<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_402"
                     title="Minimally Invasive Surgery Takes Toll on MDs, Poll Shows (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18306?impressionId=1265809136613"
                     
      &lt;p&gt;Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the surgeons who perform them.&lt;/p&gt;
&lt;p&gt;More than 80% of surgeons completing an online questionnaire reported pain or stiffness in the hands, neck, back, or legs after performing minimally invasive surgeries, according to Adrian Park, MD, of the University of Maryland Medical Center in Baltimore, and colleagues.&lt;/p&gt;
&lt;p&gt;For most symptoms, the strongest predictor was high case volume, the researchers reported online in the &lt;em&gt;Journal of the American College of Surgeons&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Park and colleagues warned of &quot;an impending epidemic&quot; of occupational injuries among clinicians specializing in minimally invasive surgeries, as such procedures become more common.&lt;/p&gt;
&lt;p&gt;&quot;Now, especially in the face of an impending shortage of general surgeons in the U.S., the last thing that we as a society can afford is surgical careers shortened by occupationally related symptoms and conditions,&quot; they asserted.&lt;/p&gt;
&lt;p&gt;The researchers recommended more research into the ergonomics of laparoscopic surgery, as well as better implementation of existing guidelines meant to reduce injuries associated with the awkward postures and long surgical times often required with these procedures.&lt;/p&gt;
&lt;p&gt;&quot;That research must more clearly and emphatically define the ergonomic impact of minimally invasive surgery on the practicing surgeon (then set about improving it) is now all too painfully clear,&quot; Park and colleagues concluded.&lt;/p&gt;
&lt;p&gt;The researchers invited some 2,000 board-certified members of the Society of American Gastrointestinal and Endoscopic Surgeons (of which Park is currently secretary) to complete the online survey.&lt;/p&gt;
&lt;p&gt;The response rate was 14.4%, with 317 surgeons identified as actively and regularly involved in laparoscopic practices participating.&lt;/p&gt;
&lt;p&gt;Of these, 272 reported experiencing physical symptoms or discomfort that they believed were the result of performing minimally invasive procedures.&lt;/p&gt;
&lt;p&gt;This rate of reported symptoms is markedly higher than that found in earlier studies and surveys, in which the prevalences were in the range of 15% to 60%, Park and colleagues noted.&lt;/p&gt;
&lt;p&gt;They speculated that the current survey, as the most recent, may better reflect the accumulation of injuries over time as surgeons&apos; careers doing minimally invasive surgery have grown longer.&lt;/p&gt;
&lt;p&gt;Fortunately, they found, symptoms were generally not persistent. Only 10.8% of respondents indicated that pain or discomfort continued beyond the immediate aftermath of surgery.&lt;/p&gt;
&lt;p&gt;The largest class of symptoms were those occurring during surgery, with 20.8% of surgeons saying they had symptoms only during procedures and 27.8% reporting symptoms both during and immediately after surgery.&lt;/p&gt;
&lt;p&gt;Another 22.4% indicated that symptoms occurred only immediately after surgery and not persistently.&lt;/p&gt;
&lt;p&gt;About 15% chose &quot;nothing bothers me&quot; in the questionnaire.&lt;/p&gt;
&lt;p&gt;Age appeared to be a factor in the incidence of some complaints, although the pattern was not what might be expected. In particular, hand pain was most common among surgeons younger than 40 and in those older than 60, whereas it was least frequent among surgeons in their 50s.&lt;/p&gt;
&lt;p&gt;Park and colleagues did not report specific hazard ratios or correlation coefficients for case volume as a predictor of symptoms, but they indicated that it was associated with complaints more strongly than other factors such as age, career duration, gender, and height.&lt;/p&gt;
&lt;p&gt;About three-quarters of respondents attributed symptoms to instrument design. Some 40% indicated that operating room table setup and the display monitor location were also contributing factors.&lt;/p&gt;
&lt;p&gt;On the other hand, more than 180 respondents said they had slight or no awareness of published recommendations on surgical ergonomics, such as guidelines published last year in the journal &lt;em&gt;Surgical Endoscopy&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Among those reporting any level of knowledge about the guidelines, only 60% indicated that they had applied it in their practices, Park and colleagues indicated. But more than 90% of surgeons who said they had high awareness of ergonomic guidelines reported putting it to use.&lt;/p&gt;
&lt;p&gt;The researchers said future studies should address other issues not covered adequately in the survey, such as the effects of different monitor positions and instrument designs, as well as whether surgeon discomfort during laparoscopic surgery leads to adverse patient outcomes.&lt;/p&gt;
&lt;p&gt;Park and colleagues also suggested that similar research be conducted on open surgery.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_901"
                     title="Learning Disabilities Linked to Early Surgeries"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/Anesthesiology/tb/13412?impressionId=1265809136613"
                     
      ROCHESTER, Minn., March 24 -- Young children undergoing repeated anesthesia may be at increased risk for learning disabilities, researchers here said.
              &lt;p&gt; 
              &lt;p&gt;In a retrospective cohort study, children with two exposures to anesthesia before age 4 were 59% more likely than unexposed children to be diagnosed with learning disabilities (95% CI 6% to 137%) according to Juraj Sprung, M.D., Ph.D., of the Mayo Clinic, and colleagues reporting online in &lt;em&gt;Anesthesiology&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;Youngsters with three or more exposures had a 2.6-fold increased risk of learning disabilities (95% CI 1.6 to 4.2), the researchers found.
              &lt;p&gt; 
              &lt;p&gt;&quot;The cumulative incidence of LD diagnosed by age 19 among those with repeated anesthetic exposures was almost twice as high (35.1%) compared with children not exposed to anesthesia (20.0%),&quot; they added.
              &lt;p&gt; 
              &lt;p&gt;Dr. Sprung and colleagues noted that the data don&apos;t prove causality. &quot;However, these results suggest that the possibility of potential adverse effects of repeated anesthetic exposures on human neurodevelopment cannot be excluded,&quot; they concluded.
              &lt;p&gt; 
              &lt;p&gt;The results emerged from the ongoing study of children born in Olmsted County, Minn. (the area surrounding the Mayo Clinic) from 1976 to 1982. Dr. Sprung and colleagues analyzed medical records from 5,357 participants to correlate the number of anesthesia exposures and subsequent diagnoses of learning disabilities.
              &lt;p&gt; 
              &lt;p&gt;They identified 593 children who had at least one anesthesia exposure before age 4, involving a total of 875 surgeries. Of these children, 100 had two exposures and 44 had three or more. Most surgeries involved ear-nose-throat, orthopedic, urologic, or &quot;general&quot; procedures.
              &lt;p&gt; 
              &lt;p&gt;About 88% of surgeries involved halothane and 91% used nitrous oxide. Other agents included isoflurane, enflurane, sodium thiopental, etomidate, ketamine, and diazepam, but none was used in as many as 9% of procedures.
              &lt;p&gt; 
              &lt;p&gt;In calculating hazard ratios for anesthesia exposure, Dr. Sprung and colleagues adjusted for sex, birth weight, and gestational age.
              &lt;p&gt; 
              &lt;p&gt;The researchers found no association between single anesthesia exposures and learning disabilities (HR 1.0, 95% CI 0.79 to 1.27).
              &lt;p&gt; 
              &lt;p&gt;Nor was there a relationship with duration of exposure, except for children undergoing extremely long procedures (HR 1.56 for exposures of two hours or more, 95% CI 1.11 to 2.19).
              &lt;p&gt; 
              &lt;p&gt;The apparent dose-response relationship between anesthesia exposure and learning disabilities supports the hypothesis that anesthetic drugs affect neurodevelopment, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;But it remains possible that other factors associated with anesthesia -- such as stress responses to surgery -- are actually to blame, they said.
              &lt;p&gt; 
              &lt;p&gt;They also could not exclude the possibility that the underlying conditions for which surgery was performed were responsible.
              &lt;p&gt; 
              &lt;p&gt;But they noted that prospective controlled studies in animal models have demonstrated alterations in neural development as a result of anesthesia drug exposure.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was funded by the National Institutes of Health and internal Mayo Clinic funds.
              &lt;p&gt; 
              &lt;p&gt;No potential conflicts of interest were reported.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
             
    </recommendedItem>
    <recommendedItem id="20090101_19_2382"
                     title="C-Section Anesthetics Not Linked to Learning Disabilities"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/Anesthesiology/tb/15281?impressionId=1265809136613"
                     
      TORONTO, July 28 -- Anesthesia during a cesarean delivery is not associated with an increased risk of learning disabilities compared with vaginal birth, researchers said. 
              &lt;p&gt;
              &lt;p&gt;The finding -- from a population-based birth cohort -- suggests that brief exposure to anesthetics during birth has no long-term neurodevelopmental consequences, according to Juraj Sprung, MD, PhD, of the Mayo Clinic, and colleagues. 
              &lt;p&gt;
              &lt;p&gt;Indeed, in an unexpected finding, regional anesthesia during cesarean was associated with a lower risk of learning disabilities compared with vaginal birth, Dr. Sprung and colleagues said in the August issue of &lt;em&gt;Anesthesiology&lt;/em&gt;. 
              &lt;p&gt;
              &lt;p&gt;One possible explanation for that observation, they said, is that cesarean delivery with regional anesthesia &quot;attenuates the neonatal stress response to vaginal delivery that in turn has significant effects on later neural development.&quot; 
              &lt;p&gt;
              &lt;p&gt;But Dr. Sprung and colleagues cautioned that more study is needed to confirm or refute the observation. He noted that the apparent protective effect could well be a marker for unknown factors that influence learning disabilities. 
              &lt;p&gt;
              &lt;p&gt;Even so, &quot;it&apos;s reassuring that the anesthetics required for cesarean delivery do not appear to cause long-term brain problems,&quot; Dr. Sprung said in a statement. 
              &lt;p&gt;
              &lt;p&gt;The issue has been of concern, since animal studies have shown that anesthetics can cause degenerative changes when applied to the young brain. 
              &lt;p&gt;
              &lt;p&gt;In addition, the same researchers recently showed that repeated exposure to anesthesia and surgery before the age of 4 was associated with an increased risk of learning disabilities. 
              &lt;p&gt;
              &lt;p&gt;To clarify the issue, Dr. Sprung and colleagues turned to the educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minn., from 1976 through 1982 and who were still in the community at age 5. 
              &lt;p&gt;
              &lt;p&gt;All told, the cohort consisted of 5,320 children, of whom 193 were delivered by cesarean under general anesthesia and 304 by cesarean under regional anesthesia. 
              &lt;p&gt;
              &lt;p&gt;Within the group, 921 children were diagnosed with a learning disability before the age of 19, the researchers found. 
              &lt;p&gt;
              &lt;p&gt;Among those delivered vaginally, the cumulative incidence of learning disabilities was 20.8%, compared with 19.4% for those whose mothers received general anesthesia for cesarean delivery and 15.4% for those whose mothers had a regional anesthetic for cesarean delivery. 
              &lt;p&gt;
              &lt;p&gt;In an unadjusted proportional hazard regression, the incidence of learning disabilities did not differ significantly across the three modes of delivery, the researchers said. 
              &lt;p&gt;
              &lt;p&gt;But the pairwise comparison of vaginal birth with cesarean delivery and regional anesthetic yielded a hazard ratio of 0.73, which was significant at &lt;em&gt;P&lt;/em&gt;=0.046. 
              &lt;p&gt;
              &lt;p&gt;After adjusting for sex, birth weight, gestational age, exposure to anesthesia between birth and age 4, and maternal education, the pattern was similar -- little difference across all three modes, but a hazard ratio of 0.64 for the pairwise comparison of cesarean delivery and regional anesthetic with vaginal delivery. 
              &lt;p&gt;
              &lt;p&gt;The researcher noted that the study was retrospective, which has inherent limitations, and was unable to account for all possible confounders. 
              &lt;p&gt;
              &lt;p&gt;They added that the birth cohort included mainly Caucasian children, which may limit how widely the findings apply. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the Mayo Clinic and the NIH. The researchers did not report any conflicts.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
         
    </recommendedItem>
    <recommendedItem id="20090101_2_280"
                     title="Surgery Increases Risk of Cognitive Decline Among Elderly"
                     score="-0.005"
                     href="