Interventions to improve ergonomics in the operating theatre: A systematic review of ergonomics training and intra-operative microbreaks

Musculoskeletal occupational injury is prevalent within the surgical community. This is a multi-factorial issue, but is contributed to by physical posture, environmental hazards and administrative deficiency. There is growing awareness of this issue, with several behavioural, educational and administrative techniques being employed. The literature on this topic is, however, sporadic and difficult to access by healthcare practitioners. The aim of this systematic review was to evaluate the literature on the current interventions used to minimise musculoskeletal occupational injury in surgeons and interventionalists. This review will focus on administrative and human factor interventions, such as intra-operative microbreaks and ergonomics training.

Study protocol - Interventions to reduce musculoskeletal occupational injury in surgeons and interventionalists: A systematic review

Musculoskeletal occupational injury is prevalent within the surgical community. This is a multi-factorial issue, but is contributed to by physical posture, environmental hazards and administrative deficiency. There is growing awareness of this issue, with several behavioural, educational and administrative techniques being employed. The literature on this topic is, however, sporadic and difficult to access by healthcare practitioners. The primary aim of this systematic review is to evaluate the literature on the current interventions used to minimise musculoskeletal occupational injury in surgeons. This review will focus on administrative, human factor interventions and ergonomics training.

The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines

INTRODUCTION

The SCARE Guidelines were published in 2016 to provide a structure for reporting surgical case reports. Since their publication, SCARE guidelines have been widely endorsed by authors, journal editors, and reviewers, and have helped to improve reporting transparency of case reports across a range of surgical specialties. In order to encourage further progress in reporting quality, the SCARE guidelines must themselves be kept up to date. We completed a Delphi consensus exercise to update the SCARE guidelines.

METHODS

A Delphi consensus exercise was undertaken. All members of the previous Delphi group were invited to participate, in addition to researchers who have previously studied case reports, and editors from the International Journal of Surgery Case Reports. The expert group was sent an online questionnaire where they were asked to rate their agreement with proposed changes to each of the 24 items.

RESULTS

56 people agreed to participate and 45 (80%) invitees completed the survey which put forward modifications to the original guideline. The collated responses resulted in modifications. There was high agreement amongst the expert group.

CONCLUSION

A modified and improved SCARE checklist is presented, after a Delphi consensus exercise was completed. The SCARE 2018 Statement: Updating Consensus Surgical CAse REport (SCARE) Guidelines.

An Extensive Volar Forearm Laceration - The Spaghetti Wrist: A Systematic Review

Purpose

'Spaghetti wrist' is an extensive laceration that involves multiple structures in the volar wrist, including tendons, nerves and arteries. This injury is frequently encountered in trauma units, but despite its complex nature, management is often handled by junior surgeons.Furthermore, the guidance on how to approach these injuries is limited, with a relatively poor evidence base on management and outcomes.

Methods

In this article, we perform a systematic review of the literature on the management and outcomes of the spaghetti wrist injury. Patient demographics, definitions of spaghetti wrist, mechanism of injury, operative and rehabilitative techniques and surgical outcomes are discussed.

Results

Results from this study show significant physical, functional, psychological and financial impacts of spaghetti wrist injuries. Operative technique appears relatively consistent; even though reporting of injuries and outcomes was heterogeneous, no current classification system is in common usage.

Conclusions

An increased focus on the standardisation of assessment, management and rehabilitation and on overcoming the obstacles to care will serve as a guidance to the operative and post-operative management of the spaghetti wrist injury. The use of a single definition and classification system has been proposed to standardise outcome measures and improve inter-observer reliability.

Type of study/level of evidence

Systematic Review: Level IIa evidence.

The Academic Surgical Collaborative: A three-year review of a trainee research collaborative

INTRODUCTION

The Academic Surgical Collaborative (ASC) is a trainee research collaborative (TRC) formed in the UK in October 2014. Three years on, the achievements are presented along with advice for emerging and established TRCs. Methods: A retrospective review of internal, member-maintained ASC records was conducted. Membership numbers, PubMed indexed publications, presentations and prizes awarded were all calculated over time. Google Scholar was used to calculate citations per ASC publication. An online survey was distributed to members to ascertain member satisfaction.

RESULTS

With 62 active members (predominantly medical students) the ASC has published 33 PubMed indexed papers over three years, with a mean of 21 citations per paper (SD 89, range 0-491). 54 presentations have been delivered and eight prizes have been awarded for ASC research projects. 60% of ASC members believe the ASC delivers research that improves patient care. Key learning points for the ASC have been the use of a set of resources distributed to new members, the value of regular meetings, close mentoring throughout research projects to develop the skills of junior researchers, encouragement for junior members to present at conferences, and an ongoing focus on research conduct and improving evidence based medicine.

CONCLUSIONS

The ASC has fulfilled many of its goals set out at its inception. The ASCs subsequent aims are to enhance existing research training for junior members, advances in the field of core outcome development and also multi-collaborative research.

The First 500 Registrations to the Research Registry®: Advancing Registration of Under-Registered Study Types

Introduction

The Declaration of Helsinki 2013 encourages the registration of all research studies involving human participants. However, emphasis has been placed on prospective clinical trials, and it is estimated that only 10% of observational studies are registered. In response, Research Registry^®1 was launched in February 2015; a retrospectively curated registry that is free and easy to use. Research Registry^® enables prospective or retrospective registration of studies, including those study types that cannot be registered on existing registries. In this study, we describe the first 500 registrations on Research Registry^®.

Methods

Since the launch of Research Registry^® in February 2015, data of registrations have been collected, including type of studies registered, country of origin, and data curation activity. Inappropriate registrations, such as duplicates, were identified by the data curation process. These were removed from the database or modified as required. A quality score was assigned for each registration, based on Sir Austin Bradford Hill’s criteria on what research studies should convey. Changes in quality scores over time were assessed.

Results

A total of 500 studies were registered on Research Registry^® from February 2015 to October 2015, with a total of 1.7 million patients enrolled. The most common study types were retrospective cohort studies (37.2%), case series (14.8%), and first-in-man case reports (10.4%). Registrations were received from 57 different countries; the most submissions were received from Turkey, followed by China and the United Kingdom. Retrospective data curation identified 80 studies that were initially registered as the incorrect study type, and were subsequently correct. The Kruskal–Wallis test identified a significant improvement in quality scores for registrations from February 2015 to October 2015 (p < 0.0001).

Conclusions

Since its conception in February 2015, Research Registry^® has established itself as a new registry that is free, easy to use, and enables the registration of various study types, including observational studies and first-in-man case reports. Going forward, our plan is to continue developing Research Registry^® in line with user feedback and usability studies. We plan to further promote Research Registry^® to advance the cause of registration of research, to increase compliance with the Declaration of Helsinki 2013.

How to make an academic poster

Academic posters are an excellent way to showcase your work at conferences and meetings. They can be used in poster presentations and serve as a summary of your project. In this how to article, we demonstrate how trainees can make and deliver a successful academic poster.

•

Academic posters are an excellent way for trainees to showcase their work at conferences and meetings.

•

When done effectively they provide a succinct and attractive summary of your project.

•

This guide aims to provide trainees with a practical and concise method to prepare their academic poster.

Tendon Reconstruction with Tissue Engineering Approach--A Review

Tendon injuries are a common and rising occurrence, associated with significant impairment to quality of life and financial burden to the healthcare system. Clinically, they represent an unresolved problem, due to poor natural tendon healing and the inability of current treatment strategies to restore the tendon to its native state. Tissue engineering offers a promising alternative, with the incorporation of scaffolds, cells and growth factors to support the complete regeneration of the tendon. The materials used in tendon engineering to date have provided significant advances in structural integrity and biological compatibility and in many cases the results obtained are superior to those observed in natural healing. However, grafts fail to reproduce the qualities of the pre-injured tendon and each has weaknesses subject to its constituent parts. Furthermore, many materials and cell types are being investigated concurrently, with seemingly little association or comparison between research results. In this review the properties of the most-investigated and effective components have been appraised in light of the surrounding literature, with research from early in-vitro experiments to clinical trials being discussed. Extensive comparisons have been made between scaffolds, cell types and growth factors used, listing strengths and weaknesses to provide a stable platform for future research. Promising future endeavours are also described in the field of nanocomposite material science, stem cell sources and growth factors, which may bypass weaknesses found in individual elements. The future of tendon engineering looks bright, with growing understanding in material technology, cell and growth factor application and encouraging recent advances bringing us ever closer to regenerating the native tendon.

Peripheral neuron plasticity is enhanced by brief electrical stimulation and overrides attenuated regrowth in experimental diabetes

Peripheral nerve regrowth is less robust than commonly assumed, particularly when it accompanies common clinical scenarios such as diabetes mellitus. Brief extracellular electrical stimulation (ES) facilitates the regeneration of peripheral nerves in part through early activation of the conditioning injury response and BDNF. Here, we explored intrinsic neuronal responses to ES to identify whether ES might impact experimental diabetes, where regeneration is attenuated. ES altered several regeneration related molecules including rises in tubulin, Shh (Sonic hedgehog) and GAP43 mRNAs. ES was associated with rises in neuronal intracellular calcium but its strict linkage to regrowth was not confirmed. In contrast, we identified PI3K-PTEN involvement, an association previously linked to diabetic regenerative impairment. Following ES there were declines in PTEN protein and mRNA both in vitro and in vivo and a PI3K inhibitor blocked its action. In vitro, isolated diabetic neurons were capable of mounting robust responsiveness to ES. In vivo, ES improved electrophysiological and behavioral indices of nerve regrowth in a chronic diabetic model of mice with pre-existing neuropathy. Regrowth of myelinated axons and reinnervation of the epidermis were greater following ES than sham stimulation. Taken together, these findings identify a role for ES in supporting regeneration during the challenges of diabetes mellitus.

Physiologic effects of prazosin HCl: consequences of diuretic combination therapy

The physiologic action of prazosin in man was studied in 23 patients including 10 treated with prazosin plus polythiazide. Responders to prazosin alone (blood pressure fell greater than 10 mm Hg) had a decrease in peripheral resistance (p less than 0.02) and no significant change in plasma volume, while nonresponders' plasma volume rose significantly (p less than 0.02). 10 patients treated with prazosin and polythiazide (blood pressure not normalized on prazosin alone) were analyzed at baseline (Rx 0), after prazosin (Rx 1), and after prazosin plus polythiazide (Rx 2). Mean supine blood pressure fell from 184/118 +/- 8/5 (SE) mm Hg at Rx 0 to 161/106 +/- 7/4 mm Hg at Rx 1 (p less than 0.005) and 129/89 +/- 4/4 mm Hg at Rx 2 (p less than 0.001). Supine renin increased in each group, but the increase with prazosin alone was not significant. Stimulated renin activity increased significantly after Rx 2 (p less than 0.0025). Cardiac output fell, plasma volume returned to baseline values, and peripheral resistance fell by 467 dyn s/cm-5 during thiazide treatment (p less than 0.025).