Surg J R Coll Surg E
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The systemic inflammatory response to cardiac surgery is common, and resultant impairment of multiple organ function is generally mild or subclinical due to physiological reserve within organ systems. Unfortunately, the changing profile of patients referred for surgery suggests that the systemic inflammatory response may prominently influence surgical outcome in the future. Older, co-morbid patients with more limited physiological reserve are being referred for complex lengthy procedures, and paediatric surgery has witnessed a shift to earlier complex primary correction or palliation involving long cardiopulmonary bypass times or a period of suboptimal organ perfusion using circulatory arrest or low flow cardiopulmonary bypass. Unique to cardiac surgery is the predictability of the inflammatory response, but prophylactic therapies have not translated into clinical benefit, which the preconditioning phenomenon may address.
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Surg J R Coll Surg E · Dec 2007
Incentive spirometry decreases respiratory complications following major abdominal surgery.
Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery. Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery. ⋯ In a nonrandomised pilot study of 263 patients we have found that the addition of the incentive spirometer, as part of an intensive post-operative physiotherapy programme, decreased the occurrence of pulmonary complications (6 vs 17%, p = 0.01) and length of stay on the surgical high dependency unit (3.1 vs 4 days p = 0.03). The two groups were comparable when age, sex, smoking history, the need for emergency surgery and post-operative analgesia were compared.
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Analyses of adverse events in surgery reveal that underlying causes are often behavioural, such as communication failures, rather than technical. Non-technical (i.e. cognitive and interpersonal) skills, whilst recognised, are not explicitly addressed in surgical training. However, surgeons need to demonstrate high levels of these skills, as well as technical proficiency, to maximise safety and quality in the operating theatre. This article describes a prototype training course to raise surgeons' awareness of non-technical skills. ⋯ It was concluded that this type of training could enhance the surgical training portfolio and should be an integral feature of the development and assessment of operative skills.
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Surg J R Coll Surg E · Apr 2007
Trauma education of junior hospital doctors at a major Australian trauma service.
Junior hospital doctors are often involved in the early management of major trauma. The present study assesses the access to trauma education and clinical trauma exposure and skills of junior doctors at a major trauma service. ⋯ Despite working in a major trauma service, the studied cohort of resident medical officers, including Basic Surgical Trainees, have minimal exposure to major trauma, restricted access to trauma education and limited self-perceived confidence and experience in basic trauma resuscitative procedures.