ANZ journal of surgery
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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a global pandemic. Surgical care has been impacted, with concerns raised around surgical safety, especially in terms of laparoscopic versus open surgery. Due to potential aerosol transmission of SARS-CoV-2, precautions during aerosol-generating procedures and production of surgical plume are paramount for the safety of surgical teams. ⋯ As a result of the rapid review, evidence-based guidance has been produced to support safe surgical practice.
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ANZ journal of surgery · Sep 2020
ReviewColorectal peritoneal metastases: pathogenesis, diagnosis and treatment options - an evidence-based update.
Peritoneal metastases confer the worst survival among all sites in patients with metastatic colorectal cancer. They develop largely through transcoelomic spread, with a sequence of events that allow cells to first detach from primary tumours, survive in the peritoneal environment, attach to the peritoneal surface of organs and migrate into the submesothelial space to create a microenvironment conducive to metastatic growth. Diagnostic challenges have previously hindered early identification of peritoneal metastases. ⋯ While peritoneal recurrence can be reliably predicted from high-risk features in primary tumours such as a perforated cancer, ovarian metastases or T4a cancers, the use of prophylactic second look surgery with HIPEC or adjuvant HIPEC failed to demonstrate any survival benefit in high-risk cases in recent clinical trials, raising further questions about the efficacy of HIPEC. With high failure rates from systemic chemotherapy in unresectable disease, novel surgical techniques such as pressurized intraperitoneal aerolized chemotherapy are being investigated in clinical trials worldwide. Further collaborative research is needed to explore newer avenues of treatment for this poor prognostic cohort.
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ANZ journal of surgery · Apr 2020
ReviewTargeted muscle reinnervation to improve electromyography signals for advanced myoelectric prosthetic limbs: a series of seven patients.
Upper limb amputation is a devastating injury. Patients may choose to use a passive prosthesis, a traditional body-powered prosthesis or a myoelectric prosthesis driven by electromyography (EMG) signals generated by underlying muscles. Targeted muscle reinnervation (TMR) aims to surgically create strong and reliable signals to permit the intuitive use of a myoelectric prosthesis with the greatest number of movements possible. We review the Alfred Hospital experience of using TMR to improve upper limb prosthesis control. ⋯ The use of TMR to improve and increase the number of EMG signals has been successful in generating more degrees of freedom for upper limb amputees with myoelectric prostheses.
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ANZ journal of surgery · Apr 2020
ReviewReview of emotional intelligence in health care: an introduction to emotional intelligence for surgeons.
The aim of this review is to explain the components of emotional intelligence (EI) and explore the benefits within today's health care system with an emphasis on surgery. EI is a person's ability to understand their own emotions and those of the individuals they interact with. Higher individual EI has multiple proposed benefits, such as reducing stress, burnout and increasing work satisfaction. The business world recognizes EI as beneficial in terms of performance and outcomes. Could surgeons benefit from being more cognisant of EI and methods of assessing and improving EI to reap the aforementioned benefits? ⋯ To perform optimally, surgeons must be aware of their own emotions and others. EI differs from IQ and can be taught, learnt and improved upon. EI is measured via validated self-reporting questionnaires and 'multi-rater' assessments. High EI is positively associated with leadership skills in surgeons, non-technical skills, reduction in surgeon stress, burnout and increased job satisfaction, all of which translate to better patient relationships and care. Future implications of EI have been postulated as a measure of performance, a selection tool for training positions and a marker of burnout. EI should be an explicit part of contemporary surgical education and training.
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ANZ journal of surgery · Mar 2020
ReviewFrailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management - a narrative review.
The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post-operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. ⋯ Establishing multidisciplinary collaborative services to provide person-centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large-scale studies should focus on implementing and evaluating such multicomponent models of care.