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Sample records for barber surgeons

  1. [Between barber's and hospital: the role of barber-surgeons in Osijek in the period from 1687 to 1746].

    Science.gov (United States)

    Atalić, Bruno; Fatović-Ferencić, Stella

    2007-01-01

    This paper presents emergence and role of medical practitioners especially surgeons and barbers in particular in Osijek in the period marked by the Christian liberation in 1687 to the pronouncement of Regulationenfür Baderen in 1746. On the bases of archival sources we have revealed their identity, origin, number and reputation, and demonstrated differences in their duties in comparison to the other towns of the Habsburg Monarchy. We argued that their presence and activities can be explained by the position of Osijek as an important military fortification at the Othoman Empire's border, as well as with deficiency of physicians. The data presented in this paper demonstrate the very beginnings of medical practitioners in Osijek and are therefore important in understanding of the further development and the organization of health on this territory. PMID:18257339

  2. Instructional Materials for Cosmetology and Barbering.

    Science.gov (United States)

    Scott, Olive P.

    The purpose of this paper is to aid curriculum development specialists, state leadership personnel, and local supervisors of trade and industry in evaluating curriculum and instructional materials development in cosmetology and barbering. Intended to help either the new or experienced teacher improve programs and identify useful instructional…

  3. Barber's Point, Oahu, Hawaii Drift Card Study 2002-2004

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Drift cards were be released from Barber's Point, Oahu, approximately once a month during the two year span to get an idea of the distribution of card drift under...

  4. 75 FR 38019 - Safety Zone; Fixed Mooring Balls, South of Barbers Pt. Harbor Channel, Oahu, HI

    Science.gov (United States)

    2010-07-01

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Fixed Mooring Balls, South of Barbers Pt... placement of six fixed mooring balls in an area south of Barbers Pt. Harbor Channel, the Coast Guard is... Safety Zone; Fixed Mooring Balls, South of Barbers Pt Harbor Channel, Oahu, Hawaii. (a) Location....

  5. Society of Thoracic Surgeons

    Science.gov (United States)

    ... With Its Intense Demands New Website from The Society of Thoracic Surgeons Puts the Power of Information ... Hotel Discount for STS Members Copyright © 2016 The Society of Thoracic Surgeons. All rights reserved. Expanded Proprietary ...

  6. Society of Gynecologic Surgeons

    Science.gov (United States)

    ... Events Please join us in Chicago for the Society of Gynecologic Surgeons (SGS) 25th Annual Postgraduate Course ... cases Kris Strohbehn, MD Director of Postgraduate Education, Society of Gynecologic Surgeons SGS Mission The mission of ...

  7. Society of Reproductive Surgeons

    Science.gov (United States)

    The Society of Reproductive Surgeons Home About Us About SRS Mission Statement Officers The Role of Reproductive Surgeons For ... Fact Sheets and Booklets SRS is an affiliated society to the American Society for Reproductive Medicine . Below ...

  8. Barbers' knowledge and practice about occupational biological hazards was low in Gondar town, North West Ethiopia

    Directory of Open Access Journals (Sweden)

    Beyen Teresa Kisi

    2012-11-01

    Full Text Available Abstract Background Several health hazards including communicable diseases and skin conditions are associated with Barbers’ profession to which their visitors are exposed. Thus, knowledge and practice of Barbers would play a vital part in prevention and control of these health hazards. So, the aim of this study is to assess knowledge and practice, and associated factors among barbers about biological hazards associated with their profession in Gondar town, North West Ethiopia. Methods To assess knowledge and practice, and associated factors among barbers about biological hazards associated with their profession in Gondar town, North West Ethiopia, A work place based cross-sectional study was conducted from March 28 to April 6, 2012. The total numbers of Barbers in the town were 960 of which 400 Barbers were participated in the study. Sample size was determined using the formula for single population proportion by considering, 51% proportion, knowledgeable Barbers from Jimma, Ethiopia, 95% level of confidence, 5% margin of error and 15% none response rate. The numbers of barbers included in the study were selected by using systematic random sampling. Data was collected by face to face interview using a structured and pre-tested questionnaire. Binary and multivariate logistic regression analyses were conducted to identify factors associated with knowledge and practice of barbers. Results Of 400 barbers, only 72 (18% had good knowledge about biological hazards associated to their profession, While only 61 (15.3% were practicing safely during barbering. Knowledge of the barbers was associated significantly with educational level, owner of the business, working hour and work experience, while practice was associated only with availability of UV sterilizers in the room and working hour. Conclusion Barbers’ practice and knowledge to prevent biological hazards associated with their profession is very poor. Thus, giving training for the Barbers is

  9. Military Surgeon and Humanity

    Institute of Scientific and Technical Information of China (English)

    LU Lu; WANG Yiran

    2015-01-01

    Military surgeons are a special group of doctors. They are both medical workers and soldiers.Their mission is to serve the wounded on the battlefield.And there is no doubt that military surgeons will save our comrades in the army. However,should a military surgeon save the wounded enemy? It is indeed a dilemma.Some may save the wounded enemy because military surgeons are doctors after all and they can't possibly abandon anybody to his fate,but some refuse to do so because military surgeons are soldiers.Therefore,some situations on the battlefield are discussed and advice is suggested for military surgeons,with heartfelt anticipation for there being less casualties on the battlefield as well as alleviating human suffering caused by war.

  10. Levantamiento tridimensional de la plaza Barberà de Badalona

    OpenAIRE

    Vega Carro, Daniel

    2013-01-01

    El siguiente documento redacta la realización de un proyecto que consiste en el levantamiento topográfico de la plaza Barberà de Badalona. En él se consigue además un modelo tridimensional, a escala 1/100, de todas las fachadas que se encuentran en dicha plaza. Una de ellas es la fachada principal de la iglesia de Santa María, considerada patrimonio cultural de Cataluña. El levantamiento está georreferenciado en el sistema de referencia ETRS89 con coordenadas UTM. El modelo tridimension...

  11. Congress of Neurological Surgeons

    Science.gov (United States)

    ... 3, 2016 5th Annual Miami Neuro Symposium Biltmore Hotel, Coral Gables, Florida View All Events Corporate Partners Learn More About Our Industry Allies Council Partners Congress of Neurological Surgeons 10 ...

  12. Find a Dermatologic Surgeon

    Science.gov (United States)

    ... PANAMA ROMANIA SAUDI ARABIA SINGAPORE SOUTH AFRICA SOUTH KOREA SPAIN SWITZERLAND TAIWAN TAIWAN ROC THAILAND TRINIDAD UNITED ARAB EMIRATES UNITED KINGDOM USA Doctor & Procedures Surgeon Last Name: Procedures: Acne Scar ...

  13. General or specialist surgeons?

    Science.gov (United States)

    Shrestha, B M

    2009-01-01

    General Surgery is a broad surgical specialty that focuses on diseases related to abdominal organs, skins and hernias, both in elective and emergency settings. With the prevalent trend for increasing subspecialisation in today's surgical practice, general surgery has lost some of its former glory and scope. This has led to suffering of the image of the general surgeons (GS) in the eyes of trainees, peers, the public and even GS themselves. A comprehensive review of literature is presented to address the controversy surrounding the role and future of general and specialist surgeons in the current perspectives. PMID:20795470

  14. Surgeons' vision rewarded.

    Science.gov (United States)

    Baillie, Jonathan

    2010-08-01

    Surgeons and clinical staff, theatre circulation and scrub personnel, and anaesthetists, as well as the estates and facilities team at Kent's Maidstone Hospital, have worked with specialist supplier of integrated audio, video, and instrumentation systems for the operating room, Olympus Medical, to develop what is claimed is among the UK's most advanced operating theatres yet built for laparoscopic and endoscopic surgery. HEJ editor Jonathan Baillie discussed the project with Amir Nisar, the surgeon who championed efforts to get the facility built, and Olympus Medical national sales manager, systems integration, James Watts. PMID:20839526

  15. Barbers Point Sewage Outfall Fish Census from Annual Surveys 1991-2010 (NODC Accession 0073346)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Honouliuli Wastewater Treatment Plant (WWTP) located in Ewa, Oahu, Hawaii, near Barbers Point (Kalaeloa) has been in operation since 1982. It releases...

  16. American Society of Plastic Surgeons

    Science.gov (United States)

    ... doctor who is a member of the American Society of Plastic Surgeons (ASPS®), you can rest assured ... ASPS The Plastic Surgery Foundation Copyright © 2016 American Society of Plastic Surgeons | Privacy Policy | Sitemap | Terms and ...

  17. Nostalgia and Cultural Memory in Barber's Knoxville:Summer of 1915

    OpenAIRE

    Taylor, Benedict

    2008-01-01

    Samuel Barber's “lyric rhapsody” for soprano and orchestra, Knoxville: Summer of 1915 (1947), is one of his most celebrated and complicated pieces. The most ostensibly backward-looking, nostalgic work of this “conservative,” neoromantic composer, Knoxville is yet atypical of Barber in that by most accounts it is the most American piece in an oeuvre otherwise rarely seen as touched by national flavor. Dating from an era just recovering from the cataclysm of World War II, Knoxville can be seen ...

  18. Pembuatan Program Grafik Barber Johnson di Rumah Sakit Umum Mitra Sejati Medan Tahun 2010

    OpenAIRE

    Hasibuan, Salmia

    2011-01-01

    Barber Johnson’s Graph is one indicator of hospital assessments conducted by the calculation of Bed Occupancy Rate (BOR), Length of Stay (LOS), Turn Over Interval (TOI) and Bed Turn Over (BTO). At the Mitra Sejati General Hospital in Medan, it was made program of Barber Johnson Graphic by using Microsoft Excel. The calculation of BOR, LOS, TOI & BTO is done by inputing data of the number of beds available, the number of beds used and the number of patients go home. The purpose of making Ba...

  19. American Academy of Orthopaedic Surgeons

    Science.gov (United States)

    ... Member Groups Distribution of member types. Get Social Facebook Twitter American Academy of Orthopaedic Surgeons Tweets by @AAOSmembers Advertisement Career Opportunities Northwest Permanente, PC Shoulder and Elbow ...

  20. Bilingual Skills Training Program. Barbering/Cosmetology. Module 9.0: Respiratory System.

    Science.gov (United States)

    Northern New Mexico Community Coll., El Rito.

    This module on the respiratory system is the ninth of ten (CE 028 308-318) in the barbering/cosmetology course of a bilingual skills training program. (A Vocabulary Development Workbook for modules 6-10 is available as CE 028 313.) The course is designed to furnish theoretical and laboratory experiences. Module objectives are for students to…

  1. Bilingual Skills Training Program. Barbering/Cosmetology. Module 2.0: Sterilization and Sanitation.

    Science.gov (United States)

    Northern New Mexico Community Coll., El Rito.

    This module on sterlization and sanitation is the second of ten (CE 028 308-318) in the barbering/cosmetology course of a bilingual skills training program. (A Vocabulary Development Workbook for modules 6-10 is available as CE 028 313.) The course is designed to furnish theoretical and laboratory experience. Module objectives are for students to…

  2. Bilingual Skills Training Program. Barbering/Cosmetology. Module 7.0: Endocrine System.

    Science.gov (United States)

    Northern New Mexico Community Coll., El Rito.

    This module on the endocrine system is the seventh of ten (CE 028 308-318) in the barbering/cosmetology course of a bilingual skills training program. (A Vocabulary Development Workbook for modules 6-10 is available as CE 028 313.) The course is designed to furnish theoretical and laboratory epxerience. Module objectives are for students to…

  3. Barbering/Cosmetology, Module 6-10: Bilingual Vocational Language Development Workbook.

    Science.gov (United States)

    Northern New Mexico Community Coll., El Rito.

    This vocabulary language development workbook accompanies modules 6-10 in the barbering/cosmetology course of the Bilingual Skills Training Program (CE 028 314-318). For each module the trade-related vocabulary to be learned and practiced is first presented in both English and Spanish. Various types of activities and exercises using both the…

  4. What Is a Pediatric Heart Surgeon?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Heart Surgeon? Page Content Article Body If your ... require heart surgery. What Kind of Training Do Pediatric Heart Surgeons Have? Pediatric heart surgeons are medical ...

  5. What Is a Foot and Ankle Surgeon?

    Science.gov (United States)

    ... Foot & Ankle Surgeon? A A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle ... of conditions that affect people of every age. What education has a foot and ankle surgeon received? ...

  6. Benthic faunal sampling adjacent to the Barbers Point ocean outfall, Oahu, Hawaii, 1986-2010 (NODC Accession 9900098)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Benthic fauna in the vicinity of the Barbers Point (Honouliuli) ocean outfall were sampled from 1986-2010. To assess the environmental quality, sediment grain size...

  7. STD/AIDS Education and Behavioral Intervention Among Shenzhen Female Barbers

    Institute of Scientific and Technical Information of China (English)

    ZENG Xuchun(曾序春); HONG Fuchang(洪福昌); LUO Bin(罗斌); CAI Yumao(蔡于茂); LI Xiaohuan(李小环); ZHOU Hua(周华); DONG Shifu(董时富); Joseph Lau(刘德辉)

    2002-01-01

    Objective: To understand female barbers' currentawareness of STD/AIDS and evaluate the effect of healtheducation and behavioral interventions.Methods: 53 barbershops in Shenzhen were selected bysampling, and their 382 female barbers were given abase-line survey and assessment of intervention followingthe intervention. Results: The survey showed that female barbersgenerally have little education and knew little aboutSTDs/AIDS. They also had some misunderstanding aboutSTDs/AIDS. Most of them knew the main transmission ofSTDs/AIDS' through sexual contact, but didn't knowwhether AIDS could be transmitted through casual contactin daily life. Their knowledge of STDs/AIDS was limited,but they had lower condom use rates and correct ideasabout when to see the doctor.Conclusion: Health education and behavioralintervention related to STD/AIDS on special populationwere effective and of good social consequence.

  8. Barber's hair sinus in a female hairdresser: uncommon manifestation of an occupational disease: a case report

    OpenAIRE

    Efthimiadis, Christopher; Kosmidis, Christopher; Anthimidis, George; Grigoriou, Marios; Levva, Sofia; Fachantidis, Panagiotis; Psihidis, George

    2008-01-01

    Background Barber's disease is an acquired occupational disease produced by short customers' hairs that penetrate the interdigital spaces of the hands. The lesion has been reported to occur mostly on the hands of male hairdressers. The purpose of this article is to report a rare case of a female hairdresser who developed a pilonidal sinus in the interdigital web of her non-dominant hand and review the relevant literature. Case presentation A 29 year-old Greek female hairdresser underwent surg...

  9. Plastic surgeons: a gender comparison.

    Science.gov (United States)

    Capek, L; Edwards, D E; Mackinnon, S E

    1997-02-01

    This study surveyed plastic surgeons for the purpose of identifying gender-related differences within the specialty. A confidential 108-item questionnaire was mailed to all female members and candidates of the American Society of Plastic and Reconstructive Surgeons (ASPRS) and to an equal number of male colleagues. The survey was conducted between September of 1992 and October of 1993 using a modified Dillman five-step computerized method. The response rate was 73 percent for women (157 of 216) and 57 percent for men (124 of 216). Of those who responded, 65 percent of women and 89 percent of men were married (p delaying childbearing until they had begun full-time practice of plastic surgery (p < 0.001). No significant gender-related differences were noted with respect to medical school rank, training history, advanced degrees, subspecialty practiced, hospital affiliation, or hours worked. Women surgeons in academic practice held lower rank than men and were less likely to be tenured (p < 0.04). Gross annual income was lower for women (p < 0.001). In contrast to men (27 percent), most women (89 percent) perceived sexual discrimination and harassment (p < 0.001). The majority of plastic surgeons were satisfied with their financial situation (80 percent), work (94 percent), and family life (76 percent). Over 90 percent of both women and men were happy with their career choice and would encourage medical students to become surgeons. Plastic surgeons do not differ in training or professional practice characteristics. Discrimination and harassment and unequal promotion and remuneration of women in the university environment are problems that need to be eliminated. PMID:9030134

  10. Sero-prevalence of Hepatitis C antibodies in the people visiting roadside barbers

    International Nuclear Information System (INIS)

    Sharing of blades and shaving kits, especially unsterilized ones are known risk factors for the transmission of Hepatitis C. The objective of this study was to determine the prevalence of Hepatitis C antibodies reactivity among the patients admitted due to any medical condition and who have been visiting roadside barbers. Methodology: This was a descriptive study conducted from July 2007 to June 2008 in the Medical Unit-111, Jinnah Postgraduate Medical Center, Karachi. The study was designed to include patient's demographics (age, occupation, marital status and education), clinical information and duration of the visits to roadside barbers with an approximate frequency of shavings per month. The patients with history of > 3 visits to a roadside barber during the last six months were included in the study. Whereas, the patients with history of liver disease, blood transfusion, surgery, dental treatment, tattoo marks, intravenous drug use, on regular injectable medicine (like insulin, etc), multiple sexual partners and on haemodialysis were excluded from the study. A blood sample was collected at the time of admission and the screening for HCV-antibodies was done by Enzyme Linked Immuno-Sorbant Assay (ELISA). Results: A total of 184 male patients were included in the study. The mean age + SD of the patients under the study was 33.8+13.2 years. The majority of study patients were uneducated and belonged to low socioeconomic group. Out of 184 patients, 70(38%) were found to be HCV-antibodies reactive. In comparison to younger patients (age <40 years), the older patients as well as those with history of longer duration of visits to roadside barbers had high prevalence of HCV-antibodies reactivity, P.015 and P.02 respectively. There was no statistical significant difference for the prevalence of HCV- antibodies reactivity among the different socioeconomic groups, educational level and marital status. Conclusion: In the present study, it is concluded that the sharing of

  11. Active Art Education in a University Museum: The Example of the Barber Institute

    Directory of Open Access Journals (Sweden)

    Şehnaz Yalçın Wells

    2014-05-01

    Full Text Available Museums provide individuals with access to a variety of artworks at a quality and quantity that is not possible any other way. Museum education is of great importance to get effective benefit from museums. Nowadays museum education starts at an early age, and is simultaneously given in appropriate subjects of different lessons. Turkey has made important progresses in museum education and museum studies in recent years, but clearly there is much more to do when compared to more developed countries. These steps can be summarised (a increasing research into museum education and museology, (b staff training, (c creation of social awareness, (d development and application of new projects. Managing all these is not possible with the state’s efforts. Private entrepreneurs and civil society should take the initiative and contribute towards museum education and museology. The aim of this research is to determine the potential and function of art education, and to introduce the museum/art activities made in this context in the Barber Museum of Fine Arts Institute at Birmingham University, England. In line with these aims the answers to these questions are being sought: 1. How was Barber Institute Museum been established and developed? a What is the history of the museum’s foundation? b In the context of the development of museology and art, how can the establishment of the museum by a person/family be evaluated? 2. What are the institutional features of the Barber Institute Museum? a What are the administrative features of the museum? b What are the spatial features and importance of the museum? c What is the artistic significance of its collections? 3. How is museum/art education applied at the Barber Institute Museum? 4. How can the example of the Barber Institute be assessed in terms of museology and museum/art education? Method: This is a qualitative research study, and the case study method is used accordingly. This method foresees the portrayal

  12. Counterclockwise barber-pole sign on CT: SMA/SMV variance without midgut malrotation

    International Nuclear Information System (INIS)

    We report on a 10-year-old girl who presented with worsening pain and anorexia after blunt trauma to the abdomen. Contrast-enhanced CT of the abdomen was performed, and a counterclockwise rotation of the superior mesenteric vein around the superior mesenteric artery was seen. An upper gastrointestinal (UGI) series with small-bowel follow-through demonstrated a normally located duodenal-jejunal junction. This is the first case report of a counterclockwise barber-pole sign seen by CT with UGI that was negative for malrotation or volvulus. (orig.)

  13. Counterclockwise barber-pole sign on CT: SMA/SMV variance without midgut malrotation

    Energy Technology Data Exchange (ETDEWEB)

    Clark, Paul [Tripler Army Medical Center, Department of Radiology, Honolulu, Hawaii (United States); Ruess, Lynne [Tripler Army Medical Center, Department of Radiology, Honolulu, Hawaii (United States); Uniformed Services University of the Health Sciences, Department of Radiology and Radiological Sciences and Pediatrics, Bethesda, MD (United States)

    2005-11-01

    We report on a 10-year-old girl who presented with worsening pain and anorexia after blunt trauma to the abdomen. Contrast-enhanced CT of the abdomen was performed, and a counterclockwise rotation of the superior mesenteric vein around the superior mesenteric artery was seen. An upper gastrointestinal (UGI) series with small-bowel follow-through demonstrated a normally located duodenal-jejunal junction. This is the first case report of a counterclockwise barber-pole sign seen by CT with UGI that was negative for malrotation or volvulus. (orig.)

  14. Endometriosis for the Colorectal Surgeon

    OpenAIRE

    Slaughter, Katrina; Gala, Rajiv B.

    2010-01-01

    Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. Although the exact pathophysiology is unclear, endometriosis is a well-known cause of pelvic pain and infertility in reproductive-aged women. Endometriosis can have extrapelvic manifestations relevant for colorectal surgeons to appreciate, such as cyclic constipation, diarrhea, hematochezia, and dyschezia. The treatment of endometriosis involves a combination of medical and surgical intervent...

  15. Surgeon General's Family Health History Initiative

    Science.gov (United States)

    ... Tool Printable Versions Source Code The Surgeon General's Family Health History Initiative To help focus attention on the importance of family history, the Surgeon General, in cooperation with other ...

  16. Hand dominance in orthopaedic surgeons.

    LENUS (Irish Health Repository)

    Lui, Darren F

    2012-08-01

    Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.

  17. Veterinary surgeons as vectors of Salmonella dublin.

    OpenAIRE

    Williams, E

    1980-01-01

    Salmonella dublin is an important bovine pathogen, causing dysentery, abortion, and death from septicaemia. S dublin dermatitis, a little-recognised occupational hazard for veterinary surgeons, does not cause serious disability or inconvenience. During a survey of brucellosis in south-west Wales four cases of S dublin dermatitis were seen in veterinary surgeons. One surgeon was reinfected three years later. On all five occasions the veterinary surgeons had not worn or had discarded polyethyle...

  18. ARE LEFT HANDED SURGEONS LEFT OUT?

    OpenAIRE

    SriKamkshi Kothandaraman; Balasubramanian Thiagarajan

    2012-01-01

    Being a left-handed surgeon, more specifically a left-handed ENT surgeon, presents a unique pattern of difficulties.This article is an overview of left-handedness and a personal account of the specific difficulties a left-handed ENT surgeon faces.

  19. 21 CFR 878.4460 - Surgeon's glove.

    Science.gov (United States)

    2010-04-01

    ... DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4460 Surgeon's glove. (a) Identification. A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgeon's glove. 878.4460 Section 878.4460...

  20. Use of commercial live feeds enrichment during first feeding period of the barber goby Elacatinus figaro

    Directory of Open Access Journals (Sweden)

    Marcelo R. P. Shei

    2012-03-01

    Full Text Available t. The first feeding period is the most critical phase for the production of marine fish larvae. The utilization of n-3 HUFA enrichment on live feed has improved the results for several species during the larviculture. To evaluate the effect of n-3 HUFA enrichment on survival and growth of the barber goby Elacatinus figaro Sazima, Moura & Rosa, 1997, newly hatched larvae were divided in two experimental groups (200 larvae per group, with two replicates each. One group was fed on non-enriched rotifers Brachionus plicatilis and the other group was fed with n-3 HUFA enriched rotifers. After 14 days of experiment, survival of larvae fed n-3 HUFA enriched rotifers was three times higher (35.7 ± 3.1% than those fed non-enriched rotifers (11.1 ± 5.2 %, however this difference was not significant. Growth was faster for larvae fed n-3 HUFA enriched rotifers after the first week of life, but at the end of 14 days, it was no longer significantly different between the two groups (6.09 ± 0.62 and 5.69 ± 0.66 mm. The results of this experiment suggest that barber goby should be fed n-3 HUFA enriched rotifer in order to maximize juvenile production.

  1. The academic surgeon and industry.

    Science.gov (United States)

    Kaiser, L R

    2000-04-01

    Academic surgeons should be aware of the tremendous potential that exists to partner with private companies on projects relating either to basic or clinical research. This is particularly timely now because many of these companies are experiencing unprecedented growth and market valuation. The development of these relationships requires knowing who to deal with as well as how to negotiate. Most academic medical centers have individuals who have expertise in developing sponsored research agreements, and young investigators should take advantage of this expertise. PMID:10727959

  2. 33 CFR 110.236 - Pacific Ocean off Barbers Point, Island of Oahu, Hawaii: Offshore pipeline terminal anchorages.

    Science.gov (United States)

    2010-07-01

    ..., Island of Oahu, Hawaii: Offshore pipeline terminal anchorages. 110.236 Section 110.236 Navigation and... Grounds § 110.236 Pacific Ocean off Barbers Point, Island of Oahu, Hawaii: Offshore pipeline terminal... vessels of over 100 gross tons shall not approach within 1,000 yards at a speed in excess of 6 knots....

  3. Barberà i Cuní: dos models entonatius per a programes informatius

    Directory of Open Access Journals (Sweden)

    Nil Torrent Adell

    2016-02-01

    Full Text Available En aquest treball, s’analitza i es descriu el model entonatiu de dos dels presentadors més coneguts de programes informatius (entrevistes i tertúlies de la televisió catalana, Jaume Barberà i Josep Cuní. La investigació s’ha basat en el mètode Anàlisi Melòdica de la Parla i s’ha dut a terme utilitzant, principalment, l’aplicació d’anàlisi i de síntesi de veu Praat, i el programa SPSS per comprovar-ne la significativitat. S’han descrit els trets que tenen en comú ambdós locutors i els trets en els quals divergeixen, i s’ha constatat que en la locució del cos del contorn presenten diferències significatives: Barberà marca gairebé totes les síl·labes tòniques de les paraules del contorn amb ascensos elevats, davant de Cuní, que en marca menys, també en tòniques, i amb ascensos tonals més discrets. Pel que fa a l’ús de patrons i de trets melòdics propis del català en parla espontània, els presentadors només n’utilitzen una part i de manera força recurrent, fet que dóna un ritme característic al seu discurs.

  4. Fish Census Data from Annual Surveys at Selected Shallow-water Sites Near the Barber's Point Sewage Outfall, Ewa, Oahu, Hawaii, 1991 - 2010 (NODC Accession 0073346)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Honouliuli Wastewater Treatment Plant (WWTP) located in Ewa, Oahu, Hawaii, near Barbers Point (Kalaeloa) has been in operation since 1982. It releases...

  5. Community Structure of Fish and Macrobenthos at Selected Shallow-water Sites in Relation to the Barber's Point Outfall, Oahu, Hawaii, 1991 - 1999 (NODC Accession 0000174)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This report provides the results of the eight years of an annual quantitative monitoring of shallow marine communities inshore of the Barbers Point Ocean Outfall...

  6. Sediment Monitoring and Benthic Faunal Sampling Adjacent to the Barbers Point Ocean Outfall, Oahu, Hawaii, 1986-2010 (NODC Accession 9900098)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Benthic fauna and sediment in the vicinity of the Barbers Point (Honouliuli) ocean outfall were sampled from 1986-2010. To assess the environmental quality,...

  7. [Michel Latarjet (1913-1999), surgeon explorer!].

    Science.gov (United States)

    Awada, T; Liverneaux, P

    2010-05-01

    In 1954, Michel Latarjet, anatomist and surgeon of Lyon, developed an original surgical technique to treat the unstable shoulder . This technique since kept his name: "Latarjet". He was a character in 1000 facets: highly skilled anatomist, skillful surgeon, talented sportsman, accomplished musician, big traveler, and many others... An eclectic life, symbol of an abundant XXth century. PMID:20303312

  8. Penciptaan Drama Musikal Sweeney Todd: The Demon Barber of Fleet Street (Sweeney Todd:Tukang Cukur Haus Darah)

    OpenAIRE

    Husni Wardhana; Suharyoso Suharyoso

    2013-01-01

    Proses kreatif penyutradaraan Sweeney Todd: The Demon Barber of Fleet Street memberi banyak pelajarantentang drama musikal. Drama musikal memiliki keunikan tersendiri dalam proses maupun bentuk penyajiannya.Jenis drama ini sangat populer di Amerika, dan merupakan satu-satunya sumbangan Amerika dalam memperkayajenis teater dunia. Cerita ini merupakan kisah legendaris Inggris. Berkali-kali naskah karya Christopher Bond inidimainkan di berbagai benua di dunia, namun bila dilihat dari sejarah pen...

  9. The Future of Plastic Surgery: Surgeon's Perspective.

    Science.gov (United States)

    Ozturk, Sinan; Karagoz, Huseyin; Zor, Fatih

    2015-11-01

    Since the days of Sushruta, innovation has shaped the history of plastic surgery. Plastic surgeons have always been known as innovators or close followers of innovations. With this descriptive international survey study, the authors aimed to evaluate the future of plastic surgeons by analyzing how plastic surgery and plastic surgeons will be affected by new trends in medicine. Aesthetic surgery is the main subclass of plastic surgery thought to be the one that will change the most in the future. Stem cell therapy is considered by plastic surgeons to be the most likely "game changer." Along with changes in surgery, plastic surgeons also expect changes in plastic surgery education. The most approved assumption for the future of plastic surgery is, "The number of cosmetic nonsurgical procedures will increase in the future." If surgeons want to have better outcomes in their practice, they must at least be open minded for innovations if they do not become innovators themselves. Besides the individual effort of each surgeon, international and local plastic surgery associations should develop new strategies to adopt these innovations in surgical practice and education. PMID:26594981

  10. [To be a good expert surgeon].

    Science.gov (United States)

    Funabiki, Takahiko

    2004-05-01

    The clinical and scientific level of Japanese surgeons leads the world needless to say, in the field of early gastric cancer, supported by double-contrast roentgenogram, endoscopy and surgical procedure including lymph node dissection with good outcomes. Surgical skills of Japanese surgeons have been improved by watching of cine or videotaped programs at the academic assemblies, breaking through apprenticeship. Ambitious young surgeons could freely learned excellent technical procedure from the pictures. Young surgeon must be an ever-thinking surgeon to get any hint on the film. Even though medical examinations and treatments including surgical procedures are on the way of standardization through EBM, manuals, guidelines and DPC payment system, medical doctors including surgeons must critically continue to think and seek for better treatment for the patients. Since the every patient differs in terms of age. sex, stage of disease, complicated conditions and social background, the treatment should be different, patient to patient, as tailor made fashion. Unless any progress is made, science and arts of medicine will decline. As another advice for a young surgeon from my experience you should write an operation protocol of every procedure by your self, even if that operation is the first experience or you joined as an assistant. After you wrote, you read the protocol by your instructor. Then you learn many knowledge and surgical know-how. Certainly, the book of the protocols will be your valuable treasure. Furthermore, you should not aim to be a skillful surgeon, but to be a good surgeon performing reliable and gentle operations for the patients. PMID:15176525

  11. Surgeon volume and outcomes in benign hysterectomy.

    Science.gov (United States)

    Doll, Kemi M; Milad, Magdy P; Gossett, Dana R

    2013-01-01

    Annual surgeon case volume has been linked to patient outcome in a variety of surgical fields, although limited data focus on gynecologic surgery performed by general gynecologists. Herein we review the literature addressing the associations between intraoperative injury, postoperative morbidity, and resource use among surgeons performing a low vs high volume of hysterectomies. Although study design and populations differ, individual and composite morbidity outcomes consistently favored high-volume surgeons. Given the growing emphasis on competency-based evaluation in surgery, gynecology departments may soon consider volume requirements a component of privileging. PMID:23622760

  12. Guy de Chauliac: pre-eminent surgeon of the Middle Ages.

    Science.gov (United States)

    Watters, David A K

    2013-10-01

    Guy de Chauliac (c1300-1368) trained in Toulouse and the University of Montpellier from where he achieved the highest possible degree of Master of medicine. He undertook fellowships in Bologna (anatomical dissection) and Paris (surgery) and was qualified as a physician not a Barber Surgeon. He took Holy Orders and was appointed as physician to three Avignon-based Popes. He survived an epidemic of the Black Death (1348-1350), suffering an axillary bubo. His book Chirugia Magna was written in medieval Latin in 1363, then circulated in manuscript form before its first printing in 1478. There were 70 editions as it became the most influential surgical text for over 200 years, particularly in France, spanning the period from the late 14th century until Paré (1510-1590). He divided surgery into swellings, wounds, ulcers, fractures and dislocations, and special diseases. Well researched and referenced, based on evidence and experience, he succeeded in incorporating antiquarian and contemporary thinking from French, Arabian, Italian (Bologna), Egyptian and Greek scholars about anatomy, surgical disease and treatment. He was a strong advocate for evaluating outcomes, knowing when not to operate, professionalism and the non-technical competencies. His framework of professionalism was based on four domains: being learned, expert, ingenious and adaptable. The surgical aspirants and leaders of the following two centuries recognized the academic, professional and practical value of his teaching through their reference to and use of Chirugia Magna. The Cowlishaw collection in the Royal Australasian College of Surgeons' library contains four French copies, under the title La Grande Chirugie. PMID:24099124

  13. Barber's hair sinus in a female hairdresser: uncommon manifestation of an occupational disease: a case report

    Science.gov (United States)

    Efthimiadis, Christopher; Kosmidis, Christopher; Anthimidis, George; Grigoriou, Marios; Levva, Sofia; Fachantidis, Panagiotis; Psihidis, George

    2008-01-01

    Background Barber's disease is an acquired occupational disease produced by short customers' hairs that penetrate the interdigital spaces of the hands. The lesion has been reported to occur mostly on the hands of male hairdressers. The purpose of this article is to report a rare case of a female hairdresser who developed a pilonidal sinus in the interdigital web of her non-dominant hand and review the relevant literature. Case presentation A 29 year-old Greek female hairdresser underwent surgical excision of the pilonidal sinus and curettage. She was not hospitalised, while prompt resolution of the condition and prevention of recurrence was achieved. Conclusion Pilonidal sinus of the interdigital spaces of the hand is a rare and preventable acquired occupational disease. The personal hygiene with thorough removal of any hairs that have penetrated the epidermis during the working day could prevent the formation of the disease. Surgical excision, curettage and primary healing seem to be a safe method of treatment. PMID:18837967

  14. Barber Pole Sign in CT Angiography, Adult Presentation of Midgut Malrotation: A Case Report

    Directory of Open Access Journals (Sweden)

    Garcelan-Trigo

    2015-07-01

    Full Text Available Adult midgut volvulus is a challenging diagnosis because of its low incidence and nonspecific symptoms. Diagnostic delay and long-term complaints are frequent in this clinical scenario. We reported a patient referred to our diagnostic imaging unit with intermittent abdominal pain, bloating and episodic vomiting for several years. He underwent barium gastrointestinal transit and abdominal ultrasound, which revealed severe gastric dilatation, food retention and slow transit until a depressed duodenojejunal flexure, with malrotation of the midgut and jejunal loops being located in the right upper quadrant. Computed tomography angiography was performed, showing rotation of the small intestine around the mesentery root, suggestive of midgut malrotation. In addition, an abnormal twisted disposition of superior mesenteric artery with corkscrew appearance was seen, shaping the pole-barber sign which was evident in volume rendering three-dimensional reconstructions. The patient underwent scheduled surgical treatment without any complication and had good outcome after hospital discharge and follow-up. Computed tomography plays an important role in evaluation of adult midgut volvulus. In addition, angiographic reconstructions can help us to assess the anatomic disposition of mesenteric vascular supply. Both of these assessments are useful in preoperative management.

  15. Barber Pole Sign in CT Angiography, Adult Presentation of Midgut Malrotation: A Case Report.

    Science.gov (United States)

    Garcelan-Trigo, Juan Arsenio; Tello-Moreno, Manuel; Rabaza-Espigares, Manuel Jesus; Talavera-Martinez, Ildefonso

    2015-07-01

    Adult midgut volvulus is a challenging diagnosis because of its low incidence and nonspecific symptoms. Diagnostic delay and long-term complaints are frequent in this clinical scenario. We reported a patient referred to our diagnostic imaging unit with intermittent abdominal pain, bloating and episodic vomiting for several years. He underwent barium gastrointestinal transit and abdominal ultrasound, which revealed severe gastric dilatation, food retention and slow transit until a depressed duodenojejunal flexure, with malrotation of the midgut and jejunal loops being located in the right upper quadrant. Computed tomography angiography was performed, showing rotation of the small intestine around the mesentery root, suggestive of midgut malrotation. In addition, an abnormal twisted disposition of superior mesenteric artery with corkscrew appearance was seen, shaping the pole-barber sign which was evident in volume rendering three-dimensional reconstructions. The patient underwent scheduled surgical treatment without any complication and had good outcome after hospital discharge and follow-up. Computed tomography plays an important role in evaluation of adult midgut volvulus. In addition, angiographic reconstructions can help us to assess the anatomic disposition of mesenteric vascular supply. Both of these assessments are useful in preoperative management. PMID:26557278

  16. What Is a Foot and Ankle Surgeon?

    Science.gov (United States)

    ... school, the foot and ankle surgeon enters a postgraduate residency in podiatric medicine and surgery approved by ... disorders and injuries that affect people of all ages. They are uniquely qualified to detect the early ...

  17. Penciptaan Drama Musikal Sweeney Todd: The Demon Barber of Fleet Street (Sweeney Todd:Tukang Cukur Haus Darah

    Directory of Open Access Journals (Sweden)

    Husni Wardhana

    2013-11-01

    Full Text Available Proses kreatif penyutradaraan Sweeney Todd: The Demon Barber of Fleet Street memberi banyak pelajarantentang drama musikal. Drama musikal memiliki keunikan tersendiri dalam proses maupun bentuk penyajiannya.Jenis drama ini sangat populer di Amerika, dan merupakan satu-satunya sumbangan Amerika dalam memperkayajenis teater dunia. Cerita ini merupakan kisah legendaris Inggris. Berkali-kali naskah karya Christopher Bond inidimainkan di berbagai benua di dunia, namun bila dilihat dari sejarah penciptaannya, kisah balas dendam seorangtukang cukur ini telah melalui proses adaptasi yang panjang. Beberapa penulis besar di jamannya sebelum melewatitangan kreatif Christopher Bond telah mengkreasi ulang naskah ini. Drama musikal ini berawal dari komedi musikaldan sejak tahun 1920 mengangkat tema-tema serius yang biasa disebut musik Broadway atau musik Amerika. Biasadisajikan dalam panggung besar West End dan Broadway di London, New York, Australia dan Asia. Beberapa kalidipanggungkan oleh kelompok teater sekolah atau kelompok teater amatir. Hampir seluruh pertunjukan drama musikal Sweeney Todd: The Demon Barber of Fleet Street diiringi dengan musik dan dinyanyikan. Dialog diubahmenjadi nyanyian. Para aktor di tuntut untuk dapat menyanyi, akting, dan menari. Drama musikal merupakanpertunjukan yang menggunakan tiga ciri utama, yakni menyanyi, menari, dan berakting yang mendominasi hampirseluruh pertunjukan.Kata kunci: penyutradaraan, drama musikal, kisah legendaris, Sweeney Todd, teater sekolah.ABSTRACTThe musical drama Sweeney Todd: Th e Demon Barber of Fleet Street. The creative directing process of this drama has given many good lessons to the art work of performing arts, especially to musical drama performance. The musical drama has its own unique characteristics in its process and performance. This type of drama is very popular in the USA, and has been the only contribution from the USA to enrich the typical of world theater. Sweeney Todd: The Demon

  18. Canadian cardiac surgeons' perspectives on biomedical innovation.

    Science.gov (United States)

    Snyman, Gretchen; Tucker, Joseph E L; Cimini, Massimo; Narine, Kishan; Fedak, Paul W M

    2012-01-01

    Barriers to successful innovation can be identified and potentially addressed by exploring the perspectives of key stakeholders in the innovation process. Cardiac surgeons in Canada were surveyed for personal perspectives on biomedical innovation. Quantitative data was obtained by questionnaire and qualitative data via interviews with selected survey participants. Surgeons were asked to self-identify into 1 of 3 categories: "innovator," "early adopter," or "late adopter," and data were compared between groups. Most surgeons viewed innovation favourably and this effect was consistent irrespective of perceived level of innovativeness. Key barriers to the innovation pathway were identified: (1) support from colleagues and institutions; (2) Canada's health system; (3) sufficient investment capital; and (4) the culture of innovation within the local environment. Knowledge of the innovation process was perceived differently based on self-reported innovativeness. The majority of surgeons did not perceive themselves as having the necessary knowledge and skills to effectively translate innovative ideas to clinical practice. In general, responses indicate support for implementation of leadership and training programs focusing on the innovation process in an effort to prepare surgeons and enhance their ability to successfully innovate and translate new therapies. The perspectives of cardiac surgeons provide an intriguing portal into the challenges and opportunities for healthcare innovation in Canada. PMID:22902159

  19. The Survey of Knowledge, Attitude and Performance Of Female Barbers in Relation to Job's Environmental Health: A Case Study of Malayer City

    Directory of Open Access Journals (Sweden)

    Ali Almasi

    2016-07-01

    Full Text Available Hygiene disregarding and usage of contaminated tools leads to viral infections, fungal, bacterial and skin diseases, eczema, warts, tetanus and so on. Thus assessment of knowledge, attitudes and performance of barbers in order to ensure the security and public health is really necessary. This study is aimed at determining the knowledge, attitude and performance of female barbers in relation to job's environmental health in Malayer city. In present descriptive- analytical study, 75 female barbers sampling of Malayer city were selected by clusters – systematic method. The data were obtained through questionnaires for completion and checklist. Data analysis was performed using SPSS 21 statistical software. The result showed, 86.66% of people have attained correct awareness of regulations and 92.28% had positive attitude toward regulations and 86.38% of people in this study showed appropriate health practice. In order to, compare the average knowledge level in regard to parameters such as age, work experiences and income situation showed a statistically significant difference. In attitude and performance section, the difference between age and mentioned parameters was not statistically significant (P≥ 0.05. Despite the desirable level of knowledge, attitude and practice of barbers female in Malayer city, in order to improve the situation, to be better the presence of barbers in special guilds courses to train seriously.

  20. Occupational health related concerns among surgeons.

    Science.gov (United States)

    Memon, Anjuman Gul; Naeem, Zahid; Zaman, Atif; Zahid, Faryal

    2016-04-01

    The surgeon's daily workload renders him/her susceptible to a variety of the common work-related illness. They are exposed to a number of occupational hazards in their professional work. These hazards include sharp injuries, blood borne pathogens, latex allergy, laser plumes, hazardous chemicals, anesthetic gases, equipment hazards, static postures, and job related stressors. However, many pay little attention to their health, and neither do they seek the appropriate help when necessary. It is observed that occupational hazards pose a huge risk to the personal well-being of surgeons. As such, the importance of early awareness and education alongside prompt intervention is duly emphasized. Therefore, increased attention to the health, economic, personal, and social implications of these injuries is essential for appropriate management and future prevention. These risks are as great as any other occupational hazards affecting surgeons today. The time has come to recognize and address them. PMID:27103909

  1. Orthopaedic Surgeon Burnout: Diagnosis, Treatment, and Prevention.

    Science.gov (United States)

    Daniels, Alan H; DePasse, J Mason; Kamal, Robin N

    2016-04-01

    Burnout is a syndrome marked by emotional exhaustion, depersonalization, and low job satisfaction. Rates of burnout in orthopaedic surgeons are higher than those in the general population and many other medical subspecialties. Half of all orthopaedic surgeons show symptoms of burnout, with the highest rates reported in residents and orthopaedic department chairpersons. This syndrome is associated with poor outcomes for surgeons, institutions, and patients. Validated instruments exist to objectively diagnose burnout, although family members and colleagues should be aware of early warning signs and risk factors, such as irritability, withdrawal, and failing relationships at work and home. Emerging evidence indicates that mindfulness-based interventions or educational programs combined with meditation may be effective treatment options. Orthopaedic residency programs, departments, and practices should focus on identifying the signs of burnout and implementing prevention and treatment programs that have been shown to mitigate symptoms. PMID:26885712

  2. Ancillary services available to the orthopedic surgeon.

    Science.gov (United States)

    Bert, Jack M

    2008-01-01

    The delivery of high quality medical services is approaching a crisis situation in the United States. As physician reimbursements decline and overhead increases, orthopedic surgeons must seek additional sources of revenue to remain financially viable and control the quality of medical care that they deliver. The orthopedic surgeon group is well positioned to control its own service lines and deliver excellent patient care as a result. This article reviews the possibilities of multiple types of ancillary service lines available for the orthopedic group practice. PMID:18061762

  3. The business acumen of Canadian plastic surgeons.

    Science.gov (United States)

    Bliss, J A; Caputy, G G

    1995-08-01

    We as plastic surgeons are engrossed and consumed by our quest to optimize patient care. In so doing, we are often distracted by that aspect of our practice which has direct bearing on patient care yet for which we are the least prepared--the business aspect. The entire population of Canadian plastic surgeons was surveyed in an effort to establish real and perceived needs of this group with respect to the business management of their practices. The survey elicited demographic information, information on business educational background, interest, and current commitment in acquiring business knowledge, and a final category of questions dealing with how well these surgeons function as business managers. Of the 315 plastic surgeons surveyed, 122 (39 percent) responded, which, in and of itself, indicates an interest in this aspect of their practices. Twelve respondents were excluded from the study for various reasons. Eighty of the 110 remaining respondents (72 percent) used a hospital-integrated facility for both emergency and elective outpatient procedures. Eighty-four of the 110 respondents (76 percent) indicated that 10 percent of their hours per week of inpatient booked operating time was canceled. Ninety-three percent of respondents felt that a business course to familiarize surgeons with common business situations and areas of personal finance would be beneficial. Few were previously educated in business, and similarly, few had great ongoing interest in business, although the majority of respondents used publications specifically dealing with financial matters (provided by the Canadian Medical Association). Twenty-three percent of respondents saw themselves in a growing role as businesspeople; 24 percent felt this dual role was enjoyable, while 29 percent felt this role was forced on them. A total of 21 percent of respondents did not see themselves as businesspeople at all. The six basic functions of a manager (planning, acquiring, organizing, actuating

  4. A Modular Laparoscopic Training Program for Pediatric Surgeons

    OpenAIRE

    Nakajima, Kiyokazu; WASA, MASAFUMI; Takiguchi, Shuji; Taniguchi, Eiji; Soh, Hideki; Ohashi, Shuichi; Okada, Akira

    2003-01-01

    Objectives: A structured endoscopic training program for pediatric surgeons has not yet been established. This study was conducted to develop a modular training program (MTP) for pediatric surgeons and to evaluate its effectiveness for surgeons with and without previous experience in laparoscopic surgery. Methods: Nine pediatric surgeons participated in the study. They were divided into 2 groups: group A (n=4), surgeons who had experienced more than 10 cases of laparoscopic surgery prior to M...

  5. Plan empresarial para la creación de una barbería estilo clásica en Madrid: Imperitus Barbershop

    OpenAIRE

    Peñaloza-Sandoval, Andrea C.

    2016-01-01

    El presente plan de negocio plantea la puesta en marcha de una barbería al estilo tradicional propio de los años 50, pretendiendo atacar un nicho de mercado que plantea la necesidad de consumir productos alejados de las grandes industrias y apoya el retorno de las actividades tradicionales y artesanales como lo es la barbería. Mediante el análisis del sector, el desarrollo de un plan de marketing, el planteamiento de una estructura de operaciones óptimas y la realización de un plan económi...

  6. Society of American Gastrointestinal Endoscopic Surgeons

    Science.gov (United States)

    ... U SAGES.TV iMAGES Wiki MyCME HealthySooner SAGES Society of American Gastrointestinal and Endoscopic Surgeons Home SAGES ... and Co-Chairs Officers and Representatives of the Society SAGES Past Presidents Awards George Berci Award Pioneer ...

  7. The nature of surgeon human capital depreciation.

    Science.gov (United States)

    Hockenberry, Jason M; Helmchen, Lorens A

    2014-09-01

    To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs. PMID:24973949

  8. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup;

    the existing literature on musculoskeletal pain in surgeons. Methods: A systematic literature search was employed. In total, 1.849 titles were scrutinized and 24 articles were found relevant. Due to the diversity of data, a narrative synthesis method was applied. Results: The prevalence of...

  9. Smart apps for the smart plastic surgeon.

    Science.gov (United States)

    Venkataram, Aniketh; Ellur, Sunderraj; Kujur, Abha Rani; Joseph, Vijay

    2015-01-01

    Smartphones have the ability to benefit plastic surgeons in all aspects of patient care and education. With the sheer number of applications available and more being created everyday, it is easy to miss out on apps which could be of great relevance. Moreover, the range of android applications available has not been extensively discussed in the literature. To this end, we have compiled an exhaustive list of android smartphone applications, which we feel can help our day to day functioning. The apps have been extensively reviewed and neatly described along with all their potential uses. In addition, we have made an effort to highlight 'non-medical' or efficiency apps which can improve departmental functioning. These apps have not been described in prior articles, and their functionality might not be known to all. We believe that the technology savvy plastic surgeon can make maximum use of these apps to his benefit. PMID:25991890

  10. Working night shifts affects surgeons' biological rhythm

    DEFF Research Database (Denmark)

    Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob;

    2015-01-01

    BACKGROUND: Chronic sleep deprivation combined with work during the night is known to affect performance and compromise residents' own safety. The aim of this study was to examine markers of circadian rhythm and the sleep-wake cycle in surgeons working night shifts. METHODS: Surgeons were monitored...... prospectively for 4 days: pre call, on call, post call day 1 (PC1), and post call day 2 (PC2). The urinary metabolite of melatonin and cortisol in saliva were measured to assess the circadian rhythm. Sleep and activity were measured by actigraphy. Subjective measures were assessed by the Karolinska Sleepiness...... Scale and Visual Analog Scale of fatigue, general well-being, and sleep quality. RESULTS: For both metabolite of melatonin and cortisol, a significant difference (P < .05) was found in the measurement period between on call and pre call values. There was increased sleep time during the day on call and...

  11. Ethics and the facial plastic surgeon.

    Science.gov (United States)

    Sethi, Neeraj

    2016-09-01

    The facial plastic surgeon potentially has a conflict of interest when confronted with the patients requesting surgery, due to the personal gain attainable by agreeing to perform surgery. The aim of this review is to discuss the potential harm the surgeon can inflict by carrying out facial plastic surgery, beyond the standard surgical complications of infection or bleeding. It will discuss the desire for self-improvement and perfection and increase in the prevalence facial plastic surgery. We address the principles of informed consent, beneficence and non-maleficence, as well as justice and equality and how the clinician who undertakes facial plastic surgery is at risk of breaching these principles without due care and diligence. PMID:26254909

  12. Smart apps for the smart plastic surgeon

    Directory of Open Access Journals (Sweden)

    Aniketh Venkataram

    2015-01-01

    Full Text Available Smartphones have the ability to benefit plastic surgeons in all aspects of patient care and education. With the sheer number of applications available and more being created everyday, it is easy to miss out on apps which could be of great relevance. Moreover, the range of android applications available has not been extensively discussed in the literature. To this end, we have compiled an exhaustive list of android smartphone applications, which we feel can help our day to day functioning. The apps have been extensively reviewed and neatly described along with all their potential uses. In addition, we have made an effort to highlight ′non-medical′ or efficiency apps which can improve departmental functioning. These apps have not been described in prior articles, and their functionality might not be known to all. We believe that the technology savvy plastic surgeon can make maximum use of these apps to his benefit.

  13. Ashley W. Oughterson, MD: Surgeon, Soldier, Leader

    OpenAIRE

    Kunstman, John W.; Longo, Walter E

    2015-01-01

    Ashley W. Oughterson, MD, (1895-1956) was a longtime faculty surgeon at Yale University. He performed some of the earliest pancreatic resections in the United States. During World War II, Colonel Oughterson was the primary “Surgical Consultant” in the South Pacific and present at nearly every major battle. His meticulously kept diary is regarded as the foremost source detailing wartime surgical care. Colonel Oughterson led the initial Army team to survey Hiroshima and Nagasaki following the n...

  14. Nanotechnology Tolls the Bell for Plastic Surgeons

    OpenAIRE

    Salehahmadi, Zeinab; Hajiliasgari, Fatemeh

    2013-01-01

    Nanotechnology is an emerging discipline, having power to revolutionarize every scientific field to a very deep level which previously thought to be a science fiction. Having a great potential to beneficially change the way a disease is diagnosed, treated and prevented, nanotechnology practically impacts on state of the art healthcare technologies and plays a crucial role in changing the field of surgery. Surgeons are constantly looking for minimally invasive ways to treat their patients, as ...

  15. Technologies Enhance Tumor Surgery: Helping Surgeons Spot and Remove Cancer

    Science.gov (United States)

    ... External link, please review our exit disclaimer . Subscribe Technologies Enhance Tumor Surgery Helping Surgeons Spot and Remove ... over time. NIH-funded researchers are developing new technologies to help surgeons determine exactly where tumors end ...

  16. Bir Üniversite Müzesinde Aktif Sanat Eğitimi: Barber Enstitüsü Örneği-Active Art Education in a University Museum: The Example of the Barber Institute

    OpenAIRE

    Yalçın Wells, Şehnaz

    2014-01-01

    Özet Bu çalışmada İngiltere'de Birmingham Üniversitesi'nde bulunan Barber Güzel Sanatlar Enstitüsü Galerisi, sanat eğitimi potansiyel ve işlevi bakımından incelenmektedir. Bu temel amaca paralel olarak araştırmada müzenin tarihsel gelişimi, müze olarak sahip olduğu koleksiyonun sanatsal değeri ve müze/sanat eğitimi bağlamında yapılan faaliyetler ortaya konmaktadır. Araştırma bir kurum ve süreci herhangi bir müdahalede bulunmadan mevcut haliyle ortaya koymayı amaçladığından durum çalışması ...

  17. Plaster of Paris: the orthopaedic surgeon heritage.

    Science.gov (United States)

    Hernigou, Philippe

    2016-08-01

    Plastering is one of the most ancient of the building handicrafts. Plaster is the common name for calcium sulphate hemi hydrate made by heating the mineral gypsum, the common name for sulphate of lime. In the tenth century the Arabs used liquid plaster in orthopaedic treatment. At the beginning of the nineteenth century, patients with fractures of the lower extremities-and often of the upper extremities as well-were treated in bed with restriction of all activity for many weeks until the fractures united. It was the practice of surgeons to dress wounds and fractures at frequent intervals. The bandages, pads, and splints were removed, the fractures manipulated, and the dressings reapplied. The search for simpler, less cumbersome methods of treatment led to the development of occlusive dressings, stiffened at first with starch and later with plaster of Paris. The ambulatory treatment of fractures was the direct result of these innovations. Two military surgeons, Antonius Mathijsen of the Netherlands, and Nikolai Ivanovitch Pirogov of Russia, were responsible for the introduction of the new plaster bandage technique. At the beginning of the twentieth century the technique was improved by Jean-François Calot, a French surgeon, who invented the hand manufacture of plaster bandage as a roll. During the twentieth century, walking cast and ambulation for fresh fractures were developed with plaster and pin incorporated in plaster; the open fracture care concept was introduced with plaster of Paris by Trueta before the external fixation. PMID:27055448

  18. Comprehensive feedback on trainee surgeons' non-technical skills

    DEFF Research Database (Denmark)

    Spanager, Lene; Dieckmann, Peter; Beier-Holgersen, Randi;

    2015-01-01

    OBJECTIVE: This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons' non-technical skills. METHODS: Trainee surgeons and their supervisors used the Non...

  19. Emil Theodor Kocher (1841-1917)--orthopaedic surgeon and the first surgeon Nobel Prize winner.

    Science.gov (United States)

    Bumbasirević, Marko Z; Zagorac, Slavisa G; Lesić, Aleksandar R

    2013-01-01

    Theodor Emil Kocher (1841-1917), born in Bern, educated in many universities in Europe. Kocher as many surgeons of that time performed orthopedic surgery, general surgery, neurosurgery and endocrine surgery, but he become famous in orthopaedic surgery and endocrine surgery. He is remember as a surgeon who described the approach to the hip joint, elbow joint, maneuver for the reduction of dislocated shoulder joint. He introduced many instruments and many of them, such as Kocher clamp is still in use. Most important Kocher work was the thyroid gland surgery, and he received the Nobel Prize for Medicine in 1909, for-in this matter. His nature of meticulous surgeon, scientific and hard working person, dedicated to his patients and students made- found him the place in a history of medicine. PMID:24669574

  20. Phacoemulsification--a senior surgeon's learning curve.

    Science.gov (United States)

    Thomas, R; Braganza, A; Raju, R; Lawrence; Spitzer, K H

    1994-08-01

    We sought to prospectively document and evaluate the learning curve of an experienced extracapsular surgeon making a supervised transition from extracapsular cataract extraction (ECCE) to phacoemulsification. Over a period of 2 weeks, 51 phacoemulsification procedures using an endocapsular nucleofractis technique were performed by a single senior surgeon at the Christian Medical College in Vellore, India under the supervision of a visiting US expert with more than 15 years' experience in the technique. Vitreous loss occurred in seven eyes (six prior to the stage of cortical aspiration); failure of capsulorhexis necessitated conversion to standard ECCE in four. Injury to the inferior iris during phacoemulsification was cosmetically significant in three eyes. Two eyes had mild persistent localized corneal edema, but there were no instances of permanent corneal damage. One eye had intraoperative displacement of the nucleus into the vitreous. In one eye with vitreous loss, the implanted intraocular lens dislocated into the vitreous cavity. Two patients had clinically detectable cystoid macular edema at 6 weeks. Eleven patients were lost to follow up after 3 weeks. Six weeks after surgery, 36 of the remaining 40 eyes (90%) had achieved a best-corrected visual acuity of 6/6. We conclude that phacoemulsification requires supervised learning, even for an experienced surgeon. Complications still occurred, but were restricted to the unfamiliar steps of the surgery. Factors identified in the first 2 days of surgery (10 cases) as critical in the smooth transition to phacoemulsification were careful selection of initial cases, a successful capsulorhexis, and hydrodissection with vigorous nucleus mobilization.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7970530

  1. Emergency surgeon-performed hepatobiliary ultrasonography.

    LENUS (Irish Health Repository)

    Kell, M R

    2012-02-03

    BACKGROUND: Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined. METHODS: A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2-5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2-5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses. RESULTS: Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94.3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95.2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96.2 per cent of patients. Time to scan was significantly shorter following SUS (3.1 versus 12.0 h, P < 0.05). CONCLUSION: SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.

  2. Anticipation of Artemia sp. supply in the larviculture of the barber goby Elacatinus figaro (Gobiidae: Teleostei influenced growth, metamorphosis and alkaline protease activity

    Directory of Open Access Journals (Sweden)

    Maria Fernanda da Silva-Souza

    2015-09-01

    Full Text Available The barber goby Elacatinus figaro is considered endangered due to overexploitation by the ornamental industry. Farming marine ornamental fishes, especially the threatened ones, can be one of the measures to minimize the pressure on the natural stocks. Among the priority issues for their production is the determination of the most appropriate feeding management. The feeding protocol commonly used in the larviculture of barber goby, when the start of Artemia sp. offer occurred at the 18th DAH (days after hatching (treatment T18, was modified, by anticipating brine shrimp supply in 6 days (treatment T12. Alkaline proteases activity, growth and metamorphosis of larvae were evaluated in both protocols. Juveniles at T12 showed higher weight (0.04 ± 0.001 g and lower activity of total alkaline proteases (1.3 ± 0.2 mU mg-1 protein compared to T18 (0.02 ± 0.001 g; 2.8 ± 0.4 mU mg-1 protein, respectively. With anticipation of brine shrimp, the commencing and end of larval transformation was observed earlier (at 24 and 34 DAH, respectively in comparison to those with the supply of Artemia sp. at 18 DAH (27 and 41 DAH, respectively. Thus, the Artemia sp. anticipation was beneficial during the larviculture of the barber goby, considering that larvae reached metamorphosis earlier.

  3. Ultrasound of the acute abdomen performed by surgeons in training

    DEFF Research Database (Denmark)

    Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.;

    2008-01-01

    perform valid abdominal ultrasound examinations of patients referred with acute abdominal pain. METHODS: Patients referred with acute abdominal pain had an ultrasound examination by a surgeon in training as well as by an experienced consultant radiologist whose results served as the gold standard. All...... participating surgeons were without any pre-existing ultrasound experience and received one hour of introduction to abdominal ultrasound. RESULTS: Thirty patients underwent 40 surgeon performed and 30 radiologist performed ultrasound examinations. Regarding gallstone and cholecholecystitis the sensitivity...

  4. Pharmacovigilance Among Surgeons and in Surgical Wards: Overlooked or Axiomatic?

    OpenAIRE

    Rodrigues, Gabriel Sunil; Khan, Sohil Ahmed

    2010-01-01

    To review the status of pharmacovigilance system among surgeons and in surgical wards with recommendations. Literature search using MEDLINE, cross-reference of published data and review of World Health Organization—Pharmacovigilance transcripts. Pharmacovigilance system is still in its infancy among surgeons and in surgical wards. No major studies have been published addressing this issue, till date. Surgeons are professionals least likely to report adverse drug reactions. Moreover widespread...

  5. Work-related ocular events among Nigerian dental surgeons

    OpenAIRE

    Azodo, Clement C.; Ezeja, Ejike B

    2015-01-01

    Objective Daily clinical activities in dental operatory expose dental surgeons to varied forms of ocular events. The purpose of the study was to determine the prevalence and pattern of ocular splashes and foreign bodies among dental surgeons in Nigeria. Methods This questionnaire-based cross-sectional of dental surgeons in Southern Nigeria was conducted between September 2010 and August 2011. The information elicited were demography, experience and type of ocular event, implicated dental proc...

  6. The uses of the iPhone for surgeons.

    Science.gov (United States)

    Dala-Ali, Benan M; Lloyd, Mary Anne; Al-Abed, Yahya

    2011-02-01

    Mobile technology is continuously improving and it is important that all physicians are aware of its new advances. Smartphones have the potential to improve diagnostic skills and education of a surgeon. The iPhone is a popular type of smartphone in the market. This article intends to educate surgeons about its uses, functions and medical applications. The phone is an invaluable tool for the modern day surgeon. PMID:21195331

  7. Two surgeons and the ECG-a double blind study

    Institute of Scientific and Technical Information of China (English)

    Ulf Martin Schilling

    2012-01-01

    Objective: To assess the capability of operating abdominal and orthopaedic surgeons to analyze a set of standardized ECG. Methods: Twenty operating abdominal and orthopaedic surgeons at a university hospital were included. Each participant analyzed a set of five standardized ECG with an answering scheme for eight different items, giving a maximum score of 40. The answers were matched according to specialty and experience of the doctors of less than 5 years, between 5 and 10 years or more than 10 years. The reference standard was set by two independent consultants in cardiology. Results: The mean overall score was 25.25 (63.13%±4.78%) varying between 38 (95%) and 20(50%). Abdominal surgeons performed a mean score of 27.625 (69.06%±9.53%), and orthopaedic surgeons 23.67 points (59.17%±3.69%). The difference between the performance of abdominal and orthopaedic surgeons was not significant (P=0.09). 20/20 surgeons identified ST-elevation and no surgeon accepted the ECG showing acute ST-elevation myocardial infarction as normal. Conclusions: Abdominal and orthopaedic surgeons provided an answering scheme are able to interprete the ECG and identify both the normal and the ECG showing life-threatening pathology. The hypothesis that surgeons were unable to interprete the ECG must be rejected.

  8. Emil Theodor Kocher (1841-1917: Orthopaedic surgeon and the first surgeon Nobel Prize winner

    Directory of Open Access Journals (Sweden)

    Bumbaširević Marko Ž.

    2013-01-01

    Full Text Available Theodor Emil Kocher (1841-1917 was born in Bern and educated in several universities in Europe. Like many surgeons of that time, Kocher performed orthopaedic surgery, general surgery, neurosurgery and endocrine surgery and became famous in many fields. He is remembered for his description of a new approach to the hip joint and elbow joint, as well as a maneuver for reduction of dislocated shoulder joints. He introduced many instruments and some of them, such as the Kocher clamp are still in use. His most important contribution was thyroid gland surgery, and he received the Nobel Prize for Medicine in 1909, for this advancement. He was a scientific, hard working meticulous surgeon, dedicated to his patients and students, which found him a place in the history of medicine.

  9. Emil Theodor Kocher (1841-1917): Orthopaedic surgeon and the first surgeon Nobel Prize winner

    OpenAIRE

    Bumbaširević Marko Ž.; Zagorac Slaviša G.; Lešić Aleksandar R.

    2013-01-01

    Theodor Emil Kocher (1841-1917) was born in Bern and educated in several universities in Europe. Like many surgeons of that time, Kocher performed orthopaedic surgery, general surgery, neurosurgery and endocrine surgery and became famous in many fields. He is remembered for his description of a new approach to the hip joint and elbow joint, as well as a maneuver for reduction of dislocated shoulder joints. He introduced many instruments and some of them, su...

  10. A newly designed ergonomic body support for surgeons

    NARCIS (Netherlands)

    Albayrak, A.; Van Veelen, M.A.; Prins, J.F.; Snijders, C.J.; De Ridder, H.; Kazemier, G.

    2007-01-01

    Background: One of the main ergonomic problems during surgical procedures is the surgeon's awkward body posture, often accompanied by repetitive movements of the upper extremities, increased muscle activity, and prolonged static head and back postures. In addition, surgeons perform surgery so concen

  11. Surgeon General's Call to Action to Prevent Skin Cancer

    Science.gov (United States)

    THE SURGEON GENERAL’S CALL TO ACTION TO PREVENT SKIN CANCER From the Surgeon General Skin cancer is the most common type of cancer the ... be disfiguring and even deadly. Medical treatment for skin cancer is costly for individuals, families, and the nation. ...

  12. Telementoring in education of laparoscopic surgeons: An emerging technology

    OpenAIRE

    Bogen, Moredehi Etai; Augestad, Knut Magne; Patel, Hitendra R. H.; Lindsetmo, Rolv-Ole

    2014-01-01

    Laparoscopy, minimally invasive and minimal access surgery with more surgeons performing these advanced procedures. We highlight in the review several key emerging technologies such as the telementoring and virtual reality simulators, that provide a solid ground for delivering surgical education to rural area and allow young surgeons a safety net and confidence while operating on a newly learned technique.

  13. Decreased heart rate variability in surgeons during night shifts

    DEFF Research Database (Denmark)

    Amirian, Ilda; Toftegård Andersen, Lærke; Rosenberg, Jacob;

    2014-01-01

    BACKGROUND: Heart rate variability (HRV) has been used as a measure of stress and mental strain in surgeons. Low HRV has been associated with death and increased risk of cardiac events in the general population. The aim of this study was to clarify the effect of a 17-hour night shift on surgeons'...

  14. The surgeon's role in molecular biology.

    Science.gov (United States)

    Rocco, Gaetano

    2012-09-01

    The biomolecular era is rapidly becoming shaped around the supreme interest in targeted therapy for patients with non-small cell lung cancer. Tissue analysis has become crucial in the definition of biomarkers and genomic signatures able to predict the response to treatment or even survival. Lung screening programs and minimally invasive thoracic surgery are jointly aimed at increasing the quantity and quality of specimens of non-small cell lung cancer caught at the earliest stages with the attendant, significant, effect on patient survival. In addition, biomolecular researchers are disclosing an ever-increasing cohort of patients with specific genetic mutations that make their cancer susceptible to individualized treatment. When needed for immunohistochemical characterization, investigators are ready to request "research biopsies" to consolidate tissue availability for clinical trials, translational research, and in biobanks. With unique and diverse tools in the surgical armamentarium, the thoracic surgeon plays a central role in this new multidisciplinary professional environment, actively participating in creating the foundations of the biomolecular era. PMID:22739075

  15. Nanotechnology tolls the bell for plastic surgeons.

    Science.gov (United States)

    Salehahmadi, Zeinab; Hajiliasgari, Fatemeh

    2013-06-01

    Nanotechnology is an emerging discipline, having power to revolutionarize every scientific field to a very deep level which previously thought to be a science fiction. Having a great potential to beneficially change the way a disease is diagnosed, treated and prevented, nanotechnology practically impacts on state of the art healthcare technologies and plays a crucial role in changing the field of surgery. Surgeons are constantly looking for minimally invasive ways to treat their patients, as recovery is faster when a lesser trauma is inflicted upon a patient, scarring is lessened and there are usually fewer complications in the aftermath of the operation. Through nanotechnology, tiny biosensors could be constructed which could take these factors into account, thus shortening the patient recovery period and saving hospitals money, reducing infection rates within the hospital, reducing the waiting lists for operation and allowing doctors to treat more patients in the same period of time. This review employs a thematic analysis of online series of academic papers focuses on the potentials of nanotechnology in surgery, especially in plastic surgery and addresses the possible future prospects of nanotechnology in this field. PMID:25489508

  16. [Surgeons and Neurosurgeons as Nobel Prize Winners].

    Science.gov (United States)

    Chrastina, Jan; Jančálek, Radim; Hrabovský, Dušan; Novák, Zdeněk

    2016-01-01

    Since 1901 Nobel Prize is awarded for exceptional achievements in physics, chemistry, literature, peace, economy (since 1968) and medicine or physiology. The first aim of the paper is to provide an overview of surgeons - winners of Nobel Prize for medicine or physiology. Although the prominent neurosurgeons were frequently nominated as Nobel Prize candidates, surprisingly no neurosurgeon received this prestigious award so far despite that the results of their research transgressed the relatively narrow limits of neurosurgical speciality.The most prominent leaders in the field of neurosurgery, such as Victor Horsley, Otfrid Foerster, Walter Dandy and Harvey Cushing are discussed from the point of their nominations. The overview of the activity of the Portuguese neurologists and Nobel Prize Winter in 1949 Egas Moniz (occasionally erroneously reported as neurosurgeon) is also provided. Although his work on brain angiography has fundamentally changed the diagnostic possibilities in neurology and neurosurgery, he was eventually awarded Nobel Prize for the introduction of the currently outdated frontal lobotomy.The fact that none of the above mentioned prominent neurosurgeons has not been recognised by Nobel Prize, may be attributed to the fact that their extensive work cannot be captured in a short summary pinpointing its groundbreaking character. PMID:27256150

  17. Exposure of the orthopaedic surgeon to radiation

    International Nuclear Information System (INIS)

    We monitored the amount of radiation received by surgeons and assistants during surgery carried out with fluoroscopic assistance. The radiation was monitored with the use of MYDOSE MINIX PDM107 made by Aloka Co. Over a one year period from Aug 20, 1992 to Aug 19, 1993, a study was undertaken to evaluate exposure of the groin level to radiation with or without use of the lead apron during 106 operation (Group-1). In another group, radiation was monitored at the breast and groin level outside of the lead apron during 39 operations (Group-2). In Group-1, the average exposure per person during one year was 46.0 μSV and the average exposure for each procedure was 1.68 μSV. The use of the lead apron affirmed its protective value; the average radiation dose at the groin level out-side of the apron was 9.11 μSV, the measured dose beneath the apron 0.61 μSV. The average dose of exposure to the head, breast at groin level outside of the lead apron, were 7.68 μSV, 16.24 μSV, 32.04 μSV respectively. This study and review of the literature indicate that the total amount of radiation exposure during surgery done with fluoroscopic control remains well within maximum exposure limits. (author)

  18. Sarcocystis schneideri n. sp. (Sarcocystidae) infecting the barber skink Eumeces schneideri schneideri (Scincidae) Daudin, 1802. A light and ultrastructural study.

    Science.gov (United States)

    Bashtar, Abdel-Rahman; Al Aal, Zain Abd; Maarouf, Wael; Morsy, Kareem; Al Quraishy, Saleh

    2014-06-01

    The current study provides the first record of infection with Sarcocystis species in the barber skink Eumeces schneideri schneideri (Scincidae) captured from the north region of Egypt around the cities of El-Hamam and Al-Dabaa, Mersa Matruh Governorate, Egypt. Morphology of the parasite cysts was described using light and transmission electron microscopy. Five out of 80 (6.25%) of the examined skinks were found to be infected. The infection was recorded firstly by light microscopy as spindle-shaped cysts embedded in the muscle tissue. The cysts were microscopic and measured 250-900 μm in length × 50-100 μm in width (mean, 575 × 75 μm). The validity of this species was confirmed by means of ultrastructural characteristics of the primary cyst wall (0.28 μm thick) which revealed the presence of irregularly shaped crowded and osmiophilic knob-like projections underlined by a thin layer of ground substance measuring 0.15-0.17 μm (mean, 0.16 μm). This layer consisted mainly of fine, dense homogenous granules enclosing the developing metrocytes and merozoites that usually contain nearly all the structures of the apical complex and fill the interior cavity of the cyst. Several septa derived from the ground substance divided the cyst into compartments. The merozoites were banana-shaped and measured 3-5 μm in length and 1.5-2.5 in width with centrally or posteriorly located nuclei. The morphological and morphometric data obtained during study were compared with those recorded previously from organisms within the Scincidae family. It was observed that this parasite possessed some distinguishing characteristics from the comparable species, which should be considered as a new species of the Sarcocystis genus, and the proposed name was Sarcocystis schneideri n. sp. with new host and locality records in Egypt. PMID:24728518

  19. 21 CFR 878.4470 - Surgeon's gloving cream.

    Science.gov (United States)

    2010-04-01

    ...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4470 Surgeon's gloving cream... device is exempt from the premarket notification procedures in subpart E of part 807 of this...

  20. Surgeons' Emotional Experience of Their Everyday Practice - A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Massimiliano Orri

    Full Text Available Physicians' emotions affect both patient care and personal well-being. Surgeons appear at particularly high risk, as evidenced by the high rate of burnout and the alarming consequences in both their personal lives and professional behavior. The aim of this qualitative study is to explore the emotional experiences of surgeons and their impact on their surgical practice.27 purposively selected liver and pancreatic surgeons from 10 teaching hospitals (23 men, 4 women participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and thematically analyzed independently by 3 researchers (a psychologist, a psychiatrist, and a surgeon. 7 themes emerged from the analysis, categorized in 3 main or superordinate themes, which described surgeons' emotional experience before, during, and after surgery. Burdensome emotions are present throughout all 3 periods (and invade life outside the hospital-surgeons' own emotions, their perception of patients' emotions, and their entwinement. The interviewees described the range of emotional situations they face (with patients, families, colleagues, the influence of the institutional framework (time pressure and fatigue, cultural pressure to satisfy the ideal image of a surgeon, as well as the emotions they feel (including especially anxiety, fear, distress, guilt, and accountability.Emotions are ubiquitous in surgeons' experience, and their exposure to stress is chronic rather than acute. Considering emotions only in terms of their relations to operative errors (as previous studies have done is limiting. Although complications are quite rare events, the concern for possible complications is an oppressive experience, regardless of whether or not they actually occur.

  1. Ocular health practices by dental surgeons in Southern Nigeria

    OpenAIRE

    Azodo, Clement Chinedu; Ezeja, Ejike B

    2014-01-01

    Background Dental professionals are among the occupational groups that experience ocular injuries and problems as they perform their daily dental works. The purpose of the study was to determine the ocular health practices by dental surgeons in Southern Nigeria. Methods This cross-sectional study was conducted on dental surgeons working in Southern Nigerian tertiary oral healthcare centers using self-developed validated questionnaire as the tool of data collection. Results Of the 148 responde...

  2. Perceptions of animal physiotherapy amongst Irish veterinary surgeons.

    OpenAIRE

    Doyle Aoife; Horgan N Frances

    2006-01-01

    Abstract The aim of this study was to investigate veterinary surgeons' perceptions, knowledge and use of animal physiotherapy in the Republic of Ireland. A questionnaire was developed and sent to 200 veterinary surgeons, of which 97 were returned. Results indicated that 77 (79%) of respondents were aware of animal physiotherapists. Common sources of information included veterinary colleagues, owners and professional journals, with physiotherapists themselves and undergraduate training being l...

  3. High Occupational Stress and Low Career Satisfaction of Korean Surgeons

    OpenAIRE

    Kang, Sang Hee; Boo, Yoon Jung; Lee, Ji Sung; Han, Hyung Joon; Jung, Cheol Woong; Kim, Chong Suk

    2015-01-01

    Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the ...

  4. A national study of burnout among American transplant surgeons.

    Science.gov (United States)

    Bertges Yost, W; Eshelman, A; Raoufi, M; Abouljoud, M S

    2005-03-01

    This study examines burnout in a national sample of transplant surgeons. Data analyses were conducted on a sample of 209 actively practicing transplant surgeons. Measures included the Maslach Burnout Inventory, a demographic survey, and the Surgeon Coping Inventory. Burnout was reflected in 38% of surgeons scoring high on the Emotional Exhaustion dimension, whereas 27% showed high levels of Depersonalization, and 16% had low levels of Personal Accomplishment. Several significant predictors of emotional exhaustion were identified and included questioning one's career choice, giving up activities, and perceiving oneself as having limited control over the delivery of medical services (R2= 0.43). Those who perceived themselves as having a higher ability to control delivery of medical services and who felt more appreciated by patients had lower levels of depersonalization and were less likely to question their career choice (R2= 0.16). Surgeons with high personal accomplishment experienced greater professional growth opportunities, perceived their institution as supportive, felt more appreciated by patients, and were less likely to question their career (R2= 0.24). The prioritization of goals to reflect both professional and personal values accounted for a significant amount of the variance in predicting both emotional exhaustion and personal accomplishment in separate regression equations. Recommendations to decrease burnout would include greater institutional support, increased opportunities for professional growth, and greater surgeon control over important services to facilitate efficient work. Coping strategies to moderate stress and burnout are also beneficial and should include prioritizing goals to reflect both professional and personal values. PMID:15848732

  5. Ergonomic surgeon's chair for use during minimally invasive surgery.

    Science.gov (United States)

    Schurr, M O; Buess, G F; Wieth, F; Saile, H J; Botsch, M

    1999-08-01

    The characteristic working situation in laparoscopic surgery involves elongated instruments and limited mobility of the surgeon during the operation. These circumstances require new technical solutions to enhance the surgeon's comfort. In other surgical fields with special ergonomic situations, such as microsurgery, some surgeons prefer to operate from a seated position at the operating room table. We developed a new surgeon's chair dedicated to the ergonomic and functional requirements of laparoscopic surgery. The chair allows the surgeon to maintain a semi-standing position during the operation. Foot pedals for high frequency and suction/irrigation are integrated into the base of the chair. The pedals are purposely aligned to be comparable to foot pedals in a car. The chair is driven by electromotors, controlled with a special foot switch that operates independent of assisting personnel during surgery. Initial clinical testing of the chair could prove the theory that supporting the surgeon with a cockpit type of operating room chair helps to avoid fatigue during long endoscopic procedures. Such assistance is especially important in combination with robotic devices for use during solo surgery. PMID:10871169

  6. Preventing infection in general surgery: improvements through education of surgeons by surgeons.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-08-01

    Surgical patients are at particular risk of healthcare-associated infection (HCAI) due to the presence of a surgical site leading to surgical site infection (SSI), and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice; this was used to inform the development of a targeted educational initiative by surgeons specifically for surgical trainees. Parameters assessed during the initial audit and a further audit after the educational initiative were related to intra- and postoperative aspects of the prevention of SSIs, as well as care of peripheral venous catheters (PVCs) in surgical patients. The proportion of prophylactic antibiotics administered prior to incision across 360 operations increased from 30.0% to 59.1% (P<0.001). Surgical site dressings were observed in 234 patients, and a significant decrease was found in the percentage of dressings that were tampered with during the initial 48h after surgery (16.5% vs 6.2%, P=0.030). In total, 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVCs in situ (37.9% vs 24.4%, P<0.001), PVCs in situ for >72h (10.6% vs 3.1%, P<0.001) and PVCs covered with clean and intact dressings (87.3% vs 97.6%, P<0.001). Significant improvements in surgical practice were established for the prevention of SSI and CRBSI through a focused educational programme developed by and for surgeons. Potentially, other specific measures may also be warranted to achieve further improvements in infection prevention in surgical practice.

  7. Are shoulder surgeons any good at diagnosing rotator cuff tears using ultrasound?: A comparative analysis of surgeon vs radiologist

    Directory of Open Access Journals (Sweden)

    Jeyam Muthu

    2008-01-01

    Full Text Available High-resolution ultrasound has gained increasing popularity as an aid in the diagnosis of rotator cuff pathology. With the advent of portable machines, ultrasound has become accessible to clinicians. Aim: This study was conducted to evaluate the accuracy and reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist. Materials and Methods: Seventy patients undergoing shoulder arthroscopy for rotator cuff pathology underwent preoperative ultrasonography (US. All patients were of similar demographics and pathology. The surgeon used a Sonosite Micromax portable ultrasound machine with a 10-MHz high frequency linear array transducer and the radiologist used a 9-12 MHz linear array probe on a Siemens Antares machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared. Results: The sensitivity in detecting full thickness tears was similar for both the surgeon (92% and the radiologist (94%. The radiologist had 100% sensitivity in diagnosing partial thickness tears, compared to 85.7% for the surgeon. The specificity for the surgeon was 94% and 85% for the radiologist. Discussion: Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution portable ultrasound in the outpatient setting. Conclusion: Office ultrasound, by a trained clinician, is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics.

  8. Numerical Simulation of Regional Changes in Ground-Water Levels and in the Freshwater-Saltwater Interface Induced by Increased Pumpage at Barbers Point Shaft, Oahu, Hawaii

    Science.gov (United States)

    Souza, William R.; Meyer, William

    1995-01-01

    The effect on the regional ground-water system of southern Oahu from increased pumpage at Barbers Point shaft was estimated by a numerical ground-water model developed for the Oahu Regional Aquifer Systems Analysis (RASA) study. The RASA model was updated by revising pumping and ground-water recharge data. Pumpage data used in the new simulations were based on the allocated pumping rates for 1995 as set by the State Commission on Water Resource Management. On the basis of numerical simulation, Barbers Point shaft can sustain a withdrawal rate of 4.34 million gallons per day without adversely affecting wells in the Waianae aquifer. From results of numerical simulations, it is estimated that, as a result of increasing pumpage in Barbers Point shaft by 2 million gallons per day above the 1995-allocated rate of 2.337 million gallons per day, regional declines in ground-water levels will be about 0.4 to 0.7 feet throughout the Waianae aquifer and about 0.8 ft at the shaft. The corresponding rise of the freshwater-saltwater interface, as a result of declines in ground-water levels, is estimated to be about 20 to 30 feet. Numerical simulation also indicates that changes in ground-water levels greater than about 0.1 feet do not extend across either the Waianae-Koolau unconformity or the south Schofield barrier. The model-estimated position of the freshwater-saltwater interface, as a result of additional pumpage, ranges from 500 to 860 feet below sea level in the southern and northern parts of the aquifer, respectively, and about 540 feet below sea level at the shaft. On the basis of an estimate of the thickness of the transition-zone, the freshwater lens would remain about 240 feet thick below the shaft. In addition, the estimated declines in ground-water levels throughout the aquifer are small compared with the thickness of the freshwater lens and these declines would not be expected to affect the yields of other wells in terms of quantity. Chloride concentrations in the

  9. Where the Sun Shines: Industry's Payments to Transplant Surgeons.

    Science.gov (United States)

    Ahmed, R; Chow, E K; Massie, A B; Anjum, S; King, E A; Orandi, B J; Bae, S; Nicholas, L H; Lonze, B E; Segev, D L

    2016-01-01

    The Open Payments Program (OPP) was recently implemented to publicly disclose industry payments to physicians, with the goal of enabling patient awareness of potential conflicts of interests. Awareness of OPP, its data, and its implications for transplantation are critical. We used the first wave of OPP data to describe industry payments made to transplant surgeons. Transplant surgeons (N = 297) received a total of $759 654. The median (interquartile range [IQR]) payment to a transplant surgeon was $125 ($39-1018), and the highest payment to an individual surgeon was $83 520; 122 surgeons received $10 000. A higher h-index was associated with 30% higher chance of receiving >$1000 (relative risk/10 unit h-index increase = 1.18 1.301.44 , p companies accounted for 62% of all payments. Kidney transplant and liver transplant (LT) centers that received >$1000 had higher center volumes (p $1000 had a higher percentage of private-insurance/self-pay patients (p < 0.01). Continued surveillance of industry payments may further elucidate the relationship between industry payments and physician practices. PMID:26317315

  10. The Effect of Surgeon Empathy and Emotional Intelligence on Patient Satisfaction

    Science.gov (United States)

    Weng, Hui-Ching; Steed, James F.; Yu, Shang-Won; Liu, Yi-Ten; Hsu, Chia-Chang; Yu, Tsan-Jung; Chen, Wency

    2011-01-01

    We investigated the associations of surgeons' emotional intelligence and surgeons' empathy with patient-surgeon relationships, patient perceptions of their health, and patient satisfaction before and after surgical procedures. We used multi-source approaches to survey 50 surgeons and their 549 outpatients during initial and follow-up visits.…

  11. The first cataract surgeons in Latin America: 1611–1830

    Science.gov (United States)

    Leffler, Christopher T; Wainsztein, Ricardo D

    2016-01-01

    We strove to identify the earliest cataract surgeons in Latin America. Probably by 1611, the Genovese oculist Francisco Drago was couching cataracts in Mexico City. The surgeon Melchor Vásquez de Valenzuela probably performed cataract couching in Lima by 1697. Juan Peré of France demonstrated cataract couching in Veracruz and Mexico City between 1779 and 1784. Juan Ablanedo of Spain performed couching in Veracruz in 1791. Cataract extraction might have been performed in Havana and Caracas by 1793 and in Mexico by 1797. The earliest contemporaneously documented cataract extractions in Latin America were performed in Guatemala City by Narciso Esparragosa in 1797. In addition to Esparragosa, surgeons born in the New World who established the academic teaching of cataract surgery included José Miguel Muñoz in Mexico and José María Vargas in Caracas. Although cataract surgery came quite early to Latin America, its availability was initially inconsistent and limited. PMID:27143845

  12. Disaster Management and the Role of Oral Maxillofacial Surgeons.

    Science.gov (United States)

    Kattimani, Vivekanand Sabanna; Tiwari, Rahul Vinaychandra; Pandi, Srinivas Chakravarthi; Meka, Sridhar; Lingamaneni, Krishna Prasad

    2015-12-01

    "Disaster" the word itself suggests an event resulting in great loss and misfortune. In this developing world, India is becoming more powerful and is shining across the world. But we are still left to deal with various disasters, so that no harm comes to mankind. India has the occasional national disaster to which we have to promptly respond. Like the rest of the world, India has become a terror prone nation and recent attacks since the last decades affected not only the function but also it made citizens insecure. As we are in a large nation so, no matter how large a disaster it may be; we have to overcome it. The oral and maxillofacial region in a human body is very delicate with complicated anatomy, which decides the life of a human being. The management of disaster is a multitask approach, in which maxillofacial surgeon plays an important role. It is a very difficult task to operate in disaster zone. It is essential for a surgeon to make quick and important decisions under stressful conditions. Usually the surgeries are performed in a well-equipped hospital but, when it comes to disaster zone the surgeon have to treat the patient with a minimal armamentarium available within a fraction of time. The surgical competence in a disaster field is an alarming situation. Disaster management itself is not an alarming situation but the time management is important for better outcomes. A surgeon however should be trained, so that he should not miss injuries for better outcomes along with personal safety. The article discusses about disaster management strategy and guidelines for both oral maxillofacial surgeons and the statuary body to make maxillofacial surgeon as part of disaster management team for better outcomes. PMID:26816920

  13. Reporting sharp injuries among Surgeons in Zagazig University Hospitals, Egypt

    Directory of Open Access Journals (Sweden)

    Eman Mohamed Mortada

    2015-12-01

    Full Text Available Background and rationale of the study: Although Sharps injuries are a preventable hazard faced by medical personnel in the operating room yet it continues to be one of the hidden problems among HCP. The potential consequence of such injuries includes transmission of blood-borne pathogens with detrimental effects. Despite the advances in technology and increased awareness of medical staff, annually around 600 thousand to one million workers are affected thus considered as one of the most serious threats facing health care workers specially surgeon.Methodology: a cross sectional study of Zagazig University Hospitals surgical departments. Using a sample composed of 287 surgeons randomly chosen from different surgical departments. A questionnaire assessed in addition to personal and professional characteristics, the history of sharp injuries, types of instrument causing the injury, their post exposure prophylaxis including reporting. The results: There were total 287 surgeons participated in this study. (47% of the respondent surgeons had been exposed to at least one episode of sharp injury in the preceding 3 months and most of the exposures (68% occurred in the operation room. The injury was mainly caused during suturing (83%. The commonest devices, accused in most of the injuries were suturing needle and scalpel (74 and 59%. The majority of the surgeons (62% didn’t report the SI and it was largely explained by the majority of the sampled respondents (89% were not aware of the reporting system existing in their hospital.Conclusions: The most common reason of underreporting  in our study was the lack of awareness that all injuries must be reported.Recommendations: The observed high level of under reporting reflects the need for education on prevention. Our results can guide in planning an education program for the surgeons to increase awareness about dangers of sharp injuries and help improve the reporting strategy  and other potential

  14. Age is highly associated with stereo blindness among surgeons

    DEFF Research Database (Denmark)

    Fergo, Charlotte; Burcharth, Jakob; Pommergaard, Hans-Christian; Rosenberg, Jacob

    2016-01-01

    affecting surgical outcome. 3D laparoscopy offers stereoscopic vision of the operative field to improve depth perception and is being introduced to several surgical specialties; however, a normal stereo vision is a prerequisite. The aim of this study was to establish the prevalence of stereo blindness among...... surgeons in the field of general surgery, gynecology, and urology as these are potential users of 3D laparoscopy. METHODS: The study was conducted according to the STROBE guidelines for cross-sectional studies. Medical doctors from the department of general surgery, gynecology, and urology were recruited...... relevant since stereo blind surgeons will not benefit from the implementation of 3D laparoscopy....

  15. Cosmetic surgery in times of recession: macroeconomics for plastic surgeons.

    Science.gov (United States)

    Krieger, Lloyd M

    2002-10-01

    Periods of economic downturn place special demands on the plastic surgeon whose practice involves a large amount of cosmetic surgery. When determining strategy during difficult economic times, it is useful to understand the macroeconomic background of these downturns and to draw lessons from businesses in other service industries. Business cycles and monetary policy determine the overall environment in which plastic surgery is practiced. Plastic surgeons can take both defensive and proactive steps to maintain their profits during recessions and to prepare for the inevitable upturn. Care should also be taken when selecting pricing strategy during economic slowdowns. PMID:12360083

  16. Optimal Brain Surgeon on Artificial Neural Networks in

    DEFF Research Database (Denmark)

    Christiansen, Niels Hørbye; Job, Jonas Hultmann; Klyver, Katrine; Høgsberg, Jan Becker

    2012-01-01

    It is shown how the procedure know as optimal brain surgeon can be used to trim and optimize artificial neural networks in nonlinear structural dynamics. Beside optimizing the neural network, and thereby minimizing computational cost in simulation, the surgery procedure can also serve as a quick...

  17. Metabolic acidosis: neo-considerations for general surgeons.

    Science.gov (United States)

    Martin, L C E; Abah, U; Bean, E; Gupta, S

    2012-11-01

    Hyperchloraemic metabolic acidosis is a documented complication of neobladder formation. However, it usually improves with time and is mild. Severe and persistent metabolic acidosis may manifest when patients undergo further surgery for other reasons. Neobladder formation following radical cystectomy or cystoprostatectomy is becoming increasingly common, and surgeons treating patients with neobladders should recognise and treat metabolic acidosis with intravenous fluids and bicarbonate. PMID:23131216

  18. Role of the plastic surgeon in a cancer hospital

    International Nuclear Information System (INIS)

    This paper discusses and illustrates the complicated problems faced by the plastic surgeon in a cancer hospital. His patients are often weakened, both physically and psychologically, not only by the cancer itself, but also by extensive ablative surgery. The goal of the plastic surgeon is rehabilitation of the patient after he is cured of cancer. Good planning with the cancer surgeon before the ablative operation is very important, as is immediate repair, whenever possible. The simplest procedure with the fewest stages that can accomplish satisfactory repair in the shortest time should be chosen, as we can never, even after the most extensive cancer operation, be sure that no recurrence will appear. Partial surgical repair and the use of a prosthesis should be considered for complicated defects in old and weak patients. Postoperative radiation therapy, if indicated, can be given after the flap has healed into the defect but before the pedicle is separated. The plastic surgeon should always be aware that his most important goal is speedy and satisfactory rehabilitation of the patient

  19. Surgeon's view of the skull base from the lateral approach.

    Science.gov (United States)

    Goldenberg, R A

    1984-12-01

    This paper presents the surgical anatomy of the skull base and infratemporal fossa. The information has been derived from the author's own experience in surgical and cadaver dissection, standard anatomical references, and selected experience of other skull base surgeons. Because the lateral approach has become the utilitarian method of exposure, the intricate detailed anatomy is demonstrated from this view at five levels of dissection, so the surgeon may gain a practical understanding of the surgical relationship of critical structures. Consistent anatomical landmarks can be used by the surgeon in the location of these critical structures. The styloid process, sphenoidal spine, and middle meningeal artery identify the internal carotid artery as it enters the carotid canal. The bony or fibrous septum that divides the jugular foramen into neural and vascular compartments may be used to better identify nerves IX, X, and XI. The zygomatic root is useful for location of the middle fossa dura. The lateral pterygoid plate leads directly to the foramen ovale. The increased precision of dissection permitted by use of the microscope requires an increased level of knowledge of anatomical structures in this area. It is hoped that the information presented in this paper will assist surgeons in the meticulous and thorough removal of skull base tumors and in the preservation of neural and vascular structures that are presently being sacrificed. PMID:6503585

  20. Designing Wearable Personal Assistants for Surgeons: An Egocentric Approach

    DEFF Research Database (Denmark)

    Jalaliniya, Shahram; Pederson, Thomas

    2015-01-01

    it in the design of a wearable personal assistant (WPA) for orthopedic surgeons. The result is a Google Glass-based prototype system aimed at facilitating touchless interaction with x-ray images, browsing of electronic patient records (EPR) when on the move, and synchronized ad hoc remote...

  1. [The surgeon's viewpoint concerning Complex Regional Pain Syndrome 1].

    Science.gov (United States)

    Chrestian, P; Giaufré, E; Maximin, M-C; Puech, B; Nicaud, M; Sarrail, R

    2012-01-01

    The complex regional pain syndrome type 1 from the surgeon's point of view: description of the symptoms, imaging (nuclear medicine, MRI) and of the associated psychological context. Importance of the need for a multi-disciplinary organization from the diagnostic to the therapeutic care. PMID:22197041

  2. Occupational hazards concerning the dental surgeon: identification, prevention and legislation

    International Nuclear Information System (INIS)

    This thesis concerns the legislation about the work of dentistry and the different obligations relative to this work, patient protection and dental surgeon protection are concerned as well. A special point is developed relative to the radiation protection and the training necessary to control it and apply it

  3. Update on Early Childhood Caries since the Surgeon General's Report

    OpenAIRE

    Tinanoff, Norman; Reisine, Susan

    2009-01-01

    The 2000 Surgeon General's Report on Oral Health (SGROH) included a limited discussion of the condition known as Early Childhood Caries (ECC). Because of its high prevalence, its impact on young children's quality of life and potential for increasing their risk of caries in the permanent dentition, ECC is arguably one of the most serious and costly health conditions among young children.

  4. H1N1 Message from the Acting Surgeon General

    Centers for Disease Control (CDC) Podcasts

    2009-05-13

    In this podcast, Acting Surgeon General Dr. Steven Galson discusses what you can do to protect yourself from H1N1 flu.  Created: 5/13/2009 by U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC).   Date Released: 5/13/2009.

  5. Can a surgeon drill accurately at a specified angle?

    Science.gov (United States)

    Brioschi, Valentina; Cook, Jodie; Arthurs, Gareth I

    2016-01-01

    Objectives To investigate whether a surgeon can drill accurately a specified angle and whether surgeon experience, task repetition, drill bit size and perceived difficulty influence drilling angle accuracy. Methods The sample population consisted of final-year students (n=25), non-specialist veterinarians (n=22) and board-certified orthopaedic surgeons (n=8). Each participant drilled a hole twice in a horizontal oak plank at 30°, 45°, 60°, 80°, 85° and 90° angles with either a 2.5  or a 3.5 mm drill bit. Participants then rated the perceived difficulty to drill each angle. The true angle of each hole was measured using a digital goniometer. Results Greater drilling accuracy was achieved at angles closer to 90°. An error of ≤±4° was achieved by 84.5 per cent of participants drilling a 90° angle compared with approximately 20 per cent of participants drilling a 30–45° angle. There was no effect of surgeon experience, task repetition or drill bit size on the mean error for intended versus achieved angle. Increased perception of difficulty was associated with the more acute angles and decreased accuracy, but not experience level. Clinical significance This study shows that surgeon ability to drill accurately (within ±4° error) is limited, particularly at angles ≤60°. In situations where drill angle is critical, use of computer-assisted navigation or custom-made drill guides may be preferable. PMID:27547423

  6. Surgeons' knowledge about the costs of orthopaedic implants.

    Science.gov (United States)

    Rohman, Lebur; Hadi, Saifullah; Whitwell, George

    2014-08-01

    PURPOSE. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. METHODS. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. RESULTS. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600-3000) and £1448 (range, £985- 2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600-6000) and £1737 (range, £1192-2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600-6000) and £1316 (range, £995-1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600-2000) and £1296 (range, £698-1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75-150) and £94 (range, £80-100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80-500) and £306 (range, £272-335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50-250) and £242 (range, £170-260), with an underestimation of 37%. CONCLUSION. The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed. PMID:25163960

  7. The veterinary surgeon in natural disasters: Italian legislation in force.

    Science.gov (United States)

    Passantino, A; Di Pietro, C; Fenga, C; Passantino, M

    2003-12-01

    Law No. 225/1992 established a National Service of Civil Protection, with the important role of 'safeguarding life, goods, settlements and the environment from damage deriving from natural disasters, catastrophes and calamities' (art. 1). This law arranges civil protection as a co-ordinated system of responsibilities administrated by the state, local and public authorities, the world of science, charitable organisations, the professional orders and other institutions, and the private sector (art. 6). The President of the Republic's Decree No. 66/1981 'Regulation for the application of Law No. 996/1970, containing norms for relief and assistance to populations hit by natural disasters--Civil Protection' mentions veterinary surgeons among the people that are called upon to intervene. In fact, in natural disasters the intervention of the veterinary surgeon is of great importance. The authors examine these laws and other legislation relating to the National Service of Civil Protection. PMID:15005549

  8. Quality Measurement: A Primer for Hand Surgeons.

    Science.gov (United States)

    Kamal, Robin N; Kakar, Sanjeev; Ruch, David; Richard, Marc J; Akelman, Edward; Got, Chris; Blazar, Philip; Ladd, Amy; Yao, Jeffrey; Ring, David

    2016-05-01

    As the government and payers place increasing emphasis on measuring and reporting quality and meeting-specific benchmarks, physicians and health care systems will continue to adapt to meet regulatory requirements. Hand surgeons' involvement in quality measure development will help ensure that our services are appropriately assessed. Moreover, by embracing a culture of quality assessment and improvement, we will improve patient care while demonstrating the importance of our services in a health care system that is transitioning from a fee-for-service model to a fee-for-value model. Understanding quality and the tools for its measurement, and the application of quality assessment and improvement methods can help hand surgeons continue to deliver high-quality care that aligns with national priorities. PMID:26576831

  9. Intelligent noncontact surgeon-computer interface using hand gesture recognition

    Science.gov (United States)

    Zhao, Michael; Nowatzyk, Andreas G.; Lu, Thomas; Farkas, Daniel L.

    2008-02-01

    We present the development of advanced neural network and 3D image processing algorithms to identify hand gestures for a novel Surgeon-Computer-Interface (SCI) in the operating room. Feature extraction methods have been identified to reliably extract unique attributes and recognize dynamic hand gestures such as "Point and Click" and "Hand Waiving" features. We show an experimental demonstration of a non-linear neural network classifier that is capable of reliably recognizing 8 complex hand gesture patterns.

  10. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    OpenAIRE

    Sheikh Asfandyar; Ali Sajid; Ejaz Sadaf; Farooqi Marium; Ahmed Syed; Jawaid Imran

    2012-01-01

    Abstract Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeon...

  11. Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

    OpenAIRE

    Ahmet Serdar Karaca

    2013-01-01

    Aim: Mesh repair of inguinal hernia repairs are shown to be an effective and reliable method. In this study, a single surgeon%u2019s experience with plug-mesh method performs inguinal hernia repair have been reported. Material and Method: 587 patients with plug-mesh repair of inguinal hernia, preoperative age, body / mass index, comorbid disease were recorded in terms of form. All of the patients during the preoperative and postoperative hernia classification of information, duration of oper...

  12. SUSHRUTA: A GREAT SURGEON AND VISIONARY OF AYURVEDA

    OpenAIRE

    Paliwal Murlidhar; Byadgi P.S.

    2012-01-01

    Ayurveda is described as science of life and it was recalled by Brahma as mentioned in Ayurvedic treatises. Brahma transmitted his noble knowledge to Prajapati or Daksha, later Daksha passed his legacy to Ashwins and Indra received knowledge from Aswins. As per Sushruta opinion, Indra taught Ayurveda to Dhanvantari, the surgeon of gods embodied as king Divodasa of Banaras (Kashiraja). Divodasa then transmitted medical knowledge with special reference to surgery to the wise men like Sushruta a...

  13. Why on earth do surgeons need quality assurance?

    OpenAIRE

    1988-01-01

    The article discusses the ways in which surgeons should respond to the growing external and internal pressures for ensuring the quality and appropriateness of surgical treatment. Quality Assurance is defined. Its development in the USA is described and it is debated whether or not a similar system should be introduced into the United Kingdom. The reasons for initiating a system of quality assurance into one health district and the experience so far gained is reported. The problems of quality ...

  14. A surgeon to remember: notes about Vladimir Demikhov.

    Science.gov (United States)

    Shumacker, H B

    1994-10-01

    Vladimir Demikhov, first to transplant an auxiliary heart into the chest of a warm-blooded animal, first to replace the heart with a homograft, first to carry out a pulmonary transplantation, first to perform a complete heart and lung replacement, and first to perform a successful internal mammary-coronary anastomosis, deserves a place among the great experimental surgeons of all times. He has not had the widespread recognition he earned. PMID:7944786

  15. The First Cataract Surgeons in Anglo-America

    OpenAIRE

    Leffler, Christopher T; Schwartz, Stephen G.; Grzybowski, Andrzej; Puneet S. Braich

    2014-01-01

    We tried to identify the earliest cataract surgeons in the English-speaking areas of America. In 1751, couching was performed on the Caribbean island of Montserrat by John Morphy. William Stork of England, who couched cataracts, practiced in Jamaica in 1760 and then in cities from Annapolis to Boston between 1761 and 1764. Frederick William Jericho of Germany, upon completion of his training at Utrecht, published his 1767 treatise on his preferred surgical technique of extracapsular cataract ...

  16. Awareness among medical fraternity regarding the role of plastic surgeon

    OpenAIRE

    Vijay Kumar; Arun Kumar Singh; Ameer Faisal; Nandini, R.

    2011-01-01

    The field of plastic surgery, while being famous for aesthetic surgery, also includes craniofacial surgery, hand surgery, burn surgery, microsurgery, reconstructive plastic surgery and paediatric plastic surgery. The magnanimous progress in these areas, though a hot topic in conferences, remains cryptic to the layman and also to generalists who are and will remain to be the most important referral source of these patients. [1] Hence, it becomes the duty of plastic surgeons themselves to sprea...

  17. How Important Is Surgeon's Skill for Weight-Loss Surgery Outcomes?

    Science.gov (United States)

    ... news/fullstory_158292.html How Important Is Surgeon's Skill for Weight-Loss Surgery Outcomes? Study saw no ... WEDNESDAY, April 13, 2016 (HealthDay News) -- A surgeon's skill level does not seem to have a big ...

  18. Acellular Dermal Matrix in Reconstructive Breast Surgery: Survey of Current Practice among Plastic Surgeons

    Directory of Open Access Journals (Sweden)

    Ahmed M. S. Ibrahim, MD

    2015-04-01

    Conclusions: Plastic surgeons currently use ADM in breast reconstruction for both immediate and staged procedures. Of those responding, a majority of plastic surgeons will incorporate drains and use postoperative antibiotics for more than 48 hours.

  19. [Erik Vio, surgeon from Rijeka at history's crossroad].

    Science.gov (United States)

    Lazzarich, Marinko

    2016-08-01

    The fact that many famous denizens of Rijeka belong to different nationalities confirms this city's historic multicultural image. The life story of Erik Vio (1910-1966), renowned surgeon of international reputation, reflects the fate of many displaced residents of Rijeka who left to live in exile. After graduating in Rome, Vio worked as a medical doctor in Hong Kong for almost three decades. The question is weather a surgeon from Rijeka chose to live in Hong Kong because it reminded him of his hometown? The author finds the root of this thesis in Vio's novel The Pathways of Freedom (˝Irwege der Freiheit˝, Köln 1978), a particular medical-philosophic diagnosis of the contemporary civilization's spiritual state. Rare fragments dedicated to Rijeka confirm Vio's actual detachment; faced with his own identity, but also with the others' with whom he shared his living space, a surgeon from Rijeka became a true citizen of the world and at the same time a stateless person with no roots of his own. Through the projection of Hong Kong one can detect the novel's identification backbone: writer's provocation of the ideological perspective on socio-cultural relations. By engaging in the interpretation of Vio's The Pathways of Freedom the author seeks to dissect a sociological dimension of descriptions of dual identities in border space. This leads to the issue of understanding and tolerance toward the others. PMID:27598959

  20. Project Muskan : Social responsibility of the plastic surgeon

    Directory of Open Access Journals (Sweden)

    Bhatt Yogesh

    2008-01-01

    Full Text Available Although exact statistics are not available, Indian plastic surgeons see around 7,00,000-8,00,000 burn admissions annually with around 10,00,000 cleft patients yet to be operated. In spite of this voluminous load, India does not have national health programs for the various deformities Indian plastic surgeons typically treat. As Plastic Surgeons, it is our social responsibility to treat these patients and bring ′ muskan ′ (smile in Hindi back into their lives. Project Muskan was initiated as an innovative model for targeting these patients and is probably one of its kind in the field of plastic surgery in our country. It is unique because it is a perfect collaboration of government institutions, a Non Government Organization (NGO, and cooperative sectors providing free health care at the doorstep. Identification of the patients was done with the help of the extensive milk dairy network in the state of Gujarat. Provision of transport and other facilities was done by the NGOs and quality health care provision was taken care of by the government hospital. Project Muskan started from a single village but now covers around 3000 villages and tribal areas of Gujarat. It is a system that can be easily reproducible in all hospitals and has reestablished the faith of the common man in government institutes.

  1. Teaching plastic surgeons how to be better teachers.

    Science.gov (United States)

    Weber, Robert A; Armstrong, Elizabeth G

    2012-05-01

    The purpose of this article is to introduce plastic surgeons to a theory of adult education. Most surgeons have been hired by their parent institution because of their clinical skills, and rightly so. At the same time, these same surgeons choose or are expected to be involved to varying degrees in the surgical education process with medical students, surgical residents, fellows, and allied health workers. Likewise, busy surgical residents are also expected to teach other residents and students, and yet these two groups of teachers of surgery have little or no training in the theory and practice of adult education. This article has four major sections. The first is a scenario designed to bring to mind a context and set of ideas with which the reader is already familiar. The second provides new information, Kolb's theory of adult learning and Arseneau and Rodenberg's teaching principles, and discusses their implications. The third section is designed to give the reader an opportunity to work with the new knowledge and practice possible applications, and the fourth encourages the reader to use the new knowledge in concrete ways in a real-world environment. PMID:22544100

  2. Shouldice Herniorrhaphy Technique: Surgeons Need to Remember It

    Directory of Open Access Journals (Sweden)

    Adem Dervişoğlu

    2012-01-01

    Full Text Available Aim: Hernia surgery is the second most common surgical intervention performed by general surgeons following emergent surgeries. Shouldice herniorraphy is a classical surgery which is in the high tension repair group. This technique should be known by every surgeon. Also being an alternative method, it can be a necessity in cases in which tension free methods can not be performed. In the present study we investigated the advantages, disadvantages and complications of the Shouldice herniorraphy and Lichtenstein technique with the review of the technical literature. Material and Method: We compared 75 patients who were diagnosed with inguinal hernia and treated with Lichtenstein herniorraphy with 33 patients who were treated with Shouldice herniorraphy in Samsun Bafra Public Hospital between April 2007 and May 2008. Age, sex, hernia type, anesthesia method, mean hospitalisation length, early and late post operative complications were recorded. Result: Early post operative complications were urinary retention, wound infection and hematoma. The patients under spinal anesthesia with urinary retention were treated with urinary catheterization. Superficial wound infection was treated with drainage and antibiotic threapy. Among late postoperative complications; we observed paresthesia in the thigh in one patient in the Shouldice group and relapse hernia in one patient in the Lichtenstein group. Discussion: We suggest that this surgical technique which should be known by every surgeon should be taught to new surgery attenders as an alternative technique. This technique can be an alternative method and also may be the first choice in patients in whom tension free methods can not be applicated.

  3. Team Work on Burn And Surgeon as a Team Leader

    Directory of Open Access Journals (Sweden)

    Huseyin Karagoz

    2013-02-01

    Full Text Available Burn traumas are a type of trauma that causes adverse changes in all the functions of the organism. Multi-disciplinary approaches are of great importance in the treatment of burn traumas. Among those involved in the treatment of burns are people of many branches such as surgeons, infection specialists, rehabilitation specialists, psychiatrists, and nurses. And there is a need for a single specialist in charge to coordinate the disciplines in the stage of organizing to treatment. The person to take on this task is often a surgeon specialized in burns. Research has shown that auxiliary personnel involved in burn treatment in Turkey are in need of training on up-to-date information. The surgeon in charge should actively participate in research and training activities, and train the relevant personnel through knowledge transfer so that burn treatment could remain effective in the light of current developments, which would be the fundamental way for burn centers to take their technique- and skill-based practices further. [TAF Prev Med Bull 2013; 12(1.000: 111-114

  4. Sarcoidosis in a dental surgeon: a case report

    Directory of Open Access Journals (Sweden)

    Mattia Daniele

    2010-08-01

    Full Text Available Abstract Introduction Although the causes of sarcoidosis are still unknown, past and current studies have provided evidence that this disease may be associated with occupational exposure to specific environmental agents. We describe a case of sarcoidosis in a dental surgeon with long exposure to inorganic dusts. To the best of our knowledge, this is the first report of this kind in the literature. Case presentation At the beginning of 2000, a 52-year-old Caucasian man, who worked as a dental surgeon, presented with shortness of breath during exercise, cough and retrosternal pain. After diagnosis of sarcoidosis, a scanning electronic microscopy with X-ray microanalysis of biopsy specimens was used in order to determine whether the disease could be traced to an occupational environmental agent. Results showed the presence of inorganic dust particles within sarcoidotic granulomas, and demonstrated that the material detected was identical to that found in a powder used by our patient for several years. Conclusions Although these results cannot be considered as definitive proof, they do however provide strong evidence that this disease may be associated with material used by dental surgeons.

  5. The first cataract surgeons in Anglo-America.

    Science.gov (United States)

    Leffler, Christopher T; Schwartz, Stephen G; Grzybowski, Andrzej; Braich, Puneet S

    2015-01-01

    We tried to identify the earliest cataract surgeons in the English-speaking areas of America. In 1751, couching was performed on the Caribbean island of Montserrat by John Morphy. William Stork of England, who couched cataracts, practiced in Jamaica in 1760 and then in cities from Annapolis to Boston between 1761 and 1764. Frederick William Jericho of Germany, upon completion of his training at Utrecht, published his 1767 treatise on his preferred surgical technique of extracapsular cataract extraction. Jericho had practiced in the Leeward Islands by 1776 and then in cities from Charleston to Boston between 1783 and 1785. The French surgeon Lewis Leprilete was the first to advertise cataract extraction in the United States in 1782 and probably passed on the skill to his protégé, Nathaniel Miller of Massachusetts. Leprilete was also the first to publicize Benjamin Franklin's invention of bifocals. These pioneers exposed American doctors and the public to cataract surgery. Shortly after their arrival, evidence emerges of other surgeons performing these procedures in America. PMID:25444521

  6. Turning a blind eye: physical standards for surgeons.

    Science.gov (United States)

    O'Connor, Mike

    2009-02-01

    Requiring professionals in high-risk industries to regularly meet minimal physical standards is a well-accepted principle. Pilots in both civil and military aviation must meet rigorous physical standards, including visual acuity, colour and peripheral vision. Australian medical practitioners have a general obligation to notify their medical registration board if they have suffered an illness which might affect their physical or mental capacity to practise medicine. However, no specific minimal physical standards are defined. It would be possible for a surgeon to be ineligible for an unrestricted motor vehicle driver's licence yet continue to perform surgical procedures. The visual requirements for a surgeon differ from those of a driver, the surgeon requiring good acuity for fine detail at close range, good depth perception as well as good colour vision. The driver needs good peripheral vision and adequate visual acuity at longer distances. However, a good yardstick for any doctor intending to perform surgical procedures would be that he or she should at least meet the Australian standard for an unrestricted driver's licence. That requirement could easily be incorporated into the annual declaration which each doctor must make when seeking renewal of her or his medical registration. PMID:19297870

  7. Are surgeons happy in practice? Examining a quarter-century of Alberta’s surgical graduates

    OpenAIRE

    Frayn, Cassidy; Masson, Valerie; Erichsen, Shannon; White, Jonathan

    2015-01-01

    Every year, hundreds of new surgeons graduate from residency programs across Canada. Much time and effort is spent on preparing these surgeons for independent practice, but there is little literature about the career trajectories of surgeons after they finish training and enter practice. We surveyed all surgeons graduating from the residency programs of a single Canadian medical school over 25 years (1985–2010). Most respondents rated their job satisfaction as high/very high and indicated the...

  8. Laparoscopic Skills and Cognitive Function are not Affected in Surgeons During a Night Shift

    DEFF Research Database (Denmark)

    Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob;

    2014-01-01

    OBJECTIVE: To monitor surgeons' performance and cognition during night shifts. DESIGN: Surgeons were monitored before call and on call (17-hour shift). Psychomotor performance was assessed by laparoscopic simulation and cognition by the d2 test of attention. The surgeons performed the laparoscopic...... compared with on-call values. The d2 test of attention showed significantly improved values on call compared with before call. CONCLUSION: Sleep deprivation during a 17-hour night shift did not impair surgeons' psychomotor or cognitive performance....

  9. Challenges in multidisciplinary cancer care among general surgeons in Canada

    Directory of Open Access Journals (Sweden)

    McLeod Robin S

    2008-12-01

    Full Text Available Abstract Background While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings. Methods General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance, information seeking (source, frequency of and reasons for use, key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square. Standard qualitative methods were used to thematically analyze open-ended responses. Results The response rate was 44.2% (170/385 representing all 14 health regions. System resource constraints (60.4%, comorbidities (56.4% and physiologic factors (51.8% were top-ranked issues creating information needs. Local surgical colleagues (84.6%, other local colleagues (82.2% and the Internet (81.1% were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care. Conclusion General surgeons appear to use a wide range of information

  10. Being a surgeon--the myth and the reality: a meta-synthesis of surgeons' perspectives about factors affecting their practice and well-being

    OpenAIRE

    Orri, Massimiliano; Farges, Olivier; Clavien, Pierre-Alain; Barkun, Jeffrey; Revah-Lévy, Anne

    2014-01-01

    OBJECTIVES Synthesize the findings from individual qualitative studies about surgeons' account of their practice. BACKGROUND Social and contextual factors of practice influence doctors' well-being and therapeutic relationships. Little is known about surgery, but it is generally assumed that surgeons are not affected by them. METHODS We searched international publications (2000-2012) to identify relevant qualitative research exploring how surgeons talk about their practice. Meta-ethnograp...

  11. Plastic Surgeons' Opinions of Facial Surgery for Individuals with Down Syndrome.

    Science.gov (United States)

    May, Deborah C.; Turnbull, Nancy

    1992-01-01

    One hundred plastic surgeons responded to a survey on opinions toward facial plastic surgery for individuals with Down's syndrome. Twenty-four of the surgeons had performed the surgery. Surgeons indicated appropriate circumstances for the surgery, consent requirements, degree of understanding expected of the patient, and degree of discomfort…

  12. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    Directory of Open Access Journals (Sweden)

    Sheikh Asfandyar

    2012-11-01

    Full Text Available Abstract Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6% was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9% was most frequently disagreed. In the event of a medical error, majority (67.7% were ready

  13. Large, Sparse Optimal Matching with Refined Covariate Balance in an Observational Study of the Health Outcomes Produced by New Surgeons

    OpenAIRE

    Pimentel, Samuel D.; Kelz, Rachel R; Silber, Jeffrey H.; Rosenbaum, Paul R.

    2015-01-01

    Every newly trained surgeon performs her first unsupervised operation. How do the health outcomes of her patients compare with the patients of experienced surgeons? Using data from 498 hospitals, we compare 1252 pairs comprised of a new surgeon and an experienced surgeon working at the same hospital. We introduce a new form of matching that matches patients of each new surgeon to patients of an otherwise similar experienced surgeon at the same hospital, perfectly balancing 176 ...

  14. Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

    DEFF Research Database (Denmark)

    Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels;

    2015-01-01

    INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level of...... surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all...

  15. Impact of assistant surgeon on outcomes in robotic surgery

    Science.gov (United States)

    Nayyar, Rishi; Yadav, Siddharth; Singh, Prabhjot; Dogra, Prem Nath

    2016-01-01

    Introduction: It is believed that the outcomes of robotic surgery depends not only on the experience of the console surgeon but also the patient-side assistant. However, objective data supporting it is lacking. The aim of this study was to objectively determine change in operative outcomes with increasing experience of patient-side assistant. Materials and Methods: We performed a retrospective analysis of 222 urologic robotic procedures performed by two teams of surgeon-assistant and split the data into two chronological halves according to date of surgery. We considered that the assistant was inexperienced in the 1st half and had become experienced by the 2nd half, and we compared mean operative time and blood loss between these two halves of his experience. Results: We observed that with increasing experience of the assistant, the mean operative time reduced from 138.06 to 124.32 min (P = 0.001) and mean blood loss decreased from 191.93 to 187.61 ml (P = 0.57). On subset analysis, a consistent trend of reduction in the mean operative time was noted for both the assistants separately and for all surgical procedures included in the analysis. Maximum reduction was noted for pyeloplasty which was the most commonly performed surgery. The mean blood loss had a varied relation to the experience of the assistant and did not reach statistical significance in either direction. Conclusions: With increasing experience of the patient-side surgeon, the mean operative time for all robotic procedures showed a consistent trend of reduction across all types of surgery with greater reduction for commonly performed procedures. PMID:27555678

  16. Quality improvement 101 for surgeons: Navigating the alphabet soup.

    Science.gov (United States)

    Santore, Matthew T; Islam, Saleem

    2015-12-01

    It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. PMID:26653158

  17. An American surgeon's contribution to Chinese health care.

    Science.gov (United States)

    Shumacker, H B

    1981-03-01

    A prominent American thoracic surgeon, Leo Eloesser, while serving with UNICEF, contributed significantly to the health care of the Chinese people in the late 1940s, during the final years of the civil war and before the establishment of the People's Republic of China. The concepts he developed, especially concerning rural health service in poor, medically deprived nations, and the factors he felt must be taken into account in developing a health care system in any nation had lasting value. The story of the origin of his plan and his efforts to implement it is briefly related. PMID:7011075

  18. [Richard von Volkmann, one career of orthopaedic surgeon and poet].

    Science.gov (United States)

    Bumbasirević, M; Lesić, A; Sudjić, V; Zagorac, S

    2010-01-01

    Richard von Volkman was one of the most famous and important surgeons in the 19th century. He pioneered antiseptic procedures and was especially known for his achivements in orthopedic surgery. Von Volkmann was born in Leipzig, Germany and attended medical schools in Giessen, Halle, and Berlin. Starting in 1867, he worked as a professor of surgery at the University of Halle, also leading its surgical clinic. He was active as a surgeon during Seven Weeks' War with Austria in 1866 and the Franco-Prussian war 1870/1871, in the latter as consulting Generalarzt. He was important in the introduction of antiseptic wound treatment in Germany, and through it to the United States of America. Two observations in orthopaedic surgery bear his name to these days: Volkmans contracture and Heuter-Volkmans low. Volkmann also wrote poetry under the name Richard Leander and his book entitled "Dreams by French Firesides" which still has a place in literature. He died of paralysis due to a chronic spinal disease, following a prolonged illness, in the Binswanger institution in Jena in 1889, at the top of his careere. PMID:20954309

  19. Radiographic imaging of calcaneal fractures - the surgeons view point

    International Nuclear Information System (INIS)

    This paper presents a detailed description of calcaneal fractures, which are underestimated and neglected despite their relatively high frequency. In association with significant anatomic destruction of the calcaneus they lead to unsatisfactory results of fracture treatment. Radiographic features of a healthy calcaneal bone together with pathomechanism and radiographic attributes of most common fracture types are presented. The prognostic role of the posterior talo-calcaneal joint and extraarticular anatomy of the calcaneus are emphasized. Special attention is directed to the methods of calcaneal imaging, especially the most valuable in the authors opinion - lateral radiographic view and computed tomography. Other commonly used views: axial, antero-posterior or Broden, are also described, with explanation why they are rarely recommended. The widely used standard classification system for calcaneal fractures introduced by Sanders, based on computed tomography is presented. Correct x-ray imaging is the basis for further diagnostic workup and treatment, giving also valuable prognostic information. The orthopedic surgeon, who undertakes the difficult task of treating the broken calcaneus receives thorough information about bone damage, which helps to realize the consequences of injury and of possible negligence. According to the authors experience, problems discussed in this paper are rarely fully appreciated by radiologists and orthopedic surgeons resulting in, often, catastrophic consequences. (author)

  20. Herbal therapy: what every facial plastic surgeon must know.

    Science.gov (United States)

    Pribitkin, E D; Boger, G

    2001-01-01

    Herbal medicine (phytomedicine) uses remedies possessing significant pharmacological activity and, consequently, potential adverse effects and drug interactions. The explosion in sales of herbal therapies has brought many products to the marketplace that do not conform to the standards of safety and efficacy that physicians and patients expect. Unfortunately, few surgeons question patients regarding their use of herbal medicines, and 70% of patients do not reveal their use of herbal medicines to their physicians and pharmacists. All surgeons should question patients about the use of the following common herbal remedies, which may increase the risk of bleeding during surgical procedures: feverfew, garlic, ginger, ginkgo, and Asian ginseng. Physicians should exercise caution in prescribing retinoids or advising skin resurfacing in patients using St John's wort, which poses a risk of photosensitivity reaction. Several herbal medicines, such as aloe vera gel, contain pharmacologically active ingredients that may aid in wound healing. Practitioners who wish to recommend herbal medicines to patients should counsel them that products labeled as supplements have not been evaluated by the US Food and Drug Administration and that no guarantee of product quality can be made. PMID:11368667

  1. Role of surgeons in determining outcome of histopathology specimens

    Directory of Open Access Journals (Sweden)

    Akinfenwa T Atanda

    2013-01-01

    Full Text Available Background: In the changing world of clinicopathologic practice where surgeons and pathologists are faced with increasing therapeutic demands, precise demands of each group from the other have often been reduced to blames and counter-blames. This study is thus aimed at auditing the current practice of specimen handling as a means of highlighting areas where mutual best practice is required. Materials and Methods: A total of 200 specimens and 100 separate request cards received over the 3 months were audited for: Use of fixative, adequacy of fixative used, types of specimen containers and appropriate labeling of containers. The request cards were audited for: Documentation of patients′ hospital numbers, ages, histories of disease, sites of biopsy, examination findings, investigations done, provisional diagnosis and concordance of clinical diagnosis with histopathological diagnosis. Results: About 20% of specimens were unfixed, 23.5% had inadequate fixative, 16.5% were in inappropriate containers and 32.5% were incompletely labeled respectively. In 25%, 50% and 53% of forms the age, clinical history and examination findings respectively were not documented. Provisional diagnosis was in concordance with eventual histological diagnosis in 69% of cases. Conclusion: To ensure the quality of histopathological diagnosis with minimal turnaround time, the surgeon plays a vital role by ensuring adequate and prompt fixation of tissue biopsies, put in the right container and accompanied by well labeled request cards.

  2. Imaging of bone tumors for the musculoskeletal oncologic surgeon

    Energy Technology Data Exchange (ETDEWEB)

    Errani, C., E-mail: costantino.errani@ior.it [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Kreshak, J., E-mail: j.kreshak@yahoo.com [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Ruggieri, P., E-mail: pietro.ruggieri@ior.it [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Alberghini, M., E-mail: marco.alberghini@ior.it [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Picci, P., E-mail: piero.picci@ior.it [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Research, Istituto Ortopedico Rizzoli, Bologna (Italy); Vanel, D., E-mail: daniel.vanel@ior.it [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Research, Istituto Ortopedico Rizzoli, Bologna (Italy)

    2013-12-01

    The appropriate diagnosis and treatment of bone tumors requires close collaboration between different medical specialists. Imaging plays a key role throughout the process. Radiographic detection of a bone tumor is usually not challenging. Accurate diagnosis is often possible from physical examination, history, and standard radiographs. The location of the lesion in the bone and the skeleton, its size and margins, the presence and type of periosteal reaction, and any mineralization all help determine diagnosis. Other imaging modalities contribute to the formation of a diagnosis but are more critical for staging, evaluation of response to treatment, surgical planning, and follow-up.When necessary, biopsy is often radioguided, and should be performed in consultation with the surgeon performing the definitive operative procedure. CT is optimal for characterization of the bone involvement and for evaluation of pulmonary metastases. MRI is highly accurate in determining the intraosseous extent of tumor and for assessing soft tissue, joint, and vascular involvement. FDG-PET imaging is becoming increasingly useful for the staging of tumors, assessing response to neoadjuvant treatment, and detecting relapses.Refinement of these and other imaging modalities and the development of new technologies such as image fusion for computer-navigated bone tumor surgery will help surgeons produce a detailed and reliable preoperative plan, especially in challenging sites such as the pelvis and spine.

  3. Mentoring during residency education: a unique challenge for the surgeon?

    Science.gov (United States)

    Pellegrini, Vincent D

    2006-08-01

    A mentor serves as role model, counselor, and advocate for an understudy or protégé. The art and science of mentoring have been investigated most thoroughly in the educational literature, yet there are unique situational and individual considerations in the surgical arena that may warrant special consideration. The general attributes of successful mentors are not foreign to academic surgeons but may require deliberate cultivation to optimize mentorship in the context of academic medicine. Moreover, the stages of productive mentoring may be counter to the learned adaptive behaviors and instinctive personality traits of some accomplished surgeon educators. Indeed, examples of failed mentorship are common in our medical centers and, specifically, in surgical training programs. The behavioral adaptation that supports surgical decision-making under conditions of incomplete data and unusual stress often devalues succession planning and derivation of satisfaction from the success of other members of the team. Accordingly, fostering effective mentoring relationships in academic surgery will require a concerted effort to develop appropriate behaviors conducive to the mentoring process. The personal and professional growth of our students as well as the succession planning for our specialty are dependent upon the successful creation of an environment conducive to mentoring in academic orthopaedics. PMID:16760803

  4. Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon.

    Science.gov (United States)

    Fernández, Luis G

    2016-09-01

    Traditionally, the surgical approach to managing abdominal injuries was to assess the extent of trauma, repair any damage and close the abdomen in one definitive procedure rather than leave the abdomen open. With advances in medicine, damage control surgery using temporary abdominal closure methods is being used to manage the open abdomen (OA) when closure is not possible. Although OA management is often observed in traumatic injuries, the extension of damage control surgery concepts, in conjunction with OA, for the management of the septic patient requires that the general surgeon who is faced with these challenges has a comprehensive knowledge of this complex subject. The purpose of this article is to provide guidance to the acute care and general surgeon on the use of OA negative pressure therapy (OA-NPT; ABTHERA™ Open Abdomen Negative Pressure Therapy System, KCI, an ACELITY Company, San Antonio, TX) for OA management. A literature review of published evidence, clinical recommendations on managing the OA and a case study demonstrating OA management using OA-NPT have been included. PMID:27547961

  5. Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

    DEFF Research Database (Denmark)

    Carstensen, Lena; Rose, Michael; Bentzon, Niels;

    2015-01-01

    surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all......INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level of...... implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast...

  6. [Treatments of Soft Tissue Sarcomas by Orthopaedic Surgeons in Japan].

    Science.gov (United States)

    Tanaka, Kazuhiro

    2016-01-01

    In Japan, the treatment of soft tissue sarcomas (STS) has been performed mainly by orthopaedic surgeons. The standard therapy for all cases of STS is surgical resection of the tumor. The prognosis of patients with unresectable tumors or distant metastases is poor despite treatment with intensive chemotherapy. Adjuvant chemotherapy is indicated for patients with resectable tumors. Round-cell STS, including extraskeletal Ewing sarcoma and rhabdomyosarcoma, have high sensitivity to chemotherapy. The standard treatment for round-cell STS is multimodal therapy with surgery and chemotherapy, with or without radiotherapy. On the other hand, non-round cell STS, including leiomyosarcoma, synovial sarcoma, and liposarcoma, have low sensitivity to chemotherapy. Thus, the standard treatment for non-round cell STS is essentially, surgery. Large and high-grade non-round cell STS are also treated using adjuvant chemotherapy along with surgery. In this review, the standard therapies for STS and the future perspective in Japan are discussed. PMID:26809525

  7. Smoking cessation: the role of the foot and ankle surgeon.

    Science.gov (United States)

    Greenhagen, Robert M; Johnson, Adam R; Bevilacqua, Nicholas J

    2010-02-01

    Tobacco cigarette smoking causes many negative effects on the body, and it is the leading preventable cause of death in the United States. These negative effects are a concern for the foot and ankle surgeon, as smoking can increase the risk of diabetes and peripheral artery disease and delay healing of surgical incisions and ulcerations of the lower extremities. Tobacco cigarette smoking can also increase the risk of avascular necrosis and delayed union and nonunions of fractures and osteotomies. Smoking cessation is an important component in the overall treatment of conditions affecting the foot and ankle. Smoking cessation can be a difficult goal to achieve, but proper education and support can help patients reach this goal. PMID:20400436

  8. Old Disease…New Location…Surgeons Be Alerted

    Directory of Open Access Journals (Sweden)

    K. B. Ashok

    2011-04-01

    Full Text Available Echinococcus granulosus causes a zoonotic infection called Cystic Echinococcosis (CE. Surgeons meet with hydatid cysts of the liver and lungs with reasonable frequency. However hydatid cyst may appear in other parts of the body too.A 30 yrs old lady presented with a smooth slow-growing subcutaneous nodule on the anteromedial side of the right thigh with no detectable primary site in the liver or lung. The case subsequently diagnosed as hydatid cyst of muscle and radical surgery was done under coverage of anihelminthic drug.The common practice in this type of case is to do FNAC taking the lesion to be a soft tissue neoplasm. The aim of this case presentation is to make aware of the fact that in a case of diffuse non-tender swelling with history of gradual increase in size hydatid cyst also has to be considered in the differential diagnosis.

  9. Plastic surgeons and the Internet: results of a worldwide survey.

    Science.gov (United States)

    Koch, Horst; Dabernig, Jörg; Allert, Sixtus; Puchinger, Markus; Scharnagl, Erwin

    2002-11-01

    To obtain information on the use of the Internet, 3,139 survey forms were sent out to plastic surgeons throughout the world. More than 90% of the 565 respondents have access to the Internet and 85.5% use electronic mail for professional matters. They use the World Wide Web to search the literature, to read scientific articles, and to obtain information on congresses. A substantial proportion of the contributors have a positive attitude toward virtual congresses on the Internet and most would welcome a newsgroup dedicated to plastic surgery. Perceived apprehensions include secure transmission of sensitive data, slow data transmission, and the lack of structure and of an authority to control the contents of the Internet. Virtual congresses and a newsgroup on plastic surgery seem to be worthwhile future goals. Some problems pointed out in this survey have already been solved, at least partially, and possible solutions for the rest are discussed. PMID:12439012

  10. Clinical Core Competency Training for NASA Flight Surgeons

    Science.gov (United States)

    Polk, J. D.; Schmid, Josef; Hurst, Victor, IV; Doerr, Harold K.; Doerr, Harold K.

    2007-01-01

    Introduction: The cohort of NASA flight surgeons (FS) is a very accomplished group with varied clinical backgrounds; however, the NASA Flight Surgeon Office has identified that the extremely demanding schedule of this cohort prevents many of these physicians from practicing clinical medicine on a regular basis. In an effort to improve clinical competency, the NASA FS Office has dedicated one day a week for the FS to receive clinical training. Each week, an FS is assigned to one of five clinical settings, one being medical patient simulation. The Medical Operations Support Team (MOST) was tasked to develop curricula using medical patient simulation that would meet the clinical and operational needs of the NASA FS Office. Methods: The MOST met with the Lead FS and Training Lead FS to identify those core competencies most important to the FS cohort. The MOST presented core competency standards from the American Colleges of Emergency Medicine and Internal Medicine as a basis for developing the training. Results: The MOST identified those clinical areas that could be best demonstrated and taught using medical patient simulation, in particular, using high fidelity human patient simulators. Curricula are currently being developed and additional classes will be implemented to instruct the FS cohort. The curricula will incorporate several environments for instruction, including lab-based and simulated microgravity-based environments. Discussion: The response from the NASA FS cohort to the initial introductory class has been positive. As a result of this effort, the MOST has identified three types of training to meet the clinical needs of the FS Office; clinical core competency training, individual clinical refresher training, and just-in-time training (specific for post-ISS Expedition landings). The MOST is continuing to work with the FS Office to augment the clinical training for the FS cohort, including the integration of Web-based learning.

  11. Subfascial endoscopic perforator vein surgery (SEPS): current practice among British surgeons.

    OpenAIRE

    Whiteley, M. S.; Smith, J. J.; Galland, R. B.

    1998-01-01

    Subfascial endoscopic perforator vein surgery (SEPS) has recently caused considerable interest among British surgeons. There are no data indicating which, if any, patients benefit from SEPS. A series of 47 British surgeons, identified as having taken up SEPS, were sent a questionnaire asking about their current practice; 26 were returned completed (55% response rate). Of those surgeons replying, 22 (85%) had performed their first SEPS procedure within the previous 21 months, 18 (69%) within t...

  12. Hepatitis-B Vaccination Status Among Dental Surgeons in Benin City, Nigeria

    OpenAIRE

    Azodo, CC; Ehizele, AO; Uche, I; Erhabor, P

    2012-01-01

    Background: The development of success-oriented hepatitis-B vaccine uptake approach among dental surgeons is dependent on the availability of comprehensive baseline data. Objective: To determine the hepatitis-B vaccination status among dental surgeons in Benin City. Materials and Methods: This questionnaire-based cross-sectional study of dental surgeons in Benin City was conducted in May 2011. The questionnaire elicited information on demography, occupational risk rating of contracting hepati...

  13. Work-related musculoskeletal disorders among dental surgeons: A pilot study

    Directory of Open Access Journals (Sweden)

    Abdul Rahim Shaik

    2011-01-01

    Full Text Available Aim: To describe the work-related musculoskeletal disorders among on-job dental surgeons. Objectives: To identify the musculoskeletal disorders in terms of perception of pain and stiffness experienced by the dental surgeons due to the rigors of dental work, to determine the prevailing working environment with particular reference to dental work station in relation to musculoskeletal disorders, and to find the association between pain and stiffness experienced by the dental surgeons and the selected socio-demographic variables. Materials and Methods: The study was conducted on 30 graduated dental surgeons having a work experience of 1 year or more, post graduates and faculty members of various specialties at Yenepoya Dental College Hospital, Mangalore. The subjects were selected randomly from the hospital and they were given closed-ended questionnaire to find out perception of pain and stiffness experienced in the past 6 months. The observation of the working environment was done by walk-through observational survey. Results: The study showed that 6.6% dental surgeons always experienced shoulder pain, while 83.3% dental surgeons sometimes experienced back pain and 70% sometimes experienced neck pain. Majority of the dental surgeons (73.3% experienced stiffness in the back and 23.3% experienced severe pain in their neck. It was observed that the number of patients attended per day by the dental surgeons had a significant association (P = 0.024 with the pain they experienced in their hip/thigh region. The frequency of pain experienced by the dental surgeons in the hip/thigh and knee joints also showed a significant association (P = 0.037 with the height of the dental surgeons. Conclusion: The study revealed that various socio-demographic variables contributed to the musculoskeletal disorders experienced by the dental surgeons. However, the number of patients attended per day by the dental surgeons vis-à-vis pain experienced in the back, wrist, and

  14. Psychological and Physical Stress in Surgeons Operating in a Standard or Modern Operating Room

    DEFF Research Database (Denmark)

    Klein, M.; Andersen, L.P.H.; Gögenür, Ismayil; Rosenberg, J.; Alamili, M.

    2010-01-01

    Purpose: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect...... psychological and physiological stress in experienced laparoscopic surgeons. Methods: This was a prospective case-controlled study including 10 experienced surgeons. Surgery was performed in 2 different ORs: a standard room and a modern room (OR1-suite, Karl Storz). The surgeons filled out questionnaires...... modern OR compared with a standard room...

  15. Psychological and Physical Stress in Surgeons Operating in a Standard or Modern Operating Room

    DEFF Research Database (Denmark)

    Klein, M.; Andersen, L.P.H.; Alamili, M.; Gögenür, Ismayil; Rosenberg, J.

    2010-01-01

    Purpose: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect...... psychological and physiological stress in experienced laparoscopic surgeons. Methods: This was a prospective case-controlled study including 10 experienced surgeons. Surgery was performed in 2 different ORs: a standard room and a modern room (OR1-suite, Karl Storz). The surgeons filled out questionnaires...

  16. Role of Surgeon in Length of Stay in ICU after Cardiac Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Mahmood Sheikhfathollahi

    2010-02-01

    Full Text Available Background: We presumed that the surgeon himself has an impact on the results after coronary artery bypass grafting (CABG as there is no unique protocol for the discharge of post-operative cardiac patients at our institution. Therefore, we examined whether the surgeon himself has an impact on the intensive care unit (ICU stay of isolated CABG patients.Methods: We prospectively studied a total of 570 consecutive patients undergoing elective CABG. Length of stay in the ICU was defined as the number of days in the ICU unit post-operatively. Seven operating surgeons were classified in 3 categorieson the basis of the mean hospital stay of their patients (1, 2 and 3 if the mean total patients' stay in hospital was 48 hours and examined the role of surgeon in this regard.Results: Incidence of post-operative arrhythmia and length of ICU stay were higher in the patients of surgeon category 3 than those of surgeon categories 1 and 2. Surgeon category 3 also operated on patients with higher EuroSCOREs than did surgeon categories 1 and 2. With the aid of a multivariable stepwise analysis, three variables were identified as independent predictors significantly associated with ICU length of stay: age, history of cerebrovascular accident, and surgeon category.Conclusion: Surgeon category may independently predict a prolonged length of stay in the ICU. We suggest that a unique discharge protocol for post-CABG patients be considered to restrict the role of surgeon in the ICU stay of these patients.

  17. 76 FR 28308 - Compliance Policy Guide: Surgeons' Gloves and Patient Examination Gloves; Defects-Criteria for...

    Science.gov (United States)

    2011-05-17

    ... announcing the availability of Compliance Policy Guide Sec. 335.700, Surgeons' Gloves and Patient Examination.... Background FDA is announcing the availability of a guidance document entitled ``Compliance Policy Guide Sec... HUMAN SERVICES Food and Drug Administration 21 CFR Part 800 Compliance Policy Guide: Surgeons'...

  18. Learning curve: the surgeon as a prognostic factor in colorectal cancer surgery.

    Science.gov (United States)

    Renzulli, Pietro; Laffer, Urban T

    2005-01-01

    The individual surgeon is an independent prognostic factor for outcome in colorectal cancer surgery. The surgeon's learning curve is therefore directly related to the patient's outcome. The exact shape of the learning curve, however, is unknown. The present study reviewed supervision, training/teaching, specialization, surgeon's caseload, and hospital's caseload as the five main surgeon- and hospital-related confounding factors for outcome, and examined their influence on the learning curve as well as their interactions and prognostic significance. All five confounding factors were related to outcome. The highest degree of evidence, however, was found for training/teaching (introduction of total mesorectal excision), specialization in colorectal surgery (special interest, board-certification, specialized colorectal cancer units), and the surgeon's caseload. Five surgeon- and hospital-related factors directly influence the surgeon's learning curve and are therefore rightly considered predictors of outcome in colorectal cancer surgery. Improvements in supervision, training/teaching, specialization, the surgeon's caseload, and the hospital's caseload will therefore translate into enhanced patient outcome. PMID:15865024

  19. Accuracy of navigated pedicle screw insertion by a junior spine surgeon without spinal surgery experience

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate pedicle screw placement accuracy during navigated surgery by a junior spine surgeon who had no spinal surgery experience. A junior spine surgeon with no spinal surgery experience implanted a total of 137 pedicle screws by using a navigation system. Postoperative computerized tomography was performed to evaluate screw placement, and the pedicle perforation rate was 2.2%. There were no neurologic or vascular complications related to the pedicle screws. The results demonstrated that pedicle screws can be placed safely and effectively by a junior spine surgeon who has no spinal surgery experience when instructed by a senior spine surgeon. The results of this study suggest that navigation can be used as a surgical training tool for junior spine surgeons. (author)

  20. [The entrance to the guild chamber of the Amsterdam Guild of Surgeons].

    Science.gov (United States)

    Ottenhof, Anne; IJpma, Frank A; van Gulik, Thomas M

    2016-01-01

    In the 17th and 18th centuries the entrance to the guild chamber of the Amsterdam Guild of Surgeons was located in the right corner-tower of the Waag on the Nieuwmarkt in Amsterdam. The surgeons entered their guild chamber through this door for guild meetings or to take surgical exams. The entrance also gave access to the anatomy theatre, the 'Theatrum Anatomicum', where anatomical dissections - anatomy lessons - took place. There was a bust of Hippocrates in the facade above the door, and the inscription 'Theatrum Anatomicum'. The series of 'anatomy lessons' reminds us of the famous paintings that were commissioned by the Surgeons' Guild. At the beginning of the 17th century, a skeleton was painted on the door in the gateway, and this marked the entrance to the Surgeons' Guild for almost 200 years. We examined, from a historical perspective, how the gateway to the guild chamber of the Amsterdam Guild of Surgeons was transformed over time. PMID:27122076

  1. Radiation exposure to the surgeon during closed interlocking intramedullary nailing

    Energy Technology Data Exchange (ETDEWEB)

    Levin, P.E.; Schoen, R.W. Jr.; Browner, B.D.

    1987-06-01

    During interlocking intramedullary nailing of twenty-five femoral and five tibial fractures, the primary surgeon wore both a universal film badge on the collar of the lead apron and a thermoluminescent dosimeter ring on the dominant hand to quantify the radiation that he or she received. When distal interlocking was performed, the first ring was removed and a second ring was used so that a separate recording could be made for this portion of the procedure. At the conclusion of the study, all of the recorded doses of radiation were averaged. The average amount of radiation to the head and neck during the entire procedure was 7.0 millirems of deep exposure and 8.0 millirems of shallow exposure. The average dose of radiation to the dominant hand during insertion of the intramedullary nail and the proximal interlocking screw was 13.0 millirems, while the average amount during insertion of the distal interlocking nail was 12.0 millirems. Both of these averages are well within the government guidelines for allowable exposure to radiation during one-quarter (three months) of a year. Precautions that are to be observed during this procedure are recommended.

  2. Breast imaging: a surgeon's prospective

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, Anne M. [Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093 (United States); Department of Surgery, University of California, San Diego, La Jolla, CA 92093 (United States); Comstock, Christopher [Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093 (United States); Department of Radiology, University of California, San Diego, La Jolla, CA 92093 (United States); Hoh, Carl K. [Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093 (United States); Department of Radiology, University of California, San Diego, La Jolla, CA 92093 (United States); Vera, David R. [Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093 (United States); Department of Radiology, University of California, San Diego, La Jolla, CA 92093 (United States)

    2005-10-01

    Mammography, ultrasound, magnetic resonance imaging, positron emission tomography, gamma camera and intraoperative gamma detection, and computed tomography are employed in the diagnosis and treatment of breast cancer. This paper summarizes the role of each modality from the perspective of the physician responsible for management of the patient's care. An understanding of an imaging modality's current role can provide insights into the design of new applications and diagnostic agents. Moreover, knowledge of the mechanism by which each modality provides clinical information can guide the design of new imaging methods that complement and add certainty to the patient's management. The reader should note the lack of molecular information provided by the current imaging methods. The perspective concludes with a request for an imaging technique that can measure the biologic aggressiveness of a woman's cancer. The surgeon notes that basing the formation of an image on a molecular process would be compatible with current medical practice, which utilizes molecular concepts to base medical decisions. In addition, molecular imaging will enable rapid translation between basic science and medical practice.

  3. Recognizing surgeon's actions during suture operations from video sequences

    Science.gov (United States)

    Li, Ye; Ohya, Jun; Chiba, Toshio; Xu, Rong; Yamashita, Hiromasa

    2014-03-01

    Because of the shortage of nurses in the world, the realization of a robotic nurse that can support surgeries autonomously is very important. More specifically, the robotic nurse should be able to autonomously recognize different situations of surgeries so that the robotic nurse can pass necessary surgical tools to the medical doctors in a timely manner. This paper proposes and explores methods that can classify suture and tying actions during suture operations from the video sequence that observes the surgery scene that includes the surgeon's hands. First, the proposed method uses skin pixel detection and foreground extraction to detect the hand area. Then, interest points are randomly chosen from the hand area so that their 3D SIFT descriptors are computed. A word vocabulary is built by applying hierarchical K-means to these descriptors, and the words' frequency histogram, which corresponds to the feature space, is computed. Finally, to classify the actions, either SVM (Support Vector Machine), Nearest Neighbor rule (NN) for the feature space or a method that combines "sliding window" with NN is performed. We collect 53 suture videos and 53 tying videos to build the training set and to test the proposed method experimentally. It turns out that the NN gives higher than 90% accuracies, which are better recognition than SVM. Negative actions, which are different from either suture or tying action, are recognized with quite good accuracies, while "Sliding window" did not show significant improvements for suture and tying and cannot recognize negative actions.

  4. Day-care hypospadias surgery: Single surgeon experience

    Directory of Open Access Journals (Sweden)

    Chandrasekharam V.V.S.S

    2007-01-01

    Full Text Available Aim: To report the results of the early discharge of children after hypospadias repair with an indwelling catheter. Materials and Methods: To facilitate early the discharge of children after hypospadias repair, the author adopted the technique of draining the indwelling urinary catheter into diapers in children undergoing this operation. Home catheter care was taught to the mother; the dressings and catheters were subsequently managed in the outpatient clinic. Results: Over a 2-year period, 43 children were managed by this technique and were sent home within 24-48 h after the operation with an indwelling catheter. Minor problems requiring outpatient visits to the surgeon occurred in nine (20% children after discharge from the hospital. All the nine children were successfully managed as outpatients and no child required rehospitalisation. The catheter remained in position for 5 days in all the children. The overall results were satisfactory with an acceptable (7% fistula rate. Conclusions: It is possible to reduce the duration of the hospital stay of children after hypospadias repair without compromising on the final results.

  5. The Role of Plastic Surgeons in Advancing Development Global.

    Science.gov (United States)

    Broer, P Niclas; Jenny, Hillary E; Ng-Kamstra, Joshua S; Juran, Sabrina

    2016-05-01

    In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment. However, as many as five billion people lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Surgery, and specifically plastic surgery, should be incorporated into the international development and humanitarian agenda. As a community of care providers dedicated to the restoration of the form and function of the human body, plastics surgeons have a collective opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty. As surgical disease comprises a significant burden of disease and surgery can be delivered in a cost-effective manner, surgery must be considered a public health priority. PMID:27579265

  6. Vascular access in chronic dialysis: a plastic surgeon's approach.

    Science.gov (United States)

    Pieptu, Dragos; Luchian, Stefan; Hriscu, Mihaela; Mititiuc, Irina; Florea, Manuela; Romete, Simona; Popa, Maria; Ungureanu, Angela; Chirita, Loredana

    2003-01-01

    Thirty-five years after Brescia et al. (N Engl J Med 275:1089-1092, 1966) realized the first peripheral autogenous arteriovenous fistula, the "Achilles' heel" of chronic dialysis is still the absence of a good-quality permanent vascular access. The number of patients depending on hemodialysis is increasing. Until 10 years ago, in Romania, there was a need to treat isolated critical cases. Nowadays, every dialysis center needs algorithms for a standardized approach, adaptable for each case. We reviewed 171 consecutive arteriovenous fistulas (132 patients) performed in adults in identical standard conditions: use of an inflatable tourniquet during the vascular dissection, microsurgical techniques, and use of only autogenous tissues. We analyzed our results, the technical difficulties encountered, and their management in long-term follow-up. The aim of this study was to set up the basic principles of our algorithms. Our approach, based on our education as plastic surgeons involved in hand surgery and microsurgery, might present the advantage of sparing renal patients vascular capital. PMID:12833323

  7. [Perioperative conflicts between anaesthesiologists and surgeons: ethics and professionalism].

    Science.gov (United States)

    Bazin, J-E; Attias, A; Baghdadi, H; Baumann, A; Bizouarn, P; Claudot, F; Eon, B; Fieux, F; Frot, C; Guibet Lafaye, C; Muzard, O; Nicolas-Robin, A; Orjubin, V; Otero-Lopez, M; Pelluchon, C; Pereira, J; Roussin, F; Vigué, B; Beydon, L

    2014-05-01

    In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution. PMID:24821342

  8. Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

    Directory of Open Access Journals (Sweden)

    Ahmet Serdar Karaca

    2013-10-01

    Full Text Available Aim: Mesh repair of inguinal hernia repairs are shown to be an effective and reliable method. In this study, a single surgeon%u2019s experience with plug-mesh method performs inguinal hernia repair have been reported. Material and Method: 587 patients with plug-mesh repair of inguinal hernia, preoperative age, body / mass index, comorbid disease were recorded in terms of form. All of the patients during the preoperative and postoperative hernia classification of information, duration of operation, antibiotics, perioperative complications, and later, the early and late postoperative complications, infection, recurrence rates and return to normal daily activity, verbal pain scales in terms of time and postoperative pain were evaluated. Added to this form of long-term pain ones. The presence of wound infection was assessed by the presence of purulent discharge from the incision. Visual analog scale pain status of the patients was measured. Results: 587 patients underwent repair of primary inguinal hernia mesh plug. One of the patients, 439 (74% of them have adapted follow-ups. Patients%u2019 ages ranged from 18-86. Was calculated as the mean of 47±18:07. Follow-up period of the patients was found to be a minimum of 3 months, maximum 55 months. Found an average of 28.2±13.4 months. Mean duration of surgery was 35.07±4.00 min (min:22mn-max:52mn, respectively. When complication rates of patients with recurrence in 2 patients (0.5%, hematoma development (1.4% in 6 patients, the development of infection in 11 patients (2.5% and long-term groin pain in 4 patients (0.9% appeared. Discussion: In our experience, the plug-mesh repair of primary inguinal hernia repair safe, effective low recurrence and complication rates can be used.

  9. Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective

    Directory of Open Access Journals (Sweden)

    Paix Andrew

    2009-02-01

    Full Text Available Abstract Introduction Gastro-oesophageal reflux disease (GORD is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise the morbidity and mortality. Methods 301 patients underwent laparoscopic treatment for GORD by a single consultant surgeon in our NHS Trust from September 1999. The data was prospectively collected and entered into a database. The data was retrospectively analysed for presentations for complications and their management. Results Surgery was completed laparoscopically in all patients, except in five, where the operation was technically difficult due to pre-existing conditions. The complications we encountered during surgery and follow-up period were major intra-operative bleeding (n = 1, 0.33%, severe post-operative nausea and vomiting (n = 1, 0.33%, wound infection (n = 3, 1%, port-site herniation (n = 1, 0.33%, wrap-migration (n = 2, 0.66%, wrap-ischaemia (n = 1, 0.33%, recurrent regurgitation (n = 4, 1.32%, recurrent heartburn (n = 29, 9.63%, tension pneumothorax (n = 2, 0.66%, surgical emphysema (n = 8, 2.66%, and port-site pain (n = 4, 1.33%. Conclusion Minimal access approach to treat GORD has presented with some specific and unique complications. It is important to recognise these complications at the earliest possible stage as some of these patients may present in an acute setting requiring emergency surgery. All members of the department, and not just the members of the specialised team, should be aware about these complications to minimise the morbidity and mortality.

  10. Action ethical dilemmas in surgery: an interview study of practicing surgeons

    Directory of Open Access Journals (Sweden)

    Nordam Ann

    2005-07-01

    Full Text Available Abstract Background The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. Methods Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. Conclusion The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.

  11. Why veteran orthopaedic trauma surgeons are being fired and what we can do about it?

    Science.gov (United States)

    Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J

    2013-06-01

    The financial realities of providing trauma care to injured patients can make it difficult to produce an accurate assessment of the cumulative value orthopaedic trauma surgeons provide to healthcare and university institutions. As with many political battles in the field of medicine, physicians who have been diligently focused on providing patient care were completely unaware of the impending upheaval around them. Whether orthopaedic trauma surgeons are employed or in some type of partnership with hospitals, too often surgeons find the relationship one-sided. In order to effectively negotiate with hospitals, surgeons must demonstrate the comprehensive value they provide to their respective healthcare institutions and universities. Orthopaedic trauma surgeons make direct and indirect financial contributions to the hospital in addition to educational and community services. The sum total of these valued contributions helps fund non-revenue generating programs, provides marketing opportunities, and improves the regional and national reputation of the healthcare institution. This paper provides a comprehensive review of the value contributed to healthcare institutions by orthopaedic trauma surgeons and will serve as a blueprint for all surgeons to accurately account for and demonstrate their value to hospitals while providing efficient and compassionate care to our patients. PMID:23571292

  12. Comparison of temperament and character profiles of anesthesiologists and surgeons : a preliminary study.

    Directory of Open Access Journals (Sweden)

    Mitra S

    2003-10-01

    Full Text Available BACKGROUND: Given the high levels of stress in anesthesiologists and also their close working liaison with surgeons, it may be worthwhile to compare the personality profiles of these two groups of professionals. AIM: To compare the personality profiles of surgeons and anesthesiologists, using a well-standardized and validated instrument. SETTINGS AND DESIGN: Survey (cross-sectional on surgeons and anesthesiologists working in several medical institutes in India. MATERIAL & METHODS: The self-report Temperament and Character Inventory, 125-item version (TCI-125 was mailed out to an incidental sample of surgeons and anesthesiologists working in medical institutes in India. Of the 200 questionnaires sent (100 to anesthesiologists and surgeons each, 93 completed responses were returned (46 anesthesiologists, 47 surgeons; return rate 46.5%. STATISTICAL ANALYSIS: Student′s unpaired ′t′ test; P<0.05 was considered statistically significant. RESULTS: The mean scores of anesthesiologists vis-a-vis surgeons on the various temperament dimensions were Novelty seeking: 8.6 vs. 9.2; Harm avoidance: 7.3 vs. 8.1; Reward dependence: 8.1 vs. 8.0; and Persistence: 3.0 vs. 3.1, respectively. Similar scores for the character dimensions were Self-directedness: 16.9 vs. 15.9; Cooperativeness: 17.5 vs. 16.5; and Self-transcendence: 7.0 vs. 6.7, respectively. There was no significant difference between the surgeons and anesthesiologists on any of the temperament and character variables of personality chosen for the study. CONCLUSION: Personality measures did not differ significantly between surgeons and anesthesiologists in this preliminary investigation. If replicated on a larger and more representative sample, the findings have clinical relevance to improve the working relationship between these two groups of closely working professionals.

  13. How many general surgeons do you need in rural areas? Three approaches to physician resource planning in southern Manitoba.

    OpenAIRE

    Roos, N.; Black, C.; Wade, J.; DECKER, K.

    1996-01-01

    OBJECTIVE: To assess critically the results of using three different approaches to planning for the number of general surgeons in rural areas. DESIGN: Estimates of the number of general surgeons needed using a ratio approach, a and a population-needs-based approach. SETTING: Rural southern Manitoba. OUTCOME MEASURE: Number of general surgeons needed. RESULTS: The ratio approach supported the recruitment of 7.8 to 14.5 additional general surgeons to rural southern Manitoba. The repatriation ap...

  14. Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons

    Science.gov (United States)

    Cavallini, Gian Maria; Verdina, Tommaso; Forlini, Matteo; Volante, Veronica; De Maria, Michele; Torlai, Giulio; Benatti, Caterina; Delvecchio, Giancarlo

    2016-01-01

    Purpose To determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons. Patients and methods Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software. Results Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B. Conclusion B-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less

  15. SUSHRUTA: A GREAT SURGEON AND VISIONARY OF AYURVEDA

    Directory of Open Access Journals (Sweden)

    Paliwal Murlidhar

    2012-02-01

    Full Text Available Ayurveda is described as science of life and it was recalled by Brahma as mentioned in Ayurvedic treatises. Brahma transmitted his noble knowledge to Prajapati or Daksha, later Daksha passed his legacy to Ashwins and Indra received knowledge from Aswins. As per Sushruta opinion, Indra taught Ayurveda to Dhanvantari, the surgeon of gods embodied as king Divodasa of Banaras (Kashiraja. Divodasa then transmitted medical knowledge with special reference to surgery to the wise men like Sushruta and others who approached him as pupils, out of sympathy for the suffering humanity and also in order to prolong their own life. This school of thoughts is known as Dhanvantara-Sampradaya i.e. the school of surgery. All the fellows of Sushruta and Sushruta himself composed texts on the base of the perceptions of the teacher Divodasa Dhanvantari. Sushruta composed ‘Sushruta-Samhita’ which is fully available till now and is considered the best book for Sharira. Nagarjuna redacted the Sushruta-Samhita and possibly added Uttaratantra in 5th century A.D. In 10th century Chandrata, son of Tisata did the Pathashuddhi and renewed the Sushruta-Samhita on the basis of commentary done by Jejjata.In due course of time, many commentaries in Sanskrit, Hindi and English were written which show the growing acceptance and utility of the text. Charaka-Samhita, Sushruta-Samhita and Samhitas of Vagbhata are considered as Brihat-trayee i.e. three main treatises. In Kshemakutuhala text, it is well versed that a Vaidya who has listened many more text books but not listened the Sushruta-Samhita is devoid of actual benefits and if studied many other books but not the Charaka-Samhita gets defame or criticism among Vaidyas who have studied both the Samhitas. Vagbhata says that if the texts written by seers and sages get recognition in society then except Charaka-Samhita and Sushruta-Samhita why Bhela-Samhita etc. are not studied. All these references prove the gravity of Charaka

  16. The Prediction of Surgeon-Specific Operating Room Time (Experience with the Michigan Surgical Monitor)

    OpenAIRE

    Schmidt, Nancy M.; Brown, Allan C.D.

    1984-01-01

    A method to predict operating room time reliably is a prerequisite for effective surgical scheduling. A computer-based method of predicting surgeon-specific operating room time is described. Statistical validation of the method is presented and discussed.

  17. Surgeons agree more on treatment recommendations than on classification of proximal humeral fractures

    DEFF Research Database (Denmark)

    Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik; Jensen, Steen Lund; Sørensen, Anne Kathrine; Krogsgaard, Michael; Hróbjartsson, Asbjørn

    2012-01-01

    Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations....

  18. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael; Foss, Nicolai Bang; Kehlet, Henrik; Gebuhr, Peter Henrik

    2006-01-01

    OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior...... registrars operated on 23% (137/600) of all and 15% (56/365) of technically demanding proximal femoral fractures. The latter had a higher re-operation rate within 6 months, compared with the rate when more experienced surgeons were present. In logistic regression analysis combining age, gender, American...

  19. Are surgeons happy in practice? Examining a quarter-century of Alberta's surgical graduates.

    Science.gov (United States)

    Frayn, Cassidy; Masson, Valerie; Erichsen, Shannon; White, Jonathan

    2015-10-01

    Every year, hundreds of new surgeons graduate from residency programs across Canada. Much time and effort is spent on preparing these surgeons for independent practice, but there is little literature about the career trajectories of surgeons after they finish training and enter practice. We surveyed all surgeons graduating from the residency programs of a single Canadian medical school over 25 years (1985–2010). Most respondents rated their job satisfaction as high/very high and indicated they would still pursue a residency in surgery and/or their specialty if they had it to do over again. This commentary discusses important information about where our graduates go and what their careers are like, challenging existing stereotypes about careers in surgery. Our survey findings should be communicated to students interested in careers in surgery. PMID:26384145

  20. Implementing an Advanced Laparoscopic Procedure by Monitoring with a Visiting Surgeon

    NARCIS (Netherlands)

    Briet, Justine M.; Mourits, Marian J. E.; Kenkhuis, Monique J. A.; van der Zee, Ate G. J.; de Bock, Geertruida H.; Arts, Henriette J. G.

    2010-01-01

    Study Objective: To investigate the feasibility of safely implementing a total laparoscopic hysterectomy (LH) in established gynecologists' practices with on-site coaching and monitoring of the learning curve by an experienced visiting surgeon. Design: Multicenter prospective feasibility and impleme

  1. My Family Health Portrait, A tool from the Surgeon General | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. My Family Health Portrait, A tool from the Surgeon General ... use Why is it important to know my family medical history? Your family medical history is a ...

  2. Cation Exchange Resins and colonic perforation. What surgeons need to know

    Directory of Open Access Journals (Sweden)

    María Rita Rodríguez-Luna

    2015-01-01

    Conclusion: Despite the low incidence of colonic complication and lethal colonic necrosis associated with the CER clinical use, the general surgeon needs a high index of suspicion when dealing with patients treated with CER and abdominal pain.

  3. Psychological and physical stress among experienced and inexperienced surgeons during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Andersen, Lars Peter Holst; Klein, Mads; Gögenur, Ismail;

    2012-01-01

    : Surgical procedures are mentally and physically demanding, and stress during surgery may compromise patient safety. We investigated the impact of surgical experience on surgeons' stress levels and how perioperative sleep quality may influence surgical performance....

  4. Supply and demand: Will we have enough vascular surgeons by 2030?

    Science.gov (United States)

    Williams, Katherine; Schneider, Brandon; Lajos, Paul; Marin, Michael; Faries, Peter

    2016-08-01

    The increase in prevalence of certain cardiovascular risk factors increases susceptibility to vascular disease, which may create demand for surgical intervention. In our study, data collected by the American Association of Medical Colleges Physician Specialty Databook of 2012, the United States Census Bureau, and other nationwide organizations were referenced to calculate future changes in vascular surgeon supply and prevalence of people at risk for vascular disease. In 2010, there were 2853 active vascular surgeons. By 2040, the workforce is expected to linearly rise to 3573. There will be an exponential rise in people with cardiovascular risk factors. Adding to concern, in 2030, an estimated 3333 vascular surgeons will be available for 180,000,000 people with at least one risk factor for peripheral arterial disease. The paucity of properly trained surgeons entering the workforce needs to be addressed before this shortage becomes a larger burden on healthcare providers and governmental spending. PMID:26199290

  5. [The Journey of a Surgeon Begins with a Camera-Holder].

    Science.gov (United States)

    Li, Hui

    2016-06-20

    The techniques of thoracic surgery has undergone evolutionary changes, and currently video-assisted thoracic surgery (VATS) has already been or is going to be the predominant procedure of various thoracic surgeries. The safe and artistic VATS with high quality is closely associated with the cooperation of camera-holder and the surgeon. If an excellent thoracotomy is the result of perfect integral cooperation of the brain, eyes, hands and the body of the surgeon, the camera-holder in VATS procedure, then, is responsible for the eyes of both the surgeons and himself. This is more meticulous and difficult than that for a single person's brain, eyes, hands and body. Meanwhile, an excellent camera-holder will undoubtedly become an excellent surgeon in the foreseeable future. PMID:27335299

  6. #SocialMedia for the Academic Plastic Surgeon-Elevating the Brand.

    Science.gov (United States)

    Humphries, Laura S; Curl, Brandon; Song, David H

    2016-01-01

    The link between social media and surgery has been under increasingly popular discussion. This article discusses the potential role of social media in creating and maintaining the brand of an academic plastic surgeon. PMID:27104098

  7. High-Volume Hospitals with High-Volume and Low-Volume Surgeons: Is There a "Field Effect" for Pancreaticoduodenectomy?

    Science.gov (United States)

    Wood, Thomas W; Ross, Sharona B; Bowman, Ty A; Smart, Amanda; Ryan, Carrie E; Sadowitz, Benjamin; Downs, Darrell; Rosemurgy, Alexander S

    2016-05-01

    Since the Leapfrog Group established hospital volume criteria for pancreaticoduodenectomy (PD), the importance of surgeon volume versus hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine whether low-volume surgeons attain the same outcomes after PD as high-volume surgeons at high-volume hospitals. PDs undertaken from 2010 to 2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified. Surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges were examined relative to surgeon volume. Six high-volume hospitals were identified. Each hospital had at least one surgeon undertaking ≥ 12 PDs per year and at least one surgeon undertaking < 12 PDs per year. Within these six hospitals, there were 10 "high-volume" surgeons undertaking 714 PDs over the three-year period (average of 24 PDs per surgeon per year), and 33 "low-volume" surgeons undertaking 225 PDs over the three-year period (average of two PDs per surgeon per year). For all surgeons, the frequency with which surgeons undertook PD did not predict LOS, in-hospital mortality, discharge status, or hospital charges. At the six high-volume hospitals examined from 2010 to 2012, low-volume surgeons undertaking PD did not have different patient outcomes from their high-volume counterparts with respect to patient LOS, in-hospital mortality, patient discharge status, or hospital charges. Although the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there seems to be a hospital "field effect." PMID:27215720

  8. Surgeons agree more on treatment recommendations than on classification of proximal humeral fractures

    OpenAIRE

    Brorson Stig; Olsen Bo; Frich Lars; Jensen Steen; Sørensen Anne; Krogsgaard Michael; Hróbjartsson Asbjørn

    2012-01-01

    Abstract Background Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations. Methods We conducted a multi-centre observer-study. Five experienced shoulder surgeons independently assessed a consecutive series of 193 radiographs at two occasions three months...

  9. Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study

    Energy Technology Data Exchange (ETDEWEB)

    Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Abrahamse, Paul [Department of Internal Medicine, University of Michigan, Ann Arbor, MI (United States); Morrow, Monica [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hamilton, Ann S. [Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA (United States); Graff, John J. [Department of Radiation Oncology, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Katz, Steven J. [Department of Internal Medicine, Division of General Medicine and Department of Health Management and Policy, School of Public Health, University of Michigan Health System, Ann Arbor, MI (United States)

    2012-04-01

    Purpose: To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists. Methods and Materials: We surveyed attending surgeons and radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in metropolitan Detroit and Los Angeles. We identified 419 surgeons, of whom 318 (76%) responded, and 160 radiation oncologists, of whom 117 (73%) responded. We assessed demographic, professional, and practice characteristics; challenges to coordinated care; and attitudes toward management in three scenarios. Results: 92.1% of surgeons and 94.8% of radiation oncologists indicated access to a multidisciplinary tumor board. Nevertheless, the most commonly identified challenge to radiation oncologists, cited by 27.9%, was failure of other providers to include them in the treatment decision process early enough. Nearly half the surgeons (49.7%) stated that few or almost none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist before undergoing definitive surgery. Surgeons and radiation oncologists differed in their recommendations in management scenarios. Radiation oncologists were more likely to favor radiation than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (p = 0.03); surgeons were more likely to favor more widely clear margins after breast conservation than were radiation oncologists (p = 0.001). Conclusions: Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.

  10. Health consequences of using smokeless tobacco: summary of the Advisory Committee's report to the Surgeon General.

    OpenAIRE

    Cullen, J W; Blot, W; Henningfield, J.; Boyd, G; Mecklenburg, R; Massey, M M

    1986-01-01

    On March 25, 1986, the Surgeon General of the Public Health Service released a report that detailed the results of the first comprehensive, indepth review of the relationship between smokeless tobacco use and health. This review, prepared under the auspices of the Surgeon General's Advisory Committee on the Health Consequences of Using Smokeless Tobacco, is summarized in this article. In the United States, smokeless tobacco is used predominantly in the forms of chewing tobacco and snuff. Duri...

  11. Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study

    International Nuclear Information System (INIS)

    Purpose: To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists. Methods and Materials: We surveyed attending surgeons and radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in metropolitan Detroit and Los Angeles. We identified 419 surgeons, of whom 318 (76%) responded, and 160 radiation oncologists, of whom 117 (73%) responded. We assessed demographic, professional, and practice characteristics; challenges to coordinated care; and attitudes toward management in three scenarios. Results: 92.1% of surgeons and 94.8% of radiation oncologists indicated access to a multidisciplinary tumor board. Nevertheless, the most commonly identified challenge to radiation oncologists, cited by 27.9%, was failure of other providers to include them in the treatment decision process early enough. Nearly half the surgeons (49.7%) stated that few or almost none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist before undergoing definitive surgery. Surgeons and radiation oncologists differed in their recommendations in management scenarios. Radiation oncologists were more likely to favor radiation than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (p = 0.03); surgeons were more likely to favor more widely clear margins after breast conservation than were radiation oncologists (p = 0.001). Conclusions: Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.

  12. Preoperative education for lumbar radiculopathy: A survey of US spine surgeons

    OpenAIRE

    Louw, Adriaan; Butler, David S.; Diener, Ina; Puentedura, Emilio J.

    2012-01-01

    Background We sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured i...

  13. Correlation between Surgeon's Experience, Surgery Complexity and the Alteration of Stress Related Physiological Parameters

    OpenAIRE

    Marrelli, Massimo; Gentile, Stefano; Palmieri, Francesca; Paduano, Francesco; Tatullo, Marco

    2014-01-01

    Introduction In the present work we analyzed the hormonal (salivary Cortisol; sC), immune (salivary Immunoglobulin A; sIgA) and cardiovascular (Heart rate, HR, and systolic blood pressure, SBP) responses induced by stress conditions in oral surgeons, randomly recruited according to their expertise level. Materials and methods Each surgeon performed three different surgical procedures with increasing degrees of technical difficulty and under time-limited conditions, to assess whether these var...

  14. The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer.

    OpenAIRE

    Tsang, G M; Watson, D C

    1992-01-01

    BACKGROUND: The treatment and prognosis of non-small cell lung cancer, and assessment of the results of treatment, depend on accurate perioperative staging. The extent to which this is carried out in the United Kingdom is unknown. METHODS: A postal questionnaire survey was undertaken in 1990 to determine the perioperative staging practices of cardiothoracic surgeons in the United Kingdom. RESULTS: Replies from 77 surgeons, who between them performed about 4833 pulmonary resections a year for ...

  15. Twelve Years of Scientific Production on Medline by Latin American Spine Surgeons

    OpenAIRE

    Falavigna, Asdrubal; Botelho, Ricardo Vieira; Teles, Alisson Roberto; Guarise da Silva, Pedro; Martins, Delio; Guyot, Juan Pablo; Gonzalez, Alvaro Silva; Avila, José Maria Jiménez; Defino, Helton Luiz Aparecido

    2014-01-01

    Background Despite the small contribution of LA in the Science Citation Index (SCI), a growing contribution by LA research to international literature has been observed in recent years. Study Design Systematic review. Purpose To evaluate the scientific contribution of Latin American (LA) Spine Surgeons in the last decade. Methods A literature search of publications by LA spinal surgeons on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The resul...

  16. Getting back together after a break-up: Relationship advice for anatomists and surgeons.

    Science.gov (United States)

    Phitayakorn, Roy; Lachman, Nirusha

    2015-10-01

    The "surgeon-anatomist" was originally a single individual who self-pursued knowledge and understanding of anatomy as the foundation for successful surgical outcomes. However, recent advances in medical education have ironically led to the separation of anatomy and surgery. This physical and emotional "divorce" of anatomists and surgeons into separate individuals has created several critical educational issues for medical and surgical educators including a general lack of anatomical knowledge in medical students and misalignment of graduate medical education procedural specialty training with the Accreditation Council of Graduate Medical Education Core Competencies and now the Next Accreditation System. There are numerous opportunities for anatomists and surgeons to work together to improve educational instruction of established difficult anatomical regions, procedural training, or even develop new techniques and procedures. Similarly, anatomists with specialized training in medical education would be invaluable partners to ensure that procedural assessments align with instructional technologies for truly longitudinal curricula that starts at the medical student level, but stops at the patient outcomes of attending surgeons. This mutually beneficial relationship would be similar to multidisciplinary care teams and current surgeon and PhD/EdD partnerships. The restoration of the relationship between anatomists and surgeons would be invaluable to surgical education and remains an exciting research opportunity. PMID:26174432

  17. Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

    International Nuclear Information System (INIS)

    There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance)

  18. Correlation between Surgeon's experience, surgery complexity and the alteration of stress related physiological parameters.

    Directory of Open Access Journals (Sweden)

    Massimo Marrelli

    Full Text Available In the present work we analyzed the hormonal (salivary Cortisol; sC, immune (salivary Immunoglobulin A; sIgA and cardiovascular (Heart rate, HR, and systolic blood pressure, SBP responses induced by stress conditions in oral surgeons, randomly recruited according to their expertise level.Each surgeon performed three different surgical procedures with increasing degrees of technical difficulty and under time-limited conditions, to assess whether these variants may influence the risks of stress-induced secondary hypertension among the involved health professionals. sC and sIgA samples and cardiovascular function measurements were taken up before, during, and two hours after every surgery. Salivary samples and cardiovascular measurements were taken also during non-surgical days, as baseline controls.We observed that more experienced surgeons showed a higher stress management ability compared to those with less experience or, generally, younger, which are more exposed to the risks of developing secondary hypertension. Nevertheless, indipendently of sex and experience, oral surgeons are constantly exposed to high risks of developing stress-related diseases.On the basis of the issues addressed and the results obtained, we have highlighted the importance of the investigated stress biomarkers to monitor and to prevent stress-related pathologies among oral surgeons. This approach is aimed to emphasize the significance of these specific stress-biomarkers, which represent a powerful instrument to evaluate stress levels in oral surgeons, and that may help to reduce the most severe life-threatening risks to which they are daily exposed. In conclusion, final goal of this study is to suggest an useful guideline to monitor the stress levels of oral and maxillofacial surgeons in order to improve their quality of life, which is inevitably reflected on the quality of the performances provided and, finally, to prevent possible mistakes in their daily activities.

  19. Success of Debridement and Implant Retention in Periprosthetic Joint Infection – Does the Surgeon Matter?

    Science.gov (United States)

    Young, Simon W; Zhu, Mark; Ravi, Saiprasad; Luey, Chris

    2016-01-01

    Objective: Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty (TJA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) surgery is often the initial treatment and success rates vary. This study aimed to identify factors affecting success rates of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon can affect outcome. Method: This retrospective review included one hundred and sixty-two patients undergoing DAIR for first-episode PJI following hip and knee arthroplasty at one of three tertiary hospitals. Treatment success was defined as no relapse within two years of DAIR. Data on patient, hospital, and surgical factors were identified including duration of symptoms, time from primary, previous revisions, age of prosthesis, bacterial subtype, whether modular component exchange was performed and whether an arthroplasty surgeon performed the procedure. Adjusted multivariate analysis was performed to identify factors associated with success of the DAIR procedure. Results: Overall success rate of DAIR in both hip and knee arthroplasty was 60%. A specialist arthroplasty surgeon was present in 42% of cases. Arthroplasty surgeons performed modular exchange in 51% of cases compared to 32.5% for other surgeons. Inclusion of modular exchange in the procedure was the only factor associated with DAIR success (OR 3.1, p<0.013). Time to theatre of less than 24 hours (OR 0.59), duration of symptoms less than one week (OR 1.28), age of prosthesis less than 3 months (OR 1.47) and having an arthroplasty surgeon perform DAIR (OR 1.6) did not lead to statistically significant improvements in success rate. Conclusions: Modular exchange was associated with a significantly higher success rate for both hip and knee PJI, suggesting thorough debridement is important in DAIR. Arthroplasty surgeons were more likely to perform modular exchange, but their presence in theatre alone

  20. Surgeons' Knowledge and Practices Regarding the Role of Radiation Therapy in Breast Cancer Management

    International Nuclear Information System (INIS)

    Purpose: Population-based studies suggest underuse of radiation therapy, especially after mastectomy. Because radiation oncology is a referral-based specialty, knowledge and attitudes of upstream providers, specifically surgeons, may influence patients' decisions regarding radiation, including whether it is even considered. Therefore, we sought to evaluate surgeons' knowledge of pertinent risk information, their patterns of referral, and the correlates of surgeon knowledge and referral in specific breast cancer scenarios. Methods and Materials: We surveyed a national sample of 750 surgeons, with a 67% response rate. We analyzed responses from those who had seen at least 1 breast cancer patient in the past year (n=403), using logistic regression models to identify correlates of knowledge and appropriate referral. Results: Overall, 87% of respondents were general surgeons, and 64% saw >10 breast cancer patients in the previous year. In a scenario involving a 45-year-old undergoing lumpectomy, only 45% correctly estimated the risk of locoregional recurrence without radiation therapy, but 97% would refer to radiation oncology. In a patient with 2 of 20 nodes involved after mastectomy, 30% would neither refer to radiation oncology nor provide accurate information to make radiation decisions. In a patient with 4 of 20 nodes involved after mastectomy, 9% would not refer to radiation oncology. Fewer than half knew that the Oxford meta-analysis revealed a survival benefit from radiation therapy after lumpectomy (45%) or mastectomy (32%). Only 16% passed a 7-item knowledge test; female and more-experienced surgeons were more likely to pass. Factors significantly associated with appropriate referral to radiation oncology included breast cancer volume, tumor board participation, and knowledge. Conclusions: Many surgeons have inadequate knowledge regarding the role of radiation in breast cancer management, especially after mastectomy. Targeted educational interventions may

  1. Surgeons' Knowledge and Practices Regarding the Role of Radiation Therapy in Breast Cancer Management

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Jessica [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Hawley, Sarah T.; Zikmund-Fisher, Brian J. [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Janz, Nancy K. [Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan (United States); Sabel, Michael S. [Department of Surgery, University of Michigan, Ann Arbor, Michigan (United States); Katz, Steven J. [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2013-12-01

    Purpose: Population-based studies suggest underuse of radiation therapy, especially after mastectomy. Because radiation oncology is a referral-based specialty, knowledge and attitudes of upstream providers, specifically surgeons, may influence patients' decisions regarding radiation, including whether it is even considered. Therefore, we sought to evaluate surgeons' knowledge of pertinent risk information, their patterns of referral, and the correlates of surgeon knowledge and referral in specific breast cancer scenarios. Methods and Materials: We surveyed a national sample of 750 surgeons, with a 67% response rate. We analyzed responses from those who had seen at least 1 breast cancer patient in the past year (n=403), using logistic regression models to identify correlates of knowledge and appropriate referral. Results: Overall, 87% of respondents were general surgeons, and 64% saw >10 breast cancer patients in the previous year. In a scenario involving a 45-year-old undergoing lumpectomy, only 45% correctly estimated the risk of locoregional recurrence without radiation therapy, but 97% would refer to radiation oncology. In a patient with 2 of 20 nodes involved after mastectomy, 30% would neither refer to radiation oncology nor provide accurate information to make radiation decisions. In a patient with 4 of 20 nodes involved after mastectomy, 9% would not refer to radiation oncology. Fewer than half knew that the Oxford meta-analysis revealed a survival benefit from radiation therapy after lumpectomy (45%) or mastectomy (32%). Only 16% passed a 7-item knowledge test; female and more-experienced surgeons were more likely to pass. Factors significantly associated with appropriate referral to radiation oncology included breast cancer volume, tumor board participation, and knowledge. Conclusions: Many surgeons have inadequate knowledge regarding the role of radiation in breast cancer management, especially after mastectomy. Targeted educational

  2. Comparison of specimen adequacy in fine-needle aspiration biopsies performed by surgeons and pathologists

    International Nuclear Information System (INIS)

    Fine-needle aspiration biopsy (FNAB) may yield different results depending on its operator. We compared the proportions of unsatisfactory aspirates obtained by pathologists vs. surgeons. In a retrospective review, all FNAB reports and slides performed between March 2002 and February 2003 were grouped by organ/site and according to whether they were done by pathologist or a surgeon. The proportions of unsatisfactory aspirates for pathologists and surgeons were compared. Of 692 FNAB's, 390 were performed by pathologists at the FNAC clinic and the remainder by surgeons. Overall, 15.5% of aspirates obtained were unsatisfactory (n=107). Of aspirates obtained by surgeons, 29.5% were unsatisfactory, compared to 4.6% of those obtained by pathologists (P<0.001). Pathologists had significantly lower proportions of unsatisfactory aspirates in all sites. A 33% reduction in the number of lymph node excisional biopsies has been reported subsequent to establishment of the FNAC clinic. The advantages of a pathologist performing FNAB are that a rapid evaluation can be rendered regarding specimen adequacy and the need for repeating the procedure. In addition, pathologists can direct the distribution of aspirated material for other tests such as culture study, flow cytometry and electron microscopy, as indicated by preliminary evaluation of the smears. These factors significantly lower the proportions of unsatisfactory specimens and improve the diagnstic accuracy of FNAB technique. (author)

  3. Surgeons' efficiency change is a major determinant of their productivity change.

    Science.gov (United States)

    Nakata, Yoshinori; Watanabe, Yuichi; Narimatsu, Hiroto; Yoshimura, Tatsuya; Otake, Hiroshi; Sawa, Tomohiro

    2016-05-01

    Purpose - The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons' productivity in one year. Design/methodology/approach - The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons' Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI. Findings - The only significant difference between the two groups was ECs (p value - EC is a major determinant of surgeons' productivity change. The best way to improve surgeons' productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds. PMID:27142950

  4. Surgeon factor on laser in situ keratomileusis in low and moderate myopia

    Directory of Open Access Journals (Sweden)

    Istiantoro Istiantoro

    2003-09-01

    Full Text Available The purpose of this study was to evaluate the effectiveness and predictability of laser in situ keratomileusis (LASIK procedure performed by three surgeons in low and moderate myopia. One hundred twenty nine eyes from 68 patients underwent LASIK procedure, performed by three different surgeons (X, Y, Z using the same procedure and same instruments were reviewed. These patients are divided into two groups, group A (below – 6.00 diopters and group B (between – 6.00 and –10.00 diopters. Patients were observed on day 1, day 7, 1st month and 3rd month. Results: The evaluation of effectiveness and predictability is based upon uncorrected visual acuity (UCVA and spherical equivalent refraction, respectively. The variation dispersion between attempted correction and achieved correction is measured using coefficient of determination (R2. The statistical analysis shows indifferent results for the three surgeons. The conclusion was that the effectiveness and predictability of LASIK procedure performed by the three surgeons in both groups are indifferent. Hence, this study suggests that the surgeon factor does not affect the result of LASIK procedure. (Med J Indones 2003; 12: 148-54 Keywords: LASIK, spherical equivalent, visual aquity

  5. Supply and demand for liver transplant surgery: Are we training enough surgeons?

    Science.gov (United States)

    Tuttle-Newhall, J. E.; Pietrobon, R.; Marroquin, C. E.; Collins, B. H.; Desai, D. M.; Kuo, P. C.; Pappas, T. N.

    2008-01-01

    The purpose of our study is to determine whether the current level of transplant fellow training is sufficient to meet the future demand for liver transplantation in the United States. Historical data from the Nationwide Inpatient Samples (NIS) for the years 1998 through 2003 were used to construct an estimate of the annual number of liver transplant procedures currently being performed in the United States, and the number projected for each year through 2020. Estimates for the current and future number of surgeons performing liver transplant procedures were also constructed using the same database. The NIS database was used because current national transplant registries do not include information on the number of surgeons performing liver transplant procedures. Using historical data derived from the NIS database, we project that the estimated number of liver transplant procedures per surgeon will remain relatively stable through 2020, with each surgeon performing an average of 12.9 procedures in 2020 compared to 12.9 currently. We conclude that the relationship between demand for liver transplantation in the United States and the supply of liver transplant surgeons will remain stable over the next 15 years. PMID:18695755

  6. Attitudes towards chiropractic: an analysis of written comments from a survey of north american orthopaedic surgeons

    Directory of Open Access Journals (Sweden)

    Busse Jason W

    2011-10-01

    Full Text Available Abstract Background There is increasing interest by chiropractors in North America regarding integration into mainstream healthcare; however, there is limited information about attitudes towards the profession among conventional healthcare providers, including orthopaedic surgeons. Methods We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopaedic surgeons that inquired about demographic variables and their attitudes towards chiropractic. Our survey included an option for respondants to include written comments, and our present analysis is restricted to these comments. Two reviewers, independantly and in duplicate, coded all written comments using thematic analysis. Results 487 surgeons completed the survey (response rate 49%, and 174 provided written comments. Our analysis revealed 8 themes and 24 sub-themes represented in surgeons' comments. Reported themes were: variability amongst chiropractors (n = 55; concerns with chiropractic treatment (n = 54; areas where chiropractic is perceived as effective (n = 43; unethical behavior (n = 43; patient interaction (n = 36; the scientific basis of chiropractic (n = 26; personal experiences with chiropractic (n = 21; and chiropractic training (n = 18. Common sub-themes endorsed by surgeon's were diversity within the chiropractic profession as a barrier to increased interprofessional collaboration, endorsement for chiropractic treatment of musculoskeletal complaints, criticism for treatment of non-musculoskeletal complaints, and concern over whether chiropractic care was evidence-based. Conclusions Our analysis identified a number of issues that will have to be considered by the chiropractic profession as part of its efforts to further integrate chiropractic into mainstream healthcare.

  7. Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons

    Directory of Open Access Journals (Sweden)

    Cavallini GM

    2016-05-01

    Full Text Available Gian Maria Cavallini, Tommaso Verdina, Matteo Forlini, Veronica Volante, Michele De Maria, Giulio Torlai, Caterina Benatti, Giancarlo Delvecchio Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy Purpose: To determine the efficacy of bimanual microincision cataract surgery (B-MICS performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO incidence, and clear corneal incision (CCI architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons. Patients and methods: Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A. Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B. Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software. Results: Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05. In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025. Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively

  8. Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

    Science.gov (United States)

    Wiley, Kevin F; Yousuf, Tariq; Pasque, Charles B; Yousuf, Khalid

    2014-06-01

    Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals. According to the survey results, residents and fellows have a similar knowledge of coding and billing, regardless of their level of training or type of business education received in residency. Most residents would like formal training in coding, billing, and practice management didactics; this is consistent with data from previous studies. PMID:24945481

  9. Interprofessional non-technical skills for surgeons in disaster response: a literature review.

    Science.gov (United States)

    Willems, Anneliese; Waxman, Bruce; Bacon, Andrew K; Smith, Julian; Kitto, Simon

    2013-09-01

    Natural disasters impose a significant burden on society. Current disaster training programmes do not place an emphasis on equipping surgeons with non-technical skills for disaster response. This literature review sought to identify non-technical skills required of surgeons in disaster response through an examination of four categories of literature: "disaster"; "surgical"; "organisational management"; and "interprofessional". Literature search criteria included electronic database searches, internet searches, hand searching, ancestry searching and networking strategies. Various potential non-technical skills for surgeons in disaster response were identified including: interpersonal skills such as communication, teamwork and leadership; cognitive strategies such flexibility, adaptability, innovation, improvisation and creativity; physical and psychological self-care; conflict management, collaboration, professionalism, health advocacy and teaching. Such skills and the role of interprofessionalism should be considered for inclusion in surgical disaster response training course curricula. PMID:23751138

  10. Ambroise Paré (1510 to 1590): a surgeon centuries ahead of his time.

    Science.gov (United States)

    Shen, James T; Weinstein, Michael; Beekley, Alec; Yeo, Charles; Cowan, Scott

    2014-06-01

    In their extensive writings, Hippocrates and Celsus counseled physicians to be knowledgeable in both the medical and surgical management of patient recovery. However, their words fell by the wayside because cutting of the body was forbidden by the Roman Catholic Church. Furthermore, the contemporaneous Arabic medical teachings emphasized tradition and authority over observation and personal experience. This created an ever-growing rift between the schools of surgical and pharmacologic medicine with both groups denying their involvement in the other domain. Surgeons had been plagued by postoperative complications including infection, malnutrition, and muscular wasting for centuries. Surgeons were forced to re-examine how diet and exercise affected outcomes before the advent of microbiology and advances in pharmacology. All of this changed when Ambroise Paré, a 16th century surgeon, revolutionized the medical world with his astute observations of postoperative diet and exercise. PMID:24887788

  11. [The surgeon and the Emperor--a humanitarian on the battlefield].

    Science.gov (United States)

    Feinsod, M

    1998-11-01

    The Baron Dominique-Jean Larrey, one of the greatest names in military surgery, participated as Chief Surgeon in all the Napoleonic campaigns. He developed the concept of early evacuation from the battlefield, and of immediate treatment of the wounded, even under fire. He implemented improved surgical techniques and improved wound care that were followed by surgeons all over Europe. His devotion to wounded soldiers crossed national boundaries and became a way of life. Here is an account of Larrey's involvement in the aftermath of the Battles of Lutzen and Bautzen (May-June 1813), when many soldiers were accused of self-mutilation and were about to be executed. He dared to oppose, singlehanded, the Emperor, the highest military authorities and their concurring physicians and surgeons, armed only by his undisputed honesty, professional authority and exceptional reputation won over years of devotion to wounded soldiers. Larrey saved the lives of many soldiers and set an example of unbent ethical integrity. PMID:10911440

  12. Who's buying lunch: are gifts to surgeons from industry bad for patients?

    Science.gov (United States)

    Grant, David C; Iserson, Kenneth V

    2005-11-01

    Why does gifting exist in the medical marketplace? It provides a sales advantage in a competitive marketplace by establishing crucial relationships with the patients' fiduciary: the physician and surgeon. Do gifts to physicians from industry harm patients? One can cite mountains of indirect evidence that they do, and maybe in the case of recalled devices and drugs there are actual corpses, but these examples are retrospective and it is impossible to prove that removing detailing eliminates the harm. Banning gifts to surgeons would not completely fix the ethical problem of pharmaceutical and device marketing. Gifts are important because they buy access and foster relationships, but inherent bias in research and the medical literature makes it very difficult to remain objective. It is a race, and education has not kept pace with advertising; only 10% of 575 internal medicine physicians thought they had had sufficient training during medical school and residency regarding professional interaction with sales representatives. Would banning gifts help at all? Would enforcing an unpopular ethical code protect patients? There might be a small improvement, but not as significant as eliminating representatives and product samples altogether. This is not likely to happen without an enormous fight against the wealthiest industry in America. The solution is education. To borrow industry's argument, physicians and surgeons are ethical creatures with capacity for judgment and integrity. They need to understand and believe the magnitude of the problem. Detailing exists because there is a market for it, empowering surgeons with ethical training reduces the demand for goodies, and at some point the popular choice will be to buy their own lunch. Business ethics are not medical ethics. Industry is behaving exactly as it must to maximize profits. Although it is painful for some surgeons, surgical residencies, and professional organizations to envision a future with diminished corporate

  13. Clinical Efficacy of Simulated Vitreoretinal Surgery to Prepare Surgeons for the Upcoming Intervention in the Operating Room

    OpenAIRE

    Deuchler, Svenja; Wagner, Clemens; Singh, Pankaj; Müller, Michael; Al-Dwairi, Rami; Benjilali, Rachid; Schill, Markus; Ackermann, Hanns; Bon, Dimitra; Kohnen, Thomas; Schoene, Benjamin; Koss, Michael; Koch, Frank

    2016-01-01

    Purpose: To evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons’ performance. Methods: In a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly de...

  14. Customised 3D Printing: An Innovative Training Tool for the Next Generation of Orbital Surgeons.

    Science.gov (United States)

    Scawn, Richard L; Foster, Alex; Lee, Bradford W; Kikkawa, Don O; Korn, Bobby S

    2015-01-01

    Additive manufacturing or 3D printing is the process by which three dimensional data fields are translated into real-life physical representations. 3D printers create physical printouts using heated plastics in a layered fashion resulting in a three-dimensional object. We present a technique for creating customised, inexpensive 3D orbit models for use in orbital surgical training using 3D printing technology. These models allow trainee surgeons to perform 'wet-lab' orbital decompressions and simulate upcoming surgeries on orbital models that replicate a patient's bony anatomy. We believe this represents an innovative training tool for the next generation of orbital surgeons. PMID:26121063

  15. Canadian Hepatitis C Look-Back Investigation to Detect Transmission from an Infected General Surgeon

    Directory of Open Access Journals (Sweden)

    Meenakshi Dawar

    2010-01-01

    Full Text Available BACKGROUND: In February 2007, a general surgeon in Charlottetown, Prince Edward Island, tested positive for hepatitis C virus (HCV. The surgeon’s infection onset date could not be determined; however, episodic hepatic enzyme elevations were first detected in November 2004 and again in February 2007. HCV transmission during surgery, alhough rare, has been documented. A phased look-back HCV screening program was conducted to detect HCV transmission from this surgeon to patients who underwent the highest-risk procedures in the three years before his positive test.

  16. Surgeon factor on laser in situ keratomileusis in low and moderate myopia

    OpenAIRE

    Istiantoro Istiantoro; Nandia Primadina

    2003-01-01

    The purpose of this study was to evaluate the effectiveness and predictability of laser in situ keratomileusis (LASIK) procedure performed by three surgeons in low and moderate myopia. One hundred twenty nine eyes from 68 patients underwent LASIK procedure, performed by three different surgeons (X, Y, Z) using the same procedure and same instruments were reviewed. These patients are divided into two groups, group A (below – 6.00 diopters) and group B (between – 6.00 and –10.00 diopters). Pati...

  17. Education and Training to Address Specific Needs During the Career Progression of Surgeons.

    Science.gov (United States)

    Sachdeva, Ajit K; Blair, Patrice Gabler; Lupi, Linda K

    2016-02-01

    Surgeons have specific education and training needs as they enter practice, progress through the core period of active practice, and then as they wind down their clinical work before retirement. These transitions and the career progression process, combined with the dynamic health care environment, present specific opportunities for innovative education and training based on practice-based learning and improvement, and continuous professional development methods. Cutting-edge technologies, blended models, simulation, mentoring, preceptoring, and integrated approaches can play critical roles in supporting surgeons as they provide the best surgical care throughout various phases of their careers. PMID:26612024

  18. Differences between endocrinologists and endocrine surgeons in management of the solitary thyroid nodule

    DEFF Research Database (Denmark)

    Walsh, John P; Ryan, Simon A; Lisewski, Dean;

    2007-01-01

    BACKGROUND: It is not known whether management of the solitary thyroid nodule differs between endocrinologists and endocrine surgeons. METHODS: A questionnaire containing a hypothetical case (a 42-year-old euthyroid woman with a 2-x-3-cm solitary thyroid nodule) and 13 clinical variations was sent...

  19. Cadaveric Anatomy in the Future of Medical Education: What Is the Surgeon's View?

    Science.gov (United States)

    Sheikh, Ahmad Hassan; Barry, Denis S.; Gutierrez, Humberto; Cryan, John F.; O'Keeffe, Gerard W.

    2016-01-01

    Reduced contact hours and access to cadaveric/prosection-based teaching in medical education has led to many doctors reporting inadequate anatomical knowledge of junior doctors. This trend poses significant risk, but perhaps most of all in surgery. Here the opinions of surgeons regarding current and future teaching practices in anatomy were…

  20. Clinical Decision Analysis and Markov Modeling for Surgeons: An Introductory Overview.

    Science.gov (United States)

    Hogendoorn, Wouter; Moll, Frans L; Sumpio, Bauer E; Hunink, M G Myriam

    2016-08-01

    This study addresses the use of decision analysis and Markov models to make contemplated decisions for surgical problems. Decision analysis and decision modeling in surgical research are increasing, but many surgeons are unfamiliar with the techniques and are skeptical of the results. The goal of this review is to familiarize surgeons with techniques and terminology used in decision analytic papers, to provide the reader a practical guide to read these papers, and to ensure that surgeons can critically appraise the quality of published clinical decision models and draw well founded conclusions from such reports.First, a brief explanation of decision analysis and Markov models is presented in simple steps, followed by an overview of the components of a decision and Markov model. Subsequently, commonly used terms and definitions are described and explained, including quality-adjusted life-years, disability-adjusted life-years, discounting, half-cycle correction, cycle length, probabilistic sensitivity analysis, incremental cost-effectiveness ratio, and the willingness-to-pay threshold.Finally, the advantages and limitations of research with Markov models are described, and new modeling techniques and future perspectives are discussed. It is important that surgeons are able to understand conclusions from decision analytic studies and are familiar with the specific definitions of the terminology used in the field to keep up with surgical research. Decision analysis can guide treatment strategies when complex clinical questions need to be answered and is a necessary and useful addition to the surgical research armamentarium. PMID:26756750

  1. Attitudes and beliefs about placebo surgery among orthopedic shoulder surgeons in the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Karolina Wartolowska

    Full Text Available OBJECTIVES: To survey surgeons on their beliefs and attitudes towards the use of placebo in surgery. METHODS: British orthopedic shoulder surgeons, attending a national conference in the United Kingdom, were asked to complete a self-report online questionnaire about their beliefs and attitudes towards the use of placebo related to surgical intervention. The survey included questions about ethical issues, the mechanism of placebo effects, and any concerns regarding its use. RESULTS: 100 surgeons who participated in the survey believed that placebo surgery is ethically acceptable (96%, especially as a part of a clinical trial (46%. Respondents thought that a placebo effect in surgery is real i.e. has a scientific basis (92%, that placebo can be therapeutically beneficial (77%, and that it involves psychological mechanisms (96%. Over half of the respondents (58% have used a surgical procedure with a significant placebo component at least once in their professional career. Their main concern about placebo use in surgery was that it might involve an element of deception. CONCLUSIONS AND IMPLICATIONS: Surgeons generally agreed that a placebo component to surgical intervention might exist. They also supported placebo use in clinical trials and considered it ethical, providing it does not involve deception of patients. More studies are needed, particularly among other surgical specialties and with larger numbers of participants, to better understand the use of placebo in surgery.

  2. 论外科医师的社会责任%Social responsibility of surgeons

    Institute of Scientific and Technical Information of China (English)

    顾晋

    2012-01-01

    外科医师是一个神圣的职业.通过外科手术解除患者的病痛是外科医师的职业责任;而社会责任感是外科医师必备的素质.注重社会责任的培训,强化社会责任的实现,坚持以患者的利益至上,努力在临床实践中遵循以患者为中心的原则,是时代对我们提出的要求.%Surgeon is sacred career.To cure patients by surgery is the surgeon's work,while the sociall responsibility is the surgeon's soul.To strengthen and promote the social responsibility is a demand of our age; thus,every surgeon should adhere to the supremacy of the patients' interests in clinical practice.

  3. Musculoskeletal pain among surgeons performing minimally invasive surgery: a systematic review

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup;

    2016-01-01

    quality of reporting of the included studies. Semi-quantitative comparisons were made. Results: In total, 2685 records were screened and 15 articles were included in the analysis. All studies were observational with sample sizes ranging from one single surgeon to 250 questionnaire responses. None of the...

  4. The William Houston Gold Medal of the Royal College of Surgeons of Edinburgh 2014, orthodontic cases.

    Science.gov (United States)

    Almuzian, Mohammed

    2015-09-01

    The William Houston Medal is awarded to the individual achieving the highest mark at, the Membership in Orthodontics (MOrth) examination at the Royal College of Surgeons of Edinburgh. As part of the examination the candidate must submit five clinical cases. Details of two cases treated by the winning candidate are presented in this paper. PMID:26082385

  5. Workflow Driven Decision Support Systems: A case of an intra-operative visualization system for surgeons

    NARCIS (Netherlands)

    Jalote-Parmar, A.

    2009-01-01

    Inadequate visualization during Minimally Invasive Surgeries (MIS) has led several technology research labs to develop decision support systems such as Intra-operative Visualization Systems (IVS). IVS focuses on providing surgeons with real-time imaging support to improve task visualization and navi

  6. Caution: Alcohol Advertising and the Surgeon General's Alcohol Warnings May Have Adverse Effects on Young Adults.

    Science.gov (United States)

    Blood, Deborah J.; Snyder, Leslie B.

    A study investigated the effects of the newly introduced Surgeon General's alcohol warnings and advertisements on college students. One hundred fifty-nine undergraduates in communication sciences at the University of Connecticut viewed slides of alcohol products, with or without advertisements and warnings. Following the viewings, subjects filled…

  7. Determinants of burnout among transplant surgeons: a national survey in the United States.

    Science.gov (United States)

    Jesse, M T; Abouljoud, M; Eshelman, A

    2015-03-01

    Burnout is a response to chronic strain within the workplace characterized by feelings of inefficacy (reduced personal accomplishment), cynicism (depersonalization) and emotional exhaustion. The purpose of this study was to report prevalence and explore organizational and interpersonal contributors of burnout in transplant surgeons. We performed a national cross-sectional survey of 218 transplant surgeons on sociodemographics, professional characteristics, frequency of difficult patient interactions and comfort in dealing with difficult patient interactions, decisional authority, psychological job demands, supervisor and coworker support, with burnout as the outcome. 40.1% reported high levels of emotional exhaustion, 17.1% reported high levels of depersonalization and 46.5% reported low personal accomplishment. Greater emotional exhaustion was predicted by lower decisional authority, higher psychological work demands, and lower coworker support. Greater discomfort with difficult patient interactions and lower coworker support predicted depersonalization. Lastly, lower decisional authority, lower coworker support, less frequent difficult patient interactions but greater discomfort with difficult patient interactions predicted lower personal accomplishment. The findings of this study show that unsupportive environments with little decisional control and high work-related demands contribute to the development of burnout in transplant surgeons. Implications for interventions aimed at prevention of burnout in transplant surgeons are discussed. PMID:25676165

  8. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael;

    2006-01-01

    OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal reh...

  9. Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons.

    Science.gov (United States)

    Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M

    2005-09-15

    For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy. PMID:16163102

  10. Bacterial contamination of surgeons' gloves during shunt insertion; a pilot study

    DEFF Research Database (Denmark)

    Sørensen, Preben; Ejlertsen, Tove; Aaen, Dorte;

    2008-01-01

    handling the shunt and completing the operation. The plates were cultured for 6 days in both aerobic and anaerobic environment. In all cases the surgeons gloves were contaminated, and in six cases also the nurses' gloves were contaminated, as well as all three assistants. Propionebacterium acnes were...

  11. Qualitative evaluation of a form for standardized information exchange between orthopedic surgeons and occupational physicians

    Directory of Open Access Journals (Sweden)

    van Staa Anne

    2006-11-01

    Full Text Available Abstract Background Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advices to the patient. Therefore, we evaluated a standardized information exchange form for the exchange of relevant information between the orthopedic surgeon and the occupational physician. The main goals of this qualitative study are to evaluate whether the form improved information exchange, whether the form gave relevant information, and to generate ideas to further improve this information exchange. Methods The information exchange form was developed in two consensus meetings with five orthopedic surgeons and five occupational physicians. To evaluate the information exchange form, a qualitative evaluation was set up. Structured telephone interviews were undertaken with the patients, interviews with the physicians were face-to-face and semi-structured, based on a topic list. These interviews were recorded and literally transcribed. Each interview was analyzed separately in Atlas-Ti. Results The form was used for 8 patients, 7 patients agreed to participate in the qualitative evaluation. All three orthopedic surgeons involved and three of the six involved occupational physicians agreed to be interviewed. The form was transferred to 4 occupational physicians, the other 3 patients recovered before they visited the occupational physician. The information on the form was regarded to be useful. All orthopedic surgeons agreed that the occupational physician should take the initiative. Most physicians felt that the form should not be filled out for each patient visiting an orthopedic surgeon, but only for those patients who do not recover as expected. Orthopedic surgeons suggested that a copy of the medical information provided to the general practitioner could also be provided to occupational physicians. Conclusion

  12. Twelve Years of Scientific Production on Medline by Latin American Spine Surgeons

    Science.gov (United States)

    Falavigna, Asdrubal; Botelho, Ricardo Vieira; Teles, Alisson Roberto; Guarise da Silva, Pedro; Martins, Delio; Guyot, Juan Pablo; Gonzalez, Alvaro Silva; Avila, José Maria Jiménez; Defino, Helton Luiz Aparecido

    2014-01-01

    Background Despite the small contribution of LA in the Science Citation Index (SCI), a growing contribution by LA research to international literature has been observed in recent years. Study Design Systematic review. Purpose To evaluate the scientific contribution of Latin American (LA) Spine Surgeons in the last decade. Methods A literature search of publications by LA spinal surgeons on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The results were limited to articles published from January 2000 to December 2011. The quality of the publication was evaluated with the journal impact factor (IF), Oxford classification and number of citations. Results This study comprised 320 articles published in the Medline database by LA spine surgeons from 2000 to 2011. In recent years, there has been an increase in the number of publications by LA spine surgeons. It was observed that 38.4% of LA papers were published in LA journals. 46.6% of the articles were published in journals with an IF lower than 1, and there was no statistically significant difference in the number of articles published in journals with a higher IF during the period. Linear-by-linear association analysis demonstrated an improvement in the level of evidence provided by LA articles published in recent years. Conclusions This study showed a growth in the number of publications in last 12 years by LA spinal surgeons. It is necessary to discuss a way to increase quantity and quality of scientific publications, mainly through a better education in research. PMID:24505336

  13. Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.

    LENUS (Irish Health Repository)

    McCartan, D P

    2012-02-01

    Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.

  14. Reliable assessment of general surgeons' non-technical skills based on video-recordings of patient simulated scenarios

    DEFF Research Database (Denmark)

    Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter; Konge, Lars; Rosenberg, Jacob; Oestergaard, Doris

    2013-01-01

    Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training....

  15. The Influence of Ambient Scent and Music on Patients' Anxiety in a Waiting Room of a Plastic Surgeon

    NARCIS (Netherlands)

    Fenko, Anna; Loock, Caroline

    2014-01-01

    OBJECTIVE: This study investigates the influence of ambient scent and music, and their combination, on patients' anxiety in a waiting room of a plastic surgeon. BACKGROUND: Waiting for an appointment with a plastic surgeon can increase a patient's anxiety. It is important to make the waiting time

  16. Can Surgeons Assess CT Suitability for Endovascular Repair (EVAR) in Ruptured Abdominal Aortic Aneurysm? Implications for a Ruptured EVAR Trial

    International Nuclear Information System (INIS)

    The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% of cases (95% CI, 23.1-68.5%; 9/20 scans; κ = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.

  17. A combined Raman microscopy, XRF and SEM-EDX study of three valuable objects - A large painted leather screen and two illuminated title pages in 17th century books of ordinances of the Worshipful Company of Barbers, London

    Science.gov (United States)

    Chaplin, Tracey D.; Clark, Robin J. H.; Martinón-Torres, Marcos

    2010-07-01

    Raman microscopy has been used to identify the pigments decorating three valuable items owned by the Worshipful Company of Barbers (established in 1308 in London), one being a large leather screen dating to before 1712, the other two being illuminated title pages of books of ordinances of the Company dating to 1605 and 1658. Pigments which could not be fully characterised by this technique (particularly the green paints) have also been subject to XRF or SEM-EDX analysis. The combined analytical approach has shown that the pigments identified on all three items are typical of those in use as artists' pigments in the 17th C and include azurite, indigo, vermilion, red lead, pink and yellow lakes, verdigris, lead white, calcite (and chalk), gypsum, carbon-based black, and gold and silver leaf. However in the case of the screen alone, restoration in the 1980s has been carried out with different pigments - haematite, phthalocyanine green, rutile, and a mixture of azurite, malachite and barium sulfate. This work constitutes the first in-depth study of painted leatherwork and demonstrates that the palette used for this purpose is similar to that used on other works of art of the same date. It has also allowed the original colour schemes of the decorations to be determined where pigment degradation has occurred. The combined analysis has also provided a more complete understanding of the materials used for, or on, objects to which access is limited.

  18. How do surgeons decide to refer patients for adjuvant cancer treatment? Protocol for a qualitative study

    Directory of Open Access Journals (Sweden)

    Urquhart Robin

    2012-10-01

    Full Text Available Abstract Background Non-small cell lung cancer, breast cancer, and colorectal cancer are commonly diagnosed cancers in Canada. Patients diagnosed with early-stage non-small cell lung, breast, or colorectal cancer represent potentially curable populations. For these patients, surgery is the primary mode of treatment, with (neoadjuvant therapies (e.g., chemotherapy, radiotherapy recommended according to disease stage. Data from our research in Nova Scotia, as well as others’, demonstrate that a substantial proportion of non-small cell lung cancer and colorectal cancer patients, for whom practice guidelines recommend (neoadjuvant therapy, are not referred for an oncologist consultation. Conversely, surveillance data and clinical experience suggest that breast cancer patients have much higher referral rates. Since surgery is the primary treatment, the surgeon plays a major role in referring patients to oncologists. Thus, an improved understanding of how surgeons make decisions related to oncology services is important to developing strategies to optimize referral rates. Few studies have examined decision making for (neoadjuvant therapy from the perspective of the cancer surgeon. This study will use qualitative methods to examine decision-making processes related to referral to oncology services for individuals diagnosed with potentially curable non-small cell lung, breast, or colorectal cancer. Methods A qualitative study will be conducted, guided by the principles of grounded theory. The study design is informed by our ongoing research, as well as a model of access to health services. The method of data collection will be in-depth, semi structured interviews. We will attempt to recruit all lung, breast, and/or colorectal cancer surgeons in Nova Scotia (n ≈ 42, with the aim of interviewing a minimum of 34 surgeons. Interviews will be audiotaped and transcribed verbatim. Data will be collected and analyzed concurrently, with two investigators

  19. Does the surgeon still have a role to play in the diagnosis and management of lymphomas?

    Directory of Open Access Journals (Sweden)

    Verghese Anju

    2008-02-01

    Full Text Available Abstract Background Over the course of the past 40 years, there have been a significant number of changes in the way in which lymphomatous disease is diagnosed and managed. With the advent of computed tomography, there is little role for staging laparotomy and the surgeon's role may now more diagnostic than therapeutic. Aims To review all cases of lymphoma diagnosed at a single institution in order determine the current role of the surgeon in the diagnosis and management of lymphoma. Patients and methods Computerized pathology records were reviewed for a five-year period 1996 to 2000 to determine all cases of lymph node biopsy (incisional or excisional in which tissue was obtained as part of a planned procedure. Cases of incidental lymphadenopathy were thus excluded. Results A total of 297 biopsies were performed of which 62 (21% yielded lymphomas. There were 22 females and 40 males with a median age of 58 years (range: 19–84 years. The lymphomas were classified as 80% non-Hodgkin's lymphoma, 18% Hodgkin's lymphoma and 2% post-transplant lymphoproliferative disorder. Diagnosis was established by general surgeons (n = 48, ENT surgeons (n = 9, radiologists (n = 4 and ophthalmic surgeons (n = 1. The distribution of excised lymph nodes was: cervical (n = 23, inguinal (n = 15, axillary (n = 11, intra-abdominal (n = 6, submandibular (n = 2, supraclavicular (n = 2, periorbital (n = 1, parotid (n = 1 and mediastinal (n = 1. Fine needle aspiration cytology had been performed prior to biopsy in only 32 (52% cases and had suggested: lymphoma (n = 10, reactive changes (n = 13, normal (n = 5, inadequate (n = 4. The majority (78% of cervical lymph nodes were subjected to FNAC prior to biopsy whilst this was performed in only 36% of non-cervical lymphadenopathy. Conclusion The study has shown that lymphoma is a relatively common cause of surgical lymphadenopathy. Given the limitations of FNAC, all suspicious lymph nodes should be biopsied following FNAC even

  20. Video recording of cardiac surgical procedures: what the surgeon needs to know.

    Science.gov (United States)

    Massetti, M; Neri, E; Banfi, C; Buklas, D; Gerard, J L; Vigano, M; Chitwood, R W

    2008-10-01

    In the past, rudimentary devices were used to record surgical operations. Currently, the introduction of technologic advances such as high-definition television and the miniaturization of high-resolution digital video cameras provides an opportunity for making significantly enhanced surgical records. These enhancements, coupled with the recent advances in telemedicine and surgical simulation, will improve cardiac surgery training and skill acquisition, decrease operative times and costs, minimize morbidity, and improve overall patient care. The present paper provides a discussion of the media technology offered to surgeons for recording a surgical procedure on video. Hardware technology, including different types of cameras and analogical or digital post processing methods, are reviewed with a surgical ''eye''. This ''how to'' paper provides practical suggestions to surgeons in order to enhance surgical video recording. PMID:18670389

  1. Utility of Surgeon-Performed Ultrasound Assessment of the Lateral Neck for Metastatic Papillary Thyroid Cancer

    Directory of Open Access Journals (Sweden)

    Cortney Y. Lee

    2012-01-01

    Full Text Available Ultrasound is the recommended staging modality for papillary thyroid cancer. Surgeons proficient in US assessment of the neck and experienced in the management of papillary thyroid cancer (PTC appear uniquely qualified to assess the lateral cervical lymph nodes for metastatic disease. Of 310 patients treated for PTC between 2000 and 2008, 109 underwent surgeon-performed ultrasound (SUS of the lateral neck preoperatively. Fine needle aspiration was performed on suspicious lateral lymph nodes. SUS findings were compared with FNA cytology and results of postoperative imaging studies. The sensitivity and negative predictive value of SUS were 88% and 97%, respectively. Four patients were found to have missed metastatic disease within 6 months. No patient underwent a nontherapeutic neck dissection. SUS combined with US-guided FNA of suspicious lymph nodes can accurately stage PTC to reliably direct surgical management.

  2. What is the role of the orthopaedic surgeon in management of fragility fractures?

    Science.gov (United States)

    Sharif, Khalid M; Dimitriou, Rozalia; Giannoudis, Peter V

    2011-06-01

    Fragility fractures are the most prevalent trauma condition that orthopaedic surgeons face today. Osteoporosis and susceptibility to falls are the key predisposing factors. Despite evidence supporting the impact of treating osteoporosis on reducing the incidence of fragility fractures, it is often left untreated. Orthopaedic surgeons are often the first physicians to assess and treat the patient after a fragility fracture. Their role therefore does not end in the skillful fixation of the fractures, but they have a unique opportunity to ensure that preventive measures are implemented. This includes falls prevention, investigation of possible causes underlying osteoporosis, attention to diet, exercise, calcium, and vitamin D supplementation as well as prescription of anti-resorptive and anabolic medication. The need for a dedicated multidisciplinary team needs to be emphasized and therefore effective communication between the different parties is of paramount importance. PMID:21566474

  3. Bleeding risks of herbal, homeopathic, and dietary supplements: a hidden nightmare for plastic surgeons?

    Science.gov (United States)

    Wong, Wendy W; Gabriel, Allen; Maxwell, G Patrick; Gupta, Subhas C

    2012-03-01

    The utilization of complementary and alternative medicine has increased tremendously in the last two decades. Herbal products, homeopathic medicines, and dietary supplements are extremely popular and are available without a prescription (which likely contributes to their popularity). Despite their "natural" characteristics, these remedies have the potential to cause bleeding in patients who undergo surgery. The high use of these supplements among cosmetic surgery patients, coupled with increasing reports of hematomas associated with herbal and homeopathic medicines, prompted the authors to conduct a comprehensive review focused on bleeding risks of such products in an effort to raise awareness among plastic surgeons. This review focuses on 19 herbs, three herbal formulas, two herbal teas, and several other supplements that can cause bleeding perioperatively and postoperatively. In addition to being aware of such adverse effects, plastic surgeons must adequately screen all patients and educate them on the possible dangers associated with these treatments. PMID:22395325

  4. Improving surgeon wellness: The second victim syndrome and quality of care.

    Science.gov (United States)

    Marmon, Louis M; Heiss, Kurt

    2015-12-01

    Improving quality of care logically involves optimizing the duty-readiness and well-being of the healthcare provider. Medical errors and poor outcomes adversely impact the involved providers, especially surgeons, as well as the patients and their families. Unfortunately our current system does little to support these "second victims" who experience various degrees of emotional and psychological stresses including confusion, loss of confidence, and debilitating anxiety. These factors contribute to the alarmingly high rates of professional "burnout," substance abuse, and suicide of healthcare providers as well as increase the likelihood of subsequent medical errors. Mindful efforts to improve the healthcare culture and develop personal support systems can help surgeons become more resilient, provide higher quality patient care, and have longer productive professional lives. Institutional support systems are also necessary to assist "second victims" to recover from the impact of an adverse patient event. PMID:26653167

  5. Social media, surgeons, and the Internet: an era or an error?

    Science.gov (United States)

    Azu, Michelle C; Lilley, Elizabeth J; Kolli, Aparna H

    2012-05-01

    According to the National Research Corporation, 1 in 5 Americans use social media sites to obtain healthcare information. Patients can easily access information on medical conditions and medical professionals; however physicians may not be aware of the nature and impact of this information. All physicians must learn to use the Internet to their advantage and be acutely aware of the disadvantages. Surgeons are in a unique position because, unlike in the primary care setting, less time is spent developing a long-term relationship with the patient. In this literature review, we discuss the impact of the Internet, social networking websites, and physician rating websites and make recommendations for surgeons about managing digital identity and maintaining professionalism. PMID:22546128

  6. Cadaveric anatomy in the future of medical education: What is the surgeons view?

    Science.gov (United States)

    Sheikh, Ahmad Hassan; Barry, Denis S; Gutierrez, Humberto; Cryan, John F; O'Keeffe, Gerard W

    2016-03-01

    Reduced contact hours and access to cadaveric/prosection-based teaching in medical education has led to many doctors reporting inadequate anatomical knowledge of junior doctors. This trend poses significant risk, but perhaps most of all in surgery. Here the opinions of surgeons regarding current and future teaching practices in anatomy were surveyed. Eighty surgeons were invited to complete a questionnaire, 48 of which were returned for a 60% response rate. Respondents were asked to select the method they viewed as the best method of teaching anatomy. Sixty-five percent of respondents selected "cadaver/prosection demonstration" (P integrated into anatomical education. These findings support the continued use of cadaveric/prosection-based teaching, and will help inform the integration of radiology in the design and implementation of anatomy teaching in medical education. Anat Sci Educ 9: 203-208. © 2015 American Association of Anatomists. PMID:26213365

  7. Patients attitude towards surgeons attire in Our Lady of Lourdes Hospital Drogheda

    OpenAIRE

    Babak Meshkat; Gary Allan Bass; Melania Matcovici; Zarah Farnes; Claire Buckley; Omar Al Saffar; Peter Gillen

    2015-01-01

    Background A doctor’s competence and professionalism is often judged on the basis of attire. Our Lady of Lourdes (OLOL) is a leading Irish hospital in the implementation of Bare Below the Elbows (BBTE) policy, however surgical attire is not standardised and there is great variability in attire worn on wards. We aimed to evaluate patients attitude towards surgeons attire in OLOL. Methods A prospective survey of adult surgical in-patients was conducted from October 2013 to Feb...

  8. Asian Outcomes of Primary Breast Augmentation in 162 Consecutive Cases by a Single Surgeon

    OpenAIRE

    Kim, Cheol Hwan

    2015-01-01

    Background: In 162 Asian patients, primary breast augmentation was performed by a single surgeon during 5 years. The purpose of this study evaluates Asian outcomes in primary breast augmentation using single antibiotic breast irrigation by a single surgeon’s practice and examines the comparison of Asian and Western outcomes in primary breast augmentation. Methods: A retrospective chart review was performed to examine a total of 162 patients who received the same brand of implants for primary ...

  9. Fat injection to correct contour deformities of the reconstructed breast: a single surgeon experience

    OpenAIRE

    Youssef Tahiri; Jonathan Kanevsky; Joshua Vorstenbosch; James Lee; Karl Schwarz

    2015-01-01

    Aim: Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast reconstruction. The purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast reconstruction. Methods: A single surgeon, prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill University Health Center was revie...

  10. Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis

    Directory of Open Access Journals (Sweden)

    Clement S. Sun, MS

    2013-11-01

    Conclusions: The use of individual plastic surgeon–elicited probability information is not encouraged unless the individual’s prediction skill has been evaluated. In the absence of this information, a group consensus on the probability of outcomes is preferred. Without a large evidence base for calculating probabilities, estimates assessed from a group of plastic surgeons may be acceptable for purposes of breast reconstruction decision analysis.

  11. Combined single photon emission computerized tomography and conventional computerized tomography: Clinical value for the shoulder surgeons?

    Directory of Open Access Journals (Sweden)

    Michael T Hirschmann

    2011-01-01

    Full Text Available With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT to shoulder surgeons, illustrate the possible clinical value it may offer as new diagnostic radiologic modality, and discuss its limitations. SPECT/CT may facilitate the establishment of diagnosis, process of decision making, and further treatment for complex shoulder pathologies. Some of these advantages were highlighted in cases that are frequently seen in most shoulder clinics.

  12. Acellular Dermal Matrix in Reconstructive Breast Surgery: Survey of Current Practice among Plastic Surgeons

    OpenAIRE

    Ahmed M. S. Ibrahim, MD; Pieter G. L. Koolen, MD; Azra A. Ashraf, MD, MPH; Kuylhee Kim, MD; Marc A. M. Mureau, MD, PhD; Bernard T. Lee, MD, MBA; Samuel J. Lin, MD

    2015-01-01

    Background: Acellular dermal matrices (ADMs) in plastic surgery have become increasingly popular particularly for breast reconstruction. Despite their advantages, questions exist regarding their association with a possible increased incidence of complications. We describe a collective experience of plastic surgeons’ use of ADMs in reconstructive breast surgery using an internet-based survey. Methods: Members of the American Society of Plastic Surgeons were recruited through voluntary, anonymo...

  13. Combined single photon emission computerized tomography and conventional computerized tomography: Clinical value for the shoulder surgeons?

    OpenAIRE

    Hirschmann, Michael T.; Rahel Schmid; Ranju Dhawan; Jiri Skarvan; Helmut Rasch; Friederich, Niklaus F.; Roger Emery

    2011-01-01

    With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT) to shoulder surgeons, illustrate the possible clinical value it may offer as new diagnostic radiologic modality, and discuss its limitations. SPECT/CT may facilitate the establishment of diagnosis, process of decision making, and further treatment for complex shoulder pathologies. Some of these advantages were highlighted in cases that...

  14. Principle of perioperative management for hepatic resection and education for young surgeons

    OpenAIRE

    Nanashima, Atsushi; Sumida, Yorihisa; Abo, Takafumi; Tanaka, Kenji; Takeshita, Hiroaki; HIDAKA, SHIGEKAZU; Yano, Hiroshi; Sawai, Terumitsu; Obatake, Masayuki; Yasutake, Toru; Nagayasu, Takeshi

    2008-01-01

    Background/Aims: An expert technique and special anatomical or physiological knowledge are needed in the field of hepatic surgery compared to other abdominal surgeries. The establishment of basic policy and operative techniques for hepatectomy and stepwise training for young hepatic surgeons are necessary. Methodology: We scheduled hepatic resection based on the indocyanine green retention rate at 15 minutes and volumetric analysis. Limited resection or preoperative portal vein embolization w...

  15. Are plastic surgery advertisements conforming to the ethical codes of the american society of plastic surgeons?

    Science.gov (United States)

    Spilson, Sandra V; Chung, Kevin C; Greenfield, Mary Lou V H; Walters, Madonna

    2002-03-01

    Cosmetic surgeons have increasingly come under fire for using advertisements that may be deceptive or intended for the solicitation of vulnerable consumers. However, aesthetic surgery is a growing business that relies heavily on advertising to survive. To prevent the use of deceptive advertisements, the American Society of Plastic Surgeons has developed a code of ethics for its physician members. We conducted a study to determine the prevalence of cosmetic surgery advertisements considered objectionable by the lay public. These advertisements were published in the Yellow Pages of the 10 largest U.S. cities. Because all of the advertisements in this study contained the American Society of Plastic Surgeons logo, we also determined whether its members are upholding the ethical code of advertising. We asked a convenience sample of 50 participants to rate 104 advertisements using four yes/no questions derived from the code of ethics and one overall yes/no question regarding whether the advertisement was objectionable. We obtained the mean percentage of "yes" responses for each advertisement, from the total sample, for each question. We found that the study participants felt that 25 percent of the advertisements used images of persons or facsimiles that falsely and deceptively created unjustified expectations of favorable results. The participants responded that 22 percent of the advertisements appealed primarily to the layperson's fears, anxieties, or emotional vulnerabilities. In addition, 18 percent of the advertisements were considered to be objectionable. Discretion is currently left up to physicians as to the ethical nature of their advertisements. Although the majority of American Society of Plastic Surgeons members uphold the ethical code of advertising, there are still a substantial number of published advertisements that the average consumer considers to be in violation of this code. PMID:11884856

  16. Ottawa Ankle Rules and Subjective Surgeon Perception to Evaluate Radiograph Necessity Following Foot and Ankle Sprain

    OpenAIRE

    Pires, RES; Pereira, AA; Abreu-e-Silva, GM; Labronici, PJ; Figueiredo, LB; Godoy-Santos, AL; Kfuri, M

    2014-01-01

    Background: Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to poor functional outcomes. Aim: The present study aims to evaluate the reliability of the Ottawa ankle rules and the orthopedic surgeon subjective perception to assess foot and ankle fractures after sprains. Subjects and Methods: A cross-sectional study was ...

  17. Third molars and dental crowding: different opinions of orthodontists and oral surgeons among Italian practitioners

    OpenAIRE

    Gavazzi, Michela; De Angelis, Donato; Blasi, Sergio; Pesce, Paolo; Lanteri, Valentina

    2014-01-01

    Background The role of third molars as a cause of incisor crowding, especially in the lower arch, continues to be controversial. The aim of this work is to compare opinions of Italian oral surgeons and orthodontists on this topic. Methods One hundred ninety-three Italian practitioners of the Society of Orthodontics (SIDO) and the Italian Society of Oral Surgery (SICOI) were asked to fill out an online questionnaire made up of six questions. Practitioners were asked to express their opinion on...

  18. Systemic immunotherapy delays photoreceptor cell loss and prevents vascular pathology in Royal College of Surgeons rats

    OpenAIRE

    Adamus, Grazyna; Wang, Shaomei; Kyger, Madison; Worley, Aneta; Lu, Bin; Burrows, Gregory G.

    2012-01-01

    Purpose Degenerative retinopathies, including retinitis pigmentosa, age-related retinal degeneration, autoimmune retinopathy, and related diseases affect millions of people around the world. Currently, there is no effective treatment for most of those diseases. We investigated systemic recombinant T-cell receptor ligand (RTL) immunotherapy for preventing retinal degeneration and vascular damage in the Royal College of Surgeons (RCS) rat model of retinal degeneration. Methods RCS rats were tre...

  19. Treatment for Malignant Struma Ovarii in the Eyes of Thyroid Surgeons

    OpenAIRE

    Luo, Jiang-rong; Xie, Chun-bao; Li, Zhi-hui

    2014-01-01

    Abstract Malignant struma ovarii (MSO) is a rare malignant ovarian germ cell tumor that has been scarcely reported by thyroid surgeons focusing on treatment. There are no golden standards for its treatment. There has not been any Chinese case included in the English language literatures. This is the first study by collecting all Chinese cases with clinical information. We emphasize on using I131 therapy after operation. Presented is a case of struma ovarii with malignant histologic features w...

  20. Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopaedic surgeries

    International Nuclear Information System (INIS)

    In this study, a mathematical method was used to estimate the entrance surface dose (ESD) to the patient and the scattered dose (Ds) to the operating surgeon during various fluoroscopically guided surgical orthopaedic procedures. For 204 patients, the procedure type, the fluoroscopy time and the highest tube potential and current values observed during fluoroscopy were recorded. For the most often performed procedures (intramedullary nailing of peritrochanteric fractures, open reduction and internal fixation of malleolar fractures and intramedullary nailing of diaphyseal fractures of the femur), the respective mean fluoroscopy times were 3.2, 1.5 and 6.3 min while the estimated mean ESDs were 183, 21 and 331 mGy, respectively. The estimated Ds rates for the hands, chest, thyroid, eyes, gonads and legs of the operating surgeon were on average to 0.103, 0.023, 0.013, 0.012, 0.066 and 0.045 mGy min-1, respectively, and compare well with the literature. The mathematical estimation of doses cannot replace actual measurements; however, it can be used for a preliminary assessment of the radiation dose levels during various surgical procedures, so that the operator, the surgeon and the rest of the medical staff involved could be aware of the associated radiation risk and the radiation protection measures required. (authors)

  1. Postmenopausal Breast Cancer, Aromatase Inhibitors, and Bone Health: What the Surgeon Should Know.

    Science.gov (United States)

    Baatjes, K J; Apffelstaedt, J P; Kotze, M J; Conradie, M

    2016-09-01

    Breast cancer, as the most common malignancy in women, remains a major public health issue despite countless advances across decades. Endocrine therapy is the cornerstone of treatment of the hormone-sensitive subtype of breast cancer. The use of aromatase inhibitors (AIs) in the postmenopausal women has extended the survival beyond that of Tamoxifen, but harbors a subset of side effects, most notably accelerated bone loss. This, however, does not occur in all women undergoing treatment. It is vital to identify susceptible patients early, to limit such events, employ early treatment thereof, or alter drug therapy. International trials on AIs, predominantly performed in North American and European females, provide little information on what to expect in women in developing countries. Here, surgeons often prescribe and manage endocrine therapy. The prescribing surgeon should be aware of the adverse effect of the endocrine therapy and be able to attend to side effects. This review highlights clinical and biochemical factors associated with decrease in bone mineral density in an, as yet, unidentified subgroup of postmenopausal women. In the era of personalized medical care, appropriate management of bone health by surgeons based on these factors becomes increasingly important. PMID:27189076

  2. Pain management procedures used by dental and maxillofacial surgeons: an investigation with special regard to odontalgia

    Directory of Open Access Journals (Sweden)

    Nadstawek Joachim

    2005-12-01

    Full Text Available Abstract Background Little is known about the procedures used by German dental and maxillofacial surgeons treating patients suffering from chronic orofacial pain (COP. This study aimed to evaluate the ambulatory management of COP. Methods Using a standardized questionnaire we collected data of dental and maxillofacial surgeons treating patients with COP. Therapists described variables as patients' demographics, chronic pain disorders and their aetiologies, own diagnostic and treatment principles during a period of 3 months. Results Although only 13.5% of the 520 addressed therapists returned completely evaluable questionnaires, 985 patients with COP could be identified. An orofacial pain syndrome named atypical odontalgia (17.0 % was frequent. Although those patients revealed signs of chronification, pain therapists were rarely involved (12.5%. For assessing pain the use of Analogue Scales (7% or interventional diagnostics (4.6% was uncommon. Despite the fact that surgical procedures are cofactors of COP therapists preferred further surgery (41.9% and neglected the prescription of analgesics (15.7%. However, most therapists self-evaluated the efficacy of their pain management as good (69.7 %. Conclusion Often ambulatory dental and maxillofacial surgeons do not follow guidelines for COP management despite a high prevalence of severe orofacial pain syndromes.

  3. Making Master Surgeons Out of Trainees: Part I. Teaching Surgical Judgment.

    Science.gov (United States)

    Kempton, Steve J; Bentz, Michael L

    2016-05-01

    The training of competent and ethical plastic surgery residents has become more difficult, as surgeons face increasing clinical and research demands, concern for medicolegal liability, and pressure to increase efficiency to decrease health care expenditures. The resulting variation in operative experience among plastic surgery trainees exemplifies the need for educational reform to accommodate change. Although the Accreditation Council for Graduate Medical Education has mandated a transition to competency-based training, and state-of-the-art technologies in surgical simulation are being developed to improve operative skills, the construction of a system to teach and assess operative judgment is deficient and should be thoughtfully created and implemented. Established educational methods and curriculums can be used in this effort and include apprenticeship operative teaching, surgical simulation, morbidity and mortality conferences, and resident clinics. The first step in this effort is to require trainees to make decisions, communicating their judgments and recommendations using language that demonstrates clear thinking and thoughtful analysis. For faculty, this means carving out dedicated preoperative teaching time in addition to efficient use of intraoperative time and sharing of postoperative outcomes. For programs, this means developing metrics to evaluate progress and build procedure-specific simulations. The goal should be not just to settle for training safe and ethical surgeons but to produce masterful surgeons with mature judgment. PMID:27119935

  4. Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures

    International Nuclear Information System (INIS)

    Owing to the continuous turnover of registrars and radiographers, most of the trauma-related orthopedic surgery in this academic hospital is done by inexperienced surgeons-in-training and the fluoroscopy by junior radiographers. This could result in excessive radiation doses. Calibrated lithium fluoride thermoluminescent chips were secured to various parts of the primary surgeon's body to quantify the radiation dose received during the insertion of an intramedullary nail. Closed intramedullary fixation of 15 fractures of the femur was done with interlocking as necessary. The total average exposure time was 14 minutes 45 seconds per procedure. Distal locking took up 31% of this time. The mean radiation dose to the surgeon's eyes and thyroid was 0,13 mGy and to the dominant hand 2,10 mGy. This would allow the performance of about 350 such procedures per year before the maximum permissible dose level was reached. Recommendations to decrease irradiation dosage are made. 6 refs., 6 tabs

  5. Interactive multicentre teleconferences using open source software in a team of thoracic surgeons.

    Science.gov (United States)

    Ito, Kazuhiro; Shimada, Junichi; Katoh, Daishiro; Nishimura, Motohiro; Yanada, Masashi; Okada, Satoru; Ishihara, Shunta; Ichise, Kaori

    2012-12-01

    Real-time consultation between a team of thoracic surgeons is important for the management of difficult cases. We established a system for interactive teleconsultation between multiple sites, based on open-source software. The graphical desktop-sharing system VNC (virtual network computing) was used for remotely controlling another computer. An image-processing package (OsiriX) was installed on the server to share the medical images. We set up a voice communication system using Voice Chatter, a free, cross-platform voice communication application. Four hospitals participated in the trials. One was connected by gigabit ethernet, one by WiMAX and one by ADSL. Surgeons at three of the sites found that it was comfortable to view images and consult with each other using the teleconferencing system. However, it was not comfortable using the client that connected via WiMAX, because of dropped frames. Apart from the WiMAX connection, the VNC-based screen-sharing system transferred the clinical images efficiently and in real time. We found the screen-sharing software VNC to be a good application for medical image interpretation, especially for a team of thoracic surgeons using multislice CT scans. PMID:23209271

  6. [DR. SHOSHANA SZKOP-FRENKIEL: THE FIRST FEMALE PLASTIC SURGEON IN ISRAEL].

    Science.gov (United States)

    Shehory-Rubin, Zipora

    2015-11-01

    In the history of Israeli medicine, Dr. Shoshana Szkop-Frenkiel is regarded as the first plastic surgeon in the country and among the founders of the profession of plastic surgery. This article describes the long road she traveled, from her acceptance into medical studies in Vilna--at a time when the entry of any woman to the faculty of medicine was strictly limited and of Jewish women in particular; her emigration to Eretz Israel and her struggles as she underwent training in internal medicine at the "Hadassah" Hospital in Tel-Aviv, when she was denied training as a surgeon; and up to the moment she was accepted by the plastic surgery unit of the Tel Hashomer Hospital and became the first such female practitioner in Israel. Dr. Shoshana Szkop-Frenkiel thus fulfilled a childhood dream to become a surgeon at a time when women were excluded from surgery on the grounds that it called for "male" characteristics. This article is intended to illustrate the character of a female doctor pursuing a career in surgery during the time of the British Mandate, to illuminate her professional travails in Israel, and to emphasize her important contribution in the field. PMID:26821508

  7. General surgeons' views on Oncologic Multidisciplinary Group meetings as part of colorectal cancer care.

    Science.gov (United States)

    Feroci, Francesco; Lenzi, Elisa; Baraghini, Maddalena; Cantafio, Stefano; Scatizzi, Marco

    2012-12-01

    This study aimed to assess the current effectiveness of Oncologic Multidisciplinary Groups (OMGs) meetings across central Tuscany through surgeons' reports and their individual perceived benefits on colorectal cancer management. One hundred and sixty-seven general surgeons received a questionnaire with 21 questions covering organizational characteristics of OMGs and the individual perceived benefits of OMGs. The responses were analyzed by hospital setting (teaching vs. community hospital). The reply rate was 62.8 %, and 82 respondent surgeons (49.1 %) were involved in the treatment of colorectal cancer patients. At community hospitals, there was a more frequent participation of medical oncologists, radiation oncologists and pathologists; a less selection of discussed cases was performed; and almost all decisions were inserted into official patient charts (p OMGs ensure that all treatment options are considered and improve timeliness of care, patient outcomes, patient satisfaction and communication with patients (p OMGs offer a modest degree of protection from malpractice but improve communications between colleagues and are an opportunity for personal professional development. Professionals regularly participating in well-conducted and well-organized OMGs for colorectal cancer felt that the multidisciplinary strategy may be advantageous to both patients and caregivers. PMID:22987014

  8. The impact of in-house surgeons and operating room resuscitation on outcome of traumatic injuries.

    Science.gov (United States)

    Hoyt, D B; Shackford, S R; McGill, T; Mackersie, R; Davis, J; Hansbrough, J

    1989-08-01

    As trauma systems develop, more patients can potentially benefit from immediate surgery. With in-house surgeons available, enthusiasm for direct transfer from the scene to the operating room (OR) has developed in many institutions. The purpose of this study was to define precisely which patients should be taken to the OR for resuscitation. Three hundred twenty-three patients were taken to the OR directly from the field during a 4-year period (6.9% of trauma activations). Indications included the following: (1) cardiac arrest--one vital sign present, (2) persistent hypotension despite field intravenous fluid, and (3) uncontrolled external hemorrhage. A board-certified surgeon and resuscitation team met the field transport team in the OR in all cases. Cardiopulmonary resuscitation for patients with blunt trauma was not accompanied by survival even with immediate surgery by a trained surgeon and it wastes valuable OR resources. Patients with prehospital hypotension unresponsive to fluid resuscitation indicate the need for rapid surgery. Patients with blunt injuries even with hypotension infrequently undergo operations in less than 20 minutes and can be resuscitated in traditional areas where better roentgenograms are obtained. Penetrating injuries to the chest and abdomen with hypotension are the primary indications for OR resuscitation. It can be anticipated with field communication and accompanied by enhanced survival. PMID:2757502

  9. Imaging in anorectal malformations: What does the surgeon need to know?

    Directory of Open Access Journals (Sweden)

    Christopher Westgarth-Taylor

    2015-10-01

    Full Text Available Imaging is essential in the diagnosis, management, surgical planning and eventual outcome in patients with anorectal malformation (ARM. This article outlines the imaging that may be required and the information needed by the surgeon to attain the best possible surgical outcome. ARM encompasses a wide spectrum of congenital malformations relating to the distal rectum and anus as well as the urinary and or gynaecological systems. The malformations range from a relatively simple perineal fistula with the potential for an excellent functional outcome, to complex cloacal malformation that requires specialist care and intervention. Approximately half of these children will have associated abnormalies. In the first 24–48 hours of life, imaging is used to determine if any associated anomalies are severe enough to preclude an operation, and what operation will be required so that the child can grow as normally as possible. If a colostomy is done, pre-definitive repair imaging in the form of a high-pressure distal colostogram determines the surgical approach required to repair the malformation. In more complicated cases of cloacal malformation, advanced imaging in the form of MRI or 3D fluoroscopy is valuable. In the South African setting, 2D fluoroscopy with the surgeon present is adequate to help in planning for the surgical management. Communication between the radiologist and paediatric surgeon is essential to ensure that such patients have the best possible outcome.

  10. Learning Curve of a Young Surgeon's Video-assisted Thoracic Surgery Lobectomy during His First Year Experience in Newly Established Institution

    OpenAIRE

    Ra, Yong Joon; Ahn, Hyo Yeong; Kim, Min Su

    2012-01-01

    Background The purpose of this paper is to present a guideline for beginning video-assisted thoracic surgery (VATS) lobectomy to junior surgeons, and to review the first year experience of a new surgeon performing VATS lobectomies who had not performed a VATS lobectomy unassisted during his training period. Materials and Methods A young surgeon opened a division of general thoracic surgery at a medical institution. The surgeon had performed about 100 lobectomies via conventional thoracotomy d...

  11. Patients Attitude towards Surgeons Attire in Our Lady of Lourdes Hospital Drogheda

    Directory of Open Access Journals (Sweden)

    Babak Meshkat

    2015-04-01

    Full Text Available Background A doctor’s competence and professionalism is often judged on the basis of attire. Our Lady of Lourdes (OLOL is a leading Irish hospital in the implementation of Bare Below the Elbows (BBTE policy, however surgical attire is not standardised and there is great variability in attire worn on wards. We aimed to evaluate patients attitude towards surgeons attire in OLOL. Methods A prospective survey of adult surgical in-patients was conducted from October 2013 to February 2014. A twelve-question questionnaire was used as data collection tool, using a five point Likert scale to assess patients response to each question. Data were collected on patient demographics, patients level of trust and confidence based on different surgical attire, and patients perception of different attire worn by surgical teams. Results There were 150 completed surveys during the study period with a male to female ratio of 44% to 56% respectively. The mean patient length of in-hospital stay (LOS was 4.7 days (range 1–22. The most commonly represented age group was 30–40 years (18%, with a comparable spread among all age groups. The majority of patients found the attire worn by surgeons on the ward to be very appropriate (93%. Majority of responders believed scrubs to be the most appropriate attire for surgeons on wards (39%, followed by shirt and tie with white coat (38% followed by short sleeved shirt and no tie (18%. Shirt and tie with white coat had a positive effect on patients trust in 63% of responders, a negative effect in 10% and no effect in 26%. Scrubs had a positive effect on patients trust in 63%, negative effect in 11% and no effect in 25%. Short sleeved shirt and no tie had a positive effect in 44%, negative effect in 25% and no effect in 30% of patients. Conclusion Patients in OLOL find attire worn by surgeons to be appropriate. Shirt and tie with white coat or scrubs remains the patient’s choice attire for surgeons. Shirt and tie with white

  12. Implantation of peritoneal catheters by laparotomy: nephrologists obtained similar results to general surgeons

    Directory of Open Access Journals (Sweden)

    Restrepo CA

    2014-10-01

    Full Text Available Cesar A Restrepo, Carlos Alberto Buitrago, Cielo Holguin Division of Nephrology, Department of Health Sciences, Caldas University, Caldas, ColombiaPurpose: To analyze the complications and costs of minilaparotomies performed by a nephrologist (group A compared with conventional laparotomies performed by a surgeon (group B for peritoneal catheter implantation.Setting: Two university hospitals (Santa Sofia and Caldas in Manizales, Caldas, Colombia.Methods: The study included stage 5 chronic kidney disease patients, with indication of renal replacement therapy, who were candidates for peritoneal dialysis and gave informed consent for a peritoneal catheter implant. Minilaparotomies were performed by a nephrologist in a minor surgery room under local anesthesia. Conventional laparotomies were performed by a surgeon in an operating room under general anesthesia.Results: Two nephrologists inserted 157 peritoneal catheters, and seven general surgeons inserted 185 peritoneal catheters. The groups had similar characteristics: the mean age was 55 years, 49.5% were men, and the primary diagnoses were diabetic nephropathy, hypertensive nephropathy, and unknown etiology. The implant was successful for 98.09% of group A and 99.46% of group B. There was no procedure-related mortality. The most frequent complications in the first 30 days postsurgery in group A versus group B, respectively, were: peritonitis (6.37% versus 3.78%, exit-site infection (3.82% versus 2.16%, tunnel infection (0% versus 0.54%, catheter entrapment by omentum (1.27% versus 3.24%, peritoneal effluent spillover (1.91% versus 2.16%, draining failure (4.46% versus 6.49%, hematoma (0% versus 1.08%, catheter migration with kinking (3.18% versus 2.70%, hemoperitoneum (1.27% versus 0%, and hollow viscera accidental puncture (1.91% versus 0.54%. There were no statistically significant differences in the number of complications between groups. In 2013, the cost of a surgeon-implanted peritoneal

  13. Surgery or consultation: a population-based cohort study of use of orthopaedic surgeon services.

    Directory of Open Access Journals (Sweden)

    Elizabeth M Badley

    Full Text Available BACKGROUND: This population-based cohort study has the objective to understand the sociodemographic characteristics and health conditions of patients who do not receive surgery within 18 months following an ambulatory visit to an orthopaedic surgeon. METHODS: Administrative healthcare databases in Ontario, Canada were linked to identify all patients making an initial ambulatory visit to orthopaedic surgeons between October 1(st, 2004 and September 30(th, 2005. Logistic regression was used to examine predictors of not receiving surgery within 18 months. RESULTS: Of the 477,945 patients in the cohort 49% visited orthopaedic surgeons for injury, and 24% for arthritis. Overall, 79.3% did not receive surgery within 18 months of the initial visit, which varied somewhat by diagnosis at first visit (84.5% for injury and 73.0% for arthritis with highest proportions in the 0-24 and 25-44 age groups. The distribution by income quintile of patients visiting was skewed towards higher incomes. Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33. The odds of not getting surgery were significantly higher for women than men for injury and other conditions; the opposite was true for arthritis and bone conditions. CONCLUSION: A substantial proportion of referrals were for expert diagnosis or advice on management and treatment. The findings also suggest socioeconomic inequalities in access to orthopaedic care. Further research is needed to investigate whether the high caseload of non-surgical cases affects waiting times to see a surgeon. This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of

  14. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature

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    Lau Rick L

    2012-12-01

    Full Text Available Abstract Background A number of factors have been identified as influencing total knee arthroplasty outcomes, including patient factors such as gender and medical comorbidity, technical factors such as alignment of the prosthesis, and provider factors such as hospital and surgeon procedure volumes. Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of total joint arthroplasty to higher volume centers, and adoption of volume standards. To contribute to the discussions concerning the optimization of provider factors and proposals to regionalize total knee arthroplasty practices, we undertook a systematic review to investigate the association between surgeon volume and primary total knee arthroplasty outcomes. Methods We performed a systematic review examining the association between surgeon volume and primary knee arthroplasty outcomes. To be included in the review, the study population had to include patients undergoing primary total knee arthroplasty. Studies had to report on the association between surgeon volume and primary total knee arthroplasty outcomes, including perioperative mortality and morbidity, patient-reported outcomes, or total knee arthroplasty implant survivorship. There were no restrictions placed on study design or language. Results Studies were variable in defining surgeon volume (‘low’: 5 to >70 total knee arthroplasty per year. Mortality rate, survivorship and thromboembolic events were not found to be associated with surgeon volume. We found a significant association between low surgeon volume and higher rate of infection (0.26% - 2.8% higher, procedure time (165 min versus 135 min, longer length of stay (0.4 - 2.13 days longer, transfusion rate (13% versus 4%, and worse patient reported outcomes. Conclusions Findings suggest a trend towards better outcomes for higher volume surgeons, but results must be interpreted with caution.

  15. The God of Mercy or the King of the Hell? Plastic Surgeon Depicted in Parodies of Altar Portraits of Buddha.

    Science.gov (United States)

    Hwang, Se Ho; Hwang, Kun

    2015-06-01

    The aim of this paper is to see how the plastic surgeons are depicted in some recently made parodies of altar portraits of Buddha. Three of Kim's traditional paintings depicting a plastic surgeon were collected and 3 types of altar portraits of Buddha were also collected. The Water-Moon Avalokiteshvara (Symbol: see text) sits on a rocky outcropping above the waves. At the lower right, is the boy pilgrim Sudhana (Symbol: see text). In the "Plastic Surgeon as a Bodhisattva," the plastic surgeon is wreathed in gold necklaces and seated on stones as if he were a wise man or perhaps a divine being, only it is his services that help allow for transformation. Below him, there is a female who yearns for man-made beauty. In Emma's court, there is a "Mirror of Perfect Clarity" that reflects unfailingly, the past misconduct and sins of the dead. In "Judgment of the Obese" (Symbol: see text), the plastic surgeon looks down on his patients from above and makes severe judgments about their looks. The women are holding their hands out desperately, standing haggard in front of the mirror, pleading to the doctor. The Great Master of Seon Buddhism holds a large fly-whisk. In the "Portrait of a Plastic Surgeon" (Symbol: see text), a surgeon is sitting in a chair holding a huge surgical knife as if the patriarch holds a monk's stick. Like the patients at our clinic and the sole of the dead at the Emma's court, we plastic surgeons should have a "Mirror" to reflect our practices and ask ourselves whether we are "good" doctors or not. PMID:26080171

  16. Sources of information influencing decision-making in orthopaedic surgery - an international online survey of 1147 orthopaedic surgeons

    OpenAIRE

    Schulz, Arndt P; Jönsson, Anders; Kasch, Richard; Jettoo, Prithee; Bhandari, Mohit

    2013-01-01

    Background Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was t...

  17. Predicting the unpredictable: A new prediction model for operating room times using individual characteristics and the surgeon's estimate

    OpenAIRE

    Eijkemans, René; Houdenhoven, van, M.; Nguyen Van, Tien; Boersma, Eric; Steyerberg, Ewout; Kazemier, Geert

    2010-01-01

    textabstractBackground: Routine predictions made by surgeons or historical mean durations have only limited capacity to predict operating room (OR) time. The authors aimed to devise a prediction model using the surgeon's estimate and characteristics of the surgical team, the operation, and the patient. Methods: Seventeen thousand four hundred twelve consecutive, elective operations from the general surgical department in an academic hospital were analyzed. The outcome was OR time, and the pot...

  18. Survey of Common Practices among Oculofacial Surgeons in the Asia-Pacific Region: Management of Orbital Floor Blowout Fractures

    OpenAIRE

    Koh, Victor; Chiam, Nathalie; Sundar, Gangadhara

    2014-01-01

    A web-based anonymous survey was performed to assess common practices of oculofacial surgeons in the management of traumatic orbital floor blowout fractures. A questionnaire which contained questions on several controversial topics in the management of orbital floor fractures was sent out via e-mail to 131 oculofacial surgeons in 14 countries in the Asia-Pacific region. A total response rate of 58.3% was achieved from May to December 2012. The preferred time for surgical intervention was with...

  19. Clearing the backlog: trichiasis surgeon retention and productivity in northern Ethiopia.

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    Esmael Habtamu

    Full Text Available BACKGROUND: In 2006 there were an estimated 645,000 people in Amhara, Ethiopia, with trachomatous trichiasis (TT who needed surgery. Despite an extensive integrated eye care worker training programme (IECW and robust support for TT surgical services, productivity has not reached targets. We investigated why surgeon productivity was below target. METHODOLOGY/PRINCIPAL FINDINGS: Confidential interviews were conducted in person with TT surgeons trained from 24 selected districts in Amhara Region and their supervisors. Determinants of attrition and productivity were investigated. We interviewed 225 people who had received IECW training; 139 (59% had subsequently changed career/job. Staff retention was associated with good road access to their health centre, mobile telephone network and a shorter time from initial training. Amongst the 94 IECW still working in the programme, the average number of patients operated was 41/year, which was mostly (86% done through outreach campaigns and only 14% of cases were performed in the static facilities where they routinely worked. Spot checks were made of surgical instruments and consumables: only 3/94 IECW had the minimum instruments and consumables to perform surgery. The main barriers to operating were lack of time, shortage of consumables, lack of patients, lack of support and equipment problems. Very few IECW received ongoing supervision or active management. CONCLUSIONS/SIGNIFICANCE: Surgeon attrition rates are high. Vertical surgery campaigns were effective in treating large numbers of cases, whilst static-site service productivity was low. Good health system management is key to building a well-staffed and well-run service.

  20. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

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    Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; da Costa, Eduardo Fernandes; Hidaka, Alexandre Kyoshi

    2016-01-01

    ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP. PMID:27136471

  1. Exoresection via partial lamellar sclerouvectomy approach for uveal tumors: A successful performance by a novice surgeon

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    Rengin Aslıhan Kurt

    2010-01-01

    Full Text Available Rengin Aslıhan Kurt, Kaan GündüzDepartment of Ophthalmology, Ankara University Faculty of Medicine, Ankara, TurkeyPurpose: To evaluate the results and complications of exoresection via a partial lamellar sclerouvectomy (PLSU procedure for uveal tumors performed by a novice surgeon without help from an experienced surgeon.Methods: Medical records of 22 patients who underwent exoresection for uveal tumors between February 1999 and January 2009 were evaluated retrospectively. Exoresection was considered for tumors with their epicenter in the iris or in the ciliary body.Results: Twenty-two patients with a mean age of 45.9 years (range: 19–72 years were included in this study. The histopathologic diagnosis was uveal malignant melanoma in 16 patients, iridociliary nevus in 2 patients, iris nevus in 2 patients, and iridociliary melanocytoma in 2 patients. Postoperative complications included cataract in 11 patients (50%, scleral thinning in 4 patients (18%, vitreous hemorrhage in 2 patients (9%, hyphema in 2 patients (9%, secondary glaucoma in 2 patients (9%, iridodialysis in 1 patient (4.5%, bullous keratopathy in 1 patient (4.5%, and posterior synechiae in 1 patient (4.5%. At a mean follow-up of 40.1 months (range: 1–98 months, there were no recurrences or metastatic events.Conclusions: Exoresection seems to be an effective treatment option in selected cases of iridociliary and ciliary body tumors. Novice surgeons with limited training in PLSU should not discourage themselves from doing this type of surgery. Several postoperative complications inevitably occur and require frequent patient monitoring.Keywords: uveal melanoma, uveal nevus, iris, ciliary body, choroid, iris nevus, iris melanoma, ciliary nevus, ciliary melanoma, choroidal melanoma, ciliochoroidal melanoma, iridociliochoroidal melanoma, partial lamellar sclerouvectomy, exoresectionErratum for this paper has been published

  2. Surgical stapling device–tissue interactions: what surgeons need to know to improve patient outcomes

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    Chekan E

    2014-09-01

    Full Text Available Edward Chekan,1 Richard L Whelan2 1Ethicon Inc., Cincinnati, OH, USA; 2St Luke’s Roosevelt Hospital, New York, NY, USA Abstract: The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a “knowledge gap” that is potentially dangerous. The goal of this review is to present a framework for the study of device–tissue interactions and to initiate the process of “filling in” the knowledge gap via the available literature. Surgical staplers, which are continually being developed, are the focus of this piece. The integrity of the staple line, which depends on adequate tissue compression, is the primary factor in creating a stable anastomosis. This review focuses on published studies that evaluated the creation of stable anastomoses in bariatric, thoracic, and colorectal procedures. Understanding how staplers interact with target tissues is key to improving patient outcomes. It is clear from this review that each tissue type presents unique challenges. The thickness of each tissue varies as do the intrinsic biomechanical properties that determine the ideal compressive force and prefiring compression time for each tissue type. The correct staple height will vary depending on these tissue-specific properties and the tissue pathology. These studies reinforce the universal theme that compression, staple height, tissue thickness, tissue compressibility, and tissue type must all be considered by the surgeon prior to choosing a stapler and cartridge. The surgeon's experience, therefore, is a critical factor. Educational programs need to be established to inform and update surgeons on

  3. Three cases of triple A syndrome (Allgrove syndrome) in pediatric surgeons' view.

    Science.gov (United States)

    Erginel, Başak; Gün, Feryal; Kocaman, Hakan; Çelik, Alaadin; Salman, Tansu

    2016-04-01

    Triple A syndrome, also known as Allgrove syndrome, is a rare disease, and presents mainly in children. Its cardinal symptoms are achalasia, alacrima, and adrenocorticotropic hormone (ACTH) insensitivity. We report three cases of Triple A syndrome. Our aim is to inform pediatric surgeons about the existence of this rare syndrome and to highlight the need for suspicion of alacrima and ACTH insensitivity in cases of pediatric achalasia. Triple A syndrome should be considered in patients presenting with achalasia. Alacrima should be investigated by a Schirmer test, and adrenal dysfunction should be tested in cases of suspected triple A. PMID:27385299

  4. Ibn al-Quff (1233-1286 AD), a medieval Arab surgeon and physician.

    Science.gov (United States)

    Dalfardi, Behnam; Yarmohammadi, Hassan

    2016-02-01

    Abū'l-Faraj ibn Ya'qūb ibn Isḥāq Ibn al-Quff al-Karakī (1233-1286 AD), best known as Ibn al-Quff in the West, was a 13(th) century Arab physician-surgeon. During his lifetime, Ibn al-Quff made some important contributions to the art of healing. He authored several books and commentaries in the field of medicine, in particular surgery. This paper aims to review Ibn al-Quff's life, career, and contributions to medical science. PMID:24585631

  5. [Sauveur-Henri-Victor Bouvier (1799-1877): orthopaedist, surgeon and promoter of physical education].

    Science.gov (United States)

    Monet, Jacques; Quin, Grégory

    2013-01-01

    This article establishes the biography of a little known physician of the 19th century., whose commitment with orthopaedics and formulation of medical gymnastics was important: the surgeon-orthopaedist Sauveur-Henri-Victor Bouvier. Several constitutive processes of the medical field of the 19th century are analysed: specialization (around orthopaedics), professionalization and development of various therapeutic and hygienic methods (among them medical gymnastics). Bouvier's biography is particularly instructive and sheds new light on these different processes, as well as on the institutionalization of orthopaedics from the 1820's up to the 1870's, at the intersection between medical and educative fields, between hospital, medical faculty and teaching of gymnastics. PMID:24308261

  6. Selected Correspondence from the Papers of Thomas Pettigrew (1791-1865, Surgeon and Antiquary

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    Gabriel Moshenska

    2012-05-01

    Full Text Available The papers of the nineteenth century antiquary and surgeon Thomas Pettigrew are of considerable interest in the histories of science, medicine and archaeology. The letters presented here were received by Pettigrew between 1817 and 1859, and form part of the Pettigrew Papers held at Yale University. They were transcribed during research into Pettigrew’s life and work, focusing in particular on his contributions to archaeology and Egyptology, and are presented in the form of texts. They are likely to be of interest and use to scholars of early nineteenth century intellectual history, and historians of archaeology in particular.

  7. Pseudoangiomatous squamous cell carcinoma: a challenge for pathologists and plastic surgeons

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    Dimitrios Kanakopoulos

    2015-04-01

    Full Text Available Pseudo-angiosarcomatous or pseudovascular squamous cell carcinoma (SCC of the skin is an unusual variant form of acantholytic SCC that mimics the histopathological appearance of angiosarcoma. We describe a case of pseudovascular SCC in a 77-year-old lady to highlight the frequent recurrence and aggressiveness, as well as the clinicopathological features of this rare form of cutaneous SCC, and demonstrate the difficulties in establishing the correct diagnosis. Plastic surgeons involved in the care of patients with cutaneous malignancies should be aware of this variant of SCC and its aggressive nature in order to manage these patients appropriately.

  8. Imposters of androgenetic alopecia: diagnostic pearls for the hair restoration surgeon.

    Science.gov (United States)

    Rogers, Nicole

    2013-08-01

    It is crucial that hair restoration surgeons understand the basic clinical diagnosis and pathologic condition of other hair loss conditions that are not always amenable to successful hair transplantation. In this article nonscarring and scarring mimickers of androgenetic alopecia are discussed. Nonscarring conditions include alopecia areata, telogen effluvium, and tinea capitis. Some of the more common scarring alopecias include lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia. Less common inflammatory conditions include pseudopelade of Brocq, discoid lupus erythematosus, and folliculitis decalvans. PMID:24017974

  9. Virtual reality phacoemulsification: a comparison between skilled surgeons and students naive to cataract surgery

    Science.gov (United States)

    Soderberg, Per; Laurell, Carl-Gustaf; Simawi, Wamidh; Nordqvist, Per; Skarman, Eva; Nordh, Leif

    2005-04-01

    We have developed a simulator for virtual phacoemulsification surgery. In the current study, the performance of one experienced cataract surgeon was compared to the performance of four subjects naive to cataract surgery. They all operated on the same virtual patient and a number of different response variables were measured. It was found that the experienced subject performed better than the naive subjects on almost all response variables. This indicates that the simulator developed by us is authentic for phaco emulsification surgery. The lack of negative effects in case of complications during virtual phacoemulsification surgery makes the phaco simulator that we developed a very attractive tool for learning phacoemulsification surgery.

  10. Umbilical endometriosis mimicking as papilloma to general surgeons: A case report

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    A Singh

    2012-05-01

    Full Text Available IntroductionCutaneous or umbilical endometriosis is a rare entity that isoften overlooked because of chronic abdominal pain. Wepresent a case of umbilical hernia that presented to thegeneral surgeons due to chronic abdominal pain and nodulein the umbilicus, which was clinically diagnosed as umbilicalpapilloma.Case presentationA 48-year old multiparous Caucasian woman presented withpainful nodule in the umbilicus for two and half years. Thenodule was excised and the histopathological diagnosis wasumbilicus endometriosis.ConclusionUmbilical endometriosis is a very rare disease but should beconsidered as a differential diagnosis in women presentingwith umbilical swelling.

  11. Patient sources of information and decision factors in selecting cosmetic surgeons.

    Science.gov (United States)

    Nowak, L I; Washburn, J H

    1998-01-01

    This paper presents the results of an exploratory study designed to examine influential information sources and decision factors in the selection of plastic surgeons for cosmetic versus medical procedures. Physician referrals were found to be the most influential sources of information for both groups. Word-of-mouth and magazine and newspaper articles were also important information sources for cosmetic patients. Primary selection factors were significantly different between groups, with board certification the most influential for cosmetic patients and recommendation by physician most influential for medical patients. PMID:10185452

  12. Appropriate Levels of Detail in 3-D Visualisation: the House of the Surgeon, Pompeii

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    P.S. Murgatroyd

    2008-02-01

    Full Text Available The use of three-dimensional computer models in archaeological projects is a relatively new but rapidly growing area, both as a means of presenting research to the public and also as an aid to interpretation. This work uses the House of the Surgeon in Pompeii as a case study and seeks to illustrate the most effective ways to display information to a range of audiences. In using the flexibility of computer modelling techniques it seeks to show that the levels of detail in a 3-D computer model can be tailored to individual circumstances to produce the most effective result.

  13. Surgeons agree more on treatment recommendations than on classification of proximal humeral fractures

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    Brorson Stig

    2012-06-01

    Full Text Available Abstract Background Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations. Methods We conducted a multi-centre observer-study. Five experienced shoulder surgeons independently assessed a consecutive series of 193 radiographs at two occasions three months apart. All pairs of radiographs were classified according to Neer. Subsequently, the observers were asked to recommend one of three treatment modalities for each case: non-operative treatment, locking plate osteosynthesis, or hemiarthroplasty. Results At both classification rounds mean kappa-values for inter-observer agreement on treatment recommendations (0.48 and 0.52 were significantly higher than the agreement on Neer classification (0.33 and 0.36 (p  Conclusions We found a significantly higher agreement on treatment recommendations compared to agreement on fracture classification. The low observer agreement on the Neer classification reported in several observer studies may have less clinical importance than previously assumed. However, inter-observer agreement did not exceed moderate levels.

  14. Facts that every vascular surgeon needs to know about the diabetic foot.

    Science.gov (United States)

    Edmonds, M

    2014-04-01

    This paper describes important aspects of the diabetic foot which the vascular surgeon needs to understand to efficiently manage the diabetic foot. Firstly, it emphasises the three main pathologies which come together in the diabetic foot, namely neuropathy, ischemia and immunopathy, the latter predisposing to infection. As a result of neuropathy, the signs and symptoms of tissue breakdown, infection and ischemia may be minimal. Nevertheless the pathology emanating from such clinical events proceeds rapidly without the body being aware of it and the end stage of tissue death and necrosis is quickly reached. It is important to have a prompt system of evaluation and intervention to prevent the rapid progression to necrosis. Thus, secondly, the paper describes a simple rapid assessment of the diabetic foot, which comprises inspection, palpation and sensory testing and leads on to a modern classification and staging of the diabetic foot. This classifies six subdivisions of the diabetic foot: foot with neuropathic ulceration, Charcot foot, neuroischemic foot, critically ischemic foot, acutely ischemic foot and renal ischemic foot and six stages in the natural history of each of these subdivisions: normal foot, high risk foot, ulcerated foot, infected foot, necrotic foot and unsalvageable foot. Thirdly, it describes modern management of the diabetic foot, emphazising wound care and revascularization within the context of a multidisciplinary care team that provides integrated care focused in a diabetic foot clinic, to which patients with diabetes should have easy and rapid access. Members of the team include podiatrist, nurse, orthotist, physician, radiologist and surgeons. PMID:24796920

  15. Victim or player: pediatric surgeons deal with quality improvement and the information age.

    Science.gov (United States)

    Heiss, Kurt

    2002-02-01

    Medicine as a profession is changing from a cottage industry to an information industry. Physicians and surgeons historically have measured quality of care in a retrospective fashion, reviewing complications in peer review forums, in morning report, or in regular morbidity and mortality conferences. Increasing pressure is placed on hospital systems and clinicians to show measurable improvements in outcomes of care and to remove waste. The retrospective system of quality assurance is being replaced by a prospective measurement of care processes called quality improvement (QI). The measurements are returned to clinicians to enable them to understand and manage the processes and improve patient care. QI has made dramatic improvements in several other industries, including aviation and communications. QI tools are intuitive to most physicians, are easily transferable to medicine, and can be used to remove waste and improve patient care, education, and management of resources. As demand increases for improved quality of care, pediatric surgeons can play a leadership role or have quality changes imposed on them without representation. PMID:11815935

  16. Living kidney donor assessment: challenges, uncertainties and controversies among transplant nephrologists and surgeons.

    Science.gov (United States)

    Tong, A; Chapman, J R; Wong, G; Craig, J C

    2013-11-01

    The assessment of living kidney donors presents unique ethical challenges and complex psychosocial implications. This study aimed to ascertain the perspectives of transplant nephrologists and surgeons on living kidney donor assessment. Semi-structured, face-to-face interviews were conducted with 110 transplant nephrologists and surgeons from 43 transplant units in 12 countries from Europe, Australasia and North America. The challenge of defining acceptable risk to the donor was central to five themes identified: burden of responsibility (personal accountability, policing morality, democratic decision making, meeting legal obligations, optimizing outcomes and innovation, relinquished control); medical protectiveness (prognostic uncertainty, skepticism of donor risk perception, avoidance of undue coercion, concerns for dubious motivations and coercion, safeguard donor well-being, ethical information disclosure); respecting donor autonomy (facilitate informed-decision making, concede to donor risk acceptance, benefit of the doubt, donor mandate to maintain health, acceptable altruism); driving ideologies (preserving equity, championing living donation, cognizance of anti-paternalism) and contextual pressures (evolving donor demographic, resource limitations). Living kidney donor assessment involves complex interactions between safeguarding the donors' welfare and respecting their autonomy. In our opinion, authoritative and well-described transplant unit, hospital and public policy positions that make explicit the considerations that are often implicit may reduce the uncertainty within which living donors are assessed today. PMID:24020905

  17. Which is the Ideal Breast Size?: Some Social Clues for Plastic Surgeons.

    Science.gov (United States)

    Raposio, Edoardo; Belgrano, Valerio; Santi, PierLuigi; Chiorri, Carlo

    2016-03-01

    To provide plastic surgeons with more detailed information as to factors affecting the perception of female attractiveness, the present study was aimed to investigate whether the interaction effect of breast and body size on ratings of female attractiveness is moderated by sociodemographic variables and whether ratings of shapeliness diverge from those of attractiveness.A community sample of 958 Italian participants rated the attractiveness and the shapeliness of 15 stimuli (5 breast sizes × 3 body sizes) in which frontal, 3/4, and profile views of the head and torso of a faceless woman were jointly shown.Bigger breast sizes obtained the highest attractiveness ratings, but the breast-by-body size interaction was also significant. Evidence was found of a moderator role of sex, marital status, and age. When the effects of breast and body size and their interaction had been ruled out, sex differences were at best very slight and limited to very specific combinations of breast and body sizes. Ratings of attractiveness and shapeliness were highly correlated and did not significantly differ.Results suggest that to address women's psychological needs, concerns, and expectations about their appearance, plastic surgeons should not simply focus on breast size but should carefully consider the 'big picture': the body in its entirety. PMID:25664414

  18. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

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    de Gara Chris

    2010-06-01

    Full Text Available Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  19. Intraoperative translabial ultrasound for urethral diverticula: A road map for surgeons

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    El-Zein, C.; Khoury, N.; El-Zein, Y. [Department of Diagnostic Radiology, American University of Beirut Medical Center, Bliss Street, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut (Lebanon); Bulbul, M. [Department of Urology, American University of Beirut Medical Center, Bliss Street, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut (Lebanon); Birjawi, G. [Department of Diagnostic Radiology, American University of Beirut Medical Center, Bliss Street, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut (Lebanon)], E-mail: gb02@aub.edu.lb

    2009-04-15

    Purpose: To highlight the importance of intraoperative translabial ultrasound, for identification of diverticular neck allowing complete resection of periurethral diverticula and decrease in the recurrence rate. Material and methods: This study included 4 women of age range between 38 and 68 years presenting for recurrent urinary tract infections and urethral pain. All had translabial urethral ultrasound and cystoscopy with and without U/C guidance. Results: Prior cystoscopy in all these patients failed to demonstrate the diverticulum. Translabial ultrasound showed the diverticula some of which were infected. Ultrasound was used intraoperatively to guide the surgeon. With this approach the abnormality was confirmed and the neck of the diverticulum was identified through percutaneous needle insertion. This allowed complete resection of the diverticula. Conclusion: Translabial ultrasound is a non-invasive technique that plays a major role in examining the urethra and identifying the periuthral diverticula. In our experience, it was very useful as an adjunct to guide the surgeon intraoperatively allowing complete excision of the diverticulum.

  20. Managed care: future good news or bad news for vascular surgeons.

    Science.gov (United States)

    Hallett, J W

    1998-08-01

    Recently, William W. McGuire, Chief Executive Officer of United Health-Care, emphasized that the key from the patient's viewpoint is access. He stated, "We use the term gateway rather than gatekeeper." He emphasizes the importance of direct access of the patient to the right physician, whether it be a specialist or a generalist. Although some health care strategists believe that patients should initially see a generalist before receiving specialty care, this approach may not save dollars in the long run. Managed care is likely to have a major impact on vascular surgeons. Currently, business purchasing cooperatives are one model for containing costs of expensive invasive procedures among the working population. Such cooperatives are likely to achieve a stronger penetration in the health care market and to negotiate aggressively for packaged fee contracts for specialized cardiovascular care and procedures. Because the vast majority of vascular patients are more than 65 years of age, the movement of Medicare toward managed care may also affect vascular surgery in a major way. If vascular surgeons are to survive financially in the managed care environment, they must continue to provide evidence-based solutions to clinical problems at a reasonable cost and with good outcomes. They must also understand that involvement in the administrative and political leadership of health care is essential to maintaining some influence on the future reimbursement for our services. PMID:9719337

  1. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2016 Update on Outcomes and Quality.

    Science.gov (United States)

    Jacobs, Jeffrey P; Mayer, John E; Mavroudis, Constantine; O'Brien, Sean M; Austin, Erle H; Pasquali, Sara K; Hill, Kevin D; He, Xia; Overman, David M; St Louis, James D; Karamlou, Tara; Pizarro, Christian; Hirsch-Romano, Jennifer C; McDonald, Donna; Han, Jane M; Dokholyan, Rachel S; Tchervenkov, Christo I; Lacour-Gayet, Francois; Backer, Carl L; Fraser, Charles D; Tweddell, James S; Elliott, Martin J; Walters, Hal; Jonas, Richard A; Prager, Richard L; Shahian, David M; Jacobs, Marshall L

    2016-03-01

    The Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This article summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operations performed from January 2011 to December 2014 and documenting overall discharge mortality (interquartile range among programs with more than 9 cases): off-bypass coarctation, 1.0% (0.0% to 0.9%); ventricular septal defect repair, 0.7% (0.0% to 1.1%); tetralogy of Fallot repair, 1.0% (0.0% to 1.7%); complete atrioventricular canal repair, 3.2% (0.0% to 6.5%); arterial switch operation, 2.7% (0.0% to 5.6%); arterial switch operation plus ventricular septal defect, 5.3% (0.0% to 6.7%); Glenn/hemiFontan, 2.1% (0.0% to 3.8%); Fontan operation, 1.4% (0.0% to 2.4%); truncus arteriosus repair, 9.6% (0.0 % to 11.8%); and Norwood procedure, 15.6% (10.0% to 21.4%). PMID:26897186

  2. Eduardo Martínez Alonso (1903-72): gallant surgeon who undertook special operations.

    Science.gov (United States)

    Coni, Nicholas

    2010-02-01

    Eduardo Martínez Alonso was of Spanish and Uruguyan extraction and was born in Vigo in Galicia in 1903. Due to his father's occupation, he was educated in the UK and qualified from the University of Liverpool. He returned to Madrid to practise and during the Civil War he found himself in the Republican zone where his connections with the Royal Family brought him under suspicion. Threatened with execution, he escaped to serve as a surgeon in the Nationalist Army. Being bilingual, he was medical adviser to the British Embassy during World War II; because of his allegiance to this country and acting from humanitarian motives, he became a ringleader in a plot to smuggle fugitives from Nazi-occupied Europe across a pro-Axis Spain to safety. When the Gestapo was closing in on him, he was smuggled to the UK via Portugal. He underwent training as a potential undercover agent should Franco take Spain into the war but, when hostilities ceased, he returned to Madrid and became a leading thoracic surgeon. PMID:20207896

  3. A population-based study of ambulatory and surgical services provided by orthopaedic surgeons for musculoskeletal conditions

    Directory of Open Access Journals (Sweden)

    Davis Aileen M

    2009-03-01

    Full Text Available Abstract Background The ongoing process of population aging is associated with an increase in prevalence of musculoskeletal conditions with a concomitant increase in the demand of orthopaedic services. Shortages of orthopaedic services have been documented in Canada and elsewhere. This population-based study describes the number of patients seen by orthopaedic surgeons in office and hospital settings to set the scene for the development of strategies that could maximize the availability of orthopaedic resources. Methods Administrative data from the Ontario Health Insurance Plan and Canadian Institute for Health Information hospital separation databases for the 2005/06 fiscal year were used to identify individuals accessing orthopaedic services in Ontario, Canada. The number of patients with encounters with orthopaedic surgeons, the number of encounters and the number of surgeries carried out by orthopaedic surgeons were estimated according to condition groups, service location, patient's age and sex. Results In 2005/06, over 520,000 Ontarians (41 per 1,000 population had over 1.3 million encounters with orthopaedic surgeons. Of those 86% were ambulatory encounters and 14% were in hospital encounters. The majority of ambulatory encounters were for an injury or related condition (44% followed by arthritis and related conditions (37%. Osteoarthritis accounted for 16% of all ambulatory encounters. Orthopaedic surgeons carried out over 140,000 surgeries in 2005/06: joint replacement accounted for 25% of all orthopaedic surgeries, whereas closed repair accounted for 16% and reductions accounted for 21%. Half of the orthopaedic surgeries were for arthritis and related conditions. Conclusion The large volume of ambulatory care points to the significant contribution of orthopaedic surgeons to the medical management of chronic musculoskeletal conditions including arthritis and injuries. The findings highlight that surgery is only one component of the work

  4. Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.

    Science.gov (United States)

    Yang, Yun Seok; Kim, Seung Hyun; Jin, Chan Hee; Oh, Kwoan Young; Hur, Myung Haeng; Kim, Soo Young; Yim, Hyun Soon

    2014-01-01

    The objective of this study was to present the initial operative experience of solo surgeon single-port laparoscopic surgery (SPLS) in the laparoscopic treatment of benign gynecologic diseases and to investigate its feasibility and surgical outcomes. Using a novel homemade laparoscope-anchored instrument system that consisted of a laparoscopic instrument attached to a laparoscope and a glove-wound retractor umbilical port, we performed solo surgeon SPLS in 13 patients between March 2011 and June 2012. Intraoperative complications and postoperative surgical outcomes were determined. The primary operative procedures performed were unilateral salpingo-oophorectomy (n = 5), unilateral salpingectomy (n = 2), adhesiolysis (n = 1), and laparoscopically assisted vaginal hysterectomy (n = 5). Additional surgical procedures included additional adhesiolysis (n = 4) and ovarian drilling (n = 1).The primary indications for surgery were benign ovarian tumors (n = 5), ectopic pregnancy (n = 2), pelvic adhesion (infertility) (n = 1), and benign uterine tumors (n = 5). Solo surgeon SPLS was successfully accomplished in all procedures without a laparoscopic assistant. There were no intraoperative or postoperative complications. Our laparoscope-anchored instrument system obviates the need for an additional laparoscopic assistant and enables SPLS to be performed by a solo surgeon. The findings show that with our system, solo surgeon SPLS is a feasible and safe alternative technique for the treatment of benign gynecologic diseases in properly selected patients. PMID:24509292

  5. A sample of Canadian orthopedic surgeons expressed willingness to participate in osteoporosis management for fragility fracture patients

    Science.gov (United States)

    Bogoch, Earl R.; Snowden, Elizabeth

    2008-01-01

    Objective The orthopedic community is in a unique position to initiate and provide osteoporosis care in fragility fracture patients to prevent future hip fractures in a high-risk population. The attitudes and intentions of Canadian orthopedic surgeons in the domain of osteoporosis care are unknown. Our objective was to identify current attitudes and osteoporosis management practices and to determine their overall willingness to participate in osteoporosis care for fragility fracture patients. Methods A real-time interactive polling session was conducted at the 58th Annual Meeting of the Canadian Orthopaedic Association. Results Of the orthopedic surgeons who responded, 90.4% agreed that the current emphasis on osteoporosis in orthopedic practice is appropriate; 85.2% of surgeons indicated that they currently refer or personally investigate for osteoporosis, or both, in fragility fracture patients. Conclusion Most of the Canadian orthopedic surgeons sampled consider themselves to be currently engaged or ready to engage in osteoporosis care for fragility fracture patients. Focus should now shift from education and persuasion to program support through provision of resources and system modification that will enable Canadian orthopedic surgeons to effectively manage osteoporosis in their fracture patients. PMID:18248700

  6. Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference

    Directory of Open Access Journals (Sweden)

    Ehsan Saadat

    2014-12-01

    Full Text Available Unilateral anterior cruciate ligament (ACL tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2% surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2% preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58% or hamstring autograft (41% were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.

  7. Up Close and Personal: A Statewide Collaborative's Effort to Get Individual Surgeon Quality Improvement Data to the Practitioner.

    Science.gov (United States)

    Daley, Brian J; Cecil, William; Cofer, Joseph B; Clarke, P Chris; Guillamondegui, Oscar

    2016-03-01

    Ranking of surgeons and hospitals focuses on procedure volume and hospitality. The National Surgical Quality Improvement Program provides vetted outcomes of surgical quality and therefore can direct improvement. Our statewide collaborative's analysis creates personalized surgeon data to drive quality improvement. Statewide National Surgical Quality Improvement Program data generated specific measures from 103,656 general/vascular cases and identified individual surgeon's outcome of occurrences and length of procedure. We assumed a normal distribution and called the top 2.5 per cent as exemplars and the bottom 2.5 per cent as outliers. For length of operation, a standard duration was calculated, and identified outliers as longer than the 95th percentile of the upper confidence interval/procedure. Since 2009, sharing best practice reduced statewide mortality rate by 31.5 per cent and postoperative morbidity by 33.3 per cent. For length of surgery, long outliers have more complications (urinary tract infection, organ space/surgical site infection, sepsis, septic shock, prolonged intubation, pneumonia, deep venous thrombosis, deep incisional infection, and wound disruption). No significant trends in surgeon performance were seen over 24 months. A statewide collaborative has resulted in substantial risk-adjusted reductions in surgical morbidity and mortality. These results of the individual surgeon demonstrate best practices are shared, a proven tool for improvement in our collaborative. PMID:27099053

  8. Interprofessional non-technical skills for surgeons in disaster response: a qualitative study of the Australian perspective.

    Science.gov (United States)

    Willems, Anneliese; Waxman, Buce; Bacon, Andrew K; Smith, Julian; Peller, Jennifer; Kitto, Simon

    2013-03-01

    Interprofessional non-technical skills for surgeons in disaster response have not yet been developed. The aims of this study were to identify the non-technical skills required of surgeons in disaster response and training for disaster response and to explore the barriers and facilitators to interprofessional practice in surgical teams responding to disasters. Twenty health professionals, with prior experience in natural disaster response or education, participated in semi-structured in-depth interviews. A qualitative matrix analysis design was used to thematically analyze the data. Non-technical skills for surgeons in disaster response identified in this study included skills for austere environments, cognitive strategies and interprofessional skills. Skills for austere environments were physical self-care including survival skills, psychological self-care, flexibility, adaptability, innovation and improvisation. Cognitive strategies identified in this study were "big picture" thinking, situational awareness, critical thinking, problem solving and creativity. Interprofessional attributes include communication, team-player, sense of humor, cultural competency and conflict resolution skills. "Interprofessionalism" in disaster teams also emerged as a key factor in this study and incorporated elements of effective teamwork, clear leadership, role adjustment and conflict resolution. The majority of participants held the belief that surgeons needed training in non-technical skills in order to achieve best practice in disaster response. Surgeons considerring becoming involved in disaster management should be trained in these skills, and these skills should be incorporated into disaster preparation courses with an interprofessional focus. PMID:22830532

  9. Survey of Common Practices among Oculofacial Surgeons in the Asia-Pacific Region: Management of Orbital Floor Blowout Fractures.

    Science.gov (United States)

    Koh, Victor; Chiam, Nathalie; Sundar, Gangadhara

    2014-09-01

    A web-based anonymous survey was performed to assess common practices of oculofacial surgeons in the management of traumatic orbital floor blowout fractures. A questionnaire which contained questions on several controversial topics in the management of orbital floor fractures was sent out via e-mail to 131 oculofacial surgeons in 14 countries in the Asia-Pacific region. A total response rate of 58.3% was achieved from May to December 2012. The preferred time for surgical intervention was within 2 weeks for adult patients, porous polyethylene implant was the most popular choice, and most surgeons preferred the transconjunctival approach. Postoperatively, diplopia was the most commonly encountered complication and most oculofacial surgeons reviewed their patients regularly for up to 12 months. We report the results of the first survey of oculofacial surgeons within the Asia-Pacific region on the management of orbital floor blowout fractures. Compared with previous surveys (from year 2000 to 2004), the duration to surgical intervention was comparable but there was a contrasting change in preferred surgical approach and choice of orbital implant. PMID:25136408

  10. The Demography of Royal Navy Surgeons: Some Views on the Process of Prosopography

    Directory of Open Access Journals (Sweden)

    Christopher H Myers

    2015-08-01

    Full Text Available This study is a brief social biography and demography of British naval doctors during the nineteenth century, asking why Scottish-educated surgeons were so prominent.  Understanding the demography and changing dynamics of naval surgeons’ labor illuminates the complex relationship among the military, discrimination, and nationalism that shaped this influential labor market. This study reviews how to collect demographic information from multiple types of sources: university archives, matriculation records, digitized medical journals, and student rolls.  It also uses chi-square tests to show the significance of the demographic information collected.  The results show us the entangled relationship between database conceptualization, data collection, and data analysis.  

  11. Orthopaedic surgeon's nightmare: iatrogenic fractures of talus and medial malleolus following tibial nailing

    Institute of Scientific and Technical Information of China (English)

    Sanjay Meena; Vivek Trikha; Pramod Saini; Rakesh Kumar; Buddhadev Chowdhary

    2013-01-01

    Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures.The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice.Despite adequate surgeon experience,tibial nailing is not without complications if proper techniques are not followed.A case of iatrogenic talar neck and medial malleolus fractures during intramedullary nailing of tibia in a 24-year-old male is reported.It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed.To the best of our knowledge,no such case has been reported in the literature.It is possible to reduce the risk of this complication by adoption of preventive measures.

  12. 3D Bioprinting of Cartilage for Orthopedic Surgeons: Reading between the Lines

    Science.gov (United States)

    Di Bella, Claudia; Fosang, Amanda; Donati, Davide M.; Wallace, Gordon G.; Choong, Peter F. M.

    2015-01-01

    Chondral and osteochondral lesions represent one of the most challenging and frustrating scenarios for the orthopedic surgeon and for the patient. The lack of therapeutic strategies capable to reconstitute the function and structure of hyaline cartilage and to halt the progression toward osteoarthritis has brought clinicians and scientists together, to investigate the potential role of tissue engineering as a viable alternative to current treatment modalities. In particular, the role of bioprinting is emerging as an innovative technology that allows for the creation of organized 3D tissue constructs via a “layer-by-layer” deposition process. This process also has the capability to combine cells and biomaterials in an ordered and predetermined way. Here, we review the recent advances in cartilage bioprinting and we identify the current challenges and the directions for future developments in cartilage regeneration. PMID:26322314

  13. Interdisciplinary shock-room care: tasks for the radiologist from the viewpoint of the trauma surgeon

    International Nuclear Information System (INIS)

    Efficient resuscitation of major trauma requests an interdisciplinary communication between trauma surgeons, anaesthesiologists and radiologists. Trauma outcome is significantly influenced by horizontal trauma team organisation and coherence to clinical algorithms, which allow fast diagnosis and intervention. A radiologist present on patients arrival in the trauma room provides a major impact on trauma care. Nevertheless optimal integration in the trauma team implies profound knowledge of the priorities of advanced trauma life support and trauma algorithms. His or her involvement is not limited to patient care only, also active participation in trauma room design, interdisciplinary algorithm development and trauma research are essential tasks for radiologists devoted to emergency radiology. Based on the pathophysiology of polytrauma and the structure of German trauma system, current concepts and proven clinical algorithms with special regard to the radiologist and his duties and tasks will are presented. (orig.)

  14. Civil Surgeon Tuberculosis Evaluations for Foreign-Born Persons Seeking Permanent U.S. Residence.

    Science.gov (United States)

    Bemis, Kelley; Thornton, Andrew; Rodriguez-Lainz, Alfonso; Lowenthal, Phil; Escobedo, Miguel; Sosa, Lynn E; Tibbs, Andrew; Sharnprapai, Sharon; Moser, Kathleen S; Cochran, Jennifer; Lobato, Mark N

    2016-04-01

    Foreign-born persons in the United States seeking to adjust their status to permanent resident must undergo screening for tuberculosis (TB) disease. Screening is performed by civil surgeons (CS) following technical instructions by the Centers for Disease Control and Prevention. From 2011 to 2012, 1,369 practicing CS in California, Texas, and New England were surveyed to investigate adherence to the instructions. A descriptive analysis was conducted on 907 (66%) respondents. Of 907 respondents, 739 (83%) had read the instructions and 565 (63%) understood that a chest radiograph is required for status adjustors with TB symptoms; however, only 326 (36%) knew that a chest radiograph is required for immunosuppressed status adjustors. When suspecting TB disease, 105 (12%) would neither report nor refer status adjustors to the health department; 91 (10%) would neither start treatment nor refer for TB infection. Most CS followed aspects of the technical instructions; however, educational opportunities are warranted to ensure positive patient outcomes. PMID:25672993

  15. The role of imaging for the surgeon in primary malignant bone tumors of the chest wall

    International Nuclear Information System (INIS)

    Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach. Positive margins after surgical procedure are the principal risk factor of local recurrence, therefore to perform adequate surgery a correct preoperative staging is mandatory. Imaging techniques are used for diagnosis, to determine anatomic site and extension, to perform a guided biopsy, for local and general staging, to evaluate chemotherapy response, to detect the presence of a recurrence. This article will focus on the role of imaging in guiding this often difficult surgery and the different technical possibilities adopted in our department to restore the mechanics of the thoracic cage after wide resections

  16. Orthopaedic surgeon's nightmare: iatrogenic fractures of talus and medial malleolus following tibial nailing.

    Science.gov (United States)

    Meena, Sanjay; Trikha, Vivek; Saini, Pramod; Kumar, Rakesh; Chowdhary, Buddhadev

    2013-01-01

    Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice. Despite adequate surgeon experience, tibial nailing is not without complications if proper techniques are not followed. A case of iatrogenic talar neck and medial malleolus fractures during intramedullary nailing of tibia in a 24-year-old male is reported. It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed. To the best of our knowledge, no such case has been reported in the literature. It is possible to reduce the risk of this complication by adoption of preventive measures. PMID:23910680

  17. A comparison of performances of consultant surgeons, NCHDs and medical students in a modified HPAT examination.

    LENUS (Irish Health Repository)

    Quinn, A

    2010-06-01

    Following the implementation of the Fottrell report, entry to medical school in Ireland has undergone significant change. Medical school studentship is now awarded based on a combination of points obtained from the final examination of Irish secondary schools (the leaving certificate) combined with HPAT scores (Health Professions Admissions Test). The HPAT is designed to test a candidate\\'s knowledge in several different fields including problem solving skills, logical and non verbal reasoning. A sample HPAT was administered to a test group composed of consultant surgeons, non consultant hospital doctors, and medical students. Statistical analysis was performed and no significant difference was found between the performances of the groups. This is surprising as it was expected that groups with greater experience at medical problem solving would have translated to higher scores. This exposes a flaw within the HPAT system and a potential weakness in the process of doctor selection.

  18. Dental surgeons with natural rubber latex allergy: a report of 20 cases.

    Science.gov (United States)

    Field, E A

    1999-02-01

    Latex allergy is becoming a major occupational health issue and dental surgeons are at risk from becoming sensitized to natural rubber latex. A study was conducted to investigate risk factors and glove-related symptoms reported by dentists with natural rubber latex allergy. Twenty dentists, who had undergone serological or dermatological testing for a Type I allergy to latex, were identified from a questionnaire survey. Risk factors investigated were: gender, years in clinical practice, exposure to latex gloves, atopic history and food allergy. The majority of dentists (75%) gave an atopic history. Glove-related adverse reactions ranged from cutaneous to systemic manifestations. All twenty dentists reported itching of the hands in response to latex gloves. One respondent was unable to continue in dental practice because of her glove-related allergies; nineteen dentists were able to continue by using synthetic, non-latex gloves. PMID:10436562

  19. The Association of Surgeons in Training Conference: #ASiT2015 Glasgow.

    Science.gov (United States)

    Gokani, V J; Beamish, A J; Sinclair, P; Robson, A; Harries, R L

    2015-11-01

    The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. ASiT is in-dependent of the National Health Service (NHS), Surgical Royal Colleges, and specialty associations and represents trainees in all ten surgical specialties. ASiT was delighted to welcome a number of distinguished guests and speakers to Glasgow for #ASiT2015. The theme of 'The Future of Surgery' delved into challenges surgical training faces, exciting developments into using technology to help patients, a glance at the past with the development of the Glasgow Coma Score and whether mortality truly is the future of measured outcomes. More than £3500 of prizes was awarded by the incoming President, Miss. Rhiannon Harries to the highest scoring papers presented selected from over 1000 abstracts submitted. PMID:26525269

  20. Civil Surgeon Tuberculosis Evaluations for Foreign-Born Persons Seeking Permanent U.S. Residence

    Science.gov (United States)

    Bemis, Kelley; Thornton, Andrew; Rodriguez-Lainz, Alfonso; Lowenthal, Phil; Escobedo, Miguel; Sosa, Lynn E.; Tibbs, Andrew; Sharnprapai, Sharon; Moser, Kathleen S.; Cochran, Jennifer

    2016-01-01

    Foreign-born persons in the United States seeking to adjust their status to permanent resident must undergo screening for tuberculosis (TB) disease. Screening is performed by civil surgeons (CS) following technical instructions by the Centers for Disease Control and Prevention. From 2011 to 2012, 1,369 practicing CS in California, Texas, and New England were surveyed to investigate adherence to the instructions. A descriptive analysis was conducted on 907 (66 %) respondents. Of 907 respondents, 739 (83 %) had read the instructions and 565 (63 %) understood that a chest radiograph is required for status adjustors with TB symptoms; however, only 326 (36 %) knew that a chest radiograph is required for immunosuppressed status adjustors. When suspecting TB disease, 105 (12 %) would neither report nor refer status adjustors to the health department; 91 (10 %) would neither start treatment nor refer for TB infection. Most CS followed aspects of the technical instructions; however, educational opportunities are warranted to ensure positive patient outcomes. PMID:25672993

  1. [An important son of Aub: the military surgeon and ophthalmologist Johann Adam Schmidt (1759-1809)].

    Science.gov (United States)

    Krogmann, Frank; Vollmuth, Ralf

    2009-01-01

    The following article gives you a review to the life and work of the military surgeon and ophthalmologist Johann Adam Schmidt who was born in Aub/Lower Franconia on the 12th of October 1759. He had got his surgical education in Würzburg and had worked as an Unterchirurgus in the War of the Bavarian succession. Later on he completed his education in Vienna where he, by joining different work places, had been appointed to a professorship at the Medico-Surgical Joseph's Academy and became a leading figure of the Austrian military medical service. Also as an ophthalmologist Johann Adam Schmidt obtained high credit for his practical activity and his academic work. Johann Adam Schmidt died on the 19th of February 1809 and left a multiplicity of publications. He got not least publicity as the doctor of Beethoven, who dedicated the trio for piano, clarinet or violin and violoncello (Es-major) Opus 38 to Schmidt. PMID:20509447

  2. Development of Personal Protection Equipment for Medical Staff: Case of Dental Surgeon

    Directory of Open Access Journals (Sweden)

    Tran Thi Anh Dao

    2015-12-01

    Full Text Available During daily oral health care, dental surgeons are in contact with numerous potentially infectious germs from patients’ saliva and blood. Appropriate personal protection equipment should be chosen to mitigate these risks, but the garment must also be comfortable and not hamper activities. This paper presents our research work on optimised working clothing for dentists and discusses some important points in the functional design. Following a consumer study on how users wear the garment and what are their expectations, three main functions were investigated: protection, ergonomics and thermal comfort. Aesthetic appearance was also taken into consideration as it is necessary that the wearer should feel appropriately and attractively dressed in the context of health care.

  3. How does reviewing the evidence change veterinary surgeons' beliefs regarding the treatment of ovine footrot? A quantitative and qualitative study.

    Directory of Open Access Journals (Sweden)

    Helen M Higgins

    Full Text Available Footrot is a widespread, infectious cause of lameness in sheep, with major economic and welfare costs. The aims of this research were: (i to quantify how veterinary surgeons' beliefs regarding the efficacy of two treatments for footrot changed following a review of the evidence (ii to obtain a consensus opinion following group discussions (iii to capture complementary qualitative data to place their beliefs within a broader clinical context. Grounded in a Bayesian statistical framework, probabilistic elicitation (roulette method was used to quantify the beliefs of eleven veterinary surgeons during two one-day workshops. There was considerable heterogeneity in veterinary surgeons' beliefs before they listened to a review of the evidence. After hearing the evidence, seven participants quantifiably changed their beliefs. In particular, two participants who initially believed that foot trimming with topical oxytetracycline was the better treatment, changed to entirely favour systemic and topical oxytetracycline instead. The results suggest that a substantial amount of the variation in beliefs related to differences in veterinary surgeons' knowledge of the evidence. Although considerable differences in opinion still remained after the evidence review, with several participants having non-overlapping 95% credible intervals, both groups did achieve a consensus opinion. Two key findings from the qualitative data were: (i veterinary surgeons believed that farmers are unlikely to actively seek advice on lameness, suggesting a proactive veterinary approach is required (ii more attention could be given to improving the way in which veterinary advice is delivered to farmers. In summary this study has: (i demonstrated a practical method for probabilistically quantifying how veterinary surgeons' beliefs change (ii revealed that the evidence that currently exists is capable of changing veterinary opinion (iii suggested that improved transfer of research

  4. Unfolding the Remarkable Orthopedic Surgeon. How to unleash the quest for excellence and the sense of caring.

    Science.gov (United States)

    Rosinski, Philippe; Thienpont, Emmanuel

    2015-12-01

    Orthopedic surgery is a challenging profession, both at the diagnostic and therapeutic level. Successful treatment of patients requires teamwork with different stakeholders, with various personalities and motives. Coping with the stress of the quest for the ultimate surgical result might not be easy for everyone. While some surgeons see their activities as a job or at best as a career, others who face similar difficulties seem to respond to a higher calling. They are the ones striving for continuous improvement and excellence, and are committed to serving their patients with a deep sense of caring. In this article, we introduce a surgeon typology based on these two variables. We also introduce global coaching as a novel approach to help surgeons on this potentially transformational journey. We focus on the qualities that global coaching can help to develop as well as briefly mention some of the models and tools that can be called upon. Evidence from the Harvard Grant longitudinal study confirms that humans continue to develop during their adulthood and suggests that the following hypothesis is likely to be accurate: remarkable surgeons committed to technical excellence and caring deeply for their patients are likely to be most successful both in their careers and in their lives. If necessary, surgeons have a chance, a choice and a responsibility to change course, to reconnect with their profession and to establish more intimate relationships with their patients, colleagues as well as in their personal lives. By growing into becoming remarkable surgeons, they will serve others as well as themselves. PMID:26790780

  5. Impact of Nonvascular Thoracic MR Imaging on the Clinical Decision Making of Thoracic Surgeons: A 2-year Prospective Study.

    Science.gov (United States)

    Ackman, Jeanne B; Gaissert, Henning A; Lanuti, Michael; Digumarthy, Subba R; Shepard, Jo-Anne O; Halpern, Elkan F; Wright, Cameron D

    2016-08-01

    Purpose To determine the impact of nonvascular thoracic magnetic resonance (MR) imaging on the clinical decision making and diagnostic certainty of thoracic surgeons. Materials and Methods Seven thoracic surgeons at Massachusetts General Hospital, an academic quaternary referral hospital, participated in this 2-year, prospective, institution review board-approved, HIPAA-compliant pre- and post-MR imaging survey study after completing a one-time demographic survey. Between July 16, 2013, and July 13, 2015, each time a thoracic surgeon ordered a nonvascular thoracic MR imaging study via radiology order entry, he or she was sent a link to the pre-test survey that ascertained the clinical rationale for MR imaging, the clinical management plan if MR imaging was not an option, and pre-test diagnostic certainty. Upon completion of the MR imaging report, the surgeon was sent a link to the post-test survey assessing if/how MR imaging changed clinical management, the surgeon's comfort with the clinical management plan, and post-test diagnostic certainty. Data were analyzed with Student t, Wilcoxon, and McNemar tests. Results A total of 99 pre- and post-test surveys were completed. Most MR imaging studies (64 of 99 [65%]) were requested because of indeterminate computed tomographic findings. The use of MR imaging significantly reduced the number of planned surgical interventions (P management plan in 95% (94 of 99) of cases. Increased diagnostic certainty as a result of MR imaging was highly significant (P < .0001). In 21% (21 of 99) of cases, definitive MR imaging results warranted no further follow-up or clinical care. Conclusion In appropriate cases, assessment with nonvascular thoracic MR imaging substantially affects the clinical decision making and diagnostic certainty of thoracic surgeons. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on May 2, 2016

  6. Clinical Efficacy of Simulated Vitreoretinal Surgery to Prepare Surgeons for the Upcoming Intervention in the Operating Room.

    Directory of Open Access Journals (Sweden)

    Svenja Deuchler

    Full Text Available To evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons' performance.In a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9 or not (n = 12. Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room.Comparing each surgeon's performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room.Despite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.

  7. Migration to the ICD-10 coding system: A primer for spine surgeons (Part 1

    Directory of Open Access Journals (Sweden)

    Gazanfar Rahmathulla

    2014-01-01

    Full Text Available Background: On 1 October 2015, a new federally mandated system goes into effect requiring the replacement of the International Classification of Disease-version 9-Clinical Modification (ICD-9-CM with ICD-10-CM. These codes are required to be used for reimbursement and to substantiate medical necessity. ICD-10 is composite with as many as 141,000 codes, an increase of 712% when compared to ICD-9. Methods: Execution of the ICD-10 system will require significant changes in the clinical administrative and hospital-based practices. Through the transition, diminished productivity and practice revenue can be anticipated, the impacts of which the spine surgeon can minimizeby appropriate education and planning. Results: The advantages of the new system include increased clarity and more accurate definitions reflecting patient condition, information relevant to ambulatory and managed care encounters, expanded injury codes, laterality, specificity, precise data for safety and compliance reporting, data mining for research, and finally, enabling pay-for-performance programs. The disadvantages include the cost per physician, training administrative staff, revenue loss during the learning curve, confusion, the need to upgrade hardware along with software, and overall expense to the healthcare system. Conclusions: With the deadline rapidly approaching, gaps in implementation result in delayed billing, delayed or diminished reimbursements, and absence of quality and outcomes data. It is thereby essential for spine surgeons to understand their role in transitioning to this new environment. Part I of this article discusses the background, coding changes, and costs as well as reviews the salient features of ICD-10 in spine surgery

  8. Fate of abstracts presented at Association of Paediatric Surgeons of Nigeria annual meetings

    Directory of Open Access Journals (Sweden)

    Abdulrasheed A Nasir

    2012-01-01

    Full Text Available Background: The purpose of this study was to examine the characteristics of abstracts presented at the annual scientific meetings of Association of Paediatric Surgeons of Nigeria and their final publication rate. Materials and Methods: All abstracts accepted for presentation at the Association of Paediatric Surgeons of Nigeria meetings from 2004 to 2009 were identified from literature, search engines and other online materials. Abstracts accepted for the meetings but not presented during the meetings were excluded. Results: A total of 153 abstracts were examined, of which 52 (34% resulted in publication in peer-reviewed journals. Median time from presentation to publication was 2 years (range 1-5 years. The median number of abstracts presented per year was 30 (range 25-40. About three quarters of abstracts were presented by consultants (114, 74.5% and 39 (25.4% by surgical trainees. Approximately three-quarters of the abstracts were case series (111, 75.8%. Case reports accounted for 22.8% of the abstracts. Thirty-two (39.5% of 81 retrospective studies, 8/31 (25.8% prospective studies, and 11/35 (31.4% case reports were converted to full publication (P = 0.403. Abstracts on surgical infection, paediatric surgical oncology, and gastrointestinal tract had the highest publication rates (54.5% [6/11], 46.2% [6/13], and 33.3% [22/66], respectively, P = 0.237. The largest numbers of the reports were published in the African Journal of Paediatric Surgery (16 of 48; 33%, the official Journal of the Association. Conclusions: Only a third of presented abstracts were subsequently published in peer-reviewed journals. Effort to encourage the publication rates of presented abstracts by improving quality of research work as well as encouraging preconference submission of full-length articles for accepted abstracts, for publication in a conference supplement of the Association′s journal is advised.

  9. Male gender is not a risk factor for the outcome of laparoscopiccholecystectomy: A single surgeon experience

    International Nuclear Information System (INIS)

    Previous studies regarding the outcome of laparoscopic cholecystectomy(LC) in men have reported inconsistent findings. We conducted thisprospective study to test the hypothesis that the outcome of LC is worse inmen than women. Between 1997 and 2002, a total of 391 consecutive LCs wereperformed by a single surgeon at King Fahd Hospital of the University. Wecollected and analyzed data including age, gender, body mass index (kg/m2),the American Society of Anesthesiologists (ASA) class, mode of admission(elective or emergency), indication for LC (chronic or acute) cholecystitis[AC]), comorbid disease, previous abdominal surgery, conversion to opencholecystectomy, complications, operation time and length of postoperativehospital stay. Bivariate analysis showed that both genders were matched forage, ASA class and mode of admission. The incidence of AC (P=0.003) andcomobrid disease (P=0.031) were significantly higher in men. Women weresignificantly more obese than men (P<0.001) and had a higher incidence ofprevious abdominal surgery (P=0.017). There were no statistical differencesbetween genders with regards to rate of conversion (P=0.372) andcomplications (P=0.647) and operation time (P=0.063). The postoperative staywas significantly longer in men than women (P=0.001). Logistic regressionanalysis showed that male gender was not an independent predictor ofconversion (Odds ratio [or] = 0.37 and P=0.43) or complications (OR=0.42,P=0.42). Linear regression analysis showed that male gender was not anindependent predictor of the operation time, but was associated with a longerpostoperative stay (P=0.02). Male gender is not an independent risk factorfor satisfactory outcome of LC in the experience of a single surgeon. (author)

  10. Papillary thyroid carcinoma: How much should the surgeon read from Fine needle aspiration cytology reports?

    Directory of Open Access Journals (Sweden)

    Das Dilip

    2010-10-01

    Full Text Available Objective: During routine fine needle aspiration cytodiagnosis of papillary thyroid carcinoma (PTC, a number of cases are diagnosed as suspicious; or it is suggested that PTC or a neoplasm be ruled out by histopathology. Since these diagnostic labels are likely to put the clinicians in a difficult situation while planning the management, this study aims to find out how much the surgeon should read from these reports. Materials and Methods: The patients were divided into two groups. Group A included 38 cases diagnosed as PTC or suspicious of PTC. Group B included 40 cases in which it was suggested that PTC/a neoplasm to be ruled out and non-neoplastic lesions with one or more cytologic features of PTC. The two groups were compared with clinical, imaging and cytomorphologic features. Results: A significant difference was observed with respect to age between Group A and Group B (P<0.001. The frequency of the following five cytologic features was significantly higher in Group A: papillary formation (P<0.001, psammoma bodies (P=0.054, fine nuclear chromatin (P=0.010, frequent nuclear grooves (P<0.001 and intra-nuclear cytoplasmic inclusion (P<0.001. Three or more of the five cytologic features were also reported in significantly higher number of Group A cases (P<0.001. Majority (81.8% of the cases with subsequent histology in Group A were confirmed as PTC as opposed to 7.7% in Group B (P<0.001. Conclusions: Thus, cases with definitive cytodiagnosis of PTC and suggestive of PTC (Group A should be taken much more seriously by the surgeons as compared to Group B cases.

  11. Finding the right hip implant for patient and surgeon: the Dutch strategy--empowering patients.

    Science.gov (United States)

    Poolman, Rudolf W; Verhaar, Jan A N; Schreurs, B Willem; Bom, L Paul A; Nelissen, Rob G H H; Koot, Henk W J; Goosen, Jon H M; Verheyen, Cees C P M

    2015-01-01

    We describe the implementation process of hip prostheses selection in the Netherlands. The recent problems with large head metal-on-metal hip prostheses resulted in substantial damage to the surgeons' credibility and reputation in the media. This led to a true sense of urgency among orthopaedic surgeons to increase their activities to secure patient safety. The board of the Dutch Orthopaedic Association (NOV) in the Netherlands established a Dutch Hip Task Force (DHTF) with the explicit assignment of formulating criteria to classify the quality of total hip implants on the Dutch market based on survivorship. The aim was to offer unequivocal information enabling a balanced choice of total hip prosthesis. The ultimate goal of the NOV is that all implanted total hip prostheses implanted in the Netherlands are based on reliable clinical evidence. The DHTF decided to adapt the principles of the National Institute for Health and Care Excellence (NICE, UK) (www.nice.org.uk). The taskforce uses data from the registries as well as the Orthopaedic Data Evaluation Panel (ODEP). If the ODEP guidelines had been chosen as standard alone, one quarter of our listed hip components would not have been included. In our view this underlines the strength in the Dutch approach where high quality registry data and ODEP ratings are complementary and result in a list of reliable hip prostheses. Most importantly we offer patients insights into the known quality of the implants by sharing the results of our implant review. This will facilitate shared decision making by empowering patients in their knowledge on available hip arthroplasties. PMID:25633758

  12. Atrial Fibrillation Following Surgical Management of Ischemic Heart Disease; One Year, Single Center, Single Surgeon Results

    Directory of Open Access Journals (Sweden)

    Ahmet Barış Durukan

    2012-08-01

    Full Text Available Introduction: Postoperative atrial fibrillation is the most common arrhythmia following bypasssurgery with significant morbidity, mortality and increased healthcare costs. The aim of this studyis to determine the incidence and timing of atrial fibrillation, identify the risk factors coveringpreoperative and intraoperative periods, evaluate rate of return to sinus rhythm by disharge, andexplore the impact on postoperative outcomes in a large group of patients operated in a singlecenter by a single surgeon.Patients and Methods: Between January 2011 and January 2012, 418 patients on preoperativesinus rhythm were operated for ischemic heart disease and associated complications (left ventricleaneurysm repair and ischemic mitral insufficiency in a single center, by a single surgeon.The preoperative, intraoperative and postoperative variables were studied.Results: The mean age of the patients were 61.92 ± 10.05, and 77.5% were male. Atrial fibrillationdeveloped in 68 (16.3% patients. The incidence peaked at second day. Patients with atrialfibrillation were older (p< 0.001. Gender, preoperative comorbidities, ejection fraction, left atrialdiameter, preoperative beta-blocker use, leukocyte count, type of operation and intraoperativevariables did not affect its occurence. Intensive care unit and hospital length of stay were longer(p< 0.05. 95.5% (n= 65 of patients were in normal sinus rhythm at discharge.Conclusion: Postoperative atrial fibrillation is a popular subject with unknowns and controversialresults which may lead to wrong interpretations. We believe that every center has its own risk factors related with the population of that region. Discussion will last, but simple precautions and close monitoring will help to minimizeadverse outcomes.

  13. Hand-assisted laparoscopic colorectal surgery: Initial experience of a single surgeon

    Directory of Open Access Journals (Sweden)

    Abdul-Wahed N Meshikhes

    2011-01-01

    Full Text Available Background/Aim: As totally laparoscopic colorectal surgery is considered challenging and technically demanding with a long steep learning curve, we adopted hand-assisted laparoscopic colorectal surgery as a bridge to totally laparoscopic assisted colorectal surgery. This prospective study aims to highlight the initial experience of a single surgeon with this technique. Materials and Methods: A prospective analysis of the first 25 cases of hand-assisted laparoscopic colorectal resections which were performed by a single surgeon over a 15-month period. There were 15 males and 10 females with a mean age of 55.5 (range 20-82 years. Results: The indication in majority of cases was cancer (76%. The procedures consisted of 18 (72% various colectomies and 7 (28% anterior resections. The operative time ranged between 110-400 (mean 180 min. There was one conversion (4% and the mean operative blood loss was 80 (range 60-165 ml. The number of lymph nodes retrieved in the cancer cases was 5-31 (mean 15 nodes. The mean length of hospital stay was five (range 3-10 days. The total number of short-term complications was six (24% and there was one death due to anastomatic leak and multiorgan failure. Long-term complications after a maximum follow up of 30 months were two incisional hernias at the hand port site, but none of the patients developed adhesive small bowel obstruction or late anastomotic stricture. Currently all our colorectal procedures are conducted laparoscopically. Conclusion: Hand-assisted laparoscopic colorectal procedures are easy to learn as a good bridge to master totally laparoscopic colorectal surgery.

  14. Personal dosimetry TLD 100 in orthopedic surgeons exposed to ionizing radiation in Bogota - Colombia

    International Nuclear Information System (INIS)

    Orthopedic surgeons should be considered as professionals occupationally exposed to ionizing radiation, for using C arc (fluoroscope) an equipment of X type radiation emission, during surgical procedures for imaging generation. Some health institutes, use of C arc under uncontrolled circumstances, such a lack of dosimetry control, incomplete or absence of personnel protective elements and protective measures, which in turn, lead to a high exposition to the personnel. Materials and methods. Study of double match cohort by age and gender, was conducted, in four health institutions of second and third level of attention in Bogota city. Personal dosimetry measurements with TLD-100 dosimetry crystals in both cohorts and environmental dosimetry in each of operation rooms used for orthopedic procedures, were carry out during six months of follow up. Dosimetry crystals were read in a Harshaw 4500 - Bicron equipment, in the Medical Physics Laboratory of National University of Colombia. Results. Dosimetry measurements are compatibles with those of occupationally exposed personnel 3.44 mSv/6 m CI 95% (1.66-3.99), even does not overpass ICRP recommendations, are higher as were expect at the beginning of the study. The median of effective accumulative dose in thorax is 3,4 mSv CI 95% (1,66-3,99), higher in comparison with neck value 2,7 mSv CI 95% (1,73-3,80) and hand dosimetry 1,42 mSv CI 95% (0,96-2,34). Conclusions: Orthopedic surgeons should be considered occupational exposed to ionizing radiation, who has to accomplish to the radiological protection measures, dosimetric follow up and maintenance of the used X ray equipment. It was confirm throughout this study that dosimetry shows higher levels as expected at the beginning of the study, compatible with occupationally exposed personnel. (Author)

  15. Differentiating C8–T1 Radiculopathy from Ulnar Neuropathy: A Survey of 24 Spine Surgeons

    OpenAIRE

    Stoker, Geoffrey E.; Kim, Han Jo; Riew, K. Daniel

    2013-01-01

    Study Design Questionnaire. Objective To evaluate the ability of spine surgeons to distinguish C8–T1 radiculopathies from ulnar neuropathy. Methods Twenty-four self-rated “experienced” cervical spine surgeons completed a questionnaire with the following items. (1) If the ulnar nerve is cut at the elbow, which of the following would be numb: ulnar forearm, small and ring fingers; only the ulnar forearm; only the small and ring fingers; or none of the above? (2) Which of the following muscles a...

  16. Orthopaedic Surgeons as Clinical Leaders in the National Health Service, United Kingdom (NHS UK): Can the World Learn From Us?

    Science.gov (United States)

    Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr

    2015-07-01

    This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction. PMID:26208560

  17. Do geography and resources influence the need for colostomy in Hirschsprung′s disease and anorectal malformations? A Canadian association of paediatric surgeons: Association of paediatric surgeons of Nigeria survey

    Directory of Open Access Journals (Sweden)

    Lukman O. Abdur-Rahman

    2014-01-01

    Full Text Available Background: This survey compared surgical management of Hirschsprung′s disease (HD and anorectal malformations (ARM in high and low resource settings. Materials and Methods: An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS and the Association of Paediatric Surgeons of Nigeria (APSON. Results: The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97. Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05 and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05. Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%. CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P < 0.05. The frequency of colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources. Conclusions: Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care.

  18. 21 CFR 800.20 - Patient examination gloves and surgeons' gloves; sample plans and test method for leakage defects...

    Science.gov (United States)

    2010-04-01

    ...; sample plans and test method for leakage defects; adulteration. 800.20 Section 800.20 Food and Drugs FOOD... plans and test method for leakage defects; adulteration. (a) Purpose. The prevalence of human... adulteration for patient examination and surgeons' gloves as a means of assuring safe and effective devices....

  19. Development of an On-Line Surgeon-Specific Operating Room Time Prediction System (Experience with the Michigan Surgical Monitors)

    OpenAIRE

    Brown, Allan C.D.; Schmidt, Nancy M.

    1984-01-01

    The development of a micro-computer application for the on-line prediction of surgeon-specific operating room time using an IBM - PCXT is described. The reasons leading to the project, together with an assessment of the Condor 20 relational database management system as the basis for the application are discussed.

  20. A study on the radiation dose of the orthopaedic surgeon and staff from a mini c-arm fluoroscopy unit

    International Nuclear Information System (INIS)

    In this study, radiation exposure to the surgeon and supporting staff from a mini C-arm unit during fluoroscopically guided orthopaedic surgeries was studied. A Diadose dosemeter and Gamma-Scout meter were used for air-kerma measurements for primary and scattered radiations. The entrance dose of hands, eyes and thyroid of the surgeon was measured during direct observation. Scattered air-kerma rate was measured to quantify the received entrance dose of the supporting staff. During direct observation, the skin-entrance exposure rates of the surgeon's hand, eye and thyroid gland were 8036, 0.85 and 0.9 μGy min-1, respectively. The scattered exposure rate was precipitously dropped beyond the path of the primary radiation beam, and reached 0.51 μGy min-1 at a distance of 40 cm from the beam's central axis. This study showed that the surgeon's hand was the most dose-limiting organ for fluoroscopically guided orthopaedic surgery procedures when it was exposed to primary radiation. The exposure of supporting staff at a working distance of >20 cm from the beam was minimal during fluoroscopy by mini C-arm unit. (authors)

  1. Hanging foot switch for bipolar forceps: a device for surgeons operating in the standing position: technical note.

    Science.gov (United States)

    Shimizu, Satoru; Kondo, Koji; Yamazaki, Tomoya; Koizumi, Hiroyuki; Miyazaki, Tomoko; Osawa, Shigeyuki; Sagiuchi, Takao; Nakayama, Kenji; Yamamoto, Isao; Fujii, Kiyotaka

    2013-01-01

    For surgeons operating in the standing position, the manipulation of foot switches involves shifting of the weight to the pivoting leg and the possible loss of contact between the switch and the foot. We solved this problem by changing the position of the switch that operates bipolar forceps. Our novel device is made of aluminum plates. The base plate features a foot strap and a height-adjustable overhang over the switch-operating foot. A commercially-available disc type foot switch is attached to the underside of the overhang in upside-down position, so the switch is operable with the toe. To turn on the switch, the toe is flexed dorsally to push the switch pedal, so the action is limited to the part distal to the metatarsophalangeal joints. Our switch was used in more than 100 consecutive microsurgeries performed by surgeons operating in the standing position. The switch manipulation required no shifting of the weight and was easier and quicker than manipulation of conventionally-placed switches. The surgeons were able to change the foot position freely with the modified switch, thereby avoiding loss of contact with the switch. The modified switch placement reduced physical fatigue in the lower extremities, annoyance related to the manipulation of conventionally-placed switches, and increased the comfort of surgeons operating in the standing position. PMID:23358172

  2. Customization of a tool to assess Danish surgeons´ non-technical skills in the operating room

    DEFF Research Database (Denmark)

    Spanager, Lene; Lyk-Jensen, Helle Teglgaard; Dieckmann, Peter;

    2012-01-01

    Errors in surgery often stem from failure related to non-technical skills such as communication and teamwork. Tools for training and assessment of non-technical skills are needed to ensure safe surgery. The aim of this study was to customize the Non-Technical Skills for Surgeons (NOTSS) rating...

  3. 76 FR 24901 - Request for Input To Inform a Possible Surgeon General Action on Prescription Drug Abuse in Youth

    Science.gov (United States)

    2011-05-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Request for Input To Inform a Possible Surgeon General... work group has received expert input on the state of the science for addressing prescription drug...

  4. Robotic Assistance Enables Inexperienced Surgeons to Perform Unicompartmental Knee Arthroplasties on Dry Bone Models with Accuracy Superior to Conventional Methods

    Directory of Open Access Journals (Sweden)

    Monil Karia

    2013-01-01

    Full Text Available Robotic systems have been shown to improve unicompartmental knee arthroplasty (UKA component placement accuracy compared to conventional methods when used by experienced surgeons. We aimed to determine whether inexperienced UKA surgeons can position components accurately using robotic assistance when compared to conventional methods and to demonstrate the effect repetition has on accuracy. Sixteen surgeons were randomised to an active constraint robot or conventional group performing three UKAs over three weeks. Implanted component positions and orientations were compared to planned component positions in six degrees of freedom for both femoral and tibial components. Mean procedure time decreased for both robot (37.5 mins to 25.7 mins (P=0.002 and conventional (33.8 mins to 21.0 mins (P=0.002 groups by attempt three indicating the presence of a learning curve; however, neither group demonstrated changes in accuracy. Mean compound rotational and translational errors were lower in the robot group compared to the conventional group for both components at all attempts for which rotational error differences were significant at every attempt. The conventional group’s positioning remained inaccurate even with repeated attempts although procedure time improved. In comparison, by limiting inaccuracies inherent in conventional equipment, robotic assistance enabled surgeons to achieve precision and accuracy when positioning UKA components irrespective of their experience.

  5. Occupational hazards concerning the dental surgeon: identification, prevention and legislation; Risques professionnels au cabinet dentaire: identification, prevention et legislation

    Energy Technology Data Exchange (ETDEWEB)

    Amory, C

    2004-07-01

    This thesis concerns the legislation about the work of dentistry and the different obligations relative to this work, patient protection and dental surgeon protection are concerned as well. A special point is developed relative to the radiation protection and the training necessary to control it and apply it.

  6. What patients look for when choosing a plastic surgeon: an assessment of patient preference by conjoint analysis.

    Science.gov (United States)

    Waltzman, Joshua T; Scholz, Thomas; Evans, Gregory R D

    2011-06-01

    The knowledge of patient preference is crucial for plastic surgeons to determine optimal marketing strategies. Conjoint analysis is a statistical technique whereby research participants make a series of trade-offs. Analysis of these trade-offs reveals the relative importance of component attributes. This study will evaluate the relative importance of attributes that influence the selection and decision-making process when choosing a plastic surgeon. A questionnaire consisting of 18 plastic surgeon profiles was rated by 111 patients. Attributes analyzed were as follows: travel distance, number of years in practice, board certification status, method of referral, office décor, and procedure cost. A traditional full-profile conjoint analysis was performed. Subjects consisted of 10 men and 101 women (n = 111). Median age was 51 years (range, 19-72). The "mean importance" of the attributes are as follows: board certification status, 39.7%; method of referral, 23.5%; distance from home to office, 13.2%; office décor, 9.0%; number of years in practice, 7.5%; and cost of procedure, 7.2%. Internal validity checks showed a high correlation (Pearson ρ = 0.995; P health care system. The level of importance for each attribute reliably helps plastic surgeons to understand the preferences of their patients, thus being able to improve marketing strategies for private practices and institutions. The present study indicates that the most important attributes were board certification and method of referral. PMID:21042177

  7. Can the referring surgeon enhance accrual of breast cancer patients to medical and radiation oncology trials? The ENHANCE study

    Science.gov (United States)

    Arnaout, A.; Kuchuk, I.; Bouganim, N.; Pond, G.; Verma, S.; Segal, R.; Dent, S.; Gertler, S.; Song, X.; Kanji, F.; Clemons, M.

    2016-01-01

    Introduction The accrual rate to clinical trials in oncology remains low. In this exploratory pilot study, we prospectively assessed the role that engaging a referring surgeon plays in enhancing nonsurgical oncologic clinical trial accrual. Methods Newly diagnosed breast cancer patients were seen by a surgeon who actively introduced specific patient-and physician-centred strategies to increase clinical trial accrual. Patient-centred strategies included providing patients, before their oncology appointment, with information about specific clinical trials for which they might be eligible, as evaluated by the surgeon. The attitudes of the patients about clinical trials and the interventions used to improve accrual were assessed at the end of the study. The primary outcome was the clinical trial accrual rate during the study period. Results Overall clinical trial enrolment during the study period among the 34 participating patients was 15% (5 of 34), which is greater than the institution’s historical average of 7%. All patients found the information delivered by the surgeon before the oncology appointment to be very helpful. Almost three quarters of the patients (73%) were informed about clinical trials by their oncologist. The top reasons for nonparticipation reported by the patients who did not participate in clinical trials included lack of interest (35%), failure of the oncologist to mention clinical trials (33%), and inconvenience (19%). Conclusions Accrual of patients to clinical trials is a complex multistep process with multiple potential barriers. The findings of this exploratory pilot study demonstrate a potential role for the referring surgeon in enhancing nonsurgical clinical trial accrual.

  8. The localization of 10% of the pathologic glands in secondary hyperparathyroidism depends on the surgeon experience

    Directory of Open Access Journals (Sweden)

    José Luis D’Addino

    2015-07-01

    Full Text Available Methods for preoperative localization of parathyroidin secondary hyperparathyroidism are controversial in the literature and have different and dissimilar sensitivity. With the objective to determine the correlation between preoperative ultrasound, scintigraphy MIBI and intraoperative findings in secondary hyperparathyroidism we review our 10 years statistic.Between2004-2014, 100 patients underwent parathyroidectomy due to secondary hyperparathyroidism. Data obtained from medical records included: preoperative serum parathormona, ultrasound, scintigraphy. Positive predictive value and negative predictive value were analyzed in correlation with intraoperative findings.The method of calculation of ROC curves and area under the curve and other screening values (confidence index, index of validity and likelihood ratio were used. 68% were women; mean age was 52,7 years. Mean PTH value was 1486 pg/ml. The specificity and sensitivity of preoperative ultrasound were 94,44% and 30,14%, respectively. PPV was 93,62% and NPV was 33,33%. For scintigraphy, the sensitivity was 25,34%, specificity 98,15%, PPV was 97,37% and NPV was 32,72%. The ultrasound diagnosed 94 glands among a possibility of 400, the scintigraphy showed 76 and the surgery founded 292. Recurrence, 22%. Ultrasound and scintigraphy allow the localization of pathological parathyroid; however, in 10% of cases,glands could not be detected preoperatively, making surgeons experience fundamental in gland localization

  9. Farmers' perception of the role of veterinary surgeons in vaccination strategies on British dairy farms.

    Science.gov (United States)

    Richens, I F; Hobson-West, P; Brennan, M L; Lowton, R; Kaler, J; Wapenaar, W

    2015-11-01

    There is limited research investigating the motivators and barriers to vaccinating dairy cattle. Veterinary surgeons have been identified as important sources of information for farmers making vaccination and disease control decisions, as well as being farmers' preferred vaccine suppliers. Vets' perception of their own role and communication style can be at odds with farmers' reported preferences. The objective of this study was to investigate how dairy farmers perceived the role of vets in implementing vaccination strategies on their farm. Semi-structured interviews were conducted with 24 dairy farmers from across Britain. The data were analysed using thematic analysis. Analysis revealed that farmers perceive vets to have an important role in facilitating decision-making in all aspects of vaccination, including the aspects of vaccine distribution and advice on implementation. This important role is acknowledged by farmers who have regular veterinary contact, but also farmers with solely emergency veterinary contact. Given this finding, future work should investigate the attitudes of vets towards vaccination and how they perceive their role. Combining this knowledge will enable optimisation of vaccination strategies on British dairy farms. PMID:26530434

  10. Pattern of traumatic brain injury treated by general surgeons in a tertiary referral hospital.

    Science.gov (United States)

    Chattopadhyay, Shankar Das; Karmakar, Nisith Chandra; Sengupta, Ritankar; SenGupta, Tamal Kanti; Ray, Debasis; Basus, Shibaji

    2013-09-01

    The number of polytrauma patient with associated brain injury or commonly referred as 'head injury' has increased tremendously in recent times courtesy to road traffic accident or other causes. This prospective observational study was conducted in patients of head injury admitted through emergency in the department of general surgery in NRS Medical College, Kolkata during the year 2011 to determine the pattern of head injury patients admitted and nature of intervention. A total number of 3861 patients were admitted in a single year. Obviously this represents the tip of the iceburg. Traumatic brain injury was the highest in the age group of 31-40 years (33.5%) followed by 21-30 years (29.1%) in the most fruitful phase of life. The traumatic brain injury death was more common in males. The maximum number of cases was from rural areas ie, farmers and labours. To minimise the morbidity and mortality resulting from head injury there is need for better maintenance of roads, improvement of road visibility and lighting, rigid enforcement of traffic rules and imparting road safety education to school children. Despite valiant efforts and advancement in medical sciences and infrastructure in the form of neurosurgery departments and trauma care units to cope with the changing world of trauma, there still remains a huge responsibility and a definite part to be played by the general surgeons to manage head injury patient even in tertiary hospitals. PMID:24968524

  11. Sorting swimmers shoulders: An observational study on swimmers that presented to a shoulder surgeon

    Directory of Open Access Journals (Sweden)

    Daniel Butler

    2015-01-01

    Full Text Available Context: It is common for swimmers to suffer shoulder injuries resulting in a wealth of research focusing on the causes and types of injury. However, there is a lack of evidence regarding current management for shoulder injuries in swimmers. Aims: To investigate the diagnosis, subsequent management, and the return to swimming outcomes for swimmers presenting to an orthopedic practice. Settings and Design: Retrospective cohort study of competitive swimmers presenting to an orthopedic practice. Materials and Methods: The diagnosis, subsequent management, and the return to swimming outcomes were analyzed for 14 swimmers whose injuries were managed by a shoulder surgeon. Statistical Analysis Used: Descriptive analysis. Results: No significant association was identified between swimming stroke and type of injury. The majority of swimmers had good scapula rhythm, with no visible dyskinesis, including those with impingement. Swimmers with impingement did not require arthroscopy, and with nonoperative management had a mean time to return to swimming of 1.6 months. All labral tears required arthroscopic labral repair, with these swimmers having a mean time of 2.9 months postsurgery to return to swimming. Conclusion: The study demonstrated that an accurate diagnosis, and appropriate choice of nonoperative and surgical treatments lead to reassuring outcomes for swimmers suffering from shoulder injuries.

  12. Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures.

    Science.gov (United States)

    Romanova, K; Vassileva, J; Alyakov, M

    2015-07-01

    The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. PMID:25944961

  13. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2016 Update on Research.

    Science.gov (United States)

    Jacobs, Marshall L; Jacobs, Jeffrey P; Pasquali, Sara K; Hill, Kevin D; Hornik, Christoph; O'Brien, Sean M; Shahian, David M; Habib, Robert H; Edwards, Fred H

    2016-09-01

    The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) is the largest congenital and pediatric cardiac surgical clinical data registry in the world. With more than 400,000 total operations from nearly all centers performing pediatric and congenital heart operations in North America, the STS CHSD is an unparalleled platform for clinical investigation, outcomes research, and quality improvement activities in this subspecialty. In 2015, several major original publications reported analyses of data in the CHSD pertaining to specific diagnostic and procedural groups, age-defined cohorts, or the entire population of patients in the database. Additional publications reported the most recent development, evaluation, and application of metrics for quality measurement and reporting of pediatric and congenital heart operation outcomes. This use of the STS CHSD for outcomes research and for quality measurement continues to expand as database participation and the available wealth of data in it continue to grow. This article reviews outcomes research and quality improvement articles published in 2015 based on STS CHSD data. PMID:27492669

  14. Transsphenoidal surgery for pituitary tumors from microsurgery to the endoscopic surgery. Single surgeon's experience

    International Nuclear Information System (INIS)

    We reviewed results of the surgical outcome of pituitary tumors treated via the transsphenoidal approach between January, 1994 and January, 2010 at our institution. This data included 100 patients (124 procedures) treated through the sublabial transsphenoidal approach and 45 patients (54 procedures) treated through the endoscopic endonasal (bilateral nostrils) transsphenoidal approach performed by a single surgeon. The extent of tumor removal was significantly improved with endoscopic surgery; adjuvant gamma knife radiosurgery was needed for 65% of patients undergoing microsurgery vs. 30% for patients who had endoscopic surgery (p<0.0001). Patients who underwent endoscopic surgery had less intraoperative blood loss (mean volume: 100 mL for microsurgery patients vs. 30 mL for endoscopic surgery patients, p<0.0001), less pain, and less need for postoperative hormone replacement therapy (19% for microsurgery patients vs. 6% for endoscopic surgery patients; p<0.05). Cerebrospinal fluid (CSF) leakage and meningitis were experienced in one microsurgery patient (1%) and one endoscopic surgery patient (2.2%). Endoscopic surgery is a reasonable alternative to microsurgery and our experience supports the concept that an otolaryngologist/neurosurgeon team skilled in endoscopic techniques and pituitary surgery can safely make the transition from microsurgery to endoscopic surgery. (author)

  15. Multimodal approach to the patient with pancreatic disease - what the surgeon wants to know

    International Nuclear Information System (INIS)

    Full text: Introduction: In modern medicine the approach to patients with diseases of the pancreas is imperative multidisciplinary, involving physicians from many different specialties. Due to the difficulties in the diagnosis and treatment of the pancreatic diseases only that approach and knowledge about the specific requirements of different specialties can result to a favorable outcome. What you will learn: to know and describe the findings in the main nosological units affecting to the pancreas; How to distinguish benign from malignant lesions of the pancreas; What kind of information is needed by the surgeon for the surgery, Advantages and limitations of the imaging diagnosis in pancreatic diseases. Discussion: Most patients are diagnosed late, when the disease is incurable. Despite major advances in the diagnosis and treatment of the pancreatic diseases, the prognosis for these patients remains poor. For the purpose of better diagnosis and therapy it is necessary to have good knowledge on: epidemiology, clinical risk factors; various diagnostic imaging methods - classic and new; methods for the pancreatic diseases treatment. Conclusion: Good knowledge of the diagnostic algorithm and treatment of the pancreatic diseases allow choosing the most effective methods for the diagnosis and treatment in different clinical situations and conditions of the patients with these diseases

  16. Role of the surgeon in quality and safety in the operating room environment.

    Science.gov (United States)

    Cima, Robert R; Deschamps, Claude

    2013-01-01

    Medical errors in the OR can result in substantial morbidity, poor functional outcomes and mortality. They are associated with significant increases in direct and indirect healthcare costs. In addition, errors in the OR associated with harm often have a profound negative impact on the patient, their family, and the medical providers' psychological and social well being. The majority of medical errors are believed to be preventable. Rarely, an error is the result of an isolated single failure in the delivery of care. More commonly, multiple linked processes contribute to the error. Poorly designed systems of care delivery, poor information and knowledge transfer, ambiguous communication between providers and poor coordination of care are frequently identified as the underlying drivers of errors. Solving the problem is as complex as the causes. Raising awareness that an error is more than an individual's problem or behavior is the first step toward a solution. Thoughtful planning in developing systems of care delivery through optimizing and leveraging the knowledge of the team members that provide care is the single most important defense against medical errors. Surgeons play an important role in facilitating the development of and empowering the teams they work through their active participation and effective leadership within the operating room team. PMID:22810462

  17. Efficacy and safety of chemoradiotherapy when performed by head and neck surgeon

    International Nuclear Information System (INIS)

    Concurrent chemoradiotherapy (CCRT) has been recognized as a standard treatment for the local advanced SCCHN. We perform 40-50 CCRT annually during operations on more than 230 patients in our division. CCRT with high-dose single-agent cisplatin is now the standard of care for nonsurgical treatment for local advanced SCCHN. We use a similar method for eligible cases. All patients were able to receive the full dose of radiotherapy (70 Gy) and completed at least two courses chemotherapy. We were able to perform this regimen with sufficient supportive care. This regimen is feasible for the treatment of Japanese patients with SCCHN, and does not require the modification of the treatment plan to account for racial differences. The introduction of this regimen is expected in the future in many other institutions in Japan. The new CCRT menu has been made by prospective clinical studies and requires a multicenter study. It is necessary to give an opinion from a surgical viewpoint with respect to the structure of the protocol and such matters to clinical oncologists who are expert in protocol formation. Head and neck surgeons constitute the treatment team for patients with head and neck cancer and should control the treatment plan. (author)

  18. Farmers’ perception of the role of veterinary surgeons in vaccination strategies on British dairy farms

    Science.gov (United States)

    Richens, I. F.; Hobson-West, P.; Brennan, M. L.; Lowton, R.; Kaler, J.; Wapenaar, W.

    2015-01-01

    There is limited research investigating the motivators and barriers to vaccinating dairy cattle. Veterinary surgeons have been identified as important sources of information for farmers making vaccination and disease control decisions, as well as being farmers’ preferred vaccine suppliers. Vets’ perception of their own role and communication style can be at odds with farmers’ reported preferences. The objective of this study was to investigate how dairy farmers perceived the role of vets in implementing vaccination strategies on their farm. Semi-structured interviews were conducted with 24 dairy farmers from across Britain. The data were analysed using thematic analysis. Analysis revealed that farmers perceive vets to have an important role in facilitating decision-making in all aspects of vaccination, including the aspects of vaccine distribution and advice on implementation. This important role is acknowledged by farmers who have regular veterinary contact, but also farmers with solely emergency veterinary contact. Given this finding, future work should investigate the attitudes of vets towards vaccination and how they perceive their role. Combining this knowledge will enable optimisation of vaccination strategies on British dairy farms. PMID:26530434

  19. Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures

    International Nuclear Information System (INIS)

    The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/ shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. (authors)

  20. Sources of information influencing decision-making in orthopaedic surgery - an international online survey of 1147 orthopaedic surgeons

    Science.gov (United States)

    2013-01-01

    Background Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was to evaluate the subjective usefulness and usage of different sources of information upon which orthopaedic surgeons base their decisions when acquiring new implants or techniques. Methods We undertook an online survey of 1174 orthopaedic surgeons worldwide (of whom n = 305 were head of their department). The questionnaire included 34 items. Sequences were randomized to reduce possible bias. Questions were closed or semi-open with single or multiple answers. The usage and relevance of different sources of information when learning about and selecting orthopaedic treatments were evaluated. Orthopaedic surgeons and trainees were targeted, and were only allowed to respond once over a period of two weeks. Baseline information included country of workplace, level of experience and orthopaedic subspecialisation. The results were statistically evaluated. Results Independent scientific proof had the highest influence on decisions for treatment while OEM (Original Equipment Manufacturer) driven activities like newsletters, white papers or workshops had the least impact. Comparison of answers from the three best-represented countries in this study (Germany, UK and USA) showed some significant differences: Scientific literature and congresses are significantly more important in the US than in the UK or Germany, although they are very important in all countries. Conclusions Independent and peer-reviewed sources of information are preferred by surgeons when choosing between methods and

  1. Protecting and improving health through the radiological sciences. A report to the Surgeon General

    International Nuclear Information System (INIS)

    This is the third in a series of reports prepared by the-National Advisory Committee on Radiation for the Surgeon General of the Public Health Service. The first two were directed to the broad responsibilities of the Service in the field of radiation control and to problems concerned with the protection of the public against undue radiation exposure from contamination of the environment with radioactive materials. In this report the Committee traces the remarkable growth that has taken place in the uses of ionizing radiation in the health professions, in industry, and in other walks of life. It also notes a number of emerging problems which not only are of importance from the point of view of radiation protection, but also, if not alleviated, threaten the quality of medical care in the United States and the translation of the advances of atomic research into needed benefits for the people. These problems include (a) serious weaknesses in academic departments of radiology which have restricted efforts to provide adequate instruction of medical and post-doctoral students in the clinical applications of ionizing radiation, including radiation protection; and (b) an increasingly severe shortage of manpower in all branches of the radiological sciences. The magnitude and complexity of these problems are sufficiently great that a concerted effort is needed by the Public Health Service to correct them. The alleviation of the problems just cited is but a part of a more comprehensive series of responsibilities faced by the Service in the radiological sciences. The Service must play an important role in the prevention of undue exposure of the population from medical, occupational, and environmental sources of ionizing radiation; at the same time, it must actively support the development and application of radiological methods in the diagnosis and treatment of diseases. In order that the Service may effectively meet its enlarging responsibilities in the radiological sciences

  2. Apoptose, neutrófilos e o cirurgião Apoptosis, neutrophils and the surgeon

    Directory of Open Access Journals (Sweden)

    Fernando Antonio Campelo Spencer Netto

    2001-02-01

    Full Text Available O estudo do processo de morte celular programada ganhou impulso a partir da demonstração da sua presença em células maduras não germinativas em 1971. A apoptose é um mecanismo vital normal, que acontece a todo o tempo nos organismos, permitindo a preservação da homeostase e renovação celular, possuindo características cito/histológicas próprias. Este trabalho faz uma revisão sumária de aspectos básicos da apoptose de interesse do cirurgião. São revistos dados da literatura referentes à apoptose no tocante às características cito/histológicas e sua importância na ontogênese, homeostasia, patogênese, inflamação sistêmica, sepse abdominal e trauma. Alterações no processo de apoptose no embrião podem levar a malformações congênitas. No adulto, algumas doenças expressam-se por aumento (ex. isquemia miocárdica, Alzheimer etc. ou diminuição nas taxas de apoptose (ex. câncer, doenças auto-imunes etc.. De particular interesse para o cirurgião, a elevação numérica dos neutrófilos que ocorre durante processos de inflamação sistêmica e trauma, deve-se à inibição da apoptose. A morte celular programada nos neutrófilos pode ser alterada por uma série de processos celulares (ex: adesão, transmigração etc., substâncias endógenas e exógenas (ex: citocinas e lipopolissacarídeo, produzindo diferentes taxas de apoptose de acordo com a interação dos fatores. O aprofundamento no estudo da morte celular programada, com a possibilidade de sua modulação, a coloca como potencialmente aliada na terapêutica.Studies addressing programmed cellular death process as have increased since 1971, when their presence in non-germinatives mature cells were observed. Apoptosis is a normal vital process that always happens in organisms preserves homeostasis and allows cellular renovation, with proper morphologic characters. This article reviews the basic aspects about apoptosis that are interesting for surgeons read

  3. Non-intubated thoracic surgery—A survey from the European Society of Thoracic Surgeons

    Science.gov (United States)

    Sorge, Roberto; Akopov, Andrej; Congregado, Miguel; Grodzki, Tomasz

    2015-01-01

    Background A survey amongst the European Society of Thoracic Surgeons (ESTS) members has been performed to investigate the currents trends, rates of adoption as well as potential for future expansion of non-intubated thoracic surgery (NITS) performed under spontaneous ventilation. Methods A 14-question-based questionnaire has been e-mailed to ESTS members. To facilitate the completion of the questionnaire, questions entailed either quantitative or multiple-choice answers. Investigated issues included previous experience with NITS and number of procedures performed, preferred types of anesthesia protocols (i.e., thoracic epidural anesthesia, intercostal or paravertebral blocks, laryngeal mask, use of additional sedation), type of procedures, ideal candidates for NITS, main advantages and technical disadvantages. Non-univocal answer to multiple-choice questions was permitted. Results Out of 105 responders, 62 reported an experience with NITS. The preferred types of anesthesia were intercostal blocks with (59%) or without (50%) sedation, followed by laryngeal mask with sedation (43%) and thoracic epidural anesthesia with sedation (20%). The most frequently performed procedures included thoracoscopic management of recurrent pleural effusion (98%), pleural decortication for empyema thoracis and lung biopsy for interstitial lung disease (26% each); pericardial window and mediastinal biopsy (20% each). More complex procedures such as lobectomy, lung volume reduction surgery and thymectomy have been performed by a minority of responders (2% each). Poor-risk patients due to co-morbidities (70%) and patients with poor pulmonary function (43%) were considered the ideal candidates. Main advantages included faster, recovery (67%), reduced morbidity (59%) and shorter hospital stay with decreased costs (43% each). Reported technical disadvantages included coughing (59%) and poor maneuverability due to diaphragmatic and lung movements (56%). Overall, 69% of responders indicated

  4. Management of chest drains: A national survey on surgeons-in-training experience and practice

    Directory of Open Access Journals (Sweden)

    Emeka B Kesieme

    2015-01-01

    Full Text Available Background: Chest tube insertion is a simple and sometimes life-saving procedure performed mainly by surgical residents. However with inadequate knowledge and poor expertise, complications may be life threatening. Objective: We aimed to determine the level of experience and expertise of resident surgeons in performing tube thoracostomy. Methodology: Four tertiary institutions were selected by simple random sampling. A structured questionnaire was administered to 90 residents after obtaining consent. Results: The majority of respondents were between 31 and 35 years. About 10% of respondents have not observed or performed tube thoracostomy while 77.8% of respondents performed tube thoracostomy for thefirst time during residency training. The mean score was 6.2 ± 2.2 and 59.3% of respondents exhibited good experience and practice. Rotation through cardiothoracic surgery had an effect on the score (P = 0.034. About 80.2% always obtained consent while 50.6% always used the blunt technique of insertion. About 61.7% of respondents routinely inserted a chest drain in the Triangle of safety. Only 27.2% of respondents utilized different sizes of chest tubes for different pathologies. Most respondents removed chest drains when the output is <50 mL. Twenty-six respondents (32.1% always monitored air leak before removal of tubes in cases of pneumothorax. Superficial surgical site infection, tube dislodgement, and tube blockage were the most common complications. Conclusion: Many of the surgical resident lack adequate expertise in this lifesaving procedure and they lose the opportunity to learn it as interns. There is a need to stress the need to acquire this skill early, to further educate and evaluate them to avoid complications.

  5. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine.

    Science.gov (United States)

    Mellor, Adrian; Dodds, Naomi; Joshi, Raj; Hall, John; Dhillon, Sundeep; Hollis, Sarah; Davis, Pete; Hillebrandt, David; Howard, Eva; Wilkes, Matthew; Langdana, Burjor; Lee, David; Hinson, Nigel; Williams, Thomas Harcourt; Rowles, Joe; Pynn, Harvey

    2015-01-01

    To support leaders and those involved in providing medical care on expeditions in wilderness environments, the Faculty of Pre-Hospital Care (FPHC) of The Royal College of Surgeons of Edinburgh convened an expert panel of leading healthcare professionals and expedition providers. The aims of this panel were to: (1) provide guidance to ensure the best possible medical care for patients within the geographical, logistical and human factor constraints of an expedition environment. (2) Give aspiring and established expedition medics a 'benchmark' of skills they should meet. (3) Facilitate expedition organisers in selecting the most appropriate medical cover and provider for their planned activity. A system of medical planning is suggested to enable expedition leaders to identify the potential medical risks and their mitigation. It was recognised that the scope of practice for wilderness medicine covers elements of primary healthcare, pre-hospital emergency medicine and preventative medicine. Some unique competencies were also identified. Further to this, the panel recommends the use of a matrix and advisory expedition medic competencies relating to the remoteness and medical threat of the expedition. This advice is aimed at all levels of expedition medic, leader and organiser who may be responsible for delivering or managing the delivery of remote medical care for participants. The expedition medic should be someone equipped with the appropriate medical competencies, scope of practice and capabilities in the expedition environment and need not necessarily be a qualified doctor. In addition to providing guidance regarding the clinical competencies required of the expedition medic, the document provides generic guidance and signposting to the more pertinent aspects of the role of expedition medic. PMID:26629337

  6. Surgeon-Performed Hemodynamic Transesophageal Echocardiography in the Burn Intensive Care Unit.

    Science.gov (United States)

    Held, Jenny M; Litt, Jeffrey; Kennedy, Jason D; McGrane, Stuart; Gunter, Oliver L; Rae, Lisa; Kahn, Steven A

    2016-01-01

    The use of transesophageal echocardiography (TEE) for resuscitation after burn injury has been reported in small case studies. Conventional TEE is invasive and often requires a subspecialist with a high level of training. The authors report a series of surgeon-performed hemodynamic TEE with an indwelling, less bulky, user-friendly probe. Records of patients treated in a regional burn center who underwent hemodynamic TEE between October 1, 2012 and May 30, 2014 were reviewed. The clinical course of each patient was recorded. All bedside interpretations were retrospectively reviewed for accuracy by a cardiac anesthesiologist. Eleven patients were included in the study. Median age was 68.5 years (interquartile range, 49.5-79.5). Median burn size was 37% TBSA (interquartile range: 16.3-53%). Seven patients were male, and four suffered inhalation injury. The operator's interpretation matched that of the echocardiography technician and cardiac anesthesiologist in all instances. No complications occurred from probe placement. Four patients underwent hemodynamic TEE to determine volume status during resuscitation. Changes in volume status on echocardiography preceded the eventual changes in urine output and vital signs for one patient. Hemodynamic TEE diagnosed cardiogenic shock and was used to titrate inotropes and vasopressors in seven elderly patients. Hemodynamic TEE is a useful adjunct to manage the burn patient who deviates off the expected course, especially if there is a question of cardiac function or volume status. It is less invasive and can be accurately performed by surgical intensivists when transthoracic echo windows are limited. The role of echocardiography in optimizing routine burn resuscitations needs to be further studied. PMID:26594864

  7. Compliance of ENT emergency surgery with the Royal College of Surgeons standards.

    Science.gov (United States)

    Sharma, S; Yao, A; Mahalingam, S; Persaud, R

    2016-01-01

    Introduction In 2011 The Royal College of Surgeons of England (RCS) set out best practice standards for emergency surgery. This national pilot audit aimed to determine the compliance of otolaryngology departments in England with these published guidelines. Methods A 26-item online questionnaire was devised that encompassed all the 36 best practices as set out by the RCS for ear, nose and throat (ENT) surgery. This was sent to ENT trainees and consultants based at units in England providing emergency ENT services. Results Data were obtained from 55 of the 102 units (response rate: 54%). A mean compliance of 71% was achieved (range: 25-94%). No units achieved all of the best practices. The standards with the highest compliance included 24-hour availability of blood transfusion and haematology opinion for patients with epistaxis, availability of a consultant or ST3/equivalent for immediate discussion of severe post-tonsillectomy bleeding, 24-hour access to blood transfusion for arrest of haemorrhage and immediate theatre access for arrest of haemorrhage. The areas with the lowest compliance were provision of a pathway for angiography/embolisation for epistaxis and provision of an equipped ENT room on a paediatric ward. Conclusions This audit has highlighted that the majority of departments in England are providing a good standard of ENT emergency care. There is room for improvement in certain areas, such as the provision of an embolisation pathway in the context of refractory epistaxis. We hope that this audit will encourage ENT departments to evaluate their current provision of emergency care and institute changes (where necessary) to maintain and improve their practices. PMID:26688399

  8. Ethical practice of evidence-based medicine: A review for plastic surgeons

    Directory of Open Access Journals (Sweden)

    Rajeev B Ahuja

    2013-01-01

    Full Text Available Last decade has witnessed a spurt in articles focused on the topic of evidence-based medicine (EBM and medical ethics. These articles are not only educative, but draw attention to the changing scenario of medical practice. Surgeons seem a bit less attentive to practice of EBM, more so in the developing world. The theme is now percolating in our realm for demonstrable incorporation of EBM in our practice, which is allegorical of a good physician and is also likely to become demanding legally. In practicing EBM, several conflicts may arise with the ethical vows of medicine. However, majority of these conflicting issues have germinated from a capitalistic approach to medical practice, where the fear of extraneous compulsions dictating prescriptions and procedures in the garb of ′evidence-based practice′ conflicts ethical behaviour. This review shall appraise the reader with important definitions of medical ethics, EBM and how to incorporate best evidence into ones practice. While, EBM brings objectivity to treatment to derive measurable outcomes it should not become regimented or metamorphose as a pseudonym for defensive medicine to escalate treatment costs. EBM also has several limitations one of which is to place the onus on the practicing physician to search for the best evidence and the other is the resource constraint of practice in the developing world. How a plastic surgery practice could be made to conform to evidence based (EB procedures is proposed as insufficient surgical skills can pose a serious threat to not only the practice of EB procedures, but to ethical responsibilities as well. In conclusion, it is necessary to incorporate ethical temperance into EB procedures to withstand societal, peer and legal pressures of current times.

  9. Beyond antisepsis: Examining the relevance of the works of Joseph Baron Lister to the contemporary surgeon-scientist

    Directory of Open Access Journals (Sweden)

    Graeme E Glass

    2014-01-01

    Full Text Available As the father of antispesis, the legacy of Joseph Baron Lister is assured and his influence on the development of contemporary surgical practice is recognised in the context of his achievement of predictable, infection-free surgery. However, looking beyond Lister′s finest achievement and examining this work in the context of his whole career as a surgeon-scientist reveals important lessons pertinent to aspiring peers in how, by replacing surgical dogma with observation, deductive reasoning and scientific verification, by pursuing good ideas in the face of resistance and by making research directly relevant and patient-focused, lasting changes can be accomplished. This short paper aims to put Lister′s developments in antisepsis in the context of his whole career, to evaluate his legacy and to commend his approach to contemporary surgeon-scientists.

  10. Beyond antisepsis: Examining the relevance of the works of Joseph Baron Lister to the contemporary surgeon-scientist.

    Science.gov (United States)

    Glass, Graeme E

    2014-01-01

    As the father of antispesis, the legacy of Joseph Baron Lister is assured and his influence on the development of contemporary surgical practice is recognised in the context of his achievement of predictable, infection-free surgery. However, looking beyond Lister's finest achievement and examining this work in the context of his whole career as a surgeon-scientist reveals important lessons pertinent to aspiring peers in how, by replacing surgical dogma with observation, deductive reasoning and scientific verification, by pursuing good ideas in the face of resistance and by making research directly relevant and patient-focused, lasting changes can be accomplished. This short paper aims to put Lister's developments in antisepsis in the context of his whole career, to evaluate his legacy and to commend his approach to contemporary surgeon-scientists. PMID:25593429

  11. Deceased Donor Intervention Research: A Survey of Transplant Surgeons, Organ Procurement Professionals, and Institutional Review Board Members.

    Science.gov (United States)

    Rodrigue, J R; Feng, S; Johansson, A C; Glazier, A K; Abt, P L

    2016-01-01

    Innovative deceased donor intervention strategies have the potential to increase the number and quality of transplantable organs. Yet there is confusion over regulatory and legal requirements, as well as ethical considerations. We surveyed transplant surgeons (n = 294), organ procurement organization (OPO) professionals (n = 83), and institutional review board (IRB) members (n = 317) and found wide variations in their perceptions about research classification, risk assessment for donors and organ transplant recipients, regulatory oversight requirements, and informed consent in the context of deceased donor intervention research. For instance, when presented with different research scenarios, IRB members were more likely than transplant surgeons and OPO professionals to feel that study review and oversight were necessary by the IRBs at the investigator, donor, and transplant center hospitals. Survey findings underscore the need to clarify ethical, legal, and regulatory requirements and their application to deceased donor intervention research to accelerate the pace of scientific discovery and facilitate more transplants. PMID:26484950

  12. Medical and surgical tourism: the new world of health care globalization and what it means for the practicing surgeon.

    Science.gov (United States)

    Unti, James A

    2009-04-01

    In this issue of the Bulletin, the leadership of the American College of Surgeons has published a Statement on Medical and Surgical Tourism (see page 26). The statement addresses a number of concerns about this new industry and some of the safety and quality issues that patients may encounter if they seek health care services outside of the U.S. On June 16, 2008, the American Medical Association adopted its own first set of guidelines on medical tourism to help ensure the safety of patients who are considering traveling abroad for medical care. The American College of Surgeons' statement and the American Medical Association's guidelines together provide an important set of principles for consideration by patients, employers, insurers, and other third-party groups responsible for coordinating such travel outside of the country. PMID:19492750

  13. A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon.

    Science.gov (United States)

    Kim, Won-Gon

    2016-08-01

    A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921-1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book. PMID:27525246

  14. Bilateral Simultaneous Anterior Cruciate Ligament Injury: A Case Report and National Survey of Orthopedic Surgeon Management Preference

    OpenAIRE

    Ehsan Saadat; Emily J. Curry; Xinning Li; Matzkin, Elizabeth G.

    2014-01-01

    Unilateral anterior cruciate ligament (ACL) tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States) to determine the prevalence of simultaneous bilateral ACL tear and preferred management s...

  15. “Pregnant and Operating”: Evaluation of a Germany-wide Survey Among Female Gynaecologists and Surgeons

    OpenAIRE

    Knieper, C.; Ramsauer, B; Hancke, K.; Woeckel, A.; Ismail, L; Bühren, A.; Toth, B.

    2014-01-01

    The current law on the protection of expectant and nursing mothers largely rules out surgical activities during pregnancy for female doctors who perform surgical roles in hospitals. The proportion of female junior staff in gynaecology amounts to 80 %, and, for many of these women, surgical further training is not possible following official notification of an existing pregnancy. In a Germany-wide survey of female gynaecologists and surgeons using a questionnaire, it was determined to what ext...

  16. “What Motivates Her”: Motivations for Considering Labial Reduction Surgery as Recounted on Women's Online Communities and Surgeons' Websites

    Directory of Open Access Journals (Sweden)

    Sandra Zwier, PhD

    2014-04-01

    Conclusions: Feelings of emotional and psychosexual distress in addition to functional distress are a highly prevalent motivation among women considering labial reduction surgery. Emotional distress appears to be greater and more freely emphasized when women communicate on online communities, while functional issues appear to receive greater notice on surgery provider's websites. Zwier S. “What motivates her”: Motivations for considering labial reduction surgery as recounted on women's online communities and surgeons' websites. Sex Med 2014;2:16–23.

  17. Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals.

    OpenAIRE

    Flood, A B; W.R. Scott; Ewy, W; Forrest, W H

    1982-01-01

    In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of...

  18. Is there a surgeon or hospital volume–outcome relationship in off-pump coronary artery bypass surgery?

    OpenAIRE

    Sepehripour, Amir H.; Athanasiou, Thanos

    2012-01-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether there is a surgeon or hospital volume–outcome relationship in patients undergoing off-pump coronary artery bypass surgery. A total of 281 papers were found using the reported searches, of which six represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the...

  19. Endoscopic Treatment of Vesicoureteral Reflux in Children with Dextranomer/Hyaluronic Acid—A Single Surgeon's 6-Year Experience

    OpenAIRE

    Hou-Chuan Chen; Chou-Ming Yeh; Chia-Man Chou

    2010-01-01

    Endoscopic treatment for vesicoureteral reflux (VUR) has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We present the outcome of endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux) for VUR in children by a single surgeon at our institute from October 2003 to October 2009. We reviewed the cases of 150 patients (total 239 ureters), 56 girls (37%) and 94 boys (63%), with a mean age of 2.2 years and a median followu...

  20. Multivariate analyses to assess the effects of surgeon and hospital volume on cancer survival rates: a nationwide population-based study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chun-Ming Chang

    Full Text Available BACKGROUND: Positive results between caseloads and outcomes have been validated in several procedures and cancer treatments. However, there is limited information available on the combined effects of surgeon and hospital caseloads. We used nationwide population-based data to explore the association between surgeon and hospital caseloads and survival rates for major cancers. METHODOLOGY: A total of 11,677 patients with incident cancer diagnosed in 2002 were identified from the Taiwan National Health Insurance Research Database. Survival analysis, the Cox proportional hazards model, and propensity scores were used to assess the relationship between 5-year survival rates and different caseload combinations. RESULTS: Based on the Cox proportional hazard model, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer survival rates, and hazard ratios ranged from 1.3 in head and neck cancer to 1.8 in lung cancer after adjusting for patients' demographic variables, co-morbidities, and treatment modality. When analyzed using the propensity scores, the adjusted 5-year survival rates were poorer for patients treated by low-volume surgeons in low-volume hospitals, compared to those treated by high-volume surgeons in high-volume hospitals (P<0.005. CONCLUSIONS: After adjusting for differences in the case mix, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer 5-year survival rates. Payers may implement quality care improvement in low-volume surgeons.

  1. For patients with breast cancer, geographic and social disparities are independent determinants of access to specialized surgeons. A eleven-year population-based multilevel analysis

    Directory of Open Access Journals (Sweden)

    Gentil Julie

    2012-08-01

    Full Text Available Abstract Background It has been shown in several studies that survival in cancer patients who were operated on by a high-volume surgeon was better. Why then do all patients not benefit from treatment by these experienced surgeons? The aim of our work was to study the hypothesis that in breast cancer, geographical isolation and the socio-economic level have an impact on the likelihood of being treated by a specialized breast-cancer surgeon. Methods All cases of primary invasive breast cancer diagnosed in the Côte d’Or from 1998 to 2008 were included. Individual clinical data and distance to the nearest reference care centre were collected. The Townsend Index of each residence area was calculated. A Log Rank test and a Cox model were used for survival analysis, and a multilevel logistic regression model was used to determine predictive factors of being treated or not by a specialized breast cancer surgeon. Results Among our 3928 patients, the ten-year survival of the 2931 (74.6 % patients operated on by a high-volume breast cancer surgeon was significantly better (LogRank p  Conclusions A disadvantageous socio-economic environment, a rural lifestyle and living far from large specialized treatment centres were significant independent predictors of not gaining access to surgeons specialized in breast cancer. Not being treated by a specialist surgeon implies a less favourable outcome in terms of survival.

  2. Performance Assessment of Suture Type, Water Temperature, and Surgeon Skill in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters

    Energy Technology Data Exchange (ETDEWEB)

    Deters, Katherine A.; Brown, Richard S.; Carter, Kathleen M.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2010-05-01

    This study assessed performance of seven suture types in subyearling Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Nonabsorbable (Ethilon) and absorbable (Monocryl) monofilament and nonabsorbable (Nurolon, silk) and absorbable (Vicryl, Vicryl Plus, Vicryl Rapide) braided sutures were used to close incisions in Chinook salmon. Monocryl exhibited greater suture retention than all other suture types 7 d after surgery. Both monofilament suture types were retained better than all braided suture types at 14 d. Incision openness and tag retention did not differ among suture types. Wound inflammation was similar for Ethilon, Monocryl, and Nurolon at 7 d. Wound ulceration was lower for Ethilon, Monocryl, and Nurolon than for all other suture types at 14 d post-surgery. Fish held in 12°C water had more desirable post-surgery healing characteristics (i.e., higher suture and tag retention and lower incision openness, wound inflammation, and ulceration) at 7 and 14 d after surgery than those held in 17°C water. The effect of surgeon was a significant predictor for all response variables at 7 d. This result emphasizes the importance of including surgeon as a variable in telemetry study analyses when multiple surgeons are used. Monocryl performed better with regard to post-surgery healing characteristics in the study fish. The overall results support the conclusion that Monocryl is the best suture material to close incisions created during surgical implantation of acoustic microtransmitters in subyearling Chinook salmon.

  3. What do gastroenterologists, surgeons and oncologists tell patients with colon cancer ? results of a survey from the northern france area

    Science.gov (United States)

    Adenis; Vennin; Hecquet

    1998-09-01

    This regional survey was aimed to detect hypothetical variations in attitudes among truth telling in colon cancer by an anonymous questionnaire sent to the 290 gastroenterologists, surgeons and oncologists of the Northern France area. The answers were assessed as always (A), often (O), rarely and never. Diagnosis was revealed to the patient (whether or not he asked the question) or to his spouse in 83%, 40% and 93% of the cases, respectively. The diagnosis of diffuse metastasis was revealed (A + O) to the patient or to his spouse in 23% and 95% of the cases, respectively. Only 3% of the physicians told (A + O) the patient that his condition was incurable while this aspect was A + O revealed to the patient's spouse in 34% of the cases. Most of the time, the diagnosis of colon cancer was revealed by oncologists rather than by surgeons or gastroenterologists. Conversely the full truth was more commonly told to the family by surgeons and gastroenterologists than by oncologists. We found variation in attitudes towards truth telling in colon cancer which depend on the physician's speciality. It seems to us that the magnitude of the full truth told to the patient or his family in Northern France area, is somewhat intermediate between the attitude of doctors in Northern Europe and in Latin Mediterranean or Eastern Europe countries. PMID:9770596

  4. For patients with breast cancer, geographic and social disparities are independent determinants of access to specialized surgeons. A eleven-year population-based multilevel analysis.

    OpenAIRE

    Gentil Julie; Dabakuyo Tienhan; Ouedraogo Samiratou; Poillot Marie-Laure; Dejardin Olivier; Arveux Patrick

    2012-01-01

    Abstract Background It has been shown in several studies that survival in cancer patients who were operated on by a high-volume surgeon was better. Why then do all patients not benefit from treatment by these experienced surgeons? The aim of our work was to study the hypothesis that in breast cancer, geographical isolation and the socio-economic level have an impact on the likelihood of being treated by a specialized breast-cancer surgeon. Methods All cases of primary invasive breast cancer d...

  5. Spinal surgeons' learning curve for lumbar microendoscopic discectomy:a prospective study of our first 50 and latest 10 cases

    Institute of Scientific and Technical Information of China (English)

    RONG Li-min; XIE Pei-gen; SHI De-hai; DONG Jian-wen; LIU Bin; FENG Feng; CAI Dao-zhang

    2008-01-01

    Background Microendoscopic discectomy (MED) is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation,but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve.We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons'learning curve.Methods Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each:A-E.The control group F was ten MED patients treated later by the same medical team (September-October 2006).All operations were performed by the same team of spinal surgeons with no MED experience before June 2002.We compared groups by operation time,blood loss,complications and need for open surgery after MED failure.Results Operation times by group were:A,(107±14) minutes;B,(85±13) minutes;C,(55±19) minutes;D,(52±12) minutes;E,(51±13) minutes;and F,(49±15) minutes.Blood loss were:A,(131±73) ml;B,(75±20) ml;C,(48±16) ml;D,(44±17) ml;E,(45±18) ml;and F,(45±16) ml.Both operation time and blood loss in groups C,D,E and F were smaller and more stable compared with groups A and B.Japanese Orthopedic Association assessment (JOA) score of each group in improvement rate immediately and one year after operation were as follows (in percentage):A,(79.8±8.8)/(89.8±7.7);B,(78.6±8.5)/(88.5±7.8);C,(80.8±11.3)/(90.8±6.7);D,(77.7±11.4)/(88.9±9.3);E,(84.0±8.7)/(89.6±9.0);and F,(77.8±11.6)/(86.9±8.4).Groups showed no statistical difference in improvement rates.Complications developed in three patients in group A,two in group B,and none in the other groups.Conclusions Spinal surgeons performing MED become proficient after 10-20 operations,when their skill becomes fairly sophisticated.Patients' improvement rate is the same regardless of surgeons' phase of learning curve.

  6. Fat injection to correct contour deformities of the reconstructed breast: a single surgeon experience

    Directory of Open Access Journals (Sweden)

    Youssef Tahiri

    2015-06-01

    Full Text Available Aim: Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast reconstruction. The purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast reconstruction. Methods: A single surgeon, prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill University Health Center was reviewed. Patient characteristics, breast history, type of breast reconstruction, volume of fat injected, and complications were analyzed. Results: One hundred and twenty-four patients benefited from autologous fat injection from January 2008 to November 2013, for a total of 187 treated breasts. The patients were on average 49.3 years old (΁ 8.9 years. Fat was harvested from the medial thighs (20.5%, flanks (39.1%, medial thighs and flanks (2.9%, trochanters (13.3%, medial knees (2.7%, and abdomen (21.9%. An average of 49.25 mL of fat was injected into each reconstructed breast. A total of 187 breasts in 124 patients were lipo-infiltrated during the second stage of breast reconstruction. Thirteen breasts (in 12 separate patients were injected several years after having undergone lumpectomy and radiotherapy. Of the 187 treated breasts, 118 were reconstructed with expanders to implants, 45 with deep inferior epigastric perforator flaps, 9 with latissimus dorsi flaps with implants, 4 with transverse rectus abdominis myocutaneous flaps, and 13 had previously undergone lumpectomy and radiotherapy. Six complications were noted in the entire series, for a rate of 3.2%. All were in previously radiated breasts. Average follow-up time was 12 months (range: 2-36 months. Conclusion: Fat injection continues to grow in popularity as an adjunct to breast reconstruction. Our experience demonstrates a low complication rate as compared to most surgical interventions of the breast

  7. Surgeons often underestimate the amount of blood loss in replacement surgeries

    Directory of Open Access Journals (Sweden)

    Ram Ganesan Ganesan

    2014-07-01

    Full Text Available 【Abstract】Objective:To assess the accuracy of the clinically estimated blood loss (EBL when compared with the actual blood loss (ABL in replacement surgeries. Methods: This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013. Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits. Exclusion criteria were intake of antiplatelet drug or anti-coagulant, bleeding disorders, thrombotic episode, and haematological disorders. There were 65 men and 75 women. In this study, the consultants were free to use any clinical method to estimate the blood loss, including counting the blood-soaked mops and gauze pieces (estimating the volume of blood carried in all the mops and gauzes, measuring blood lost to suction bottles and blood in and around the operative field. The ABL was calculated based on a modification of the Gross’s formula using haematocrit values. Results: In 42 of the 140 cases, the EBL exceeded the ABL. These cases had a negative difference in blood loss (or DIFF-BL<0 and were included in the overestimation group, which accounted for 30% of the study population. Of the remaining 98 cases (70%, the ABL exceeded the EBL. Therefore they were put into the underestimation group who had a positive difference in blood loss (DIFF-BL>0. We found that when the average blood loss was small, the accuracy of estimation was high. But when the average blood loss exceeded 500 ml, the accuracy rate decreased significantly. This suggested that clinical estimation is inaccurate with the increase of blood loss. Conclusion:This study has shown that using clinical estimation alone to guide blood transfusion is inadequate. In this study, 70% of patients had their blood loss underestimated, proving that surgeons often underestimate blood loss in replacement

  8. Surgeons often underestimate the amount of blood loss in replacement surgeries

    Institute of Scientific and Technical Information of China (English)

    Ganesan Ganesan Ram; Perumal Suresh; Phagal Varthi Vijayaraghavan

    2014-01-01

    Objective:To assess the accuracy of the clinically estimated blood loss (EBL) when compared with the actual blood loss (ABL) in replacement surgeries.Methods:This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013.Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits.Exclusion criteria were intake of antiplatelet drug or anti-coagulant,bleeding disorders,thrombotic episode,and haematological disorders.There were 65 men and 75 women.In this study,the consultants were free to use any clinical method to estimate the blood loss,including counting the blood-soaked mops and gauze pieces (estimating the volume of blood carded in all the mops and gauzes),measuring blood lost to suction bottles and blood in and around the operative field.The ABL was calculated based on a modification of the Gross's formula using haematocrit values.Results:In 42 of the 140 cases,the EBL exceeded the ABL.These cases had a negative difference in blood loss (or DIFF-BL<0) and were included in the overestimation group,which accounted for 30% of the study population.Of the remaining 98 cases (70%),the ABL exceeded the EBL.Therefore they were put into the underestimation group who had a positive difference in blood loss (DIFF-BL>0).We found that when the average blood loss was small,the accuracy of estimation was high.But when the average blood loss exceeded 500 ml,the accuracy rate decreased significantly.This suggested that clinical estimation is inaccurate with the increase of blood loss.Conclusion:This study has shown that using clinical estimation alone to guide blood transfusion is inadequate.In this study,70% of patients had their blood loss underestimated,proving that surgeons often underestimate blood loss in replacement surgeries.

  9. Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiotherapy: A survey of UK breast surgeons.

    Science.gov (United States)

    Duxbury, Paula J; Gandhi, Ashu; Kirwan, Cliona C; Jain, Yogesh; Harvey, James R

    2015-08-01

    Decision-making for women requiring reconstruction and post-mastectomy radiotherapy (PMRT) includes oncological safety, cosmesis, patient choice, potential delay/interference with adjuvant treatment and surgeon/oncologist preference. This study aimed to quantitatively assess surgeons' attitudes and perceptions about reconstructive options in this setting, and to ascertain if surgical volume influenced advice given. A questionnaire was sent to surgical members of the UK Association of Breast Surgery (ABS) in March-June 2014. The questionnaire elicited information on surgeon volume, reconstructive practice and drivers influencing decision-making. Response rate was 42% (148/355), representing 71% of UK breast units. Delayed breast reconstruction (DBR) was offered more commonly than immediate implant, delayed-immediate or immediate autologous reconstruction (p effect on reconstruction choice. Common decision-making drivers included negative effects of radiotherapy upon reconstructive and cosmetic outcome. The majority of surgeons (77%) believe the current evidence base is insufficient to guide decision-making. Despite surgeons believing that cosmesis and quality of life are not equivalent between IBR and DBR, DBR remains the commonest approach to this difficult clinical scenario. Surgeons perceive they are using a variety of newer techniques such as Delayed-Immediate Reconstruction and Acellular Dermal Matrices to try to ameliorate the effects of PMRT. This survey demonstrates that there is wide variation in reported surgical practice in this difficult setting. There is widespread acknowledgement of the lack of evidence to guide decision-making. PMID:26021276

  10. HIV/AIDS cancer and impact on surgical practice: Implication for the surgeon

    Directory of Open Access Journals (Sweden)

    A Z Sule

    2010-01-01

    cancers varies with the socio-demographic characteristics of the population studied indicating risk factors for cancer differs amongst populations. There remain some controversies as to why cancers occur at increased rates. In immunosuppressed PHA, risk of AIDS-related cancer generally increased with degree of immunosuppression. In Hodgkin′s lymphoma, incidence has an inverse relationship with CD4 count. Some tumours are observed more frequently in PHA because of lifestyles that expose them to specific carcinogens such as lung cancer. Other tumours have been reported to have marginal or inconsistent increases in PHA, and their associations are still controversial. Over the past 20years, AIDS has been transformed from a disease that was almost inevitably fatal to a chronic condition that is manageable. The longer survival will likely increase the importance of cancer as a clinical problem. In recognition of the increasing importance of cancer as a cause of mortality and mortality in PHA, managing persons affected according to standard practices regardless of HIV status is stressed. These practices should emphasize helping PHA avail high-risk lifestyles such as smoking and screening for early detection of cancers. Paying detail attention to safety survival practices and appropriating the right choice of procedures for HIV related cancer surgeries in addition to identification of preoperative chronic conditions such as diabetes and hypertension, etc. is important. With the population′s geographic and social diversity, Nigeria also presents unique research opportunities relating to cancer for the surgeon that can be embedded in programs targeting HIV/AIDS.

  11. User and Task Analysis of the Flight Surgeon Console at the Mission Control Center of the NASA Johnson Space Center

    Science.gov (United States)

    Johnson, Kathy A.; Shek, Molly

    2003-01-01

    Astronauts in a space station are to some extent like patients in an intensive care unit (ICU). Medical support of a mission crew will require acquisition, transmission, distribution, integration, and archiving of significant amounts of data. These data are acquired by disparate systems and will require timely, reliable, and secure distribution to different communities for the execution of various tasks of space missions. The goal of the Comprehensive Medical Information System (CMIS) Project at Johnson Space Center Flight Medical Clinic is to integrate data from all Medical Operations sources, including the reference information sources and the electronic medical records of astronauts. A first step toward the full CMIS implementation is to integrate and organize the reference information sources and the electronic medical record with the Flight Surgeons console. In order to investigate this integration, we need to understand the usability problems of the Flight Surgeon's console in particular and medical information systems in general. One way to achieve this understanding is through the use of user and task analyses whose general purpose is to ensure that only the necessary and sufficient task features that match users capacities will be included in system implementations. The goal of this summer project was to conduct user and task analyses employing cognitive engineering techniques to analyze the task of the Flight Surgeons and Biomedical Engineers (BMEs) while they worked on Console. The techniques employed were user interviews, observations and a questionnaire to collect data for which a hierarchical task analysis and an information resource assessment were performed. They are described in more detail below. Finally, based on our analyses, we make recommendations for improvements to the support structure.

  12. Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

    Directory of Open Access Journals (Sweden)

    Walker A

    2006-03-01

    Full Text Available Abstract Objective To assess variations in decisions to revascularise patients with coronary heart disease between general cardiologists, interventional cardiologists and cardiac surgeons Design Six cases of coronary heart disease were presented at an open meeting in a standard format including clinical details which might influence the decision to revascularise. Clinicians (n = 53 were then asked to vote using an anonymous electronic system for one of 5 treatment options: medical, surgical (CABG, percutaneous coronary intervention (PCI or initially medical proceeding to revascularisation if symptoms dictated. Each case was then discussed in an open forum following which clinicians were asked to revote. Differences in treatment preference were compared by chi squared test and agreement between groups and between voting rounds compared using Kappa. Results Surgeons were more likely to choose surgery as a form of treatment (p = 0.034 while interventional cardiologists were more likely to choose PCI (p = 0.056. There were no significant differences between non-interventional and interventional cardiologists (p = 0.13 in their choice of treatment. There was poor agreement between all clinicians in the first round of voting (Kappa 0.26 but this improved to a moderate level of agreement after open discussion for the second vote (Kappa 0.44. The level of agreement among surgeons (0.15 was less than that for cardiologists (0.34 in Round 1, but was similar in Round 2 (0.45 and 0.45 respectively Conclusion In this case series, there was poor agreement between cardiac clinical specialists in the choice of treatment offered to patients. Open discussion appeared to improve agreement. These results would support the need for decisions to revascularise to be made by a multidisciplinary panel.

  13. The role of SVS volunteer vascular surgeons in the care of combat casualties: results from Landstuhl, Germany.

    Science.gov (United States)

    Bush, Ruth L; Fairman, Ronald M; Flaherty, Stephen F; Gillespie, David L

    2009-01-01

    With a shortage of active duty vascular surgeons in the military, Society for Vascular Surgery (SVS) members have been called upon to perform short-term rotations at Landstuhl Regional Medical Center (LRMC), the US military's receiving facility for combat injuries sustained in the Iraq and Afghanistan conflicts. From September 2007 to May 2008, 20 SVS vascular surgeons have performed 2-week rotations at LRMC through American Red Cross and US Army sponsorship. Volunteers were surveyed for previous military and/or trauma experience. In addition to reporting number and types of procedures performed, volunteers were queried on their experience and impression of the rotation. Several volunteers have had prior military experience and all have had vascular trauma experience through residency, fellowship, and current practices. With most definitive vascular repairs being done in theater, SVS members were most often called upon for clinical expertise in the care of combat casualties and evaluation of revascularization procedures. The volunteers contributed to daily rounds, patient care, and teaching conferences, as well as actively participated in surgical procedures with the most common being wound examinations under anesthesia for which intraoperative vascular consultation was occasionally requested (5-20 per volunteer). Additional procedures that volunteers performed included: inferior vena cava (IVC) filter placement, thrombectomy, revision of lower and upper extremity interposition vein grafts, retroperitoneal spine exposures, diagnostic and therapeutic angiograms, iliac stenting, and duplex ultrasound scan interrogation of vascular repairs, suspected arterial injuries, and deep vein thrombosis. All volunteers described the experience as valuable and will return if needed. With a limited number of military vascular surgeons and the unpredictable need for a vascular specialist at LRMC, civilian volunteers are playing an important role in providing high-quality vascular

  14. Mead Johnson Critical Care Symposium for the Practising Surgeon. 4. Abdominal crisis in the intensive care unit.

    Science.gov (United States)

    Gregor, P; Prodger, J D

    1988-09-01

    Abdominal crises are common in critically ill patients who are admitted to the intensive care unit for problems unrelated to the abdomen. General surgeons may be asked to assess these patients for such reasons as pain, distension, possible sepsis, radiologic or laboratory abnormalities. Since many of the diagnostic signs and symptoms of acute abdomen are blunted or absent in critically ill patients who may be comatose or have been given analgesics or steroids, frequent thorough physical examination and close cooperation with the service admitting the patient are necessary to ensure early diagnosis and aggressive treatment of the abdominal crisis. PMID:3046730

  15. Undermining and bullying in surgical training: A review and recommendations by the Association of Surgeons in Training.

    Science.gov (United States)

    Wild, J R L; Ferguson, H J M; McDermott, F D; Hornby, S T; Gokani, V J

    2015-11-01

    The 2012 General Medical Council National Trainees' Survey found that 13% of UK trainees had experienced undermining or bullying in the workplace. The Association of Surgeons in Training subsequently released a position statement raising concerns stemming from these findings, including potential compromise to patient safety. This article considers the impact of such behaviour on the NHS, and makes recommendations for creating a positive learning environment within the NHS at national, organisational, and local levels. The paper also discusses the nature of issues within the UK, and pathways through which trainees can seek help. PMID:26369864

  16. Reduction of Costs for Pelvic Exenteration Performed by High Volume Surgeons: Analysis of the Maryland Health Service Cost Review Commission Database.

    Science.gov (United States)

    Althumairi, Azah A; Canner, Joseph K; Gorin, Michael A; Fang, Sandy H; Gearhart, Susan L; Wick, Elizabeth C; Safar, Bashar; Bivalacqua, Trinity J; Efron, Jonathan E

    2016-01-01

    High volume hospitals (HVHs) and high volume surgeons (HVSs) have better outcomes after complex procedures, but the association between surgeon and hospital volumes and patient outcomes is not completely understood. Our aim was to evaluate the impact of surgeon and hospital volumes, and their interaction, on postoperative outcomes and costs in patients undergoing pelvic exenteration (PE) in the state of Maryland. A review of the Maryland Health Services Cost Review Commission database between 2000 and 2011 was performed. Patients were compared for demographics and clinical variables. The differences in length of hospital stay , length of intensive care unit (ICU) stay, operating room (OR) cost, and total cost were compared for surgeon volume and hospital volume controlling for all other factors. Surgery performed by HVS at HVH had the shortest ICU stay and lowest OR cost. When PE was performed by a low volume surgeon at an HVH, the OR cost and total cost were the highest and increased by $2,683 (P costs reduced when surgery was performed by an HVS at an HVH ($-1632, P = 0.008). PE performed by HVS at HVH is significantly associated with lower OR costs and ICU stay. We feel this is indicative of lower complication rates and higher quality care. PMID:26802857

  17. 微创时代外科医生的成长与挑战%Surgeons in the era of,minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    黄志强

    2009-01-01

    Since the Success of the first case of laparoscopic cholecystectomy in 1987,minimally invasive surgery has become the most active field in all the branches of surgery.The traditional concept of surgery needs to be changed as the rapid development of surgical procedures,medical materials and devices,and the requirement of biopsychosocial model of medieine also poses great challenges to today's surgeons.Traditionally trained surgeons may find it difficult to adapt to the new developments.While,on the other hand,young laparoscopists may be at a loss when facing the difficulties encountered during the laparoscopic operation.The surgeons of tomorrow should have profound base of the knowledge of surgery and skillful in laparoscopy at the same time.

  18. Accuracy of Percutaneous Pedicle Screw Insertion Technique with Conventional Dual Fluoroscopy Units and a Retrospective Comparative Study Based on Surgeon Experience.

    Science.gov (United States)

    Nakahara, Masayuki; Yasuhara, Takao; Inoue, Takafumi; Takahashi, Yuichi; Kumamoto, Shinji; Hijikata, Yasukazu; Kusumegi, Akira; Sakamoto, Yushi; Ogawa, Koichi; Nishida, Kenki

    2016-06-01

    Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A (n = 74) and B (n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: fluoroscopy units in the lumbar and sacral spine is fairly accurate and provides good clinical outcomes, even among surgeons lacking experience. PMID:27190733

  19. Verbal auditory agnosia with focal EEG abnormality: an unusual case of a child presenting to an ENT surgeon with "deafness".

    Science.gov (United States)

    Kale, U; el-Naggar, M; Hawthorne, M

    1995-05-01

    Verbal auditory agnosia implies the failure to recognize sounds in a patient who is nevertheless not deaf. We present a child referred to the ENT outpatients for suspected hearing loss investigation. At one point she had grommets inserted on the basis of a flat tympanogram but with no effect. All hearing tests, including electrocochleography and distraction tests, revealed normal hearing thresholds. At the age of three years and three months, and on direct questioning of the parents, we discovered that the child responded remarkably well to music. Paediatric neurologists made the diagnosis of verbal auditory agnosia. The condition is very similar to another acquired language disorder called Landau-Kleffner syndrome. It is unusual for such a case to present primarily to an ENT surgeon. PMID:7798001

  20. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

    DEFF Research Database (Denmark)

    Andersen, M. J.; Gromov, K.; Brix, M.; Troelsen, A.; Danish Fracture Database, Collabora

    2014-01-01

    procedures by junior residents grew from 30% during to 40% (p <0.001) outside regular hours. CONCLUSION: Interns and junior residents together performed almost half of all fracture-related surgery. The extent of supervision was generally high; however, a third of the primary procedures performed by junior......-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based on the...... surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Muller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries by...

  1. Implementation of an electronic surgical referral service. Collaboration, consensus and cost of the surgeon – general practitioner Delphi approach

    Directory of Open Access Journals (Sweden)

    Augestad KM

    2014-09-01

    Full Text Available Knut Magne Augestad,1–3 Arthur Revhaug,1,3 Roar Johnsen,4 Stein-Olav Skrøvseth,2 Rolv-Ole Lindsetmo1,3 1Department of Gastrointestinal Surgery, 2Department of Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway; 3Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 4Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Background: Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines. Methods: Prospective observational survey of implementation of electronic medical record (EMR-supported guidelines for surgical treatment. Results: One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs' EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £ to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401–670 and 37 (range 29–49 referred patients, respectively, were needed to provide a cost-effective service. Conclusion: A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to

  2. J. Mikulicz-Radecki, K. H. Bauer, and W. Bross. Three great surgeons, three different epochs, one clinic in Wroclaw.

    Science.gov (United States)

    Kustrzycki, Wojciech Anatol

    2013-09-01

    The city of Wroclaw (Breslau) lies where the cultural and economic influences of the eastern, southern, and western Europe meet. Over a thousand years of history it changed the state affiliation several times. Since 1945, similarly as seven centuries ago, it lies within the borders of Poland. The historical complex of hospital buildings constructed at the end of the 19th century for the medical faculty remained almost untouched, despite catastrophic war destructions in the whole city. The building of surgical clinic witnessed epoch-making events in the discipline of surgery performed by the three great personalities. Jan Mikulicz-Radecki (1850-1905), the first head of the department, world famous physician and scientist, created in Wroclaw a modern surgical center. From among his numerous achievements the most important seems to be the performance of the world's first safe thoracotomy in the low-pressure chamber (1904). Karl Heinrich Bauer (1890-1979) was the next great personality, who had been leading the surgical department since 1933. Genetics, transplantology, traumatology and oncology were the main points of his interest. Because of political reasons he had to leave Wroclaw. He continued his surgical and scientific career in Heidelberg. Wiktor Bross (1903-1994) came to the ruined city directly after the World War II. As an experienced general and thoracic surgeon he created a new surgical school. First in Poland open heart surgery (1958) and renal transplantation (1966) were performed by him and his team in the same building, where Mikulicz-Radecki and Bauer worked in the past. The memory of all three great surgeons has been honored by placing their sculptures among the prominent Wroclaw citizens in the city hall. PMID:23212163

  3. Factors which influence the cardiac surgeon's decision not to operate on patients referred for consideration of surgery

    Directory of Open Access Journals (Sweden)

    Sivaprakasam Rajesh

    2008-02-01

    Full Text Available Abstract Background The aim of this study was to document what proportion of patients referred for consideration of cardiac surgery are turned down, the reasons given for not operating and also to evaluate what happens to those patients who do not undergo surgery. Methods 382 elective patients referred for consideration of cardiac surgery to one of six consultant cardiac surgeons at Wythenshawe Hospital during a one year period from were included in the study. Data for those patients who underwent an operation were collected prospectively in a cardiac surgery database. The case notes of those patients who did not undergo an operation were reviewed to establish reasons given by surgeons for not operating. Patients were followed up to determine vital status at the end of the study period. Results 333 (87.2% patients underwent an operation and 49 (12.8% did not. 68% of patients turned down were thought to be too high-risk. 14% of patients did not fulfill symptomatic or prognostic criteria for surgery and in 8% of patients coronary artery surgery was thought ineffective due to poor distal vessels. 6% of patients declined an operation and 4% were thought to be more suitable for coronary angioplasty. Patients turned down for surgery had more renal dysfunction (p = 0.017, respiratory disease (p Conclusion 12.8% of patients referred for consideration of cardiac surgery did not undergo an operation. Two thirds of patients not accepted for surgery were thought too high risk. Those patients who did not undergo an operation had a significantly worse mortality.

  4. Comparison of the Temperament and Character of Patients Referred to Cosmetic Nasal Surgeon in Shiraz Hospitals, 2015

    Science.gov (United States)

    Sharif, Farkhondeh; Anooshehpoor, Behnaz; Mani, Arash; Zarshenas, Ladan; Zare, Najaf; Haghighatian, Ali

    2016-01-01

    Background: Rhinoplasty is the most common cosmetic surgery which has been dramatically increasing in Iran. Currently, Iran is ranked the first in the world in rhinoplasty. In the present study, we aimed to assess the character and temperament traits of the applicants referred to rhinoplasty surgeons in Shiraz, southwest Iran in 2015. Methods: In this cross-sectional study, we recruited 500 participants among rhinoplasty applicants for case and among students and clerks residing in Shiraz by convenience sampling method in 2015. The two groups were matched regarding the gender, age and educational level. Data were collected using a demographic questionnaire and temperament and character inventory to assess the four dimensions of temperament (including novelty seeking; harm avoidance; reward dependence; persistence) and the three dimensions of character (including self-directedness; cooperativeness; self-transcendence). Data were analyzed using SPSS software, version 20. Chi- square and t-test were used as appropriated. Results: The mean±SD age of the participants was 27.43±6.6. The results showed a significant difference between the case and control groups with respect to the temperaments of novelty (9.47±2.80), harm avoidance (9.12±3.3), persistence (2.69±1.04), the characters of cooperativeness (15.38±4.02), and self-transcendence (9.48±3.41). Conclusion: Evaluating character and temperament traits in rhinoplasty applicants will be so helpful in identifying and predicting good candidates for such cosmetic surgery. Selecting the ideal patients can not only reduce the costs resulting from rhinoplasty imposed on families and society but also enhance the satisfaction of the patients and the surgeons. PMID:27218111

  5. THE CLINICAL IMAGE OF SCURVY IN LIGHT OF THE STATEMENT OF JAN KŁOSSOWICZ, A SURGEON, FROM THE YEAR 1811

    OpenAIRE

    Jacek Starzyk; Katarzyna Starzyk-Łuszcz

    2013-01-01

    Issuing medical statements is important in the professional activity of doctors. A medical statement of the surgeon Jan Kłossowicz from 1811 is presented in the paper. In this statement, the clinical image of scurvy was presented. This disease has been known since the 13th century. It was found in the 16th century that lemon juice prevents and treats this disease. In 1928, the ascorbic acid active substance was isolated. The description of scurvy drawn by the surgeon Jan Kłossowicz was compar...

  6. When Eastern Surgeons Meet Western Patients: A Pilot Study of Gastrectomy with Lymphadenectomy in Caucasian Patients at a Single Korean Institute.

    Science.gov (United States)

    Nakagawa, Masatoshi; Choi, Yoon Young; An, Ji Yeong; Seo, Sang Hyuk; Shin, Hyun Beak; Bang, Hui Jae; Li, Shuangxi; Kim, Hyung Il; Cheong, Jae Ho; Hyung, Woo Jin; Noh, Sung Hoon

    2016-09-01

    East Asian surgeons generally report lower morbidity and mortality rates for gastrectomy with D2 lymphadenectomy than do surgeons in Western countries; however, the disparity remains unexplained. The aim of this article was to determine the feasibility and safety regarding cases in which East Asian surgeons perform such procedures in Caucasian patients (CPs). Twelve CPs underwent gastrectomy with lymphadenectomy for gastric cancer at Yonsei University Severance Hospital, Seoul, Korea between June 2011 and April 2014. Procedures performed included total gastrectomy (7 of 12, 58%), distal gastrectomy (4 of 12, 33%), and completion total gastrectomy (1 of 12, 8%). Nine patients (75%) underwent D2 lymphadenectomy, and D1+ lymphadenectomy was performed in three others (25%). In four patients (33%), combined resections were carried out. The median values of surgical parameters were as follows: operative time, 266.5 min (range, 120-586 min); estimated blood loss, 90 mL (range, 37-350 mL); retrieved lymph node count, 37.5 (range, 22-63); and postoperative hospital stay, 13.7 days (range, 5-63 days). No mortality was encountered, although two patients (17%) experienced complications (both Clavien-Dindo classification grade IIIa anastomotic leakages), which were successfully managed by conservative treatment. In the hands of East Asian surgeons, mortality and short-term morbidity appears to be acceptably low in CPs subjected to gastrectomy with lymphadenectomy for gastric cancer. PMID:27401666

  7. The doctor and the market: about the influence of market reforms on the professional medical ethics of surgeons and general practitioners in the Netherlands

    NARCIS (Netherlands)

    J. Dwarswaard; M. Hilhorst; M. Trappenburg

    2011-01-01

    To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2-3 years aft

  8. The Benefit of the Smartphone in Oral and Maxillofacial Surgery: Smartphone Use Among Maxillofacial Surgery Trainees and iPhone Apps for the Maxillofacial Surgeon.

    Science.gov (United States)

    Carey, Elinor; Payne, Karl Frederick Braekkan; Ahmed, Nabeela; Goodson, Alexander

    2015-06-01

    The use of smartphones has soared among healthcare professionals in recent years, with estimated figures reporting that the majority of clinicians own and use smartphones in the workplace. Smartphones allow the clinician to carry textbooks in their pocket, write documents on the move and use email and internet to enhance productivity and clinical decision making. These advances in smartphone technology have enabled access to healthcare information for the clinician and transfer of data between team members, giving rise to the phenomenon of telemedicine. With the ability to instantly transfer clinical data to the off-site surgeon, combined with purpose-built medical apps, the smartphone is rapidly becoming an invaluable tool for the modern surgeon. Many studies have linked the benefits of smartphones and apps in other surgical specialities, but no article to date has highlighted the merits and full scope of this technology to the Oral and Maxillofacial Surgeon. We report that 94 % of British maxillofacial surgery trainees own a smartphone, with 61 % owning an iPhone. 89 % of trainees questioned had downloaded medical apps and used them regularly during clinical activities. We discuss the clinical application of the smartphone in the field of oral and maxillofacial surgery and review a list of useful and relevant apps for the modern maxillofacial surgeon using the iPhone as an example platform. PMID:26028826

  9. O perfil dos cirurgiões de catarata no sul do Brasil The profile of cataract surgeons in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Rafael Faustini Loeff

    2003-10-01

    Full Text Available OBJETIVOS: Avaliar o perfil e as preferências dos cirurgiões de catarata que atuam na região sul do Brasil. MÉTODOS: Um questionário sobre a rotina da cirurgia de catarata foi elaborado pelos autores e enviado a 1.000 oftalmologistas dos três estados que compõem essa região do país (Paraná, Santa Catarina e Rio Grande do Sul. Ao questionário foi anexada uma carta explicando os propósitos do trabalho, e um envelope pré-selado. A avaliação dos dados colhidos foi realizada por meio do pacote estatístico SPSS 8.0 for Windows®. RESULTADOS: Apenas 210 questionários (21% foram remetidos pelos entrevistados, devidamente preenchidos. Pela análise dos itens nele contidos, observou-se que fazem parte das preferências desses cirurgiões: o uso da anestesia peribulbar e a extração da catarata pela técnica extracapsular, com implantação de lentes de 5 e 6 milímetros de área óptica e sutura por meio de pontos separados. A facoemulsificação só é usada por 39% desses cirurgiões, em cerca de 60% das suas operações. CONCLUSÃO: Apesar dos constantes avanços tecnológicos observados nessa área da medicina, viu-se que técnicas modernas, como a facoemulsificação, não são ainda utilizadas rotineiramente pelos oftalmologistas da região sul do Brasil que participaram da presente pesquisa.PURPOSE: To evaluate the profile and preferences of cataract surgeons working in southern Brazil. METHODS: A questionnaire about the routines of cataract surgery was elaborated by the authors and sent to 1,000 ophthalmologists of the three states of southern Brazil (Paraná, Santa Catarina and Rio Grande do Sul. A presentation letter signed by the authors and a pre-sealed envelope were attached to the questionnaire. Data analysis was done using the statistical package SPSS 8.0 for Windows®. RESULTS: Only 210 completely filled out questionnaires were sent back by the interviewees. Through the analysis of the gathered data, one could observe

  10. Different views about work-hour limitations in medicine: a qualitative content analysis of surgeons', lawyers', and pilots' positive and negative arguments.

    Directory of Open Access Journals (Sweden)

    Adrian P Businger

    Full Text Available Whereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate. The aim of the present study was to evaluate arguments in favour of and against work-hour limitations in medicine given by Swiss surgeons, lawyers, and pilots.An electronic questionnaire survey with four free-response items addressing the question of what arguments speak in favour of or against work-hour limitations in general and in medicine was sent to a random sample of board-certified surgeons, lawyers in labour law, and pilots from SWISS International Airlines Ltd.In all, 279/497 (56% of the respondents answered the survey: 67/117 surgeons, 92/226 lawyers, and 120/154 pilots. Support for work-hour limitations in general and in medicine was present and higher among lawyers and pilots than it was in surgeons (p<0.001. The latter agreed more with work-hour limitations in general than in medicine (p<0.001. The most often cited arguments in favour of work-hour limitations were "quality and patient safety," "health and fitness," and "leisure and work-family balance," whereas the lack of "flexibility" was the most important argument against. Surgeons expected more often that their "education" and the "quality of their work" would be threatened (p<0.001.Work-hour limitations should be supported in medicine also, but a way must be found to reduce problems resulting from discontinuity in patient care and to minimise the work in medicine, which has no education value.

  11. A Multidisciplinary survey on controversies in the use of EUS-guided FNA: assessing perspectives of surgeons, oncologists and gastroenterologists

    Directory of Open Access Journals (Sweden)

    Rosenthal Yoav

    2011-11-01

    Full Text Available Abstract Background EUS-guided FNA can help diagnose and differentiate between various pancreatic and other lesions. The aim of this study was to compare approaches among involved/relevant physicians to the controversies surrounding the use of FNA in EUS. Methods A five-case survey was developed, piloted, and validated. It was collected from a total of 101 physicians, who were all either gastroenterologists (GIs, surgeons or oncologists. The survey compared the management strategies chosen by members of these relevant disciplines regarding EUS-guided FNA. Results For CT operable T2NOM0 pancreatic tumors the research demonstrated variance as to whether to undertake EUS-guided FNA, at p Conclusions Controversies as to ideal application of EUS-FNA persist. Optimal guidelines should reflect the needs and concerns of the multidisciplinary team who treat patients who need EUS-FNA. Multi-specialty meetings assembled to manage patients with these disorders may be enlightening and may help develop consensus.

  12. Moisès Broggi i Vallès (1908-2012): Military surgeon and Catalan humanitarian.

    Science.gov (United States)

    Derby, Mark; Jorge, David

    2016-02-01

    Catalan surgeon Moisès Broggi entered medical practice in 1931 as Spain was modernizing rapidly. Five years later, however, an attempted military coup sparked a nationwide civil war. Broggi offered his services to the embattled Republic and joined the Medical Service of the International Brigades. He served alongside colleagues from many countries, helping to develop advances in military medicine and especially trauma surgery. Broggi chose to remain working in Barcelona as Franco's Nationalist forces entered the city, in spite of the risk of reprisal he faced as a former officer of the International Brigades. Although forced from his leading position in the public health service, he developed a distinguished private practice. In the year of Franco's death he became President of Barcelona's Royal Academy of Medicine and he received many other honours. Just months before his death at the remarkable age of 104, Dr Moisès Broggi continued to discuss and write about the concerns that had directed the course of his life--advances in medical science and the intellectual and political repression that had hindered delivery of those advances. In an article titled Exile and Silence he noted the groundbreaking work carried out under the auspices of the prestigious scientific institutions founded during Spain's Second Republic and the subsequent dark decades of exile suffered by many of their prominent scientists, some of them his close friends. PMID:26873168

  13. Peri-Operative Management of Older Adults with Cancer—The Roles of the Surgeon and Geriatrician

    Directory of Open Access Journals (Sweden)

    Ruth Mary Parks

    2015-08-01

    Full Text Available Optimal surgical management of older adults with cancer starts pre-operatively. The surgeon plays a key role in the appropriate selection of patients and procedures, optimisation of their functional status prior to surgery, and provision of more intensive care for those who are at high risk of post-operative complications. The literature, mainly based on retrospective, non-randomised studies, suggests that factors such as age, co-morbidities, pre-operative cognitive function and intensity of the surgical procedure all appear to contribute to the development of post-operative complications. Several studies have shown that a pre-operative geriatric assessment predicts post-operative mortality and morbidity as well as survival in older surgical cancer patients. Geriatricians are used to working in multidisciplinary teams that assess older patients and make individual treatment plans. However, the role of the geriatrician in the surgical oncology setting is not well established. A geriatrician could be a valuable contribution to the treatment team both in the pre-operative stage (patient assessment and pre-operative optimisation and the post-operative stage (patient assessment and treatment of medical complications as well as discharge planning.

  14. The early management of patients with multiple injuries: an evidence-based, practical guide for the orthopaedic surgeon.

    Science.gov (United States)

    Moran, C G; Forward, D P

    2012-04-01

    There have been many advances in the resuscitation and early management of patients with severe injuries during the last decade. These have come about as a result of the reorganisation of civilian trauma services in countries such as Germany, Australia and the United States, where the development of trauma systems has allowed a concentration of expertise and research. The continuing conflicts in the Middle East have also generated a significant increase in expertise in the management of severe injuries, and soldiers now survive injuries that would have been fatal in previous wars. This military experience is being translated into civilian practice. The aim of this paper is to give orthopaedic surgeons a practical, evidence-based guide to the current management of patients with severe, multiple injuries. It must be emphasised that this depends upon the expertise, experience and facilities available within the local health-care system, and that the proposed guidelines will inevitably have to be adapted to suit the local resources. PMID:22434457

  15. Insights from the early experience of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

    Science.gov (United States)

    Rumsfeld, John S; Holmes, David R; Stough, Wendy Gattis; Edwards, Fred H; Jacques, Louis B; Mack, Michael J

    2015-03-01

    The current system for postmarket surveillance of medical devices in the United States is limited. To help change this paradigm for transcatheter valve therapies (TVTs), starting with transcatheter aortic valve replacement, the Society of Thoracic Surgeons and the American College of Cardiology partnered to form the TVT Registry program in close collaboration with the U.S. Food and Drug Administration and the Center for Medicare and Medicaid Services. The goal of the TVT Registry is to measure and improve quality of care and patient outcomes in clinical practice and to have a pivotal role in the scientific evidence and surveillance for medical devices. Challenges were faced in the early experience of the registry included developing multistakeholder partnerships, data collection requirements, and the use of the registry for pre- and post-market device evaluations. In addressing these challenges, the TVT Registry demonstrates that it is feasible for professional societies to assume a pivotal role in pre- and/or post-market studies, leveraging a clinical registry infrastructure. Sharing the TVT Registry experience may help other professional societies and stakeholders better anticipate and plan for these challenges. PMID:25703888

  16. Pneumatosis cystoides intestinalis- a morphological curio or a pitfall for surgeons: report of two cases and literature review

    Directory of Open Access Journals (Sweden)

    Anjali N. Bode

    2014-08-01

    Full Text Available Pneumatosis Cystoides Intestinalis (PCI is an uncommon but well recognised clinical entity in which gas-filled cysts appear in the intestinal wall.PCI can be an incidental finding or it may be detected during radiography or laparotomy. We came across two cases of PCI with characteristic morphological features associated with perforation peritonitis in and sigmoid volvulus respectively. In both cases PCI was not suspected pre-operatively.Both patients underwent urgent surgical exploration for the abdominal emergencies and were discharged in good general condition. It is imperative that the imaging finding of PCI is carefully correlated with the findings of physical examination, clinical history, and laboratory test results to determine which patients can be managed medically by treating the underlying disease and which will require emergency surgery. This decision can be difficult because the origin of the gas is often unclear and the patients symptoms can be volatile, presenting a major dilemma for the surgeon. [Int J Res Med Sci 2014; 2(4.000: 1791-1794

  17. Surgeon point-of-view recording: Using a high-definition head-mounted video camera in the operating room

    Directory of Open Access Journals (Sweden)

    Akshay Gopinathan Nair

    2015-01-01

    Full Text Available Objective: To study the utility of a commercially available small, portable ultra-high definition (HD camera (GoPro Hero 4 for intraoperative recording. Methods: A head mount was used to fix the camera on the operating surgeon′s head. Due care was taken to protect the patient′s identity. The recorded video was subsequently edited and used as a teaching tool. This retrospective, noncomparative study was conducted at three tertiary eye care centers. The surgeries recorded were ptosis correction, ectropion correction, dacryocystorhinostomy, angular dermoid excision, enucleation, blepharoplasty and lid tear repair surgery (one each. The recorded videos were reviewed, edited, and checked for clarity, resolution, and reproducibility. Results: The recorded videos were found to be high quality, which allowed for zooming and visualization of the surgical anatomy clearly. Minimal distortion is a drawback that can be effectively addressed during postproduction. The camera, owing to its lightweight and small size, can be mounted on the surgeon′s head, thus offering a unique surgeon point-of-view. In our experience, the results were of good quality and reproducible. Conclusions: A head-mounted ultra-HD video recording system is a cheap, high quality, and unobtrusive technique to record surgery and can be a useful teaching tool in external facial and ophthalmic plastic surgery.

  18. Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review

    Directory of Open Access Journals (Sweden)

    Pfeifer Roman

    2009-02-01

    Full Text Available Abstract Background Work-hour limitations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME in July 2003 in order to minimize fatigue related medical adverse events. The effects of this regulation are still under intense debate. In this literature review, data of effects of limited work-hours on the quality of life, surgical education, and patient care was summarized, focusing on surgical subspecialities. Methods Studies that assessed the effects of the work-hour regulation published following the implementation of ACGME guidelines (2003 were searched using PubMed database. The following search modules were selected: work-hours, 80-hour work week, quality of life, work satisfaction, surgical education, residency training, patient care, continuity of care. Publications were included if they were completed in the United States and covered the subject of our review. Manuscrips were analysed to identify authors, year of publication, type of study, number of participants, and the main outcomes. Review Findings Twenty-one articles met the inclusion criteria. Studies demonstrate that the residents quality of life has improved. The effects on surgical education are still unclear due to inconsistency in studies. Furthermore, according to several objective studies there were no changes in mortality and morbidity following the implementation. Conclusion Further studies are necessary addressing the effects of surgical education and studying the objective methods to assess the technical skill and procedural competence of surgeons. In addition, patient surveys analysing their satisfaction and concerns can contribute to recent discussion, as well.

  19. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

    Directory of Open Access Journals (Sweden)

    Skedros John G

    2007-07-01

    Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

  20. Searching for Surgeons

    Science.gov (United States)

    ... State Legislative Action Center Leadership & Advocacy Summit 2017 Leadership & Advocacy Summit 2016 Webinars Practice Management Practice Management Practice Management CPT Coding Bulletin Articles ...

  1. American College of Surgeons

    Science.gov (United States)

    ... State Legislative Action Center Leadership & Advocacy Summit 2017 Leadership & Advocacy Summit 2016 Webinars Practice Management Practice Management Practice Management CPT Coding Bulletin Articles ...

  2. Training a cataract surgeon

    Directory of Open Access Journals (Sweden)

    M Babar Qureshi

    2014-07-01

    Full Text Available Training in cataract surgery is one of the key factors needed to ensure high quality cataract surgery with good visual outcomes and patient satisfaction. The training has to impart the right skills to the right person by the right trainer and in the right environment.

  3. Creativity and the surgeon.

    Science.gov (United States)

    Gauderer, Michael W L

    2009-01-01

    This Robert E. Gross lecture is an analysis of the concept of creativity and how it relates to the practice of surgery. The questions-why surgery and creativity are closely associated; what influences creativity; why we should be concerned about it; and, finally, what rewards it brings-are discussed. In a personal note, the author describes his approach to creativity, with simplification as a central theme. He presents 6 examples of his work and the lessons learned from this activity. He stresses the importance of fostering creativity in all institutions in which physicians are trained and the need to focus on medical students, residents, and fellows. The critical importance of identifying, nurturing, and protecting innovators, as well as the role of the mentor, is emphasized. Because creativity has a place in many settings and discovery encompasses a wide spectrum, the author provides multiple suggestions aimed at encouraging the participation of those providing surgical care in the fulfilling experience of creative activity and innovation. PMID:19159713

  4. Find a Surgeon

    Science.gov (United States)

    ... and build a good life are waiting. Having 3rd Molar Surgery The AAOMS and AAO present "Having Third Molar ... and build a good life are waiting. Having 3rd Molar Surgery The AAOMS and AAO present "Having Third Molar ...

  5. A surgeon's quest

    Indian Academy of Sciences (India)

    M S Valiathan

    2008-09-01

    This last part of surgery, namely, operations, is a reflection on the healing art; it is a tacit acknowledgement of the insufficiency of surgery. It is like an armed savage who attempts to get that by force which a civilised man would get by stratagem.

  6. Find a Hand Surgeon

    Science.gov (United States)

    ... Symptom Picker Hand and Arm Conditions Carpal Tunnel Ganglion Cysts Trigger Finger Arthritis Base of the Thumb See ... Symptom Picker Hand and Arm Conditions Carpal Tunnel Ganglion Cysts Trigger Finger Arthritis Base of the Thumb See ...

  7. Society of Laparoendoscopic Surgeons

    Science.gov (United States)

    ... click” scholarly search is here! Search through SLS’s open access journal, textbooks, various conference syllabi, and much more. Look up the hottest topics or search JSLS Online for articles pertaining to your research. Directory of SLS Members To find a doctor who ...

  8. Physicians and Surgeons

    Science.gov (United States)

    ... More Sources of Data Publications Latest Publications » The Economics Daily Monthly Labor Review Beyond the Numbers Spotlight on Statistics Reports & Bulletins Commissioner's Corner Career Outlook Occupational Outlook Handbook Handbook of Methods Research Papers Copyright Information Contact & ...

  9. Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective (Conference Presentation)

    Science.gov (United States)

    Nehal, Kishwer S.; Rajadhyaksha, Milind

    2016-02-01

    Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective About 350 publications worldwide have reported the ability of reflectance confocal microscopy (RCM) imaging to detect melanocytic skin lesions in vivo with specificity of 84-88% and sensitivity of 71-92%, and non-melanocytic skin lesions with specificity of 85-97% and sensitivity 100-92%. Lentigo maligna melanoma can be detected with sensitivity of 93% and specificity 82%. While the sensitivity is comparable to that of dermoscopy, the specificity is 2X superior, especially for lightly- and non-pigmented lesions. Dermoscopy combined with RCM imaging is proving to be both highly sensitive and highly specific. Recent studies have reported that the ratio of equivocal (i.e., would have been biopsied) lesions to detected melanomas dropped by ~2X when guided by dermoscopy and RCM imaging, compared to that with dermoscopy alone. Dermoscopy combined with RCM imaging is now being implemented to guide noninvasive diagnosis (to rule out malignancy and biopsy) and to also guide treatment, with promising initial impact: thus far, about 3,000 patients have been saved from biopsies of benign lesions. These are currently under follow-up monitoring. With fluorescence confocal microscopy (FCM) mosaicing, residual basal cell carcinomas can be detected in Mohs surgically excised fresh tissue ex vivo, with sensitivity of 94-97% and specificity 89-94%. FCM mosaicing is now being implemented for guiding Mohs surgery. To date, about 600 Mohs procedures have been performed, guided with mosaicing, and with pathology being performed in parallel to confirm the final outcome. These latest advances demonstrate the promising ability of RCM and FCM to guide patient care.

  10. [The Protomedicato Tribunal and minorities in Castile at the end of the 17th century: the case of surgeon Roldán Solimán].

    Science.gov (United States)

    Arrizabalaga, J

    1996-01-01

    This note aims to provide a small set of documents which report the vicissitudes of a North-African Muslim surgeon who tried to settle professionally during the late seventeenth century in the Kingdom of Castile. The four letters exchanged between the Royal Palace and the Castilian tribunal of the Protomedicato reveal that the Spanish king Charles II (1661-1700) resoluted supported the surgeon's aspirations, and the Protomedicato's concerted resistence to the royal will. These eloquent documents shed light on the history of the Castilian Protomedicato during the final years of the reign of the last Habsburg king in Spain by providing evidence about the role of this institution in the process of segregation/exclusion of ethnic minorities from the practice of health professions. PMID:11624992

  11. Otolaryngology – Head and Neck Surgeon unemployment in Canada: a cross-sectional survey of graduating Otolaryngology – Head and Neck Surgery residents

    OpenAIRE

    Brandt, Michael G.; Scott, Grace M; Doyle, Philip C.; Ballagh, Robert H

    2014-01-01

    Objective Recently graduated Otolaryngology - Head and Neck Surgeons (OTO-HNS) are facing an employment crisis. To date, there has been no systematic evaluation of the factors contributing to this situation, graduating OTO-HNS trainee employment rates, nor the employment concerns of these graduating residents. This investigation sought to empirically evaluate prospective OTO-HNS graduate employment, identify factors contributing to this situation, and provide suggestions going forward. Method...

  12. Comparison of clinical outcomes, patient, and surgeon satisfaction following topical versus peribulbar anesthesia for phacoemulsification and intraocular lens implantation: A randomized, controlled trial

    Directory of Open Access Journals (Sweden)

    Kuldeep Dole

    2014-01-01

    Full Text Available Background: Both cataract surgery and anesthesia techniques are rapidly evolving to become more patient friendly. However, comparison of topical anesthesia (TA and peribulbar anesthesia (PA for phacoemulsification and cataract surgery is limited. We evaluated the clinical outcomes and patient and surgeon satisfaction between anesthetic techniques. Materials and Methods: This randomized clinical trial was conducted between January and June 2012. Patients were randomly assigned to TA and PA groups for surgery. Visual acuity at 4 weeks postoperatively, status of the cornea and the wound and intraoperative complications were compared between groups at day 1, and 1 and 4 weeks after surgery. Patients and the surgeon completed a close-ended questionnaire on satisfaction with analgesia and comfort. The relative risk (RR with 95% confidence intervals (CI was calculated. Result: There were 500 patients in each group. There were no significant differences between groups preoperatively. Complications at 1-day postoperatively were significantly greater in the TA group (RR = 1.36, 95% CI: 1.17-1.58. Satisfaction with the mitigation of pain was statistically significantly greater in the PA group compared to the TA group (χ2 = 10.9, df = 3, P = 0.001. Surgeons were more satisfied with PA compared to TA (RR = 1.4, 95% CI: 1.34-1.63. There were more anesthesia-related complications in the PA group compared to the TA group. Conclusions: Patients who underwent surgery with topical anesthetic experienced lower complications by more pain compared to patients who underwent PA. Topical anesthetic supplemented with analgesic medications could help the patient and surgeon during cataract surgery.

  13. Fifteen year outcome of the ceraver hermes posterior-stabilized total knee arthroplasty: safety of the procedure with experienced and inexperienced surgeons.

    Science.gov (United States)

    Hernigou, Philippe; Manicom, Olivier; Flouzat-Lachaniete, Charles Henri; Roussignol, Xavier; Filippini, Paolo; Poignard, Alexandre

    2009-01-01

    We wished to determine whether total knee replacement (TKA) performed by young surgeons increased rates of mortality and complications compared with TKA performed by senior surgeons using the same model of arthroplasty. There were no significant pre-operative differences between the groups in terms of age, gender, height, weight, body mass index, diagnosis, comorbidity and duration of follow-up, which was a mean of 15 years in both groups. Hence, we assessed the 15 year survival of the first 150 Ceraver Posterior-Stabilized total knee arthroplasties undertaken by young surgeons (aged of less than 30 years) in formation in a single university hospital setting (Group B). We used survival curve analysis, with strict definitions regarding end-points, and evaluated a number of different endpoint criteria to assess the outcome and to compare the results with those obtained by the two seniors (aged of more than 40 years) with their 50 first implantations (Group A). The clinical results and survival rate of implants at intermediate to long-term follow-up were similar in both Groups. Kaplan-Meier survival analysis, with revision as the endpoint for failure, showed that the rate of survival at ten years was 96% (95% CI, 93 to 100) in both groups. At fifteen years the rate of survival was 91% (95% CI, 85 to 97) in group B, and 92% (95% CI, 90 to 94) in group A. The implant used in this series appears particularly safe since the usual complications observed with posterior stabilized arthroplasties were not observed even with young surgeons. PMID:19572035

  14. The prehospital management of chest injuries: a consensus statement. Faculty of Pre‐hospital Care, Royal College of Surgeons of Edinburgh

    OpenAIRE

    Lee, Caroline; Revell, Matthew; Porter, Keith; Steyn, Richard

    2007-01-01

    This paper provides a guideline for the management of prehospital chest injuries after a consensus meeting held by the Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK, in January 2005. An overview of the prehospital assessment, diagnosis and interventions for life threatening chest injury are discussed, with the application of skills depending on the training, experience and competence of the individual practitioner.

  15. Report on the international Primary Neurosurgical Life Support course in the eighth Asian Congress of Neurological Surgeons in Kuala Lumpur, Malaysia

    OpenAIRE

    Nakamura, Takehiro; Ajimi, Yasuhiko; Okudera, Hiroshi; Yamada, Mikito; Toyoda, Izumi; Itoh, Katsuhiro; Imizu, Shuei; Iwase, Masaaki; Natori, Yoshihiro; Ohkuma, Hiroki; Hirayama, Teruyasu; Shima, Katsuji; Kawamoto, Keiji; Kato, Yoko

    2011-01-01

    On November 22, 2010, a simulation-based hands-on education course for medical staff in the neurosurgical fields was held in 8th Asian Congress of Neurological Surgeons (ACNS) in Kuala Lumpur, Malaysia. The present education course called Primary Neurosurgical Life Support (PNLS) course had been started by the Japan Society of Neurosurgical Emergency since 2008. This report summarizes the international version of PNLS course in 8th ACNS.

  16. [Information for patients with cancer of the colon: results of a survey of gastroenterologists, surgeons, and oncologists of the North region].

    Science.gov (United States)

    Adenis, A; Vennin, P; Hecquet, B

    1998-09-01

    This regional survey was aimed to detect hypothetical variations in attitudes among truth telling in colon cancer by an anonymous questionnaire sent to the 290 gastroenterologists, surgeons and oncologists of the Northern France area. The answers were assessed as always (A), often (O), rarely and never. Diagnosis was revealed to the patient (whether or not he asked the question) or to his spouse in 83%, 40% and 93% of the cases, respectively. The diagnosis of diffuse metastasis was revealed (A + O) to the patient or to his spouse in 23% and 95% of the cases, respectively. Only 3% of the physicians told (A + O) the patient that his condition was incurable while this aspect was A + O revealed to the patient's spouse in 34% of the cases. Most of the time, the diagnosis of colon cancer was revealed by oncologists rather than by surgeons or gastroenterologists. Conversely the full truth was more commonly told to the family by surgeons and gastroenterologists than by oncologists. We found variation in attitudes towards truth telling in colon cancer which depend on the physician's specialty. It seems to us that the magnitude of the full truth told to the patient or his family in Northern France area, is somewhat intermediate between the attitude of doctors in Northern Europe and in Latin Mediterranean or Eastern Europe countries. PMID:9817065

  17. Management of patients taking antiplatelet or anticoagulant medication requiring invasive breast procedures: United Kingdom survey of radiologists' and surgeons' current practice

    International Nuclear Information System (INIS)

    Aim: To determine the current practice in the UK National Health Service Breast Screening Programme for invasive diagnostic procedures and surgery in patients taking anticoagulant and antiplatelet medication. Materials and methods: Lead radiologists and surgeons at each breast screening service were surveyed to determine current practice. One hundred and five respondents provided information regarding their services, protocols, and willingness to proceed with combinations of procedures and anti-haemostatic medications. Results: Between units there was wide variation in practice. Within 21 services providing more than one response, 10 (48%) disagreed on whether protocols existed. Decisions to perform biopsies were unrelated to professional group. The taking of a drug history was variable. Surgeons reported more adverse effects than radiologists [21 (48%) versus 12 (26%)], but no difference in self-assessment of knowledge. Conclusion: Both radiologists and surgeons have expressed uncertainty about their understanding of anticoagulant and antiplatelet treatment. This is reflected in a wide range of practice. Guidance regarding the management of these patients is suggested

  18. Using a Surgeon-modified Iliac Branch Device to Preserve the Internal Iliac Artery during Endovascular Aneurysm Repair: Single-center Experiences and Early Results

    Institute of Scientific and Technical Information of China (English)

    Wei-Wei Wu; Chen Lin; Bao Liu; Chang-Wei Liu

    2015-01-01

    Background:To evaluate the feasibility of a new surgeon-modified iliac branch device (IBD) technique to maintain pelvic perfusion in the management of common iliac artery (CIA) aneurysm during endovascular aneurysm repair (EVAR).Methods:From January 2011 to December 2013,a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm.A stent-graft limb was initially deployed in vitro,anastomosed with vascular graft,creating a modified IBD reloaded into a larger sheath,with or without a guidewire preloaded into the side branch.The reloaded IBD was then placed in the iliac artery,with a covered stent bridging internal iliac artery and the branch.Finally,a bifurcated stent-graft was deployed,and a limb device was used to connect the main body and IBD.Results:Technical successes were obtained in all patients.The mean follow-up length was 24 months (range:6-38 months).All grafts remained patent without any sign of endoleaks.There were no aneurysm ruptures,deaths,or other complications related to pelvic flow.Conclusions:Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.

  19. Management of patients taking antiplatelet or anticoagulant medication requiring invasive breast procedures: United Kingdom survey of radiologists' and surgeons' current practice

    Energy Technology Data Exchange (ETDEWEB)

    Pritchard, M.G. [West Midlands Breast Screening Quality Assurance Reference Centre, West Midlands Cancer Intelligence Unit, University of Birmingham, Edgbaston, Birmingham (United Kingdom); Townend, J.N.; Lester, W.A. [University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston, Birmingham (United Kingdom); England, D.W. [South Birmingham Breast Screening Programme, Breast Assessment Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham Women' s Hospital, Edgbaston, Birmingham (United Kingdom); Kearins, O. [West Midlands Breast Screening Quality Assurance Reference Centre, West Midlands Cancer Intelligence Unit, University of Birmingham, Edgbaston, Birmingham (United Kingdom); Bradley, S.A. [South Birmingham Breast Screening Programme, Breast Assessment Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham Women' s Hospital, Edgbaston, Birmingham (United Kingdom)], E-mail: sally.bradley@uhb.nhs.uk

    2008-03-15

    Aim: To determine the current practice in the UK National Health Service Breast Screening Programme for invasive diagnostic procedures and surgery in patients taking anticoagulant and antiplatelet medication. Materials and methods: Lead radiologists and surgeons at each breast screening service were surveyed to determine current practice. One hundred and five respondents provided information regarding their services, protocols, and willingness to proceed with combinations of procedures and anti-haemostatic medications. Results: Between units there was wide variation in practice. Within 21 services providing more than one response, 10 (48%) disagreed on whether protocols existed. Decisions to perform biopsies were unrelated to professional group. The taking of a drug history was variable. Surgeons reported more adverse effects than radiologists [21 (48%) versus 12 (26%)], but no difference in self-assessment of knowledge. Conclusion: Both radiologists and surgeons have expressed uncertainty about their understanding of anticoagulant and antiplatelet treatment. This is reflected in a wide range of practice. Guidance regarding the management of these patients is suggested.

  20. Added value of coronal reformations for duty radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    To assess the added value of coronal reformation for radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis. Contrast-enhanced CT was performed using 16-detector-row scanners in 110 patients, 46 of whom had appendicitis. Transverse (5-mm thickness, 4-mm increment), coronal (5-mm thickness, 4-mm increment), and combined transverse and coronal sections were interpreted by four radiologists, two surgeons and two emergency physicians. The area under the receiver operating characteristic curve (Az value), sensitivity, specificity, (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared. For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs 0.986, ρ=0.076) and pooled sensitivity (92% [95% CI: 88,96] vs. 96% [93,99]), and enhanced appendiceal visualization in true-positive cases (ρ= 0.031). For non-radiologists, no such enhancement was observed, and the confidence for excluding acute appendicitis declined (ρ=0.013). Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (ρ<0.05). The added value of coronal reformation is more apparent for radiologists compared to referring physicians or surgeons in the CT diagnosis of acute appendicitis

  1. United States neurosurgery annual case type and complication trends between 2006 and 2013: An American College of Surgeons National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Cote, David J; Karhade, Aditya V; Larsen, Alexandra M G; Burke, William T; Castlen, Joseph P; Smith, Timothy R

    2016-09-01

    We aimed to identify trends in the neurosurgical practice environment in the United States from 2006 to 2013 using the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database, and to determine the complication rate for spinal and cranial procedures and identify risk factors for post-operative complications across this time period. We performed a search of the American College of Surgeons-NSQIP database for all patients undergoing an operation with a surgeon whose primary specialty was neurological surgery from 2006 to 2013. Analysis of patient demographics and pre-operative co-morbidities was performed, and multivariate analysis was used to determine predictors of surgical complications. From 2006 to 2013, the percentage of spinal operations performed by neurosurgeons relative to cranial and peripheral nerve cases increased from 68.0% to 76.8% (p<0.001) according to the NSQIP database. The proportion of cranial cases during the same time period decreased from 29.7% to 21.6% (p<0.001). The overall 30-day complication rate among all 94,621 NSQIP reported patients undergoing operations with a neurosurgeon over this time period was 8.2% (5.6% for spinal operations, 16.1% for cranial operations). The overall rate decreased from 11.0% in 2006 to 7.5% in 2013 (p<0.001). Several predictors of post-operative complication were identified on multivariate analysis. PMID:27183956

  2. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

    Science.gov (United States)

    Davila, Hugo H; Storey, Raul E; Rose, Marc C

    2016-09-01

    Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN. PMID:27272759

  3. Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database

    Science.gov (United States)

    Ruffini, Enrico; Detterbeck, Frank; Van Raemdonck, Dirk; Rocco, Gaetano; Thomas, Pascal; Weder, Walter; Brunelli, Alessandro; Evangelista, Andrea; Venuta, Federico; Khaled, AlKattan; Arame, Alex; Refai, Majed; Casadio, Caterina; Carbognani, Paolo; Cerfolio, Robert; Donati, Giovanni; Foroulis, Christophoros N; Gebitekin, Cengiz; de Antonio, David Gomez; Kernstine, Kemp H; Keshavjee, Shaf; Moser, Bernhard; Lequaglie, Cosimo; Liberman, Moishe; Lim, Eric; Nicholson, Andrew G; Lang-Lazdunski, Loic; Mancuso, Maurizio; Altorki, Nasser; Nosotti, Mario; Novoa, Nuria M; Brioude, Geoffrey; Oliaro, Alberto; Filosso, Pier Luigi; Saita, Salvatore; Scarci, Marco; Schützner, Jan; Terzi, Alberto; Toker, Alper; Van Veer, Hans; Anile, Marco; Rendina, Erino; Voltolini, Luca; Zurek, Wojciech

    2014-01-01

    OBJECTIVES A retrospective database was developed by the European Society of Thoracic Surgeons, collecting patients submitted to surgery for thymic tumours to analyse clinico-pathological prognostic predictors. METHODS A total of 2151 incident cases from 35 institutions were collected from 1990 to 2010. Clinical-pathological characteristics were analysed, including age, gender, associated myasthenia gravis stage (Masaoka), World Health Organization histology, type of thymic tumour [thymoma, thymic carcinoma (TC), neuroendocrine thymic tumour (NETT)], type of resection (complete/incomplete), tumour size, adjuvant therapy and recurrence. Primary outcome was overall survival (OS); secondary outcomes were the proportion of incomplete resections, disease-free survival and the cumulative incidence of recurrence (CIR). RESULTS A total of 2030 patients were analysed for OS (1798 thymomas, 191 TCs and 41 NETTs). Ten-year OS was 0.73 (95% confidence interval 0.69–0.75). Complete resection (R0) was achieved in 88% of the patients. Ten-year CIR was 0.12 (0.10–0.15). Predictors of shorter OS were increased age (P < 0–001), stage [III vs I HR 2.66, 1.80–3.92; IV vs I hazard ratio (HR) 4.41, 2.67–7.26], TC (HR 2.39, 1.68–3.40) and NETT (HR 2.59, 1.35–4.99) vs thymomas and incomplete resection (HR 1.74, 1.18–2.57). Risk of recurrence increased with tumour size (P = 0.003), stage (III vs I HR 5.67, 2.80–11.45; IV vs I HR 13.08, 5.70–30.03) and NETT (HR 7.18, 3.48–14.82). Analysis using a propensity score indicates that the administration of adjuvant therapy was beneficial in increasing OS (HR 0.69, 0.49–0.97) in R0 resections. CONCLUSIONS Masaoka stages III–IV, incomplete resection and non-thymoma histology showed a significant impact in increasing recurrence and in worsening survival. The administration of adjuvant therapy after complete resection is associated with improved survival. PMID:24482389

  4. The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

    International Nuclear Information System (INIS)

    The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons. A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing. Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11-0.52). Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53-0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).??The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures. (orig.)

  5. The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

    Energy Technology Data Exchange (ETDEWEB)

    Chiavaras, Mary M. [McMaster University, Department of Radiology, Hamilton, Ontario (Canada); Hamilton General Hospital, Department of Diagnostic Imaging, Hamilton, Ontario (Canada); Bains, Simrit [University of Western Ontario Medical School, London, Ontario (Canada); Choudur, Hema; Parasu, Naveen [McMaster University, Department of Radiology, Hamilton, Ontario (Canada); Jacobson, Jon [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Ayeni, Olufemi; Petrisor, Brad; Sprague, Sheila; Bhandari, Mohit [McMaster University, Department of Orthopedic Surgery, Hamilton, Ontario (Canada); Chakravertty, Rajesh [University of Toronto, Department of Orthopedic Surgery, Toronto, Ontario (Canada)

    2013-08-15

    The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons. A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing. Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11-0.52). Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53-0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).??The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures. (orig.)

  6. O papel atual do cirurgião no tratamento do GIST The role of the surgeon in the management of GIST

    Directory of Open Access Journals (Sweden)

    Marcus Valadão

    2009-07-01

    Full Text Available Recent progress in gastrointestinal stromal tumor's (GIST treatment were responsible for changing GIST's natural history. Knowlegde acquirement of molecular mechanism-based systemic therapy gave rise to the development of targeted antineoplastic drugs capable of reaching outcomes that had never been reached before. The introduction of imatinib in the clinical practice not only changed GIST's patients survival but also shifted paradigms. However, besides all these new advances and the improved results with imatinib, the surgeon still plays a pivotal role in the management of the primary GIST tumor and even in the metastatic setting.

  7. Imaging neonates and children with Pierre Robin sequence before and after mandibular distraction osteogenesis: what the craniofacial surgeon wants to know

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, Arthur B. [Children' s Hospital of Wisconsin, Department of Imaging, Medical College of Wisconsin, P.O. Box 1997, Milwaukee, WI (United States); Zei, Markus G. [Medical College of Wisconsin, Milwaukee, WI (United States); St. Louis University School of Medicine, St. Louis, MO (United States); Denny, Arlen D. [Children' s Hospital of Wisconsin, Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI (United States)

    2015-08-15

    Pierre Robin sequence is characterized by micrognathia and glossoptosis causing upper airway obstruction. Mandibular distraction osteogenesis is a mandibular lengthening procedure performed in neonates and children with Pierre Robin sequence to alleviate airway compromise. This pictorial review demonstrates the role of imaging in the preoperative and postoperative assessment of these children. It is important for pediatric radiologists to know what information about the mandible and airway the craniofacial surgeon needs from preoperative imaging and to identify any complications these children may encounter after surgery. (orig.)

  8. USE OF TWO STEP FOOT - REST UTILIZED FOR MAKING LITHOTOMY POSITION FOR ANORECTO - UROGENITAL SURGERIES IN INFANT PATIENTS WITH EASY APPROACH FOR ANAESTHESIOLOGIST AS WELL AS FOR SURGEON

    Directory of Open Access Journals (Sweden)

    Suresh Chandra

    2015-06-01

    Full Text Available This study was carried out in 40 infant patients with the aim is to provide optimal position for better surgical access and better access for anaesthesiologist regarding patient’s monitoring while minimizing manpower with easily available resourc es i.e. two step foot - rest for positioning of infant patient undergoing anorecto - urogenital operating procedures in operation theatre with less potential risk to the patient including peripheral neuropathies. This article addresses towards use of two step foot - rest, which is comfortable for the patient as well as for the anaesthesia team. The single surgeon may carry out perineal surgeries without much assistance.

  9. Imaging neonates and children with Pierre Robin sequence before and after mandibular distraction osteogenesis: what the craniofacial surgeon wants to know

    International Nuclear Information System (INIS)

    Pierre Robin sequence is characterized by micrognathia and glossoptosis causing upper airway obstruction. Mandibular distraction osteogenesis is a mandibular lengthening procedure performed in neonates and children with Pierre Robin sequence to alleviate airway compromise. This pictorial review demonstrates the role of imaging in the preoperative and postoperative assessment of these children. It is important for pediatric radiologists to know what information about the mandible and airway the craniofacial surgeon needs from preoperative imaging and to identify any complications these children may encounter after surgery. (orig.)

  10. The Hospital for Special Surgery Affiliates with Cornell University Medical College and New York Hospital, 1951; Philip D. Wilson Retires as Surgeon-in-Chief, 1955

    OpenAIRE

    Levine, David B.

    2009-01-01

    When World War II ended in 1945, the Hospital for Special Surgery (HSS), the oldest orthopedic hospital in the country, was entering its eighth decade. Only 5 years previously, its name was changed from the Hospital for the Ruptured and Crippled (R & C). In 1934, Dr. Philip D. Wilson (1886–1969) had been recruited to fill the office of the fifth Surgeon-in-Chief with a key charge to restore the hospital as the leading orthopedic institution in our country, a role it originally held for over h...

  11. THE CLINICAL IMAGE OF SCURVY IN LIGHT OF THE STATEMENT OF JAN KŁOSSOWICZ, A SURGEON, FROM THE YEAR 1811

    Directory of Open Access Journals (Sweden)

    Jacek Starzyk

    2013-11-01

    Full Text Available Issuing medical statements is important in the professional activity of doctors. A medical statement of the surgeon Jan Kłossowicz from 1811 is presented in the paper. In this statement, the clinical image of scurvy was presented. This disease has been known since the 13th century. It was found in the 16th century that lemon juice prevents and treats this disease. In 1928, the ascorbic acid active substance was isolated. The description of scurvy drawn by the surgeon Jan Kłossowicz was compared with the descriptions of this disease in medical textbooks from the early second half of the 19th century and the end of the 20th century. It was found that within the timespan of nearly 200 years the way in which the medical image of this disease is presented has not changed significantly. It was stressed that the medical statements concerning the state of health which were issued by doctors in previous centuries are a valuable source of information on the symptomatology of diseases.

  12. Simplification of total mesorectal excision with colonic J-pouch anal anastomosis for middle and lower rectal cancer. One surgeon's experience

    International Nuclear Information System (INIS)

    The introduction of total mesorectal excision (TME) has dramatically improved local control of rectal cancer. Yet, despite its complexity, there is no clear technical explanation of this procedure in the text references. Thus, we attempted to simplify the TME procedure according to its original concept. Our procedure has three principles: posterolateral dissection, which is helpful for performing complete TME with autonomic nerve preservation; detachment of the hiatal ligament, which enables mobilization of the whole mesorectum and transection of the distal rectum just above the anal canal; and colonic J-pouch anal anastomosis to support fecal continence. We evaluated our modified TME, focusing on one surgeon's experience. Between 1993 and 2006, 164 patients underwent modified TME, performed by one surgeon (M.K.). Intraoperative blood loss and operating time were both significantly lower than for conventional resection (P<0.01), and the rate of anastomotic leakage was less than 1%. Modified TME combined with radiotherapy or chemotherapy, or both, also improved prognosis considerably. We have succeeded in simplifying the original TME procedure and improved its outcome even further, based on our familiarity with its anatomyoriented elements. (author)

  13. A retrospective randomized study to compare the energy delivered using CDE with different techniques and OZil settings by different surgeons in phacoemulsification

    Directory of Open Access Journals (Sweden)

    Ming Chen

    2009-07-01

    Full Text Available Ming Chen1, Henry W Sweeney2, Becky Luke3, Mindy Chen4, Mathew Brown51University of Hawaii, Honolulu, Hawaii, USA; 2Research Support Services, the Queens Medical Center, Honolulu, Hawaii, USA; 3Surgical Suite, Honolulu, Hawaii, USA; 4University of California, Irvine, CA, USA; 5University of California, San Diego, CA, USAAbstract: Cumulative dissipated energy (CDE was used with Infiniti® Vision System (Alcon Labs as an energy delivery guide to compare four different phaco techniques and phaco settings. The supracapsular phaco technique and burst mode is known for efficiency and surgery is faster compared with the old phaco unit. In this study, we found that supracapsular phaco with burst mode had the least CDE in both cataract and nuclear sclerosis cataract with the new Infiniti® unit. We suggest that CDE can be used as one of the references to modify technique and setting to improve outcome for surgeons, especially for new surgeons. Keywords: CDE (cumulative dissipated energy, cataract surgery, phacoemulsification, supracapsular, burst mode, Divide–Conquer

  14. Effect of surgeon on transprosthetic gradients after aortic valve replacement with Freestyle® stentless bioprosthesis and its consequences: A follow-up study in 587 patients

    Directory of Open Access Journals (Sweden)

    Bauer Stefan

    2007-10-01

    Full Text Available Abstract Background The implantation of stentless valves is technically demanding and the outcome may depend on the performance of surgeons. We studied systematically the role of surgeons and other possible determinants for mid-term survival, postoperative gradients and Quality of Life (QoL after aortic valve replacement (AVR with Freestyle® stentless bioprostheses. Methods Between 1996 and 2003, 587 patients (mean 75 years underwent AVR with stentless Medtronic Freestyle® bioprostheses. Follow-up was 99% complete. Determinants of morbidity, mortality, survival time and QoL were evaluated by multiple, time-related, regression analysis. Risk models were built for all sections of the Nottingham Health Profile (NHP: energy, pain, emotional reaction, sleep, social isolation and physical mobility Results Actuarial freedom from aortic valve re-operation, structural valve deterioration, non-structural valve dysfunction, prosthetic valve endocarditis and thromboembolic events at 6 years were 95.9 ± 2.1%, 100%, 98.7 ± 0.5%, 97.0 ± 1.5%, 79.6 ± 4.3%, respectively. The actuarial freedom from bleeding events at 6 years was 93.1 ± 1.9%. Estimated survival at 6 years was similar to the age-matched German population (61.4 ± 3.8 %. Predictors of survival time were: diabetes mellitus, atrial fibrillation, peripheral vascular disease, renal dysfunction, female gender > 80 years and patients 0.7 for each of the 6 QoL sections. Early transvalvular gradients were identified as independent risk factors for impaired physical mobility (c-index 0.77, p Conclusion In addition to the valve size (in relation to body size, subcoronary technique (versus total root and various patient-related factors the risk of elevated gradients after stentless valve implantation depends, considerably on the individual surgeon. Although there was no effect on survival time and most aspects of QoL, higher postoperative transvalvular gradients affect physical mobility after AVR.

  15. James F. McGinnis, D.C., N.D., C.P. (1873-1947): spinographer, educator, marketer and bloodless surgeon.

    Science.gov (United States)

    Keating, J C

    1998-12-01

    Perhaps best remembered for his contributions to B.J. Palmer's earliest developments in spinography, James F. McGinnis also pioneered in marketing methods while a straight chiropractic practitioner in Iowa. His advertising brought him to the attention of organized medicine, which sought his prosecution. Relocating to California in the early 1920s, he broadened his scope of practice and earned a naturopathic doctorate. In the 1930s he became one of the best known of several chiropractic bloodless surgeons and traveled around the nation to teach his methods. Although initially a passionate member of the Universal Chiropractors Association and receptive to Palmer's introduction of the neurocalometer, McGinnis eventually changed his political allegiance and became an active member of the National Chiropractic Association. He died in 1947 while on a teaching tour of Claifornia's San Joaquin Valley. PMID:11623684

  16. The Appendix and Aganglionosis. A Note of Caution—How the Histology Can Mislead the Surgeon in Total Colonic Hirschsprung Disease

    Science.gov (United States)

    Lane, Victoria Alison; Levitt, Marc A.; Baker, Peter; Minneci, Peter; Deans, Katherine

    2015-01-01

    We present the case of a child with presumed total colonic Hirschsprung disease (HD) to highlight the problems the surgeon is likely to encounter if he/she relies on the appendix alone for histopathologic diagnosis. A newborn male infant, who was presumed to have total colonic aganglionosis when the appendix was found to be aganglionic at the time of initial exploratory laparoscopy, was managed with an ileostomy in the newborn period; however, at the time of his planned pull-through procedure, the rectal biopsy revealed normal ganglion cells. The child was subsequently managed with ileostomy closure and observed for normal feeding and stooling prior to discharge home. We discuss the histopathologic findings of the appendix in separate cases of confirmed total colonic HD seen in our center, and review the normal histopathologic findings of the appendix. PMID:26171305

  17. Views of West African surgeons on how well their educational and professional backgrounds may have prepared them for health leadership roles

    Directory of Open Access Journals (Sweden)

    Abdulraheem O. Mahmoud

    2010-12-01

    Full Text Available Background: Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. Aim: To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. Material and Methods: Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents’ bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians’ involvement in health managerial roles, probable influence of some physicians’ characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. Results: 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role “strongly important” (28.4% among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. Conclusions: Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.

  18. Views of West African surgeons on how well their educational and professional backgrounds may have prepared them for health leadership roles

    Directory of Open Access Journals (Sweden)

    Abdulraheem O Mahmoud

    2010-01-01

    Full Text Available Background: Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. Aim: To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. Material and Methods: Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents′ bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians′ involvement in health managerial roles, probable influence of some physicians′ characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. Results: 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role "strongly important" (28.4% among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. Conclusions: Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.

  19. Tailoring through Technology: A Retrospective Review of a Single Surgeon's Experience with Implant-Based Breast Reconstruction before and after Implementation of Laser-Assisted Indocyanine Green Angiography.

    Science.gov (United States)

    Harless, Christin A; Jacobson, Steven R

    2016-05-01

    Reported complication rates of implant-based breast reconstruction in the literature exceed 50%, with mastectomy skin flap necrosis reported to occur in up to 25% of cases. Laser-assisted indocyanine green angiography (LA-ICGA) technology allows the surgeon to optimize preservation of the mastectomy skin flap while avoiding skin necrosis. The purpose of this study was to determine if outcomes of breast reconstruction are beneficially affected by using LA-ICGA. A total 269 consecutive women (467 breast reconstructions) undergoing implant-based breast reconstruction from 2008 to 2013 were examined. The complication rates of those who underwent reconstruction prior to the implementation of LA-ICGA were compared with those who were reconstructed after implementation of LA-ICGA. A total of 254 consecutive breast reconstructions were performed prior to implementation of LA-ICGA, and 213 breasts were reconstructed with the use of LA-ICGA. After implementation of LA-ICGA System, the rate of mastectomy skin flap necrosis decreased by 86% (6.7% versus 0.9%, p = 0.02). The overall complication rate prior to LA-ICGA was 13.8% compared with 6.6% with the use of LA-ICGA (p = 0.01). After LA-ICGA was incorporated, the percentage of patients undergoing single-stage reconstruction increased from 12% to 32% (p = skin necrosis. The objective assessment of mastectomy flap perfusion allows the surgeon to tailor breast reconstruction intraoperatively, in real-time, adjusting for the individual patient's mastectomy flap perfusion. PMID:26899399

  20. Real-Time Teleguidance of a Non-Surgeon Crew Medical Officer Performing Orthopedic Surgery at the Amundsen-Scott South Pole Station During Winter-Over

    Science.gov (United States)

    Otto, Christian

    2010-01-01

    The Amundsen-Scott South Pole Research station located at the geographic South Pole, is the most isolated, permanently inhabited human outpost on Earth. Medical care is provided to station personnel by a non-surgeon crew medical officer (CMO). During the winter-over period from February to October, the station is isolated, with no incoming or outgoing flights due to severe weather conditions. In late June, four months after the station had closed for the austral winter, a 31 year old meteorologist suffered a complete rupture of his patellar tendon while sliding done an embankment. An evacuation was deemed to be too risky to aircrews due to the extreme cold and darkness. A panel of physicians from Massachusetts General Hospital, Johns Hopkins University and the University of Texas Medical Branch were able to assess the patient remotely via telemedicine and agreed that surgery was the only means to restore mobility and prevent long term disability. The lack of a surgical facility and a trained surgical team were overcome by conversion of the clinic treatment area, and intensive preparation of medical laypersons as surgical assistants. The non-surgeon CMO and CMO assistant at South Pole, were guided through the administration of spinal anesthetic, and the two-hour operative repair by medical consultants at Massachusetts General Hospital. Real-time video of the operative field, directions from the remote consultants and audio communication were provided by videoconferencing equipment, operative cameras, and high bandwidth satellite communications. In real-time, opening incision/exposure, tendon relocation, hemostatsis, and operative closure by the CMO was closely monitored and guided and by the remote consultants. The patient s subsequent physical rehabilitation over the ensuing months of isolation was also monitored remotely via telemedicine. This was the first time in South Pole s history that remote teleguidance had been used for surgery and represents a model for

  1. Personal dosimetry TLD 100 in orthopedic surgeons exposed to ionizing radiation in Bogota - Colombia; Dosimetria personal TLD 110 en medicos ortopedistas expuestos a radiacion ionizante en Bogota - Colombia

    Energy Technology Data Exchange (ETDEWEB)

    Sierra C, B. Y.; Jimenez, Y. [Universidad Nacional de Colombia, Departamento de Fisica, Grupo de Fisica Medica, Carrera 45 No. 26-85, Bogota (Colombia); Plazas, M. C. [Hospital Universitario Fundacion Santa Fe de Bogota, Instituto de Oncologia Carlos Ardila Lulle, Calle 119, No. 7-90, 220246 Bogota (Colombia); Eslava S, J. [Universidad Nacional de Colombia, Instituto de Investigaciones Clinicas, Grupo Equidad en Salud, Carrera 45 No. 26-85, Bogota (Colombia); Groot R, H., E-mail: brigith.sierra@gmail.com [Universidad de los Andes, Laboratorio de Genetica Humana, Carrera 1 No. 18A -12, Bogota (Colombia)

    2014-08-15

    Orthopedic surgeons should be considered as professionals occupationally exposed to ionizing radiation, for using C arc (fluoroscope) an equipment of X type radiation emission, during surgical procedures for imaging generation. Some health institutes, use of C arc under uncontrolled circumstances, such a lack of dosimetry control, incomplete or absence of personnel protective elements and protective measures, which in turn, lead to a high exposition to the personnel. Materials and methods. Study of double match cohort by age and gender, was conducted, in four health institutions of second and third level of attention in Bogota city. Personal dosimetry measurements with TLD-100 dosimetry crystals in both cohorts and environmental dosimetry in each of operation rooms used for orthopedic procedures, were carry out during six months of follow up. Dosimetry crystals were read in a Harshaw 4500 - Bicron equipment, in the Medical Physics Laboratory of National University of Colombia. Results. Dosimetry measurements are compatibles with those of occupationally exposed personnel 3.44 mSv/6 m CI 95% (1.66-3.99), even does not overpass ICRP recommendations, are higher as were expect at the beginning of the study. The median of effective accumulative dose in thorax is 3,4 mSv CI 95% (1,66-3,99), higher in comparison with neck value 2,7 mSv CI 95% (1,73-3,80) and hand dosimetry 1,42 mSv CI 95% (0,96-2,34). Conclusions: Orthopedic surgeons should be considered occupational exposed to ionizing radiation, who has to accomplish to the radiological protection measures, dosimetric follow up and maintenance of the used X ray equipment. It was confirm throughout this study that dosimetry shows higher levels as expected at the beginning of the study, compatible with occupationally exposed personnel. (Author)

  2. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results

    Directory of Open Access Journals (Sweden)

    Tanya Nazemi

    2006-02-01

    Full Text Available PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2004 by a single surgeon was entered in a Microsoft Access DatabaseTM and queried. Following appropriate statistical analysis, p values < 0.05 were considered significant. RESULTS: Of 57 patients, the open, robotic, laparoscopy with or without hand assistance radical nephrectomy were performed in 18, 6, 21, and 12 patients, respectively. The age, sex, body mass index (BMI, incidence of malignancy, specimen and tumor size, tumor stage, Fuhrman grade, hospital stay, change in postoperative creatinine, drop in hemoglobin, and perioperative complications were not significantly different between the methods. While the estimated median blood loss, postoperative narcotic use for pain control, and hospital stay were significantly higher in the open surgery method (p < 0.05, the median operative time was significantly shorter compared to the robotic method (p = 0.02. Operating room costs were significantly higher in the robotic and laparoscopic groups; however, there was no significant difference in total hospital costs between the 4 groups. CONCLUSIONS: The study demonstrates that radical nephrectomy can be safely performed either by open, robotic, or laparoscopic with or without hand assistance methods without significant difference in perioperative complication rates. A larger cohort and longer follow up are needed to validate our findings and establish oncological outcomes.

  3. Medication Related Osteonecrosis of the Jaw: 2015 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons.

    Science.gov (United States)

    Kim, Kyoung Min; Rhee, Yumie; Kwon, Yong-Dae; Kwon, Tae-Geon; Lee, Jeong Keun; Kim, Deog-Yoon

    2015-11-01

    Bisphosphonates are the most widely prescribed drugs for the treatment of osteoporosis, and are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that occurrence of osteonecrosis of the jaw (ONJ) could be related with bisphosphonate exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research (ASBMR) and American Association of Oral and Maxillofacial Surgeons (AAOMS) reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects a consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) antibody family, and bevacizumab, an anti-angiogenesis inhibitor. In 2009, a statement on ONJ was also reported locally by a relevant organization, which has served as basis for clinical treatment in Korea. In addition to the new official stance of the AAOMS and ASBMR, with an increasing pool of ONJ clinical experience, a revised version of the 2009 local statement is needed. As such, the Korean Society for Bone and Mineral Research (KSBMR) and the Korean Association of Oral and Maxillofacial Surgeons (KAOMS) have collectively formed a committee for the preparation of an official statement on MRONJ, and have reviewed recent local and international data to propose guidelines customized for the local Korean situation. PMID:26713306

  4. Translation Strategies Used in Translating Tess Gerritsen’s Medical Thrillers: Paulina Kruglinskienė’s translation of the Novel The Surgeon and Jonas Čeponis’ Translation of the Novel Life Support

    OpenAIRE

    Statkutė, Kotryna

    2014-01-01

    The Master Thesis “Translation Strategies Used in Translating Tess Gerritsen’s Medical Thrillers: Paulina Kruglinskienė’s Translation of the Novel The Surgeon and Jonas Čeponis’ Translation of the Novel Life Support” analyses two novels written by Tess Gerritsen (The Surgeon and Life Support) and their Lithuanian translations by Paulina Kruglinskienė and Jonas Čeponis. The following hypothesis was raised: translation by using an equivalent item and low localization strategy are the most popul...

  5. Dental writings in a medical self-help book of 1650.

    Science.gov (United States)

    Ring, Malvin E

    2004-11-01

    Only one copy exists of the very first medical self-help book written in the Yiddish language. The author, a well respected. barber-surgeon in Prague, states that he wrote the book for those too poor to consult a physician. Physicians were not as knowledgable or experienced as the barber-surgeons who were the principal providers of medical care for the masses. The book follows the format of discussing illnesses from head to toe, and includes numerous prescriptions for toothache, loose teeth, foul mouth and sore tongue. We derive an interesting picture of what dental treatment was like in the mid-seventeenth century. PMID:15666502

  6. Radiological imaging of congenital hand anomalies - a 6-year single-centre experience and what the hand surgeons want to know

    International Nuclear Information System (INIS)

    Congenital hand anomalies present a rare but important physical and emotional challenge for children and parents. Radiological imaging is important for accurate diagnosis, to aid decision making and to monitor changes in the growing hand. The goal of any treatment is to help the child achieve his/her maximum potential, to provide a useful hand with attention to cosmesis. We investigated the range of congenital hand anomalies imaged in a tertiary referral centre. We examined the timing of imaging and the key clinical questions. The radiology imaging system was searched retrospectively for radiographs of congenital hand anomalies over a 6-year period. The images were reviewed and patient demographics, diagnosis and other imaging recorded. Over 6 years, 85 patients had imaging. Twenty-three patients had bilateral problems and 11 had recognised syndromes. The most common abnormalities imaged were duplicated thumbs (28 %), followed by syndactyly (18 %). Children were first imaged as early as 1 day old, with the median age of initial imaging 12 months. Thumb duplication and syndactyly are the most common conditions for which radiographs are requested at our hospital, although overall syndactyly is considered the most common congenital hand anomaly. For a variety of reasons, children are often imaged very early, before review by the Specialist in Children's Hand Surgery (despite surgery being unlikely before 1 year of age.) We discuss the classification systems and specific issues that hand surgeons want to know from the radiologists. (orig.)

  7. Differences between pulmonologists, thoracic surgeons and radiation oncologists in deciding on the treatment of stage I non-small cell lung cancer: A binary choice experiment

    International Nuclear Information System (INIS)

    Background and purpose: Surgery is the standard of care in stage I non-small cell lung cancer (NSCLC), but stereotactic ablative radiotherapy (SABR) is increasingly used to treat patients at high-risk for surgical complications. We studied which patient- and clinician-related characteristics influenced treatment recommendations. Material and methods: A binary choice experiment with hypothetical cases was conducted. Cases varied on five patient-related characteristics: patient age, Chronic Obstructive Pulmonary Disease Global Initiative for Chronic Obstructive Lung Disease (COPD GOLD) score, Charlson co-morbidity index, World Health Organization performance status (WHO-PS) and patient treatment preference (surgery/SABR). Clinician characteristics were recorded. Responses were analyzed using generalized linear mixed models. Results: 126 clinicians completed the survey. All patient-related characteristics, the clinician speciality, and whether clinicians considered outcomes of surgery comparable to SABR, significantly influenced treatment recommendations. Pulmonologists were most influenced by WHO-PS and comorbidity, whereas comorbidity and age had greatest influence on radiation oncologists and surgeons. Clinicians were less influenced by stated patient preference and COPD GOLD score. Limited consistency was observed in treatment recommendations. Conclusions: This study suggests that more efforts are needed to develop uniform approaches for making treatment recommendations, and also to incorporate patient preferences when making treatment decisions for stage I NSCLC

  8. "Must do CPR??": strategies to cope with the new College of Physicians and Surgeons of Ontario policy on end-of-life care.

    Science.gov (United States)

    Hawryluck, Laura; Oczkowski, Simon J W; Handelman, Mark

    2016-08-01

    The College of Physicians and Surgeons of Ontario recently released a new policy, Planning for and Providing Quality End-of-Life Care. The revised policy is more accurate in its consideration of the legal framework in which physicians practice and more reflective of ethical issues that arise in end-of-life (EOL) care. It also recognizes valid instances for not offering cardiopulmonary resuscitation (CPR). Nevertheless, the policy poses a significant ethical and legal dilemma-i.e., if disputes over EOL care arise, then physicians must provide CPR even when resuscitation would fall outside this medical standard of care. While the policy applies in Ontario, it is likely to influence other physician colleges across Canada as they review their standards of practice. This paper explores the rationale for the mandated CPR, clarifies the policy's impact on the medical standard of care, and discusses strategies to improve EOL care within the policy. These strategies include understanding the help-hurt line, changing the language used when discussing cardiac arrest, clarifying care plans during the perioperative period, engaging the intensive care unit team early in goals-of-care discussions, mentoring hospital staff to improve skills in goals-of-care discussions, avoiding use of the "slow code", and continuing to advocate for quality EOL care and a more responsive legal adjudication process. PMID:27126679

  9. What the cardiothoracic surgeon wants to know from the radiologist: from X-ray reporting to imaging consultancy and Heart Team membership

    Energy Technology Data Exchange (ETDEWEB)

    Bogers, Ad J.J.C. [Erasmus MC, Department of Cardiothoracic Surgery, Thoraxcentre, Bd 557, P.O. Box 2040, Rotterdam (Netherlands); Head, Stuart J.; Kappetein, A.P. [Erasmus MC, Department of Cardiothoracic Surgery, Rotterdam (Netherlands)

    2015-01-01

    In the early days of cardiac surgery, the pretreatment multidisciplinary discussion involved a presentation of the case history and diagnostic imaging by the clinical cardiologist. At this time, most, if not all, cardiac imaging techniques were in the hands of the cardiologist. If the radiologist made a report, this was done relatively late in the clinical process and only concerned the perioperative radiographs. In recent years, multidisciplinary decision-making in the context of a Heart Team has gained an increasingly important role in the process of decision-making with regard to the available therapy options in individual patients. Nevertheless, the concept of the Heart Team is still evolving. The minimal requirements for the Heart Team include the presence of the attending cardiologist, an interventional cardiologist and a cardiac surgeon. Those members of the Heart Team should be aware of the local possibilities, should correctly make conclusions about the available data and should put this information into the clinical context and preference of the patient. In addition, in areas where expertise in cardiac imaging such as CT and MRI is relevant, this would explicitly require expertise of the Heart Team in these specific areas, most often by involving a radiologist, to provide the optimal joint treatment strategy recommendation. (orig.)

  10. What the cardiothoracic surgeon wants to know from the radiologist: from X-ray reporting to imaging consultancy and Heart Team membership

    International Nuclear Information System (INIS)

    In the early days of cardiac surgery, the pretreatment multidisciplinary discussion involved a presentation of the case history and diagnostic imaging by the clinical cardiologist. At this time, most, if not all, cardiac imaging techniques were in the hands of the cardiologist. If the radiologist made a report, this was done relatively late in the clinical process and only concerned the perioperative radiographs. In recent years, multidisciplinary decision-making in the context of a Heart Team has gained an increasingly important role in the process of decision-making with regard to the available therapy options in individual patients. Nevertheless, the concept of the Heart Team is still evolving. The minimal requirements for the Heart Team include the presence of the attending cardiologist, an interventional cardiologist and a cardiac surgeon. Those members of the Heart Team should be aware of the local possibilities, should correctly make conclusions about the available data and should put this information into the clinical context and preference of the patient. In addition, in areas where expertise in cardiac imaging such as CT and MRI is relevant, this would explicitly require expertise of the Heart Team in these specific areas, most often by involving a radiologist, to provide the optimal joint treatment strategy recommendation. (orig.)

  11. From precocious fame to mature obscurity: David Walker (1837-1917) MD, LRCSI, surgeon and naturalist to the Fox Arctic Expedition of 1857-59.

    Science.gov (United States)

    Froggatt, Peter; Walker, Brian M

    2012-11-01

    The Belfast-born David Walker was the 19-year-old surgeon and naturalist on the epic Fox Arctic Expedition (1857-59) that established the fate of Sir John Franklin's unsuccessful (1845) search for the North-West Passage. On return the crew were fêted as heroes and decorated, and shared in a £5000 government bounty: Walker was also received by the Queen and (in Ireland) by the Lord Lieutenant, was honoured by the principal British and Irish natural history societies and his portrait was exhibited in the National Portrait Gallery, London. This paper describes his adventurous life, including the Fox Expedition, which from 1862 was spent abroad and included time in the Cariboo gold fields, service in the United States Army, practice in a notorious Californian frontier town and, in later life, the comparative quiet of general and occupational medical practice in Portland, Oregon. Once a household name, his death went unrecorded in the British and Irish medical and lay press. PMID:23143316

  12. Evaluation of a new press-fit in situ setting composite porous scaffold for cancellous bone repair: towards a "surgeon-friendly" bone filler?

    Science.gov (United States)

    Peroglio, M; Gremillard, L; Eglin, D; Lezuo, P; Alini, M; Chevalier, J

    2010-09-01

    In this study, a composite porous material obtained by coating a poly(ester urethane) foam with a calcium phosphate cement is proposed as novel cancellous bone filler with easy handling, in situ hardening and press-fitting properties. The coating can be applied to the foam in the surgical theater, allowing refinement of scaffold shape to the needs of the ongoing surgery. An innovative experiment was developed in order to determine the setting curve of the composite scaffold as well as the time of manipulation available to the surgeon without risk of material damage. This composite material is soft and can be press-fit in a cavity without damaging the scaffold in the first 5 min after coating application. The composite scaffold hardens quickly (22 min) and, once the cement has set, its compressive strength and fracture energy are increased by over an order of magnitude as compared to the initial poly(ester urethane) foam. This set of interesting properties makes calcium phosphate cement-coated elastomeric scaffolds a new promising strategy for cancellous bone filling. PMID:20230921

  13. Radiological imaging of congenital hand anomalies - a 6-year single-centre experience and what the hand surgeons want to know

    Energy Technology Data Exchange (ETDEWEB)

    Gerety, E.L.; Hopper, M.A. [Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Cambridge (United Kingdom); Grant, I. [Cambridge University Hospitals NHS Foundation Trust, Department of Plastic Surgery, Cambridge (United Kingdom)

    2014-12-19

    Congenital hand anomalies present a rare but important physical and emotional challenge for children and parents. Radiological imaging is important for accurate diagnosis, to aid decision making and to monitor changes in the growing hand. The goal of any treatment is to help the child achieve his/her maximum potential, to provide a useful hand with attention to cosmesis. We investigated the range of congenital hand anomalies imaged in a tertiary referral centre. We examined the timing of imaging and the key clinical questions. The radiology imaging system was searched retrospectively for radiographs of congenital hand anomalies over a 6-year period. The images were reviewed and patient demographics, diagnosis and other imaging recorded. Over 6 years, 85 patients had imaging. Twenty-three patients had bilateral problems and 11 had recognised syndromes. The most common abnormalities imaged were duplicated thumbs (28 %), followed by syndactyly (18 %). Children were first imaged as early as 1 day old, with the median age of initial imaging 12 months. Thumb duplication and syndactyly are the most common conditions for which radiographs are requested at our hospital, although overall syndactyly is considered the most common congenital hand anomaly. For a variety of reasons, children are often imaged very early, before review by the Specialist in Children's Hand Surgery (despite surgery being unlikely before 1 year of age.) We discuss the classification systems and specific issues that hand surgeons want to know from the radiologists. (orig.)

  14. Pelvic lymph node dissection in the context of radical cystectomy: a thorough insight into the connection between patient, surgeon, pathologist and treating institution

    Directory of Open Access Journals (Sweden)

    Seiler R

    2013-08-01

    Full Text Available Roland Seiler, George N Thalmann, Pascal ZehnderDepartment of Urology, University of Bern, Bern, SwitzerlandAbstract: Pelvic lymph node dissection (PLND in patients with bladder cancer varies widely in extent, technique employed, and pathological workup of specimens. The present paper provides an overview of the existing evidence regarding the effectiveness of PLND and elucidates the interactions between patient, surgeon, pathologist, and treating institution as well as their cumulative impact on the final postoperative lymph node (LN staging. Bladder cancer patients undergoing radical cystectomy with extended PLND appear to have better oncologic outcomes compared to patients undergoing radical cystectomy and limited PLND. Attempts have been made to define and assess the quality of PLND according to the number of lymph nodes identified. However, lymph node counts depend on multiple factors such as patient characteristics, surgical template, pathological workup, and institutional policies; hence, meticulous PLND within a defined and uniformly applied extended template appears to be a better assurance of quality than absolute lymph node counts. Nevertheless, the prognosis of the patients can be partially predicted with findings from the histopathological evaluation of the PLND specimen, such as the number of positive lymph nodes, extracapsular extension, and size of the largest LN metastases. Therefore, particular prognostic parameters should be addressed within the pathological report to guide the urologist in terms of patient counseling.Keywords: bladder cancer, outcome, pathological workup, postoperative staging

  15. A comparison of the management of potentially malignant oral mucosal lesions by oral medicine practitioners and oral & maxillofacial surgeons in the UK.

    Science.gov (United States)

    Marley, J J; Linden, G J; Cowan, C G; Lamey, P J; Johnson, N W; Warnakulasuriya, K A; Scully, C

    1998-11-01

    This study describes the results of a survey undertaken to assess the management of potentially malignant oral mucosal lesions by oral medicine practitioners and compares their approach with that of oral & maxillofacial surgeons that we have previously described. Significant differences were noted between the two groups in the use of photography to document the lesions and in the use of certain special investigations, which included measurement of serum iron, serum ferritin, serum Vit B12, red cell folate and candidal isolation. The groups also varied in the perceived importance of the age of the patient and anatomical site of the lesion when deciding on the need for further biopsy. There was also significant variation in the use of certain treatment modalities, including excising non-dysplastic and severely dysplastic/carcinoma in-situ lesions and eliminating trauma when treating mild/moderately dysplastic and severely dysplastic/carcinoma in-situ lesions. Significant differences in the frequency and duration of follow-up were noted for non-dysplastic lesions. Finally, the two groups differed significantly when asked to rank the perceived importance of certain factors (the histopathology of the most recent biopsy and the anatomical site of the lesion) when deciding the need to follow-up. Possible reasons for the variation are discussed. PMID:9831962

  16. 2016 Laboratory guidelines for postvasectomy semen analysis: Association of Biomedical Andrologists, the British Andrology Society and the British Association of Urological Surgeons.

    Science.gov (United States)

    Hancock, P; Woodward, B J; Muneer, A; Kirkman-Brown, J C

    2016-07-01

    Post-vasectomy semen analysis (PVSA) is the procedure used to establish whether sperm are present in the semen following a vasectomy. PVSA is presently carried out by a wide variety of individuals, ranging from doctors and nurses in general practitioner (GP) surgeries to specialist scientists in andrology laboratories, with highly variable results.Key recommendations are that: (1) PVSA should take place a minimum of 12 weeks after surgery and after a minimum of 20 ejaculations. (2) Laboratories should routinely examine samples within 4 h of production if assessing for the presence of sperm. If non-motile sperm are observed, further samples must be examined within 1 h of production. (3) Assessment of a single sample is acceptable to confirm vasectomy success if all recommendations and laboratory methodology are met and no sperm are observed. Clearance can then be given. (4) The level for special clearance should be methods contained within these guidelines. Surgeons are responsible both preoperatively and postoperatively for the counselling of patients and their partners regarding complications and the possibility of late recanalisation after clearance. These 2016 guidelines replace the 2002 British Andrology Society (BAS) laboratory guidelines and should be regarded as definitive for the UK in the provision of a quality PVSA service, accredited to ISO 15189:2012, as overseen by the United Kingdom Accreditation Service (UKAS). PMID:27083211

  17. Does it matter if clinicians recruiting for a trial don't understand what the trial is really about? Qualitative study of surgeons' experiences of participation in a pragmatic multi-centre RCT

    Directory of Open Access Journals (Sweden)

    Snowdon Claire

    2007-01-01

    Full Text Available Abstract Background Qualitative methods are increasingly used to study the process of clinical trials and patients understanding of the rationale for trials, randomisation and reasons for taking part or refusing. Patients' understandings are inevitably influenced by the recruiting clinician's understanding of the trial, yet relatively little qualitative work has explored clinicians' perceptions and understandings of trials. This study interviewed surgeons shortly after the multi-centre, pragmatic RCT in which they had participated had been completed. Methods We used in-depth interviews with surgeons who participated in the Spine Stabilisation Trial (a pragmatic RCT to explore their understanding of the trial purpose and how this understanding had influenced their recruitment procedures and interpretation of the results. A purposive sample of eleven participating surgeons was chosen from 8 of the 15 UK trial centres. Results Although the surgeons thought that the trial was addressing an important question there was little agreement about what this question was: although it was a trial of 'equivalent' treatments, some thought that it was a trial of surgery, others a trial of rehabilitation and others that it was exploring what to do with patients in whom all other treatment options had been unsuccessful. The surgeons we interviewed were not aware of the rationale for the pragmatic inclusion criteria and nearly all were completely baffled about the meaning of 'equipoise'. Misunderstandings about the entry criteria were an important source of confusion about the results and led to reluctance to apply the results to their own practice. Conclusion The study suggests several lessons for the conduct of future multi-centre trials. Recruiting surgeons (and other clinicians may not be familiar with the rationale for pragmatic designs and may need to be regularly reminded about the purpose during the study. Reassurance may be necessary that a pragmatic

  18. American Association of Neurological Surgeons

    Science.gov (United States)

    ... has for the past 20 years worked to educate patients, caregivers and fellow researchers on the disease, ... Neurosurgeon Issues Journal of Neurosurgery Subspecialty Section Newsletters Advertising and Marketing Disclaimer Privacy Statement Web Site Linking ...

  19. Psychoneuroimmunology and the pediatric surgeon.

    Science.gov (United States)

    Tagge, Edward P; Natali, Elizabeth Lee; Lima, Evan; Leek, Dustin; Neece, Cameron L; Randall, Kiti Freier

    2013-08-01

    The mind-body connection is receiving increasing scrutiny in a large number of clinical settings, although research has lagged in the pediatric specialties. Psychoneuroimmunology (PNI) is a novel interdisciplinary scientific field that examines the relationship of the mind to the patient's neurologic, endocrine, and immune systems by examining critical parameters such as the effects of mental stress on wound healing and infection rates. Techniques that modify a patient's emotional and mental responses to illness and surgery have positive effects on their physiology resulting in improved recoveries and higher patient satisfaction rates. In the appropriate clinical settings, an awareness of PNI can enhance outcomes for pediatric surgical patients. PMID:23870208

  20. Space Medicine: A Surgeon's Perspective

    Science.gov (United States)

    Dawson, David L.

    1999-01-01

    For the first four decades of human space flight NASA's priorities in life sciences and medical programs have been preventative medicine (astronaut selection and training); assessment of the physiologic effects of microgravity and other unique aspects of space flight, implementation of countermeasures to protect against adverse effects, and amelioration of these adverse effects. Because most of the U.S. space flight experience has been on short duration missions, the need for medical and diagnostic treatment capabilities have been limited.The first long-term crews will arrive on the International Space Station (ISS) in early 2000. This will usher in a new era, an era of sustained human presence in Low Earth Orbit. One of the principal purposes of the ISS program is to increase the knowledge of the effects of long duration space flight on humans, a pre-requisite to future exploration class missions beyond Low Earth Orbit (e.g., a return to the Moon or an exploration of Mars). Areas of particular interest include protection from radiation, muscle atrophy, bone loss, cardiovascular alterations, immune dysfunction, adverse psychological response to hazards and confinement, and neurovestibular alterations. In addition, long duration space flight requires the development of autonomous medical care capabilities, as the distances involved eliminate the possibility of real-time telemedicine or robotic intervention, and prevent a mission abort and a rapid return to Earth. The objectives of this presentation include: 1. A description of the International Space Station project, including its research facilities and on-orbit medical capabilities; 2. An overview of the physiological and medical problems associated with microgravity in space flight; 3. A review of NASA's biomedical research priorities and ongoing work to develop clinical care capabilities for space flight crews (including surgical interventions) and; 4. An overview of current and proposed research priorities for NASA Research Announcements, NASA Space Biomedical Research Institute, Small Business Innovation Research Grant, and other funding sources.