Biomedical subjects

Gina L Adrales

Publications and source records attributed to Gina L Adrales.

15 recordsLinked to original sources

PubMed2006

How surgical faculty and residents assess the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions: results of a multi-institutional study.

BACKGROUND: This study examined how surgical residents and faculty assessed the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions. METHODS: Questionnaires were administered in 9 general-surgery programs during the summer of 2004; response rates were 63% for faculty and 58% for residents (N = 259). Questions probed patient care, the residency program, quality of life, and overall assessments of the duty-hour restrictions. Results include the means, mean deviations, percentage who agree or strongly agree with the hour restrictions, and significance tests. RESULTS: Although most support the restrictions, few maintain that they improved surgical training or patient care. Faculty and residents differed (P < or = .05) on 16 of 21 items. Every difference shows that residents view the restrictions more favorably than faculty. The sex of the resident shaped the magnitude of the gap for 11 of 21 items. CONCLUSIONS: Few believe that duty-hour restrictions improve patient care or resident training. Residents, especially female residents, view the restrictions more favorably than faculty.

Attitude of Health Personnel↗

PubMed2006

Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study.

PURPOSE: To examine whether duty-hour restrictions have been consequential for various aspects of the work of surgical faculty and if those consequences differ for faculty in academic and nonacademic general surgery residency programs. METHOD: Questionnaires were distributed in 2004 to 233 faculty members in five academic and four nonacademic U.S. residency programs in general surgery. Participation was restricted to those who had been faculty for at least one year. Ten items on the questionnaire probed faculty work experiences. Results include means, percentages, and t-tests on mean differences. Of the 146 faculty members (63%) who completed the questionnaire, 101 volunteered to be interviewed. Of these, 28 were randomly chosen for follow-up interviews that probed experiences and rationales underlying items on the questionnaire. Interview transcripts (187 single-spaced pages) were analyzed for main themes. RESULTS: Questionnaire respondents and interviewees associated duty-hour restrictions with lowered faculty expectations and standards for residents, little change in the supervision of residents, a loss of time for teaching, increased work and stress, and less satisfaction. No significant differences in these perceptions (p < or = .05) were found for faculty in academic and nonacademic programs. Main themes from the interviews included a shift of routine work from residents to faculty, a transfer of responsibility to faculty, more frequent skill gaps at night, a loss of time for research, and the challenges of controlling residents' hours. CONCLUSIONS: Duty-hour restrictions have been consequential for the work of surgical faculty. Faculty should not be overlooked in future studies of duty-hour restrictions.

Attitude of Health Personnel↗

PubMed2005

Laparoscopic splenectomy: what barriers remain?

Conditions that once were considered either relative or absolute contraindications for laparoscopic splenectomy have become fewer and less significant in the overall assessment of candidates for this procedure. Advances in surgical technique, operative conduct, and instrumentation have made it feasible to perform splenectomy laparoscopically with good outcomes and minimal morbidity in a variety of different pathologic conditions. Obesity, malignancy, pregnancy, and splenomegaly are assessed here in detail.

Contraindications↗

PubMed2004

Laparoscopic approach to pancreatic disease.

Minimally invasive techniques in the treatment of pancreatic disease have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional, open surgery. Although the use of other laparoscopic solid organ procedures has outdistanced therapeutic laparoscopy of the pancreas, the advent of laparoscopic pancreatic surgery preceded the general use of laparoscopic cholecystectomy and the popularity of other solid organ procedures. This article describes four main applications of laparoscopic pancreatic procedures, which are staging of pancreatic cancer, palliative bypass procedures for pancreatic cancer, resection of benign and malignant pancreatic disease, and pancreatic drainage procedures.

Humans↗

PubMed2004

A novel intestinal anastomotic device in a porcine model.

The purpose of this study was to evaluate a novel, intraluminally deployed anastomotic device (AD). A survival study was conducted in 18 farm pigs. One early subject was excluded and replaced due to premature expiration. Six animals were placed in 1 of 3 cohorts, with euthanasia and AD explantation planned at 2, 4, and 6 weeks. A distal small intestinal side-side [functional end-end] anastomosis using the AD was performed via midline laparotomy. Fluoroscopy with double-contrast dilute barium and burst pressure measurements were performed in 4 animals in each group. Two animals in each cohort underwent fluoroscopy without contrast and resection for histology. Mucosal healing, inflammation, anastomotic alignment of the muscularis propria, and fibrosis were graded on a 4-point scale. All animals survived to the date of planned euthanasia except the excluded subject, who expired from causes unrelated to the device. Normal weight gain was seen in all. Sixteen of 18 devices sloughed prior to extraction without evidence of injury or obstruction during the survival period or at necropsy. Filling pressures of >200 mm Hg were reached; no leakage was seen. Mucosal healing and continuity were graded good to excellent at 2 weeks and excellent at 4 and 6 weeks. Inflammation improved with time, with moderate change at 2 weeks and mild at 6 weeks. Anastomotic fibrosis was mild at 2 weeks, mild to minimal at 4 weeks, and minimal at 6 weeks. The anastomotic alignment was 100 per cent except in 1 animal at 2 weeks with >50 per cent but <100 per cent alignment. The AD resulted in a stable, functional anastomosis without narrowing. All tested anastomoses withstood supraphysiologic insufflation pressures without evidence of disruption. The applicability of this novel device will be explored for use in other gastrointestinal and biliary anastomoses using minimally invasive deployment techniques.

Anastomosis, Surgical↗

PubMed2003

A valid method of laparoscopic simulation training and competence assessment.

BACKGROUND: The purpose of our study was to evaluate the construct validity of laparoscopic technical performance measures and the face validity of three laparoscopic simulations. MATERIALS AND METHODS: Subjects (N = 27) of varying levels of surgical experience performed three laparoscopic simulations, representing appendectomy (LA), cholecystectomy (LC), and inguinal hemiorrhaphy (LH). Five laparoscopic surgeons, blinded to the identity of the subjects, rated the subjects on procedural competence on a binary scale and in four skills categories on a 5-point scale: clinical judgment, dexterity, serial/simultaneous complexity, and spatial orientation. Using a task-specific checklist, non-clinical staff assessed the technical errors. The level of surgical experience was correlated with the ratings, the technical errors, and the time for each procedure. Subject responses to a survey regarding the utility of the inanimate models were evaluated. RESULTS: Years of experience directly correlated with the skills ratings (all P < 0.001) and with the competence ratings across the three procedures (P < 0.01). Experience inversely correlated with the time for each procedure (P < 0.01) and the technical error total across the three models (P < 0.05). Nearly all subjects agreed that the corresponding procedures were well represented by the simulations (LA 96%, LC 96%, LH 100%). CONCLUSION: The laparoscopic simulations demonstrated both face and construct validity. Regardless of the level of surgical experience, the subjects found the models to be suitable representations of actual laparoscopic procedures. Task speed improved with surgical experience. More importantly, the quality of performance increased with experience, as shown by the improvement in the skills assessments by expert laparoscopic surgeons.

Appendectomy↗

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