Technical skills in the operating room: Implications for perioperative leadership and patient outcomes.

Today's effective leaders create opportunities for their teams to develop both technical and non-technical skills. In the perioperative arena, the focus until now mainly has been on improving non-technical skills, with only few studies analyzing the relationship between technical skills and patient outcomes. Technical competence requires assessment of one's own strengths and weaknesses, inclusion of deliberate goal-oriented practice, objective structured feedback assessment, and a focus on best practice and improved patient outcomes. In this article, we address the prerequisites, assessment, and implications of technical skills for perioperative leadership, and provide key metrics impacting patient outcomes and leadership development

Morbidities and mortality among hospitalized patients with hypopituitarism: Prevalence, causes and management.

Hypopituitarism is a highly heterogeneous multisystem disorder that can have a major impact on long-term morbidity and mortality, but even more so during acute medical conditions requiring hospitalization. Recent studies suggest a significant in-hospital burden with prolonged length of stay, increased rate of intensive care unit (ICU) admission, and initiation of mechanical ventilation - all of which may lead to an increased risk of in-hospital mortality. On the one hand, patients with hypopituitarism are often burdened by metabolic complications, including obesity, hypertension, dyslipidemia, and hyperglycemia, which alone, or in combination, are known to significantly alter relevant physiological mechanisms, including metabolism, innate and adaptive immune responses, coagulation, and wound healing, thereby contributing to adverse in-hospital outcomes. On the other hand, depending on the extent and the number of pituitary hormone deficiencies, early recognition of hormone deficiencies and appropriate management and replacement strategy within a well-organized multidisciplinary team are even stronger determinants of short-term outcomes during acute hospitalization in this vulnerable patient population. This review aims to provide an up-to-date summary of recent advances in pathophysiologic understanding, clinical implications, and recommendations for optimized multidisciplinary management of hospitalized patients with hypopituitarism

Stereotactic posterior midline approach under direct microscopic view for biopsy of medulla oblongata tumors: technical considerations.

BACKGROUND Open and stereotactic transfrontal or transcerebellar approaches have been used to biopsy brainstem lesions. METHOD In this report, a stereotactic posterior and midline approach to the distal medulla oblongata under microscopic view is described. The potential advantages and limitations are discussed, especially bilateral damage of the X nerve nuclei. CONCLUSION This approach should be considered for biopsy of distal and posterior lesions. We strongly recommend the use of direct microscopic view to identify the medullary vessels, confirm the midline entry point, and avoid potential shift of the medulla. Further experience is needed to confirm safety and success rate of this approach

Postcraniotomy Headache: Etiologies and Treatments.

PURPOSE OF REVIEW Postcraniotomy headache (PCH) is a highly underappreciated and very common adverse event following craniotomy. RECENT FINDINGS Analgetic medication with opioids often interferes with neurologic evaluation in the acute phase of recovery and should be kept to a minimal, in general, in the treatment of chronic pain as well. We provide an update on the latest evidence for the management of acute and chronic PCH. Especially in the neurosurgical setting, enhanced recovery after surgery protocols need to include a special focus on pain control. Patients at risk of developing chronic pain must be identified and treated as early as possible

Operational and strategic decision making in the perioperative setting: Meeting budgetary challenges and quality of care goals.

Efficient operating room (OR) management is a constant balancing act between optimal OR capacity, allocation of ORs to surgeons, assignment of staff, ordering of materials, and reliable scheduling, while according the highest priority to patient safety. We provide an overview of common concepts in OR management, specifically addressing the areas of strategic, tactical, and operational decision making (DM), and parameters to measure OR efficiency. For optimal OR productivity, a surgical suite needs to define its main stakeholders, identify and create strategies to meet their needs, and ensure staff and patient satisfaction. OR planning should be based on real-life data at every stage and should apply newly developed algorithms

Gender-specific prevalence of pilonidal sinus disease over time: A systematic review and meta-analysis.

BACKGROUND Gender-specific risk factors have been suggested to promote a fourfold higher incidence of pilonidal sinus disease (PSD) in male as compared to female patients. However, in recent decades there has been an apparent shift towards an increasing prevalence of PSD in women, as body weight and other risk factors influence the disease. We aimed at determining whether PSD prevalence actually changed in men and women over time. METHODS Following PRISMA guidelines (PROSPERO ID: 42016051588), databases were systematically searched. Papers reporting on PSD published between 1833 and 2018 in English, French, German, Italian and Spanish containing precise numbers of male and female participants were selected for analysis. Gender-specific prevalence of PSD over several decades was the main outcome measure. RESULTS We screened 679 studies reporting on 104 055 patients and found that the male/female ratio in patients with PSD has remained constant over time, with women being affected in about 20% of all PSD cases (I2  = 96.18%; meta-regression p < 0.001). CONCLUSION While the prevalence of PSD has risen over the past decades, the ratio between affected males and affected females has remained constant, with women invariably representing about 20% of patients despite wide ranging socioeconomic and behavioural changes

Meditation as an Adjunct to the Management of Acute Pain.

PURPOSE OF REVIEW We aim to present current understanding and evidence for meditation, mostly referring to mindfulness meditation, for the management of acute pain and potential opportunities of incorporating it into the acute pain service practice. RECENT FINDINGS There is conflicting evidence concerning meditation as a remedy in acute pain. While some studies have found a bigger impact of meditation on the emotional response to a painful stimulus than on the reduction in actual pain intensities, functional Magnet Resonance Imaging has enabled the identification of various brain areas involved in meditation-induced pain relief. Potential benefits of meditation in acute pain treatment include changes in neurocognitive processes. Practice and Experience are necessary to induce pain modulation. In the treatment of acute pain, evidence is emerging only recently. Meditative techniques represent a promising approach for acute pain in various settings

Managing bottlenecks in the perioperative setting: Optimizing patient care and reducing costs.

Bottlenecks limit the maximum output of a system and indicate operational congestion points in process management. Bottlenecks also affect perioperative care and include dimensions such as infrastructure, architectural design and limitations, inefficient equipment and material supply chains, communication-related limitations on the flow of information, and patient- or staff-related factors. Improvement of workflow is, therefore, becoming a priority in most healthcare settings. We provide an overview of bottleneck management in the perioperative setting and introduce dimensions, including aligned strategic decision-making, tactical planning, and operational adjustments