scholarly journals Minimizing SARS-CoV-2 exposure when performing surgical interventions during the COVID-19 pandemic

2020 ◽  
Vol 12 (7) ◽  
pp. 643-647 ◽  
Author(s):  
Aditya S Pandey ◽  
Andrew J Ringer ◽  
Ansaar T Rai ◽  
Peter Kan ◽  
Pascal Jabbour ◽  
...  
Keyword(s):  
Best Practices ◽  
Negative Pressure ◽  
Hot Spots ◽  
Clinical Care ◽  
Healthcare Personnel ◽  
Neurosurgical Procedures ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Neurosurgical Treatment ◽  
The Usa

BackgroundInfection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences.MethodsWe assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment.ResultsPatients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas.ConclusionBased on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.

Assessing variability in surgical decision making among attending neurosurgeons at an academic center

2020 ◽  
Vol 132 (6) ◽  
pp. 1970-1976
Author(s):  
Ashwin G. Ramayya ◽  
H. Isaac Chen ◽  
Paul J. Marcotte ◽  
Steven Brem ◽  
Eric L. Zager ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Repeated Measures ◽  
Elective Surgery ◽  
Statistical Tests ◽  
Neurosurgical Procedures ◽  
P Values ◽  
Surgical Interventions ◽  
Radiology Reports ◽  
Operative Notes ◽  
First Time

OBJECTIVEAlthough it is known that intersurgeon variability in offering elective surgery can have major consequences for patient morbidity and healthcare spending, data addressing variability within neurosurgery are scarce. The authors performed a prospective peer review study of randomly selected neurosurgery cases in order to assess the extent of consensus regarding the decision to offer elective surgery among attending neurosurgeons across one large academic institution.METHODSAll consecutive patients who had undergone standard inpatient surgical interventions of 1 of 4 types (craniotomy for tumor [CFT], nonacute redo CFT, first-time spine surgery with/without instrumentation, and nonacute redo spine surgery with/without instrumentation) during the period 2015–2017 were retrospectively enrolled (n = 9156 patient surgeries, n = 80 randomly selected individual cases, n = 20 index cases of each type randomly selected for review). The selected cases were scored by attending neurosurgeons using a need for surgery (NFS) score based on clinical data (patient demographics, preoperative notes, radiology reports, and operative notes; n = 616 independent case reviews). Attending neurosurgeon reviewers were blinded as to performing provider and surgical outcome. Aggregate NFS scores across various categories were measured. The authors employed a repeated-measures mixed ANOVA model with autoregressive variance structure to compute omnibus statistical tests across the various surgery types. Interrater reliability (IRR) was measured using Cohen’s kappa based on binary NFS scores.RESULTSOverall, the authors found that most of the neurosurgical procedures studied were rated as “indicated” by blinded attending neurosurgeons (mean NFS = 88.3, all p values < 0.001) with greater agreement among neurosurgeon raters than expected by chance (IRR = 81.78%, p = 0.016). Redo surgery had lower NFS scores and IRR scores than first-time surgery, both for craniotomy and spine surgery (ANOVA, all p values < 0.01). Spine surgeries with fusion had lower NFS scores than spine surgeries without fusion procedures (p < 0.01).CONCLUSIONSThere was general agreement among neurosurgeons in terms of indication for surgery; however, revision surgery of all types and spine surgery with fusion procedures had the lowest amount of decision consensus. These results should guide efforts aimed at reducing unnecessary variability in surgical practice with the goal of effective allocation of healthcare resources to advance the value paradigm in neurosurgery.

Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience

2020 ◽  
Vol 25 (1) ◽  
pp. 51-56
Author(s):  
Steffen Fleck ◽  
Sascha Marx ◽  
Clara Bobak ◽  
Victoria Richter ◽  
Stephan Nowak ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Neurosurgical Procedures ◽  
Normal Brain ◽  
Indications For Surgery ◽  
Single Center ◽  
Neurosurgical Procedure ◽  
Oncological Treatment ◽  
Single Center Experience ◽  
Stage 4 ◽  
Neurosurgical Treatment

OBJECTIVEIntracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors’ aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neuroblastoma.METHODSThis study is a retrospective single-center analysis of all neurosurgical strategies used in the treatment of intracerebral metastases in neuroblastoma patients.RESULTSBetween 2009 and 2017, 237 pediatric patients (94 girls, 143 boys) with a mean age of 39 months at diagnosis were treated for neuroblastoma. Five (2.1%) of the 237 patients had a neurosurgical procedure for intracerebral metastases. The metastases occurred a mean of 46 months after initial diagnosis. All of these patients had neuroblastoma stage 4. Indications for surgery were recurrent metastases after initial successful oncological treatment or progression of the metastasis under oncological treatment as well as deterioration of neurological function. Intraoperatively, the tumor usually had a distinguishable dissection plane but was infiltrative to adjacent nerves in some spots. Mean overall survival after the neurosurgical procedure was 22 months. Furthermore, in another 3 patients, a neurosurgical procedure was done for an intracranial but extracerebral metastasis.CONCLUSIONSNeurosurgical procedures for intracerebral metastases in neuroblastoma patients are rare and were performed in 2.1% of patients in the present study. Intracerebral metastases occurred during disease progression, and the prognosis after surgery was very limited. The main indications for surgery were rapid neurological deterioration or recurrence of the metastasis after initial successful oncological treatment. Intraoperatively, the metastases usually had a distinguishable dissection plane from the normal brain tissue.

Quality of life after anti-reflux surgical interventions: possible solutions to the problem

2020 ◽  
pp. 3-25
Author(s):  
D. Lukanin ◽  
G. Rodoman ◽  
M. Klimenko ◽  
A. Sokolov ◽  
A. Sokolov
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
Nissen Fundoplication ◽  
Laparoscopic Nissen Fundoplication ◽  
Partial Fundoplication ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

scholarly journals Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

2019 ◽  
Vol 8 (4) ◽  
pp. 555 ◽  
Author(s):  
Cátia Caneiras ◽  
Cristina Jácome ◽  
Sagrario Mayoralas-Alises ◽  
José Ramon Calvo ◽  
João Almeida Fonseca ◽  
...  
Keyword(s):  
Clinical Research ◽  
Patient Experience ◽  
Clinical Care ◽  
Research Priorities ◽  
Specific Patient ◽  
Quality Healthcare ◽  
Body Of Knowledge ◽  
Number Of Patients ◽  
Patient Reported ◽  
System Sustainability

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

scholarly journals Global research activity on antimicrobial resistance in food-producing animals

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Waleed M. Sweileh
Keyword(s):  
Antimicrobial Resistance ◽  
Hot Spots ◽  
One Health ◽  
Research Collaboration ◽  
Search Query ◽  
Scientific Publications ◽  
Research Theme ◽  
The Usa ◽  
Number Of Publications ◽  
Number Of Citations

Abstract Background Antimicrobial resistance (AMR) is a global challenge that requires a “One Health” approach to achieve better public health outcomes for people, animals, and the environment. Numerous bibliometric studies were published on AMR in humans. However, none was published in food-producing animals. The current study aimed at assessing and analyzing scientific publications on AMR in food-producing animals. Method A validated search query was developed and entered in Scopus advanced search function to retrieve and quantitatively analyze relevant documents. Bibliometric indicators and mapping were presented. The study period was from 2000 to 2019. Results The search query retrieved 2852 documents. During the period from 2015 to 2019, approximately 48% of the retrieved documents were published. The article about the discovery of plasmid-mediated colistin resistance in pigs received the highest number of citations (n = 1970). The Journal of Food Protection (n = 123; 4.3%) ranked first in the number of publications while the Applied and Environmental Microbiology journal ranked first in the number of citations per document. The USA led with 576 (20.2%) documents followed by China (n = 375; 13.1%). When the number of publications was standardized by income and population size, India (n = 51.5) ranked first followed by China (n = 38.3) and Brazil (n = 13.4). The growth of publications from China exceeded that of the USA in the last 3 years of the study period. Research collaboration in this field was inadequate. Mapping author keywords showed that E. coli, Salmonella, poultry, Campylobacter, chicken, cattle, and resistant genes were most frequent. The retrieved documents existed in five research themes. The largest research theme was about AMR in Salmonella in food-producing animals. The most recent research theme was about the dissemination and molecular transfer of AMR genes into the environment and among different bacterial strains. Conclusion Hot spots of research on AMR in food-producing animals match the world regions of reported hot spots of AMR in animals. Research collaboration in this field is of great importance, especially with low- and middle-income countries. Data on AMR need to be collected nationally and internationally to implement the “One Health” approach in the fight against AMR.

scholarly journals Structural vulnerability: migration and health in social context

2021 ◽  
Vol 6 (Suppl 1) ◽  
pp. e005109
Author(s):  
Lauren Carruth ◽  
Carlos Martinez ◽  
Lahra Smith ◽  
Katharine Donato ◽  
Carlos Piñones-Rivera ◽  
...  
Keyword(s):  
Clinical Care ◽  
Professional Associations ◽  
Humanitarian Assistance ◽  
Structural Vulnerability ◽  
Global Migration ◽  
Humanitarian Interventions ◽  
Care Models ◽  
The Usa ◽  
Mexico Border ◽  
Training And Support

Based on the authors’ work in Latin America and Africa, this article describes and applies the concept ‘structural vulnerability’ to the challenges of clinical care and healthcare advocacy for migrants. This concept helps consider how specific social, economic and political hierarchies and policies produce and pattern poor health in two case studies: one at the USA–Mexico border and another in Djibouti. Migrants’ and providers’ various entanglements within inequitable and sometimes violent global migration systems can produce shared structural vulnerabilities that then differentially affect health and other outcomes. In response, we argue providers require specialised training and support; professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants; migrants should help lead efforts to reform medical and humanitarian interventions; and alternative care models in Global South to address the structural vulnerabilities inherent to migration and asylum should be supported.

Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

2021 ◽  
Vol 23 (3) ◽  
pp. 157-164
Author(s):  
Valery V. Semenov ◽  
Sofya А. Prudyeva ◽  
Alexander A. Kurygin
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Treatment Strategies ◽  
Repeated Administration ◽  
Early Postoperative Period ◽  
Diagnosis And Treatment ◽  
Wound Therapy ◽  
Active Growth ◽  
Surgical Interventions ◽  
Ventral Hernias

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of 3 h), course of the early postoperative period on days 35 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages IIIII obesity and type 2 diabetes mellitus). The use of the negative pressure wound therapy resulted in wound cleansing for 4.1 2.5 days (p 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The negative pressure wound therapy is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S 10 cm2) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

National trends in Fontan operation and in-hospital outcomes in the USA

Heart ◽  
2018 ◽  
Vol 105 (9) ◽  
pp. 708-714 ◽  
Author(s):  
Emmanuel Akintoye ◽  
William R Miranda ◽  
Gruschen R Veldtman ◽  
Heidi M Connolly ◽  
Alexander C Egbe
Keyword(s):  
Postoperative Complications ◽  
Hospital Mortality ◽  
Fontan Operation ◽  
Disease Diagnosis ◽  
Significant Decline ◽  
Cardiac Complications ◽  
Study Objective ◽  
Number Of Patients ◽  
The Usa ◽  
Significant Change

BackgroundNational prevalence and outcomes of Fontan operation in the USA is unknown. Study objective was to determine trends (temporal change) in the annual volume of Fontan operations, in-hospital mortality, postoperative complications and type of hospital discharge.MethodsReview of the Nationwide Inpatient Sample for patients that underwent Fontan operation from 2001 to 2014 using the International Classification of Diseases-Ninth Revision, Clinical Modification procedure code for Fontan operation, that is, 35.94. To evaluate for change in patients’ demographics over the years, we divided the patient population into four groups based on procedure year (2001–2004, 2005–2008, 2009–2011 and 2012–2014).ResultsAn estimated 15 934 Fontan operations were performed in the USA from 2001 to 2014. Median (Q1–Q3) age was 3 (2–4) years and 39.8% were female. Hypoplastic left heart syndrome was the most common (29%) congenital heart disease diagnosis. An estimated 1175 procedures were performed in 2001 and 1340 in 2014, but there was no significant change in the number of procedures per year (p=0.47). There was significant decline in in-hospital mortality from 4.5% (53/1175) in 2001 to 1.1% (15/1340) in 2014 (p=0.009). When we compared event rates between 2001–2004 and 2012–2014 periods, there was significant decline in postoperative cardiac complications (12.6% (459/3640) to 8% (378/4706), p=0.007) and respiratory complications (17.1% (623/3640) to 10.2% (481/4706), p<0.001). However, there was increase in the number of patients discharged to home with healthcare assistance or transferred to another acute care facility (5.8% (211/3640) to 9.4% (443/4706), p=0.01) and inflation-adjusted hospitalisation cost (US$46 978 to US$60 383, p<0.001), but no significant change in length of stay (p=0.73).ConclusionOn the average, 1062 Fontan operations are performed annually in the USA with no change in volume of procedures but a decrease in in-hospital mortality and postoperative complications over a 15-year period.

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