PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Learning Curve”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2005

Laparoscopic nephrectomy for renal diseases in children: is there a learning curve?

BACKGROUND/PURPOSE: We evaluated the impact of a surgeon's experience, divided our first 20 consecutive series that involved a single surgeon at the numerical midpoint of his experience, and compared outcomes regarding this midpoint. METHODS: From August 1996 to August 2001, laparoscopic nephrectomy or nephroureterectomy was performed in 20 consecutive children, 12 girls and 8 boys aged between 1 and 15 years (median, 5.9 years). Disease was in the right side in 11 patients and in the left side in 9. The children were divided into 2 groups of 10. We retrospectively obtained data on all patients and compared pertinent perioperative information including operation time, blood loss, length of hospital stay, and postoperative complications. RESULTS: The procedure was feasible in all cases and did not require conversion to open surgery or perioperative transfusion in any case. The operation time reduced from a median of 181 minutes over the first 10 patients to 125 minutes over the second 10, and this difference was significant (P = .02). Estimated blood loss and days to the first postoperative oral feeding for the second 10 patients were less than for those of the first 10 but there was no significant difference. The median hospital stay of the first 10 patients was 5.4 days (range, 2-10 days), significantly longer than the 2.5 days of the second 10 (range, 2-7 days) (P = .009). CONCLUSIONS: Laparoscopic nephrectomy operation times in children reduced when the surgical experience level exceeded approximately 10 cases.

Adolescent↗
PubMed1993

Diagnostic and therapeutic thoracoscopy: lessons from the learning curve.

A variety of video-assisted thoracic operations are being reported with increasing frequency. Problems encountered during the development of this technology have received less attention. During the course of 27 months, 69 consecutive patients underwent minimally invasive procedures at our institution. Conversion to thoracotomy was required in 16 of 49 (33%) patients undergoing diagnostic procedures and 1 of 20 (5%) patients undergoing therapeutic interventions. Fewer complications occurred in those patients with diagnostic procedures (10 of 49, 20%) versus therapeutic interventions (10 of 20, 50%; p = 0.01). Logistic regression analysis showed chronic obstructive pulmonary disease to be an independent risk factor for complications. The mean postoperative stay was 7.9 +/- 6.8 days for diagnostic and 12.8 +/- 9.7 days for therapeutic interventions (p = 0.02). As new technologic improvements were introduced, the mean hospital stay decreased (first 10 months: 14.6 +/- 10.0 days, 10 to 20 months: 9.8 +/- 9.6 days, more than 20 months: 5.2 +/- 3.0 days, p < 0.004). The surgeon's thoracoscopic experience was not as strongly predictive (5 or fewer cases: 8.9 +/- 5.9 days, 6 to 15 cases: 13.1 +/- 12.6 days, more than 15 cases: 5.0 +/- 2.0 days). Although thoracoscopic surgery is promising, the potential for problems requires careful surgical judgment and expertise in dealing with thoracic complications.

Adult↗
PubMed2004

The learning curve for EUS-guided FNA of pancreatic cancer.

BACKGROUND: EUS-guided FNA is an effective and safe method for tissue diagnosis of pancreatic cancer. However, EUS-guided FNA is technically challenging and requires special training. The number of cases required to become proficient and the technical steps required to achieve proficiency are unknown. METHODS: The first 57 EUS-guided FNAs of pancreatic masses by a trained endosonographer were analyzed retrospectively. For 50 masses, the histopathologic diagnosis ultimately was cancer. The sensitivity for the EUS-guided FNA diagnosis of adenocarcinoma was compared in quintiles of 10 procedures. RESULTS: Sensitivity for the diagnosis of pancreatic cancer from first to last quintile were, respectively, 50%, 40%, 70%, 90%, and 80%. There was a significant increase in sensitivity for the first 30 cases after improvement in specific technical skills: shortening of echoendoscope position, scrupulous maintenance of the US view of the needle tip at all times, swift jabbing punctures, sampling multiple areas of the mass in each pass, and performing more than 10 "jiggles" per needle pass. Sensitivity for the diagnosis of pancreatic cancer was greater than 80% for the last 20 of the 57 cases, a level that was maintained for cases 51 through 80. CONCLUSIONS: The current American Society for Gastrointestinal Endoscopy guideline of 25 supervised EUS-FNA procedures for the diagnosis of pancreatic adenocarcinoma is reasonable.

Adenocarcinoma↗
PubMed1997

The learning curve for laparoscopic pyloromyotomy.

Over a 34-month period, 51 open and 33 laparoscopic pyloromyotomies were performed for infantile hypertrophic pyloric stenosis. The patients' weight ranged from 1.2 to 5.3 kg. The mean operating time was 28 minutes for the open group and 41 minutes for the laparoscopic group. The average time to accept normal feeds was 41 hours in the open group and 32 hours in the laparoscopic group. There were three perforations, one inadequate pyloromyotomy, and one wound infection in the open group. In the laparoscopic group one patient underwent conversion to open surgery because of a duodenal perforation and three other patients required subsequent open procedures for duodenal perforation (n = 1), pyloric perforation (n = 1) and inadequate pyloromyotomy (n = 1). Additional complications in the laparoscopic group included two cases of omental extrusion through the umbilical port wound and one suture abscess. On the basis of these results we have modified our technique, and there have been no complications after laparoscopic pyloromyotomy in our last 10 patients. We believe laparoscopic pyloromyotomy requires further evaluation before it is accepted into common practice.

Clinical Competence↗
PubMed2001

[Sentinel lymph nodes in breast cancer. Multidisciplinary approach; critical analysis of the learning curve; results obtained with a radiopharmaceutical not previously utilized].

Detection of the sentinel node is slowly becoming a new and promising procedure to stage patients suffering from breast cancer. Various articles have attempted to analyze objectively the predictive value of the histopathological examination to reveal the presence of metastatic cells in the axillary node without having to carry out an axillary dissection. In this paper, 60 patients with breast cancer (T up to 3 cm, clinically negative axilla) have been studied. A colloid bound to 99m Technetium was injected. Intra-surgical radioguided detection of the sentinel lymph node was performed and this was excised and its pathology was analyzed. After a complete axillary dissection was performed. With this technique it was possible to predict the condition ot the axilla in 96.5% of the cases and the sensitivity of the method was 92%. A training program on this technique has been developed and its application is suggested. The results of the use of a radiopharmaceutical which has not been previously documented in the published literature is discussed.

Adult↗
PubMed1998

The learning curve: health education in STI clinics in South Africa.

This qualitative study aims to assess health education practice in sexually transmitted infection (STI) clinics in South Africa with a view to develop improved health education programs in such clinics. Health workers' knowledge of and attitudes towards health education practice, their perceived health education skills, the content of health education in STI clinics and the organizational structure as context for health education were investigated. In-depth interviews were conducted with 18 health care workers practicing in the area of STI control. A lack in knowledge and skills required for effective health education practice was reported. The constraints posed by health workers' current knowledge and skills around health education and the organizational structure in terms of the absence of policy and protocols to govern health education, limited time, space and resources, impede on the actual practice of health education. It seems that these obstacles to health education facilitate a biomedical approach to STI management. This approach is further portrayed in the power dynamics between the health workers as well as between health workers and patients. The data suggest that a health education intervention needs to be directed at an individual level namely at health workers and at the organizational level, i.e. the clinic that provides the context for health education. The newly adopted district health system which equally embraces medical care and health promotion augers well for a holistic management of STIs in South Africa. This would ensure the recognition of all categories of health workers' contributions to health education within their own functions, strengths and time limitations.

Community Health Services↗
PubMed2001

The learning curve in post-operative hearing results in vestibular schwannoma surgery.

PURPOSE: We chronologically investigated whether the hearing preservation (HP) rate improved or not in vestibular schwannoma (VS) surgery. SUBJECTS AND METHODS: HP surgery has been attempted in 127 VS patients with pre-operative class A and B hearing from 1976 to 1999. The HP rate was chronologically compared with hearing level and tumor size. RESULTS: The preservation rate of pre-operative class A hearing which was preserved post-operatively as class A has recently been increasing especially in patients with an intracanalicular (IC) tumor. This rate was improved to 67% from 1995, although this was 33% from 1989 to 1994. However, the preservation rate of pre-operative class B in patients with an IC tumor and that of pre-operative class A hearing which was preserved as class A in patients with a larger tumor extending into the posterior fossa, have not improved over the last 10 years. CONCLUSION: These results indicate that the improvement of the HP rate is mainly due to the increased number of patients with an IC tumor with class A pre-operative hearing. In patients with a tumor of 4-20 mm in size, especially in those showing pre-operative class B hearing, there may be histologically some limitations such as gliosis in the cochlear nerve in the preservation rate of good quality (class A or B) of hearing.

Adolescent↗
PubMed1999

Managing a dropped nucleus during the phacoemulsification learning curve.

Three patients had a pars plana vitrectomy to remove retained nuclei within 72 hours after phacoemulsification performed by a surgeon making the transition from extra-capsular cataract extraction to phacoemulsification. After vitrectomy, the nuclei were brought to the midvitreous cavity from the retinal surface with a posterior segment phacofragmenter, emulsified, and completely removed. Then, a posterior chamber intraocular lens was implanted in the sulcus through the previous cataract surgery incision and remained well centered postoperatively. Postoperative complications included cystoid macular edema in 1 patient and choroidal detachment in another. No other complications were detected. Final visual acuity ranged from 20/60 to 20/30.

Aged↗
PubMed2002

The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases.

STUDY OBJECTIVE: To compare the frequency of complications of total laparoscopic hysterectomy performed in the first and more recent years of our experience, and based on that, offer ways to prevent them. DESIGN: Retrospective, comparative study (Canadian Task Force classification II-2). SETTING: University tertiary referral center for endoscopic surgery. PATIENTS: During 1989-1995 and 1996-1999, 695 and 952 women, respectively, with benign pathology. INTERVENTION: Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: No differences in patient characteristics were found between 1989-1995 and 1996-1999. Substantial decreases in major complication rates were noted, 5.6% and 1.3%, respectively. No major vessel injury occurred. Excessive hemorrhage (1.9%) and need for blood transfusion (2.2%) during the first period were statistically higher than in the second period (both 0.1%, p <0.005). Urinary complications (2.2%) including 10 bladder lacerations, 4 ureter injuries, and 1 vesicovaginal fistula occurred more frequently in the first period than in the second period (0.9%), when 6 bladder and 2 ureter lacerations and 1 vesicovaginal fistula occurred (p <0.005). One bowel injury and one bowel obstruction occurred in the first period, but no bowel complications in the second. Between periods, 33 (4.7%) and 8 (1.4%) conversions to laparotomy were necessary. During the first period there were nine reoperations; of six laparotomies, four were due to urinary injuries, one due to heavy vaginal bleeding, and one due to a vesicovaginal fistula; three diagnostic laparoscopies were required due to postoperative abdominal pain. Three reoperations during the second period were two laparoscopies due to heavy vaginal bleeding and one laparotomy due to a vesicovaginal fistula (p <0.005). Statistically significant differences in median (range) uterine weight 179.5 g (22-904 g) and 292.0 g (40-980 g) and operating times 115 minutes (40-270 min) and 90 minutes (40-180 min), respectively, were recorded (p <0.005). CONCLUSION: Laparoscopic hysterectomy was safe, effective, and reproducible after training, and with current technique, had a low rate of complications.

Adult↗