Search

Background/purpose: A key measure to maintain and improve the quality of healthcare is the formal accreditation of provider units. The European Society of Endocrine Surgeons (ESES) therefore proposes a system of accreditation for endocrine surgical centers in Europe to supplement existing measures that promote high standards in the practice in endocrine surgery. Methods: A working group analyzed the current healthcare situation in the field of endocrine surgery in Europe. Two surveys were distributed to ESES members to acquire information about the structure, staffing, caseload, specifications, and technology available to endocrine surgery units. Further data were sought on tracer diagnoses for quality standards, training provision, and research activity. Existing accreditation models related to endocrine surgery were included in the analysis. Results: The analysis of existing accreditation models, available evidence, and survey results suggests that a majority of ESES members aspire to a two-level model (termed competence and reference centers), sub-divided into those providing neck endocrine surgery and those providing endocrine surgery. Criteria for minimum caseload, number and certification of staff, unit structure, on-site collaborating disciplines, research activities, and training capacity for competence center accreditation are proposed. Lastly, quality indicators for distinct tracer diagnoses are defined. Conclusions: Differing healthcare structures, existing accreditation models, training models, and varied case volumes across Europe are barriers to the conception and implementation of a pan-European accreditation model. However, there is consensus on accepted standards required for accrediting an ESES competence center. These will serve as a basis for first-stage accreditation of endocrine surgery units. [ABSTRACT FROM AUTHOR]

Introduction:  Potential neurotoxicity of anesthetic drugs has been among the most intensively discussed issue in pediatric anesthesia for more than 10 years. It remains unclear how far this discussion has reached the European pediatric surgical community. Our aim was to investigate the thoughts of pediatric surgeons regarding this topic. In addition, we provide an update on the current scientific evidence regarding neurotoxicity together with recommendations for clinical practice.Materials and Methods:  A web-based survey to assess the thoughts of practicing European pediatric surgeons regarding neurotoxicity and how it may have influenced their daily practice of pediatric surgery was launched via the European Pediatric Surgeons' Association Web site.Results:  A total of 72 responses could be analyzed. A majority of the respondents were interested in the topic but felt a need to further explore it. Thirty-one respondents have changed their daily practice of pediatric surgery due to potential anesthetic drug toxicity. Eighteen respondents reported to be concerned about neurotoxicity, 29 held a neutral position, and 8 were not concerned. Twenty-seven respondents found it a shared responsibility of the surgeon and the anesthesiologist to deal with the neurotoxicity issue. The majority of respondents found a necessity for further research on anesthetic drug neurotoxicity, assigning the highest priority to prospective longitudinal human studies and the lowest to animal studies.Conclusion:  The neurotoxicity question has reached the pediatric surgical community. Currently available scientific data do not support the theory of anesthetic drug-induced neurotoxicity in young children. Recent interdisciplinary clinical research focuses on neurodevelopmental outcome after surgery in neonates and infants. The European Safe Anesthesia For Every Tot initiative suggests focusing on proper conduct of anesthesia in children rather than on possible anesthetic drug neurotoxicity. [ABSTRACT FROM AUTHOR]

Introduction Pediatric surgery is essential for the surgical treatment of children in Europe and is generally a well-accepted specialty in Europe. There are still limited data on the training conditions within the European national associations of pediatric surgery. Materials and Methods A questionnaire designed by the executive committee of UEMS Section of Pediatric Surgery was distributed among all ordinary and associated UEMS members, which have national pediatric surgical associations, and to Russia. These questionnaires were completed by colleagues of the national associations and returned to the authors. Results In this study, 29 out of 37 (78%) national associations of pediatric surgery answered the questionnaire. In 90% of these countries, pediatric surgery is a distinct specialty. Training usually starts with a common surgical trunk (75%) of 1 to 2 years; the whole training lasts ~ 6 years. Nonsurgical parts of the training, such as pediatrics, are part of the training program in 54% of countries. The content of the training comprises general pediatric surgery and newborn surgery in all countries, pediatric surgical oncology and pediatric urology in most countries, and pediatric traumatology and pediatric neurosurgery only in some countries. More than 90% of countries use a training logbook, and 79% require a final examination. The European Board of Pediatric Surgery exam is recognized only in 54% of the countries. Conclusion This study reveals that a uniform training schedule in pediatric surgery throughout Europe has not been achieved. This situation mandates urgent attempt to harmonize both training curricula and final exams at European level. [ABSTRACT FROM AUTHOR]

Aim This study aims to define patterns of Hirschsprung disease (HD) management. Methods An online questionnaire was sent to all European Paediatric Surgeons' Association (EUPSA) members. Results A total of 294 members (61 countries) answered (response rate: 61%).Diagnosis: All respondents perform rectal biopsies (61% rectal suction [RSBs], 39% open full-thickness), 96% contrast enema, and 31% anorectal manometry. At RSB, 17% take the most distal biopsy 1 cm above the dentate line, 34% take 2 cm, 30% take 3 cm, and 19% take > 3 cm. Rectal biopsy staining's are hematoxylin/eosin (77%), acetylcholinesterase (74%), calretinin (31%), S100 (2%), nicotinamide adenine dinucleotide-tetrazolium reductase (2%), succinate dehydrogenase (1%), and neuron-specific enolase (1%). A total of 85% respondents recognize entities including hypoganglionosis (69%), intestinal neuronal dysplasia (55%), and ultrashort segment HD (50%).Surgery: Pull-through (PT) is performed at diagnosis by 33% or delayed by 67% (4 months or > 5 kg). Awaiting definitive surgery, 77% perform rectal irrigations, 22% rectal dilatation/stimulations, and 33% perform a stoma. The preferred type of PT is the Soave approach (65%), performed with transanal technique by 70% respondents. If symptoms persist after PT, most opt for conservative approach (enemas/laxatives = 76%; botulinum toxin = 27%), 30% would redo the PT. Total colonic aganglionosis: PT is performed in neonates (4%), at 1 to 6 months (29%), 6 to 12 months (37%) or older (30%). If required, a stoma is sited in the ileum (31%), according to intraoperative biopsies (54%), macroscopic impression (13%), and radiology (2%). Duhamel PT is performed by 52%, Soave by 31%, and Swenson by 17%. Overall, 31% would perform a J-pouch. Conclusions Most aspects of HD management lack consensus with wide variations in obtaining a diagnosis. Transanal Soave PT is the most common technique in standard segment HD. Guidelines should be developed to avoid such variability in management and to facilitate research studies. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease (CD) is frequently complicated by intestinal strictures, which are commonly treated by endoscopic balloon dilation (EBD). However, available data on this area of treatment is limited. The aim of this study was to depict the heterogeneity of endoscopic management of CD-associated strictures among international CD specialists to identify common treatment standards.Methods: IBD experts of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD), the European Crohn's and Colitis Organization (ECCO), and from the Prospective Value In IBD trials (PROVIT) completed a web-based questionnaire to evaluate their endoscopic experience, practice setting, and number of EBDs performed annually. Additionally, two case scenarios and technical practice parameters were investigated.Results: A total of 126 subjects from 15 countries completed the survey. The maximal length of dilated stricture was 4.5 ± 1.7 cm. The most commonly used maximal balloon size was graded as 15-18 mm. While 87.2 % of the participants favored EBD for anastomotic strictures, only 58.6 % did so in the case of naïve strictures. Only 35.7 % of physicians dilated actively inflamed strictures. Interventional endoscopists were more likely to dilate only clinically symptomatic strictures (p = 0.046). Surgeons favored surgical treatment of de novo ileocecal strictures compared to gastroenterologists (p = 0.026), reported a shorter stricture length being amendable by EBD (p = 0.045), and more frequently used concomitant therapies (p = 0.001). Operator experience increased the likelihood of EBD use in actively inflamed strictures (p = 0.002), maximum length of stricture, and maximum balloon size (p = 0.001).Conclusions: EBD is a widely used treatment approach for stricturing CD. Individual approaches differ significantly based on background of the operator, experience level, and practice setting. [ABSTRACT FROM AUTHOR]

Background: Females are less attracted than males to surgical specialties, which may be due to differences in the acquisition of skills. The aim of this study was to systematically review studies that investigate gender differences in the acquisition of surgical skills.Methods: We performed a comprehensive database search using relevant search phrases and MeSH terms. We included studies that investigated the role of gender in the acquisition of surgical skills.Results: Our search yielded 247 studies, 18 of which were found to be eligible and were therefore included. These studies included a total of 2,106 study participants. The studies were qualitatively synthesized in five categories (studies on medical students, studies on both medical students and residents, studies on residents, studies on gender differences in needed physical strength, and studies on other gender-related training conditions). Male medical students tended to outperform females, while no gender differences were found among residents. Gaming experience and interest in surgery correlated with better acquisition of surgical skills, regardless of gender. Although initial levels of surgical abilities seemed lower among females, one-on-one training and instructor feedback worked better on females and were able to help the acquisition of surgical skills at a level that negated measurable gender differences. Female physicians possess the required physical strength for surgical procedures, but may face gender-related challenges in daily clinical practice.Conclusion: Medical students are a heterogeneous group with a range of interests and experiences, while surgical residents are more homogeneous perhaps due to selection bias. Gender-related differences are more pronounced among medical students. Future surgical curricula should consider tailoring personalized programs that accommodate more mentoring and one-on-one training for female physicians while giving male physicians more practice opportunities in order to increase the output of surgical training and acquisition of surgical skills. [ABSTRACT FROM AUTHOR]

Background: One undisputed benefit of digital support is the possibility of contact reduction, which has become particularly important in the context of the COVID-19 pandemic. However, to the best of our knowledge, there is currently no study assessing the Europe-wide use of digital online pre-operative patient information or evaluation in the health sector. The aim of this study was to give an overview of the current status in Europe. Methods: A web-based questionnaire covering the informed consent process was sent to members of the European Society of Anaesthesia and Intensive Care Medicine (ESAIC) in 47 European countries (42,433 recipients/930 responses). Six questions related specifically to the practice in paediatrics. Results: A total of 70.2% of the respondents indicated that it was not possible to obtain informed consent via the Internet in a routine setting, and 67.3% expressed that they did not know whether it is in line with the legal regulations. In paediatric anaesthesia, the informed consent of only one parent was reported to be sufficient by 77.6% of the respondents for simple interventions and by 63.8% for complex interventions. Just over 50% of the respondents judged that proof of identity of the parents was necessary, but only 29.9% stated that they ask for it in clinical routine. In the current situation, 77.9% would favour informed consent in person, whereas 60.2% could imagine using online or telephone interviews as an alternative to a face-to-face meeting if regulations were changed. Only 18.7% participants reported a change in the regulations due to the current pandemic situation. Conclusion: Whether informed consent is obtained either online or on the telephone in the paediatric population varies widely across Europe and is not currently implemented as standard practice. For high-risk patients, such as the specific cohort of children with congenital heart defects, wider use of telemedicine might provide a benefit in the future in terms of reduced contact and reduced exposure to health risks through additional hospital stays. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is little knowledge around the world about training and certification for general thoracic surgeons, and the relationship between thoracic surgery and cardiac surgery. Examination of the membership of European Association for Cardio-Thoracic Surgery (EACTS) and European Society of Thoracic Surgeons (ESTS) can clarify the training, practice and academic activity of European thoracic surgeons, as well as the similarities and differences between these two professional societies. Methods: A 38-item survey was designed to assess training, practice, demographics and relationships of general thoracic and cardiac surgeons in EACTS and ESTS. Results: A total of 447 respondents were tabulated from the EACTS (N =238) and ESTS (N =141) or both (N =68). As many as 33% of ESTS members were also members of EACTS, while 22% of EACTS members were members of both societies. ESTS members were younger but had similar numbers of female members (6% EACTS vs 9% ESTS). ESTS members self-designated as exclusive general thoracic surgeons (80%) compared with 33% of EACTS members (p <0.001), although 38% of EACTS members had practice patterns consistent with a dominant general thoracic practice. ESTS members are board certified in cardiac (29%) or thoracic surgery (83%) compared with 72% and 71% for EACTS members, respectively. ESTS members were more likely to perform oesophageal surgery as a significant portion of their practice (46% vs 26%, respectively, p <0.001). Median length of specialised cardiac and thoracic training was 4 years for both society memberships, although the median length of total surgical training was 1 year longer for EACTS members (6 vs 7 years). Practice in an academic setting and the number of peer-reviewed manuscripts was similar amongst memberships in both societies. Conclusion: Members of EACTS and ESTS are very similar in length of training, board certification and academic practice and activity, although they have expected practice variation, given the different membership focus and demographics. Both societies provide important education and advocacy services for their members. Increased co-operation may further propagate improvements in cardiothoracic education and improve patient access and outcomes through shared specialty advocacy. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the influence of the status of vascular surgery (VS) training paradigms on the actual practice of endovascular therapy among the European countries. Methods: An email-based survey concerning vascular surgery training models and endovascular practices of different clinical specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. Results: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1. Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p =0.006), while increasing overall training devoted specifically to VS (3.9 vs 2.7 years, p =0.008). Among countries with independent certification an average of 76% of aortic and 50% of peripheral endovascular procedures are performed by vascular surgeons, while the corresponding values, for countries with a non-independent certification, are 69% and 36% respectively. Countries with independent vascular certification, despite their lower average endovascular index (procedures per 100,000 population), reported a higher growth rate of aortic endovascular procedures (VS independent 132% vs VS non-independent 87%), within a four-year period (2003–2007). Peripheral endovascular procedures, though, have similar growth rates in both country groups (VS independent 62% vs VS non-independent 60%). Conclusions: In European countries with VS as an independent specialty, vascular surgeons have a shorter total training period but spend more time in VS training, although they may not undertake a greater proportion of the endovascular procedures their countries appear to have adopted endovascular technologies more rapidly compared to the ones with non-independent VS curricula. Whether such differences influence patient outcomes requires investigation in future studies. [Copyright &y& Elsevier]

The authors discuss the aspects of the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) in the practice of cardiac surgery in 21st century. The authors argue on the importance of EuroSCOREII in surgical performance assessment. Moreover, the authors concluded that EuroSCORE II showed the European Cardiothoracic Surgery community the need for systematic approach in the quality measurement of cardiac surgery in Europe.

An introduction to the journal is presented in which the editor discusses the 16th European Paediatric Surgeons' Association (EUPSA)'s Annual Congress in Ljubljana, Slovenia on June 17–20, 2015.

The article focuses on the policies in rendering surgical training in Europe. It is stated that hospitals impose limited training hours for surgeons because overfatigue and stress can cause medical errors. In response to the policies, the European Working Time Directive (EWTD) has implemented the 48 hour weekly training which will be effective by August 2009.

The article provides information on the Division of Coloproctology, a surgical specialty section of the Union Européene des Medicins Specialistes (UEMS) Section of Surgery. It says the division started in 1998 under the European Board of Surgical Qualification (EBSQ) Coloproctology's governance, and has acquired accreditation and certification in Coloproctology in Europe. Details on the accreditation process and EBSQ Diploma's expansion are also discussed.

Background. Dialysis adequacy, assessed by urea kinetics, is an important determinant of patient outcome, and is therefore an important clinical performance indicator. In this perspective, renal registry data may be useful to compare practices across countries. To serve that purpose available data should be comparable and preferably collected using a standardized procedure. The aim of this study, initiated by the European Renal Association–European Dialysis and Transplantation Association (ERA–EDTA) QUality European STudies (QUEST) initiative, was to make an inventory of the different methods used to determine urea kinetic measurements in the light of the European Best Practice Guidelines. Methods. Via their national and regional registries, European haemodialysis centres were invited to complete a questionnaire regarding their practice of measuring dialysis adequacy. Results. Fourteen regional or national registries among 51 sent back 255 questionnaires. Great variability in the methodology to assess Kt/V was observed. The urea reduction ratio (URR) was used alone by 37% (in association 46%) of dialysis centres, spKt/V by 25% (35%) and on-line clearance by 4% (12%), whereas only 10% (13%) used eKt/V, as recommended by EBPG. Forty percent of centres measured urea removal less than once a month, 6% of which never measured urea removal and 9% only every 6 months or less frequently. Conclusion. Despite the fact that the use of URR is not recommended by EBPG, it was the most commonly used indicator to measure urea removal, whereas eKt/V was only used by a small minority of centres. This study allowed us to point out the need to standardize definitions and procedures and to develop an effective plan for implementation of the guidelines. [ABSTRACT FROM AUTHOR]

Reports that the Joint Residency Advisory and Accreditation Committee paid the first European Site Visit to the Department of Neurosurgery of the University of Lublin in Poland. Claim that this department was the first to officially apply for accreditation as European Training Centre in Neurosurgery; Role of the site visits in enhancing the relationship between European neurosurgeons.