Fostering innovation and sustainable thinking in surgery: an evaluation of a surgical hackathon

INTRODUCTION

Surgery represents a major source of carbon emissions, with numerous initiatives promoting more sustainable practices. Healthcare innovation and the development of a digitally capable workforce are fundamental in leveraging technologies to tackle challenges, including sustainability in surgery.

METHODS

A surgical hackathon was organised with three major themes: (1) how to make surgery greener, (2) the future of plastic surgery in 10 years, and (3) improving healthcare outcomes using machine learning. Lectures were given on sustainability and innovation using the problem, innovation, market size, strategy and team (PIMST) framework to support their presentations, as well as technological support to translate ideas into simulations or minimum viable products. Pre- and post-event questionnaires were circulated to participants.

RESULTS

Most attendees were medical students (65%), although doctors and engineers were also present. There was a significant increase in delegates' confidence in approaching innovation in surgery (+20%, p < 0.001). Reducing waste packaging (70%), promoting recyclable material usage (56%) and the social media dimension of public perceptions towards plastic surgery (40%) were reported as the most important issues arising from the hackathon. The top three prizes went to initiatives promoting an artificial intelligence-enhanced operative pathway, instrument sterilisation and an educational platform to teach students research and innovation skills.

CONCLUSIONS

Surgical hackathons can result in significant improvements in confidence in approaching innovation, as well as raising awareness of important healthcare challenges. Future innovation events may build on this to continue to empower the future workforce to leverage technologies to tackle healthcare challenges such as sustainability.

Intraosseous lipoma - A rare cause of ‘cystic’ lesion of calcaneum

Intraosseous lipoma is an uncommon benign bone neoplasm with most of them detected incidentally on multimodality imaging while being evaluated for an unrelated pathology. Long and cancellous bones are commonly involved. This lesion can present a diagnostic challenge to those uninitiated in its appearence because they can be often mistaken for other benign or malignant bone lesions such as enchondroma, fibrous dysplasia, osteoblastoma, bone infarct, bone cyst and chondrosarcoma.   Here we report a case of symptomatic calcaneal lipoma in a 50 year old lady who presented with heel pain. Plain X-ray suggested cystic lesion of calcaneum. MRI revealed the presence of intralesional fat and histopathological examination confirmed the diagnosis. We present this report for its rarity and  the clinching MRI features of this lesion, the excellent prognosis and near negligible recurrence rates, so that misdiagnosis leading to unnecessary workup, biopsy and treatment may be avoided, especially in asymptomatic patients.

Papillary carcinoma thyroid - A 11 year epidemiological study with histopathological correlation in a tertiary care centre in South Malabar Region in Kerala, India

Background: Thyroid cancer is the commonest endocrine malignancy. Based on recent data, thyroid cancer is the fifth most common cancer in women. To our knowledge the  present study  is the first of its kind, correlating epidemiological and histomorphological data so as to assess the  major cause hypothesis for thyroid cancers, focusing more on  papillary  carcinoma and its variants, comparing it with each other and with other  thyroid carcinomas and also correlating with gender, life style and religion.Materials and methods: This study was conducted in the Department of Pathology, MES Medical College, Perinthalmanna, Kerala, India, from January 2004 to June 2015.Two thousand and fifty thyroidectomy cases were studied.Results: Out of the total 2050  cases, thyroid cancers constituted  295 (14.39%);  of which 10.1% (208 cases) were Papillary carcinoma thyroid (PCT) and its variants; 165 cases were seen in females (79.33%) and  the incidence in males were only 20.68% (43 cases).The commonest variant encountered was classical papillary carcinoma (113 cases, 54.32%).Conclusion: Our study of papillary thyroid carcino

Cardiac conduction system- A detailed study in 46 cases of sudden death

Background: Atherosclerotic coronary artery disease is the modern pandemic and is said to be responsible for a major chunk of sudden cardiac deaths. However, in few cases; especially among the young, conduction system abnormalities were found to be the cause of death with absence of significant coronary lesions. These days, examination of the cardiac conduction system during autopsy has been abandoned as it is said to be a time consuming process. The present study was undertaken to highlight the importance of examining the cardiac conduction system in all sudden death cases.Materials and Methods: This study was a prospective one, conducted from June 2007 to June 2009 in the department of Pathology, Kasturba Medical College, Mangalore. Forty six hearts of persons who died suddenly were studied.Results: Our study showed that even though atherosclerotic coronary lesions were the most common cause of sudden death, cardiac conduction defects also contributed to a significant number of cases; especially in the young. In our study of 46 cases; 6 cases showed only conduction system abnormalities. These were young adults who had died suddenly. The predominant lesion identified in them was fibromuscular dysplasia of the nodal arteries.Conclusion: A detailed examination of the coronaries and the cardiac conduction system should be made mandatory in all sudden death cases, especially in the young as they will help to throw some light into the cause of death.Journal of Pathology of Nepal (2015) Vol. 5, 709-716

Low grade endometrial stromal sarcoma – A series of 4 cases and review of relevant literature

Endometrial stromal tumors are rare uterine malignancies composed of cells resembling those of proliferative endometrial stroma. Because of their indistinct clinical and radiological features, these malignancies are very rarely diagnosed preoperatively. They are mostly often diagnosed as fibroid uteruspreoperatively and as a result managed conservatively many a time. Usually distinguishing these tumors from benign smooth muscle tumors of the uterus are not problematic by light microscopy, however, difficulties arise in distinction between highly cellular leiomyomas and endometrial stromal sarcomas with smooth muscle differentiation. Here we present four consecutive cases of low grade endometrial stromal sarcomaswith emphasis on their clinical, histopathological and immunohistochemical features. By this study, we have attempted to document the histologic features of LGESS with discussion of the differential diagnoses to contribute to this rare spectrum of uterine neoplasms.Journal of Pathology of Nepal (2015) Vol. 5, 774-777

Pharmacists' role in the post-discharge management of patients with heart failure: a literature review

BACKGROUND AND OBJECTIVE

The incidence of heart failure is increasing in developed countries. In the aged population, heart failure is a common cause of hospitalization and hospital readmission, which in conjunction with post-discharge care, impose a significant cost burden. Inappropriate medication management and drug-related problems have been identified as major contributors to hospital readmissions. In order to enhance the care and clinical outcomes, and reduce treatment costs, heart failure disease management programmes (DMPs) have been developed. It is recommended that these programmes adopt a multi-disciplinary approach, and pharmacists, with their understanding and knowledge of medication management, can play a vital role in the post-discharge care of heart failure patients. The aim of this literature review was to assess the role of pharmacists in the provision of post-charge services for heart failure patients.

METHOD

An extensive literature search was undertaken to identify published studies and review articles evaluating the benefits of an enhanced medication management service for patients with heart failure post-discharge.

RESULTS

Seven studies were identified evaluating 'outpatient' or 'post-discharge' pharmacy services for patients with heart failure. In three studies, services were delivered prior to discharge with either subsequent telephone or home visit follow-up. Three studies involved the role of a pharmacist in a specialist heart failure outpatient clinic. One study focused on a home-based intervention. In six of these studies, positive outcomes, such as decreases in unplanned hospital readmissions, death rates and greater compliance and medication knowledge were demonstrated. One study did not show any difference in the number of hospitalizations between intervention and control groups. The quality of evidence of the randomized controlled trials was assessed using the Jadad scoring method. None of the studies achieved a score of more than 2, out of a maximum of 5, indicating the potential for bias.

DISCUSSION

The DMPs carried out by pharmacists have contributed to positive patient outcomes, which has highlighted the value of extending the traditional roles of pharmacists from the provision of professional guidance to the delivery of continuity of care through a more holistic and direct approach.

CONCLUSION

This review has demonstrated the effectiveness of pharmacists' interventions to reduce the morbidity and mortality associated with heart failure. However, there is an on-going need for the development and evaluation of pharmacy services for these patients.