Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland—a survey

Background: The aim of this study was to assess the use of mechanical bowel preparation (MBP) and antimicrobial prophylaxis in elective colorectal surgery in Switzerland. Methods: Ninety-eight heads of surgical departments in Switzerland and 42 visceral surgeons in private practice were asked to answer an 18-item questionnaire in October 2008 about arguments in favor of or against MBP. The participants also indicated whether they use MBP and antimicrobial prophylaxis in colorectal surgery, and if so, what agents were used. Of the participants, 117/140 (83%) responded. Additional data were collected pertaining to the respondents' experience and work situation. Results: MBP was used significantly more often for rectal surgery than for left colonic resections (83% vs. 53%; p < 0.001) and more often for left than for right colonic resections (53% vs. 43%; p = 0.001), regardless of the open or laparoscopic approach. Younger surgeons and surgeons with a higher case load in colorectal surgery used MBP significantly less frequently in open right colonic resections. For MBP, cathartics were used in 90% of patients, and enemas were used in 10% of patients. Of the respondents, 37% considered MBP to be useful, even very useful. Based on the literature, because of introduction of fast-track protocols or for considerations of patient comfort, 86% of the respondents had changed the bowel preparation regime during the last 10years in terms of a reduction of the quantity of cathartics or restricted the indications for MBP. Antimicrobial prophylaxis was used by 100% of the respondents, 88% used a single prophylactic dose only, while 70% administered the antibiotics 30-59min before the incision. Most of the surgeons used second-generation cephalosporins in combination with metronidazole, and 24% changed the antibiotic agent or reduced the duration of administration of antibiotics during the last 10years. Conclusions: MBP is often used in open and laparoscopic rectal surgery, but not in right colonic resections. Scientific evidence regarding MBP has yielded a rethinking about rigorous bowel preparation regimes. As of now, surgeons in Switzerland are not yet unanimously ready to abandon MBP in elective colorectal surgery. In Switzerland, surgeons are influenced by the benefit of antimicrobial prophylaxis in colorectal surger

Temporal factors in violence related injuries—An 11year trend analysis of violence-related injuries from a Swiss Emergency Department

Summary: Background: Injury from interpersonal violence is a major social and medical problem in the industrialized world. Little is known about the trends in prevalence and injury pattern or about the demographic characteristics of the patients involved. Methods: In this retrospective analysis, we screened the database of the Emergency Department of a large university hospital for all patients who were admitted for injuries due to interpersonal violence over an 11year period. For all patients identified, we gathered data on age, country of origin, quality of injury, and hospitalization or outpatient management. A trend analysis was performed using Kendall's tau-b correlation coefficients for regression analysis. Results: The overall number of patients admitted to our Emergency Department remained stable over the study period. Non-Swiss nationals were overrepresented in comparison to the demographics of the region where the study was conducted. There was a trend toward a more severe pattern of injury, such as an increase in the number of severe head injuries. Conclusions: Although the overall number of patients remained stable over the study period, there was an alarming trend toward a more severe pattern of injury, expressed by an increase in severe head trauma

The workday of hospital surgeons: what they do, what makes them satisfied, and the role of core tasks and administrative tasks; a diary study.

BACKGROUND Many surgeons report passion for their work, but not all tasks are likely to be satisfying. Little is known about how hospital surgeons spend their days, how they like specific tasks, and the role of core tasks (i.e. surgery-related tasks) versus tasks that may keep them from core tasks (e.g., administrative work). This study aimed at a more detailed picture of hospital surgeons' daily work - how much time they spend with different tasks, how they like them, and associations with satisfaction. METHODS Hospital surgeons (N = 105) responded to a general survey, and 81 of these provided up to five daily questionnaires concerning daily activities and their attractiveness, as well as their job satisfaction. The data were analyzed using t-tests, analysis of variance, as well as analysis of covariance and repeated measures analysis of variance for comparing means across tasks. RESULTS Among 14 tasks, surgery-related tasks took 21.2%, patient-related tasks 21.7% of the surgeons' time; 10.4% entailed meetings and communicating about patients, and 18.6% documentation and administration. The remaining time was spent with teaching, research, leadership and management, and not task-related activities (e.g. walking between rooms). Surgery was rated as most (4.25; SD = .66), administration as least attractive (2.63; SD = .78). A higher percentage of administration predicted lower perceived legitimacy; perceived legitimacy of administrative work predicted job satisfaction (r = .47). Residents were least satisfied; there were few gender differences. CONCLUSIONS Surgeons seem to thrive on their core tasks, most notably surgery. By contrast, administrative duties are likely perceived as keeping them from their core medical tasks. Increasing the percentage of medical tasks proper, notably surgery, and reducing administrative duties may contribute to hospital surgeons' job satisfaction

Effect of the 50-hour workweek limitation on training of surgical residents in Switzerland

The 50-hour workweek limitation for surgical residents in Switzerland has a major effect on surgical training, resident quality of life, and patient care

Different views about work-hour limitations in medicine: a qualitative content analysis of surgeons', lawyers', and pilots' positive and negative arguments.

Whereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate. The aim of the present study was to evaluate arguments in favour of and against work-hour limitations in medicine given by Swiss surgeons, lawyers, and pilots.An electronic questionnaire survey with four free-response items addressing the question of what arguments speak in favour of or against work-hour limitations in general and in medicine was sent to a random sample of board-certified surgeons, lawyers in labour law, and pilots from SWISS International Airlines Ltd.In all, 279/497 (56%) of the respondents answered the survey: 67/117 surgeons, 92/226 lawyers, and 120/154 pilots. Support for work-hour limitations in general and in medicine was present and higher among lawyers and pilots than it was in surgeons (p<0.001). The latter agreed more with work-hour limitations in general than in medicine (p<0.001). The most often cited arguments in favour of work-hour limitations were "quality and patient safety," "health and fitness," and "leisure and work-family balance," whereas the lack of "flexibility" was the most important argument against. Surgeons expected more often that their "education" and the "quality of their work" would be threatened (p<0.001).Work-hour limitations should be supported in medicine also, but a way must be found to reduce problems resulting from discontinuity in patient care and to minimise the work in medicine, which has no education value