO, and HA-PAO, most cases were performed in female patients and patients aged 30 to 49 years, 10 to 19 years, and 10 to 29 years, respectively. The 5-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% confidence interval 8.6%-9.8%) in the HA group and 6.5% (95% confidence interval 4.1%-8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the greatest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission. Conclusions HA is more frequently performed than PAO for hip dysplasia. HA-PAO is increasing at the greatest rate, demonstrating fewer complications and reoperations. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
- Juan Serna
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Kira Furie
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Stephanie E Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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Fried S, Bar-Shai A, Frydman S, Freund O. Transition of care interventions to manage severe COVID-19 in the ambulatory setting: a systematic review. Intern Emerg Med 2024; 19:765-775. [PMID: 38104299 DOI: 10.1007/s11739-023-03493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Severe COVID-19, with the need in supplemental oxygen and hospitalization, leads to major burden on patients and healthcare systems. As a result, safe and effective ambulatory treatment strategies for severe COVID-19 are of urgent need. In this systematic review, we aimed to evaluate interventions to transition care to the ambulatory setting for patients with active severe COVID-19 that required supplemental oxygen. METHODS We searched Medline, Scopus, Web of Science, and DOAJ databases to identify articles with original data published until the 1st of April 2023. Characteristics and outcomes of interventions to transition care to home management were reviewed. Given the heterogeneous settings and outcomes studied, a meta-analysis was not performed. RESULTS Of the 235 studies identified, 11 observational studies, with 2645 patients, were included. The interventions were initiated from the emergency department, observation units or inpatient units, and included continuous home telemonitoring (n = 8), mobile applications (n = 2), and patient-initiated medical contact (n = 3). Included patients had an overall short length of hospital stay, high readmission rates, and positive patients' feedback. There was a lack of prospective controlled data and cost-effectiveness analyses. CONCLUSION Our findings highlight the potential in treating severe COVID-19 at the ambulatory setting and the lack of high-quality data in this field. Dedicated medical teams, adjusted monitoring methods, improving clinical trajectory, and correct inclusion settings are needed for safe and effective transition of care.
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Affiliation(s)
- Sabrina Fried
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Amir Bar-Shai
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Shir Frydman
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel
| | - Ophir Freund
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel.
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel.
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Ravindran S, Matharoo M, Rutter MD, Ashrafian H, Darzi A, Healey C, Thomas-Gibson S. Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents from the National Reporting and Learning System (NRLS). Endoscopy 2024; 56:89-99. [PMID: 37722604 DOI: 10.1055/a-2177-4130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Despite advances in understanding and reducing the risk of endoscopic procedures, there is little consideration of the safety of the wider endoscopy service. Patient safety incidents (PSIs) still occur. We sought to identify nonprocedural PSIs (nPSIs) and their causative factors from a human factors perspective and generate ideas for safety improvement. METHODS Endoscopy-specific PSI reports were extracted from the National Reporting and Learning System (NRLS). A retrospective, cross-sectional human factors analysis of data was performed. Two independent researchers coded data using a hybrid thematic analysis approach. The Human Factors Analysis and Classification System (HFACS) was used to code contributory factors. Analysis informed creation of driver diagrams and key recommendations for safety improvement in endoscopy. RESULTS From 2017 to 2019, 1181 endoscopy-specific PSIs of significant harm were reported across England and Wales, with 539 (45.6%) being nPSIs. Five categories accounted for over 80% of all incidents, with "follow-up and surveillance" being the largest (23.4% of all nPSIs). From the free-text incident reports, 487 human factors codes were identified. Decision-based errors were the most common act prior to PSI occurrence. Other frequent preconditions to incidents were focused on environmental factors, particularly overwhelmed resources, patient factors, and ineffective team communication. Lack of staffing, standard operating procedures, effective systems, and clinical pathways were also contributory. Seven key recommendations for improving safety have been made in response to our findings. CONCLUSIONS This was the first national-level human factors analysis of endoscopy-specific PSIs. This work will inform safety improvement strategies and should empower individual services to review their approach to safety.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Manmeet Matharoo
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Matthew David Rutter
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom of Great Britain and Northern Ireland
- Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Hutan Ashrafian
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ara Darzi
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Chris Healey
- Gastroenterology, Airedale NHS Foundation Trust, Keighley, United Kingdom of Great Britain and Northern Ireland
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, United Kingdom of Great Britain and Northern Ireland
- Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
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