Swiss Contributions to War Surgery During the Great War

Background

The role of neutral Switzerland during World War I is somewhat mysterious and its diplomatic history has never been fully disclosed. One of the activities might have determined its role: based on its relationship to the International Committee of the Red Cross, wounded multinational prisoners-of-war were interned in Swiss hospitals and Swiss physicians worked in a medical capacity in military hospitals on both sides of the front.

Questions/purposes

The main question is whether the activities of the Swiss authorities reflected a charitable diplomatic role while retaining the country’s traditional neutral stance. Supplementary practical questions included: How did Switzerland carry out the exchange of severely wounded prisoners of war? How did Swiss physicians function in the war zones? What were the medical objectives and the ultimate results of wartime surgery in Switzerland?

Methods

This study is based on archival material from the Swiss Federal Archive in Bern (BAR) and original publications of Swiss and German physicians in professional journals. The search was performed manually in the BAR evaluating the file “Landesverteidigung (national defense)” from 1848 to 2009. Original publications and journals were searched manually in the central libraries of Munich, Heidelberg, Zurich, and Bern.

Results

The evaluation of Swiss diplomatic activities confirmed that Switzerland’s charitable mission was aimed to enforce its neutral position and that Swiss authorities were able to efficiently manage the resulting problems. The engagement of Swiss surgeons in war surgery contributed to their experience and knowledge and yielded the development of many innovative medical devices and operating procedures, numerous of which are still known today.

Conclusion

While maintaining its neutral position, Switzerland was able to deal with the practical problems while gaining innovative medical knowledge still valid today.     

Risk and resilience factors for posttraumatic stress symptomatology in Gulf War I veterans

What factors distinguish war‐exposed veterans who experience posttraumatic stress symptomatology (PTSS) from those who do not? This study used structural equation modeling procedures to examine the complex interplay among predeployment, war‐zone, and postdeployment factors as they relate to PTSS in a sample of Gulf War I veterans. A primary goal was to determine to what extent previously documented associations among Vietnam veterans would replicate in this more contemporary veteran cohort. Results supported a multivariate etiological perspective on PTSS, with war‐zone factors accounting for the largest proportion of variance in PTSS. The majority of hypothesized associations held, suggesting that the mechanisms underlying PTSS may be similar across veteran cohorts.     

Vietnam veterans in the general hospital: Seven years later

Vietnam era veterans who were originally part of a sample of 300, were surveyed in 1982 and again in 1989. There were significant increases in symptom scores in 5 of 20 questions for the combat veteran subgroup from 1982 to 1989. The avoidance group of symptoms had the highest scores in 1989. Combat veterans continued to be more symptomatic than their non-combat contemporaries. Vietnam veterans estimate of combat activity differed with the passage of time.     

Pain in veterans of the Gulf War of 1991: a systematic review

Background  

Veterans of the Persian Gulf War of 1991 have reported a range of adverse health symptoms. This systematic review aims to identify all studies that have compared the prevalence of symptoms of pain in veterans of the Gulf War to that in a non-Gulf military comparison group, and to determine whether Gulf War veterans are at increased risk of reporting pain.     

Nursing care for ambulatory day surgery: the concept and organization of nursing care

Background: the Day Surgery Unit at the University Hospital in Uppsala provides ambulatory care for people requirering Ear Nose and Throat surgery, hand and minor plastic surgery, as well as for children and adults needing dental treatment. Aim: the Day Surgery Unit has as it’s goal to provide an effective form of surgery with a high level of quality care, both pre and post operative on an ambulatory basis. To attain this goal, nursing care has as it s aim to provide high quality care through knowledge and good nursing, thereby creating trust, security and well being between patients and staff. All this together puts the patient in the center and gives individual nursing care. In this project we also wanted to evaluate patients satisfaction with the nursing care. Methods: the nursing care is organized according to four principles: patient information, primary nursing, nursing documentation and quality assurance. The patients receive information on repeated occasions, both written and oral. Written infonnation is first given to the patient by the co-ordinating nurse when the time for surgery is set up. A nurse and an assistant nurse from the care team work together with each individual patient.These nurses are primarily responsible for the patient from the first visit one week before surgery until the day after surgery. The nurses document in the patients joumal according to a Swedish system called VIPS. At the first contact a health status is taken and nursing care goals are set up with the patient. After the follow up telephone call with the patient on the day after surgery, are all the interview results with regards to post surgery and nursing care documented. The quality of nursing care is continually evaluated according to the model for quality assurance, DySSSy. Evaluation of the nursing care has been made in a patient survey in which 100 adults between the ages of 30–69 years were given questionnaires. Of these, 68 were returned and one was not responded to. Result: we found that the day surgery clinic provides a more effective form of care with a high quality of service. There is a shorter length of stay for the patients and the overall quality of care is maintained through an active program of information and a system of continuity of care. Conclusions: we have written pre and post operative information for each diagnosis. A survey is being conducted to evaluate the patients response to the post operative infonnation provided. Documentation undergoes continual evaluation and development. The DySSSy projects have included, patient integrity and safety in giving hand-over reports to the operating personel; evaluation of post operative information and pain management and nutrition for patients undergoing tonsillectomy and uvulopharyngopalatiplasty.     

A strategy for reducing surgical backlogs: lessons from a veterans administration hospital

A process was developed to use a nontraditional operative day (Saturday) to increase the number of inguinal herniorrhaphies (IHs) performed. The purpose of this analysis was to compare operating times and outcomes between patients undergoing IH on Saturday versus the weekday. A retrospective review was conducted that included patients who underwent IH from October 2008 to January 2010. This cohort was divided based on the day on which surgery occurred. The outcome measures were operative times, room turnover time, and complication rates. Operative time was shorter for Saturday IHs (50.7 vs. 67.8 min, P ≤ 0.001). The greatest difference between the two groups occurred in turnover times. We considered Saturday turnover time to be zero, which was possible because of multiple support teams and additional room availability. Turnover times during the week averaged 40.5 ± 2 minutes. There was no difference in complication rates for the two groups (Saturday IHs 17.6% vs. 20.9% for weekday IHs, P = 0.75). Elective cases can be accomplished more rapidly during nontraditional operating times if there are multiple support teams and rooms available.     

Educational curriculum and organization in the general hospital

With sufficient organization and personal activity comprehensive postgraduate medical education can successfully be carried out even at a small surgical department, especially--but not exclusively--in one's early years of postgraduate education and especially if external course offers are made use of. Postgraduate education is endangered not so much because of local circumstances, but because of external influences like official regulations on working-time, the lack of offers for rotations, and restrictions on our duty to take professional care of people.     

War injuries during the Gulf War: experience of a teaching hospital in Kuwait.

The war injuries of 361 patients admitted to Mubarak Al-Kabeer Teaching Hospital, during the Gulf War are reported. More abdominal and chest injuries were seen in this series in comparison with other conflicts owing to the short evacuation time. Of the injuries, 54% were caused by gunshots, 34% were fragment injuries and 5.5% were glass and stab injuries. Civilians accounted for 50% of the injured. Wound infection rate was 7%, average hospital stay was 8.8 days and hospital mortality was 5.5%. We advocate radical wound excision, exploration of penetrating wounds of neck and abdomen, and mainly conservative management of chest injuries that do not involve the mediastinum.