Surgeons

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the ...

The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-H...

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

Dans cet article, nous nous sommes intéressé au cas original des refus d'opérer en chirurgie esthétique, en nous basant sur quatre-vingts entretiens avec des praticiens, des observations en congrès et une analyse de revues profession-nelles. Écartant les réserves anatomiques ou physiologiques, les chirurgiens enquêtés expliquent leur décision par l'inadéquation entre le comportement ou la demande du client et leurs propres attentes. Le demandeur est alors rangé dans la catégorie de client à problèmes, en raison des conflits poten-tiels, voire des ennuis judiciaires, qu'il pourrait générer. Différents niveaux de lecture ont été proposés qui ont pour dénominateur commun le recours aux notions d'autonomie et d'identité professionnelles des chirurgiens, qui permet notamment de mettre en évidence leur fragilité médicale. Par ailleurs, sous couvert de déontologie (en se désintéressant des bénéfices financiers d'une opération), ces professionnels s'autorisent à écarter les clients qu'ils jugent indignes ou potentiellement dangereux, et ouvrent donc la porte à des processus de discriminations. L es travaux sociologiques portant sur la décision médicale ont largement interprété le fait de prescrire comme une preuve de l'action. La prescription est considérée sous deux angles : comme le signe d'une culture professionnelle ou comme la démons-tration de la pression des clients 1 pour ne pas « rentrer les mains vides » (Broom et al., 2014, p. 55, nous traduisons ; StiverS, 2002). Dans cet article portant sur la 1. En faisant référence au « client » et non au « patient », il ne s'agit surtout pas d'affirmer que le client est « le demandeur et le juge de toute production et de toute activité » (BrouSSard et al., 2006, p. 210), mais de développer une posture en rupture avec les rhétoriques des professions « prestigieuses ». Le terme de patient est pétri de jugements de valeurs, et constitue une description idéalisée non seulement de l'individu en attente de réponse médicale, mais aussi de la relation avec le médecin. En analysant l'organisation de l'activité médicale – et non seulement la chirurgie esthétique – comme n'importe quelle autre relation de service, avec ses spécificités, mettant aux prises un professionnel et un client dans un environnement concurrentiel, on s'autorise les comparaisons irrévérencieuses (HugHeS, 1996). * Laboratoire DySoLa (Dynamiques sociales et langagières), université de Rouen ; mailto:yannick.lehenaff@yahoo.fr

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the ...

Rembrandt’s Slaughtered ox, 1655, has long been seen as an allegory in the tradition of memento mori, suggesting correspondences between a dead animal and a dead human being. This paper does not dispute such cautionary readings. It expands and complicates those readings. Here, as in Rembrandt’s late history paintings, his concentrated pictorial rhetoric encouraged multiple responses. These extended to agricultural and socio-economic factors; the domestic provision of meat; links between oxen and social status; scientific and philosophical enquiry; and Rembrandt’s own creative capacity in rendering a creature naer het leven. They point to an artist rethinking animal-human relationships in a deeply interconnected world.

On sait que Philippe le Bel fut le dedicataire d'oeuvres medicales ou chirurgicales imposrtantes, comme la Chirurgia magna de Lanfranc, les Medicationis Parabole d'Anraud de Villeneuve ou la Chirurgia d'Henri de Mondeville. Au dela du caractere courtois de ces dedicaces, des indices nous invitent a reflechir sur la nouvelle attitude des gens de cour au tournant du XIVe siecle, y compris du roi Philippe le Bel. On sait qu'il avait dans son entourage de nombreux praticiens, beaucoup plus que ses predecesseurs du XIIIe siecle, et qu'il prit un tel interet a l'exercice de la chirurgie qu'il en reglementa la pratique par un edit pris en 1311. En outre, ce roi se distingue nettement d'autres souverains par le fait qu'un receptaire, une collection de recettes chirurgicales, porte son nom. C'est sur ce recueil que cet article se concentre pour finir.

Online ratings of orthopedic surgeons have not been studied. We conducted a study to evaluate the online ratings of orthopedic surgeons in a major metropolitan region, to identify trends in ratings of orthopedic surgeons, and to analyze ratings to identify variables of significance in determining overall rating. Website traffic was used to identify the 8 busiest physician rating websites: AngiesList.com, EverydayHealth.com, Thirdage.com, Yelp.com, HealthGrades.com, Vitals.com, UCompareHealthcare.com, and RateMDs.com. These websites were consulted for data regarding orthopedic surgeons in a major metropolitan region with a population of 1.3 million in September 2012. Surgeon ratings were scaled from 0 to 100 for homogeneity. Of the 8 websites considered, 4 were excluded because of inaccessible or unreliable data. The qualifying sites were HealthGrades.com, Vitals.com, UCompareHealthcare.com, and RateMDs.com, with 2185 reviews total. Across these websites, mean overall rating of ortho...

Guarantor or Healer ?
King Philip the Fair and the body, according to the Réceptaire named after him


We know that Philip the Fair was the recipient of important medical or surgical works, like Lanfranc’s Chirurgia magna, Arnold of Villanova’s Medicationis parabole or Henry of Mondeville’s Chirurgia, written for the public good and dedicated to the King.
Now, beyond the courtly dimension of the dedication, some evidences invite us to trace a new attitude of the courtiers towards surgery in the bend of the XIVth century, to begin with Philip the Fair. We know for example that the physicians of king of France are a few for the whole XIIIth century, and that things changed with the reign of Philip the Fair. The King had henceforth in his immediate medical circle numerous practitioners, several doctors but also many surgeons.

We know besides that Philip the Fair took such an interest in surgery that he regulated the exercise of this practice by an edict taken in 1311, which placed the sworn surgeons under the authority of the royal surgeon. Philip the Fair, finally, distinguishes himself from the other sovereigns by the fact that a réceptaire, a collection of surgical remedies, on which our final reflections concentrate is named after him.

To understand private consumer and clinician preferences towards different rehabilitation modes following knee or hip arthroplasty, and identify factors which influence the chosen rehabilitation pathway. Mixed methods cross-sectional study involving 95 semi-structured interviews of consumers (patients and carers) and clinicians (arthroplasty surgeons, physiotherapists and rehabilitation physicians) in Sydney, Australia, during 2014-2015. Participants were asked about the acceptability of different modes of rehabilitation provision, and factors influencing their chosen rehabilitation pathway. Interviews were in person or via the telephone. Qualitative analysis software was used to electronically manage qualitative data. An analytical approach guided data analysis. Pre-operative preferences strongly influenced the type of rehabilitation chosen by consumers. Key factors that influenced this were both intrinsic and extrinsic, including; the previous experience of self or known others, t...

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the ...

Endoscopic sinus surgery is a common surgical procedure, with low morbidity for patients. Studies have shown that endoscopic and laparoscopic surgeons have a significant risk of developing musculoskeletal symptoms, with potential adverse effects on their careers as well as patient care. We aimed to identify the prevalence of such symptoms, and any associated risk factors relating to surgical technique, in European rhinologists. An online survey was distributed to all members of the European Rhinologic Society and data collected for statistical analysis. The relevant literature was reviewed, and ergonomic recommendations made. There were 250 responses, with nearly 80% of surgeons experiencing musculoskeletal symptoms. The neck and back were the most common site of symptoms, in approximately 60% of cases. There were significant correlations between musculoskeletal symptoms and the number of procedures performed each year, operating in a standing position, and operating without a monit...

It is uncertain whether there is an ethical obligation to disclose surgical experience. This article explores the impact of principles including respect for patient autonomy, nonmaleficence, and justice, as well as professional duties including truth-telling on the decision-making relevant to the process of informed consent, taking into account surgeon experience, training, and the expected risk and uncertainty surrounding the disease process and operation. Issues such as the integrity of the doctor–patient relationship, difficulties with access to complex surgical services, and limitations in applying statistics to the future outcomes of individual surgeons are explored.

Crew resource management (CRM) describes a system developed in the late 1970s in response to a series of deadly commercial aviation crashes. This system has been universally adopted in commercial and military aviation and is now an integral part of aviation culture. CRM is an error mitigation strategy developed to reduce human error in situations in which teams operate in complex, high-stakes environments. Over time, the principles of this system have been applied and utilized in other environments, particularly in medical areas dealing with high-stakes outcomes requiring optimal teamwork and communication. While the data from formal studies on the effectiveness of formal CRM training in medical environments have reported mixed results, it seems clear that some of these principles should have value in the practice of cardiovascular surgery.

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

Laparoscopic surgery has undeniable advantages, such as reduced postoperative pain, smaller incisions, and faster recovery. However, to improve surgeons' performance, ergonomic adaptations of the laparoscopic instruments and introduction of robotic technology are needed. The aim of this study was to ascertain the influence of a new hand-held robotic device for laparoscopy (HHRDL) and 3D vision on laparoscopic skills performance of 2 different groups, naïve and expert. Each participant performed 3 laparoscopic tasks-Peg transfer, Wire chaser, Knot-in 4 different ways. With random sequencing we assigned the execution order of the tasks based on the first type of visualization and laparoscopic instrument. Time to complete each laparoscopic task was recorded and analyzed with one-way analysis of variance. Eleven experts and 15 naïve participants were included. Three-dimensional video helps the naïve group to get better performance in Peg transfer, Wire chaser 2 hands, and Knot; the ...

Surgeons' intra-operative workload is critical for effective and safe surgical performance. Detrimental conditions in the operating room (OR) environment may add to perceived workload and jeopardize surgical performance and outcomes. This study aims to evaluate the impact of different intra-operative workflow interruptions on surgeons' capacity to manage their workload safely and efficiently. This was an observational study of intra-operative interruptions and self-rated workload in two surgical specialties (general, orthopedic/trauma surgery). Intra-operative interruptions were assessed via expert observation using a well-validated observation tool. Surgeons, nurses, and anesthesiologists assessed their intra-operative workload directly after case completion based on three items of the validated Surgery Task Load Index (mental demand, situational stress, distraction). A total of 56 elective cases (35 open, 21 laparoscopic) with 94 workload ratings were included. Mean intra-...

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

Crew resource management (CRM) describes a system developed in the late 1970s in response to a series of deadly commercial aviation crashes. This system has been universally adopted in commercial and military aviation and is now an integral part of aviation culture. CRM is an error mitigation strategy developed to reduce human error in situations in which teams operate in complex, high-stakes environments. Over time, the principles of this system have been applied and utilized in other environments, particularly in medical areas dealing with high-stakes outcomes requiring optimal teamwork and communication. While the data from formal studies on the effectiveness of formal CRM training in medical environments have reported mixed results, it seems clear that some of these principles should have value in the practice of cardiovascular surgery.

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

Evidence supports that surgeons are at high risk for work-related musculoskeletal disorders. To compare the effect of different chairs on work-related musculoskeletal discomfort for surgeons during vaginal operations. This crossover study randomly assigned 4 surgeons to 4 chair types using a 4×4 Latin square model: a conventional round stool, a round stool with backrest, a saddle chair with backrest, and a Capisco chair. Subjective assessments of surgeon discomfort were performed with a validated body discomfort survey (Cornell Musculoskeletal Discomfort Questionnaire) and workload was assessed with the Surgical Task Load Index (Surg-TLX). Objective postural load was quantified with inertial measurement units of the modified Rapid Upper Limb Assessment (RULA) limits. Subjective and objective assessments of chair comfort were performed with an 11-point scale and seat interface pressure mapped distributions, respectively. The primary outcome was the difference in body discomfort score...

Judging depth is important in surgery. Although there are several cues that permit depth perception, stereoacuity has been singled out as a possible predictor of surgical ability. However, it is not clear whether high-grade stereoacuity is necessary for a career in surgery. To help answer this, we aimed to evaluate stereoacuities in practising surgeons across a range of surgical specialities. We recorded stereoacuity values on 66 surgeons working at a London teaching hospital using three standard stereotests: Titmus, TNO and Frisby. There were 36 Trainees and 30 Consultants, covering 12 surgical specialities. Median stereoacuities (with range) for the whole group were: 40 s arc on Titmus (40-800), 30 s arc on TNO (15-480) and 20 s arc on Frisby (20-600). Four surgeons had no recordable stereoacuity on TNO, and one was also unrecordable on Titmus. Three of these four were Consultants. Depending on the test used, high-grade stereopsis was found in 74%-83% of surgeons while reduced ste...