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We explored experiences and perceptions surrounding the Self-Stewardship Time-Out Program (SSTOP) intervention across implementation sites to improve antimicrobial use. Semistructured qualitative interviews were conducted with Antibiotic Stewardship physicians and pharmacists, from which 5 key themes emerged. SSTOP may serve to achieve sustainable promotion of antibiotic use improvements.
This study documents the credit outcomes of older adults immediately before and after the onset of the COVID-19 pandemic in the United States. On average, older adults experienced larger reductions in total household debt relative to younger adults. However, there is significant heterogeneity, where older adults with higher incomes experienced the largest declines, and lower-income older adults experienced an increase in total debt. Overall, these data highlight important trends in the credit experiences of older adults that may affect their future financial security.
Patients with Fontan physiology require non-cardiac surgery. Our objectives were to characterise perioperative outcomes of patients with Fontan physiology undergoing non-cardiac surgery and to identify characteristics which predict discharge on the same day.
Materials and Method:
Children and young adults with Fontan physiology who underwent a non-cardiac surgery or an imaging study under anaesthesia between 2013 and 2019 at a single-centre academic children’s hospital were reviewed in a retrospective observational study. Continuous variables were compared using the Wilcoxon rank sum test, and categorical variables were analysed using the Chi-square test or Fisher’s exact test. Multivariable logistic regression analysis results are presented by adjusted odds ratios with 95% confidence intervals and p values.
182 patients underwent 344 non-cardiac procedures with anaesthesia. The median age was 11 years (IQR 5.2–18), 56.4% were male. General anaesthesia was administered in 289 (84%). 125 patients (36.3%) were discharged on the same day. On multivariable analysis, independent predictors that reduced the odds of same-day discharge included the chronic condition index (OR 0.91 per additional chronic condition, 95% CI 0.76–0.98, p = 0.022), undergoing a major surgical procedure (OR 0.17, 95% CI 0.05–0.64, p = 0.009), the use of intraoperative inotropes (OR 0.48, 95% CI 0.25–0.94, p = 0.031), and preoperative admission (OR = 0.24, 95% CI: 0.1–0.57, p = 0.001).
In a contemporary cohort of paediatric and young adults with Fontan physiology, 36.3% were able to be discharged on the same day of their non-cardiac procedure. Well selected patients with Fontan physiology can undergo anaesthesia without complications and be discharged same day.
This chapter establishes the core concept of ‘Romantic surgery’ by exploring the distinctive emotional, intellectual, and performative dimensions of late eighteenth- and early nineteenth-century British surgery. It opens by considering how, building on the legacy of John Hunter, Romantic surgeons constructed their practice as ‘scientific’, grounded in the study of anatomy and physiology. This allegedly more scientific approach to surgery encouraged greater operative restraint, but so too did the emotional regime of Romantic sensibility, which valorised the feelings of the patient and stressed the need to temper personal ambition with emotional sensitivity. This had profound implications for the performance of surgery, as surgeons were encouraged to eschew operative bravura in favour of a more considered deportment. As this chapter demonstrates, such emotional considerations also extended to the spectacle of surgery, as surgeons were expected to manage not only their patients and themselves, but also their audience. The performative persona of the Romantic surgeon was not without ambiguities, however, and this chapter therefore concludes with a study of perhaps the era’s most contested figure, Robert Liston.
This chapter explores the beginning of the end of the emotional regime of Romantic sensibility and the origins of surgical scientific modernity. It illuminates this crucial period of transition through the juxtaposition of two distinct but conceptually and ideologically intertwined moments in surgical history. These are, firstly, the debates surrounding the practice of anatomical dissection that came to the fore in the 1820s and culminated in the passage of the Anatomy Act in 1832, and, secondly, the introduction and early use of inhalation anaesthesia in the later 1840s. In both instances it highlights the powerful influence of utilitarian thought in divesting the body, both as object and subject, of emotional meaning and agency. In the former instance it demonstrates how an ultra-rationalist understanding of sentiment was set in opposition to popular ‘sentimentalism’ in order to divest the dead bodies of the poor of emotional value. Meanwhile, in the latter, it considers how the emotional subjectivity of the newly anaesthetised patient was swiftly tamed by the operations of a techno-scientific rationale.
This chapter charts the ultimate triumph of the emotional regime of scientific modernity in the form of antisepsis, Joseph Lister’s application of germ theory to surgical practice. It begins by exploring the ways in which antisepsis eliminated the patient as an emotional agent in surgery. The 1860s saw profound concern within surgery about the devastating impact of sepsis on post-operative mortality. Many of the explanations provided for this phenomenon rested on long-standing ideas about the role of the patient’s constitution and emotional state in regulating their post-operative health. However, by focusing purely on the condition of the wound, and the need to keep it free of ‘germs’, Lister’s antisepsis effectively overwrote these explanations, rendering patient subjectivity largely meaningless. At the same time, however, if emotions no longer possessed any ontological significance in surgery, the second part of this chapter demonstrates that they nonetheless played a powerful rhetorical function, as this ‘new world of surgery’ was configured in highly sentimentalised terms. This sentimentality not only served to counter widespread popular anxieties about surgery’s moral character, but also constructed Lister, the ultimate scientific surgeon and the emotional template for surgical modernity, as a quasi-divine saviour.
What can the emotions add to our understanding of the history of surgery? Opening with George Wilson’s account of the amputation of his foot in 1842, this Introduction suggests that ‘the black whirlwind of emotion’ that defined his experience of pre-anaesthetic operative surgery should prompt us to take the place of emotions in surgery seriously. It provides a brief account of the argument advanced by the book, the historiographical context in which it is situated, the theoretical framework it employs, the chronological and conceptual parameters that determine its focus, and the rich body of source material on which it draws. It also provides an overview of the chapters that follow in terms of content and argument. Overall, it establishes how Emotions and Surgery charts the changing place of emotions within British surgery across the long nineteenth century, from an emotional regime of Romantic sensibility to one of scientific modernity, demonstrating the ways in which emotions shaped surgeons’ and patients’ experiences and identities.
This chapter uses a close reading of The Lancet medical journal, and its radical, charismatic editor Thomas Wakley, to delineate the ‘high-water mark’ of Romantic sensibility as an emotional regime. It explores the ways in which Wakley and The Lancet leveraged the emotional politics of contemporary melodrama to critique the alleged nepotism and corruption of the London surgical elites. More especially, it analyses their campaign to expose instances of surgical incompetence at the city’s leading teaching hospitals, demonstrating the ways in which this strategy weaponised the emotions of anger, pity, and sympathy, and considering its implications for the cultural norms of an inchoate profession and for the ultimate stability of the emotional regime of Romantic sensibility.
This chapter considers the emotional interiorities and intersubjectivities of Romantic surgery. It challenges the well-established stereotype of the pre-anaesthetic surgeon as dispassionate butcher by demonstrating the ways in which surgical identities and subjectivities were shaped by a culture of emotional expression and reflection. The emotional ‘authenticity’ of pre-anaesthetic surgery was rooted in the embodied experience of operative practice, and the huge challenges that came from dealing with death, disease, and disfigurement on a daily basis. But as well as encouraging emotional introspection, the experience of pre-anaesthetic surgery also demanded that the surgeon manage his patients’ emotions. After all, in this period, fear, despondency, and other states of mind were regarded as an immediate cause of death. For this reason, surgeons needed to monitor their patients’ moods and imagine themselves into their position in order to regulate their own conduct and promote optimal operative outcomes. These relations between surgeons and patients were structured by a range of factors, notably gender. For that reason, this chapter concludes with a consideration of Romantic surgical intersubjectivity in practice, utilising Astley Cooper’s casebooks to explore the ‘emotion work’ of womanhood in the elaboration and understanding of breast cancer.
This chapter considers Romantic surgery from the patient’s perspective. It uses Astley Cooper’s rich archive of personal correspondence to explore the complex emotions associated with the experience of surgical illness and its treatment, as well as the ways in which emotional expression functioned as a form of agency within the private surgical relationship. In addition to considering private patients, this chapter also examines how emotions expressed and mediated agency within what, following Michel Foucault, we might consider the ‘disciplinary’ space of the hospital. The pre-anaesthetic surgical patient was a deeply unstable and ‘messy’ ontological entity whose pre-operative health and post-operative recovery were determined by a complex melding of constitutional, nervous, and emotional factors. Thus, as this chapter demonstrates, the patient’s own body could exert an unconscious material agency, often frustrating both surgical intervention and the patient’s own will, something that was most evident in the associations between irritability and obstreperousness that characterised contemporary discourses on amputation and its discontents.
This Epilogue considers the ways in which historical accounts of the Listerian antiseptic ‘revolution’ have shaped our perception not only of surgical modernity, but also of the pre-antiseptic and pre-anaesthetic past. By examining a number of historical and reflective works written by surgeons in the years following Lister’s death in 1912, it shows that such accounts of surgical modernity served to flatten the emotional landscape of the pre-anaesthetic, Romantic era, consigning it to a surgical ‘dark age’ of suffering, misery, cruelty, and death. In turn, it contends that these myths have determined popular perceptions of the history of surgery. Indeed, they have shaped the very practice of surgery itself. As such, it concludes by considering how a more nuanced and informed history might inform surgical practice in the present.