Critical Care Surgery Research Articles

Interventions for Test Anxiety in Undergraduate Nursing Students: An Integrative Review.

An integrative review was conducted to identify and evaluate interventions for test anxiety (TA) in undergraduate nursing students. Test performance has a major impact on the academic success of nursing students. Therefore, testing is a source of stress and anxiety, which may impair academic performance. A systematic search was conducted to locate peer-reviewed literature about interventions for TA in undergraduate nursing students. Review of 33 publications dated 1973 to 2014 identified 19 interventions for TA in undergraduate nursing students. Findings included experimental evidence supporting aromatherapy, music therapy, and various cognitive or behavioral interventions. Nonexperimental evidence supporting collaborative testing, crib sheets, and humorous exam items was also found. Many interventions for mitigating TA in nursing students have been evaluated since the 1970s. Current research is needed to corroborate and strengthen the evidentiary support for existing interventions and to evaluate new interventions.

Surgery Goes Social: The Extent and Patterns of Social Media Utilization by Major Trauma, Acute and Critical Care Surgery Societies.

Context and Aims:The evolving influence of social media in trauma, acute, and critical care surgery (TACCS) cannot be ignored. We sought to investigate the extent and patterns of use of social networks by major regional, national and international TACCS societies.Materials and Methods:The two leading social networking sites, Facebook (FB) and Twitter (TW), were thoroughly examined for the presence of official accounts for each of the major TACCS societies. An official FB or TW account was defined as one which has a blue verified badge and/or is linked the society's official website. For societies with confirmed official accounts, the extent and patterns of use of the two platforms were systematically examined over a 2-week period through: (1) manual inspection of the societies’ FB and TW pages, (2) the SQLite database containing downloaded samples of posts, and (3) the TW analytics database, symplur.com. Standardized social media metrics were calculated for each society. Posted content was categorized as being: (1) society news updates, (2) event announcements, or (3) general medical information.Results:From a total of 64 TACCS societies, only 27 (42%) had FB and/or TW accounts. Ten out of the 12 American societies had accounts compared to 13/39 of European, 2/9 of Australasian, and 0/2 of international societies. For the societies with social media presence, the mean numbers of monthly tweets and FB posts per society were 22 and 8, respectively. We summarize the FB and TW activity of the studied TACCS societies. Most tweets/posts were society news updates and event announcements intended to the society's constituents not the general public. A text cloud was constructed to summarize the major featured topics.Conclusion:Less than half of the TACCS societies are currently using social media; those that do are arguably underutilizing its potential. Non-American societies in particular lag behind in their use of social networking.

Are Pediatric Emergency Physicians More Knowledgeable and Confident to Respond to a Pediatric Disaster after an Experiential Learning Experience?

Pediatric hospital disaster responders must be well-trained and prepared to manage children in a mass-casualty incident. Simulations of various types have been the traditional way of testing hospital disaster plans and training hospital staff in skills that are used in rare circumstances. The objective of this longitudinal, survey-based, observational study was to assess the effect of disaster response and management-based experiential learning on the knowledge and confidence of advanced learners. A simulation-based workshop was created for practicing Pediatric Emergency Medicine (PEM) physicians, senior PEM physicians, and critical care and pediatric surgery residents to learn how to manage a disaster response. Given that this particular group of learners had never been exposed to such a disaster simulation, its educational value was assessed with the goal of improving the quality of the hospital pediatric medical response to a disaster by increasing the responders' knowledge and confidence. Objective and subjective measures were analyzed using both a retrospective, pre-post survey, as well as case-based evaluation grids. The simulation workshop improved the learners' perceived ability to manage patients in a disaster context and identified strengths and areas needing improvement for patient care within the disaster context. Advanced learners exposed to an experiential learning activity believed that it improved their ability to manage patients in a disaster situation and felt that it was valuable to their learning. Their confidence was preserved six months later. Bank I , Khalil E . Are pediatric emergency physicians more knowledgeable and confident to respond to a pediatric disaster after an experiential learning experience? Prehosp Disaster Med. 2016;31(5):551-556.

Toward Eliminating All Harms

Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and, Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, Maryland. Correspondence: Peter J. Pronovost, MD, PhD, Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, MD 21218 ([email protected]). The author declares no conflict of interest.

Training Pathways in Pediatric Cardiac Intensive Care: Proceedings From the 10th International Conference of the Pediatric Cardiac Intensive Care Society.

The increase in pediatric cardiac surgical procedures and establishment of the practice of pediatric cardiac intensive care has created the need for physicians with advanced and specialized knowledge and training. Current training pathways to become a pediatric cardiac intensivist have a great deal of variability and have unique strengths and weaknesses with influences from critical care, cardiology, neonatology, anesthesiology, and cardiac surgery. Such variability has created much confusion among trainees looking to pursue a career in our specialized field. This is a report with perspectives from the most common advanced fellowship training pathways taken to become a pediatric cardiac intensivist as well as various related topics including scholarship, qualifications, and credentialing.

Trauma, Critical Care, and Emergency Care Anesthesiology: A New Paradigm for the "Acute Care" Anesthesiologist?

Trauma, Critical Care, and Emergency Care Anesthesiology: A New Paradigm for the "Acute Care" Anesthesiologist?

Perioperative Red Blood Cell Transfusion: What We Do Not Know.

Objective:Blood transfusion saves lives but may also increase the risk of injury. The objective of this review was to evaluate the possible adverse effects related to transfusion of red blood cell (RBC) concentrates stored for prolonged periods.Data Sources:The data used in this review were mainly from PubMed articles published in English up to February 2015.Study Selection:Clinical and basic research articles were selected according to their relevance to this topic.Results:The ex vivo changes to RBC that occur during storage are collectively called storage lesion. It is still inconclusive if transfusion of RBC with storage lesion has clinical relevance. Multiple ongoing prospective randomized controlled trials are aimed to clarify this clinical issue. It was observed that the adverse events related to stored RBC transfusion were prominent in certain patient populations, including trauma, critical care, pediatric, and cardiac surgery patients, which leads to the investigation of underlying mechanisms. It is demonstrated that free hemoglobin toxicity, decreasing of nitric oxide bioavailability, and free iron-induced increasing of inflammation may play an important role in this process.Conclusion:It is still unclear whether transfusion of older RBC has adverse effects, and if so, which factors determine such clinical effects. However, considering the magnitude of transfusion and the widespread medical significance, potential preventive strategies should be considered, especially for the susceptible recipients.

Welcome Associate Editor Zsolt Balogh

The World Journal of Surgery would like to welcome a new associate editor to our ranks. Zsolt Balogh MD PhD FRACS (ortho), F. A. Orth. A., FACS is the Director of Trauma at the John Hunter Hospital and Professor of Surgery and Traumatology at the University of Newcastle in Newcastle, Australia. Prof Balogh was born in Hungary and is a dual citizen of Hungary and Australia. He received his MD and PhD at the Albert Szent-Gyorgyi Medical University in Szeged, Hungary, where he also received his clinical training in orthopedics and traumatology and then joined the faculty in the Department of Traumatology at the Albert Szent-Gyorgyi Medical Center for 5 years. Following this, he did several trauma fellowships in the US and Australia before joining the faculty in the John Hunter Hospital in Newcastle in 2005 as Director of the Trauma Services. He became the Professor of Traumatology in 2009 and the Professor of Surgery in Newcastle in 2015. He has received 22 awards for scholarly work, including the John Mitchell Crouch Fellowship, which is the most prestigious research recognition of the Royal Australasian College of Surgeons. His students, residents, and fellows have received an additional 16 awards. His paper entitled ‘‘Epidemiology of Traumatic Deaths: Comprehensive Population Based Assessment’’ was awarded the WJS 2010 paper of the year. Prof Balogh has received 14 research grants to cover everything from basic science in trauma and inflammation to public health. He has published 150 peer review manuscripts, many in the WJS, and has guest edited a symposium for the WJS on the abdominal compartment syndrome. He has served as a reviewer for the WJS since 2005 and has served on the editorial board since 2013. Prof Balogh has presented his research internationally and has held leadership positions in the Australian Orthopedic Association, The AO Foundation, the Royal Australasian College of Surgeons, the American Association for the Surgery of Trauma, and a number of other organizations. Prof Balogh will join Ari Leppaniemi as our WJS Associate Editors for the Surgery of Trauma, Critical Care, and Acute Care Surgery. We are thrilled to have the academic talents of Zsolt Balogh on our team of Associate Editors.

The Role of Extra-Anatomic Bypass in the Surgical Treatment of Acute Abdominal Aortic Occlusion.

BackgroundAortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures.MethodsEighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis.ResultsIn all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of 21.2±9.4 months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up.ConclusionTo conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.

A Simulation Curriculum for Management of Trauma and Surgical Critical Care Patients

BackgroundExpectations continue to rise for residency programs to provide integrated simulation training to address clinical competence. How to implement such training sustainably remains a challenge. We developed a compact module for first-year surgery residents integrating theory with practice in high-fidelity simulations, to reinforce the preparedness and confidence of junior residents in their ability to manage common emergent patient care scenarios in trauma and critical care surgery. MethodsThe 3-day module features a combination of simulated patient encounters using standardized patients and electronic manikins, didactic sessions, and hands-on training. Manikin-based scenarios developed in-house were used to teach trauma and critical care management concepts and skills. Separate scenarios in collaboration with the regional organ donation program addressed communication in difficult situations such as brain death. Didactic material based on contemporary evidence, as well as skills stations, was developed to complement the scenarios. Residents were surveyed before and after training on their confidence in meeting the 14 learning objectives of the curriculum on a 5-point Likert scale. ResultsData from 15 residents who underwent this training show an overall improvement in confidence across all learning objectives defined for the module, with confidence scores before to after training improving significantly from 2.8 (σ = 0.85, median = 3) to 3.9 (σ = 0.87, median = 4) of 5, p < 0.001. Although female residents reported higher posttraining confidence scores compared with male residents (average 4.2 female vs 3.8 male, p = 0.002), there were no other significant differences in confidence scores or changes to scores owing to resident sex or program status (categorical or preliminary). ConclusionWe successfully implemented a multimodal simulation-based curriculum that provides skills training integrated with the clinical context of managing trauma and critical care patients, simultaneously addressing a range of clinical competencies. Results to date show consistent improvement in residents’ confidence in meeting learning objectives. Development of the curriculum continues for sustainability, as well as measures to embed objective evaluations of resident competence.

Editorial Comment

The authors1 present a retrospective review from the National Surgical Quality Improvement Program for the years 2005-2009, to analyze possible predictive parameters and assess mortality for Fournier gangrene (FG). Traditionally, the mortality for these patients can range from 20% to 43%2 or even higher. There have been limited studies within the recent years to identify whether advances in critical care management and surgery have improved on mortality. Additionally, a search continues to look for prognostic indicators as well.

Standardizing postoperative PICU handovers improves handover metrics and patient outcomes.

To improve handover communication and patient outcomes for postoperative admissions to a multidisciplinary PICU. Prospective cohort study. Multidisciplinary PICU in a university hospital. The multidisciplinary team responsible for postoperative PICU admissions and patient care, including attending, fellow, house staff physicians, and nurses from pediatric critical care medicine, surgery, and anesthesia. An online survey distributed to PICU, surgery, and anesthesia providers identified existing barriers and challenges to effective postoperative PICU handovers and guided the formation of a standard protocol. Handovers for postoperative PICU admissions were then directly observed for 3 months pre- and postimplementation of the protocol, with data collected on communication, metrics, and patient outcomes. Observations and data collection, as well as the online provider survey, were repeated approximately 1 year after handover protocol implementation. Survey data demonstrated increases in provider ratings of handover attendance, communication, and quality after implementation of the handover protocol (p < 0.001). Surgical report errors were eliminated (p = 0.03), and the prevalence of provider attendance for the handover duration increased from 39.3% to 68.2% (p = 0.01). Following protocol implementation, fewer patients experienced antibiotic delays (34.5% to 13.9%; p = 0.03) or required hemodynamic or respiratory interventions within the first 6 hours of PICU admission (24.6% to 9.1%; p = 0.04). Patients received their first dose of analgesia (62.3 to 17.4 min; p = 0.01) and had their admission laboratory studies sent (42.3 to 32.9 min; p = 0.04) more quickly. Data collected at 12 months postimplementation demonstrated sustained reductions in analgesia timing, antibiotic delays, and handover barriers. Postoperative communication and patient outcomes can be improved and sustained over time with implementation of a standardized handover protocol.

Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study

BackgroundAbdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. MethodsA retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. ResultsMean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p < 0.005) and operations (p < 0.005). The majority of consultations were for small bowel obstruction/ileus (n = 4, 17%), cholecystitis (n = 3, 13%) and to rule out ischemia (n = 2, 9%) ConclusionsIn the era of modern critical care and cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population.

Palliative Care Doula

Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care.

An acute care surgery fellowship benefits a general surgical residency.

There has been a trend toward subspecialization among general surgery graduates, and many subspecialists are reticent to participate in trauma care. This has resulted in a gap in the provision of emergency surgical care. The Acute Care Surgery (ACS) fellowship, incorporating trauma, critical care, and emergency general surgery, was developed to address this need. One of the most important aspects in establishing these ACS fellowships is that they do not detract from the existing general surgery residents' experience. The operative case logs for residents and fellows were compared for the number of resident cases during the 3 years before the ACS fellowship and during the 3 years after the fellowship was established. Surveys were distributed to the general surgery residents addressing the impact of the fellows from the resident's perspective at the end of the 2011 to 2012 academic year. There was no significant change in the number of total cases; total chief resident cases; and trauma, thoracic, or vascular procedures done per graduate. A decrease in the number of liver cases performed by the residents was noted but includes the increase in resident complement as well as the fellowship. ACS fellow cases increased from 172 cases in the first year to 221 cases in the second year and 295 in the third year. The survey showed that the residents had a very positive response to having the fellow as a teacher and did not feel like their operative experience was compromised with the addition of the ACS fellowship. The ACS fellow did not compromise general surgery resident experience and was regarded as an asset to the resident's education. An ACS fellowship can be beneficial to residents and fellows. Care management study, level IV.

Scudder Oration on Trauma. A century of evolution in trauma resuscitation.

Division of Trauma, Burn, General and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA *Correspondence address: Ronald V Maier, MD, FACS, Department of Surgery, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104-2499. E-mail: [email protected] Received April 24, 2014; accepted April 28, 2014. Disclosure Information: Nothing to disclose. Presented at the American College of Surgeons 99th Annual Clinical Congress, Washington, DC, October 2013.

Reduction in gastric cancer surgical mortality over 10 years: An adverse events analysis.

BackgroundThe reduction in gastric cancer mortality is due to a reduction in incidence and of surgical mortality. This study was to examine adverse events in patients with gastric cancer dying under surgical care.MethodsAdverse events in surgical care were prospectively audited in patients who died of gastric cancer in Scottish hospitals. A cohort retrospective study examining deaths and contributing adverse events was compared for the periods 1996–2000 and 2001–2005.ResultsBetween 1996 and 2005, 1083 patients with gastric cancer died on surgical wards in Scottish hospitals. The annual number of deaths under surgical care fell significantly from an average of 128 deaths per annum in years 1996–2000 to 88 deaths per annum in 2001–2005 (p < 0.001). This occurred in parallel with the decline in gastric cancer incidence over the same period. There was an increase in the proportion of gastric cancer resections carried out in 7 major hospitals in Scotland in the second period of the study (p < 0.001). The mean number of deaths in the group of patients, who had gastric cancer resection and palliative surgery, were significantly lower in the second period of the study In addition, when all patients were considered as a group, the mean number of anaesthetic, critical care, medical management and technical surgery adverse events were significantly lower in the second study period.ConclusionThere has been a reduction in deaths and adverse events for patients with gastric cancer under surgical care and this has been associated with surgical subspecialisation in oesophago-gastric cancer surgery.

If Some Hypothermia Is Good, More Hypothermia Must Be Better, Right?*

Departments of Critical Care Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA * See also p. e132. Dr. Tisherman is the co-author of submitted patent, “Emergency Preservation and Resuscitation Method.”

Invited Commentary

Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, OR

Hepatocellular Carcinoma

Log in Your account has been temporarily locked Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in 30 mins. For immediate assistance, contact Customer Service: 800-638-3030 (within USA), 301-223-2300 (international) [email protected] Invalid username or password. Try again or register an account. default message Login No user account? Register for free. Register for free. Lippincott Journals Subscribers, use your username or email along with your password to log in. Forgot Password? or Register Register for a free account Existing User Log In Existing User Log In Registered users can save articles, searches, and manage email alerts. All registration fields are required. What's your profession? Academic Medicine Acute Care Nursing Addiction Medicine Administration Advanced Practice Nursing Allergy & Immunology Allied Health Alternative & Complementary Medicine Anesthesiology Anesthesiology Nursing Audiology & Ear and Hearing Basic Science Cardiology Cardiothoracic Surgery Cardiovascular Nursing Cardiovascular Surgery Child Neurology Child Psychiatry Chiropractics Clinical Sciences Colorectal Surgery Community Health Critical Care Critical Care Nursing Dentistry Dermatology Emergency Medicine Emergency Nursing Endocrinology Endoncrinology Forensic Medicine Gastroenterology General Surgery Genetics Geriatrics Gynecologic Oncology Hand Surgery Head & Neck Surgery Hematology/Oncology Hospice & Palliative Care Hospital Medicine Infectious Disease Infusion Nursing Internal/General Medicine Internal/General Medicine Residency Library Sciences Maternal Child Nursing Medical Oncology Medical Research Neonatal/Perinatal Neonatal/Perinatal Nursing Nephrology Neurology Neurosurgery Nursing-administrative Nursing-all Specialties Nursing-education Nutrition & Dietetics Obstetrics & Gynecology Obstetrics & Gynecology Nursing Occupational & Environmental Medicine Oncology Nursing Oncology Surgery Ophthalmology/Optometry Oral & Maxillofacial Surgery Orthopedic Nursing Orthopedics/Spine/Sports Medicine Surgery Otolaryngology Pain Medicine Pathology Pediatric Surgery Pediatrics Pharmacology Pharmacy Physical Medicine & Rehabilitation Physical Therapy & Womens Health Physical Therapy Plastic Surgery Podiatary-general Podiatry-general Primary Care/Family Medicine/General Practice Psychiatric Nursing Psychiatry Psychology Public Health Pulmonology Radiation Oncology/Therapy Radiology Rheumatology Skills & Procedures Sleep Medicine Sport & Exercise/Training/Fitness Sports Medicine Surgical Nursing Transitional Care Transplant Surgery Trauma Nursing Trauma Surgery Urology Womens Health Wound Care Other What's your speciality? Addiction Medicine Allergy & Clinical Immunology Anesthesiology Audiology & Speech-Language Pathology Cardiology Cardiothoracic Surgery Critical Care Medicine Dentistry, Oral Surgery & Medicine Dermatology Dermatologic Surgery Emergency Medicine Endocrinology & Metabolism Family or General Practice Gastroenterology & Hepatology Genetic Medicine Geriatrics & Gerontology Hematology Hospitalist Immunology Infectious Diseases Internal Medicine Legal/Forensic Medicine Nephrology Neurology Neurosurgery Nursing Nutrition & Dietetics Obstetrics & Gynecology Oncology Ophthalmology Orthopedics Otorhinolaryngology Pain Management Pathology Pediatrics Plastic/ Reconstructive Sugery Pharmacology & Pharmacy Physiology Psychiatry Psychology Public, Environmental & Occupational Health Radiology, Nuclear Medicine & Medical Imaging Physical Medicine and Rehabilitation Respiratory/Pulmonary Medicine Rheumatology Sport Medicine/Science Surgery (General) Trauma Surgery Toxicology Transplantation Surgery Urology Vascular Surgery Virology I don't have a medical specialty What's your work setting? Hospital Under 250 Beds Hospital Over 250 Beds Eldercare or Hospice Facility Psychiatric or Rehabilitative Facility Private Practice Group Practice Corporation (Pharmaceutical, Biotechnology, Engineering, etc.) Doctoral University or Medical School Masters or 4-Year Academic University Community College Government Other I have read & acknowledge the End User License Agreement. I have read & accept the terms of the Privacy Policy. Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print Published Ahead-of-PrintFor Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor Permissions Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search