Preventing,Recognizing and Treating Postoperative Complications

Complications can occur after any operation, but are most likely after major surgery or in patients with significant cardiac or respiratory comorbidity. They range from distressing or inconvenient to life-threatening. Complications causing failure of a single body organ or system can lead to multiple system failure or even death. Investigating and treating complications (and litigation) cost the UK NHS billions of pounds every year. For example, a simple wound infection delays discharge from hospital by an average of 7 days, and costs an extra £1700.Surgery injures and kills cells, causing inflammatory mediators (e.g. cytokines, thromboxanes, leukotrienes, prostaglandins, nitric oxide) to be released. The inflammatory response prevents introduction of infection into the body and promotes healing. An uncomplicated recovery from surgery relies on the body being able to increase its metabolic rate to maintain its normal homeostatic mechanisms and mount an adequate inflammatory response.The normal source of energy for a cell is derived from adenosine triphosphate (ATP), created during the metabolism of glucose in the presence of oxygen. Aerobic respiration, utilizing the citric acid cycle and oxidative phosphorylation inside mitochondria, liberates sufficient energy to create 36 ATP molecules per glucose molecule. Without oxygen, only 2 ATP molecules and 2 pyruvate molecules are created per glucose molecule; pyruvate is converted to lactate. If oxygen or glucose is in short supply during or after surgery, cells switch to anaerobic metabolism, producing such small amounts of energy that membrane pumps fail. The cell swells and is eventually irreversibly damaged or ruptures. Cells with a high demand for oxygen (e.g. myocardial cells, neurons) are especially susceptible. Most postoperative complications develop when organs fail to function correctly because oxygen supply to their cells does not meet demand.The prevention of complications is paramount and, on a physiological level, can be thought of as providing cells with sufficient oxygen and glucose to meet their energy demands. This occurs when blood is oxygenated adequately and the heart can produce enough systolic pressure to perfuse the tissues. Patients must be assessed preoperatively to identify those at increased risk of postoperative hypoxaemia or organ hypoperfusion, so that their condition can be optimized and appropriate postoperative monitoring instituted (e.g. admission to an HDU). Prompt identification of postoperative hypoxaemia or organ hypoperfusion, followed by appropriate intervention, limits the severity of complications and prevents the spiral into multi-organ failure.This contribution discusses postoperative complications by reference to common scenarios.     

骨科无菌手术感染的预防

1993年7月至1994年9月,通过对手术室环境空气质量的调查与分析,结果表明:手术初始阶段和结束阶段;不同的手术时间:不同的手术环境;空气菌落数统计学并无明显差异。再次证实层流空气洁净系统对降低空气细菌含量与预防感染的有效性。对过滤空气中残留细菌菌种分析表明,表皮葡萄球菌为主要菌种。该菌种同样可自部分手术医师手培养中检出。1991年5月～1994年10月本院骨科采用综合预防感染措施以来完成的1140例无菌手术,无一例发生感染.但采用空气洁净系统以前,感染率为3～4‰。作者强调无菌手术感染的预防不能单纯依靠空气净化系统,而仍应重视综合的感染预防措施,才能达到理想的效果。     

Burnout among American surgeons

BACKGROUND: The long-term consequences of stress on the surgeon are unknown. One manifestation of stress is burnout. The purpose of this study was to measure the prevalence of burnout in actively practicing American surgeons. METHODS: The Maslach Burnout Inventory and a questionnaire of our own design were sent to 1706 graduates of various University of Michigan surgical residencies (1222) and members of the Midwest Surgical Association (484). The response rate was 44%. Responses from 582 actively practicing surgeons were the sample used for analysis. RESULTS: Thirty-two percent of actively practicing surgeons showed "high" levels of emotional exhaustion, 13% showed "high" levels of depersonalization, and 4% showed evidence for low personal accomplishment. Younger surgeons were more susceptible to burnout (r = -0.28, P <.01). Burnout was not related to caseload, practice setting, or percent of patients insured by a health maintenance organization. Important etiologic factors were a sense that work was "overwhelming" (r = 0.61, P <.01), a perceived imbalance between career, family, and personal growth (r = -0.56), P <.01), perceptions that career was unrewarding (r = -0.42, P <.01), and lack of autonomy or decision involvement (r = -0.39, P <.01). A strong association was noted between burnout elements and a desire to retire early (r = 0.50, P <.01). CONCLUSIONS: Burnout is an important problem for actively practicing American surgeons. These data could be used to modify existing surgical training curricula or as an aid to surgical leadership when negotiating about the surgical work environment.     

Orthopaedic injuries among electric bicycle users

IntroductionThe use of electric bicycles (E-bike) has dramatically increased. E-bikes offer convenient, environmental-friendly, and less expensive alternative to other forms of transport. However, E-bikes provide a new public health challenge in terms of safety and injury prevention.This study is the first to specifically investigate the E-bike related orthopaedic injuries, based on a national trauma registry.MethodsData from a National Trauma Registry were reviewed for patients hospitalized following E-bike related injuries. Between Jan 2014 to Dec 2015, a total of 549 patients were reviewed. Data were analyzed according to demography, type of orthopaedic injury, associated injuries and severity, injury mechanism and treatment in the operating room.ResultsA total of 360 (65%) patients sustained orthopaedic injuries, out of them 230 (63.8%) sustained limb/pelvis/spine fractures. Lower extremity fractures were more prevalent than upper extremity fractures (p < 0.001). The tibia was the most fractured bone (19.2%). Patients over the age of 50 years were at the highest risk for spine (20. 5%, p = 0.0001), pelvis (15.9%, p = 0.0001) and femoral neck (15.9%, p = 0.0172) fractures relative to other age groups. Approximately 42% of patients sustained associated injuries, with head/neck/face injuries being the most prevalent (30.3%). followed by chest (11.9%) and abdominal injury (13.3%). A collision between E-bike and a motorized vehicle was the mechanism of injury in 35% of cases. In this mechanism of injury, patients had 1.7 times the risk for associated injuries (p < 0.0001) and the risk for major trauma (ISS score ≥16) was more than the double (p = 0.03).One third of patients with orthopaedic injuries required treatment in the operating room.Treatment varied depending on the type of fracture.ConclusionsThis study provides unique information on epidemiological characteristics of orthpaedic injuries caused be E-bikes, pertinent both to medical care providers, as well as to health policy-makers allocating resources and formulating prevention strategies.     

Sequential Development among Dimensions of Job Burnout and Engagement among IT Employees

The current study examined the sequential development of job burnout and job engagement and their related antecedents (job demands, job resources and personality) using a three‐wave longitudinal design. We collected usable responses from 160 Information Technology employees in China. Using M‐plus 5.0, we compared four models: the exhaustion–cynicism–inefficacy model of burnout and the vigour–dedication–absorption model of engagement, the exhaustion–cynicism–inefficacy model of burnout and the dedication–absorption–vigour model of engagement, the cynicism–inefficacy–exhaustion model of burnout and the dedication–absorption–vigour model of engagement and the cynicism–inefficacy–exhaustion model of burnout and the vigour–dedication– absorption model of engagement. The results of the model comparisons revealed that the last model had the best fit with the data. In addition, we found that job demands, job resources and personality influenced burnout and engagement in different ways. The results showed that the pathways from job demands/job resources to burnout/engagement were robust and direct, whereas personality had both a direct influence and an indirect influence (through job demands/resources) on burnout/engagement. Copyright © 2013 John Wiley & Sons, Ltd.     

Orthopaedic injuries among survivors of USS COLE attack

The objective of this article is to describe the range of orthopaedic injuries and outcomes of acute treatment regimens among survivors of the USS COLE terrorist attack and to reemphasize basic treatment principles for blast injuries. With the current geopolitical environment, the average community orthopaedic surgeon may be involved in treating injuries due to an explosive terrorist attack. This is a retrospective review of a consecutive series of the 39 patients who were injured during the USS COLE attack on October 12, 2000, and were received at Naval Medical Center, Portsmouth, Virginia, from the MEDEVAC (Medical Evacuation) system. The 17 casualties from the attack were not included in this study. Data were retrospectively collected from patient charts for all patients who survived the USS COLE attack. The 39 patients who survived the USS COLE attack sustained 81 injuries. Fourteen patients sustained 32 orthopaedic injuries, of which 61% were lower extremity injuries. Of the 10 patients who required hospitalization, 6 had orthopaedic injuries (60%). Three of five open fractures (60%) became infected, and two of two (100%) open fracture wounds treated with primary closure in the initial setting were infected. Lower extremity orthopaedic injuries may predominate in a shipboard blast scenario. Even minor injuries require prolonged time before patients return to active duty. Complex wounds have high infection rates and should be treated according to previously established protocols for wartime injuries. Principles of provisional fracture stabilization prior to transport, adequate wound débridement, and delayed wound closure are reviewed.     

四川省骨科护士对围手术期病人口渴认知及临床管理的现况

目的 调查四川省骨科护士对围手术期病人口渴的认知情况及临床管理现状,为制订相关培训与管理方案提供参考依据。方法 采用便利抽样法,于2021年10月至2021年11月采用自制的问卷对四川省69家医院的骨科护士进行问卷调查,调查内容包括研究对象的一般资料、对围手术期病人口渴的认知情况及临床口渴管理现状。结果 共回收问卷1 294份,有效问卷1 267份,有效回收率为97.91%。四川省骨科护士对围手术期的口渴管理的知识掌握相对薄弱,有955名（75.37%）骨科护士未能正确回答口渴的临床表现,分别有624名（49.25%）、807名（63.69%）、892名（70.40%）、959名（75.69%）骨科护士不知晓围手术期口渴的评估时机、评估工具、干预口渴的媒介温度及干预口渴的频次;仅36名（2.84%）、32名（2.53%）骨科护士能列举5项以上干预口渴的护理措施及干预口渴的媒介。临床缺乏对围手术期口渴的规范管理,分别有1 104名（87.13%）、1 035名（81.69%）骨科护士所在科室缺乏评估口渴的工具及管理口渴的规范化流程。有388名（30.62%）骨科护士对干预口渴的效果自我评...     

Burnout among Plastic Surgery Residents in India: An Observational Study

Introduction  Burnout syndrome can be defined as emotional exhaustion, depersonalization, and perceived lack of personal accomplishment, all of which lead to decreased effectiveness at work. The Medscape burnout and depression report of 2018 suggests that the burnout range across various specialties ranges from 23 to 48%. There are no studies to assess the burnout among plastic surgery residents in India. This study is an attempt to assess the same. Materials and Methods  An online survey was conducted in March and April 2019 for plastic surgery residents across India. Various parameters including those related to gender, year of the curriculum, hobbies, exercise, and marital status were assessed. There were multiple sections in the survey, which included the demographic details, stress-related variables, and the abbreviated Maslach Burnout Inventory. The abbreviated Maslach Burnout Inventory is a validated scale that has been used to assess the burnout among plastic surgery residents in India. The three subscales, emotional exhaustion, depersonalization, and personal accomplishment were measured on a Likert scale. Univariable and multivariable analysis of factors associated with burnout was performed. Results  Of the 185 respondents, 48.4% experienced moderate-to-high burnout. Of these, 25% ( n = 46) were above the 75th centile of the overall burnout score, indicating severe burnout. Insufficient faculty involvement, insufficient time allotted for formalized teaching, conflict with colleagues, and lack of adequate support staff correlated with resident burnout on multivariate analysis. Residents who pursued their hobbies or performed physical activities for exercise had significantly lesser burnout. Conclusion  The incidence of burnout in plastic surgery residents surveyed in our study was 48.4%. The faculty of the departments and the residents themselves, as well as the governing bodies, all have a role to play to address the issue of burnout among residents. Dedicated and persistent efforts toward improving physical and psychological well-being of plastic surgery residents will positively impact not only the well-being of the residents but also the quality of patient care.     

Orthopaedic Literature and MeSH

Background  

Since 1916 there has been a recognized demand for a method of classification of orthopaedic literature inclusive enough to permit the proper collection and retrieval of all literature on the subject. Today, MEDLINE, available through the PubMed interface, has become the de facto standard for organization and retrieval of medical literature. The Medical Subject Headings (MeSH), used to provide indexing and assist in searching, are partly responsible for this standard. Understanding how MeSH is built and maintained may lead the user to a better understanding of how to use MEDLINE, and what to expect from the indexing of an article.     

Burnout,psychosomatic symptoms and job satisfaction among Dutch nurse anaesthetists: a survey

Background: To meet the increasing demand for healthcare providers, it is crucial to recruit and retain more nurse anaesthetists (NAs). The majority of NAs in the Netherlands are >45 years old, and retaining them in their jobs is very important. This study investigates the relationships among burnout, physical health and job satisfaction among Dutch NAs. Methods: Two thousand NAs working in Dutch hospitals were invited to participate in this online questionnaire. We tested the relationships among burnout, psychosomatic symptoms, sickness absence, perceived general health and job satisfaction. Results: Nine hundred and twenty‐three questionnaires were completed and analysed (46% response rate). Burnout and psychosomatic symptoms were negatively associated with job satisfaction, and predicted 27% of job satisfaction. Perceived general health was positively and sickness absence was negatively related to job satisfaction. Older NAs had a higher incidence of burnout than their younger counterparts. Conclusions: The results confirmed the importance of a healthy psychosocial work environment for promoting job satisfaction. To prevent burnout, further research is necessary to determine the factors causing stress. These findings may also apply to anaesthesiologists who share many tasks and work in close cooperation with NAs.