What is the purpose of launching World Journal of Orthopedics?

The first issue of World Journal of Orthopedics (WJO), whose preparatory work was initiated on March 11, 2010, will be published on November 18, 2010. The WJO Editorial Board has now been established and consists of 114 distinguished experts from 26 countries. Our purpose of launching WJO is to publish peer-reviewed, high-quality articles via an open-access online publishing model, thereby acting as a platform for communication between peers and the wider public, and maximizing the benefits to editorial board members, authors and readers.     

What is the purpose of launching World Journal of Diabetes?

The first issue of World Journal of Diabetes (WJD), whose preparatory work was initiated on September 23, 2008, is published on March 15, 2010. The WJD Editorial Board has now been established and consists of 323 distinguished experts from 38 countries. Our purpose of launching WJD is to publish peer-reviewed, high-quality articles via an open-access online publishing model, thereby acting as a platform for communication between peers and the wider public, and maximizing the benefits to editorial board members, authors and readers.     

What is the Future of Surgery in the UK?

Surgery is an invasive form of treatment and must be a ‘last resort’. Research into conditions that can be treated by surgery aims to make it extinct, by discovering the basis for various disease processes and treating them medically. A prime example of this is peptic ulceration, which was the ‘bread and butter’ of surgical training in the UK in the 1970s and 1980s, but is now a condition that has almost vanished from the surgical lexicon with the discovery of Helicobacter pylori and its treatment by triple therapy and proton pump inhibitors. In the ‘molecular age’, there is a strong possibility that other areas of surgery (which currently keep many surgeons occupied) will also diminish in volume and importance. Further, it would be worth looking briefly at a number of different specialties within surgery and speculating where changes may occur in the future, perhaps making operations less necessary. In those areas where molecular advances have not (or will not) eradicate open surgery, there will be a definite tendency towards minimally invasive procedures, even though the introduction of such procedures is seldom evidence based.     

Twenty Years of Biliopancreatic Diversion: What is the Goal of the Surgery?

Background: Comparative evaluation of weight loss after bariatric surgery is difficult without definition of success and without a norm for presenting results. We explored the pertinence of defining success: a residual BMI <40 or <35 kg/m², and the need for reporting results with stratification by initial obesity and length of follow-up. Methods: Results of 1,271 consecutive biliopancreatic diversion (BPD) patients were compared when presented with or without stratification, and we searched for landmarks of success which would be shared by patients themselves. Results: Presented globally, after a mean follow-up of 7.9 ± 4.2 years, BMI decreased from 48.4 ± 9.4 to 31.3 ± 6.5, and only 10% and 26% of patients would have been considered failures with a residual BMI ≥ 40 or ≥ 35 respectively. Because heavier patients were losing less in terms of percentage ( P <0.0001) and regained weight faster ( P <0.0001), global and cumulative results failed to show a failure-rate doubling every 5 years and a very high failure-rate in heavier patients. The landmarks of BMI 40 and 35 were the same unconsciously used by patients to express their own perception of failure. For patients with an initial BMI <50, a residual BMI of 35 caused a significant drop in the degree of satisfaction from 90 to 40%. For super-obese, the same critical point was found at a BMI of 40 where satisfaction dropped from 91 to 57%. Conclusion: Landmarks of success at BMI 40 and 35 were realistic, reasonable and coincided with patients' own expectations. Since initial obesity and duration after surgery made so much difference in results, a comparison of different surgical approaches was useless without stratification for both factors together.     

What is the Quality of Information About Bariatric Surgery on the Internet?

Background  The purpose of this study was to evaluate the role of Internet on patients scheduled for bariatric procedures and the quality of information available on different websites. Methods  Between July 2003 to July 2005, patients undergoing bariatric surgical procedures completed a survey. Data were collected prospectively. One hundred valid surveys were returned. Independently, two bariatric surgeons evaluated available French and English websites using major search engines. Results  Forty-two of 100 patients (42%) sought information about bariatric surgery on the Internet. Seventy-four percent of these patients (n = 31/42) used search engines with 81% visiting less than ten websites. According to the patient’s evaluation, 58% of the websites visited did not provide technical details of any surgical bariatric procedures, and only 61% provided information regarding postoperative weight loss. Furthermore, 58% of websites did not provide information about the laparoscopic approach, and 54% did not give any information on potential postoperative complications. Bariatric surgeon’s evaluation was similar except for two differences: laparoscopic approach and postoperative weight loss information were discussed in 90% (p < 0.001) and 43% (p < 0.1) of visited websites, respectively. Conclusion  When the Internet was used to search for information about bariatric surgery, search engines were preferentially used but search duration was short. Available Internet websites can be considered as moderately reliable; however, 25% of visited websites contain misleading information. Comparison between patients and surgeons views showed that patients were effective in detecting misleading information.     

What is the Cost of Free Cleft Surgery in the Middle East?

Background

This project explores the costs of cleft lip and/or palate surgeries in Palestine and Sudan, two low- and middle-income countries (LMIC), in the Middle East. Our purpose is to examine the veracity of advertisements from international cleft organizations claiming that “250 US dollars (USD) covers the cost of a single cleft surgery.” We hypothesize that the actual cost of surgery is greater than 250 USD.

Methods

Costs for each cleft surgery were organized broadly into 5 categories: hospital charges, personnel (time and money spent for health professionals to travel to LMIC, including lost wages), tests, consumables, and reusables. Each item was priced at market value during the time of data collection. Following itemization of actual costs, we compared the costs per cleft surgery among four surgical practice models: (1) visiting international surgical teams, (2) visiting international surgeon working with local teams, (3) local teams working at government hospitals, and (4) local teams working at private hospitals.

Results

Our results suggest that 250 USD is an underestimate of actual costs per cleft surgery in all models. The most expensive model in both Palestine and Sudan was the first model, visiting international teams performing all team functions; the cheapest surgical model in both countries was a local team working at government hospitals. The largest cost for any of these models is travel and lost wages for international team members. Eliminating this single cost (travel) decreases overall cost tremendously, but still does not approach the advertised cost of 250 USD.

Conclusions

We conclude that 250 USD underestimates the actual costs to perform a single cleft surgery in Palestine and Sudan. If international cleft organizations are genuinely committed to creating sustainable international cleft programs, they should focus exclusively on training local professionals to perform surgery in hospitals of their own choosing.

     

What is the Role of Autologous Blood Transfusion in Major Spine Surgery?

Major spine surgery is associated with significant blood loss, which has numerous complications. Blood loss is therefore an important concern when undertaking any major spine surgery. Blood loss can be addressed by reducing intraoperative blood loss and replenishing perioperative blood loss. Reducing intraoperative blood loss helps maintain hemodynamic equilibrium and provides a clearer operative field during surgery. Homologous blood transfusion is still the mainstay for replenishing blood loss in major spine surgery across the world, despite its known adverse effects. These significant adverse effects can be seen in up to 20% of patients. Autologous blood transfusion avoids the risks associated with homologous blood transfusion and has been shown to be cost-effective. This article reviews the different methods of autologous transfusion and focuses on the use of intraoperative cell salvage in major spine surgery. Autologous blood transfusion is a proven alternative to homologous transfusion in major spine surgery, avoiding most, if not all of these adverse effects. However, autologous blood transfusion rates in major spine surgery remain low across the world. Autologous blood transfusion may obviate the need for homologous transfusion completely. We encourage spine surgeons to consider autologous blood transfusion wherever feasible.     

Reporting the level of evidence in the Canadian Journal of Plastic Surgery: Why is it important?

The levels of evidence (LOE) table has been increasingly used by many surgical journals and societies to emphasize the importance of proper study design. Since their origin, LOE have evolved to consider multiple study designs and also the rigour of not only the study type but multiple aspects of its design. The use of LOE aids readers in appraising the literature while encouraging clinical researchers to produce high-quality evidence. The current article discusses the benefits and limitations of the LOE, as well as the LOE of articles published in the Canadian Journal of Plastic Surgery (CJPS). Along with an assessment of the LOE in the CJPS, the authors have provided recommendations to improve the quality and readability of articles published in the CJPS.