

The main objectives of this paper are to outline the essential tools, instruments, and equipment needed to set up a functional microsurgery laboratory that is affordable for low-income hospitals and to identify cost-effective alternatives for acquiring microsurgical equipment, such as refurbished or donated instruments, collaborating with medical device manufacturers for discounted rates, or exploring local suppliers.



Step-by-step instructions were provided on setting up the microsurgery laboratory, including recommendations for the layout, ergonomic considerations, lighting, and sterilization processes while ensuring cost-effectiveness, as well as comprehensive training protocols and a curriculum specifically tailored to enhance microsurgical skills in neurosurgery residents.



We explored cost-effective options for obtaining microsurgery simulators and utilizing open-source or low-cost virtual training platforms. We also included guidelines for regular equipment maintenance, instrument sterilization, and establishing protocols for infection control to ensure a safe and hygienic learning environment. To foster collaboration between low-income hospitals and external organizations or institutions that can provide support, resources, or mentorship, this paper shows strategies for networking, knowledge exchange, and establishing partnerships to enhance microsurgical training opportunities further. We evaluated the impact and effectiveness of the low-cost microsurgery laboratory by assessing the impact and effectiveness of the established microsurgery laboratory in improving the microsurgical skills of neurosurgery residents. About microsutures and microanastomosis, after three weeks of training, residents showed improvement in “surgical time” for ten separate simple stitches (30.06 vs. 8.65 min) and ten continuous single stitches (19.84 vs. 6.51 min). Similarly, there was an increase in the “good quality” of the stitches and the suture pattern from 36.36% to 63.63%.



By achieving these objectives, this guide aims to empower low-income hospitals and neurosurgery residents with the necessary resources and knowledge to establish and operate an affordable microsurgery laboratory, ultimately enhancing the quality of microsurgical training and patient care in low-income countries.


Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide

The current applications of artificial intelligence (AI) in medicine continue to attract the attention of medical students. This study aimed to identify undergraduate medical students' attitudes toward AI in medicine, explore present AI-related training opportunities, investigate the need for AI inclusion in medical curricula, and determine preferred methods for teaching AI curricula. 

Perceptions of undergraduate medical students on artificial intelligence in medicine: mixed-methods survey study from Palestine

Breast cancer remains the most prevalent cancer among women worldwide, necessitating advancements in diagnostic methods. The integration of artificial intelligence (AI) into mammography has shown promise in enhancing diagnostic accuracy. However, understanding patient perspectives, particularly considering the psychological impact of breast cancer diagnoses, is crucial. This narrative review synthesizes literature from 2000 to 2023 to examine breast cancer patients’ attitudes towards AI in breast imaging, focusing on trust, acceptance, and demographic influences on these views. Methodologically, we employed a systematic literature search across databases such as PubMed, Embase, Medline, and Scopus, selecting studies that provided insights into patients’ perceptions of AI in diagnostics. Our review included a sample of seven key studies after rigorous screening, reflecting varied patient trust and acceptance levels towards AI. Overall, we found a clear preference among patients for AI to augment rather than replace the diagnostic process, emphasizing the necessity of radiologists’ expertise in conjunction with AI to enhance decision-making accuracy. This paper highlights the importance of aligning AI implementation in clinical settings with patient needs and expectations, emphasizing the need for human interaction in healthcare. Our findings advocate for a model where AI augments the diagnostic process, underlining the necessity for educational efforts to mitigate concerns and enhance patient trust in AI-enhanced diagnostics.

Patients’ Perceptions and Attitudes to the Use of Artificial Intelligence in Breast Cancer Diagnosis: A Narrative Review

Comprehensive overview of artificial intelligence in surgery: a systematic review and perspectives.

Global neurosurgery is a public health focus in neurosurgery that seeks to ensure safe, timely, and affordable neurosurgical care to all individuals worldwide. Although investigators have begun to explore the promise of AI for neurosurgery, its applicability to global neurosurgery has been largely hypothetical. We characterize opportunities and considerations for the incorporation of AI into global neurosurgery by synthesizing key themes yielded from a series of generative pre-trained transformers (GPTs), discuss important limitations of GPTs and cautions when using AI in neurosurgery, and develop a framework for the equitable incorporation of AI into global neurosurgery. ChatGPT, Bing Chat / Copilot, You, Perplexity.ai, and Google Bard were queried with the prompt "How can artificial intelligence be incorporated into global neurosurgery?". A layered ChatGPT-based thematic analysis was performed. The authors synthesized the results into opportunities and considerations for the incorporation of AI in global neurosurgery. A Pareto analysis was conducted to determine common themes. Eight opportunities and fourteen important considerations were synthesized. Six opportunities related to patient care, one to education, and another to public health planning. Four of the important considerations were deemed specific to global neurosurgery. The Pareto analysis included all eight opportunities and five considerations. AI may be incorporated into global neurosurgery in a variety of capacities requiring numerous considerations. The framework presented in this manuscript may facilitate the incorporation of AI into global neurosurgery initiatives while balancing contextual factors and the reality of limited resources. 

Opportunities and Considerations for the Incorporation of Artificial Intelligence into Global Neurosurgery: A Generative Pre-Trained Transformer Chatbot-Based Approach.

Global surgery broadly refers to a rapidly expanding multidisciplinary field concerned with providing better and equitable surgical care across international health systems. Global surgery initiatives primarily focus on capacity building, advocacy, education, research, and policy development in low- and middle-income countries (LMICs). The inadequate surgical, anesthetic, and obstetric care currently contributes to 18 million preventable deaths each year. Hence, there is a growing interest in the rapid growth of artificial intelligence (AI) that provides a distinctive opportunity to enhance surgical services in LMICs. AI modalities have been used for personalizing surgical education, automating administrative tasks, and developing realistic and cost-effective simulation-training programs with provisions for people with special needs. Furthermore, AI may assist with providing insights for governance, infrastructure development, and monitoring/predicting stock take or logistics failure that can help in strengthening global surgery pillars. Numerous AI-assisted telemedicine-based platforms have allowed healthcare professionals to virtually assist in complex surgeries that may help to improve surgical accessibility across LMICs. Challenges in implementing AI technology include the misrepresentation of minority populations in the datasets leading to discriminatory bias. Human hesitancy, employment uncertainty, automation bias, and role of confounding factors need to be further studied for equitable utilization of AI. With a focused and evidence-based approach, AI could help several LMICs overcome bureaucratic inefficiency and develop more efficient surgical systems.

Role of Artificial Intelligence in Global Surgery: A Review of Opportunities and Challenges.

Effective and sensitive communication by the clinicians with the patients and relatives are crucial in achieving a patient-centered consultation. Competent communication is an expertise, which all health-care professionals require, but it is the one that not all of them are obviously good at. Clinical communication skills are related to the speedy recovery of patients, provided with good adherence to the medications, and improved patient satisfaction, thereby affecting the psychological, biological, and social outcomes of the treatment. As time progressed, the situation of learning clinical communication skills has been transformed from “good to have” toward “need to have.” Teaching soft skills of communication to the medical students in a controlled environment before exposing them to real-life conditions could be the key to developing rapport with the patients, leading to more appropriate diagnosis and treatment outcomes.

Clinical communication skills in India: Current trends and future perspectives

Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that is mainly used for the treatment of type 2 diabetes mellitus. The study's objective was to assess empagliflozin's effects and impacts on post-myocardial patients to highlight its worth in comparison to alternative therapies. Only studies evaluating the effects of empagliflozin on individuals who have undergone a myocardial infarction (MI) are included in this review of the literature, which employed PubMed, Google Scholar, and Embase. To compare the advantages of empagliflozin for individuals who have recently experienced a myocardial infarction, abstracts from pertinent articles were retrieved, and complete publications were reviewed. A total of four articles were reviewed, which showed that in patients who suffered from a recent MI, empagliflozin caused a significant decrease in N-terminal pro-brain natriuretic peptide (NT-proBNP). Additionally, it was shown that these individuals had better echocardiographic results for both structural and functional metrics. With studies showing a significantly larger median NT-proBNP decrease with empagliflozin compared to placebo among patients hospitalised with an acute big MI when empagliflozin was started early and administered in addition to the post-MI care suggested by guidelines, it is safe to say that the benefits outweigh the risks. There are currently larger double-blind trials in progress to prove the hypothesis of the benefits of empagliflozin for post-MI patients.

/pdf/the-use-of-empagliflozin-post-myocardial-infarction-qprkerpq.pdf

The Use of Empagliflozin Post Myocardial Infarction


 
 
 To perform an audit to check Quality & Compliance of Surgical documentation using STAR Score in the general surgery department of a tertiary hospital in India.
 
 
 
 A total of 20 case files were studied and assessed in detail from the general surgery department. The audit was done for a period of 1 month at a tertiary hospital in India. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. Interventions were carried out by a series of departmental training and meetings. After 2 weeks, a re-audit was performed.
 
 
 
 The overall compliance score of the general surgery department was seen to be 82% in the first cycle. While the initial clerking constituted 21% compliance, operative records, and discharge summaries, showed compliance of 33% and 22% respectively. Consent and Anesthetic records showed the least compliance of 7% and 14%. The highest compliance was seen in subsequent entries, constituting 35%. In the second cycle, a significant change was reported as the overall compliance score increased to 95%. All sections showed a statistically significant increase. Consent and anesthetic records demonstrated an increase of 75% and 70% compliance, respectively.
 
 
 
 We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.


/pdf/ep-271-assessing-the-impact-of-implementing-the-star-score-2xt8qkvo.pdf

EP-271 Assessing the Impact of Implementing the STAR Score at a Tertiary Level Hospital in India: A Closed-loop Clinical Audit


 
 
 To complete an audit on the level of compliance to the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India.
 
 
 
 A total of 40 general surgeries were observed at the operating theatres at a tertiary level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for a period of 2 months starting from July to August 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out by a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted after 2 weeks.
 
 
 
 Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80% and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%.
 
 
 
 Though in the first cycle of our audit the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle after rigorous awareness programs and training sessions. Compliance was seen to be greater in major surgeries than in minor surgeries. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for successful implementation of the Surgical safety checklist.


/pdf/we3-12-a-closed-loop-clinical-audit-on-the-implementation-of-3f0hys8x.pdf

WE3.12 A Closed Loop Clinical Audit on The Implementation of WHO Surgical Safety Checklist at a Tertiary Level Hospital in India: Where do we stand?

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