PubMed Health⌕ Search

Biomedical subjects

Sean Mackay

Publications and source records attributed to Sean Mackay.

12 recordsLinked to original sources
PubMed2006

Management of oesophageal carcinoma.

BACKGROUND: Treatments for oesophageal cancers have historically been surgical, and surgical treatment remains the mainstay of treatment for localised oesophageal carcinoma (stage I-III). For stage IV disease, systemic chemotherapy is the mainstay of treatment. OBJECTIVE: This article provides an overview of curative and palliative management options for oesophageal carcinoma. Surgery, endoscopic treatments, and chemotherapy, radiotherapy and combined modality chemoradiation are considered. DISCUSSION: Several surgical approaches are available and each has its positive and negative aspects. Recent advances in chemotherapy and radiotherapy have aided the surgeon's work either by down staging tumours and rendering inoperable cases amenable to surgery. These adjuvant treatments also benefit the patient by reducing the risk of mediastinal and distant metastases.

Chemotherapy, Adjuvant↗
PubMed2006

Management of gastric cancer.

BACKGROUND: Gastric cancer is a common disease with a high mortality. OBJECTIVE: This article aims to outline the management options for patients with gastric cancer. DISCUSSION: The mainstay of curative treatment remains surgical resection. The management of early stage gastric cancer is complex with proven benefit of both pre-operative chemotherapy and postoperative chemo-radiotherapy, as well as complex surgical issues and the patient benefits from management by a multidisciplinary team. The most commonly performed operations for gastric cancer are total and subtotal gastrectomy, depending on the location of the tumour and the ability to gain adequate tumour free margins. Common postoperative difficulties include early satiety, postprandial pain and diarrhoea, hypoglycaemic episodes and bile reflux. Adjuvant chemotherapy and radiotherapy has been demonstrated to have a beneficial role in survival. Palliative surgical options are directed at control of symptoms related to bleeding and obstruction. Palliative chemotherapy has been shown to confer a survival benefit, however, with notable toxicity.

Chemotherapy, Adjuvant↗
PubMed2005

Percutaneous cholecystostomy in the management of acute cholecystitis.

BACKGROUND: Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in the setting of a patient with severe comorbidities where emergency cholecystectomy would carry significant mortality. The present study aims to assess the role, efficacy and complications of PC in acute cholecystitis. METHODS: Retrospective review of case notes of patients who underwent PC at Box Hill Hospital, Melbourne, Australia between July 1997 and December 2002. RESULTS: Sixteen patients (mean age 75 years; range 50-96) underwent PC. Indications for PC were significant comorbidities (n = 6), failure of conservative treatment (n = 4), bile duct malignancy (n = 2), sepsis of unknown origin (n = 2), patient declined surgery (n = 1) and local perforation (n = 1). Technical success rate was 94%. Clinical response to PC was observed in 15 patients. Overall mortality was 18% (3/16) with one death caused by PC failure. Interval cholecystectomy was performed in seven patients (44%). CONCLUSIONS: Percutaneous cholecystostomy is a useful alternative means of treating non-resolving acute cholecystitis in circumstances where emergency surgery is hazardous. It also offers effective palliation in patients not suitable for subsequent surgery.

Aged↗
PubMed2004

Biliary pain.

BACKGROUND: Gallstones are a common cause of abdominal pain. Gallstones are present in 20% of women and 8% of men, but might not cause symptoms. OBJECTIVE: This article discusses the aetiology of biliary colic and related disorders. The differential diagnosis is examined and relevant investigations are outlined. Some less common aspects of this disease complex are described for context. DISCUSSION: The only effective treatment for symptomatic gallstones is cholecystectomy, for which the laparoscopic approach is now the gold standard.

Biliary Tract Diseases↗
PubMed2003

Multiple Objective Measures of Skill (MOMS): a new approach to the assessment of technical ability in surgical trainees.

OBJECTIVE: The assessment of surgical technical skills has become an important topic in recent years. This study presents the validation of a 6-task skills examination for junior surgical trainees (at the level of the Membership of the Royal College of Surgeons). SUMMARY BACKGROUND DATA: Six tasks were evaluated in a project that also examined the feasibility of this method of assessment. The tasks were knowledge of sutures and instruments; knowledge of surgical devices; knot formation; skin-pad suturing, closure of an enterotomy; excision of a skin lesion; and laparoscopic manipulation. Comparisons were made between a group of junior trainees (n = 13), and a group of seniors (n = 8). RESULTS: Each of the 6 tasks was able to be used to discriminate between the 2 groups. In all, there were 19 primary analyses across the 6 tasks, and 17 of these showed significant differences between the groups (P values ranging from 0.037 to < 0.001). There was generally a strong correlation between the analyses, and when a mean rank was calculated, the difference between groups was significant (P = 0.005 on Mann-Whitney U test; mean ranks 13.9 and 6.3 [of 21], for juniors and seniors respectively). Reliability of the 6-task assessment was very good at 0.70 (Cronbach's Alpha). CONCLUSIONS: A skills examination is a feasible and effective method of assessing the technical ability of basic surgical trainees.

Computer Graphics↗
PubMed2002

The relationship between motion analysis and surgical technical assessments.

BACKGROUND: Recent attempts to gain a more objective measure of surgical technical skill include the use of structured checklists and motion analysis of surgeons' hand movements. We aim to show whether a correlation exists between these two methods of assessment. METHODS: Fifty subjects were recruited from four experience groups in general surgery, ranging from basic surgical trainees to consultants and were assessed performing a standardized laboratory-based task. Motion analysis using the Imperial College Surgical Assessment Device (ICSAD), which measures hand movements and time taken, and the Objective Structured Assessment of Technical Skill (OSATS) technique were used to measure skill. RESULTS: Number of movements made, time taken, and global rating score discriminated between performance and experience group (Kruskal-Wallis, P <0.001, P <0.01, P <0.001, respectively). There was a significant correlation between movements made and global rating score (Spearman coefficient 0.53, P <0.01). Checklist scoring was not an accurate predictor of experience. CONCLUSIONS: There is a strong correlation between hand motion analysis using ICSAD and OSATS global rating assessments in this model.

Clinical Competence↗
PubMed2002

Electromagnetic motion analysis in the assessment of surgical skill: Relationship between time and movement.

INTRODUCTION: Electromagnetic motion analysis is a promising method of assessing surgical skill in a skills-laboratory setting. There is a very strong correlation between movement and time data, and this study was conducted to determine whether this relationship is fixed, or whether it can vary. METHODS: : After a pilot study, four subjects were recruited. Each performed 30 trials of a simple standardized suturing task, alternating between 'normal', 'precise', and 'fast' strategies. The number of movements, and time to complete each task were recorded. RESULTS: Comparing the 'fast' to 'normal' strategies, there was a significant decrease in total number of movements per trial (P < 0.001), and time taken (P < 0.001). Regression analysis was performed to examine the relationship between the time taken and the number of movements, and revealed significant differences between both the fast (P = 0.006), and precise (P = 0.002) strategies, when compared to the normal strategy. DISCUSSION: This study confirms that the relationship between time and movements is not fixed, but varies with the operative strategy adopted for this simple suturing task.

Clinical Competence↗
PubMed2002

Relationship between skill and outcome in the laboratory-based model.

BACKGROUND: Recent attention has been directed at developing quantitative assessments of surgical skill. This study aims to demonstrate whether objectively measuring differences in manual dexterity has an impact on a simulated surgical procedure. METHODS: Six general surgical trainees performed 5 polytetrafluoroethylene graft to artery anastomoses on a vascular model by using a standardized technique. Manual dexterity was objectively measured with (1) electromagnetic motion analysis: trackers applied to the backs of hands recorded and analyzed both hand movements and procedural time and (2) 4-parameter evaluation of the final product. Outcome parameters were assessed by (1) rate of anastomotic leakage and (2) smallest cross-sectional area of the anastomosis. RESULTS: The 2 objective measures of manual dexterity correlated closely (Pearson coefficient, 0.423; P <.02). Trainees with better manual dexterity scores produced better outcome measures. Those with better motion analysis scores produced anastomoses that leaked less (Pearson coefficient, 0.514; P <.01) and those with higher global evaluation scores had a larger anastomotic cross-sectional area (Pearson coefficient, 0.495; P <.01). Time taken for the procedure did not appear to influence either outcome measure. CONCLUSIONS: There is a significant correlation between objective measures of manual dexterity and the outcome measures in this model. This suggests that the outcome of a procedure can be predicted by measuring surgical skill.

Blood Vessel Prosthesis↗