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Article ; Online: Reply to Comment on the article titled 'Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality: analysis of 14,798 procedures' by Elliott JA et al.

Elliott, Jessie A / Ridgway, Paul F

2021 Volume 108, Issue 1, Page(s) e54

MeSH term(s)	COVID-19 ; Cross Infection ; Humans ; Postoperative Complications ; SARS-CoV-2
Language	English
Publishing date	2021-02-27
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znaa104
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Article ; Online: If in Doubt Don't Act Out! Exploring Behaviours in Clinical Decision Making by General Surgeons Towards Surgical Procedures.

Whelehan, Dale F / Conlon, Kevin C / Ridgway, Paul F

World journal of surgery

2021 Volume 45, Issue 4, Page(s) 1055–1065

Abstract: Background: Clinical decision-making (CDM) plays an integral role to surgeons work and has ramifications for patient outcomes and experience. The factors influencing a surgeons decision-making and the utility of cognitive decisional short cuts used in ... ...

Abstract	Background: Clinical decision-making (CDM) plays an integral role to surgeons work and has ramifications for patient outcomes and experience. The factors influencing a surgeons decision-making and the utility of cognitive decisional short cuts used in CDM known as 'heuristics' remains unknown. The aim of this paper is to explore how general surgeons make decisions in high-stake biliary tract clinical scenarios. Methods: This was a cross sectional survey comprising of two sections-a 'demographics section' and a 'clinical vignettes section'. Participants were recruited by an email distributed by the Royal College of Surgeons in Ireland. Non-parametric testing examined relationships and content analysis was applied for clinical reasoning. Results: 73 participants or 37.6% of the overall population completed the survey. 71.4% of these were male. Most (50%) were higher trainees with moderate levels of overall reflective practice in decision-making. A majority of participants chose conservatively in high-stake biliary tract clinical cases with disease factors (43.5%) weighted highest, followed by personal factors (41.1%) and patient factors (15.4%) in clinical reasoning. The presence of a 'hook' associated with commonly used heuristics did not significantly change decision-making behaviour. Conclusion: In high-stake scenarios, surgeons make conservative clinical decisions, predominantly dominated by disease and personal justifications. The utility of heuristics in lower-stake scenarios should be explored regarding clinical decision-making rationale and outcomes. Practitioners should consider use of patient factors in high-stake decisions to enable shared decision-making when appropriate which can reduce post-decisional regret and support the vision of patient-centred care.
MeSH term(s)	Clinical Decision-Making ; Cross-Sectional Studies ; Decision Making ; Emotions ; Humans ; Ireland ; Male ; Surgeons
Language	English
Publishing date	2021-01-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-020-05888-2
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Article ; Online: To strive or survive: An exploration of the meaning and inhibitors to thriving in surgical performance.

Whelehan, Dale F / Brown, Daniel J / Ridgway, Paul F

American journal of surgery

2021 Volume 222, Issue 3, Page(s) 504–505

MeSH term(s)	Achievement ; Adaptation, Psychological ; Clinical Competence ; Fatigue/prevention & control ; Fatigue/psychology ; Female ; General Surgery ; Humans ; Male ; Occupational Diseases/prevention & control ; Occupational Diseases/psychology ; Organizational Culture ; Peer Influence ; Self Report ; Sleep Deprivation/prevention & control ; Sleep Deprivation/psychology ; Social Skills ; Surgeons/psychology
Language	English
Publishing date	2021-03-17
Publishing country	United States
Document type	Editorial
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2021.03.010
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Article: COVID-19 and surgery: A thematic analysis of unintended consequences on performance, practice and surgical training.

Whelehan, Dale F / Connelly, Tara M / Ridgway, Paul F

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2020 Volume 19, Issue 1, Page(s) e20–e27

Abstract: Purpose: The shift in the national focus and allocation of resources to the management of COVID19 has led to significant changes to surgical practice including the delay of elective surgery. The aim of this study was to explore the implications of such ... ...

Abstract	Purpose: The shift in the national focus and allocation of resources to the management of COVID19 has led to significant changes to surgical practice including the delay of elective surgery. The aim of this study was to explore the implications of such changes on surgeons. Method: Using a qualitative study design, semi-structured interviews were conducted with general surgery consultants and non-consultant hospital doctors from a major tertiary hospital in the Dublin region between March-May 2020. Data collection proceeded iteratively using a thematic analysis approach with quality controls such as memoing and collaborative analysis. Results: Fourteen surgeons (8 male, 6 female) were interviewed. The majority (n = 11, 78.6%) were NCHDs. Significant themes determined included 'impacts' on a variety of constructs such as performance, self-reported fatigue and wellbeing. Training themes elucidated included the effects of the cancellation of elective admissions on reduced operative exposure for trainees. Senior surgical staff were particularly focused on increased complexity in patient management. New policy requirements such as personal protective equipment use and novel rotas have had implications for aspects of work engagement. The pandemic and subsequent national restrictions imposed has afforded opportunities for improved well-being but also resulted in greater solitude in surgeons. Conclusions: Rhetoric surrounding fatigue management and virus control dominates the conversation on the relationship between COVID-19 and surgery. Tipping the balance back to parity of fatigue management with service delivery in surgery will be key for sustainability of the surgical workforce.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Fatigue/epidemiology ; Female ; General Surgery/education ; Humans ; Interviews as Topic ; Ireland/epidemiology ; Male ; Organizational Policy ; Pandemics ; Physicians/psychology ; Practice Patterns, Physicians'/trends ; Qualitative Research ; SARS-CoV-2 ; Workload
Keywords	covid19
Language	English
Publishing date	2020-08-03
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2020.07.006
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Article ; Online: Would you allow a sleepy surgeon operate on you? A narrative review.

Whelehan, Dale F / Alexander, Michael / Ridgway, Paul F

Sleep medicine reviews

2020 Volume 53, Page(s) 101341

Abstract: It is unclear if work-flow patterns resulting in sleep deprivation impacts on a surgeon's performance. Similar industries provide mitigating strategies to counteract sleep that may be of benefit to surgeons. A narrative review was conducted utilising ... ...

Abstract	It is unclear if work-flow patterns resulting in sleep deprivation impacts on a surgeon's performance. Similar industries provide mitigating strategies to counteract sleep that may be of benefit to surgeons. A narrative review was conducted utilising Medline, Embase, Cinahl and Google Scholar. All English language papers including sleep and surgery and mitigating strategies for sleep deprivation in similar high-risk industries were included cumulating in 9050 non-duplicate papers. 97 studies were included in the final review. From this narrative review, it appears that there is a problem of sleep deprivation in the surgical profession. Results showed cognitive performance is more impacted than technical performance in the surgical profession in both simulated and real-life performance research. The relationship between sleep and workflow of surgeons is complex with numerous methodological approaches and contrasting research outcomes. Mitigating factors such as mandatory rest, simulation and stimulants have proven effective in other industries which parallel performance standards to surgery. This warrants a systematic review exploring the role of sleep deprivation and the potential role of mitigating interventions in areas of performance less understood like technical skill performance.
MeSH term(s)	Cognition/physiology ; Fatigue/psychology ; Humans ; Patient Safety ; Sleep Deprivation/psychology ; Surgeons/psychology
Language	English
Publishing date	2020-05-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1414211-9
ISSN	1532-2955 ; 1087-0792
ISSN (online)	1532-2955
ISSN	1087-0792
DOI	10.1016/j.smrv.2020.101341
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Article ; Online: Medicine and heuristics: cognitive biases and medical decision-making.

Whelehan, Dale F / Conlon, Kevin C / Ridgway, Paul F

Irish journal of medical science

2020 Volume 189, Issue 4, Page(s) 1477–1484

Abstract: Introduction: Clinical decision-making is a daily practice conducted by medical practitioners, yet the processes surrounding it are poorly understood. The influence of 'shortcuts' in clinical decision-making, known as heuristics, remains unknown. This ... ...

Abstract	Introduction: Clinical decision-making is a daily practice conducted by medical practitioners, yet the processes surrounding it are poorly understood. The influence of 'shortcuts' in clinical decision-making, known as heuristics, remains unknown. This paper explores heuristics and the valuable role they play in medical practice, as well as offering potential solutions to minimize the risk of incorrect decision-making. Method: The quasi-systematic review was conducted according to modified PRISMA guidelines utilizing the electronic databases Medline, Embase and Cinahl. All English language papers including bias and the medical profession were included. Papers with evidence from other healthcare professions were included if medical practitioners were in the study sample. Discussion: The most common decisional shortcuts used in medicine are the Availability, Anchoring and Confirmatory heuristics. The Representativeness, Overconfidence and Bandwagon effects are also prevalent in medical practice. Heuristics are mostly positive but can also result in negative consequences if not utilized appropriately. Factors such as personality and level of experience may influence a doctor's use of heuristics. Heuristics are influenced by the context and conditions in which they are performed. Mitigating strategies such as reflective practice and technology may reduce the likelihood of inappropriate use. Conclusion: It remains unknown if heuristics are primarily positive or negative for clinical decision-making. Future efforts should assess heuristics in real-time and controlled trials should be applied to assess the potential impact of mitigating factors in reducing the negative impact of heuristics and optimizing their efficiency for positive outcomes.
MeSH term(s)	Clinical Decision-Making/ethics ; Cognition/physiology ; Heuristics/physiology ; Humans ; Medicine/methods
Language	English
Publishing date	2020-05-14
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-020-02235-1
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Article ; Online: A rare case of perforated gastric duplication cyst associated with gastric diverticulum.

Smith, Joseph M / Elliott, Jessie A / Gillis, Amy E / Ridgway, Paul F

BMJ case reports

2021 Volume 14, Issue 3

Abstract: A 50-year-old man presented to the emergency department with a 1-day history of severe epigastric pain, vomiting and fever. He had a background of alcohol excess and smoking. The patient was tachycardic and febrile with an elevated white blood cell count ...

Abstract	A 50-year-old man presented to the emergency department with a 1-day history of severe epigastric pain, vomiting and fever. He had a background of alcohol excess and smoking. The patient was tachycardic and febrile with an elevated white blood cell count and C reactive protein. CT demonstrated extensive upper abdominal free fluid, without free air, with a large cystic lesion arising from the greater curvature of the stomach, and a second smaller cystic lesion arising from the posterior aspect of the gastric fundus. The patient was managed with nasogastric drainage, parenteral nutrition, intravenous antibiotics and proton pump inhibitors, and CT-guided abdominal drainage, with resolution of sepsis, and further outpatient care was transferred to our unit. Follow-up endoscopy demonstrated a diverticulum arising from the posterior aspect of the gastric fundus, with normal mucosa throughout the remaining stomach, while CT showed an additional cystic lesion arising from the greater curvature, with thickening of the adjacent gastric wall consistent with a gastric duplication cyst (GDC). Laparoscopy confirmed a small diverticulum at the fundus, and a large GDC anteriorly with associated omental adhesions consistent with prior perforation-two wedge resections were performed. Histology demonstrated no evidence of malignancy or ectopic mucosa. The patient recovered uneventfully and remained free from recurrent symptoms at 6 weeks postoperatively. GDC is a rare entity, which may be associated with ectopic mucosa, malignant transformation and upper gastrointestinal perforation. No previous report describes the coexistence of a GDC and gastric diverticulum. Herein we describe the investigation and management of this condition, and review the associated peer-reviewed literature.
MeSH term(s)	Cysts/complications ; Cysts/diagnostic imaging ; Cysts/surgery ; Diverticulum, Stomach ; Humans ; Male ; Middle Aged ; Stomach Neoplasms ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-03-01
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2020-239971
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Article ; Online: Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence.

Clancy, Cillian / Jordan, Patrick / Ridgway, Paul F

Irish journal of medical science

2019 Volume 188, Issue 4, Page(s) 1349–1356

Abstract: Introduction: Increasing awareness and regulatory body attention is directed towards the insertion of synthetic material for a variety of surgical procedures. This review aims to assess current evidence regarding systemic and auto-immune effects of ... ...

Abstract	Introduction: Increasing awareness and regulatory body attention is directed towards the insertion of synthetic material for a variety of surgical procedures. This review aims to assess current evidence regarding systemic and auto-immune effects of polypropylene mesh insertion in hernia repair. Methods: The electronic literature on systemic and auto-immune effects associated with mesh insertion was examined. Results: Foreign body reaction following mesh implantation initiates an acute inflammatory cellular response. Involved markers such as IL-1, IL-6, IL-10 and fibrinogen are increased in circulation in the presence of mesh but return to normal at 7 days post operatively. Oxidative degradation of implanted mesh is likely, but no evidence exists to support systemic absorption or resulting disease effects. Variable cytokine production in healthy hosts leading to unpredictable or overwhelming response to implanted biomaterial warrants further investigation. Clinical studies show no associated long-term systemic effects with mesh. Conclusion: To date, there remains no evidence to link polypropylene mesh and systemic or auto-immune symptoms. Based on current evidence, the use of polypropylene mesh is supported.
MeSH term(s)	Biomarkers/metabolism ; Foreign-Body Reaction/etiology ; Hernia, Inguinal/surgery ; Herniorrhaphy/methods ; Humans ; Inflammation/etiology ; Polypropylenes/chemistry ; Prostheses and Implants ; Surgical Mesh
Chemical Substances	Biomarkers ; Polypropylenes
Language	English
Publishing date	2019-03-27
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-019-02008-5
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Article: A systematic review of sleep deprivation and technical skill in surgery.

Whelehan, Dale F / McCarrick, Cathleen A / Ridgway, Paul F

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2020 Volume 18, Issue 6, Page(s) 375–384

Abstract: Background: It is uncertain if sleep deprivation impacts sleepy surgeons' technical skills. Lapses in surgical performance could increase morbidity and mortality. This review concludes if sleep deprivation impacts on technical skill performance in ... ...

Abstract	Background: It is uncertain if sleep deprivation impacts sleepy surgeons' technical skills. Lapses in surgical performance could increase morbidity and mortality. This review concludes if sleep deprivation impacts on technical skill performance in simulated environments. Objective: Primary: 1. To identify if sleep deprivation has an impact on technical skill proficiency in surgeons. Secondary: a. To identify if the level of surgical experience, quality of sleep, or quantity of sleep influences technical skill proficiency in sleep deprived surgeons. Methods: The review was conducted according to PRISMA guidelines utilising the databases Journals Ovid. Validation followed with two independent reviewers utilising an adapted version of BEME. Results: Thirty-three heterogeneous studies were included. Sleep deprivation likely negatively impacts technical performance between 11.9 and 32% decrement in performance. No strong evidence exists with regards to influence of experience, sleep type, or sleep length on technical proficiency. Conclusion: Sleepy surgeons' technical skills are, on balance, between 11.9 and 32% negatively impacted in a standardised simulated environment. This is likely to have clinical implications for patient safety.
MeSH term(s)	Clinical Competence ; Humans ; Postoperative Complications/epidemiology ; Sleep Deprivation/complications ; Sleep Deprivation/psychology ; Surgeons/psychology
Language	English
Publishing date	2020-02-11
Publishing country	Scotland
Document type	Journal Article ; Systematic Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2020.01.004
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Article: Self-reported surgeon health behaviours: A multicentre, cross-sectional exploration into the modifiable factors that impact surgical performance with the association of surgeons in training.

Whelehan, Dale F / Connelly, Tara M / Burke, Joshua R / Doherty, Eva M / Ridgway, Paul F

Annals of medicine and surgery (2012)

2021 Volume 65, Page(s) 102299

Abstract: Introduction: Surgeons regularly educate patients on health promoting behaviours including diet, sleep and exercise. No study thus far has explored surgeons' personal compliance with these health behaviours and their relationship with surgical ... ...

Abstract	Introduction: Surgeons regularly educate patients on health promoting behaviours including diet, sleep and exercise. No study thus far has explored surgeons' personal compliance with these health behaviours and their relationship with surgical performance. The primary outcomes of this study were self-reported health, health related behaviours, wellbeing, fatigue and surgical performance. Methods: A survey of validated themes on health related behaviours, workplace variables and performance was distributed to surgical trainees and consultants in the UK and Ireland through the Association for Surgeons in Training (ASiT). Non-parametric analysis was used to determine inferential associations. Results: Ninety five surgeons (51.5% female, 39.9% registrars) completed the survey. 94% and 74% reported 'good' or better overall health and mental wellbeing respectively. The majority (54.7%) reported inconsistent sleep patterns. Less than a quarter engage in regular exercise. Sixty two and 64.2% reported being regularly fatigued and bothered by feelings of anxiety and/or depression respectively. Poor self-reported health and wellbeing were associated with poorer reported off-call performance (p < .01). Higher levels of fatigue negatively impacted self-reported surgical and non-surgical task proficiency (p < .01). Discussion and conclusion: Surgeons reported high levels of overall health. However, healthy behaviours around sleep, diet and exercise were not consistently reported. Fewer reported good mental health and emotional well-being. Self-reported health behaviours including sleep and physical activity were associated with surgical performance. Strategies to improve modifiable lifestyle factors which will optimise physical health, mental wellbeing and levels of fatigue may optimise surgical performance.
Language	English
Publishing date	2021-04-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1016/j.amsu.2021.102299
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