Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Suicide risk after bariatric surgery Suicidio y cirugía bariátrica: Un estudio de la evidencia

© 2016, Sociedad Medica de Santiago. All rights reserved. Bariatric surgery is considered the most effective treatment for severe obesity and its benefits include improvement in medical comorbidities. However, a higher rate of suicides after this type of surgery has been reported. We performed a literature review on the subject, and concluded that the mentioned increase in suicide rates, compared to the general population, is probably caused by conditions that the patient had before surgery, especially psychiatric disorders such as depression or eating disorders. These are risk factors for suicide, and are more common in the population with indication for bariatric surgery. Therefore, it is necessary to thoroughly evaluate these patients before surgery searching for suicide risk factors, deriving them to a mental health professional if necessary and follow their mental health after surgery. Considering that the literature on the topic is inconsistent, further research is needed

Suicide risk after bariatric surgery

Bariatric surgery is considered the most effective treatment for severe obesity and its benefits include improvement in medical comorbidities. However, a higher rate of suicides after this type of surgery has been reported. We performed a literature review on the subject, and concluded that the mentioned increase in suicide rates, compared to the general population, is probably caused by conditions that the patient had before surgery, especially psychiatric disorders such as depression or eating disorders. These are risk factors for suicide, and are more common in the population with indication for bariatric surgery. Therefore, it is necessary to thoroughly evaluate these patients before surgery searching for suicide risk factors, deriving them to a mental health professional if necessary and follow their mental health after surgery. Considering that the literature on the topic is inconsistent, further research is needed

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions