# ent

id: cord-262141-th2edwh4
type: ORG
entity:
  the Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee


id: cord-300689-dz6lybgi
type: ORG
entity:
  COVID 19 Recommendations for Management of Elective Surgical Procedures American College of Surgeons Protecting


id: cord-344682-4vpm7m1h
type: WORK_OF_ART
entity:
  The Past Present and Future of Orthopedic Education Lessons Learned From the COVID 19 Pandemic Impact of the COVID 19


id: cord-254686-pclq855r
type: ORG
entity:
  the Department of Psychological Department Infectious Disease Unit Occupational Safety Health and Environment Unit Department of Primary Care Medicine and Social and Preventive Medicine Department


id: cord-348614-im7qtr9k
type: ORG
entity:
  Trauma Surgery International Association for Trauma Surgery and Intensive Care American College of Surgeons


id: cord-348614-im7qtr9k
type: ORG
entity:
  the spanish association of surgeons American Association for the Surgery of Trauma COVID 19 Resources Consensus


id: cord-351373-a21453gz
type: ORG
entity:
  the Ability of the Innervision Electrostatic Precipitator to Clear the Particulate Matter Produced by Energy


id: cord-355319-2mn9cf79
type: LAW
entity:
  the COVID 19 Pandemic ASE Statement on Protection of Patients and Echocardiography Service Providers


id: cord-260907-uuaa9ta2
type: ORG
entity:
  Association of Professors of Obstetrics and Gynecology APGO Medical Student Educational Objectives Association for Surgical Education


id: cord-352937-htmp0avc
type: ORG
entity:
  Centers for Disease Control and Prevention CDC Healthcare Infection Control Practices Advisory Committee


id: cord-352937-htmp0avc
type: ORG
entity:
  Infectious Agents Centre for Health Protection Key Elements on Prevention and Control of Coronavirus Disease COVID 19 Tracheostomy


id: cord-287376-wxldnlih
type: PRODUCT
entity:
  Chirurgische Rauchgase Gefährdungen und Schutzmaßnahmen Effect of Robotic Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients


id: cord-292129-m1ookq0l
type: ORG
entity:
  Washington Department of Labor Occupational Safety and Health Administration Department of Labor Occupational Safety and Health Administration


id: cord-028285-n4dommet
type: ORG
entity:
  The Lancet Respiratory Medicine Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers


id: cord-332960-h0be6pr0
type: ORG
entity:
  SAGES Society of American Gastrointestinal and Endoscopic Surgeons Recommendations Surgical Response


id: cord-355431-efwuy8p9
type: ORG
entity:
  the American Academy of Physical Medicine Rehabilitation Board of Governors Consideration for Optimum Surgeon Protection Guidelines for Triage of Orthopaedic Patients


id: cord-353004-ocnp758o
type: CELL_LINE
entity:
  China COVID 19 coronavirus recommended personal protective equipment for the orthopaedic and trauma surgeon Sterile field contamination from powered air purifying respirators PAPRs


id: cord-353004-ocnp758o
type: GGP
entity:
  Saf Surg DOI 10 1186 s13037 020 00254 6 sha 96f892f49c5628a06ab6bafd34ddd0a4fd114100 doc_id 353004 cord_uid ocnp758o BACKGROUND The COVID 19


id: cord-015368-a0qz4tb9
type: PROTEIN
entity:
  VEGF bFGF IGF EGF Heparin Endothelial Cell Growth Supplement and 10 Fetal Calf Serum Expression of endothelial cell surface markers CD31 CD34 CD62e CD54


id: cord-015368-a0qz4tb9
type: PROTEIN
entity:
  NCB PH plate Zimmer Company Winterthur Switzerland In 16 cases 46 osteoporosis had been diagnosed preoperatively Radiological follow up in two planes and functional outcome is assessed clinically ROM


id: cord-015368-a0qz4tb9
type: GGP
entity:
  mellitus p ¼ 0 001 OR 1 884 peripheral artery disease p ¼ 0 003 OR 1 979 cardiogenic Shock p ¼ 0 043 OR 2 957 congestive heart failure p ¼ 0 013 OR 1 601 und emergent surgery p ¼ 0 001 OR 3 032 were predictive for development of ARF Preoperative serum creatinine


id: cord-015368-a0qz4tb9
type: GGP
entity:
  behandelbar ist sollte durch Klärung ihrer Ä tiologie eine Prävention dafür möglich werden da diese Kinder wegen ihrer kritischen Voraussetzung bereits


id: cord-015368-a0qz4tb9
type: GGP
entity:
  Hirschsprung s disease G Schimpl Background Whereas in the past various operative techniques in patients with Hirschsprung s disease HD


id: cord-015368-a0qz4tb9
type: FAC
entity:
  M Tomka A Baumann P Konstantiniuk T Ott T Cohnert Division of Vascular Surgery Department of Surgery Medical University of Graz Graz Austria Background Seventeen percent


id: cord-015368-a0qz4tb9
type: CHEMICAL
entity:
  werden Zur Behandlung stehen 2 grundsätzlich differente Vorgehensweisen zur Verfügung Im Vordergrund steht eine Resektion


id: cord-015368-a0qz4tb9
type: DISEASE
entity:
  left thorax pneumothorax lesions of the diaphragm left third of the transversal colon and neck lesions


id: cord-026031-hnf5vayd
type: CELL_TYPE
entity:
  malignant hemangiosarcoma lymphoma mast cell tumor malignant fibrous histiocytoma leiomyosarcoma fibrosarcoma


id: cord-026031-hnf5vayd
type: GGP
entity:
  blockers e g propranolol Cardiac glycosides e g digoxin Urethral obstruction Ruptured bladder Anuric


id: cord-026031-hnf5vayd
type: GGP
entity:
  Angiotensin converting enzyme inhibitors e g enalapril Angiotensin receptor blockers e g losartan Cyclosporine


id: cord-026031-hnf5vayd
type: GGP
entity:
  steroids e g prednisolone methylprednisolone sodium succinate triamcinolone Depending on the severity of the patient s condition consider monitoring using the Rule of Twenty Administer antiemetics and gastroprotectant drugs to treat nausea vomiting and hematemesis Give the patient broad spectrum antibiotics ampicillin


id: cord-026031-hnf5vayd
type: GGP
entity:
  allethrin decamethrin tralomethrin fenpropanthrin pallethrin sumethrin permethrin tetramethrin cyfluthrin


id: cord-026031-hnf5vayd
type: GGP
entity:
  warfarin 0 06 0 09 mg kg day Monitoring therapy based on prothrombin time and the international normalized ratio INR 2 0 4 0


id: cord-026031-hnf5vayd
type: WORK_OF_ART
entity:
  Treatment Treatment of onion chive and garlic toxicity includes administration of intravenous fluid diuresis and induction of


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  pyometra gastrointestinal obstruction intraluminal gastrointestinal foreign body dilated bile duct or gallbladder mucocele


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  hypotension shock coagulopathies lethargy weakness muscle fasciculations lymphangitis rhabdomyolysis


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  concomitant ligamentous or neurologic compromise Box 1 41 Immediately after the initial primary survey of a patient perform a more thorough examination including an orthopedic examination Multiple injuries


id: cord-026031-hnf5vayd
type: CHEMICAL
entity:
  NaCl 2 5 dextrose 150 200 5 0 45 NaCl 2 5 dextrose 100 150 5 0 45 NaCl 2 5 dextrose 100 0 0 45 NaCl 5 dextrose


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  tremors nervousness polyphagia ataxia tachycardia muscle twitching incoordination visual disturbances


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  vomiting ataxia hypersalivation agitation tremors hyperactivity hyperthermia hypoventilation coma seizures


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  primary pulmonary parenchymal disease airway disease thoracic cage disorders congestive heart failure


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  infectious peritonitis congestive heart failure chylothorax heartworm disease hemothorax hypoalbuminemia lung lobe torsions neoplasia diaphragmatic hernia


id: cord-026031-hnf5vayd
type: CHEMICAL
entity:
  Antihistamines loratadine diphenhydramine doxylamine clemastine meclizine dimenhydrinate chlorpheniramine cyclizine terfenadine hydroxyzine


id: cord-026031-hnf5vayd
type: DISEASE
entity:
  pleural hemorrhage gastrointestinal hemorrhage pericardial hemorrhage hematuria retroperitoneal hemorrhage hemarthrosis


id: cord-006854-o2e5na78
type: GGP
entity:
  n 13 11 9 p 0 05 and organ space infection n 0 0 0 vs n 2 1 8 p 0 05 respectively Conclusions A preoperative antimicrobial protocol using cefazolin metronidazole


id: cord-006854-o2e5na78
type: WORK_OF_ART
entity:
  Hrishikesh Salgaonkar Raquel Maia Lynette Loo Wee Boon Tan Sujith Wijerathne Davide Lomanto National University Hospital Singapore Laparoscopic repair of groin hernias


id: cord-006854-o2e5na78
type: ORG
entity:
  Minimally Invasive Management of Diaphragmatic Hernias After Esophagectomy A Case Report Introduction Esophagectomy


id: cord-006854-o2e5na78
type: ORG
entity:
  Masafumi Ohira Department of Gastroenterological Surgery Hokkaido University Graduate School of Medicine Background


id: cord-006854-o2e5na78
type: WORK_OF_ART
entity:
  S359 Augmenting Spatial Awareness in Laparoscopic Surgery by Immersive Holographic Mixed Reality Navigation


id: cord-006854-o2e5na78
type: WORK_OF_ART
entity:
  Ibrahim A Salama Professor Department of Hepatobiliary Surgery National Liver Institute Menoufia University Abstract Background Iatrogenic


id: cord-006854-o2e5na78
type: WORK_OF_ART
entity:
  S359 Taking the Training Wheels Off Transitioning from Robotic Assisted to Total Laparoscopic Whipple Introduction


id: cord-006854-o2e5na78
type: WORK_OF_ART
entity:
  The Effect of Peri operative Antibiotic Drug Class on the Resolution Rate of Hypertension After Roux


id: cord-006854-o2e5na78
type: ORG
entity:
  the American College of Surgeons the Academic Association of Surgery and the Society of American Gastrointestinal and Endoscopic Surgeons


id: cord-006854-o2e5na78
type: WORK_OF_ART
entity:
  Yoshiyuki Usui MD PhD Ichiro Akiyama MD PhD Hironori Kunisue MD PhD Hideaki Mori MD PhD Tetsuya Ota MD PhD Okayama Medical Center Background and Methods


id: cord-006854-o2e5na78
type: ORG
entity:
  Laparoscopic Antireflux Surgery for Gastroesophageal Reflux Disease Effectiveness and Economic Benefits Kyung Won Seo


id: cord-006854-o2e5na78
type: WORK_OF_ART
entity:
  The Essential Role of the Transcystic Duct Tube C Tube During Laparoscopic Common Bile Duct Exploration LCBDE Towakai Hospital Introduction Laparoscopic


id: cord-006854-o2e5na78
type: ORG
entity:
  Priscila R Armijo MD 1 Dmitry Oleynikov MD 1 Sages Robotic Task Force 2 1 University of Nebraska Medical Center 2


id: cord-006849-vgjz74ts
type: DNA
entity:
  biliary tree Endoscopia Digestiva Chirurgica Policlinico Universitario A Gemelli ROME Italy 2 IHU STRASBOURG France 3 Camma Group ICube University


id: cord-006849-vgjz74ts
type: PROTEIN
entity:
  LSG R Bademci 1 R Vilallonga 2 P Alberti 2 R Renato 2 C Yuhamy 2 S S Cordero 2 L Posadas 2 1 General surgery Istanbul medipol


id: cord-006849-vgjz74ts
type: DNA
entity:
  target line Esofagogástrica Cirugía General y Ap Digestivo Hospital Regional Universitario de Málaga MALAGA Spain 2 Hepatobiliopancreática Hospital Regional Universitario de Málaga MALAGA Spain Introduction Marginal ulcer


id: cord-006849-vgjz74ts
type: PROTEIN
entity:
  LLR V Drakopoulos S Voulgaris I Iliadis K Botsakis P Trakosari V Vougas 1st Department of Surgery and Transplantation Unit District General Hospital of Athens Evangelismos ATHENS Greece Introduction Laparoscopic surgery


id: cord-006849-vgjz74ts
type: PROTEIN
entity:
  S2 153 6 62 5 min vs 179 3 55 2 min p 0 037 and 59 7 45 7 ml vs 100 0 74 0 ml p 0 027 respectively Specimen quality and early postoperative complications


id: cord-006849-vgjz74ts
type: GGP
entity:
  HSA r 0 5402 p 0 0064 however strength of association was weak r 2 0 2918 and CT consistently overestimated the size of hiatal defect intra operatively mean of differences 404 mm 2 p 0 0016 Crural tension was positively correlated with age r 0 3321 p 0 0044 hiatal height r 0 6023 p 0 0001 hiatal width r 0 766 p 0 0001 and HSA r 0 7753 p 0 0001 Crural tension


id: cord-006849-vgjz74ts
type: GGP
entity:
  mammary line 3 triangle 5 mm trocars after pneumo under vision Section with Ligasure of gastroesplenic ligament with short vessels and phrenic splenic ligament Identification and preservation of pancreatic tail Section of splenic vessels


id: cord-006849-vgjz74ts
type: CL
entity:
  fibroblastic mesenchymal neoplasm tipically arising from the pleura less frequently from other anatomic sites


id: cord-006849-vgjz74ts
type: GGP
entity:
  MEN I familial hyperparathyroidism MEN2A hyperparathyroidism jaw tumor syndrome parathyroidectomy minimally invasive for the time period up to and including December 2018 Full publications including clinical trials randomized or not retrospective studies case series case reports that provided relevant data met inclusion criteria


id: cord-006849-vgjz74ts
type: ORG
entity:
  Medical Faculty University of Tetove TETOVE Macedonia 3 Anestesiology Medical Faculty University of Tetove TETOVE Macedonia 4


id: cord-006849-vgjz74ts
type: WORK_OF_ART
entity:
  CAN WE PREDICT THE SUCCESS OF THE LAPAROSCOPIC APPROACH IN THE ADHESIVE SMALL BOWEL OBSTRUCTION C Tellez Marques E Sebastian Valverde


id: cord-006849-vgjz74ts
type: ORG
entity:
  Gastroenterological Surgery Saitama Medical University International Medical Center HIDAKA SHI SAITAMA Japan


id: cord-006849-vgjz74ts
type: EVENT
entity:
  A NOVEL ABDOMINAL NEGATIVE PRESSURE LAVAGE DRAINAGE SYSTEM FOR ANASTOMOTIC LEAKAGE AFTER R0 RESECTION


id: cord-006849-vgjz74ts
type: DISEASE
entity:
  cartilage 16001 carotid artery 81567 muscle 5149 carotid vein 7148 portal vein 22973 biliary tract 73940 gallbladder 1874 hepatic artery 16712 pancreas 2412 duodenum 34313 abdominal


id: cord-006849-vgjz74ts
type: DISEASE
entity:
  inferior mesenteric vein division Left colonic and splenic flexure mobilization Pancreas identification Rectal dissection


id: cord-006849-vgjz74ts
type: DISEASE
entity:
  postoperative complications gastrogastric anastomosis leak 1 Introduction Laparoscopic sleeve gastrectomy is the most


# bib

id: cord-001725-pw7coi3v
author: Ballus, Josep
date: 2015-07-30
txt: ./txt/cord-001725-pw7coi3v.txt
cache: ./cache/cord-001725-pw7coi3v.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520265/
doi: 10.1186/s12879-015-1050-5
summary:
  title: Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes We therefore aimed to assess the incidence, epidemiology and microbiology of SSI and its association with outcomes in patients with severe peritonitis in the intensive care unit (ICU). Physicians may consider antibiotic-resistant pathogens, gram-positive cocci and fungi when choosing empiric antibiotic treatment for SSI, although more studies are needed to confirm our results due to the inherent limitations of the microbiological sampling with swabs performed in our research. This study therefore aimed to describe the incidence, epidemiology, microbiology and outcomes of SSI in patients admitted with secondary or tertiary peritonitis to the ICU of a tertiary referral hospital. This study provides data on the incidence and microbiology of SSIs for a large cohort of critically ill patients admitted with secondary or tertiary peritonitis to a surgical ICU.

title:
  Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes

abstract:
  BACKGROUND: Surgical site infection (SSI) remains a significant problem in the postoperative period that can negatively affect clinical outcomes. Microbiology findings are typically similar to other nosocomial infections, with differences dependent on microbiology selection due to antibiotic pressure or the resident flora. However, this is poorly understood in the critical care setting. We therefore aimed to assess the incidence, epidemiology and microbiology of SSI and its association with outcomes in patients with severe peritonitis in the intensive care unit (ICU). METHODS: We prospectively studied 305 consecutive patients admitted to our surgical ICU from 2010 to 2014 with a diagnosis of secondary or tertiary peritonitis. We collected the following data: SSI diagnosis, demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II score, type of surgery, microbiology, antibiotic treatment and outcomes. Microbiological sampling was done by means of swabs. RESULTS: We identified 269 episodes of SSI in 162 patients (53.1 %) aged 64.4 ± 14.3 years, of which 200 episodes occurred in men (64.6 %). The mean APACHE II and SAPS II scores were 19.7 ± 7.8 and 36.5 ± 16.1 respectively. The mean ICU and hospital stays were 19.8 ± 24.8 and 21.7 ± 30 days respectively. Pseudomonas spp. (n = 52, 19.3 %), Escherichia coli (n = 55, 20.4 %) and Candida spp. (n = 46, 17.1 %) were the most frequently isolated microorganisms, but gram-positive cocci (n = 80, 29.7 %) were also frequent. Microorganisms isolated from SSIs were associated with a higher incidence of antibiotic resistance (64.9 %) in ICU patients, but not with higher in-hospital mortality. However, patients who suffered from SSI had longer ICU admissions (odds ratio = 1.024, 95 % confidence interval 1.010–1.039, P = 0.001). CONCLUSIONS: The incidence of SSI in secondary or tertiary peritonitis requiring ICU admission is very high. Physicians may consider antibiotic-resistant pathogens, gram-positive cocci and fungi when choosing empiric antibiotic treatment for SSI, although more studies are needed to confirm our results due to the inherent limitations of the microbiological sampling with swabs performed in our research. The presence of SSI may be associated with prolonged ICU stays, but without any influence on overall mortality.


id: cord-006563-qmigctkp
title: The abstracts of the 26th congress of ESCTAIC, Timisoara, Romania, September 22–24 2016
author: nan
date: 2017-03-07
txt: ./txt/cord-006563-qmigctkp.txt
cache: ./cache/cord-006563-qmigctkp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102034/
doi: 10.1007/s10877-017-9991-4
abstract: nan
summary:
  This is the reason why in the last decades a lot of clinical studies have been performed with the aim of reducing the magnitude of the postoperative pain, all of them directed to those factors which might influence the pain after surgery, such as: presence of preoperative chronic pain, anesthesia technique, or the need for an acute pain service. The list of proposals to be taken into consideration includes: a careful psychological evaluation and preparation of the surgical patient, a good preoperative sedation and even the use of antidepressants before surgery in specific cases. Regional anesthesia and ambulatory surgery: the role of continuous infusion devices in postoperative pain management in pediatrics Ralph J Beltran Department of Anesthesiology and Pain Medicine, Nationwide Children''s Hospital, Columbus, Columbus, OH, USA Continuous infusions of local anesthetic delivered via peripheral nerve block catheters (PNB) for postoperative pain management in adult patients has become more prevalent.


id: cord-006818-2lclcf1x
title: Reproductive emergencies in camelids
author: Tibary, A.
date: 2008-06-02
txt: ./txt/cord-006818-2lclcf1x.txt
cache: ./cache/cord-006818-2lclcf1x.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103122/
doi: 10.1016/j.theriogenology.2008.04.024
summary:
  The objective of the present paper is to review the most common reproductive emergencies in male, female, and neonatal camelids. Pregnant females may present with a variety of emergency clinical syndromes, ranging from severe colic, downer (lateral or sternal continuous recumbency), anorexia, diarrhea, depression, neurologic conditions, excessive straining, vaginal discharge, premature lactation, vulvar dilation, or vaginal prolapse. Difficulties encountered in transrectal evaluation for uterine torsion include physical limitations, particularly in alpacas (tight anal sphincter, narrow pelvis and size of the examiner''s hand and arm), as well as a lack of experience palpating late-pregnant camelids in a sternal position. Regarding obstetrical procedures, there are three major differences between camelids and ruminants: (1) the pelvic inlet is narrower; (2) the cervix and vaginal are more prone to laceration and severe inflammation (often leading to adhesions); (3) risks for neonatal hypoxia and death are increased by the forceful uterine and abdominal contractions and the rapid detachment of the microcotyledonary placenta.

abstract:
  Emergencies in theriogenology practice go beyond just saving the life of the patient, but also preserving its reproductive abilities. Camelid emergency medicine is a relatively new field. This paper discusses the most common reproductive emergencies, their diagnosis, treatment, and prognosis in male and female camelids. The conclusions drawn are based primarily on clinical observations by the authors over the last 25 years. Special consideration is given to peculiarities of the species, particularly in the choice of obstetrical manipulations and therapies.


id: cord-006849-vgjz74ts
author: nan
date: 2019-09-13
txt: ./txt/cord-006849-vgjz74ts.txt
cache: ./cache/cord-006849-vgjz74ts.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103177/
doi: 10.1007/s00464-019-07109-x
abstract: nan
summary:
  Methods: We are performing this procedures within a prospective randomized trial that is design to compare the long term results of LRYGB-B versus the standard laparoscopic Roux-en-Y gastric bypass.The video shows our technique in a case of a 46 years old female with a BMI of 46 Kg/m2. Material and methods: We present a video of the surgical intervention of a 32-year-old patient, with functional dyspepsia, with a casual diagnosis of a pseudocystic mass of the right colon after performing a CT scan: giant diverticulum of the hepatic colon angle with fecaloid content inside it under tension The patient goes to the emergency room for acute abdominal pain, pending colonoscopy, antibiotic treatment is established, and a laparoscopic approach is decided upon after the patient''s evolution. Method: We present the case of a 65-year-old patient with surgical antecedent of laparoscopic low anterior resection due to rectal cancer, presenting in postoperative period an anastomosis leakage with severe peritonitis was identified and a laparotomy with end colostomy was performed.

title:
  27th International Congress of the European Association for Endoscopic Surgery (EAES) Sevilla, Spain, 12–15 June 2019


id: cord-006854-o2e5na78
author: nan
date: 2018-04-20
txt: ./txt/cord-006854-o2e5na78.txt
cache: ./cache/cord-006854-o2e5na78.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103183/
doi: 10.1007/s00464-018-6121-4
abstract: nan
summary:
  Totally Laparoscopic ALPPS Combined with the Microwave Ablation for a Patient with a Huge HCC Hua Zhang; Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel technique for resecting hepatic tumors that were previously considered unresectable due to the insufficient future liver remnant (FLR) which may result in postoperative liver failure (PLF). Not only does this case show that a large epiphrenic diverticulm can be successfully resected via the trans-abdominal laparoscopic approach, this case makes the argument that patients undergoing any minimally-invasive epiphrenic diverticulectomy and myotomy, with or without fundoplication, may be successfully managed with early post-operative contrast studies and dietary advancement, thus decreasing their length of hospitalization and overall cost of treatment. Introduction: There are reports of increased operative duration, blood loss and postoperative morbidity, caused by difficulties in obtaining good visualization and in controlling bleeding when laparoscopic resection is performed in obese patients with colon cancer.

title:
  Scientific Session of the 16th World Congress of Endoscopic Surgery, Jointly Hosted by Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) & Canadian Association of General Surgeons (CAGS), Seattle, Washington, USA, 11–14 April 2018: Poster Abstracts


id: cord-011402-sk4tgdf8
author: Low, Tze-Yi
date: 2020-05-15
txt: ./txt/cord-011402-sk4tgdf8.txt
cache: ./cache/cord-011402-sk4tgdf8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227499/
doi: 10.1016/j.amjsurg.2020.05.021
abstract: nan
summary:
  title: Restructuring the surgical service during the COVID-19 pandemic: Experience from a tertiary institution in Singapore Restructuring the surgical service during the COVID-19 pandemic: Experience from a tertiary institution in Singapore Keywords: COVID-19 Health policy Infectious diseases Healthcare administration Surgery Designated pandemic wards managed confirmed or high-risk cases, providing natural segregation among nursing staff, who are ward-based. Central to our plan was the reorganization of medical staff in our department into three independent teams (Fig. 1) to prevent the standing team from working continuously and avoid the complete shutdown of outpatient services should any team become afflicted with the virus. To study the impact on patient care, operational and safety data in the month immediately post-activation of our pandemic preparedness plan were retrieved and compared with data from a similar period in 2019. There were 338 reported incidents for surgical patients from February to March 2020, compared to 397 for the same period in 2019 (Fig. 2d) .

title:
  Restructuring the surgical service during the COVID-19 pandemic: Experience from a tertiary institution in Singapore


id: cord-015368-a0qz4tb9
title: 48th Annual Meeting of the Austrian Society of Surgery, Graz, June 7–9, 2007
author: nan
date: 2007
txt: ./txt/cord-015368-a0qz4tb9.txt
cache: ./cache/cord-015368-a0qz4tb9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103188/
doi: 10.1007/s10353-007-0330-8
abstract: nan
summary:
  Surgical treatment and evaluation, complications, short and long term patency of our patients were compared to interventional techniques and international literature. The aim of the study was to investigate: i) relevant and combined determinants of the development, management and outcome of a representative patient cohort (n ¼ 9.991) with acute appendicitis enrolled in a prospective unicenter study through a time period of 27 years (middle Europe), and ii) the frequency and impact of specific categories (e.g., characteristics of the medical history, clinical and intraoperative findings, complications), correlation and relative risk factors of the disease and its prognosis. From 01=1997 until 12=2006 198 TEM procedures were performed in 194 patients, 104 males, 90 females, mean age was 68.9 years (38-91), the median hospital stay was 8 days . No conversion to open technique had to be performed, no postoperative surgical complications were observed, one patient died 4 weeks postoperative due to liver failure following esophageal varices bleeding.


id: cord-025176-f0frlpwh
title: Resuming elective surgical services in times of COVID-19 infection
author: Coimbra, Raul
date: 2020-05-19
txt: ./txt/cord-025176-f0frlpwh.txt
cache: ./cache/cord-025176-f0frlpwh.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246095/
doi: 10.1136/tsaco-2020-000511
summary:
  15 Most recommendations from public health officials have suggested that a steady decrease in the number of new COVID-19 cases over a period of 14 days (decreased incidence), associated with a similar trend in hospital and ICU admission, is necessary to consider resuming elective surgery (box 1). However, it is important that a staged system be implemented with partial reopening followed by interval full reassessment of the system, as the incidence of COVID-19 infection may have decreased further, allowing the opening of more operating rooms, increasing the overall number of procedures performed. After a functional period in stage 1, a reassessment of the COVID-19 infection in the community and in the hospital should occur to determine if adding operating room capacity and increasing the number of surgical cases is warranted.

abstract:
  The consequences of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus have been devastating to the healthcare system. As the positive effects of social distancing, mandatory masking, and societal lockdown on the spread of the disease and its incidence in the community were documented, societal and financial pressures mounted worldwide, prompting efforts to “re-open” countries, states, communities, businesses, and schools. The same happened with hospital, which had to start developing strategies to resume elective surgery activities. This manuscript describes the pre-requisites as well as the strategies for resuming surgical activity, be it in the outpatient or inpatient setting.


id: cord-026031-hnf5vayd
title: Emergency Care
author: Ford, Richard B.
date: 2009-05-21
txt: ./txt/cord-026031-hnf5vayd.txt
cache: ./cache/cord-026031-hnf5vayd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271342/
doi: 10.1016/b0-72-160138-3/50002-3
abstract: nan
summary:
  Fresh whole blood Coagulopathy with active hemorrhage (disseminated intravascular coagulation, thrombocytopenia; massive acute hemorrhage; no stored blood available) Stored whole blood Massive acute or ongoing hemorrhage; hypovolemic shock caused by hemorrhage that is unresponsive to conventional crystalloid and colloid fluid therapy; unavailability of equipment required to prepare blood components Packed red blood cells Nonregenerative anemia, immune-mediated hemolytic anemia, correction of anemia before surgery, acute or chronic blood loss Fresh frozen plasma Factor depletion associated with active hemorrhage (congenital: von Willebrand''s factor, hemophilia A, hemophilia B; acquired: vitamin K antagonist, rodenticide intoxication, DIC); acute or chronic hypoproteinemia (burns, wound exudates, body cavity effusion; hepatic, renal, or gastrointestinal loss); colostrum replacement in neonates Frozen plasma Acute plasma or protein loss; chronic hypoproteinemia; (contains stable colostrum replacement in neonates; hemophilia B and clotting factors) selected clotting factor deficiencies Platelet-rich plasma* Thrombocytopenia with active hemorrhage (immune-mediated thrombocytopenia, DIC); platelet function abnormality (congenital: thrombasthenia in Bassett hounds; acquired: NSAIDs, other drugs) Cryoprecipitate


id: cord-028285-n4dommet
title: COVID-19: What are the challenges for NHS surgery?
author: Weilongorska, Natasha L.
date: 2020-07-02
txt: ./txt/cord-028285-n4dommet.txt
cache: ./cache/cord-028285-n4dommet.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329670/
doi: 10.1016/j.cpsurg.2020.100856
abstract: nan
summary:
  With there being a short interval from the time of the first COVID-19 case presentation, to the development of a global pandemic, validated management algorithms to support changes in operative strategies are lacking. The key components of NHS preoperative patient screening for COVID-19 are: structured questionnaires with temperature monitoring, viral real-time polymerase chain reaction (RT PCR) for SARS-CoV-2, and chest imaging. Full PPE (fluid resistant gown, double gloving, visor or goggles, fit-tested FFP3 mask or respirator, disposable hat, shoe covers) should be worn in the operating rooms for any suspected or positive COVID-19 case, for AGP 38 (Table 3) , and for procedures for which the risk is unknown. All surgical cases require a discussion about the patient''s COVID-19 status, the degree of aerosol risk for each part of the procedure (induction of anaesthesia, extubation, and for all operative phases), with PPE requirement stated for each stage.


id: cord-029789-ttql1jpv
title: Ventral hernia patient outcomes postoperatively housed on surgical vs non-surgical units
author: Bittner, Elizabeth
date: 2020-07-27
txt: ./txt/cord-029789-ttql1jpv.txt
cache: ./cache/cord-029789-ttql1jpv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384391/
doi: 10.1007/s00464-020-07829-5
summary:
  authors: Bittner, Elizabeth; Ueland, Walker; Nisiewicz, Michael J.; Siddiqi, Hussain; Plymale, Margaret A.; Davenport, Daniel L.; Roth, John Scott Clinical characteristics including patient age, gender, BMI, and medical comorbidities were similar between patients boarded on surgical versus non-surgical units. There were no differences in ICU or PACU stay, cost, or postoperative complications in patients housed on surgical versus non-surgical units. Evaluation of patient outcomes and LOS in open ventral hernia repair patients based on hospital unit is unique to this study. The purpose of this study was to evaluate the impact of postoperative hospital units, including medical, surgical, and intensive care, upon hospital length of stay and early clinical outcomes of VHR patients. Our study did not find an increased risk of early postoperative complications, including cellulitis and wound complications, with patients housed on non-surgical units. Postoperative VHR patients experience an increased LOS and rate of location transfer when housed on a non-surgical unit.

abstract:
  BACKGROUND: Inpatient hospital units vary in staffing ratios, monitoring, procedural abilities, and experience with unique patients and diagnoses. The purpose of this study is to assess the impact of patient cohorting upon ventral hernia repair outcomes. METHODS: An IRB-approved retrospective review of open ventral hernia repairs between August 2013 and July 2017 was performed. The information of all patient locations during hospitalization, time at location, post-anesthesia care unit duration (PACU), and intensive care unit (ICU) duration was collected. Patient demographics, comorbidities, operative details, cost, and patient outcomes were analyzed. Multivariable analysis of log length of stay (LOS) was assessed with adjustment for clinical and operative factors. RESULTS: 235 patients underwent open ventral hernia repair. 179 patients were admitted to surgical units, 33 non-surgical units, and 23 stayed on both units. Clinical characteristics including patient age, gender, BMI, and medical comorbidities were similar between patients boarded on surgical versus non-surgical units. Hernia, wound, and operative data were also statistically similar. Patients admitted to non-surgical units for any duration experienced longer hospital stay (4 vs. 6 days, p < 0.001). Patients housed on a non-surgical unit were more likely to transfer rooms than patients on surgical units, 42.9% vs. 10.1% (p < 0.001), respectively. Multivariable analysis of natural log-transformed LOS showed any stay on a non-surgical unit increased LOS by 1.0 days (95% Cl 0.9–1.2 days, p = 0.026). There were no differences in ICU or PACU stay, cost, or postoperative complications in patients housed on surgical versus non-surgical units. CONCLUSIONS: Postoperative surgical patients had an increased length of stay when admitted to non-surgical units. More frequent room transfers occurred in patients admitted to non-surgical units. Evaluation of patient outcomes and LOS in open ventral hernia repair patients based on hospital unit is unique to this study.


id: cord-032756-ag7a0dx0
title: Regarding “Development of a Surgical Video Atlas for Resident Education: 3-Year Experience”
author: Goates, Andrew J.
date: 2020-09-18
txt: ./txt/cord-032756-ag7a0dx0.txt
cache: ./cache/cord-032756-ag7a0dx0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506784/
doi: 10.1177/2473974x20959069
abstract: nan
summary:
  title: Regarding "Development of a Surgical Video Atlas for Resident Education: 3-Year Experience" Regarding ''''Development of a Surgical Video Atlas for Resident Education: 3-Year Experience'''' DOI: 10.1177/2473974X20959069 We read with great interest the article by Brown et al, 1 ''''Development of a Surgical Video Atlas for Resident Education: 3-Year Experience.'''' In this article, the authors present their excellent work collaborating with the Journal of Medical Insight (JOMI) to produce 29 otolaryngology surgical videos to aid in surgical education. We congratulate the authors on their contributions and excellent work developing a high-quality product, and we look forward to seeing other innovative ways that clinicians incorporate intraoperative video resources into surgical training, particularly during this time when supplemental educational content is vital. Development of a surgical video atlas for resident education: 3-year experience An openaccess, comprehensive otolaryngology-head and neck surgery video atlas for resident education


id: cord-254686-pclq855r
author: Sanmugam, Anand
date: 2020-06-27
txt: ./txt/cord-254686-pclq855r.txt
cache: ./cache/cord-254686-pclq855r.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00383-020-04704-1
doi: 10.1007/s00383-020-04704-1
summary:
  The challenges faced by surgical specialties include, but are not limited to the risk of exposure to non-COVID-19 patients, transmission to healthcare workers (HCWs), judicious use and allocation of valuable resources such as ventilators, personal protective equipment (PPE), and blood products. The members of the paediatric surgery division of University of Malaya Medical Centre (UMMC) assumed additional responsibilities to provide assistance to both frontline HCWs and the management, in areas in need of support. This study describes the adaptive measures taken and evolving roles of the members of this paediatric surgery division upon the characterisation of COVID-19 as a pandemic. The biggest challenge we faced were to formulate a set of guidelines that ensured the safety of patients and healthcare personnel alike, at a time when there was limited published literature on the delivery of paediatric surgical service during a pandemic.

title:
  Assess, adapt and act: a paediatric surgery division’s initial approach in a rapidly evolving pandemic

abstract:
  PURPOSE: The COVID-19 pandemic has placed an unprecedented test on the delivery and management of healthcare services globally. This study describes the adaptive measures taken and evolving roles of the members of the paediatric surgery division in a developing country during this period. METHODS: We adopted multiple adaptive strategies including changes to stratification of surgeries, out-patient services by urgency and hospital alert status, policy writing involving multidisciplinary teams, and redeployment of manpower. Modifications were made to teaching activities and skills training to observe social distancing and mitigate reduced operative learning opportunities. Roles of academic staff were expanded to include non-surgical duties. RESULTS: The planned strategies and changes to pre COVID-19 practices were successful in ensuring minimal disruption to the delivery of essential paediatric surgical services and training. Despite the lack of established guidelines and literature outlining strategies to address the impact of this pandemic on surgical services, most of the initial measures employed were consistent with that of other surgical centres. CONCLUSION: Changes to delivery of surgical services and surgical training warrant a holistic approach and a constant re-evaluation of practices with emergence of new experiences and guidelines.


id: cord-258118-j26v354r
author: Karuppal, Raju
date: 2020-05-16
txt: ./txt/cord-258118-j26v354r.txt
cache: ./cache/cord-258118-j26v354r.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0972978X20301963?v=s5
doi: 10.1016/j.jor.2020.05.013
summary:
  Apart from the numerous chemicals, surgical smoke had been shown to harbour intact bacterial and virus particles especially COVID-19 in the current time. OBJECTIVE: To identify the inhalational, infectious, chemical, and mutagenic risks of surgical smoke and suggest evidence-based hazard reduction strategies. Heating of tissues causes vaporisation of protein and fat which results surgical smoke(2) which contain particles from combustion and numerous chemicals like hydrocarbons, acrylonitrile, phenols and fatty acids and biological particles, viruses, and bacteria which are known to be potentially hazardous. In COVID-19 outbreak scenario, the use of surgical diathermy has to be minimised or avoided due to the very high risk of viral spread among operating room personals. Multiple precautions like use of a standard surgical mask, laser or high filtration mask, masks coated with nanoparticles, operating room ventilation guidelines, and use of wall suction have been using to reduce the health hazards, but each one has its own limitations.

title:
  It is time for a more cautious approach to surgical diathermy, especially in COVID-19 outbreak: A schematic review

abstract:
  BACKGROUND: Many surgeons are unaware of the risks posed by the surgical diathermy. Apart from the numerous chemicals, surgical smoke had been shown to harbour intact bacterial and virus particles especially COVID-19 in the current time. OBJECTIVE: To identify the inhalational, infectious, chemical, and mutagenic risks of surgical smoke and suggest evidence-based hazard reduction strategies. Also to cogitate on the very high risk of viral spread spread by the use of surgical diathermy in COVID-19 outbreak. METHODS: A review of articles indexed for MEDLINE on PubMed using the keywords surgical smoke, diathermy, electrocautery, surgical smoke hazards, smoke evacuator, and guidelines for surgical smoke safety was performed. The review included evidences from 50 articles from the dermatology, surgery, infectious disease, obstetrics, and cancer biology literature. RESULTS: There are risks associated with surgical smoke. Although some surgeons were aware, majority were not keen in the hazard reduction strategies. CONCLUSION: Many chemical and biological particles have been found in surgical smoke. It is highly recommended to follow the standardised guidelines for surgical smoke safety. Surgical smoke carries full virus particle(such as COVID-19 virus), it is strongly recommended to minimise or avoid electrocautery during the COVID-19 outbreak.


id: cord-258243-2utl2mfl
author: Chen, Jeng-Wen
date: 2018-05-29
txt: ./txt/cord-258243-2utl2mfl.txt
cache: ./cache/cord-258243-2utl2mfl.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1371/journal.pone.0193317
doi: 10.1371/journal.pone.0193317
summary:
  We investigated the distribution of the three major categories of surgical indication according to sex, age group (<5 years, 5-11 years, 11-17 years, 18-40 years, and >40 years), hospital level (medical centers, regional hospitals, and local hospitals), and insured residence areas according to the NHI divisions (Taipei, Northern, Central, Southern, Kaoping, and Eastern). In the adult subgroup (Figs 2B and 3B) , the incidence and proportion of AT performed for RICI decreased from 46 (78%) in 1997 to 32 Table 3 indicates the number and percentage of the three categories of surgical indications according to sex, age groups, hospital level, and insured residence areas in the total study population. The trend in the AT rate and the proportion of surgical indications by the calendar year according to sex, age groups, hospital level, and insured residence areas in the total study population are shown in the supplemental data (S1 File).

title:
  Factors associated with changing indications for adenotonsillectomy: A population-based longitudinal study

abstract:
  OBJECTIVE: Adenotonsillectomy (AT) is one of the most common surgical procedures performed in children and adults. We aim to assess the factors associated with changes in the incidence of and indications for AT using population-level data. STUDY DESIGN: This retrospective cohort study investigated patients who underwent AT between 1997 and 2010 by using data from the Taiwan National Health Insurance Research Database. We examined surgical rates and indications by the calendar year as well as age, sex, hospital level, and insured residence areas for the correlating factors. RESULTS: The average annual incidence rate of AT was 14.7 per 100,000 individuals during 1997–2010. Pediatric (<18 years) patients represented 48.2% of the total AT population. More than 99% of the patients underwent the AT procedures as an inpatient intervention. Longitudinal data demonstrated an increasing trend in the pediatric AT rates from 1997 (4.3/100,000) to 2010 (5.7/100,000) (p = 0.029). In the adult subgroup, a decreasing prevalence of infectious indications (p = 0.014) coincided with an increasing neoplastic indications (p = 0.001). In the pediatric subgroup, the prevalence of obstructive indications increased (p = 0.002). The logistic regression analyses indicated that the significant factors associated with the changing surgical indications for AT were the age in the adult subgroup and hospital level in the pediatric subgroup. CONCLUSIONS: This study revealed a low AT rate in Taiwan than that in other countries. Pediatric AT incidence increased during 1997–2010. Although a rising prevalence of obstructive and neoplastic indications was noted, infection remained the most common indications for AT. Age in the adult subgroup and hospital level in the pediatric subgroup were factors associated with the changing indications for AT.


id: cord-258762-vabyyx01
author: Garbey, Marc
date: 2020-07-27
url: https://doi.org/10.3390/ijerph17155404
doi: 10.3390/ijerph17155404
title:
  A Systems Approach to Assess Transport and Diffusion of Hazardous Airborne Particles in a Large Surgical Suite: Potential Impacts on Viral Airborne Transmission

abstract:
  Airborne transmission of viruses, such as the coronavirus 2 (SARS-CoV-2), in hospital systems are under debate: it has been shown that transmission of SARS-CoV-2 virus goes beyond droplet dynamics that is limited to 1 to 2 m, but it is unclear if the airborne viral load is significant enough to ensure transmission of the disease. Surgical smoke can act as a carrier for tissue particles, viruses, and bacteria. To quantify airborne transmission from a physical point of view, we consider surgical smoke produced by thermal destruction of tissue during the use of electrosurgical instruments as a marker of airborne particle diffusion-transportation. Surgical smoke plumes are also known to be dangerous for human health, especially to surgical staff who receive long-term exposure over the years. There are limited quantified metrics reported on long-term effects of surgical smoke on staff’s health. The purpose of this paper is to provide a mathematical framework and experimental protocol to assess the transport and diffusion of hazardous airborne particles in every large operating room suite. Measurements from a network of air quality sensors gathered during a clinical study provide validation for the main part of the model. Overall, the model estimates staff exposure to airborne contamination from surgical smoke and biological material. To address the clinical implication over a long period of time, the systems approach is built upon previous work on multi-scale modeling of surgical flow in a large operating room suite and takes into account human behavior factors.


id: cord-259566-qtlq7a6l
author: Guraya, Salman Yousuf
date: 2020-06-23
txt: ./txt/cord-259566-qtlq7a6l.txt
cache: ./cache/cord-259566-qtlq7a6l.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1743919120305094
doi: 10.1016/j.ijsu.2020.06.027
summary:
  title: Transforming laparoendoscopic surgical protocols during COVID-19 pandemic; big data analytics, resource allocation and operational considerations; a review article Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up provides a brief account of the impact of the COVID-19, big data analytics of response of medical personnel in curtailing and understanding the disease process and the consensus guidelines for carrying out laparoscopic and endoscopic procedures. -Limiting the number of operating room personnel, use of disposable instruments, negative pressure air flow, and setting electrocautery energy devices at low modes can possibly reduce disease transmission during laparoendocsopic procedures.

title:
  Transforming laparoendoscopic surgical protocols during COVID-19 pandemic; big data analytics, resource allocation and operational considerations; a review article

abstract:
  The current dreadful pandemic of coronavirus disease (COVID-19) is playing havoc with humanity, socio-communal systems and economic reservoirs worldwide. Certain countries have managed to curtail COVID-19 crisis to some extent, however, a great majority still remains helpless in containing this outbreak. Rapidly evolving disease patterns and complex epidemiology of COVID-19 necessitate a tailored approach by medical experts in dealing with this devastating outbreak. Similar to other medical disciplines, surgical associations and societies have developed a tailored approach of patients’ selection and planning with improvised endolaparoscopic practice during the COVID-19 pandemic. Non-essential and non-urgent surgical procedures are deferred till this outbreak is abated. Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Laparoendoscopic procedures increase the risk of aerosol exposure, disease transmission and contamination. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up provides a brief account of the impact of the COVID-19, big data analytics of response of medical personnel in curtailing and understanding the disease process and the consensus guidelines for carrying out laparoscopic and endoscopic procedures.


id: cord-259984-csdf1a69
author: Raffiq, Azman
date: 2020-10-27
url: https://www.ncbi.nlm.nih.gov/pubmed/33154710/
doi: 10.21315/mjms2020.27.5.14
title:
  COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020

abstract:
  The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.


id: cord-260907-uuaa9ta2
title: Challenges to Medical Education on Surgical Services During the COVID-19 Pandemic
author: Schaffir, Jonathan
date: 2020-08-28
txt: ./txt/cord-260907-uuaa9ta2.txt
cache: ./cache/cord-260907-uuaa9ta2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32904384/
doi: 10.1007/s40670-020-01072-2
abstract: nan
summary:
  Clinical clerkships in surgery, obstetrics and gynecology, and anesthesiology require students to participate in surgeries and procedures to learn technical skills, and then demonstrate such skills to assess competence. The remainder of this paper focuses on the potential solutions and barriers to providing adequate undergraduate medical education in procedure-oriented fields in the setting of the COVID-19 pandemic. Educators looking to provide examples of surgical videos to their learners need to curate these collections with the knowledge base of the learner in mind [12, 13] . Creating educational tools that instruct students in surgical assisting may fill an important need. Sharing web-based video examples of appropriate communication techniques has been shown to be effective in teaching surgical trainees [23] . Students at our institution who were asked which remote teaching methods they considered the most helpful gave similar ratings to interactive online cases, remote lectures, and faculty-guided surgical videos. The effect of degree of immersion upon learning performance in virtual reality simulations for medical education


id: cord-262141-th2edwh4
title: Proper Use of Surgical N95 Respirators and Surgical Masks in the OR
author: Benson, Stacey M.
date: 2013-03-24
txt: ./txt/cord-262141-th2edwh4.txt
cache: ./cache/cord-262141-th2edwh4.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0001209213001038
doi: 10.1016/j.aorn.2013.01.015
summary:
  Surgical masks are also used to protect health care providers from contact with large infectious droplets (> 5 micrometer [mcm] in size)." 17(p357) The term protective facemask refers to a surgical N95 respirator or surgical mask that covers at least the nose and mouth to reduce the wearer''s risk of inhaling hazardous airborne particles (including dust particles and infectious agents). These fit-tested devices are personal protective devices that are worn on the face, cover at least the nose and mouth, and are composed of a filter that prevents the passage of a wide size range of hazardous airborne particulate matter, including dust particles and infectious agents, from entering the wearer''s breathing space. 47 According to the AORN "Recommended practices for laser safety in perioperative practice settings," during high-risk or aerosol-generating procedures in patients with or suspected of having transmissible infections (eg, HPV, tuberculosis, rubeola, varicella), respiratory protection that is at least as protective as a fit-tested surgical N95 respirator should be used in conjunction with local exhaust ventilation.

abstract:
  Proper adherence to infection control precautions, including appropriate selection and use of personal protective equipment (PPE), is of significant importance to the health and well-being of perioperative personnel. Surgical masks are intended for use as a barrier to protect the wearer’s face from large droplets and splashes of blood and other body fluids; however, surgical and high-filtration surgical laser masks do not provide enough protection to be considered respiratory PPE. Potential exposure to airborne contaminants and infectious agents, including those present in surgical smoke, necessitates the use of respiratory PPE, such as a surgical N95 particulate filtering facepiece respirator. Filtering facepiece respirators greatly reduce a wide size range of particles from entering the wearer’s breathing zone and are designed to protect the user from both droplet and airborne particles. Every health care worker who must use a respirator to control hazardous exposures in the workplace must be trained to properly use the respirator and pass a fit test before using it in the workplace.


id: cord-266977-5swwc6kr
author: Secker, Thomas.J.
date: 2020-09-19
txt: ./txt/cord-266977-5swwc6kr.txt
cache: ./cache/cord-266977-5swwc6kr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32956784/
doi: 10.1016/j.jhin.2020.09.021
summary:
  authors: Secker, Thomas.J.; Leighton, Timothy.G.; Offin, Douglas.G.; Birkin, Peter.R.; Hervé, Rodolphe.C.; Keevil, Charles.W. title: Journal of Hospital Infection A cold water, ultrasonic activated stream efficiently removes proteins and prion-associated amyloid from surgical stainless steel Aim: To test the efficacy of an ultrasonically activated stream for the removal of tissue 27 proteins, including prion-associated amyloid, from surgical stainless steel (SS) surfaces. This study has tested the efficacy of UAS technology for the removal of 239 total protein and prion-amyloid from stainless steel, which is considered the most difficult 240 contaminant to decontaminate in the surgical field. 335 J o u r n a l P r e -p r o o f Tissue protein (Dark grey bars) and prion-associated amyloid (light grey bars) attachment 545 from different prion-infected brain homogenates (22L, ME7 and 263K) to surgical stainless 546 steel pre and post treatment with an ultrasonically activated stream (UAS) (Graph A).

title:
  Journal of Hospital Infection A cold water, ultrasonic activated stream efficiently removes proteins and prion-associated amyloid from surgical stainless steel

abstract:
  BACKGROUND: Sterile Service Department decontamination procedures for surgical instruments struggle to demonstrate efficient removal of the hardiest infectious contaminants, such as prion proteins. A recently designed novel system, which utilises a low pressure ultrasonic activated, cold water stream, has previously demonstrated efficient hard surface cleaning of several biological contaminants. AIM: To test the efficacy of an ultrasonically activated stream for the removal of tissue proteins, including prion-associated amyloid, from surgical stainless steel (SS) surfaces. METHODS: Test surfaces were contaminated with 22L, ME7 or 263K prion infected brain homogenates. The surfaces were treated with the ultrasonically activated water stream for contact times of 5 and 10 seconds. Residual proteinaceous and amyloid contamination were quantified using sensitive microscopic analysis, and immunoblotting was used to characterize the eluted prion residues before and after treatment with the ultrasonically activated stream. FINDINGS: Efficient removal of the different prion strains from the surgical SS surfaces was observed, and reduced levels of protease sensitive and resistant prion protein was detected in recovered supernatant. CONCLUSIONS: This study demonstrated that an ultrasonically activated stream has the potential to be a cost-effective solution to improve current decontamination practices and has the potential to reduce hospital acquired infections.


id: cord-269457-i02brfzr
title: Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report
author: Kabba, Mustapha S.
date: 2020-10-17
txt: ./txt/cord-269457-i02brfzr.txt
cache: ./cache/cord-269457-i02brfzr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s12893-020-00904-7
doi: 10.1186/s12893-020-00904-7
summary:
  title: Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. CASE PRESENTATION: A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications. The presentation of our patient with a periumbilical mass and discharge of pus at the umbilicus prompted the potential differential diagnosis of an infected urachal cyst. This case shows that the diagnosis of gossypiboma can be complicated by its nonspecific presentation, which clinically and radiologically imitates other common pathologies, such as abscesses and tumors, and rare conditions, such as urachal cysts.

abstract:
  BACKGROUND: A retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. CASE PRESENTATION: A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable. CONCLUSION: This case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.


id: cord-275985-rj0o7lg2
title: Choosing the new normal for surgical education using alternative platforms
author: Keller, Deborah S.
date: 2020-08-30
txt: ./txt/cord-275985-rj0o7lg2.txt
cache: ./cache/cord-275985-rj0o7lg2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32904575/
doi: 10.1016/j.mpsur.2020.07.017
summary:
  Social media (SoMe), a tool that uses electronic communications and applications to allow users create and share information in dynamic ways, can meet this challenge. The COVID-19 pandemic has indeed created an abrupt need for new and innovative end-to-end training solutions, as well as a greater willingness for trainers and trainees to use novel technologies for surgical education. Social media and digital learning tools may be the ideal alternative platforms to meet the changing needs in surgical training and professional development. 5 Applications of SoMe specific for surgical education include live dissemination of research from peer-reviewed journals, live tweeting at medical conferences, online journal clubs, transmission of news from professional societies and surgical departments, coordination of research collaborative groups, and consultations/general discussion to further medical learning. A prime example of this communication ability is a closed Facebook group the Robotic Surgery Collaborative, which allow surgeons to share de-identified cases, post informal polls, and exchange questions and experiences regarding particular techniques or practices (Figure 1 ).

abstract:
  The traditional methods for surgical education and professional development are changing, from a variety of external factors. The COVID-19 pandemic accelerated the pace innovative alternative tools are introduced into clinical practice, creating a new normal for teaching and training. In this new normal is the challenge to create durable changes for the future of surgical education. Social media (SoMe), a tool that uses electronic communications and applications to allow users create and share information in dynamic ways, can meet this challenge. SoMe is reshaping how we communicate and learn, and offers great benefits for effective, individualized surgical education. The limits for SoMe appear endless, and elements have already help establish digital surgery to help improve the precision and outcomes of surgery. As we work to define the new normal in surgical education and professional development, SoMe digital surgery will be critical for continued growth and progress.


id: cord-277971-7upcsmg4
title: COVID‐19 and dermatologic surgery: hazards of surgical plume
author: Al‐Niaimi, Firas
date: 2020-05-15
txt: ./txt/cord-277971-7upcsmg4.txt
cache: ./cache/cord-277971-7upcsmg4.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/dth.13593
doi: 10.1111/dth.13593
abstract: nan
summary:
  Whilst we commend the authors for their work and comprehensive actions put in place, there was an omission of a critical factor highly pertinent to dermatologic surgery and potential COVID-19 transmission, namely surgical plume. The use of surgical masks may offer partial protection to respiratory droplets; however fine aerosolised particles from surgical plume may continue to pose an infectious risk to patient and staff. The use of specialised masks able to filter particles smaller than 5 microns (the threshold size for surgical masks) such as laser-specific masks or N95 masks offer better protection to aerosolised particles 4, 5 . Given that many dermatologic surgical procedures involve the head and neck area, careful attention to hazards posed by surgical plume and ablative lasers and attempts to mitigate these are essential interventions in the COVID-19 era.


id: cord-281656-8anh8rhm
title: Authors'' response: Laparoscopy and COVID-19: An off-key song?
author: Pata, Francesco
date: 2020-07-01
txt: ./txt/cord-281656-8anh8rhm.txt
cache: ./cache/cord-281656-8anh8rhm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32618961/
doi: 10.1097/ta.0000000000002842
abstract: nan
summary:
  At our knowledge, up until now, only one article demonstrated the presence of HBV in the surgical smoke in 10 of 11 HBV-positive patients undergoing laparoscopic or robotic surgery. Despite HIVand HBV being blood-borne viruses, laparoscopic surgery is being performed in HIV and HBV patients for many years, and no clear demonstration is available of viral transmission through the pneumoperitoneum or surgical smoke. For these reasons, we do not believe that results from the available literature can be extrapolated to the COVID-19 pandemic as to justify the current too restrictive guidelines on laparoscopic surgery against the evident and well-known and evidence-based advantages of laparoscopy with respect to the open approach in many fields of surgery. Thus, treating by laparotomy a reduced number of high-priority elective cases and surgical emergencies (sometimes failures of nonoperative management and, then, associated with a nonnegligible risk of conversion) may represent the safest option for patients, health workers, and system sustainability during the critical periods of COVID-19 outbreak.


id: cord-282786-kbr1p8e9
title: COVID-19: an opportunity to restructure surgical education
author: Juanz-González, Abelardo
date: 2020-07-09
txt: ./txt/cord-282786-kbr1p8e9.txt
cache: ./cache/cord-282786-kbr1p8e9.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s10353-020-00651-2
doi: 10.1007/s10353-020-00651-2
abstract: nan
summary:
  We noticed that our surgical trainees have had more time to spend on academic rather than administrative work, resulting in reduced symptoms of burnout amongst attending and resident surgeons. The construction of low-cost laparoscopic box trainers has been previously outlined [3] , and institutions that do not have access to high-end surgical training kits can still provide their surgical residents with opportunities using this accessible tool during the current pandemic. Institutions have had to adapt to K COVID-19: an opportunity to restructure surgical education different ways in which their surgical trainees learn, and-in our institution at least-have focused on reducing clinical activities and the high workload associated with surgical training to instead focus on academic and technical skills'' training. Future studies on the wider implications of this pandemic on surgical education would better outline the further adaptations required to deliver surgical training in a post-COVID-19 world.


id: cord-287376-wxldnlih
author: Krüger, Colin M.
date: 2020-08-03
txt: ./txt/cord-287376-wxldnlih.txt
cache: ./cache/cord-287376-wxldnlih.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3205/dgkh000354
doi: 10.3205/dgkh000354
summary:
  Finally, the choice of surgical method, whether open surgery or minimally invasive procedures, is critical in determining how many colleagues are exposed to the risk of infection from COVID-19 patients, sometimes for hours. Here, robot-assisted surgery can comply with the pandemic''s requirement to "keep your distance" in a unique way, since the surgeon can operate at virtually any distance from the surgical site, at least with regard to aerosol formation and exposure. There were two central factors in the German hospital landscape that led to the restrictions described below: First, the call by the German Federal Ministry of Health to substantially increase the number of intensive care beds which would allow invasive ventilation of patients by temporarily postponing elective procedures; and second, the shortage of personal protective equipment (PPE), which is mainly produced in China, that accompanied the beginning of the pandemic.

title:
  Can surgery follow the dictates of the pandemic “keep your distance”? Requirements with COVID-19 for hygiene, resources and the team

abstract:
  Since the beginning of the pandemic, there have been restrictions in the daily care of surgical patients – both elective and emergency. Readying supply capacities and establishing isolation areas and areas for suspected cases in the clinics have led to keeping beds free for treating (suspected) COVID-19 cases. It was therefore necessary to temporarily postpone elective surgery. Now, elective care can be gradually resumed with the second phase of the pandemic in Germany. However, it remains the order of the day to adapt pre-, intra- and post-operative procedures to the new COVID-19 conditions while maintaining specialized hygiene measures. This concerns the correct procedure for the use of personal protective materials as well as process adjustment for parallel treatment of positive and negative patients in the central OR, and handling of aerosols in the operating theater, operating room, and surgical site under consideration of staff and patient protection. Although dealing with surgical smoke in the operating theater has long been criticized, COVID-19 is forcing a renaissance in this area. Finally, the choice of surgical method, whether open surgery or minimally invasive procedures, is critical in determining how many colleagues are exposed to the risk of infection from COVID-19 patients, sometimes for hours. Here, robot-assisted surgery can comply with the pandemic’s requirement to “keep your distance” in a unique way, since the surgeon can operate at virtually any distance from the surgical site, at least with regard to aerosol formation and exposure.


id: cord-290209-gkx57lyq
author: Losurdo, Pasquale
date: 2020-09-14
txt: ./txt/cord-290209-gkx57lyq.txt
cache: ./cache/cord-290209-gkx57lyq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32926340/
doi: 10.1007/s13304-020-00884-6
summary:
  At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III–IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. The presence of a drain and a contaminated or dirty type of surgery (according to SWC) could increase the overall rate of SSIs, but the presence of a drain did not demonstrate an increased risk of superficial and/or deep SSIs. On the other hand, protection with surgical masks for both patient and surgeon during the post-operative period in the surgical unit and the absence of visitors, dramatically reduced superficial and deep SSIs. These two simple precautions emerged as independently associated with the reduction of both superficial and deep SSIs. Quality improvement initiatives aimed at reducing SSI rates are often hindered by limited or even conflicting evidence for proposed interventions to reduce SSI [33] . Surgery and the postoperative management of surgical wound carries a non-negligible risk of SSIs. In this study, we provided important insights into the superficial and deep surgical site infection risk assessment for patients who underwent surgery.

title:
  Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study

abstract:
  Surgical site infections are the most common in-hospital acquired infections. The aim of this study and the primary endpoint is to evaluate how the measures to reduce the SARS-CoV-2 spreading affected the superficial and deep SSI rate. A total of 541 patients were included. Of those, 198 from March to April 2018, 220 from March till April 2019 and 123 in the COVID-19 era from March to April 2020. The primary endpoint occurred in 39 over 541 patients. In COVID-19 era, we reported a lower rate of global SSIs (3.3% vs. 8.4%; p 0.035), few patients developed a superficial SSIs (0.8% vs. 3.4%; p 0.018) and none experienced deep SSIs (0% vs. 3.4%; p 0.025). Comparing the previous two “COVID-19-free” years, no significative differences were reported. At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III–IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. Furthermore, the presence of the drain was not associated with an increased risk of superficial and deep SSIs. In this study, we provided important insights into the superficial and deep SSIs risk assessment for patients who underwent surgery. Simple and easily viable precautions such as wearing surgical masks and the restriction of visitors emerged as promising tools for the reduction of SSIs risk.


id: cord-292129-m1ookq0l
author: Lee, Shu-An
date: 2008-03-07
txt: ./txt/cord-292129-m1ookq0l.txt
cache: ./cache/cord-292129-m1ookq0l.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/18326870/
doi: 10.1093/annhyg/men005
summary:
  Objectives: This study aimed at determining the protection factors (PFs) provided by N95 filtering facepiece respirators and surgical masks against particles representing bacterial and viral size ranges (aerodynamic size: 0.04–1.3 μm). Methods: The protection levels of N95 filtering facepiece respirators (four models) and surgical masks (three models) were investigated while they were donned by 12 subjects performing the OSHA (US Occupational Safety and Health Administration) fit-testing exercises in a test chamber. In this study, the number concentrations of NaCl particles (challenge aerosol) were size-selectively measured using the ELPI, so that the protection levels provided by N95 filtering facepiece respirators and surgical masks were determined when human subjects donned the tested respirators and performed the OSHA fit-testing exercises: normal breathing, deep breathing, turning head side to side, moving head up and down, talking, grimace, bending over and returning to normal breathing (Department of Labor, Occupational Safety and Health Administration, 1998) .

title:
  Respiratory Performance Offered by N95 Respirators and Surgical Masks: Human Subject Evaluation with NaCl Aerosol Representing Bacterial and Viral Particle Size Range

abstract:
  Objectives: This study aimed at determining the protection factors (PFs) provided by N95 filtering facepiece respirators and surgical masks against particles representing bacterial and viral size ranges (aerodynamic size: 0.04–1.3 μm). Methods: The protection levels of N95 filtering facepiece respirators (four models) and surgical masks (three models) were investigated while they were donned by 12 subjects performing the OSHA (US Occupational Safety and Health Administration) fit-testing exercises in a test chamber. Results: About 29% of N95 respirators and ∼100% of surgical masks had PFs <10, which is the assigned PF designated for this type of respirator by the OSHA. On average, the PFs of N95 respirators were 8–12 times greater than those of surgical masks. The minimum PFs were observed in the size range of 0.04–0.2 μm. No significant difference in PF results was found between N95 respirators with and without an exhalation valve. Conclusions: The study indicates that N95 filtering facepiece respirators may not achieve the expected protection level against bacteria and viruses. An exhalation valve on the N95 respirator does not affect the respiratory protection; it appears to be an appropriate alternative to reduce the breathing resistance.


id: cord-300689-dz6lybgi
title: The Surgical Health Services Research Agenda for the COVID-19 Pandemic
author: Jarman, Molly P.
date: 2020-06-01
txt: ./txt/cord-300689-dz6lybgi.txt
cache: ./cache/cord-300689-dz6lybgi.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32541230/
doi: 10.1097/sla.0000000000004126
abstract: nan
summary:
  Surgery programs are a source of surge capacity during the COVID-19 response, both in terms of inpatient bed capacity and clinical personnel, with many surgeons redeployed to focus on critical care or staffing COVID-19 procedure teams. COVID-19 and the resulting pandemic response broadly impact short-and long-term health outcomes for surgical patients. Payment and Delivery System What is the direct financial impact of delaying elective surgical care to hospitals, and outcomes including hospital closures, personnel layoffs, and decreased access to care for patients? Does postponement of emergency general surgery or use of nonoperative interventions to manage emergency general surgical conditions during the pandemic adversely impact outcomes for non-COVID patients, compared to emergency general surgery after prepandemic standards of care? COVID-19 will profoundly affect the US surgical system, including changes to healthcare infrastructure, payment systems, safety standards, clinical training, and population health.


id: cord-302104-wjad5q9q
author: Pavan, Nicola
date: 2020-06-05
txt: ./txt/cord-302104-wjad5q9q.txt
cache: ./cache/cord-302104-wjad5q9q.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S2405456920301565
doi: 10.1016/j.euf.2020.05.021
summary:
  title: Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic raised concerns about the safety of laparoscopy due to the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion in surgical smoke. Other clinical studies suggested a consistent risk of transmission for human papillomavirus (HPV) in the surgical treatments of HPV-related disease (mainly genital warts, laryngeal papillomas, or cutaneous lesions). Although no study was found investigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or any other coronavirus, we found that the theoretical risk of virus diffusion through surgical smoke cannot be excluded. Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era

title:
  Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era

abstract:
  CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic raised concerns about the safety of laparoscopy due to the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion in surgical smoke. Although no case of SARS-CoV-2 contagion related to surgical smoke has been reported, several international surgical societies recommended caution or even discouraged the use of a laparoscopic approach. OBJECTIVE: To evaluate the risk of virus spread due to surgical smoke during surgical procedures. EVIDENCE ACQUISITION: We searched PubMed and Scopus for eligible studies, including clinical and preclinical studies assessing the presence of any virus in the surgical smoke from any surgical procedure or experimental model. EVIDENCE SYNTHESIS: We identified 24 studies. No study was found investigating SARS-CoV-2 or any other coronavirus. About other viruses, hepatitis B virus was identified in the surgical smoke collected during different laparoscopic surgeries (colorectal resections, gastrectomies, and hepatic wedge resections). Other clinical studies suggested a consistent risk of transmission for human papillomavirus (HPV) in the surgical treatments of HPV-related disease (mainly genital warts, laryngeal papillomas, or cutaneous lesions). Preclinical studies showed conflicting results, but HPV was shown to have a high risk of transmission. CONCLUSIONS: Although all the available data come from different viruses, considering that the SARS-CoV-2 virus has been shown in blood and stools, the theoretical risk of virus diffusion through surgical smoke cannot be excluded. Specific clinical studies are needed to understand the effective presence of the virus in the surgical smoke of different surgical procedures and its concentration. Meanwhile, adoption of all the required protective strategies, including preoperative patient nasopharyngeal swab for COVID-19, seems mandatory. PATIENT SUMMARY: In this systematic review, we looked at the risk of virus spread from surgical smoke exposure during surgery. Although no study was found investigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or any other coronavirus, we found that the theoretical risk of virus diffusion through surgical smoke cannot be excluded.


id: cord-305282-x2zzzw43
title: Feasibility of Reusing Surgical Mask Under Different Disinfection Treatments
author: SUEN, C. Y.
date: 2020-05-20
url: http://medrxiv.org/cgi/content/short/2020.05.16.20102178v1?rss=1
doi: 10.1101/2020.05.16.20102178
abstract:
  The possibility to extend the lifespan or even reuse one-off personal protective equipment, especially for N95 respirator and surgical mask become critical during pandemic. World Health Organization has confirmed that wearing surgical mask is effective in controlling the spread of respiratory diseases in the community, but the supply may not be able to satisfy all the demands created all over the world in a short period of time. This investigation found that dry heat and UVC irradiance could effectively disinfect the mask material without creating significant damage to surgical mask.


id: cord-306226-znj4gp87
title: Surgical perspectives and patways in an emergency department during the COVID-19 pandemic
author: Alemanno, Giovanni
date: 2020-05-13
txt: ./txt/cord-306226-znj4gp87.txt
cache: ./cache/cord-306226-znj4gp87.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0002961020302683
doi: 10.1016/j.amjsurg.2020.05.010
abstract: nan
summary:
  According to the precautionary principle, every patient undergoing emergency surgery not already tested for COVID-19, must be considered as potentially infected, an issue that entails putting into practice of all precautions. This principle of safety for all healthcare professionals obviously translates into implementing all the provisions used in confirmed COVID-19 patients for surgical interventions that are not postponable and that require the immediate availability of the operating room (such as trauma, shock, bleeding, suicide attempts, peritonitis, etc). Patients with a negative swab for COVID-19 who require surgery undertake the "clean" pathway with dedicated operating rooms and the possibility of hospitalization in the Covid-free surgical ward. If we consider also the apparent reduction/absence of polytrauma due to social distancing measures imposed by the government, a minor human contact in patient handover (even if digital platforms are provided) and the difficulties in the technical management of surgical COVID-19 patients in emergency settings, this pandemic era is further tempering the spirit of surgeons.


id: cord-309751-7elnvjk3
title: COVID-19. An update for orthopedic surgeons
author: Abdelnasser, Mohammad Kamal
date: 2020-07-01
txt: ./txt/cord-309751-7elnvjk3.txt
cache: ./cache/cord-309751-7elnvjk3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1051/sicotj/2020022
doi: 10.1051/sicotj/2020022
summary:
  The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. Relevant information was digested and organized under 5 main headings; the impact of COVID-19 pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, perioperative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. Guidelines for ambulatory surgery centers for the care of surgically necessary/time-sensitive orthopaedic cases during the COVID-19 pandemic Perioperative considerations in urgent surgical care of suspected and confirmed COVID-19 orthopedic patients: Operating rooms protocols and recommendations in the current COVID-19 pandemic

abstract:
  The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.


id: cord-315089-csqjgozm
author: Kang, Chang Moo
date: 2020-09-24
txt: ./txt/cord-315089-csqjgozm.txt
cache: ./cache/cord-315089-csqjgozm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33029484/
doi: 10.4174/astr.2020.99.4.247
abstract: nan
summary:
  title: Non-face-to-face basic surgical skill education in the novel coronavirus disease 2019 (COVID-19) outbreak: obstacle vs. Therefore, it is considered important to develop the systematic non-face-to-face education system for proper basic surgical skill education in the novel COVID-19 pandemic moment. The education program for basic surgical sills was largely composed of student''s surgical skill practice using a portable surgical training kit and several online lectures. In the case of personal individual surgical skill practice, portable surgical training kits were previously rented to students, and pretraining education materials, such as video files showing how to perform basic surgical skills were produced and provided before the class. To establish a more effective non-face-to-face surgical education system, not to mention of more suitable portable surgical training kit, the development of a specialized SNS-based education system that can provide effective feedback between students and supervisors, and appropriate device for recording student surgical basic skills are necessary. Non-face-to-face basic surgical skill education in the COVID-19

title:
  Non-face-to-face basic surgical skill education in the novel coronavirus disease 2019 (COVID-19) outbreak: obstacle vs. opportunity?


id: cord-316483-nrx8ovvq
title: A Combined Approach to Priorities of Surgical Oncology During the COVID-19 Epidemic
author: Mazzaferro, Vincenzo
date: 2020-05-01
txt: ./txt/cord-316483-nrx8ovvq.txt
cache: ./cache/cord-316483-nrx8ovvq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32404676/
doi: 10.1097/sla.0000000000004005
abstract: nan
summary:
  All started and spread in the Lombardy region, the most populated region in Italy (10.2 million of inhabitants), with an outbreak accounting for most of the Italian registered cases of COVID-19, thousands of hospitalized patients, 15% of whom required an admission in intensive care units 2 . The current regional model of prioritization in surgical oncology, based on the "first-come, first-served" principle and able Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. With respect to the second aim, we proposed a renowned system of priority for patients with gastro-intestinal malignancies (about one quarter of the surgical volume for oncological indications) 5 largely drawn from organ transplant allocation principles, namely from the longstanding area of surgery in which the imbalance between demand and supply is permanent 6, 7 . In conclusion, an allocation scheme of priority for surgical oncology is proposed to face the dramatic restrictions in elective surgery resources during the COVID19 pandemic.


id: cord-318333-rzhrgp5q
title: COVID-19 infection, a potential threat to surgical patients and staff? A retrospective cohort study
author: Hou, Jiabao
date: 2020-09-03
txt: ./txt/cord-318333-rzhrgp5q.txt
cache: ./cache/cord-318333-rzhrgp5q.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1743919120306415?v=s5
doi: 10.1016/j.ijsu.2020.08.037
summary:
  BACKGROUND: This study aimed to describe the epidemiologic and clinical characteristics of coronavirus disease 2019 (COVID-19) in surgical patients and medical staff. 8 In this study, we report the epidemiological and clinical characteristics, treatment, and outcomes of surgical patients with confirmed COVID-19 pneumonia infection and the infection transmission from surgical patients to medical staff. 10 Patients with COVID-19 pneumonia were considered positive for SARS-CoV-2 with the use of the Chinese Center for Disease Control and Prevention (CDC) recommended kit (BioGerm, Shanghai, China), following WHO guidelines for qRT-PCR, 5 or by chest computed tomographic (CT) scans. 10 In the early stage of this epidemic (before January 23th, 2020), the nucleic acid tests were performed only on the suspected surgical patients with fever more than 37.3 ℃ and/or pulmonary infection (Chest CT/X-R ray showing) when entering the operating room, and medical staff only used the surgical mask to protect themselves.

abstract:
  BACKGROUND: This study aimed to describe the epidemiologic and clinical characteristics of coronavirus disease 2019 (COVID-19) in surgical patients and medical staff. METHODS: A single-center case series of 1586 consecutive surgical patients was selected at our hospital from January 13 to March 12, 2020. The epidemiological and clinical characteristics of COVID-19 were analyzed and followed up to May 20, 2020. The transmission of COVID-19 between the surgical patients and medical staff was also recorded. RESULTS: Seventeen (1.07%) surgical patients were diagnosed with COVID-19, with a high incidence in the thoracic department (9.37%), and the median age was 58 years (IQR, 53-73). The median time from hospital admission to COVID-19 diagnosis was 9.0 days (7.0-12.0) and was 6.0 days (4.0-7.0) from the day of surgery to COVID-19 diagnosis. Eleven (64.70%) patients suffered from pulmonary infection before surgery. When COVID-19 was diagnosed, common symptoms were fever (82.35%) and cough (94.12%), and most (82.35%) neutrophil/lymphocyte ratios were high (>3.5). Chest computed tomography (CT) (82.35%) showed bilateral dense shadows. Surgical patients with COVID-19 stayed in the hospital for approximately 35.0 days (25.5-43.0), with a mortality rate of 11.76%. Sixteen medical staff were infected with COVID-19 in the early stage. CONCLUSIONS: In this series of 1586 surgical patients, the COVID-19 infection rate was 1.07%, with an especially high incidence among patients with thoracic diseases. Middle-aged and elderly patients with preoperative pulmonary infection were more susceptible to COVID-19 infection after surgery. Medical staff were infected with COVID-19 and should take protective measures to protect themselves.


id: cord-324396-91v7uxnd
title: Commentary on ‘inimical effects of COVID-19 on surgical residency: Correspondence’
author: Jaumdally, Hannah
date: 2020-10-05
txt: ./txt/cord-324396-91v7uxnd.txt
cache: ./cache/cord-324396-91v7uxnd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.amsu.2020.09.039
doi: 10.1016/j.amsu.2020.09.039
abstract: nan
summary:
  The authors highlight several limitations to residency training including: facilities and equipment, whereby some countries may not have access to adequate animal models, simulations or cadavers to practice first hand; impact on research with reduced sample sizes and less people consenting to research; changes to learning with teaching reduced to case reports and seminars, reduced learning opportunities for junior residents in both the operating theatre and the subsequent management of surgical patients; changes to hospital processes including cancellation of elective procedures, less people attending an operating theatre at one time to reduce risk of transmission, the redeployment of surgical trainees onto COVID-related wards and the difficulties surrounding the use of personal protective equipment (PPE). Overall, we wholeheartedly agree with the authors on the potential negative consequences that the COVID-19 pandemic may have on the surgical speciality and it''s trainees and by extension, the repercussions on medical students, as we have identified.


id: cord-325290-hbzbyqi4
author: Payne, Anna
date: 2020-09-14
txt: ./txt/cord-325290-hbzbyqi4.txt
cache: ./cache/cord-325290-hbzbyqi4.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1931720420303597
doi: 10.1016/j.jsurg.2020.09.009
summary:
  title: Redeployment of surgical trainees to intensive care during the COVID-19 pandemic: evaluation of the impact on training and wellbeing OBJECTIVE: : The aim of this study was to evaluate the impact of redeployment of surgical trainees to intensive care units (ICUs) during the COVID-19 pandemicin terms of transferrable technical and non-technical skills and wellbeing. SETTING: : The study involved surgical trainees that had been redeployed to the (ICU) across all hospitals in London during the COVID-19 pandemic. CONCLUSIONS: : Redeployment of surgical trainees to ICU led to increased confidence in a number of technical and non-technical skills. 4 The aim of this study was to evaluate the impact of the redeployment of surgical trainees to critical care units during the COVID-19 pandemic in terms of transferrable skills, wellbeing and career development. Doctors working at postgraduate years two to four who were redeployed from surgical specialties to ICU during the COVID-19 pandemic were included.

title:
  Redeployment of surgical trainees to intensive care during the COVID-19 pandemic: evaluation of the impact on training and wellbeing

abstract:
  OBJECTIVE: : The aim of this study was to evaluate the impact of redeployment of surgical trainees to intensive care units (ICUs) during the COVID-19 pandemic- in terms of transferrable technical and non-technical skills and wellbeing. DESIGN: : This was a survey study consisting of a 23-point questionnaire. SETTING: : The study involved surgical trainees that had been redeployed to the (ICU) across all hospitals in London during the COVID-19 pandemic. PARTICIPANTS: : The survey was sent to 90 surgical trainees who were between postgraduate years two to four. Trainees in speciality training programs (>5 years after graduation) were not included. Thirty-two trainees responded to the questionnaire and were included in the study results. RESULTS: : All respondents spent between 4 and 8 weeks working in ICU. Prior to redeployment, 78% of participants had previous experience of ICU or an affiliated specialty, and >90% had attended at least one educational course with relevance to ICU. There were statistically significant increases in confidence performing central venous cannulation and peripheral arterial catheterisation (p<0.05). With regards to clinical skills, respondents reported feeling more confident managing ventilated patients, patients on non-invasive ventilation, dialysis and circulatory failure patients after working in ICU. Respondents (97%) felt that the experience would be beneficial to their future careers but 53% felt the redeployment had a negative impact on their mental health. CONCLUSIONS: : Redeployment of surgical trainees to ICU led to increased confidence in a number of technical and non-technical skills. However, proactive interventions are needed for training surgeons with regard to their psychological wellbeing in these extraordinary circumstances and to improve workforce planning for future pandemics.


id: cord-330940-ee63wosv
title: How do we teach surgical residents in the COVID-19 era?
author: Okland, Tyler S.
date: 2020-06-11
txt: ./txt/cord-330940-ee63wosv.txt
cache: ./cache/cord-330940-ee63wosv.txt
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mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1931720420301653
doi: 10.1016/j.jsurg.2020.05.030
summary:
  OBJECTIVE: In response to ongoing concerns regarding transmission of the novel coronavirus (COVID-19), surgical practice has changed for the foreseeable future. Practice guidelines recommend only urgent or emergent surgical procedures be performed to minimize viral transmission. This effectively limits standard training and practice for surgical residents. The purpose of this article is to describe opportunities in surgical simulation, and highlights the challenges associated with training in the COVID-19 era. CONCLUSIONS: This manuscript concisely discusses simulation options available to training programs, including the novel concept of "surgical kits." These kits include all instruments necessary to simulate a procedure at home, effectively pairing safety and utility. 3 In light of these concerns, surgical simulation appears to offer utility of both safety and procedural training for the surgical resident. In an effort to address current limitations on procedural education in our otolaryngology program, we have designed "simulation kits" to be distributed to otolaryngology junior residents.

abstract:
  OBJECTIVE: In response to ongoing concerns regarding transmission of the novel coronavirus (COVID-19), surgical practice has changed for the foreseeable future. Practice guidelines recommend only urgent or emergent surgical procedures be performed to minimize viral transmission. This effectively limits standard training and practice for surgical residents. The purpose of this article is to describe opportunities in surgical simulation, and highlights the challenges associated with training in the COVID-19 era. DESIGN: This is a perspective summarizing the potential role of surgical simulation to target training gaps caused by decreased surgical caseloads. CONCLUSIONS: This manuscript concisely discusses simulation options available to training programs, including the novel concept of “surgical kits.” These kits include all instruments necessary to simulate a procedure at home, effectively pairing safety and utility.


id: cord-332282-nehpwsqn
title: A hybrid approach to tracheostomy in COVID‐19 patients ensuring staff safety
author: Tanaka, L.
date: 2020-05-17
txt: ./txt/cord-332282-nehpwsqn.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32418207/
doi: 10.1002/bjs.11705
abstract: nan
summary:
  key: cord-332282-nehpwsqn Editor Hogan 1 reported in their correspondence that they ''endeavour, as always, to provide the highest level of patient care within the framework of imposed constraints and to preserve the health of the surgical workforce providing this care'' and that ''there is minimal evidence regarding emergency surgical Here, we describe a hybrid surgical tracheostomy using a percutaneous kit under a customized insulated field with the patient in a supine position using a thyroid drape (Fig. 1) . The goal was to avoid any leakage of viral particles through openings in the drape (made for the operator''s hands). Adding a customized insulated field and the hybrid technique, which avoids having to perform a fibreoptic bronchoscopy to check the tracheal puncture location or the final position of the Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services Global guidance for surgical care during the COVID-19 pandemic


id: cord-332960-h0be6pr0
title: Laparoscopy in the coronavirus disease 2019 (COVID-19) era
author: Angioni, Stefano
date: 2020-05-14
url: https://www.ncbi.nlm.nih.gov/pubmed/32435173/
doi: 10.1186/s10397-020-01070-7
abstract:
  The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in China at the end of 2019 has become a pandemic infection that has now involved 200 countries with 465,915 confirmed cases and 21,031 confirmed deaths. Unfortunately, many data have shown that the high number of undocumented infections could have a major role in the rapid diffusion of the disease. In most of the nations involved, non-urgent, non-cancer procedures have been stopped to reallocate medical and paramedical staff to face the emergency. Moreover, concerns have been raised that minimally invasive surgery could be a procedure that carries the risk of virus diffusion in the operating theater during surgery. This paper reports clinical recommendations and scientific studies to assist clinicians in this field.


id: cord-337958-472xu87g
title: SHOULD I BE CONCERNED? SURGICAL TRAINING IN THE TIME OF COVID19
author: Zuberi, Maaz K.
date: 2020-10-15
url: https://api.elsevier.com/content/article/pii/S1931720420303834
doi: 10.1016/j.jsurg.2020.10.006
abstract:
  As the US healthcare system restructured to deal with the COVID-19 pandemic, medical training was significantly disrupted. During the peak of the crisis, three surgical trainees in different stages of their residency shared their experiences and concerns on how this pandemic affected their training. The article is intended to generate discussion on the concerns of derailment and stagnation of surgical training and difficulties faced at all levels of surgical training to perform clinical duties and fulfill academic responsibilities during the early months of the COVID pandemic.


id: cord-342592-sf3iv8t4
title: Performance Improvement With Implementation of a Surgical Skills Curriculum
author: Loftus, Tyler J.
date: 2020-09-01
url: https://api.elsevier.com/content/article/pii/S1931720420303275
doi: 10.1016/j.jsurg.2020.08.030
abstract:
  OBJECTIVE: To assess the efficacy of an intern surgical skills curriculum involving a boot camp for core open and laparoscopic skills, self-guided practice with positive and negative incentives, and semiannual performance evaluations. DESIGN: Longitudinal cohort study. SETTING: Academic tertiary care center. PARTICIPANTS: Intervention group (n = 15): residents who completed the intern surgical skills curriculum and had performance evaluations in fall of intern year, spring of intern year, and fall of second year. Control group (n = 8): second-year residents who were 1 year ahead of the intervention group in the same residency program, did not participate in the curriculum, and had performance evaluations in fall of second year. RESULTS: In fall of second year of residency, the intervention group had better performance (presented as median values with interquartile ranges) than the control group on one-hand ties (left hand: 9.1 [6.3-10.1] vs 14.6 [13.5-15.4] seconds, p = 0.007; right hand: 8.7 [8.5-9.6] vs 11.5 [9.9-16.8] seconds, p = 0.039). The intervention group also had better performance on all open suturing skills, including mattress suturing (vertical: 33.4 [30.0-40.0] vs 55.8 [50.0-67.6] seconds, p = 0.001; horizontal: 28.7 [27.3-39.9] vs 52.7 [40.7-57.8] seconds, p = 0.003), and a water-filled glove clamp, divide, and ligate task (28.0 [25.0-31.0] vs 59.1 [53.0-93.0] seconds, p < 0.001). Finally, the intervention group had better performance on all laparoscopic skills, including peg transfer (66.0 [59.0-82.0] vs 95.2 [87.5-101.5] seconds, p = 0.018), circle cut (82.0 [69.0-124.0] seconds vs 191.8 [155.5-231.5] seconds, p = 0.002), and intracorporeal suturing (195.0 [117.0-200.0] seconds vs 359.5 [269.0-450.0] seconds, p = 0.002). CONCLUSIONS: Implementation of a comprehensive surgical skills curriculum was associated with improved performance on core open and laparoscopic skills. Further research is needed to understand and optimize motivational factors for deliberate practice and surgical skill acquisition.


id: cord-344682-4vpm7m1h
author: Ellison, E Christopher
date: 2020-09-12
txt: ./txt/cord-344682-4vpm7m1h.txt
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mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1072751520323085
doi: 10.1016/j.jamcollsurg.2020.08.766
summary:
  title: Impact of the COVID-19 Pandemic on Surgical Training and Learner Well-Being: Report of a Survey of General Surgery and Other Surgical Specialty Educators It included both closedand open-ended questions and the self-reported stages of GME during the COVID-19 pandemic as defined by the Accreditation Council for Graduate Medical Education (ACGME). Respondents reported the Sponsoring Institution''s (SI)ACGME Stage as either Stage 1: business as usual; Stage 2: increased but manageable clinical demand; or Stage 3: crossing a threshold beyond which the increase in volume and/or severity of illness creates an extraordinary circumstance where routine care education and delivery must be reconfigured to focus only on patient care. The experience with the COVID-19 pandemic highlights the need for institutions to develop disaster plans that include disruption to educational programs that not only include the "rules of engagement" around clinical redeployment but also the continuation of didactics and psychological counseling and other supportive infrastructure including childcare that are critical to sustain the wellness of learners.

title:
  Impact of the COVID-19 Pandemic on Surgical Training and Learner Well-Being: Report of a Survey of General Surgery and Other Surgical Specialty Educators

abstract:
  BACKGROUND: The COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication is to report the impact of the pandemic on surgical training and learner wellbeing and to document adaptations made by surgery departments. STUDY DESIGN: A 37-item survey was distributed to educational leaders in general surgery and other surgical specialty training programs. It included both closed- and open-ended questions and the self-reported stages of GME during the COVID-19 pandemic as defined by the Accreditation Council for Graduate Medical Education (ACGME). Statistical associations for items with Stage were assessed using categorical analysis. RESULTS: The response rate was 21% (472/2,196). U.S. Stage distribution (n=447) was Stage 1 22%, Stage 2 48%, Stage 3 30%. Impact on clinical education significantly increased by Stage with severe reductions in non-emergency operations (73%and 86% vs.98%) and emergency operations (8% and 16% vs. 34%). Variable effects were reported on minimal expected case numbers across all stages. Reductions were reported in outpatient experience (83%), in-hospital experience (70%), and outside rotations (57%). Increases in ICU rotations were reported with advancing stage (7%and 13%vs.37%). Severity of impact on didactic education increased with stage (14%and 30% vs.46%). Virtual conferences were adopted by 97% across all stages. Severity of impact on learner wellbeing increased by Stage: physical safety (6%and 9%vs.31%), physical health (0% and 7%vs.17%), emotional health (11% and 24%vs.42%). Regardless of stage most, but not all, made adaptations to support trainees’ wellbeing. CONCLUSION: The pandemic adversely impacted surgical training and wellbeing of learners across all surgical specialties proportional to increasing ACGME Stage. There is a need to develop education disaster plans, to support technical competency, and learner wellbeing. Careful assessment for program advancement will also be necessary. The experience during this pandemic shows that virtual learning and telemedicine will have significant impact on the future of surgical education.


id: cord-348614-im7qtr9k
title: International cooperation group of emergency surgery during the COVID-19 pandemic
author: Yánez Benítez, Carlos
date: 2020-10-13
txt: ./txt/cord-348614-im7qtr9k.txt
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mime: text/plain
url: https://doi.org/10.1007/s00068-020-01521-y
doi: 10.1007/s00068-020-01521-y
summary:
  These COVID-19 dedicated protocols addressed surgical team organization, operating room (OR) preparation, rational use of personal protective equipment (PPE), considerations on anesthesiology, and intraoperative management of emergency surgical pathology. Continuity performing their regular tasks was reported by 73 (54%) of the respondents, in contrast with the rest, whose newly assigned duties were to the emergency department COVID-19 triage (25%), the intensive care unit (ICU) activities (13%), or had to manage mechanically ventilated patients in the surgical ward (7%). About half (51%) of the respondents had not received training in the use of PPE for airborne infectious risk while performing emergency surgical procedures before the pandemic, and roughly over one-third (37%) had it during the studied period. This study provides an international snapshot of the level of adoption of the guidance for surgical team organization, adequacy of PPE availability and usage, OR preparation, anesthesiologic considerations, and intraoperative management of emergency surgical cases during 2 weeks of the COVID-19 pandemic.

abstract:
  PURPOSE: The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams’ adoption of recommendations during the pandemic. METHODS: Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. RESULTS: One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. CONCLUSION: Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.


id: cord-351373-a21453gz
title: Safe management of surgical smoke in the age of COVID‐19
author: Mowbray, N. G.
date: 2020-05-03
txt: ./txt/cord-351373-a21453gz.txt
cache: ./cache/cord-351373-a21453gz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32363596/
doi: 10.1002/bjs.11679
summary:
  A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. The Society of American Gastroenterology and Endoscopic Surgeons updated their advice on 30 March 2020 2 : ''Although previous research has shown that laparoscopy can lead to aerosolization of blood-borne viruses, there is no evidence to indicate that this effect is seen with COVID-19, nor that it would be isolated to MIS [minimally invasive surgery] procedures. This article reviews the best available evidence to understand the risk of transmission of COVID-19 in laparoscopic smoke, and what steps, based on physical properties of the virus, may be best placed to reduce this and justify continuing laparoscopic surgery under strict safety guidelines.

abstract:
  BACKGROUND: The COVID‐19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. METHODS: The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. RESULTS: Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set‐up, patient movement and operating theatre equipment when producing a COVID‐19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non‐filter devices, are discussed in detail. CONCLUSION: There is not enough evidence to quantify the risks of COVID‐19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.


id: cord-352884-umlxwnid
title: Surgical plume in dermatology: an insidious and often overlooked hazard
author: Searle, T.
date: 2020-08-11
txt: ./txt/cord-352884-umlxwnid.txt
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mime: text/plain
url: https://doi.org/10.1111/ced.14350
doi: 10.1111/ced.14350
summary:
  Dermatologists frequently undertake procedures using electrosurgical and ablative laser devices, generating a cloud of surgical smoke known as plume, which can pose harm to both patients and staff. A study reported the 70-year lifetime cancer risk of surgeons exposed to PAHs in electrocautery smoke was 117 times greater than that of a person exposed to the safe level of 1 9 10 À6 advised by the World Health Organization. 21 A study looking at concentrations of human papillomavirus (HPV) DNA from treated plantar warts in both ablative laser and electrocautery plume found the virus in 62% and 57%, respectively. Given the fact that ablative lasers generate greater concentrations of particles of greater infectious potential, it is highly recommended that ablative lasers are only used in patients confirmed as COVID-19free, with the maximum protection used such as filtering face piece (FFP)3 masks with appropriate filters, and plume extraction.

abstract:
  Dermatologists performing surgical procedures face occupational and health hazards when exposed to surgical plume released during electrosurgical and ablative laser procedures. These hazardous fumes have toxic, infectious and carcinogenic effects. Understanding this risk is of particular importance during the COVID‐19 pandemic as the understanding of the transmissibility and infectious nature of the virus is still evolving rapidly. In this article, we present the hazards from laser and surgical plumes, and discuss possible preventative measures aimed at reducing these risks.


id: cord-352937-htmp0avc
author: Chow, Velda Ling Yu
date: 2020-06-13
txt: ./txt/cord-352937-htmp0avc.txt
cache: ./cache/cord-352937-htmp0avc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32596489/
doi: 10.1002/lio2.417
summary:
  Comprehensive preoperative work‐up, careful patient selection, attention to details perioperation and multidisciplinary approach is essential in ensuring optimal outcomes after salvage surgery for recurrent nasopharyngeal carcinoma patients. In accordance with that suggested by the hospital infection control unit, if resources allow, patients should be quarantined in hospital 14 days prior to surgery followed by two sets of polymerase chain reaction (PCR) test for nucleic acid sequence homology in nasopharyngeal and throat swabs taken 24 hours apart. However, when performing AGP for unknown, suspected and confirmed COVID-19 patients, WHO, Centres for Disease Control and Prevention (CDC) and CHP recommend full barrier protection to avoid disease transmission to health care providers. However, as a result of the COVID-19 pandemic, outpatient services and endoscopy services have been reduced by 60% and 80% respectively to minimize social contact, conserve PPE, and reduce the risk of viral transmission amongst patients and health care providers. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease (COVID-19) in Healthcare Settings

title:
  Recommendations for surgical management of recurrent nasopharyngeal carcinoma during COVID‐19 pandemic

abstract:
  Nasopharyngeal carcinoma is endemic in southern parts of China including Hong Kong. Primary treatment entails radiotherapy ± chemotherapy depending on disease stage at presentation. Surgery is offered as a means of salvage for persistent and recurrent disease. Comprehensive preoperative work‐up, careful patient selection, attention to details perioperation and multidisciplinary approach is essential in ensuring optimal outcomes after salvage surgery for recurrent nasopharyngeal carcinoma patients. Since the COVID‐19 outbreak, we are faced with unprecedented challenges with priorities of care and resources being shifted to combat the virus. These include patient selection and timing of treatment, while preventing disease transmission to heath care providers. Practices and recommendations made in this document are intended to support safe clinical practice and efficient use of resources during this challenging time.


id: cord-353004-ocnp758o
title: COVID-19 in the operating room: a review of evolving safety protocols
author: Prakash, Lakshmanan
date: 2020-07-20
url: https://doi.org/10.1186/s13037-020-00254-6
doi: 10.1186/s13037-020-00254-6
abstract:
  BACKGROUND: The COVID-19 pandemic has already infected more than 3 million people across the world. As the healthworkers man the frontlines, the best practices model is continuously evolving as literature concerning the Coronavirus develops. METHODS: A systematic review of the available literature was performed using the keyword terms “COVID-19”, “Coronavirus”, “surgeon”, “health-care workers”, “protection” and “Orthopaedic Surgery”. All peer-reviewed articles we could find were considered. Randomized controlled trials (RCTs), prospective trials and retrospective studies, as well as reviews and case reports, were included in this systematic review. RESULTS: Even though surgical specialties including orthopedics are on the relative sidelines of the management of this pandemic but best practices models are inevitably developed for surgical specialties. The algorithm of postpone, delay, and operate only when life-threatening conditions exist is going to be useful up to a point. CONCLUSION: The surgical staff needs to keep abreast of the latest literature concerning safety measures to be taken during surgical procedures. Review articles can go some distance in helping in this educational process. This knowledge must evolve as new information comes to light.


id: cord-355319-2mn9cf79
title: Surgical facemask: an ally of exercise stress echocardiography during the COVID-19 pandemic?
author: CANO CARRIZAL, Rubén
date: 2020-10-29
txt: ./txt/cord-355319-2mn9cf79.txt
cache: ./cache/cord-355319-2mn9cf79.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1885585720304709?v=s5
doi: 10.1016/j.rec.2020.10.007
abstract: nan
summary:
  1 Regarding stress echocardiography, a key diagnostic tool in patients with coronary heart disease or suspected coronary heart disease, many studies have been delayed, giving priority to the pharmacological modality over the exercise modality, following previous ASE recommendations. 2 Nonetheless, exercise stress echocardiography (ESE) provides us with very valuable information such as the patient''s functional capacity and chronotropic response. The aim of our study was to assess whether the use of a surgical facemask during ESE negatively impacts on patients'' functional capacity and the percentage of conclusive studies. As a control group, we used patients who attended our center to perform an ESE with equal inclusion Previous studies have shown that heart rate during exercise is increased by the use of surgical facemasks in healthy participants. In conclusion, our study demonstrates that ESE with a surgical facemask is a feasible procedure.


id: cord-355431-efwuy8p9
title: The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives
author: Ambrosio, Luca
date: 2020-05-27
url: https://doi.org/10.1186/s40634-020-00255-5
doi: 10.1186/s40634-020-00255-5
abstract:
  The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19(+) patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice. In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.


