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At least 109 records · Page 6Linked to original sources
PubMed2006

A survey of competency-based training of senior house officers in performing minor surgical procedures.

INTRODUCTION: The aim of this survey was to ascertain the level of competency and training of basic surgical trainees (SHOs) in performing incision and drainage of a perianal abscess (a minor surgical procedure). MATERIALS AND METHODS: Questionnaires were sent to SHOs enquiring about preferred methods of incision and drainage and the teaching received to perform this procedure. RESULTS: Of respondent SHOs, 10% did not receive teaching when performing their first incision and drainage and over half did not received any feedback from their trainers. A mere 65% received practical supervision. Use of the curette and de-roofing of the abscess are not routine methods used. In addition, 13% reported inadequate incision and drainage, which required a second procedure. CONCLUSIONS: Competency-based training in minor surgical procedures benefits not only from didactic teaching, immediate supervision and appraisal but also from frequent practise. This was found to be lacking for incision and drainage of perianal abscesses by basic surgical trainees surveyed in the study.

Clinical Competence↗
PubMed2000

Bacterial contamination of suction tips used during surgical procedures performed on dogs and cats.

OBJECTIVE: To determine prevalence of bacterial contamination of surgical suction tips. SAMPLE POPULATION: Surgical tips used during 44 surgical procedures performed on 42 dogs and 2 cats. PROCEDURE: Surgical procedures were classified into 1 of 3 categories according to degree of bacterial contamination of the surgical site (clean, clean-contaminated, contaminated). Two sets of suction apparatuses were used for test and control suction tips. Test tips were used normally to suction blood and fluid, whereas control tips were placed on the surgical drapes but not in the surgical wound. Suction tips were collected aseptically and placed into thioglycolate broth tubes for qualitative aerobic and anaerobic bacterial culture at the end of each procedure. RESULTS: Test and control suction tips were contaminated with bacteria during 30 of 44 (68%) procedures. Staphylococcus spp were the predominant bacteria in tips used during clean and clean-contaminated surgeries. When surgery was performed on clean-contaminated or contaminated wounds, prevalence of isolation of other bacteria such as Pseudomonas spp, Streptococcus spp, and Escherichia coli from both test and control suction tips was higher than for clean wounds. Mean time of procedures during which both test and control suction tips became contaminated was not significantly different from time of procedures during which neither tip became contaminated. CONCLUSION AND CLINICAL RELEVANCE: Surgical suction tips often become contaminated during standard veterinary surgical procedures. The risk of wound infection after surgery may be influenced by bacterial contamination of surgical suction tips.

Animals↗
PubMed2000

[Quality assurance study in thyroid gland surgery. Initial comparative intermediate -term results for benign thyroid gland surgery]].

In 1998 the East German Association for Quality Securing of Surgery performed a study to evaluate the standard of performance of surgical treatment for benign goiter. In total, 46 hospitals participated and 6,029 operations could be analysed. The documentation was based on a detailed registration sheet and recorded items of preoperative complaints, diagnostic procedures, intraoperative findings with operative strategy, postoperative complications and definitive histology. All hospitals were divided into three groups regarding their number of surgical performances for benign goiter (< 50 operations, 50-150 operations, > 150 operations) to assess their training and expertise. Indications for surgical treatment were similar in all three groups with 78% for multinodular goiter and 19% for uninodular goiter. There was no statistical difference in distribution for M. Basedow, recurrent goiter or thyroid carcinoma. Hospitals with more than 150 operations per year for benign goiter performed statistical significant more extended procedures with routinely preparation of the laryngeal recurrent nerve and parathyroid glands. There was no statistical significant difference regarding postoperative complications. Because of the not finished check up (follow up 6 months postoperative), results for temporary nerve palsies (3.9%) and temporary hypoparathyroidism (6.3%) could only be stated.

Cross-Sectional Studies↗
PubMedDate not supplied

[Day surgery for cataract: descriptive survey in central and southern Italy].

Day surgery has rapidly gained worldwide acceptance especially in the field of ophthalmology. In Italy, cataract surgery is the most frequently performed surgical procedure, even on account of the ageing of the population. This procedure represents a very sensitive indicator of trends in day surgery hospitalizations and of political-managerial situations in the different regional healthcare realities. The aim of this study was to evaluate the diffusion of cataract day surgery in ophthalmology centres/divisions in central and southern Italy in 2003. A questionnaire was used to collect information regarding the number of surgical procedures performed, types of hospital admissions, time since the introduction of cataract day surgery, perioperative norms, and presence of other operative surgical centres in the area.

Ambulatory Surgical Procedures↗
PubMed1996

Surgical clerkship performance of traditional and nontraditional students in a problem-based learning environment.

BACKGROUND: To determine whether nontraditional students perform better than traditional students during surgical clerkships as reflected on the surgical clerkship final examination. METHODS: Retrospective review of medical student records from the classes of 1986 through 1993. Students admitted soon after completing undergraduate training were identified as "traditional," and those having prior careers as "nontraditional." RESULTS: There were 150 traditional and 72 nontraditional students. The ratio of men to women and admission MCAT scores were not significantly different. Traditional students were significantly younger and had higher admission grade point averages (GPAs). Nontraditional students were more likely to be married and have children. Final examination scores of traditional and nontraditional students were not significantly different. MCAT scores and college GPAs were the best predictors of final examination performance. Married students performed significantly better than single students. CONCLUSIONS: There was no significant difference between nontraditional and traditional student performance on the surgical clerkship final examination.

Adult↗
PubMed2001

Surgical treatment of early-stage breast cancer in the Department of Defense Healthcare System.

BACKGROUND: The choice between breast-conserving surgery and modified radical mastectomy in the treatment of women with early stage breast cancer in the Department of Defense Healthcare System may be influenced by demographic factors. STUDY DESIGN: The Department of Defense Automated Central Tumor Registry (ACTUR) was queried for women diagnosed with American Joint Committee on Cancer Stage I or II invasive breast carcinoma from January 1, 1986, to December 31, 1996. Univariate analysis and multivariate analysis were applied to the study variables. Year of diagnosis, age at diagnosis, tumor size, type of hospital, geographic region, and local availability of radiation therapy were evaluated with respect to the type of surgical treatment performed. Surgical treatment was either breast conservation therapy (BCT) or modified radical mastectomy. RESULTS: After excluding women for whom the data were incomplete (n = 308), 7,815 women were identified who met study criteria. There was a progressive increase in the use of BCT to treat tumors of all sizes from 16% to 47% over the 11 years of the study (p < 0.0001). BCT was more frequently used for smaller tumors (< 2cm), with an odds ratio of 2.46 (2.20-2.76, 95% CI). In 1996, 54% of women with T1 (< 2 cm) tumors were treated with BCT. Women treated with BCT were nearly the same age as those undergoing modified radical mastectomy (55.5 years versus 56.8 years, p < 0.0001). BCT was used at a slightly greater rate in medical centers than in community hospitals (31% versus 28%, p < 0.0001). Use of BCT varied among geographic regions from a low of 24% in the southwestern USA to a peak of 36% in the Northeast and 40% in hospitals outside of the continental United States (p < 0.0001). Local availability of radiation therapy did not influence choice of treatment. CONCLUSIONS: The use of BCT to treat early stage invasive breast carcinoma in the Department of Defense Healthcare System is increasing. But BCT is used less often to treat larger tumors. Regional differences in the use of BCT persist, even after controlling for other factors. Patient age and type of hospital (community versus academic center) appear to exert little influence on the choice of treatment. Local availability of radiation therapy did not seem to influence the choice of treatment. Our data suggest that efforts to promote the use of BCT should target the central and southwestern USA. Use of BCT should also be emphasized for women with larger tumors (> 2 cm).

Aged↗
PubMed1993

[Partial surgery of epitheliomas at the level of the glottis. An update].

Seven hundred and thirty three patients with glottic squamous cell carcinoma were treated with partial laryngeal surgery at our institution over a sixteen years period of time. Three hundred and ninety four patients were operated from 1972 through 1980 and three hundred and thirty three from 1980 through 1988. This retrospective study analyse local failure according to the surgical technique performed. Surgical technique was either a thyrotomy, a vertical partial laryngectomy or a supracricoid laryngectomy with cricohyoidoepiglottopexy. Among the 394 patients treated from 1972 through 1980, local failure was reported according to the T stage, the precise tumor location within each stage, the true vocal cord mobility and the surgical procedures. There was a diverse group of lesions within each T stage that responded differently to the surgical approaches. The differences in the local recurrence rates are discussed in terms of careful preoperative assessment and choice of surgical technique. This study support the premise that the choice of the surgical technique requires accurate preoperative assessment of tumor extend and laryngeal mobilities.

Carcinoma↗
PubMed1996

[An experience of right pneumonectomy in the elderly (aged 82) lung cancer].

Lung cancer in the elderly (over 80 years or over the average life) isn't generally performed surgical treatment, but we performed right pneumonectomy to aged 82 who had taken a right upper lobe's primary squamous cell lung carcinoma. He recovered well. Especially in general pneumonectomy should be avoided to over aged 80 because of the high death rate compare with other operative way (Lobectomy, Segmentectomy, Wedge resection etc.). But we think the operative indication should be determined synthetically (good performance status, not so progressive clinical staging, no existing another disease, etc.). We perform pneumonectomy in the elderly if patient's performance status is 0 or 1, and clinical staging is I or II, and the other laboratory data is good. But most important, we should explain exact information of the disease and perform surgical treatment in case it's received. We should take into consideration reduction surgery for prevention of complication without persisting in standard way of operation.

Aged↗
PubMed2006

Self-assessment of performance among surgical trainees during simulated procedures in a simulated operating theater.

BACKGROUND: The ability of surgeons to assess their own performance is essential for training and self-regulation. The latter is based on the premise that they recognize their weaknesses and seek remedial action accordingly. METHODS: Twenty-seven surgical trainees performed a simulated saphenofemoral high-tie on a synthetic model in a simulated operating theater. The performance assessment consisted of blinded rating of technical skills and a global rating of team skills by a human factors expert and a trained surgical research fellow. Subjects also were asked to assess their own performance using the same methods. Spearman's rho was used for data analysis. RESULTS: There was a strong correlation between the experts rating of technical skills and self-assessment (rho = .64). However, the correlation improved with increasing experience. It was .24 for junior trainees, .43 for those with intermediate experience, and .52 for senior trainees. There was a low correlation between the self-assessment and the expert scores for human factors skills (rho = .31). The correlation was higher for the 2 junior groups compared with the senior trainees. CONCLUSIONS: Unlike other studies on self-assessment, this study found that senior surgical trainees are accurate in their self-assessment of technical skills. However, this was not true in the case of human factors skills.

Clinical Competence↗
PubMed1994

Impact of cyanotic heart disease on school performance.

Surgical correction greatly decreases the mortality and cardiac morbidity of cyanotic congenital heart disease, but children remain at risk of long term difficulties in other areas. A historical cohort study was conducted to determine the relation between heart disease and school performance in 29 children aged 7 to 12 years old with simple transposition of the great arteries or tetralogy of Fallot. All children had surgical correction of their lesion before 2.5 years of age. Those at greater risk of school difficulties because of recognised complications of their heart disease or for reasons other than directly attributable to the heart disease were excluded. Comparison was made with 36 children who had presented with cardiac murmurs at a similar age, but who did not require treatment. Children with cyanotic disease showed significantly poorer performance in all academic areas assessed by the Wide Range Achievement Test-Revised; the difference in group mean score (adjusted for differences in maternal education, sex, and parental occupational prestige) for reading was 10.3 points (confidence interval (CI) 1.25 to 19.34), for spelling 7.8 (CI 1.11 to 14.52), and for arithmetic 6.8 (CI 0.19 to 13.39). The differences in adjusted group means for the Wechsler Intelligence Scale for Children-Revised full scale, performance and verbal IQs were significant, particularly the later at 10.1 points (CI 2.59 to 17.61). Teacher reports indicated significant differences in arithmetic when outcome was dichotomised to 'below grade' or 'not below grade'. There were no significant associations between outcome measures and the medical or perioperative parameters, however, including those related to hypoxia. It is concluded that the increased incidence of academic problems and the nature of the cognitive difficulties in children with uncomplicated corrective cardiac surgery for cyanotic heart disease are not fully explained by chronic hypoxia, or by other factors related to the cardiac surgery.

Child↗
PubMed1998

[A case of surgical treatment for Löffler's endomyocarditis].

We performed surgical treatment in a case of löffler's endocarditis. The patient was a 32-year-old male whose first symptom was easy fatigability. Blood count showed eosinophilia (eosinocyte count 6720/mm3). Echocardiography and vetriculography showed thickened bilateral endocardium and extension disturbance. We diagnosed this case as löffler's endocarditis and performed surgical treatment because medical treatment was unsuccessful. Removal of the thrombus the bilateral ventricles, endocardectomy and mitral valve replacement were performed. Endocardectomy required close attention because the border between thickened endocardium and normal myocardium was obscure. The patient survived surgery, but postoperative echocardiography (15 days) revealed slightly thickened endocardium of the right ventricle. He died of left heart failure 1 month after surgery. At that time, eosinocyte count was 110,000/mm3.

Adult↗
PubMed2000

Homograft insertion for pulmonary regurgitation after repair of tetralogy of fallot improves cardiorespiratory exercise performance.

Surgical repair of tetralogy of Fallot (TOF) with reconstruction of the right ventricular (RV) outflow tract invariably results in pulmonary regurgitation. Chronic pulmonary regurgitation has been associated with RV dysfunction and decreased exercise performance. The present study assessed the influence of pulmonary valve replacement (PVR) for severe pulmonary regurgitation after previous TOF repair on cardiorespiratory exercise performance and RV function. Eighteen patients, between the ages of 8 and 18 years, underwent an exercise test and a cardiac magnetic resonance imaging scan at least 1 year after PVR. The exercise data were compared with those obtained from 24 age-matched normal controls and 27 age-matched patients with repaired TOF and a moderate degree of pulmonary regurgitation. A subgroup of 11 patients had an exercise test performed before and after PVR. Cardiopulmonary exercise performance was evaluated by determination of the ventilatory anaerobic threshold (VAT) and by the steepness of the slope of oxygen uptake versus exercise intensity (SVO2). After PVR there was a significant increase in VAT (86+/-11% before to 106.9+/-14% after, p = 0.03) and in SVO2 (1.71+/-0.47 to 2.3+/-0.39, p = 0.004). In patients examined after PVR, the VAT and SVO2 values were not significantly different from the values in the normal controls (104+/-15% [p>0.05] and 2.03+/-0.77 after PVR vs. 2.42+/-0.68 [p>0.25], respectively). In contrast, patients with repaired TOF and a moderate degree of pulmonary regurgitation had a significantly lower VAT (86+/-11%, p<0.05) and SVO2 (1.8+/-0.74 vs. 2.42+/-0.68, p<0.05) than normal controls. Magnetic resonance imaging studies revealed residual RV dilatation and dysfunction. However, there was no correlation between RV dilatation and RV dysfunction and aerobic exercise capacity. It is concluded that aerobic exercise capacity substantially improves after PVR for severe pulmonary regurgitation after previous TOF repair. Although the right ventricle remains significantly dilated and hypocontractile, there is no relation between RV function and exercise performance.

Adolescent↗
PubMed2004

Quantitative analysis of right atrial performance after surgical repair of tetralogy of Fallot.

We aimed to assess the right atrial performance in patients after surgical correction of tetralogy of Fallot, and to clarify the relationship between the pump function of the right atrium and right ventricular systolic function. We included in the study 50 asymptomatic patients following corrective surgery of tetralogy of Fallot, comparing them to 30 normal subjects. Right atrial areas were measured by echocardiography, and the active fractional area of emptying was expressed, in percentages, as the area measured at the onset of atrial contraction, minus the minimal area, divided by the area at the onset of atrial contraction. We used this value to assess the atrial pump function. Right atrial peak strain rates were measured by tissue Doppler imaging. Compared to controls, patients with tetralogy of Fallot had a significantly reduced right atrial active fractional area of emptying (p = 0.005), along with a reduced peak late diastolic strain rate (p = 0.002). Among 20 patients who underwent magnetic resonance tomographic examination, a relatively higher right atrial peak late diastolic strain rate was shown in patients with a right ventricular ejection fraction of less than 50% (p = 0.021). Right atrial performance is reduced in patients after surgical correction of tetralogy of Fallot. When facing right ventricular systolic dysfunction, nonetheless, the right atrial pump function may be relatively enhanced. Tissue Doppler derived strain rate can provide quantitative analysis of regional right atrial performance.

Adolescent↗
PubMedDate not supplied

Evaluation of standard surgical preparation performed on superficial dermal abrasions.

OBJECTIVES: To determine the difference, if any, between the reduction of bacteria on contaminated normal skin and contaminated superficially abraded skin following standard surgical preparations at clinically relevant time points after injury. DESIGN: Prospective animal study. SETTING: Laboratory. SUBJECTS: Thirty-two New Zealand white rabbits. INTERVENTION: Two sites, two by two centimeters, one abraded and one nonabraded (control), were studied on each rabbit. Both were inoculated with encapsulated Staphylococcus aureus strain Wood 46. Four six-millimeter punch biopsies were obtained after inoculation, immediately before surgical scrub, and five minutes and then two hours after completion of the surgical scrub. The rabbits were divided into four cohort groups with surgical scrubs performed at six, twelve, twenty-four, and forty-eight hours after inoculation. Bacterial counts were determined. MAIN OUTCOME MEASUREMENTS: Numbers of bacteria on surgical sites. RESULTS: Before surgical preparation, the amount of bacteria on the normal skin (control sites) dropped significantly (p<0.02) except in the six-hour group (p<0.20). At the abraded skin sites, the bacteria flourished. The surgical scrub dropped bacterial counts at both the abraded and nonabraded skin sites significantly (p<0.05) except for the abraded site in the twenty-four-hour group (p<0.08). However in the twelve-, twenty-four-, and forty-eight-hour groups, the bacterial counts (colony-forming units) were still markedly elevated (>1x10(5) at abraded sites) when compared with the nonabraded skin sites (p<0.008) at the respective time intervals. Only at the six-hour interval were the bacterial counts reduced similarly at both the abraded and nonabraded skin sites. CONCLUSIONS: In a rabbit model the standard surgical preparation using povidone-iodine at six hours after inoculation is effective in reducing the bacterial count on abraded skin to that of surgically prepared nonabraded skin. Beyond that time, the standard surgical preparation is ineffective in reducing counts to those of nonabraded skin at similar time intervals.

Animals↗
PubMed2006

Effects of cognitive distraction on performance of laparoscopic surgical tasks.

HYPOTHESIS: To quantify the effects of cognitive distraction on surgical task performance in residents and medical students using a laparoscopic surgical simulator. DESIGN: Within-subjects design. SETTING: A surgical skills laboratory. PARTICIPANTS: Thirteen surgical residents and medical students who volunteered for the study. METHODS AND MATERIALS: Subjects performed six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), under two different conditions (distracted and undistracted). Task order remained the same for all subjects, but the order of distraction was counterbalanced. In the distracted condition, distractions consisted of mental arithmetic problems posed sequentially so that subjects were continually distracted. MAIN OUTCOME MEASURES: Time to task completion, surgical errors committed, economy of motion, and overall performance scores were generated by the MIST-VR program software. Arithmetic error was not a factor in the overall performance score. RESULTS: Time to task completion was significantly greater when subjects were distracted for all six tasks performed. Overall score and economy of motion were negatively affected by distraction but the effect did not reach th level of statistical significance. There was no effect of distract on surgical errors. CONCLUSION: Cognitive distraction appears to negatively influence the performance of laparoscopic surgical tasks by increasing task completion time. Further study is required to determine what the effects would be on experienced surgeons and actual surgical outcomes.

Analysis of Variance↗
PubMed1975

Mechanical performance of surgical sutures.

A comprehensive analysis of the mechanical performance of sutures has been made to provide information concerning the reliability and security of knotted sutures. The tests utilized in this analysis were designed to be easily reproduced by other investigators. The construction of the knot and the knot performance analysis were undertaken utilizing an Instron Tensile Tester. The mechanical reliability of each knotted suture was determined by measuring the number of throws to reach knot break, the expected slippage of the knot when it reaches knot break, and the maximal holding force at knot break. On the basis of these measurements, recommendations are made for the use of a suture at operation.

Biomechanical Phenomena↗
PubMed1992

[Assessing performance in surgical research and teaching].

The clinical registration of performance mainly serves to ascertain the staff plan. The measure of teaching and research is not quality but quantity in hours. For teaching, the time of lectures is taken with an added factor of 1.5 for lectures and 0.5 for practical training for preparation. For research it is customary to take an index of 10% of yearly working hours of all physicians working in medical care. Therefore, in an university hospital approximately 25% of the staff plan accounts for research and teaching.

Curriculum↗