Effects of Three Months of Low Molecular Weight Heparin (dalteparin) Treatment After Bypass Surgery for Lower Limb Ischemia—A Randomised Placebo-controlled Double Blind Multicentre Trial

AbstractObjectivesTo test the hypothesis that long-term postoperative dalteparin (Fragmin®, Pharmacia Corp) treatment improves primary patency of peripheral arterial bypass grafts (PABG) in lower limb ischemia patients on acetylsalicylic acid (ASA) treatment.DesignProspective randomised double blind multicenter study.Materials and methodsUsing a computer algorithm 284 patients with lower limb ischemia, most with pre-operative ischemic ulceration or partial gangrene, from 12 hospitals were randomised, after PABG, to 5000IU dalteparin or placebo injections once daily for 3 months. All patients received 75mg of ASA daily for 12 months. Graft patency was assessed at 1, 3 and 12 months.ResultsAt 1 year, 42 patients had died or were lost to follow-up. Compliance with the injection schedule was 80%. Primary patency rate, in the dalteparin versus the control group, respectively, was 83 versus 80% (n.s.) at 3 months and 59% for both groups at 12 months. Major complication rates and cardiovascular morbidity were not different between the two groups.ConclusionsIn patients on ASA treatment, long-term postoperative dalteparin treatment did not improve patency after peripheral artery bypass grafting. Therefore, low molecular weight heparin treatment cannot be recommended for routine use after bypass surgery for critical lower limb ischemia

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Civil-military collaboration in trauma training

In the present Swedish military medical organisation all medicalpersonnel, including surgeons, have to be recruited from civilianhospitals. Even if there are many civilian surgeons well qualifiedto perform trauma surgery, the injury patterns seen in e.g.Afghanistan are quite different compared to what is generallyseen in trauma patients arriving to the ED at a civilian hospital.In order to upgrade the major trauma skills of the civilian surgeons recruited to and trained for participating in internationalmissions, the (extended) military version of the DefinitiveSurgical Trauma Care (DSTC) Course has been implemented.DSTC is given with the intention not to duplicate ATLS, nor toprovide an in depth course in surgery, but rather to teach thosetechniques particularly applicable to the patient who requires surgeryand intensive care for major trauma, in a setting where suchcare is not commonly practised or even necessarily available. Thecourse, made up by a mix of lectures, case discussions and skillstations has been given at the Swedish Armed Forces Centre forDefence Medicine in Gothenburg since 2007. It has graduallyevolved to incorporate also anaesthesiologists and nursing staffinto an integrated team. The faculty during these courses hasbeen made up by a mix of international and Swedish instructors.Course candidates have primarily been military health staff, butvacant slots have been offered clinicians working in civilian hospitalsin the western part of Sweden. During the last course inSeptember 2010 17/20 (85%) of the physicians and 13/17 (76%)of the nurses rated the course as very beneficial or indispensible.The Swedish Armed Forces Centre for Defence Medicine willcontinue to run the military version of the DSTC course. Dueto a certain over-capacity, course participation can be offered thecivilian health care system

Hospital evacuation; planning, assessment, performance and evaluation

Objective: Malfunction in hospitals' complex internal systems, or extern threats, may result in a hospital evacuation. Factors contributing to such evacuation must be identified, analyzed and action plans should be prepared. Our aims in this study were 1) to evaluate the use of risk and vulnerability analysis as a basis for hospital evacuation plan, 2) to identify risks/hazards triggering an evacuation and evaluate the respond needed and 3) to propose a template with main key points for planning, performance and evaluation of such evacuation. Methods: A risk and vulnerability analysis at two county hospitals along with a systematic online literature search based on the following keywords; “evacuation/closure”, “hospitals/medical facilities” and “disaster/hazards” alone or with “planning”, was conducted. Results: We found that although all hospitals have a disaster plan, there is a lack of knowledge and appropriate instruments to plan, perform and evaluate a hospital evacuation. Risk and vulnerability analysis can be used to reveal threats leading to an evacuation (e.g. on-going climate changes and terror actions). These key points can later be used to plan, perform and evaluate such evacuation. Conclusion: There is a need for an elaborated evacuation planning for hospitals. An evacuation plan should continuously be drilled based on a risk and vulnerability analysis. A general guide can be used as foundation to plan, perform and evaluate such plan