WorldWideScience

Sample records for barber surgeons

  1. [Rise of the wound surgeon to academic surgeon: myth or historical fact?].

    Science.gov (United States)

    Gross, D

    2000-01-01

    In contrast to modern academic surgery, in 19th century German medical care was mainly taken by non-academic barber surgeons. Only after the foundation of the German Reich (1871) the practice of surgery was made conditional on a full study of medicine. The present article follows up the moot question whether the last generation of barber surgeons succeeded in rising to academic status or if the strong tradition of surgery in barber families was brought to a complete standstill. By evaluating archival documents it can be clearly shown that the professional distance between barber surgery and academic medicine was not invincible. A considerable number of barbers and their descendents (subsequently) succeeded in studying medicine and starting a medical career. PMID:10986752

  2. 15th Chapter of Surgeons Lecture: Surgeon of the new millennium--surgeon, scientist and scholar.

    Science.gov (United States)

    Tan, S K

    2004-11-01

    The surgeon of the new millennium has come a long way from his humble beginnings in the Middle Ages as the lowly barber-surgeon. The skills and techniques developed by outstanding surgeons like Astley Cooper of the 19th century have withstood the test of time and have been refined by subsequent generations of surgical masters. The scientific basis of modern surgery was put on a firm footing in the early 19th century through the discovery of anaesthesia and microorganisms as a cause of many diseases and surgical complications. The 20th century brought about rapid progress in medicine, information technology (IT) and the life sciences, and closed with a big bang with the completion of the sequencing of the human genome. For the surgeon of the 21st century to remain relevant, he must embrace the concept of the Total Surgeon. Not doing so will render him irrelevant in the course of time, for having good surgical technique alone is insufficient. He must also lead in scientific endeavours to push the frontiers of the life sciences in attempts to solve the insoluble, and be scholarly in thought, attitude and behaviour. In other words, he must be a Surgeon-Scientist-Scholar.

  3. 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…

  4. Barber/Cosmetologist Curriculum. Program Information.

    Science.gov (United States)

    Moraine Park Technical Coll., Fond du Lac, WI.

    This guide provides the instructor with materials for a barber/cosmetologist program. Seventeen study guides are provided: anatomy and physiology; applied chemistry; chemical straightening/relaxing; chemical waving; electricity and light therapy; facial services; hair coloring and lightening (bleach); hair cutting; hair, skin, and nail disorders;…

  5. 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...

  6. 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 ...

  7. Find a Surgeon

    Science.gov (United States)

    ... by oral and maxillofacial surgeons and orthodontists. Having Orthognathic Surgery The AAOMS and AAO present "Having Orthognathic ... by oral and maxillofacial surgeons and orthodontists. Having Orthognathic Surgery The AAOMS and AAO present "Having Orthognathic ...

  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. Searching for Surgeons

    Science.gov (United States)

    ... So You Want to Be a Surgeon Resident Resources Teaching Resources Online Guide to Choosing a Surgical Residency Clinical ... Patient Safety Advanced Skills Course for Rural Surgeons Support the Work of the Nora Institute ... Advocacy Advocacy Overview Quality Payment Program QPP Resource Center QPP Resource Center What Surgeons Can Do ...

  10. American College of Surgeons

    Science.gov (United States)

    ... So You Want to Be a Surgeon Resident Resources Teaching Resources Online Guide to Choosing a Surgical Residency Clinical ... Patient Safety Advanced Skills Course for Rural Surgeons Support the Work of the Nora Institute ... Advocacy Advocacy Overview Quality Payment Program QPP Resource Center QPP Resource Center What Surgeons Can Do ...

  11. 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.

  12. NASA Robot Brain Surgeon

    Science.gov (United States)

    1997-01-01

    Mechanical Engineer Michael Guerrero works on the Robot Brain Surgeon testbed in the NeuroEngineering Group at the Ames Research Center, Moffett Field, California. Principal investigator Dr. Robert W. Mah states that potentially the simple robot will be able to feel brain structures better than any human surgeon, making slow, very precise movements during an operation. The brain surgery robot that may give surgeons finer control of surgical instruments during delicate brain operations is still under development.

  13. Barber-Say syndrome: further delineation of the clinical spectrum

    Directory of Open Access Journals (Sweden)

    Fanny M. Cortés

    2000-06-01

    Full Text Available We report on a 14-year-old girl who presented a multiple congenital anomaly pattern: ablepharon, hypertelorism, telecanthus, macrostomia, helix agenesis of both ears, redundant thick skin and severe hirsutism, the 5th reported case of Barber-Say syndrome. Our patient had almost the same phenotype as that of the patient cited by Martínez Santana et al. (Am. J. Med. Genet. 47: 20-23, 1993 including the same until then undescribed dermatoglyphic pattern.Apresentamos uma paciente de 14 anos, de sexo feminino, portadora de um quadro de múltiplas anomalias congênitas: hipertelorismo, telecanto, macrostomia, agenesia da hélice em ambos os pavilhões auriculares, pele grossa e redundante e hirsutismo severo, que corresponde ao 5º caso reportado de síndrome de Barber-Say. Esta paciente tem praticamente o mesmo fenótipo que a paciente descrita por Martínez Santana et al. (Am. J. Med. Genet. 47: 20-23, 1992, incluindo o mesmo padrão dermatoglífico que não havia sido descrito até então.

  14. Congress of Neurological Surgeons

    Science.gov (United States)

    ... of the Month September 2016 32-Year-Old Female with Numbness How would you treat this month's ... All Events Corporate Partners Learn More About Our Industry Allies Council Partners Congress of Neurological Surgeons 10 ...

  15. Society of Gynecologic Surgeons

    Science.gov (United States)

    ... December 1 – 3, 2016. This year’s course includes didactic lectures by outstanding surgeons and educators who are ... held in high esteem by other medical societies. Education Evidence-Based Medicine article published in OBG Mangement ...

  16. 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...

  17. 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

  18. 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

  19. 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…

  20. 33 CFR 334.1360 - Pacific Ocean at Barber's Point, Island of Oahu, Hawaii; danger zone.

    Science.gov (United States)

    2010-07-01

    ..., Island of Oahu, Hawaii; danger zone. 334.1360 Section 334.1360 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DANGER ZONE AND RESTRICTED AREA REGULATIONS § 334.1360 Pacific Ocean at Barber's Point, Island of Oahu, Hawaii; danger zone. (a) The danger zone....

  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. Blepharophimosis Mental Retardation Syndrome Say-Barber/Biesecker/Young-Simpson Type - New Findings With Neuroimaging

    NARCIS (Netherlands)

    K. Szakszon; E. Berényi; A. Jakab; B. Bessenyei; E. Balogh; T. Koebling; J. Szilvássy; A.C. Knegt; E. Olah

    2011-01-01

    We report on a female patient with blepharophimosis mental retardation syndrome of Say/Barber/Biesecker/Young-Simpson (SBBYS) type. Main findings in her were marked developmental delay, blepharophimosis, ptosis, cleft palate, external auditory canal stenosis, small and malformed teeth, hypothyroidis

  3. 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…

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

    Science.gov (United States)

    2010-07-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOMELAND SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Fixed Mooring Balls, South of Barbers Pt. Harbor Channel, Oahu, HI AGENCY: Coast Guard, DHS. ACTION: Temporary final rule. SUMMARY: Due to...

  5. 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…

  6. Chadwick: Symphony No. 3 in F; Barber: Vanessa-Intermezzo / Andrew Achenbach

    Index Scriptorium Estoniae

    Achenbach, Andrew

    1994-01-01

    Uuest heliplaadist "Chadwick: Symphony No. 3 in F; Barber: Vanessa-Intermezzo, Under the Willow Tree. Music for a scene from Shelley, Op. 7. Medea's Meditation and Dance of Vengeance, Op. 23a. Detroit Symphony Orchestra / Neeme Järvi." Chandos CD CHAN 9253

  7. Barber: Sinfonie Nr. 1, Op. 9, Neeme Järvi / Bernhard Uske

    Index Scriptorium Estoniae

    Uske, Bernhard

    1991-01-01

    Uuest heliplaadist "Barber: Sinfonie Nr. 1, Op. 9. Ouvertüre School for Scandal, Op. 5; Beach: Sinfonie e-Moll, Op. 32, "Gaelic". Detroit Symphony Orchestra /Neeme Järvi". Chandes cassette ABTD 1550; CD CHAN 8958 (72 minutes)

  8. American Society of Plastic Surgeons

    Science.gov (United States)

    ... know the risks and trust a board-certified plastic surgeon to perform your cosmetic or reconstructive surgery. ASPS member surgeons have the training and experience that ... 1300 Chain Bridge Road McLean, VA 22101 (703) 790-5454 Timothy Germain ...

  9. 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...

  10. 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.

  11. 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? ...

  12. 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

  13. 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

  14. 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.)

  15. 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.)

  16. 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.

  17. 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.

  18. Recurrent Mutations in the Basic Domain of TWIST2 Cause Ablepharon Macrostomia and Barber-Say Syndromes

    NARCIS (Netherlands)

    Marchegiani, Shannon; Davis, Taylor; Tessadori, Federico; van Haaften, Gijs; Brancati, Francesco; Hoischen, Alexander; Huang, Haigen; Valkanas, Elise; Pusey, Barbara; Schanze, Denny; Venselaar, Hanka; Vulto-van Silfhout, Anneke T; Wolfe, Lynne A; Tifft, Cynthia J; Zerfas, Patricia M; Zambruno, Giovanna; Kariminejad, Ariana; Sabbagh-Kermani, Farahnaz; Lee, Janice; Tsokos, Maria G; Lee, Chyi-Chia R; Ferraz, Victor; da Silva, Eduarda Morgana; Stevens, Cathy A; Roche, Nathalie; Bartsch, Oliver; Farndon, Peter; Bermejo-Sanchez, Eva; Brooks, Brian P; Maduro, Valerie; Dallapiccola, Bruno; Ramos, Feliciano J; Chung, Hon-Yin Brian; Le Caignec, Cédric; Martins, Fabiana; Jacyk, Witold K; Mazzanti, Laura; Brunner, Han G; Bakkers, Jeroen; Lin, Shuo; Malicdan, May Christine V; Boerkoel, Cornelius F; Gahl, William A; de Vries, Bert B A; van Haelst, Mieke M; Zenker, Martin; Markello, Thomas C

    2015-01-01

    Ablepharon macrostomia syndrome (AMS) and Barber-Say syndrome (BSS) are rare congenital ectodermal dysplasias characterized by similar clinical features. To establish the genetic basis of AMS and BSS, we performed extensive clinical phenotyping, whole exome and candidate gene sequencing, and functio

  19. [Improving the surgeon's image: introduction].

    Science.gov (United States)

    Tajima, Tomoo

    2004-05-01

    The number of medical students who aspire to become surgeons has been decreasing in recent years. With a vicious spiral in the decreasing number and the growing deterioration of surgeons' working conditions, there is fear of deterioration of surgical care and subsequent disintegration of overall health care in Japan. The purpose of this issue is to devise a strategy for improving surgeons' image and their working conditions to attract future medical students. However, we cannot expect a quick cure for the problem of the decreasing number of applicants for surgery since this issue is deeply related to many fundamental problems in the health care system in Japan. The challenge for surgical educators in coming years will be to solve the problem of chronic sleep deprivation and overwork of surgery residents and to develop an efficient program to meet the critical educational needs of surgical residents. To solve this problem it is necessary to ensure well-motivated surgical residents and to develop an integrated research program. No discussion of these issues would be complete without attention to the allocation of scarce medical resources, especially in relation to financial incentives for young surgeons. The authors, who are conscientious representatives of this society, would like to highlight these critical problems and issues that are particularly relevant to our modern surgical practice, and it is our sincere hope that all members of this society fully recognize these critical issues in the Japanese health care system to take leadership in improving the system. With the demonstration of withholding unnecessary medical conducts we may be able to initiate a renewal of the system and eventually to fulfill our dreams of Japan becoming a nation that can attract many patients from all over the world. Furthermore, verification of discipline with quality control and effective surgical treatment is needed to avoid criticism by other disciplines for being a self

  20. Surgeons' non-technical skills.

    Science.gov (United States)

    Yule, Steven; Paterson-Brown, Simon

    2012-02-01

    The importance of non-technical skills to surgical performance is gaining wide acceptance. This article discusses the core cognitive and social skills categories thought to underpin medical knowledge and surgical expertise, and describes the rise of non-technical skill models of assessment in surgery. Behavior rating systems such as NOTSS (Non-Technical Skills for Surgeons) have been developed to support education and assessment in this regard. We now understand more about these critical skills and how they impact surgery. The challenge in the future is to incorporate them into undergraduate teaching, postgraduate training, workplace assessment, and perhaps even selection.

  1. 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.

  2. 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...

  3. 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,...

  4. 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...

  5. Scapular dyskinesis: the surgeon's perspective.

    Science.gov (United States)

    Roche, Simon J; Funk, Lennard; Sciascia, Aaron; Kibler, W Ben

    2015-10-01

    The scapula fulfils many roles to facilitate optimal function of the shoulder. Normal function of the shoulder joint requires a scapula that can be properly aligned in multiple planes of motion of the upper extremity. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons. It is best considered an impairment of optimal shoulder function. As such, it may be the underlying cause or the accompanying result of many forms of shoulder pain and dysfunction. The present review looks at the causes and treatment options for this indicator of shoulder pathology and aims to provide an overview of the management of disorders of the scapula. PMID:27582990

  6. [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

  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.

  8. 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.

  9. Flight response of the barber surgeonfish, Acanthurus bahianus Castelnau, 1855 (Teleostei: Acanthuridae, to spearfisher presence

    Directory of Open Access Journals (Sweden)

    Larissa J. Benevides

    2016-01-01

    Full Text Available ABSTRACT When confronted by predators, prey need to make an economic decision between continuing their current activity or flee. Flight Initiation Distance (FID, the distance at which an organism begins to flee an approaching threat, has been used to indicate an animal's fearfulness level and a way to examine factors influencing escape decisions. Here we investigated how the FID of the barber surgeonfish, Acanthurus bahianus, responds to the presence of spearfishers in a fishing site in northeast Brazil. Specifically, we examined whether the FID was influenced by body and group size; by the heterogeneity of species in groups formation; and the distance to shelter. Significant differences in FID were observed with increasing body size. We found no significant relationship of FID with size or group formation, neither with distance to shelter. Preferences in forming groups with A. bahianus were seen among some species, and a higher FID was associated with less sheltered substrates. Results obtained here support theories suggesting that spearfishers do influence fish behavior. We highlight that future research should focus on the indirect impacts of spearfishing on the structure of marine communities, emphasizing the anti-predator behaviour of juvenile and adult target fishes.

  10. 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

  11. 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

  12. 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.

  13. 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

  14. [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

  15. 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

  16. Working night shifts affects surgeons' biological rhythm

    DEFF Research Database (Denmark)

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

    2015-01-01

    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 ...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...... and on PC1. For all subjective measures, a marked deterioration was seen on PC1. CONCLUSION: Surgeons' circadian rhythm was affected by working night shifts....

  17. 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.

  18. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

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

    Background: A large proportion of surgeons performing minimally invasive surgery (MIS) experience musculoskeletal pain in the upper body possibly due to awkward and long-term static positions. This can be detrimental for workability and health. The objective of the present review is to sum up...... in surgeons performing MIS is high and derives mainly from static postures. Positioning of monitor, adjustment of table height and instrument design also contribute substantially. Robotic assisted laparoscopy seems less physically demanding for the surgeon compared with conventional laparoscopy. However, some...... alongside patient safety. The present literature study supports the need for a randomized controlled trial evaluating the effect of an individually designed training program for surgeons performing MIS....

  19. Sir Donald Ross, pioneer aortic valve surgeon.

    Science.gov (United States)

    Wheatley, David

    2015-06-01

    Tribute to Sir Donald Ross by David Wheatley, as read by Robert Kleinloog, President, Society of Cardiothoracic Surgeons of South Africa at the Annual Congress of the South African Heart Association 19 October 2014.

  20. The barber's pole worm CAP protein superfamily--A basis for fundamental discovery and biotechnology advances.

    Science.gov (United States)

    Mohandas, Namitha; Young, Neil D; Jabbar, Abdul; Korhonen, Pasi K; Koehler, Anson V; Amani, Parisa; Hall, Ross S; Sternberg, Paul W; Jex, Aaron R; Hofmann, Andreas; Gasser, Robin B

    2015-12-01

    Parasitic worm proteins that belong to the cysteine-rich secretory proteins, antigen 5 and pathogenesis-related 1 (CAP) superfamily are proposed to play key roles in the infection process and the modulation of immune responses in host animals. However, there is limited information on these proteins for most socio-economically important worms. Here, we review the CAP protein superfamily of Haemonchus contortus (barber's pole worm), a highly significant parasitic roundworm (order Strongylida) of small ruminants. To do this, we mined genome and transcriptomic datasets, predicted and curated full-length amino acid sequences (n=45), undertook systematic phylogenetic analyses of these data and investigated transcription throughout the life cycle of H. contortus. We inferred functions for selected Caenorhabditis elegans orthologs (including vap-1, vap-2, scl-5 and lon-1) based on genetic networking and by integrating data and published information, and were able to infer that a subset of orthologs and their interaction partners play pivotal roles in growth and development via the insulin-like and/or the TGF-beta signalling pathways. The identification of the important and conserved growth regulator LON-1 led us to appraise the three-dimensional structure of this CAP protein by comparative modelling. This model revealed the presence of different topological moieties on the canonical fold of the CAP domain, which coincide with an overall charge separation as indicated by the electrostatic surface potential map. These observations suggest the existence of separate sites for effector binding and receptor interactions, and thus support the proposal that these worm molecules act in similar ways as venoms act as ligands for chemokine receptors or G protein-coupled receptor effectors. In conclusion, this review should guide future molecular studies of these molecules, and could support the development of novel interventions against haemonchosis.

  1. 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

  2. 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...

  3. Do Surgeons Treat Their Patients Like They Would Treat Themselves?

    NARCIS (Netherlands)

    Janssen, S.J.; Teunis, T.; Guitton, T.G.; Ring, D.; Biert, J.

    2015-01-01

    BACKGROUND: There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. QUESTIONS/PURPOSES: (1) Are surgeons more likely to reco

  4. 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

  5. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad

    2014-01-01

    BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... become standard techniques for cholecystectomy within 6 years. CONCLUSIONS: The importance of risk of complications has not surprisingly a high priority among surgeons in this questionnaire. Why this is has to be investigated further before implementing SILS and NOTES as standard of care....

  6. A Bariatric Surgery Primer for Orthopedic Surgeons.

    Science.gov (United States)

    Kingsberg, Jessica G; Halpern, Alan A; Hill, Brian C

    2016-01-01

    Increasing numbers of patients who have undergone bariatric surgery are now presenting to orthopedic surgeons for elective arthroplasties. In addition, orthopedic surgeons themselves are referring more patients for consideration of bariatric surgery in anticipation of future elective procedures. Although the full effects of bariatric surgery on metabolism are not yet known, the altered digestion associated with these surgeries poses several issues for orthopedic surgeons. In this article, we address 3 aspects of care of this class of patient: review of the most commonly performed procedures and their metabolic consequences; suggested preoperative assessment of bariatric patients for any conditions that should be corrected before surgery; and evaluation of outcomes of elective procedures performed after bariatric surgery. Awareness of the unique characteristics of this group of patients helps minimize the potential for complications of planned orthopedic surgeries.

  7. 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

  8. 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

  9. 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

  10. How helpful is capsule endoscopy to surgeons?

    Institute of Scientific and Technical Information of China (English)

    Osman Ersoy; Bulent Sivri; Yusuf Bayraktar

    2007-01-01

    Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.

  11. 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.

  12. 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 ...

  13. Comparison of patient and surgeon expectations of total hip arthroplasty.

    Directory of Open Access Journals (Sweden)

    Claire Jourdan

    Full Text Available OBJECTIVES: Analysis of discrepancies between patient and surgeon expectations before total hip arthroplasty (THA should enable a better understanding of motives of dissatisfaction about surgery, but this question has been seldom studied. Our objectives were to compare surgeons' and patients' expectations before THA, and to study factors which affected surgeon-patient agreement. METHODS: 132 adults (mean age 62.8+/-13.7 years, 52% men on waiting list for THA in three tertiary care centres and their 16 surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (range 0-100. Patients' and surgeons' answers were compared, for the total score and for the score of each item. Univariate analyses tested the effect of patients' characteristics on surgeons' and patients' expectations separately, and on surgeon-patient differences. RESULTS: Surgeon and patient expectations' mean scores were high (respectively 90.9+/-11.1 and 90.0+/-11.6 over 100. Surgeons' and patients' expectations showed no systematic difference, but there was little agreement on Bland and Altman graph and correlation coefficient was low. Patients had higher expectations than surgeons for sports. Patients rated their expectations according to trust in physician and mental quality of life, surgeons considered disability. More disabled patients and patients from a low-income professional category were often "more optimistic" than their surgeons. CONCLUSION: Surgeons and patients often do not agree on what to expect from THA. More disabled patients expect better outcomes than their surgeons.

  14. 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.

  15. 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

  16. Think small: nanotechnology for plastic surgeons.

    Science.gov (United States)

    Nasir, Amir R; Brenner, Sara A

    2012-11-01

    The purpose of this article is to introduce the topic of nanotechnology to plastic surgeons and to discuss its relevance to medicine in general and plastic surgery in particular. Nanotechnology will be defined, and some important historical milestones discussed. Common applications of nanotechnology in various medical and surgical subspecialties will be reviewed. Future applications of nanotechnology to plastic surgery will be examined. Finally, the critical field of nanotoxicology and the safe use of nanotechnology in medicine and plastic surgery will be addressed.

  17. Paying surgeons less has cost more.

    Science.gov (United States)

    Bernstein, Joseph; Derman, Peter

    2012-12-01

    The Balanced Budget Act of 1997 mandated reductions in physician reimbursement. This reduction in payments could be envisioned to limit expenditures on 2 counts: first, individual fees would be lower, producing inherent savings. Furthermore, reducing fees should depress the incentive to work, thereby generating additional savings from reduced output. A rival point of view holds that lower fees might paradoxically lead to greater spending because surgeons compensate for per-case reductions by performing more cases. If this income-targeting hypothesis is correct, lower per-case fees leads to increased volume. Increased work output has particularly sizable economic effects in fields like orthopedic surgery because the total cost of orthopedic interventions is usually many times larger than the physician's fee (largely owing to the cost of implants). As such, increases in work volume more than negate the potential savings from lower surgeon's fees.This phenomenon was studied in the context of total knee arthroplasty. In the decade spanning 1996 to 2005, inflation-adjusted physician reimbursement decreased by approximately 5% per year, leading to a cumulative drop in reimbursement from $2847 to $1685. Nonetheless, because the number of procedures performed increased from 253,841 to 498,169 and because payments to hospitals far exceeded payments to surgeons, total expenditures for total knee arthroplasty increased dramatically: more than $7.1 billion additional was spent on hospital payments. Continuing to pay surgeons less is apt to continue to cost more. Counter to intuition, the best strategy for controlling overall spending might be higher, not lower, surgical fees.

  18. 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 ...

  19. 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

  20. Australia's female military surgeons of World War I.

    Science.gov (United States)

    Neuhaus, Susan J

    2013-10-01

    The war service of Lilian Violet Cooper, the first female surgeon of the Royal Australasian College of Surgeons, is well recognized. Not so well known however, are the other pioneering female doctors who also undertook work as military surgeons during World War I. At least four of the 14 Australian female doctors that undertook overseas war service during World War I were engaged as surgeons and treated Australian, British and Allied casualties. These women operated in London, in Egypt and on the frontlines of the Macedonian campaign. While none of these other women became Fellows of the Royal Australasian College of Surgeons, their war efforts deserve recognition.

  1. 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.

  2. Sir Charles Ballance: pioneer British neurological surgeon.

    Science.gov (United States)

    Stone, J L

    1999-03-01

    nerve regeneration and nerve grafting, and after many years of devoted research, he devised successful operations for facial nerve paralysis. For this and early vascular work, he is often credited as the first English surgeon to reintroduce classical Hunterian methods of experiment into surgery. He was honored as the founder and President of The Society of British Neurological Surgeons in 1926. Perhaps best known as a general and aural surgeon, Ballance was second only to Horsley in reputation as a pioneer British neurological surgeon. Described as a painstakingly slow but delicate and meticulous operator, Ballance made a contribution to neurosurgery and temporal bone surgery that was immense.

  3. [The cardiovascular surgeon and the Syntax score].

    Science.gov (United States)

    Gómez-Sánchez, Mario; Soulé-Egea, Mauricio; Herrera-Alarcón, Valentín; Barragán-García, Rodolfo

    2015-01-01

    The Syntax score has been established as a tool to determine the complexity of coronary artery disease and as a guide for decision-making among coronary artery bypass surgery and percutaneous coronary intervention. The purpose of this review is to systematically examine what the Syntax score is, and how the surgeon should integrate the information in the selection and treatment of patients. We reviewed the results of the SYNTAX Trial, the clinical practice guidelines, as well as the benefits and limitations of the score. Finally we discuss the future directions of the Syntax score.

  4. The pediatric surgeon-patient relationship.

    Science.gov (United States)

    Rackley, Sandra; Bostwick, John Michael

    2013-08-01

    Though technical aspects of surgical practice are commonly emphasized, communication is the most frequent "procedure" employed by surgeons. A good patient-physician relationship enhances the quality of surgical care by improving outcomes and patient and family satisfaction. There are general principles that can enhance communication with all children and families. Employing a developmentally sensitive approach that adjusts communication style based on a child's cognitive abilities and emotional concerns can further enhance the relationship with children of different ages. These communication skills can be learned and are improved by practice and self-reflection. PMID:23870204

  5. 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.

  6. 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.

  7. Postcardiotomy centrifugal assist: a single surgeon's experience.

    Science.gov (United States)

    Curtis, Jack J; McKenney-Knox, Charlotte A; Wagner-Mann, Colette C

    2002-11-01

    Because of the infrequent application of cardiac assist devices for postcardiotomy heart failure, most published reports include the results of learning curves from multiple surgeons. Between October 1986 and June 2001, a single surgeon used 35 Sarns Centrifugal Pumps as ventricular assist devices in 21 patients with severe hemodynamic compromise after open heart surgery (0.88% incidence). Patients' ages ranged from 39 to 77 (mean, 59.6 years). Three patients required right ventricular assist devices, 4 left ventricular assist devices, and 14 had biventricular assist devices. For all, the indication for application was inability to wean from cardiopulmonary bypass despite multiple inotropes and intraaortic balloon pumping. All were expected to be intraoperative deaths without further mechanical assistance. Patients were assisted from 2 to 434 h (median, 48 h). Fifteen patients (71.4%) were weaned from device(s), and 11 patients (52.4%) were hospital survivors. Actuarial survival in those dismissed from the hospital was 78% at 5 years and 39% at 10 years. Patients facing certain demise after cardiac surgery can be salvaged with temporary centrifugal mechanical assist. Results are competitive with that achieved with more sophisticated devices. Hospital survivors enjoy reasonable longevity.

  8. Recurrent Mutations in the Basic Domain of TWIST2 Cause Ablepharon Macrostomia and Barber-Say Syndromes

    Science.gov (United States)

    Marchegiani, Shannon; Davis, Taylor; Tessadori, Federico; van Haaften, Gijs; Brancati, Francesco; Hoischen, Alexander; Huang, Haigen; Valkanas, Elise; Pusey, Barbara; Schanze, Denny; Venselaar, Hanka; Vulto-van Silfhout, Anneke T.; Wolfe, Lynne A.; Tifft, Cynthia J.; Zerfas, Patricia M.; Zambruno, Giovanna; Kariminejad, Ariana; Sabbagh-Kermani, Farahnaz; Lee, Janice; Tsokos, Maria G.; Lee, Chyi-Chia R.; Ferraz, Victor; da Silva, Eduarda Morgana; Stevens, Cathy A.; Roche, Nathalie; Bartsch, Oliver; Farndon, Peter; Bermejo-Sanchez, Eva; Brooks, Brian P.; Maduro, Valerie; Dallapiccola, Bruno; Ramos, Feliciano J.; Chung, Hon-Yin Brian; Le Caignec, Cédric; Martins, Fabiana; Jacyk, Witold K.; Mazzanti, Laura; Brunner, Han G.; Bakkers, Jeroen; Lin, Shuo; Malicdan, May Christine V.; Boerkoel, Cornelius F.; Gahl, William A.; de Vries, Bert B.A.; van Haelst, Mieke M.; Zenker, Martin; Markello, Thomas C.

    2015-01-01

    Ablepharon macrostomia syndrome (AMS) and Barber-Say syndrome (BSS) are rare congenital ectodermal dysplasias characterized by similar clinical features. To establish the genetic basis of AMS and BSS, we performed extensive clinical phenotyping, whole exome and candidate gene sequencing, and functional validations. We identified a recurrent de novo mutation in TWIST2 in seven independent AMS-affected families, as well as another recurrent de novo mutation affecting the same amino acid in ten independent BSS-affected families. Moreover, a genotype-phenotype correlation was observed, because the two syndromes differed based solely upon the nature of the substituting amino acid: a lysine at TWIST2 residue 75 resulted in AMS, whereas a glutamine or alanine yielded BSS. TWIST2 encodes a basic helix-loop-helix transcription factor that regulates the development of mesenchymal tissues. All identified mutations fell in the basic domain of TWIST2 and altered the DNA-binding pattern of Flag-TWIST2 in HeLa cells. Comparison of wild-type and mutant TWIST2 expressed in zebrafish identified abnormal developmental phenotypes and widespread transcriptome changes. Our results suggest that autosomal-dominant TWIST2 mutations cause AMS or BSS by inducing protean effects on the transcription factor’s DNA binding. PMID:26119818

  9. Correct coding for the orthopedic surgeon.

    Science.gov (United States)

    Malek, M Mike; Friedman, Melvin M; Beach, William

    2002-04-01

    Coding accurately is one of the main principles of a successful practice. Some changes that we will see shortly include deletion of the term "separate procedure," deletion of the term "with and/or without," deletion of the term "any method," revision of the criteria for choosing E/M levels, and 52 new and revised Hand Surgery codes. Some other changes to come will be category II and category III codes. More changes are occurring as this is written, and the best advice is to stay tuned. It is obvious to the authors that coding is mainly for reimbursement purposes. The orthopedic surgeon must remain vigilant and must not pass this task on to someone else. Ignorance of coding methods is not an excuse [2]. We must all watch carefully and speak up when necessary. In this day of decreasing reimbursement, we can all increase our revenue stream without working any harder if we code our work properly, completely, and promptly.

  10. 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

  11. 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...

  12. 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...

  13. 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.

  14. Organism Encumbrance of Cardiac Surgeon During Surgery

    Science.gov (United States)

    Karabdic, Ilirijana Haxhibeqiri; Veljovic, Fikret; Straus, Slavenka

    2016-01-01

    Introduction: Most everyday activities, performed over a long period leads to performance degradation of skeletal muscles as well as spinal column which is reflected in the reduction of maximum force, reduction of the speed of response, reducing control of the movement etc. Although until now many mathematical models of muscles are developed, very small number takes into account the fatigue, and those models that take into account changes in the characteristics of muscles for extended activities, generally considered tiring under certain conditions. Given that the current models of muscle fatigue under arbitrary conditions of activation and load are very limited, this article presents a new model that includes scale of muscles overload. Material and Methods: There are three female cardiac surgeons working performing these surgeries in operating rooms, and their average anthropometric measures for this population is: a) Weight: 62 kg; b) Height: 166 cm. Age: 45 taken in the calculation within the CATIA software, that entity is entitled to 50% of healthy female population that is able to execute these and similar jobs. During the surgery is investigated the two most common positions: position “1” and “2”. We wish to emphasize that the experiment or surgical procedure lasted for two positions for five hours, with the position “1” lasted 0.5 hours, and position “2” lasted about 4.5 hours. The additional load arm during surgery is about 1.0 kg. Results: The analysis was done in three positions: “Operating position 1”, “Operating position 2 ‘, and each of these positions will be considered in its characteristic segments. These segments are: when the body takes the correct position, but is not yet burdened with external load, then when the surgeon receives the load and the third position when the load is lifted at the end of the position. Calculation of internal energy used on the joints is carried out in the context of software analysis of this

  15. 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

  16. 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.

  17. 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'...

  18. 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. ...

  19. Diagrama de Barber y Johnson para el análisis de la gestión de la cama hospitalaria en Costa Rica

    Directory of Open Access Journals (Sweden)

    Melvin Morera Salas

    2013-06-01

    Full Text Available Objetivo: Mostrar la utilidad del diagrama de Barber y Johnson para analizar comparativamente la productividad y gestión del recurso cama de los hospitales públicos de Costa Rica. Materiales y Métodos: La información de camas, egresos y estancias por centro hospitalario para el 2011 proviene de la Caja Costarricense de Seguro Social. Se utiliza el diagrama de Barber y Johnson para comparar los indicadores de estancia media, ocupación, intervalo de sustitución y egresos por cama durante un año. Se consideran centros eficientes los que poseen un índice de ocupación igual o superior a 85% y una actividad comprendida entre el promedio más o menos una desviación estándar. Resultados: En el 2011 los hospitales públicos contaron con 5 636 camas disponibles donde se hospitalizaron 323 mil pacientes, con una estancia de 1,73 millones de días. Ocho hospitales están ubicados en la zona de eficiencia. Esto grupo de centros está compuesto por un hospital nacional, seis regionales y un centro periférico de baja complejidad. Conclusión: El diagrama de Barber y Johnson es una herramienta que permite evaluar en forma gráfica la relación de cuatro indicadores tradicionales de gestión y productividad de la cama en forma conjunta, de tal forma que se pueden identificar puntos de mejora en las relaciones del trabajo médico y la labor administrativa, en el uso de la cama hospitalaria.

  20. Richard von Volkmann: surgeon and Renaissance man.

    Science.gov (United States)

    Willy, Christian; Schneider, Peter; Engelhardt, Michael; Hargens, Alan R; Mubarak, Scott J

    2008-02-01

    Richard von Volkmann (1830-1889), one of the most important surgeons of the 19(th) century, is regarded as one of the fathers of orthopaedic surgery. He was a contemporary of Langenbeck, Esmarch, Lister, Billroth, Kocher, and Trendelenburg. He was head of the Department of Surgery at the University of Halle, Germany (1867-1889). His popularity attracted doctors and patients from all over the world. He was the lead physician for the German military during two wars. From this experience, he compared the mortality of civilian and war injuries and investigated the general poor hygienic conditions in civilian hospitals. This led him to introduce the "antiseptic technique" to Germany that was developed by Lister. His powers of observation and creativity led him to findings and achievements that to this day bear his name: Volkmann's contracture and the Hueter-Volkmann law. Additionally, he was a gifted writer; he published not only scientific literature but also books of children's fairy tales and poems under the pen name of Richard Leander, assuring him a permanent place in the world of literature as well as orthopaedics. PMID:18196438

  1. [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

  2. [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.

  3. Ethical challenges in surgery as narrated by practicing surgeons

    Directory of Open Access Journals (Sweden)

    Nordam Ann

    2005-02-01

    Full Text Available Abstract Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. 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 nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.

  4. Reflection: The Early Career Surgeon-Scientist's Pathway to Independence.

    Science.gov (United States)

    Smith, Stephanie Shintani

    2016-01-01

    The surgeon-scientist offers a unique perspective as one who can arguably best comprehend clinical needs, identify areas ripe for research, and translate discoveries from bench to bedside. However, the long transition from postdoc to independent investigator can prove to be quite challenging. Surgeons have long been described as having results-oriented personalities, and so the long road to independence can be fraught with frustration at times. It requires humility in seeking scientific direction and mentorship, institutional support, and ultimately extramural funding. This reflection piece examines some hallmark steps along the pathway to independence for one otolaryngology-head and neck surgeon-scientist in her early academic career. PMID:26527611

  5. 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

    AIM: Ultrasound has a well-established role in the diagnostic assessment of acute abdominal pain where some ultrasonically easily-accessible organs account for several diagnostic possibilities. The objective of the present study was to evaluate whether surgeons without ultrasound experience could......, specificity and kappa-agreement of the surgeon performed ultrasound examination was 1.00 (0.77-1.00), 0.96 (0.79-0.99), 0.94 (0.3-1.00) and 0.40 (0.12-0.77), 0.97 (0.83-0.99), 0.44 (0.00-0.96); respectively. Visualization of the common bile duct was poor having 73% non-diagnostic surgeon-performed ultrasound...... examinations. CONCLUSION: Surgeons in training without pre-existing ultrasound experience and only a minimum of formal ultrasound education can perform valid and reliable ultrasound examinations of the gallbladder in patients admitted with acute abdominal pain...

  6. 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 ...

  7. 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.

  8. [Andreas Vesalius, distinguished surgeon of the 16th century].

    Science.gov (United States)

    Van Hee, R

    1996-01-01

    The author gives here some considerations about A. Vesalius through his life and his works as a surgeon. He was the father of the anatomical revolution against Galen but was also an eminent clinician and surgeon. He was immediately able to adapt his surgical practice whenever the promising methodology was identified (see Consilia). The author concludes with a critical analysis of the Chirurgia magna in septem libros digesta attributed to A. Vesalius.

  9. 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...

  10. The surgeon and self-harm: at the cutting edge.

    Science.gov (United States)

    Kinahan, James C; MacHale, Siobhan

    2014-12-01

    Surgeons frequently treat the consequences of self-harm. Self-harm is a common problem and presentations to Irish hospitals are increasing. It increases the risk of suicide and is associated with long term morbidity. Appropriate management can improve the prognosis. Surgeons require a number of skills to appropriately manage patients who self-harm. In this review we outline those skills including diagnosis, communication, capacity and risk assessment.

  11. 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

  12. Motivado por cirujanos Motivated by Surgeons

    Directory of Open Access Journals (Sweden)

    Carlos Salazar-Vargas

    2010-12-01

    interrogate and to examine those individuals, and every gesture, every question, every maneuver they did, was jealously kept in our minds. However even at an early stage, we clearly perceived, the differences between medical branches and practitioners, and involuntarily, every one was leaning towards this or that specialty. It was during those years when 7 wonderful persons and excellent surgeons, crossed the path of my life, inspiring me to follow their steps and to embrace a surgical career. Two were classic academicians, Dr. Manuel Aguilar Bonilla and Dr. Andres Vesalio Guzman Calleja, 3 were determined, tireless and highly skilled, Dr. Longino Soto Pacheco, Dr. Claudio Orlich Carranza, y el Dr. Carlos Prada Diaz, and 2 were, although well prepared, unassuming, practical and openly friendly, Dr. Fernando Valverde Soley y el Dr. Randall Ferris Iglesias....

  13. 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.

  14. 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.

  15. Musculoskeletal disorders among robotic surgeons: A questionnaire analysis

    Directory of Open Access Journals (Sweden)

    Claudio Giberti

    2014-06-01

    Full Text Available Objective: Robotic surgical systems offer better workplace in order to relieve surgeons from prolonged physical efforts and improve their surgical outcomes. However, robotic surgery could produce musculoskeletal disorders due to the prolonged sitting position of the operator, the fixed position of the console viewer and the movements of the limbs. Until today, no one study has been reported concerning the association between robotics and musculoskeletal pain. The aim of this work was verify the prevalence of musculoskeletal disorders among Italian robotic surgeons. Material and methods: Between July 2011 and April 2012 a modified Standardized Nordic Questionnaire was delivered to thirty-nine Italian robotic centres. Twentytwo surgeons (56% returned the questionnaires but only seventeen questionnaires (43.5% were evaluable. Results: Seven surgeons (41.2% reported musculoskeletal disorders, by since their first use of the robot which significantly persisted during the daily surgical activity (P < 0.001. Regarding the body parts affected, musculoskeletal disorders were mainly reported in the cervical spine (29.4% and in the upper limbs (23.5%. Six surgeons (35.3% defined the robotic console as less comfortable or neither comfortable/uncomfortable with a negative influence on their surgical procedures. Conclusions: In spite of some important limitations, our data showed musculoskeletal disorders due to posture discomfort with negative impact on daily surgical activity among robotic surgeons. These aspects could be due to the lack of ergonomic seat and to the fixed position of the console viewer which could have produced an inadequate spinal posture. The evaluation of these postural factors, in particular the development of an integrated and more ergonomic chair, could further improve the comfort feeling of the surgeon at the console and probably his surgical outcomes.

  16. Diversity of marine biotoxins in the near-shore ocean area: presence of a palytoxin-like entity at Barber's Point Harbor, Oahu.

    Science.gov (United States)

    Wachi, K M; Hokama, Y

    2001-11-01

    The presence of palytoxin or palytoxin-like compounds in fish extracts has been presented in this study. The hemolytic assay with sheep erythrocytes demonstrated the occurrence of hemolytic factors in fish extracts of Hawaiian reef fish from Barber's Point, Oahu. The rabbit anti-palytoxin inhibition assay with fish extracts and sheep erythrocytes demonstrated that palytoxin or its congener contributed to the lysis of sheep erythrocytes. From these results, it was concluded that sheep erythrocyte hemolysis was caused by palytoxin or palytoxin-like factors present in the fish extracts. Moderate correlation (R2) between mouse toxicity and sheep erythrocyte hemolysis was shown with 50 microg (R2 = 0.48) and 100 microg (R2 = 0.45) extracts. An inverse correlation of R2 = 0.64 was shown between hemolysis and MIA endpoint.

  17. 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.…

  18. Divan Şiirinin Sevimli Yüzleri: Osmanlı Şiirinde Berberler Cute Faces Of Ottoman Poetry: Barbers in Ottoman Poetry

    Directory of Open Access Journals (Sweden)

    İncinur ATİK GÜRBÜZ

    2012-09-01

    Full Text Available It is known in Ottomans that the barbers do not only cut or shave hair, they also carry out works such as circumcising, cupping and dentistry works. The workplace of barbers which is one of the important members of society in this aspect appears in center of social life as placeswhere people from all walks of life enter and exit, share their secrets, makegossips and keep finger on the pulse of society. In this regard, barbers whoare important cultural element and bearers of the society they live inbecome subject of many genres from poems to stories, novels to theater,tales to rhymes in almost every period with the tradition of literary works.The barbers and elements regarding barbers have found a place in theworld of metaphors of divan poetry like all other elements of social life, andhave appeared in poems in couplets or as a whole. In this study, in light ofsome examples, barbers themselves, apprentices, customers, workplaces,mirrors, combs, razors, scissors, basins, ewers, towels and shaving formelements will be discussed as an element in the use of simile poems. Our study includes examples from divan, şehrengiz, masnavi texts in different centuries. During the search activity we made, the couplets regardingbarbers have been categorized, these categories have been grouped, andscope and sections of our study has been determined from resultinggroups. We strive to choose examples in our study in same categoricalgroups by explaining subject in best way from most striking couplets. Osmanlıda berberlerin sadece sa�� kesen ya da tıraş yapan kişiler olmadıkları, aynı zamanda sünnetçilik, hacamatçılık, dişçilik gibi işler de yaptıkları bilinmektedir. Bu yönleriyle toplumun önemli simalarından biri olan berberlerin dükkânları da her kesimden insanın girip çıktığı, sırların paylaşıldığı, dedikoduların yapıldığı ve böylelikle halkın nabzının tutulduğu mekânlar olarak toplumsal yaşamın merkezinde yer

  19. Simulation-based education and performance assessments for pediatric surgeons.

    Science.gov (United States)

    Barsness, Katherine

    2014-08-01

    Education in the knowledge, skills, and attitudes necessary for a surgeon to perform at an expert level in the operating room, and beyond, must address all potential cognitive and technical performance gaps, professionalism and personal behaviors, and effective team communication. Educational strategies should also seek to replicate the stressors and distractions that might occur during a high-risk operation or critical care event. Finally, education cannot remain fixed in an apprenticeship model of "See one, do one, teach one," whereby patients are exposed to the risk of harm inherent to any learning curve. The majority of these educational goals can be achieved with the addition of simulation-based education (SBE) as a valuable adjunct to traditional training methods. This article will review relevant principles of SBE, explore currently available simulation-based educational tools for pediatric surgeons, and finally make projections for the future of SBE and performance assessments for pediatric surgeons.

  20. Advocacy--answering old mail. Canadian Association of General Surgeons.

    Science.gov (United States)

    Keith, R G

    1999-06-01

    Since its inception in 1977, the Canadian Association of General Surgeons (CAGS) has struggled with its responsibility to represent general surgeons in practices across this country. The CAGS has tended to be mute in the presentation of many of its accomplishments, which have improved the role of specialists in community practice, training programs and the subspecialties of general surgery. With the forthcoming changes in direction for the Royal College of Physicians and Surgeons of Canada, based on a recent external survey, the CAGS has a golden opportunity to advocate for a clear identity, autonomous from the Royal College for the purposes of scientific meetings, continuing professional development, scientific and practice affiliation with other surgical specialty societies, and new developments with corporate sector support for advancements in science technology and education. Advocacy for general surgery must be stressed as the priority for the CAGS into the future.

  1. 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

  2. Body dysmorphia, self-mutilation and the reconstructive surgeon.

    Science.gov (United States)

    Chan, James Kwok-Kwan; Jones, Sophie M; Heywood, Anthony J

    2011-01-01

    Body dysmorphic disorder (BDD) is a disabling preoccupation with a slight or an imagined defect in appearance. It is recognised in some patients who present to the plastic surgeon requesting multiple cosmetic procedures. Very rarely, BDD patients may wish for amputation of a healthy limb and may even mutilate themselves deliberately in order to necessitate amputation. These patients pose a diagnostic challenge as BDD is uncommon and they are often uncooperative whilst appearing mentally sound. Furthermore, they raise difficult ethical and legal issues for the surgeon. Although there is some guidance for the management of BDD patients seeking elective amputation, there is currently none for the management of those who present in the emergency setting. Illustrated by the case of a man who, having failed to find a complicit surgeon, attempted self-amputation of the hand, we review the relevant ethical, legal and management issues with advice by the British Medical Association and General Medical Council. PMID:20392680

  3. Communication between the obese patient and bariatric surgeon.

    Science.gov (United States)

    Ruiz de Angulo, David; Munitiz, Vicente; Ortiz, M Ángeles; Martínez de Haro, Luisa F; Frutos, M Dolores; Hernández, Antonio; Parrilla, Pascual

    2015-10-01

    Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important. PMID:25912163

  4. [How much business management does a surgeon need?].

    Science.gov (United States)

    Bork, U; Koch, M; Büchler, M W; Weitz, J

    2010-08-01

    The present day healthcare system in Germany is rapidly changing, even more so after the introduction of diagnosis-related groups. The basic requirements for every surgeon remain manual skills, a profound clinical knowledge and the ability for clinical decision-making even in difficult situations. However, these key elements of surgical education no longer fulfill the requirements for today's leaders in surgery. New requirements, consisting of administrative duties, strategic decision-making and department management are too complex to be made only intuitively. Nowadays surgeons also need a profound education in management skills and knowledge of economic mechanisms in order to run an efficient, profitable, patient-oriented surgical department. Every surgeon who aims at obtaining a leadership position should acquire the necessary knowledge and skills.

  5. 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

  6. 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

  7. 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.

  8. Leadership theory: implications for developing dental surgeons in primary care?

    Science.gov (United States)

    Willcocks, S

    2011-02-12

    The development of leadership in healthcare has been seen as important in recent years, particularly at the clinical level. There have been various specific initiatives focusing on the development of leadership for doctors, nurses and other health care professions: for example, a leadership competency framework for doctors, the LEO programme and the RCN clinical leadership programme for nurses. The NHS has set up a Leadership Council to coordinate further developments. However, there has not been the same focus in dentistry, although the recent review of NHS dental services (Steele review) has proposed a need for leadership initiatives in NHS dentistry as a medium-term action. Central to this will be a need to focus on the leadership role for dental surgeons. Leadership is all the more important in dentistry, given the change of government and the policy of retrenchment, major public sector reform, the emergence of new organisations such as new commissioning consortia, possible changes to the dental contract, new ways of working, and changes to the profession such as the requirements for the revalidation of dental surgeons. The question is: which leadership theory or approach is best for dental surgeons working in primary care? This paper builds on earlier work exploring this question in relation to doctors generally, and GPs, in particular, and planned work on nurses. It will seek to address this question in relation to dental surgeons working in primary care.

  9. Body Dysmorphia, the Plastic Surgeon, and the Counselor.

    Science.gov (United States)

    Renshaw, Domeena C.

    2003-01-01

    Misperceived ugliness is called body dysmorphia or dysmorphophobia, often only diagnosed after several discontented return visits to a plastic surgeon who refers the patient for counseling--rarely welcome referrals by the patient when they are convinced the problem is physical and not psychological. Careful listening and patient acceptance are…

  10. Age is highly associated with stereo blindness among surgeons

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...

  11. Optimal Brain Surgeon on Artificial Neural Networks in

    DEFF Research Database (Denmark)

    Christiansen, Niels Hørbye; Job, Jonas Hultmann; Klyver, Katrine;

    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...

  12. 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.

  13. 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

  14. ANALYSIS OF SANITATION MONITORING OF SUPPLIES IN BARBER AND BEAUTY SHOPS IN MIANYANG URBAN AREA%绵阳城区理发美容业公共用品卫生监测结果分析

    Institute of Scientific and Technical Information of China (English)

    文献英; 张代友; 吴晓红; 黄婷婷; 李晓涛; 唐果

    2011-01-01

    [目的]了解绵阳城区理发美容业的卫生状况,给广大消费者营造一个放心的消费环境,为政府制定卫生政策提供科学依据. [方法]按照《公共场所卫生监测技术规范》进行采样和《公共场所卫生标准检验方法》检验.按照《理发店、美容店卫生标准》GB9666-1996进行评判,指标中任何一项不合格即为不合格样品.[结果]绵阳城区2009年共监测理发美容业572家,合格281家,合格率为49.12%;共检测样品1 778件,合格1 298件,总合格率73.00%;绵阳城区美容专营店的公共用品消毒合格率明显高于兼营店和理发专营店,其中美容专营店、兼营店和理发专营店合格率分别为85.76%、76.28%和62.11%;公共用品毛巾的合格率最低为51.01%,床单64.93%,面膜碗70.47%,梳子94.99%,剪刀97.35%.[结论]绵阳城区理发美容业公共用品合格率较低,微生物污染严重,应采取综合措施,加强对理发美容业的卫生监督管理和公共用品的消毒,保障群众的身体健康.%[Objective] To know the sanitation situation of barber and beauty shops in Mianyang urban district, to create a comfortable environment of consumption to the consumers, so as to provide scientific foundations for the government to make health policy. [Methods] Carried out sampling in accordance with the "public places health monitoring technical specifications'' and tested samples according to "test methods for public health standards" and judged in accordance with the "the health standards for barber and beauty shop". [Results] 572 barber and beauty shops were monitored in Mianyang urban district in 2009, 281 were qualified, the qualified rate was 49.12%. The total 1 778 samples were detected, of which 1 298 samples were qualified. The qualified rate of samples was 73.00%. The qualified rate of disinfection on public supplies in city beauty shops was significantly higher than barber and beauty shops and barber shops, of

  15. 25家理发店、美容店公共用品消毒效果检测分析%Detection and Analysis on the Disinfection Effects of the Publi Goods in 25 Barber Shops and Beauty Salons

    Institute of Scientific and Technical Information of China (English)

    嵇凤杰; 宋义海

    2015-01-01

    Objective To master the the disinfection effects of the public goods in barber shops and beauty salons within our jurisdiction,find out the existing problems and puts forward solutions.MethodsTested and analyzed the disinfection effects of 179 pieces of public goods(including 26 pieces of barber's clippers、28 pieces of barber scissors、22 pieces of haircut knives、18 pieces of beard brushs、31 pieces of combs、38 pieces of towels and 16 pieces of beauty basins)in 25 barber shops and beauty salons.ResultsThe total qualified rate of disinfection sampling was 85.5%.Conclusion Improve the employees awareness of the importance of disinfection work,strengthen the training and other measures can improve the quality of disinfection.%目的:掌握本辖区内理发店、美容店公共用品的消毒效果情况,找出存在的问题并提出解决办法。方法对25家理发店、美容店的179件公共用品(其中包括推子26件、理发剪28件、理发刀22件、胡刷18件、梳子31件、毛巾38件和美容盆16件)的消毒效果进行检测分析。结果消毒抽检总合格率为85.5%。结论提高从业人员对消毒工作重要性的认识,加强培训等措施可以提高消毒质量。

  16. 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

  17. 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

  18. The 1964 Surgeon General's report and Americans' beliefs about smoking.

    Science.gov (United States)

    Marshall, Thomas R

    2015-04-01

    Half a century ago, on January 11, 1964, the U.S. Surgeon General's office released a landmark report on the health consequences of smoking. That report received massive media attention and triggered a steadily growing number of federal, state, and local restrictions on the advertising, sale, and use of cigarettes. Little is known about the report's impact on American public opinion because all the timely public opinion polls that measured the report's impact were privately commissioned by the tobacco industry and were not made publicly available. A review of these polls shows that the 1964 Surgeon General's report had a large and immediate effect on Americans' beliefs that cigarettes were a cause of lung cancer and of heart disease. However, the report had less impact on public preferences for government action or on smoking rates. PMID:25862749

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    -Technical Skills for Surgeons in Denmark tool to stimulate feedback conversations. Audio recordings of post-operation feedback conversations were collected. Trainees and supervisors provided questionnaire responses on the usefulness and comprehensiveness of the feedback. The feedback conversations were...... qualitatively analyzed for content and feedback style. Usefulness was investigated using a scale from 1 to 5 and written comments were qualitatively analyzed. RESULTS: Six trainees and six supervisors participated in eight feedback conversations. Eighty questionnaires (response rate 83 percent) were collected...

  20. 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...

  1. 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...

  2. A basic introduction to statistics for the orthopaedic surgeon.

    Science.gov (United States)

    Bertrand, Catherine; Van Riet, Roger; Verstreken, Frederik; Michielsen, Jef

    2012-02-01

    Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values. PMID:22523921

  3. 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.

  4. Left-handed surgical instruments - a guide for cardiac surgeons.

    Science.gov (United States)

    Burdett, Clare; Theakston, Maureen; Dunning, Joel; Goodwin, Andrew; Kendall, Simon William Henry

    2016-08-19

    For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.

  5. 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.

  6. 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.

  7. Why knee replacements fail in 2013: patient, surgeon, or implant?

    Science.gov (United States)

    Lombardi, A V; Berend, K R; Adams, J B

    2014-11-01

    Previous studies of failure mechanisms leading to revision total knee replacement (TKR) performed between 1986 and 2000 determined that many failed early, with a disproportionate amount accounted for by infection and implant-associated factors including wear, loosening and instability. Since then, efforts have been made to improve implant performance and instruct surgeons in best practice. Recently our centre participated in a multi-centre evaluation of 844 revision TKRs from 2010 to 2011. The purpose was to report a detailed analysis of failure mechanisms over time and to see if failure modes have changed over the past 10 to 15 years. Aseptic loosening was the predominant mechanism of failure (31.2%), followed by instability (18.7%), infection (16.2%), polyethylene wear (10.0%), arthrofibrosis (6.9%) and malalignment (6.6%). The mean time to failure was 5.9 years (ten days to 31 years), 35.3% of all revisions occurred at less than two years, and 60.2% in the first five years. With improvements in implant and polyethylene manufacture, polyethylene wear is no longer a leading cause of failure. Early mechanisms of failure are primarily technical errors. In addition to improving implant longevity, industry and surgeons must work together to decrease these technical errors. All reports on failure of TKR contain patients with unexplained pain who not infrequently have unmet expectations. Surgeons must work to achieve realistic patient expectations pre-operatively, and therefore, improve patient satisfaction post-operatively. PMID:25381419

  8. [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

  9. Perceptions of animal physiotherapy amongst irish veterinary surgeons

    Directory of Open Access Journals (Sweden)

    Doyle Aoife

    2006-02-01

    Full Text Available 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 less commonly cited. Awareness of animal physiotherapy was greatest amongst those working in equine practice (χ2 = 5.7, df 1, p = 0.017; they were more knowledgeable about its techniques (t = 2.806, df 75, p = 0.006 and more likely to refer (χ2 = 48.36, df 1, p = 0.0001. Seventy-four respondents (96% thought that more research was necessary to increase the evidence base for animal physiotherapy. If this branch of physiotherapy is to develop, there needs to be increased interaction and co-operation between veterinary surgeons and chartered animal physiotherapists.

  10. 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.

  11. 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

  12. 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.

  13. 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....

  14. 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

  15. 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...

  16. 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…

  17. 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

  18. 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...

  19. Health care delivery and the training of surgeons.

    Science.gov (United States)

    MacLean, L D

    1993-09-01

    Most countries have mastered the art of cost containment by global budgeting for public expenditure. It is not as yet clear whether the other option, managed care, or managed competition will accomplish cost control in America. Robert Evans, a Canadian health care expert, remains skeptical. He says, "HMO's are the future, always have been and always will be." With few exceptions, the amount spent on health care is not a function of the system but of the gross domestic product per person. Great Britain is below the line expected for expenditure, which may be due to truly impressive waiting lists. The United States is above the line, which is probably related to the overhead costs to administer the system and the strong demand by patients for prompt and highly sophisticated diagnostic measures and treatments. Canada is on the line, but no other country has subscribed to the Canadian veto on private insurance. Reform or changes are occurring in all countries and will continue to do so. For example, we are as terrified of managed care in Canada as you are of our brand of socialized insurance. We distrust practice by protocol just as you abhor waiting lists. From my perspective as a surgeon, I envision an ideal system that would cover all citizens, would maintain choice of surgeon by patients, would provide mechanisms for cost containment that would have the active and continuous participation of the medical profession, and would provide for research and development. Any alteration in health care delivery in the United States that compromises biomedical research and development will be a retrogressive, expensive step that could adversely affect the health of nations everywhere. Finally, a continuing priority of our training programs must be to ensure that the surgeon participating in this system continues to treat each patient as an individual with concern for his or her own needs.

  20. 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

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

    DEFF Research Database (Denmark)

    Jalaliniya, Shahram; Pederson, Thomas

    2015-01-01

    The design of general-purpose wearable computers demands particular care for how human perception, cognition, and action work and work together. The authors propose a human body-and-mind centric (egocentric as opposed to device-centric) design framework and present initial findings from deploying...... 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 collaboration...

  2. Musculoskeletal pain among surgeons performing minimally invasive surgery

    DEFF Research Database (Denmark)

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

    2016-01-01

    , and comparative data on surgeons' physical workload with robotic-assisted laparoscopy and conventional laparoscopy. Studies only describing a single surgical modality were excluded. We applied the checklist, STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), to assess the quality...... fulfilled the criteria of STROBE, with an average score of 13 (range 10-16) out of 18. DISCUSSION: Results, mainly self-reported measures, suggest that robotic-assisted laparoscopy is less strenuous compared with conventional laparoscopy. However, results are limited by the large methodological...

  3. 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

  4. Improvised explosive devices and the oral and maxillofacial surgeon.

    Science.gov (United States)

    Goksel, Tamer

    2005-08-01

    Improvised explosive devices have created a new class of casualties that presents a unique surgical challenge for oral and maxillofacial surgeons. The injury pattern and severity are different from those seen in conventional trauma patients. Because of battlefield circumstances, patients are sometimes delayed significantly in their transport to a trauma center, and they frequently arrive at a trauma center with hypotension, hypothermia, and acidosis. Definitive care is delayed while the hemodynamic status and life-threatening injuries are stabilized. Hospital triage protocols must be well established in advance to prepare a timely response to the mass casualty event. Proper resource use is an ever-evolving challenge for hospital staff during these times.

  5. 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)

  6. 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.

  7. 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.

  8. John M. T. Finney: distinguished surgeon and Oslerphile

    Science.gov (United States)

    2016-01-01

    John Finney (1863–1942) was born near Natchez, Mississippi. After receiving his medical degree from Harvard, he interned at Massachusetts General Hospital and then went to Baltimore to become one of the first interns at the new Johns Hopkins Hospital. He met William Osler the day the hospital opened and became a lifelong admirer of “the Chief.” Finney specialized in gastrointestinal surgery and was recognized for his expertise in the field. Osler recommended Finney to a physician colleague, writing, “You could not be in better hands…. Finney has been most successful and his judgment is so good.” Finney served for 33 years under William Halsted at Hopkins. After Halsted's death, Finney was offered the chair of surgery at Johns Hopkins but declined. He was a founder and first president of the American College of Surgeons. He also served as president of the American Surgical Association and the Society of Clinical Surgery. Finney became chief surgical consultant for the Allied Expeditionary Forces in World War I. He was decorated by the United States, France, and Belgium. Finney was a master surgeon and a role model for generations of students and physicians. PMID:26722185

  9. John M. T. Finney: distinguished surgeon and Oslerphile.

    Science.gov (United States)

    Stone, Marvin J

    2016-01-01

    John Finney (1863-1942) was born near Natchez, Mississippi. After receiving his medical degree from Harvard, he interned at Massachusetts General Hospital and then went to Baltimore to become one of the first interns at the new Johns Hopkins Hospital. He met William Osler the day the hospital opened and became a lifelong admirer of "the Chief." Finney specialized in gastrointestinal surgery and was recognized for his expertise in the field. Osler recommended Finney to a physician colleague, writing, "You could not be in better hands…. Finney has been most successful and his judgment is so good." Finney served for 33 years under William Halsted at Hopkins. After Halsted's death, Finney was offered the chair of surgery at Johns Hopkins but declined. He was a founder and first president of the American College of Surgeons. He also served as president of the American Surgical Association and the Society of Clinical Surgery. Finney became chief surgical consultant for the Allied Expeditionary Forces in World War I. He was decorated by the United States, France, and Belgium. Finney was a master surgeon and a role model for generations of students and physicians. PMID:26722185

  10. 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

  11. 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

  12. Salespeople in the Surgical Suite: Relationships between Surgeons and Medical Device Representatives

    Science.gov (United States)

    O’Connor, Bonnie; Pollner, Fran; Fugh-Berman, Adriane

    2016-01-01

    Background Industry payments to surgeons have received public attention, but little is known about the relationships between surgeons and medical device representatives. Medical device representatives ("device reps") have become an integral part of operating room personnel. The effect of their presence on patient care deserves discussion. Study Design We conducted a qualitative, ethnographic study to explore relationships between surgeons and medical device representatives, and characterize industry involvement in the training of surgeons. We used group and individual open-ended interviews to gain insight into the beliefs, values, and perspectives of surgeons and device reps. We conducted two focus groups, one with ear, nose, and throat surgeons, and one with hospital-based attending orthopedic surgeons. We also conducted individual interviews with three former or current medical device representatives, a director of a surgical residency program at an academic medical center, and a medical assistant for a multi-physician orthopedic practice. Results While surgeons view themselves as indisputably in charge, device reps work hard to make themselves unobtrusively indispensable in order to establish and maintain influence, and to imbue the products they provide with personalized services that foster a surgeon's loyalty to the reps and their companies. Surgeons view industry-funded training opportunities as a necessary service. Device reps and some surgeons believe that reps benefit patient care, by increasing efficiency and mitigating deficiencies among operating room personnel (including the surgeons themselves). Conclusions Our study raises ethical questions about the reliance of surgeons on device reps and device companies for education and surgical assistance and practical concerns regarding existing levels of competence among OR personnel. PMID:27486992

  13. 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

  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

    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...

  15. The general practitioner and the surgeon: stereotypes and medical specialties O clínico e o cirurgião: esteriótipos e especialidades médicas

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    2004-02-01

    Full Text Available OBJECTIVE: To investigate and characterize the professional stereotypes associated with general medicine and surgery among Brazilian medical residents. METHODS: A randomized sample of residents of the General Medicine and Surgery Residence Programs were interviewed and their perceptions and views of general and surgical doctors were compared. RESULTS: The general practitioner was characterized by the residents in general to be principally a sensitive and concerned doctor with a close relationship with the patient; (45%; calm, tranquil, and balanced (27%; with intellectual skills (25%; meticulous and attentive to details (23%; slow to resolve problems and make decisions (22%; and working more with probabilities and hypotheses (20%. The surgeon was considered to be practical and objective (40%; quickly resolving problems (35%; technical with manual skills (23%; omnipotent, arrogant, and domineering (23%; anxious, stressed, nervous, and temperamental (23%; and more decided, secure, and courageous (20%. Only the residents of general medicine attributed the surgeon with less knowledge of medicine and only the surgeons attributed gender characteristics to their own specialty. CONCLUSION: There was considerable similarity in the description of a typical general practitioner and surgeon among the residents in general, regardless of the specialty they had chosen. It was interesting to observe that these stereotypes persist despite the transformations in the history of medicine, i.e. the first physicians (especially regarding the valorization of knowledge and the first surgeons, so-called "barber surgeons" in Brazil (associated with less knowledge and the performance of high-risk procedures.OBJETIVOS: Investigar e caracterizar entre residentes brasileiros os estereótipos profissionais associados ao médico clínico e ao cirurgião. METODOLOGIA: uma amostra randomizada de residentes dos programas de Clínica Médica e Cirurgia foi entrevistada e suas

  16. 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

  17. 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.

  18. [Surgeon 2.0: the challenge is on the Web].

    Science.gov (United States)

    Belda Lozano, Ricardo; Ferrer Márquez, Manuel; García Torrecillas, Juan Manuel; Alvarez García, Antonio; Reina Duarte, Angel

    2013-01-01

    Numerous articles and opinions have been published in the last few years on how the Internet is changing clinical practice. In this article we focus on describing 2 aspects that we believe are fundamental in the web 2.0 and Medicine-Surgery inter-relationship: a) web 2.0 conceptualisation and its differences with other pre-existing tools, and b) a description of some of the tools that from a medical-surgical view could be of major interest to the professionals, the patients, and interaction between both. The time has arrived to board train 2.0, where the channels of communication between the professionals, and between them and the patients, are improving disease situations daily, to improve learning through contact with other physicians and surgeons, at the same time providing an excellent resource for maintaining health and to know the disease and its treatment.

  19. 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

  20. 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

  1. Jean Falcon (1491-1541), a great surgeon and anatomist of the 16th century.

    Science.gov (United States)

    Tsoucalas, Gregory; Karamanou, Marianna; Piagkou, Maria; Skandalakis, Panagiotis; Androutsos, George

    2013-01-01

    Jean Falcon, an Aragon native, became a famous surgeon at the Faculty of Montpellier. He was a Royal physician, wealthy enough to live a luxurious life and treat influential patients. His lectures were legendary, and his works gave him fame among the surgeons' class. Of all his manuscripts stands the "Guidon", which became an anatomical surgeons' handbook, worthy of reference from the scientific community for centuries.

  2. 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...

  3. Louisa Garrett Anderson (1873-1943), surgeon and suffragette.

    Science.gov (United States)

    Geddes, Jennian F

    2008-11-01

    Louisa Garrett Anderson, daughter of Britain's first woman doctor, has been largely forgotten today despite the fact that her contribution to the women's movement was as great as that of her mother. Recognized by her contemporaries as an important figure in the suffrage campaign, Anderson chose to lend her support through high-profile action, being one of the few women doctors in her generation who risked their professional as well as their personal reputation in the fight for women's rights by becoming a suffragette - in her case, even going so far as to spend a month in prison for breaking a window on a demonstration. On the outbreak of war, with only the clinical experience she had gained as outpatient surgeon in a women's hospital, Anderson established a series of women-run military hospitals where she was a Chief Surgeon. The most successful was the Endell Street Military Hospital in London, funded by the Royal Army Medical Corps and the only army hospital ever to be run and staffed entirely by women. Believing that a doctor had an obligation to take a lead in public affairs, Anderson continued campaigning for women's issues in the unlikely setting of Endell Street, ensuring that their activities remained in the public eye through constant press coverage. Anderson's achievement was that her work played no small part in expunging the stigma of the militant years in the eyes of the public and - more importantly - was largely instrumental in putting women doctors on equal terms with their male colleagues. PMID:18952990

  4. 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.

  5. The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    K Gnassingbé

    2011-01-01

    Full Text Available Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons′ directory was used to identify paediatric surgeons in the Francophone′s countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. Results: A total of 41 paediatric surgeons (68.33% responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%, scholarship from a non-governmental organisations in 14 (34.15% and self-sponsorships in 20 (48.78%. The average salary was 450 Euros (€ (range: 120-1 400 Euros. Most of the paediatric surgeons (68.29% had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80% had no subscription to specialised scientific journals. Conclusion: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.

  6. 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'...

  7. 77 FR 12845 - Announcement of Requirements and Registration for Surgeon General's (SG) Youth Video Contest

    Science.gov (United States)

    2012-03-02

    ... for Surgeon General's (SG) Youth Video Contest AGENCY: Centers for Disease Control and Prevention (CDC... Department of Health and Human Services (HHS) announces the launch of the Surgeon General's (SG) Youth Video... contest has been designed to engage youth and young adults in developing original videos in...

  8. Transatlantic comparison of the competence of surgeons at the start of their professional career

    NARCIS (Netherlands)

    M.P. Schijven; R.K. Reznick; O.T.J. ten Cate; T.P. Grantcharov; G. Regehr; L. Satterthwaite; A.S. Thijssen; H.M. Macrae

    2010-01-01

    Background: Although the objective in European Union and North American surgical residency programmes is similar - to train competent surgeons - residents' working hours are different. It was hypothesized that practice-ready surgeons with more working hours would perform significantly better than th

  9. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    Science.gov (United States)

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.

  10. [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

  11. 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.

  12. 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

  13. Human genomics and microarrays: implications for the plastic surgeon.

    Science.gov (United States)

    Cole, Jana; Isik, Frank

    2002-09-01

    The Human Genome Project was launched in 1989 in an effort to sequence the entire span of human DNA. Although coding sequences are important in identifying mutations, the static order of DNA does not explain how a cell or organism may respond to normal and abnormal biological processes. By examining the mRNA content of a cell, researchers can determine which genes are being activated in response to a stimulus. Traditional methods in molecular biology generally work on a "one gene: one experiment" basis, which means that the throughput is very limited and the "whole picture" of gene function is hard to obtain. To study each of the 60,000 to 80,000 genes in the human genome under each biological circumstance is not practical. Recently, microarrays (also known as gene or DNA chips) have emerged; these allow for the simultaneous determination of expression for thousands of genes and analysis of genome-wide mRNA expression. The purpose of this article is twofold: first, to provide the clinical plastic surgeon with a working knowledge and understanding of the fields of genomics, microarrays, and bioinformatics and second, to present a case to illustrate how these technologies can be applied in the study of wound healing.

  14. 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.

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

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    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.

  16. Association of Surgeons in Training Conference: Cardiff 2012.

    Science.gov (United States)

    Khera, G; Wild, J R L; Fitzgerald, J E F

    2012-01-01

    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. With a membership of over 2000 surgical trainees from all ten surgical specialities, the association provides support at both regional and national levels throughout the United Kingdom and Republic of Ireland. Originally founded in 1976, ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and speciality associations. The 2012 Annual Conference in Cardiff City Hall brought together nearly 700 delegates for an educational weekend programme with expert guest speakers. Clinical updates were complimented by debates on current training in surgery, and the weekend included 6 pre-conference courses covering a diverse range of topics including laparoscopic skills, surgical drawing and a masterclass in journal club. A record number of 1168 abstract submissions were received and those successful competed for 18 awards representing £3500 in trainee prizes and bursaries. As the only national surgical trainee meeting for all specialities, ASiT continues to grow and we look forward to an even larger and more successful conference next year.

  17. Current Practice Patterns Regarding the Conduct of Thyroidectomy and Parathyroidectomy amongst Surgeons - A Survey Study

    Directory of Open Access Journals (Sweden)

    LR Henry, LB Helou, NP Solomon, A Chang, SK Libutti, A Stojadinovic

    2012-01-01

    Full Text Available Background: Heterogeneity of surgical care exists among surgeons regarding the conduct of thyroidectomy and parathyroidectomy.Aim: To identify the current patterns of technical conduct of operation amongst surgeons performing thyroidectomy or parathyroidectomy.Methods: A survey was designed and beta-tested on five surgical oncologists for face validity and usability. The final version of this survey was constructed and disseminated using the professional version of the internet-based survey mechanism Survey Monkey and consisted of two eligibility questions and 22 questions regarding thyroidectomy/parathyroidectomy treatment patterns. The survey was disseminated electronically to American Association of Endocrine Surgeons (AAES and American College of Surgeons (ACS members. Survey results were collected, tabulated and analyzed. Responses among groups were compared using two sample T- tests. Significant responses were subsequently analyzed in generalized linear models to ascertain if significance remained with control of covariates.Results: Of 420 initial web survey visits, 236 (56.2% surveys were completed. The majority of respondents reported being 'fellowship trained', experienced and 'high-volume' surgeons. The most common fellowship trainings were endocrine (46%, oncology (22%, head & neck (13%, or combinations of the three fellowships (14%. Most surgeons reported that they dissect the course of the recurrent laryngeal nerve (RLN without using neuromonitoring. Nearly a third of respondents reported routinely using the Harmonic scalpel during the conduct of the operations. Significant differences emerged regarding operative technique according to residency training type, fellowship training, surgeon volume, and practice setting, but only those associated with residency training type and annual surgeon surgical volume remained significant within generalized linear models.Conclusion: Most surgeons who responded to this survey do not routinely

  18. 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.

  19. [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

  20. 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.

  1. 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.

  2. 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

  3. Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons

    Science.gov (United States)

    Coyne, L. A.; Latham, S. M.; Williams, N. J.; Dawson, S.; Donald, I. J.; Pearson, R. B.; Smith, R. F.; Pinchbeck, G. L.

    2016-01-01

    Objectives The use of antimicrobials in food-producing animals has been linked with the emergence of antimicrobial resistance in bacterial populations, with consequences for animal and public health. This study explored the underpinning drivers, motivators and reasoning behind prescribing decisions made by veterinary surgeons working in the UK pig industry. Methods A qualitative interview study was conducted with 21 veterinary surgeons purposively selected from all UK pig veterinary surgeons. Thematic analysis was used to analyse transcripts. Results Ensuring optimum pig health and welfare was described as a driver for antimicrobial use by many veterinary surgeons and was considered a professional and moral obligation. Veterinary surgeons also exhibited a strong sense of social responsibility over the need to ensure that antimicrobial use was responsible. A close relationship between management practices, health and economics was evident, with improvements in management commonly identified as being potential routes to reduce antimicrobial usage; however, these were not always considered economically viable. The relationship with clients was identified as being a source of professional stress for practitioners due to pressure from farmers requesting antimicrobial prescriptions, and concern over poor compliance of antimicrobial administration by some farmers. Conclusions The drivers behind prescribing decisions by veterinary surgeons were complex and diverse. A combination of education, improving communication between veterinary surgeons and farmers, and changes in regulations, in farm management and in consumer/retailer demands may all be needed to ensure that antimicrobial prescribing is optimal and to achieve significant reductions in use. PMID:27516473

  4. 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.

  5. Exhibiting coins as economic artefacts: Curating historical interpretation in Faith and Fortune: visualizing the divine on Byzantine and early Islamic coinage (Barber Institute of Fine Arts, Birmingham, November 2013-January 2015

    Directory of Open Access Journals (Sweden)

    Rebecca Darley

    2015-12-01

    Full Text Available Faith and Fortune: visualizing the divine on Byzantine and early Islamic coins was an exhibition at the Barber Institute of Fine Arts (October 2013-January 2015. It reflected on ways in which the rise of Islam in the seventh century shaped global political and economic systems, and how the early Islamic government and the Christian Byzantine Empire expressed the religious loyalties of their states visually. The exhibition, however, attempted to move away from traditional approaches to presenting coins, focusing almost exclusively on them as images and political documents. Instead, this exhibition sought to convey a sense of coins as economic artefacts, tightly woven into the day-to-day fabric of ordinary lives, in a period of extraordinary change. This article examines how the spatial, textual and temporal intersected in historical theory and exhibition design and suggests that exhibition represents an alternative method both of presenting (and teaching but also of undertaking research.

  6. The Renaissance and the universal surgeon: Giovanni Andrea Della Croce, a master of traumatology.

    Science.gov (United States)

    Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Viganò, Anna; Tomba, Patrizia; Marcacci, Maurilio

    2013-12-01

    All the medical knowledge of all time in one book, the universal and perfect manual for the Renaissance surgeon, and the man who wrote it. This paper depicts the life and works of Giovanni Andrea della Croce, a 16th Century physician and surgeon, who, endowed with true spirit of Renaissance humanism, wanted to teach and share all his medical knowledge through his opus magnum, titled "Universal Surgery Complete with All the Relevant Parts for the Optimum Surgeon". An extraordinary book which truly represents a defining moment and a founding stone for traumatology, written by a lesser known historical personality, but nonetheless the Renaissance Master of Traumatology.

  7. SUSHRUTA: A GREAT SURGEON AND VISIONARY OF AYURVEDA

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    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

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

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    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.

  9. 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;

    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...... concerning physical and psychological wellbeing before and after surgery and had their heart rate variability registered during surgery. Results: Preoperative to postoperative physical strain and pain measurements revealed a systematical difference with 14 of 15 parameters favoring the modern OR. Two...

  10. 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

  11. 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

  12. 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.

  13. Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices

    Directory of Open Access Journals (Sweden)

    Jefferis JM

    2014-09-01

    Full Text Available Joanna Mary Jefferis,1–3 Michael Patrick Clarke,1,3 John-Paul Taylor,2 Katie Rhian Brittain4 1Newcastle Eye Centre, Royal Victoria Infirmary, 2Institute for Ageing and Health, 3Institute of Neurosciences, 4Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK Background: In light of the growing number of people with dementia and age-related cataract, as well as changing anesthetic practices for cataract surgery, this study aimed to explore the experiences of cataract surgeons in managing patients with dementia and making anesthetic decisions.Methods: This was a qualitative study using semistructured interviews with senior cataract surgeons from two centers in England. Fourteen surgeons were interviewed, and a thematic approach informed by grounded theory was used for the analysis.Results: Choice of anesthesia for people with dementia was a central theme arising from the data. Surgeons varied in their thresholds for using general anesthesia. Decisions about suitability for local anesthesia were limited by time constraints and generally made rapidly and based on instinct; dementia was not always apparent at the point of preassessment. Surgeons used a variety of topical, sub-Tenon’s, and sharp needle blocks for people with dementia. Surgeons discussed techniques to help patients tolerate local anesthesia, such as clear communication, a primary nurse, hand-holding, and support from an anesthetist. However, within our sample, some surgeons had had negative experiences of operating on people with dementia, where an incorrect judgment had been made that they could tolerate local anesthetic cataract surgery. Conclusion: This study highlights the differing practices of cataract surgeons when making anesthetic choices for people with dementia and the challenges they face. In order to avoid the situation of a patient with dementia becoming distressed during awake surgery, increased time at preassessment and anesthetic support

  14. History of the ISS/SIC: Robert Danis, a true general surgeon.

    Science.gov (United States)

    Kinnaert, Paul

    2002-10-01

    Robert Danis created his Prize in 1947 to reward a surgeon-member of the Société Internationale de Chirurgie (presently ISS-SIC), "author of the most important and personal work in connection with surgical treatment of fractures." Consequently, many people believe that Robert Danis was an orthopedic surgeon. In fact, he was a man interested in all fields of surgical activity, not only in bone and joint surgery. PMID:12205551

  15. 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...

  16. The patient protection and Affordable Care Act: a primer for hand surgeons.

    Science.gov (United States)

    Adkinson, Joshua M; Chung, Kevin C

    2014-08-01

    The Affordable Care Act is the largest and most comprehensive overhaul of the United States health care industry since the inception of the Medicare and Medicaid. Contained within the 10 titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals.

  17. 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.

  18. 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.......: 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....

  19. 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...

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

    Directory of Open Access Journals (Sweden)

    Hashemi Esmat

    2005-04-01

    Full Text Available Abstract Background 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. Methods 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. Results 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 Conclusion 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.

  1. 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

  2. Impact of surgeon subspecialty training on surgical outcomes in open globe injuries

    Directory of Open Access Journals (Sweden)

    Han IC

    2015-09-01

    Full Text Available Ian C Han,1 Sidharth Puri,1 Jiangxia Wang,2 Shameema Sikder1 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, 2Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Purpose: The purpose of this study was to evaluate whether subspecialty training of the initial treating surgeon affects visual acuity and surgical outcomes in patients with open globe injuries.Design: This study is a single-institution, retrospective case series.Methods: The charts of adult patients with open globe injuries requiring surgical repair at the Wilmer Eye Institute between July 1, 2007 and July 1, 2012 were retrospectively reviewed. Clinical findings at presentation were recorded, and details of initial repair and follow-up surgeries were analyzed. Differences in visual acuity and surgical outcomes were compared based on subspecialty training of the initial surgeon.Results: The charts of 282 adult patients were analyzed, and 193 eyes had at least 6 months of follow-up for analysis. Eighty-six eyes (44.6% required follow-up surgery within the first year, and 39 eyes (20.2% were enucleated. Eyes initially treated by a vitreoretinal (VR surgeon were 2.3 times (P=0.003 more likely to improve by one Ocular Trauma Score (OTS visual acuity category and 1.9 times (P=0.027 more likely to have at least one more follow-up surgery at 6 months compared to eyes treated by non-VR surgeons. Patients with more anterior injuries treated by a VR surgeon were more likely to improve by one OTS visual acuity category compared to those treated by non-VR surgeons (P=0.004 and 0.016 for Zones I and II, respectively. There was no difference in visual acuity outcomes for eyes with posterior injuries (P=0.515 for Zone III.Conclusion: Eyes initially treated by a VR surgeon are more likely to improve by one OTS visual acuity category than those initially treated by a non-VR surgeon. However, patients initially treated by a VR surgeon also undergo more

  3. 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

  4. 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

  5. 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

  6. 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

  7. Can a Plastic Surgeon be a Department Chairman?….Really?

    Science.gov (United States)

    Neumeister, M W

    2016-04-01

    There is significant responsibility in being a Department of Surgery Chairman within a medical school. The Chairman is appointed by the Dean of Medicine to lead surgery in a path that serves the mission of the school. The Department of Surgery Chairman is charged with facilitating the academic, operational, and programmatic surgical initiatives of the School of Medicine. Traditionally the Chairman of Surgery has been a general surgeon but now our educational and clinical experiences have changed making traditional leadership less intuitive. Plastic surgeons appointed as current Chairman of the Department of Surgery are rare in the United States. Whereas, general surgeons may have less interaction with other surgical sub-specialties today, Plastic surgeons have more interaction crossing all disciplines of surgery. Innovation and creativity that defines our discipline, seems to fit well with Department leadership where strategic planning, vision and curriculum development, and the pursuit of academic and clinical quality remain core essentials to plastic surgery. This article is an editorial of my philosophy as a plastic surgeon leading a Department of Surgery. PMID:27096204

  8. 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.

  9. 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

  10. 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

  11. 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

  12. [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

  13. Accuracy of navigation in hip resurfacing with different surgeons and varying anatomy.

    Science.gov (United States)

    Schleicher, Iris; Haselbacher, Matthias; Mayr, Eckart; Kaiser, Peter M; Lenze, Florian W; Keiler, Alexander; Nogler, Michael

    2012-01-01

    The accuracy of a commercial imageless navigation system for hip resurfacing and its reproducibility among different surgeons and for varying femoral anatomy was tested by comparing conventional and navigated implantation of the femoral component on different sawbones in a hip simulator. The position of the component was measured on postoperative radiographs. Variance for varus/valgus alignment and anteversion was higher for conventional implantation. Among the three surgeons, operation time, chosen implant size and anteversion were significantly different for conventional implantation but not for the navigated method. Using navigation, no difference was found for normal and abnormal anatomy. Values obtained with the navigation system were consistent with those measured on radiographs. Navigation appeared to be accurate and helped to reduce outliers. This was true for the three different surgeons and in varying anatomical situations.

  14. 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

  15. 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

  16. 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

  17. Educating surgeons for the new golden hours: honing the skills of palliative care.

    Science.gov (United States)

    Huffman, Joan L

    2005-04-01

    All surgeons should maintain a lifetime commitment to education and learning. Those who already are in practice need to make the effort to obtain or refresh their education in basic competencies in palliative care and to provide a measured balance between philosophy and practical skills. Many resources and teaching tools are available to assist in this continuing process: surgical peers (and peers from other medical specialties),journals, textbooks, CME conferences, surgical governance and educational organizations, and palliative care websites. A tremendous summary article on palliative care education for surgeons was published recently in JACS[24]. Surgeons must be competent in the following palliative care skills:communication, holistic patient evaluation, control of pain and symptoms,understanding legal/ethical issues, withdrawing care, and the continuum of acute to chronic to terminal care. If they cannot attend to all of these areas individually, they need to be aware of the local, regional, and national resources that are available to assist the patient (or their surrogate decision maker) and themselves in the end-of-life arena. Consultations and referrals should be accomplished in such a manner that the patient does not feel abandoned by his/her surgeon at such a critical point in his/her life. Practicing surgeons also must be involved actively in the education of resident and medical students in didactic and clinical situations. Most importantly, they must model the appropriate behaviors for their charges personally, whether it be in the consultation room breaking bad news compassionately or at the bedside easing the path to the next world. In these golden hours, the educated surgeon who wields new and mighty resources can be the greatest champion of the patient who is at the end of life.

  18. 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...

  19. 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.

  20. 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.

  1. Imaging in scoliosis from the orthopaedic surgeon's point of view

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, Marc [Stiftung Orthopaedische Universitaetsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg (Germany); Abel, Rainer [Stiftung Orthopaedische Universitaetsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg (Germany)]. E-mail: rainer.abel@ok.uni-heidelberg.de

    2006-04-15

    For treating patients with scoliosis orthopaedic surgeons need diagnostic imaging procedures in order to provide answers about a possible underlying disease, choice of treatment, and prognosis. Once treatment is instituted, imaging is also critical for monitoring changes of the deformity so as to optimize therapy. The combined effort of orthopaedic surgeons and radiologists helps detect treatable causes of scoliosis at an early stage, define the need and timing for surgery, and ensure that every precaution is taken to minimize the risks of surgery. Neurosurgical causes, with particular reference to spinal cord tumours and syringomyelia, need to be addressed before scoliosis surgery can be contemplated.

  2. 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

  3. 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.

  4. 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

  5. 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.

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

    NARCIS (Netherlands)

    E. Faber (Elske); A. Burdorf (Alex); A.L. van Staa (AnneLoes); H.S. Miedema (Harald); J.A.N. Verhaar (Jan)

    2006-01-01

    textabstractBACKGROUND: 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 advice to the patient. Therefore, we evaluated a standardize

  7. 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

  8. 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.;

    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...

  9. 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

  10. 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

  11. Critical appraisal of meta-analyses: an introductory guide for the practicing surgeon

    Directory of Open Access Journals (Sweden)

    McCall Jonathan

    2009-07-01

    Full Text Available Abstract Meta-analyses are an essential tool of clinical research. Meta-analyses of individual randomized controlled trials frequently constitute the highest possible level of scientific evidence for a given research question and allow surgeons to rapidly gain a comprehensive understanding of an important clinical issue. Moreover, meta-analyses often serve as cornerstones for evidence-based surgery, treatment guidelines, and knowledge transfer. Given the importance of meta-analyses to the medical (and surgical knowledge base, it is of cardinal importance that surgeons have a basic grasp of the principles that guide a high-quality meta-analysis, and be able to weigh objectively the advantages and potential pitfalls of this clinical research tool. Unfortunately, surgeons are often ill-prepared to successfully conduct, critically appraise, and correctly interpret meta-analyses. The objective of this educational review is to provide surgeons with a brief introductory overview of the knowledge and skills required for understanding and critically appraising surgical meta-analyses as well as assessing their implications for their own surgical practice.

  12. 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

  13. Maxillofacial Surgeon as Fact Witness for Medico-Legal Cases: Indian Scenario.

    Science.gov (United States)

    Kedarnath, N S; Shruthi, R

    2015-12-01

    An Oral and Maxillofacial surgeon at any time during the practice will encounter medicolegal cases (MLC). There are lacunae in the knowledge and understanding of the correct method of dealing with such cases. Many of the practitioners are apprehensive and anxious as they have to interact with individuals and systems outside the normal realm of practice. In today's arena, it is of utmost importance to be aware of legal system and law of the land. An OMF surgeon needs to have thorough understanding in recording and maintenance of the details of all MLCs and presenting the same in the court. Professional guidelines for expert witness are often not well recognised as those relating to the clinical practice. Surgeon has an obligation to conduct him/herself to highest ethical standards. This article provides insight into the details of registration of MLC, examination and recording of injuries, collecting medico-legal evidences and writing a medico legal report. Also discusses the court proceedings and possible questions that may be faced by the surgeon in the court.

  14. Attitudes, Awareness, and Barriers Regarding Evidence-Based Surgery Among Surgeons and Surgical Nurses

    NARCIS (Netherlands)

    A.M. Knops; H. Vermeulen; D.A. Legemate; D.T. Ubbink

    2009-01-01

    Evidence-based surgery (EBS) is stressed to increase efficiency and health care quality, but not all surgeons and surgical nurses use EBS in clinical practice. To define future tailor-made interventions to improve evidence-based behavior, the aim of this study was to determine the attitude and aware

  15. The American Association of Plastic Surgeons Recent History, with a Review of the Past.

    Science.gov (United States)

    Lawrence, W Thomas

    2016-07-01

    The American Association of Plastic Surgeons was founded in 1921 and is the oldest of the plastic surgery societies. It was born out of the enthusiasm of reconstructive surgeons who had recently increased in numbers and expanded the scope of their activities as a result of the challenges posed by battle-injured soldiers during World War I. Early meetings were small, focused exclusively on the head and neck, and often included live surgical demonstrations. The Association has grown in size and scope with time, but it has maintained its academic focus. This article focuses on the most recent 15 years of the Association's history, as prior publications have chronicled the history of the organization up to 2000. The organization has remained robust in the new millennium, with the national meetings being its most prominent activity. The format of the meetings has continually been improved to remain relevant and of interest to the membership and other attendees. The organization continues to support the development of young academic plastic surgeons through the Academic Scholars Program. It has established new programs such as the Constable Fellowship to support international exchange and has also sponsored two consensus conferences to help define standards of care in plastic surgery-related issues. The Association annually recognizes significant contributors to the field through the variety of awards that it bestows as well. The mission of the American Association of Plastic Surgeons is to provide scholarly leadership in plastic surgery, and the organization continues to successfully accomplish this mission. PMID:27348660

  16. Surgeons' exposure to sevoflurane during paediatric adenoidectomy: a comparison of three airway devices.

    Science.gov (United States)

    Herzog-Niescery, J; Gude, P; Gahlen, F; Seipp, H-M; Bartz, H; Botteck, N M; Bellgardt, M; Dazert, S; Weber, T P; Vogelsang, H

    2016-08-01

    Although sevoflurane is commonly used in anaesthesia, a threshold value for maximum exposure to personnel does not exist and although anaesthetists are aware of the problem, surgeons rarely focus on it. We used a photo-acoustic infrared device to measure the exposure of surgeons to sevoflurane during paediatric adenoidectomies. Sixty children were randomly allocated to laryngeal mask, cuffed tracheal tube or uncuffed tracheal tube. The average mean (maximum) sevoflurane concentrations within the surgeons' operating area were 1.05 (10.05) ppm in the laryngeal mask group, 0.33 (1.44) ppm in the cuffed tracheal tube group and 1.79 (18.02) ppm in the uncuffed tracheal tube group, (p < 0.001), laryngeal mask and cuffed tracheal tube groups vs. uncuffed tube group. The presence of sevoflurane was noticed by surgeons in 20% of cases but there were no differences between the groups (p = 0.193). Surgical and anaesthetic complications were similar in all three groups. We conclude that sevoflurane can be safely used during adenoidectomies with all three airway devices, but in order to minimise sevoflurane peak concentrations, cuffed tracheal tubes are preferred.

  17. 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...

  18. André Latarjet (1877-1947). Anatomist and surgeon specialized in sports medicine.

    Science.gov (United States)

    Romero-Reverón, Rafael A

    2014-01-01

    André Latarjet (1877-1947), physician and surgeon, outstanding professor of anatomy, made important contributions to the study of human anatomy. He was the disciple and successor of Dr. Leo Testut and continued the diffusion of his work. He was a member of the French Academy of Medicine and President of the International Federation of Sports Medicine.

  19. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons

    NARCIS (Netherlands)

    Wauben, L.; Van Veelen, M.; Gossot, D.; Goossens, R.

    2006-01-01

    Background: This study aimed to obtain an answer for the question: Are ergonomic guidelines applied in the operating room and what are the consequences? Methods: A total of 1,292 questionnaires were sent by email or handed out to surgeons and residents. The subjects worked mainly in Europe, performi

  20. Laparoscopic partial nephrectomy: A series of one hundred cases performed by the same surgeon

    Directory of Open Access Journals (Sweden)

    José M Campero

    2012-01-01

    Conclusions: Our results are similar to those reported in the international literature. LPN is a challenging surgical technique that in hands of a trained and experienced surgeon has excellent and reproducible results for the management of small renal masses and cysts.

  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. 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

  3. 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…

  4. 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.

  5. 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…

  6. Visual-Motor Learning Using Haptic Devices: How Best to Train Surgeons?

    Directory of Open Access Journals (Sweden)

    Oscar Giles

    2012-05-01

    Full Text Available Laparoscopic surgery has revolutionised medicine but requires surgeons to learn new visual-motor mappings. The optimal method for training surgeons is unknown. For instance, it may be easier to learn planar movements when training is constrained to a plane, since this forces the surgeon to develop an appropriate perceptual-motor map. In contrast, allowing the surgeon to move without constraints could improve performance because this provides greater experience of the control dynamics of the device. In order to test between these alternatives, we created an experimental tool that connected a commercially available robotic arm with specialised software that presents visual stimuli and objectively records kinematics. Participants were given the task of generating a series of aiming movements to move a visual cursor to a series of targets. The actions required movement along a horizontal plane, whereas the visual display was a screen positioned perpendicular to this plane (ie, vertically. One group (n=8 received training where the force field constrained their movement to the correct plane of action, whilst a second group (n=8 trained without constraints. On test trials (after training the unconstrained group showed better performance, as indexed by reduced movement duration and reduced path length. These results show that participants who explored the entire action space had an advantage, which highlights the importance of experiencing the full dynamics of a control device and the action space when learning a new visual-motor mapping.

  7. Displaced Proximal Humerus Fractures in Older Patients: Shoulder Surgeons Versus Traumatologists.

    Science.gov (United States)

    Bhat, Suneel B; Secrist, Eric S; Austin, Luke S; Getz, Charles L; Krieg, James C; Mehta, Samir; Namdari, Surena

    2016-05-01

    Proximal humerus fractures are relatively common, with treatment dependent on fracture-specific, patient-specific, and surgeon-specific factors. This study sought to identify preferences among shoulder specialists and orthopedic traumatologists in the treatment of proximal humerus fractures. An anonymous Internet survey of fellowship-trained shoulder surgeons and traumatologists was conducted with radiographs and select computed tomography images of 15 unique displaced proximal humerus fractures. Participants were asked to classify each case according to Neer criteria and choose management from a list of options. Groups were analyzed using chi-square test for independence, paired t test, and Fleiss' kappa within and between each group. Among shoulder surgeons, there were a total of 19 cases selected for nonoperative management, 204 cases selected for open reduction and internal fixation (ORIF), and 122 cases selected for arthroplasty. Among traumatologists, there were 44 cases selected for nonoperative management, 234 for ORIF, and 67 for arthroplasty. Fleiss' kappa for intraobserver agreement on treatment choice was 0.26 for shoulder surgeons and 0.18 for traumatologists, and chi-square test for independence was significant between the 2 groups (Pcost. [Orthopedics. 2016; 39(3):e509-e513.]. PMID:27135449

  8. 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...

  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.

  10. 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

  11. 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

  12. 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.

  13. Willingness to Pay for Cataract Surgery Provided by a Senior Surgeon in Urban Southern China.

    Directory of Open Access Journals (Sweden)

    Mei Wang

    Full Text Available To study willingness to pay for cataract surgery and surgical service provided by a senior cataract surgeon in urban Southern China.This study was a cross-sectional willingness-to-pay (WTP interview using bidding formats. Two-hundred eleven persons with presenting visual impairment in either eye due to cataract were enrolled at a tertiary eye hospital. Participants underwent a comprehensive eye examination and a WTP interview for both surgery and service provided by a senior surgeon. Demographic information, socioeconomic status and clinical data were recorded.Among 211 (98% response rate persons completing the interview, 53.6% were women and 80.6% were retired. About 72.2% had a monthly income lower than 1000 renminbi (US $161. A total of 189 (89.6% were willing to pay for cataract and the median amount of WTP was 6000 renminbi (US$968. And 102 (50.7% were willing to pay additional fees for surgery performed by a senior surgeon, and the median amount of WTP was 500 renminbi (US$81. In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both.In urban China, cataract patients, especially those with preexisting eye conditions, are willing to pay additional fees for a senior surgeon. Moving to a system where the price of cataract surgery is proportional to the consultant' skill and expertise is possible and may have a potential impact on waiting list and quality of eye care. Further studies are needed to examine the impact of such pricing system on attitudes and choices of cataract patients.

  14. 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

  15. Edward D. Churchill as a combat consultant: lessons for the senior visiting surgeons and today's military medical corps.

    Science.gov (United States)

    Cannon, Jeremy W; Fischer, Josef E

    2010-03-01

    In World War II, Edward D. Churchill volunteered as a combat consultant. In this role, he mentored many junior surgeons and challenged the Army leadership to treat hemorrhagic shock with blood rather than plasma. These lessons have continued relevance for today's Senior Visiting Surgeons and our military medical corps.

  16. Can surgeons assess CT suitability for endovascular repair (EVAR) in ruptured abdominal aortic aneurysm? Implications for a ruptured EVAR trial.

    Science.gov (United States)

    Rayt, Harjeet; Lambert, Kelly; Bown, Matthew; Fishwick, Guy; Morgan, Robert; McCarthy, Mark; London, Nick; Sayers, Robert

    2008-01-01

    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; kappa = 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. 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

  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. Surgeons and surgery from ancient Persia (5,000 years of surgical history).

    Science.gov (United States)

    Zargaran, Arman; Fazelzadeh, Afsoon; Mohagheghzadeh, Abdolali

    2013-08-01

    The development of surgery is indebted to scientists and surgeons from various civilizations throughout history. The present study considers surgery in the ancient Persian civilization. It highlights aspects of the subject, such as findings of the first trephinated skulls in Iran; surgeons' social class (kareto baēšaza in the Avestan language-dating back 3,000 years); surgical operations such as cesarean section and procedures to treat breast cancer; and the use of anesthetic compounds and surgical practice in the military. It is hoped that this catalogue of historical evidence of surgical practice in ancient Persian civilization will contribute to the history of surgery, as an important field in medical science.

  20. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    Science.gov (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.

  1. 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

  2. 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.

  3. 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

  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. 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...

  6. Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons

    Directory of Open Access Journals (Sweden)

    GD Taylor

    1994-01-01

    Full Text Available Several studies have shown that wound infection (surgical site infection [ ssi ] rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001, 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8, 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96 and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0. In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002. ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.

  7. 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

  8. [Use of cyber library and digital tools are crucial for academic surgeons].

    Science.gov (United States)

    Tomizawa, Yasuko

    2010-10-01

    In addition to busy clinical work, an academic surgeon has to spend a lot of time and efforts in writing and submitting articles to scientific journals, teaching young surgical trainees to write an article, organizing and updating his/her academic performances in the curriculum vitae, and writing research grant applications. The use of cyber library and commercially available computer software is useful in saving time and effort.

  9. 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...

  10. 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...

  11. 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...

  12. A profile of female academic surgeons: training, credentials, and academic success.

    Science.gov (United States)

    Wyrzykowski, Amy D; Han, E; Pettitt, B J; Styblo, T M; Rozycki, G S

    2006-12-01

    The objective of this study was to determine the profile (credentials, training, and type of practice) of female academic general surgeons and factors that influenced their career choice. A survey was sent to female academic surgeons identified through general surgery residency programs and American medical schools. The women had to be Board eligible/certified by the American Board of Surgery or equivalent Board and have an academic appointment in a Department of Surgery. Data were analyzed using the SPSS program. Two hundred seventy women (age range, 32-70 years) completed the survey (98.9% response rate). Fellowships were completed by 82.3 per cent (223/270), most commonly in surgical critical care. There were 134 (50.2%, 134/367) who had two or more Board certificates, most frequently (46%, 61/134) in surgical critical care. Full-time academic appointments were held by 86.7 per cent of women, most as assistant professors, clinical track; only 12.4 per cent were tenured professors. The majority of women described their practice as "general surgery" or "general surgery with emphasis on breast." The most frequent administrative title was "Director." Only three women stated that they were "chair" of the department. The top reason for choosing surgery was "gut feeling," whereas "intellectual challenge" was the reason they pursued academic surgery. When asked "Would you do it again?", 77 per cent responded in the affirmative. We conclude that female academic surgeons are well trained, with slightly more than half having two or more Board certificates; that most female academic surgeons are clinically active assistant or associate professors whose practice is "general surgery," often with an emphasis on breast disease; that true leadership positions remain elusive for women in academic general surgery; and that 77 per cent would choose the same career again.

  13. Surgeon-administered conscious sedation and local anesthesia for ambulatory anorectal surgery.

    Science.gov (United States)

    Hina, Miss; Hourigan, Jon S; Moore, Richard A; Stanley, J Daniel

    2014-01-01

    Anorectal procedures are often performed in an outpatient setting using a variety of anesthetic techniques. One technique that has not been well studied is surgeon-administered conscious sedation along with local anesthetic. The purpose of this study was to evaluate the use of this technique with emphasis on safety, efficacy, and patient satisfaction. Chart review was performed on 133 consecutive patients who had anorectal procedures at an outpatient surgery center. Additionally, 65 patients were enrolled prospectively and completed a satisfaction survey. Inclusively, charts of 198 patients who underwent outpatient anorectal surgery under conscious sedation and local anesthesia under the direction of a colorectal surgeon from 2004 through 2008 were reviewed. Parameters related to patient and procedural characteristics, safety, efficacy, and satisfaction were evaluated. Surgeon-administered sedation consisted of combined fentanyl and midazolam in 90 per cent. Eighty per cent of procedures were performed in the prone position and 23 per cent were in combination with an endoscopic procedure. Eighty-two per cent were classified as American Society of Anesthesiologists Grade 1 or 2. Transient mild hypoxemia or hypotension occurred in 4 and 3 per cent of the patients, respectively. Mean operative time was 29 minutes with a mean stay in the postanesthesia care unit of 37 minutes. There were no early major cardiac or respiratory complications. Ninety-seven per cent of the patients surveyed reported a high degree of satisfaction. Surgeon-administered conscious sedation with local anesthesia was well tolerated for outpatient anorectal surgeries. Additional studies are needed to confirm the safety and efficacy of this technique.

  14. What motivates surgeons to teach dissection anatomy to medical students and surgical trainees?

    Directory of Open Access Journals (Sweden)

    Burgess A

    2014-12-01

    Full Text Available Annette Burgess,1 George Ramsey-Stewart2 1Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 2Disciplines of Surgery and Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia Introduction: Although a fading tradition in some institutions, having clinicians teach anatomy by whole-body dissection provides a clinical context to undergraduate and postgraduate medical students, increasing their depth of learning. The reasons for a clinician's motivation to teach may be articulated in accordance with self-determination theory (SDT. SDT proposes that for individuals to be intrinsically motivated, three key elements are needed: 1 autonomy, 2 competence, and 3 relatedness. Materials and methods: Data were collected through semistructured interviews with eight surgeons who were supervisors/facilitators in the anatomy by whole-body dissection course for undergraduate students in the Bachelor of Medicine, Bachelor of Surgery program and postgraduate students in the Master of Surgery program at the University of Sydney. Qualitative analysis methods were used to code and categorize data into themes. Results: Our study used SDT as a conceptual framework to explore surgeons' motivation to supervise students in the anatomy by whole-body dissection courses. Elements that facilitated their desire to teach included satisfaction derived from teaching, a sense of achievement in providing students with a clinical context, a strong sense of community within the dissection courses, and a sense of duty to the medical/surgical profession and to patient welfare. Conclusion: The surgeons' motivation for teaching was largely related to their desire to contribute to the training of the next generation of doctors and surgeons, and ultimately to future patient welfare. Keywords: motivation, surgery, anatomy, whole-body dissection

  15. Developing business opportunities from concept to end point for craniofacial surgeons.

    Science.gov (United States)

    Brown, Spencer A

    2012-01-01

    Craniofacial surgeons repair a wide variety of soft and hard tissues that produce the clinical expertise to recognize the need for an improved device or novel regenerative stem cell or use of molecules that may dramatically change the way clinical care for improved patient outcomes. The business pathway to bring a concept to clinical care requires knowledge, mentoring, and a team of experts in business and patent law.

  16. Thoracic Surgeons' Perception of Frail Behavior in Videos of Standardized Patients

    Science.gov (United States)

    Ferguson, Mark K.; Thompson, Katherine; Huisingh-Scheetz, Megan; Farnan, Jeanne; Hemmerich, Josh A.; Slawinski, Kris; Acevedo, Julissa; Lee, Sang Mee; Rojnica, Marko; Small, Stephen

    2014-01-01

    Background Frailty is a predictor of poor outcomes following many types of operations. We measured thoracic surgeons' accuracy in assessing patient frailty using videos of standarized patients demonstrating signs of physical frailty. We compared their performance to that of geriatrics specialists. Methods We developed an anchored scale for rating degree of frailty. Reference categories were assigned to 31 videos of standarized patients trained to exhibit five levels of activity ranging from “vigorous” to “frail.” Following an explanation of frailty, thoracic surgeons and geriatrics specialists rated the videos. We evaluated inter-rater agreement and tested differences between ratings and reference categories. The influences of clinical specialty, clinical experience, and self-rated expertise were examined. Results Inter-rater rank correlation among all participants was high (Kendall's W 0.85) whereas exact agreement (Fleiss' kappa) was only moderate (0.47). Better inter-rater agreement was demonstrated for videos exhibiting extremes of behavior. Exact agreement was better for thoracic surgeons (n = 32) than geriatrics specialists (n = 9; p = 0.045), whereas rank correlation was similar for both groups. More clinical years of experience and self-reported expertise were not associated with better inter-rater agreement. Conclusions Videos of standarized patients exhibiting varying degrees of frailty are rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition. PMID:24892734

  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. 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 ...

  19. A Single Surgeon's Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy.

    Science.gov (United States)

    Klaassen, Zachary; Kohut, Robert M; Patel, Dhruti; Terris, Martha K; Madi, Rabii

    2014-01-01

    Objective. To report the perioperative outcomes of patients treated with partial nephrectomy by a single surgeon using three surgical modalities-open, laparoscopic, and robotic. Methods. Between August 2006 and February 2012, 106 consecutive patients underwent open partial nephrectomy (OPN) (n = 23), laparoscopic partial nephrectomy (LPN) (n = 48), and robotic partial nephrectomy (RPN) (n = 35) by a single surgeon. Clinical variables, operative parameters, and renal functional outcomes were analyzed. Results. Preoperative patient characteristics were similar except for baseline glomerular filtration rate (GFR), which was highest in the RPN group (P = 0.004). Surgery time was longest in the RPN group (244 minutes) and shortest in the OPN group (163 minutes, P < 0.0001). Patients who had OPN had the highest incidence of 30-day complications (30%), while the RPN approach had the lowest (14%, P = 0.008). Conclusions. When performed by a single surgeon, robotic partial nephrectomy appears to be associated with fewer complications than both open and laparoscopic partial nephrectomy. Kidney function was not affected by surgical approach.

  20. 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

  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. 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

  3. Gatekeeper role of gastroenterologists and surgeons in recognising and discussing familial colorectal cancer.

    Science.gov (United States)

    Douma, Kirsten F L; Dekker, Evelien; Smets, Ellen M A; Aalfs, Cora M

    2016-04-01

    This study aimed to gain insight into the gatekeeper role of surgeons and gastroenterologists (including residents) during a first consultation at a tertiary gastro-intestinal centre regarding referral for genetic counselling, and to test the feasibility of a checklist for indications for referral. Consecutive patients were invited before and after introduction of a checklist, to complete a questionnaire assessing their perception of discussing cancer genetic topics. Initial consultations were audiotaped to assess the quality of this discussion by gastroenterologists and surgeons. Data on completeness of the checklist and referral were collected from medical files. No significant differences were found between the Before and After group regarding patients' reports of discussing cancer in the family (77%, n = 34 vs 89%, n = 33, p = 0.16). In 28% (n = 10) of the audiotaped consultations family history was adequately discussed, in 58% (n = 21) it was considered inadequate and in 14% (n = 5) of consultations it was not discussed at all. A checklist was present in 53% (n = 27) of the medical files. Of these, 5 (19%) were incomplete. Gastroenterologists and surgeons (in training) have difficulty in fulfilling their gatekeeper role of recognizing patients at familial risk for CRC. Although they often discuss familial cancer during the initial consultation, their exploration seems insufficient to reveal indications for referral for genetic counselling. Therefore, healthcare professionals should not only understand genetics and the importance of cancer family history, but also be effective in the communication of this subject to enable more adequate referral of patients for genetic counselling.

  4. Can surgeons think and operate with haptics at the same time?

    Science.gov (United States)

    Cao, Caroline G L; Zhou, Mi; Jones, Daniel B; Schwaitzberg, Steven D

    2007-11-01

    Much effort has been devoted to incorporating haptic feedback into surgical simulators. However, the benefits of haptics for novice trainees in the early stages of learning are not clear. Presumably, novices have less spare attentional resources to attend to haptic cues while learning basic laparoscopic skills. The aim of this study was to determine whether novice surgeons have adequate cognitive resources to attend to haptic information. Thirty surgical residents and attendings performed a TransferPlace task in a simulator, with and without haptics. Cognitive loading was imposed using a mental arithmetic task. Subjects performed 10 trials (five with cognitive loading and five without) with and without haptics. Results showed that all subjects performed significantly slower (27%) when they were cognitively loaded than unloaded, but equally accurately in both cases, suggesting a speed-accuracy tradeoff. On average, subjects performed 36% faster and 97% more accurately with haptics than without, even while cognitively loaded. Haptic feedback can not only enhance performance, but also counter the effect of cognitive load. This effect is greater for more experienced surgeons than less experienced ones, indicating greater spare cognitive capacity in surgeons with more experience.

  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. 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

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

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    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.

  8. 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.

  9. Evaluation of the Microvascular Research Center Training Program for Assessing Microsurgical Skills in Trainee Surgeons

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    Seiji Komatsu

    2013-05-01

    Full Text Available Background  We established the Microvascular Research Center Training Program (MRCPto help trainee surgeons acquire and develop microsurgical skills. Medical students wererecruited to undergo theMRCP to assessthe effectiveness oftheMRCP fortrainee surgeons.Methods  Twenty-two medical students with no prior microsurgical experience, who completed the course from2005 to 2012,were included. TheMRCP comprises 5 stages oftraining,each with specific passing requirements. Stages 1 and 2 involve anastomosing silicone tubesand blood vessels of chicken carcasses,respectively,within 20minutes. Stage 3 involves anastomosing the femoral artery and vein oflive ratswith a 1-day patency rate of > 80%. Stage4 requires replantation of free superficial inferior epigastric artery flaps in rats with a 7-daysuccessrate of > 80%. Stage 5 involvessuccessful completion of one case ofratreplantation/transplantation. We calculated the passing rate for each stage and recorded the number ofanastomosesrequired to passstages 3 and 4.Results  The passing rates were 100% (22/22 for stages 1 and 2, 86.4% (19/22 for stage3, 59.1% (13/22 for stage 4, and 55.0% (11/20 for stage 5. The number of anastomosesperformedwas 17.2± 12.2 in stage 3 and 11.3± 8.1 in stage 4.Conclusions  Majority ofthemedicalstudentswho undertook theMRCP acquired basicmicrosurgicalskills. Thus,we conclude thatthe MRCP is an effective microsurgery training programfortrainee surgeons.

  10. Vascular management during live donor nephrectomy: an online survey among transplant surgeons.

    Science.gov (United States)

    Janki, S; Verver, D; Klop, K W J; Friedman, A L; Peters, T G; Ratner, L E; Ijzermans, J N M; Dor, F J M F

    2015-06-01

    In 2006, a survey from the American Society of Transplant Surgeons disclosed significant and sometimes fatal hemorrhagic events in live donor nephrectomies (LDN) related to failure of clips, leading to the contraindication of the Weck® Hem-o-lok® clip for control of the renal artery during LDN. A survey regarding vascular control techniques, their perceived safety ratings and their failures was sent to 645 European Society for Organ Transplantation members who profiled their profession as "surgeon" and selected "kidney" as organ type. Two hundred forty-three (41%) members responded, of whom 171 (63.3%) independently perform LDN. Their responses were analyzed. For arterial and venous vascular control, the GIA™ and TA™stapler are used most frequently, and were rated the safest. Of the 121 reported hemorrhagic events, slippage and dislodgement of clips occurred at least 58 times, while stapler malfunction occurred at least 40 times. One donor death from hemorrhage related to clip dysfunction was reported. Hemorrhagic complications of LDN with fatal and non-fatal outcomes still occur. Strikingly, many surgeons do not use the vascular closing technique that they consider most safe. Failure of non-transfixion techniques is associated with greater risks for the donor. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety. PMID:25833120

  11. Fu-Chan Wei—Surgeon, Innovator, and Leader of the Legendary Chang Gung Microsurgery Center

    Science.gov (United States)

    AL Deek, Nidal Farhan

    2016-01-01

    Fu-Chan Wei is a world-renowned plastic and reconstructive surgeon. He is clearly one of the most influential and innovative surgeons in the history of plastic surgery. The Taiwanese legend is the innovator of the osteoseptocutaneous fibula flap, which revolutionized the reconstruction of composite bone and soft tissue defects in the jaw and extremities. He has pioneered several perforator flaps, including the free style variety. He has taken toe-to-hand microsurgical transplantation to a whole new level. He is not only recognized for his surgical skills and clinical innovations, but also for his vision, leadership, and teaching. The establishment and development of the famous Microsurgery Center at Chang Gung Memorial Hospital is unparalleled anywhere. The international fellowship program in microsurgery there remains the envy of all microsurgical trainees. Dr. Wei and his colleagues have trained and influenced more than 1,500 surgeons from all over the world. The aim of this video article is to share what we learned by interviewing Fu-Chan Wei at Chang Gung. The story of Fu Chan Wei, his colleagues, and the development of the Microsurgery Center in Taiwan is worth knowing. PMID:27757352

  12. Complications of bariatric surgery--What the general surgeon needs to know.

    Science.gov (United States)

    Healy, Paul; Clarke, Christopher; Reynolds, Ian; Arumugasamy, Mayilone; McNamara, Deborah

    2016-04-01

    Obesity is an important cause of physical and psychosocial morbidity and it places a significant burden on health system costs and resources. Worldwide an estimated 200 million people over 20 years are obese and in the U.K. the Department of Health report that 61.3% of people in the U.K. are either overweight or obese. Surgery for obesity (bariatric surgery) is being performed with increasing frequency in specialist centres both in the U.K. and Ireland and abroad due to the phenomenon of health tourism. Its role and success in treating medical conditions such as diabetes mellitus and hypertension in obese patients will likely lead to an even greater number of bariatric surgery procedures being performed. Patients with early postoperative complications may be managed in specialist centres but patients with later complications, occurring months or years after surgery, may present to local surgical units for assessment and management. This review will highlight the late complications of the 3 most commonly performed bariatric surgery procedures that the emergency general surgeon may encounter. It will also highlight the complications that require urgent intervention by the emergency general surgeon and those that can be safely referred to a bariatric surgeon for further management after initial assessment and investigations.

  13. [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

  14. Surgeons' exposure to radiation in single- and multi-level minimally invasive transforaminal lumbar interbody fusion; a prospective study.

    Directory of Open Access Journals (Sweden)

    Haruki Funao

    Full Text Available Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001. The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure

  15. [Happy who as Ulysse had a nice idea or tale of the brilliant inventor surgeon (BIS) in the Maze].

    Science.gov (United States)

    Guimberteau, J-C; Duche, R

    2010-10-01

    Through their personal experience, the authors want to relate the problems a surgeon has to face to make an idea accepted, either on the intellectual or the technical or the material point of view. A surgeon's everyday life, his university cursus and his psychological profile does not prepare him to a very different world, the world of administration, of files, of categories, of laws, of initials, of acronyms. Yes, the surgeon has to deal with this universe if he wants to develop his new concept. The authors relate the great efforts, which are similar sometimes to mythological works, to achieve their aim with a little humour just to survive.

  16. Incidence of Complications During the Surgeon Learning Curve Period for Primary Total Ankle Replacement: A Systematic Review.

    Science.gov (United States)

    Simonson, Devin C; Roukis, Thomas S

    2015-10-01

    Surgeons performing primary total ankle replacement have achieved outcomes comparable to ankle arthrodesis. However, while many reports exist suggesting the presence of a surgeon learning curve period during initial performance of primary total ankle replacement, no published analysis of the actual incidence of complications encountered during this period exists. Therefore, we sought to provide such an analysis through systematic review. A total of 2453 primary total ankle replacements with 1085 complications (44.2%) were identified. Our results revealed conflicting data whether an acceptably low incidence of high-grade complications leading to total ankle replacement failure exists during the surgeon learning curve period.

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

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    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

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

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    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

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

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    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

  20. [FEMALE SURGEONS SHOULD BE AWARE OF THE IMPORTANCE OF A CLEAR VISION FOR THEIR CAREER AND LIFE PLANS TO ACHIEVE THEIR CAREER DEVELOPMENT.: A SURVEY OF 20 FEMALE SURGEONS AT THE DEPARTMENT OF SURGERY AND ONCOLOGY, KYUSHU UNIVERSITY].

    Science.gov (United States)

    Nagayoshi, Kinuko; Mori, Hitomi; Kameda, Chizu; Nakamura, Katsuya; Ueki, Takashi; Tanaka, Masao

    2015-05-01

    A shortage of surgeons has been a serious problem in recent years. There is an urgent need to utilize female surgeons who tend to resign because of bearing and raising of children. To examine possible measures to deal with the issue, we performed questionnaire survey about work-life balance and career planning on 20 female surgeons in the Department of Surgery and Oncology, Kyushu University. The response rate was 80.0%. In the 16 respondents, seven were unmarried and nine were married. A large fraction of the respondents recognized the importance of work-life-balance. Female surgeons have many difficulties to continue working with good work-life balance; therefore, understanding and cooperation of both their spouses and coworkers is considered to be necessary. Married female surgeons considered that improvement of the working environment and sufficient family support were more important for good work-life balance compared to those who were unmarried. Female surgeons should recognize the importance of improvement of their environment, including the workplace and the family to continue working with good work-life balance in youth and should have the prospects about their career plan of their own.

  1. The growth of computer-assisted (robotic surgery in urology 2000–2014: The role of Asian surgeons

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    Deepansh Dalela

    2015-01-01

    Conclusion: The addition of robot to the surgical armamentarium has allowed better patient care and improved disease outcomes. VUI and surgeons of Asian origin have played a pioneering role in dissemination of computer-assisted surgery.

  2. 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.

  3. 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

  4. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  6. How a surgeon becomes superman by visualization of intelligently fused multi-modalities

    Science.gov (United States)

    Erat, Okan; Pauly, Olivier; Weidert, Simon; Thaller, Peter; Euler, Ekkehard; Mutschler, Wolf; Navab, Nassir; Fallavollita, Pascal

    2013-03-01

    Motivation: The existing visualization of the Camera augmented mobile C-arm (CamC) system does not have enough cues for depth information and presents the anatomical information in a confusing way to surgeons. Methods: We propose a method that segments anatomical information from X-ray and then augment it on the video images. To provide depth cues, pixels belonging to video images are classified as skin and object classes. The augmentation of anatomical information from X-ray is performed only when pixels have a larger probability of belonging to skin class. Results: We tested our algorithm by displaying the new visualization to 2 expert surgeons and 1 medical student during three surgical workflow sequences of the interlocking of intramedullary nail procedure, namely: skin incision, center punching, and drilling. Via a survey questionnaire, they were asked to assess the new visualization when compared to the current alphablending overlay image displayed by CamC. The participants all agreed (100%) that occlusion and instrument tip position detection were immediately improved with our technique. When asked if our visualization has potential to replace the existing alpha-blending overlay during interlocking procedures, all participants did not hesitate to suggest an immediate integration of the visualization for the correct navigation and guidance of the procedure. Conclusion: Current alpha blending visualizations lack proper depth cues and can be a source of confusion for the surgeons when performing surgery. Our visualization concept shows great potential in alleviating occlusion and facilitating clinician understanding during specific workflow steps of the intramedullary nailing procedure.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    Bacterial infection is a major cause of shunt dysfunction. It is well-known that the majority of pathogenic micro-organisms are low-virulent bacteria normally found on intact skin. Probably shunts become contaminated during surgery either by contact to the patient skin, or contact from contaminated...... 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...

  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. 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

  10. 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

  11. Art, passion, and neurosurgery: the role of the Society of Neurological Surgeons in academic neurosurgery.

    Science.gov (United States)

    Dempsey, Robert J

    2011-11-01

    Neurosurgery is at a crossroads in a time of economic uncertainty. It is also a time of remarkable potential for innovation resulting in dramatic improvement in the way neurosurgeons care for patients and the quality of outcomes. Analysis of this key time point of neurosurgical history is drawn from reflections for a presidential address to the Society of Neurological Surgeons. It is the author's opinion that the best of academic neurosurgery must and will accept this challenge by developing not only the research but also the creativity and art of what neurosurgeons do for maximal patient benefit in research, educational, and clinical missions.

  12. 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.

  13. The combined effects of hospital and surgeon volume on short-term survival after hepatic resection in a population-based study.

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    Chun-Ming Chang

    Full Text Available BACKGROUND: The influence of different hospital and surgeon volumes on short-term survival after hepatic resection is not clearly clarified. By taking the known prognostic factors into account, the purpose of this study is to assess the combined effects of hospital and surgeon volume on short-term survival after hepatic resection. METHODS: 13,159 patients who underwent hepatic resection between 2002 and 2006 were identified in the Taiwan National Health Insurance Research Database. Data were extracted from it and short-term survivals were confirmed through 2006. The Cox proportional hazards model was used to assess the relationship between survival and different hospital, surgeon volume and caseload combinations. RESULTS: High-volume surgeons in high-volume hospitals had the highest short-term survivals, following by high-volume surgeons in low-volume hospitals, low-volume surgeons in high-volume hospitals and low-volume surgeons in low-volume hospitals. Based on Cox proportional hazard models, although high-volume hospitals and surgeons both showed significant lower risks of short-term mortality at hospital and surgeon level analysis, after combining hospital and surgeon volume into account, high-volume surgeons in high-volume hospitals had significantly better outcomes; the hazard ratio of other three caseload combinations ranging from 1.66 to 2.08 (p<0.001 in 3-month mortality, and 1.28 to 1.58 (p<0.01 in 1-year mortality. CONCLUSIONS: The combined effects of hospital and surgeon volume influenced the short-term survival after hepatic resection largely. After adjusting for the prognostic factors in the case mix, high-volume surgeons in high-volume hospitals had better short-term survivals. Centralization of hepatic resection to few surgeons and hospitals might improve patients' prognosis.

  14. Pre-surgical road map for thyroid cancer and large goiters: Practical benefits of detailed radiological evaluation by surgeon

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    Ramakanth Bhargav Panchangam

    2015-01-01

    Full Text Available Introduction: Pre-surgical radiological evaluation of neck is often mandatory for surgical planning in high risk thyroid cancer and large goiters. Frequently, surgeons are overdependent on radiologist's report. In this context, we analysed the practical benefits of surgeon's independent radiological evaluation in our institutional experience. Material And Methods: This prospective study was conducted in Endocrine Surgery department of a teaching hospital in South India. Cases operated between January 2011 and June 2012 (18 months were included. Films of cross-sectional imaging were read in detail by primary and assistant surgeons in correlation with stepwise operative planning and documented. Cases with additional radiological signs on surgeon's evaluation, which were missing in radiologist's report are discussed in detail. Results: F: M ratio is 67:24. Mean age was 45.3 ± 9.8 years (37 – 76. Forty-seven cases of thyroid cancer and 44 cases of large goiters were analysed. Surgeon read additional signs such as obliterated fat plane between goiter and subcutaneous plane; level I lymph nodes; bilateral cervical lymphadenopathy, internal jugular vein thrombus, and pharyngeal invasion helped in pre-operatively planned modification of operative steps for optimal R0 resection and total thyroidectomy. A mean of 1.42 ± 0.83 (1 – 6, additional signs were detected on surgeon's radiological evaluation compared to radiologist's report in 41.7% of cases. These findings modified the pre-operative plan, facilitating better surgical outcome in 28.6% of cases. Conclusion: In high-risk thyroid cancer and large goiters, detailed radiological evaluation by surgeon facilitates optimal surgical resection and superior outcome compared to radiologist report-guided surgery.

  15. 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.

  16. 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.

  17. 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

  18. Health risks associated with exposure to surgical smoke for surgeons and operation room personnel.

    Science.gov (United States)

    Okoshi, Kae; Kobayashi, Katsutoshi; Kinoshita, Koichi; Tomizawa, Yasuko; Hasegawa, Suguru; Sakai, Yoshiharu

    2015-08-01

    Although surgical smoke contains potentially hazardous substances, such as cellular material, blood fragments, microorganisms, toxic gases and vapors, many operating rooms (ORs) do not provide protection from exposure to it. This article reviews the hazards of surgical smoke and the means of protecting OR personnel. Our objectives are to promote surgeons' acceptance to adopt measures to minimize the hazards. Depending on its components, surgical smoke can increase the risk of acute and chronic pulmonary conditions, cause acute headaches; irritation and soreness of the eyes, nose and throat; dermatitis and colic. Transmission of infectious disease may occur if bacterial or viral fragments present in the smoke are inhaled. The presence of carcinogens in surgical smoke and their mutagenic effects are also of concern. This review summarizes previously published reports and data regarding the toxic components of surgical smoke, the possible adverse effects on the health of operating room personnel and measures that can be used to minimize exposure to prevent respiratory problems. To reduce the hazards, surgical smoke should be removed by an evacuation system. Surgeons should assess the potential dangers of surgical smoke and encourage the use of evacuation devices to minimize potential health hazards to both themselves and other OR personnel.

  19. 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

  20. INFORMATION SEEKING BEHAVIOUR OF THE PHYSICIANS AND SURGEONS IN JAMMU & KASHMIR: AN EXPLORATORY STUDY

    Directory of Open Access Journals (Sweden)

    Dr. Mudasir Ashraf

    2012-01-01

    Full Text Available A survey was conducted to explore the information seeking behaviour of physicians and surgeons of J&K working at primary, secondary and tertiary health care institutions by administrating a questionnaire andemploying stratified random sampling. The findings reveal that the main reasons of professionals for seeking information are keeping up-to-date with current developments in the respective medical field and diagnosis/ treatment recommendations. The results also depict that the professionals prefer textbooks the most followed by reference books and journals and make less use of online databases. Several factors influence the use of information sources by physicians and surgeons like availability, timeliness, ease of searching, currency, relevance etc. Survey results also highlights areas in which improvements are needed, such as availability of Internet facilities at work place, establishment of libraries in every medical institution, conduct of frequent seminars, conferences, user awareness programmes etc. This study may encourage and foster further research for effectiveness and better performance of medical libraries in the State.

  1. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Surgeon-performed point-of-care ultrasound in severe eye trauma: Report of two cases

    Science.gov (United States)

    Abu-Zidan, Fikri M; Balac, Korana; Bhatia, Chetana Anand

    2016-01-01

    The indications of point-of-care ultrasound (POCUS) in the management of multiple trauma patients have been expanding. Although computed tomography (CT) scan of the orbit remains the gold standard for imaging orbital trauma, ultrasound is a quick, safe, and portable tool that can be performed bedside. Here we report two patients who had severe eye injuries with major visual impairment where surgeon-performed POCUS was very useful. One had a foreign body injury while the other had blunt trauma. POCUS was done using a linear probe under sterile conditions with minimum pressure on the eyes. Ultrasound showed a foreign body at the back of the left eye globe touching the eye globe in the first patient, and was normal in the second patient. Workup using CT scan, fundsocopy, optical coherence tomography, and magnetic resonance imaging of the orbits confirmed these findings. The first patient had vitreous and sub retinal haemorrhage and a full thickness macular hole of the left eye, while the second had traumatic optic neuropathy. POCUS gave accurate information concerning severe eye injuries. Trauma surgeons and emergency physicians should be trained in performing ocular ultrasound for eye injuries.

  4. [Recommendations on the relationship between surgeons and anesthesiologists as part of the health care team].

    Science.gov (United States)

    Daher, Michel

    2007-01-01

    Surgeon and anesthesiologist work as a team. Physicians of different but complementary specialties, they work jointly in the management of the patient during the pre, per and postoperative periods, with the main objective of ensuring the best quality of care and the greatest safety. However, the unprecedented development of new technologies during the last decades, deeply modified the conditions of exercise of these two specialities. Thus, the practice of anaesthesia is not only necessary for performing the surgical act, but also for diagnostic and therapeutic techniques using high technologies. So, from a traditional partner of the surgeon, the anesthetist became the privileged collaborator of a great number of specialists. Within these teams, the anesthetist must achieve his/her task in all independence, as stated in the Lebanese Code of Ethics. I will try in this message to point out the responsibilities of each of the two partners in this joint practice. The practice of a shared activity, in the same place, for the benefit of the patient, requires a preliminary definition of roles, in the mutual respect of competencies and responsibilities of each specialist, based on the respect of the rules edicted in the Code of Ethics. PMID:17685116

  5. Staging Investigations in Breast Cancer: Collective Opinion of UK Breast Surgeons

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    N. Chand

    2013-01-01

    Full Text Available Introduction. Certain clinicopathological factors are associated with a higher likelihood of distant metastases in primary breast cancer. However, there remains inconsistency in which patients undergo formal staging for distant metastasis and the most appropriate investigation(s. Aims. To identify UK surgeon preferences and practice with regard to staging investigations for distant metastases. Methods. A survey was disseminated to members of the Association of Breast Surgery by e-mail regarding surgeon/breast unit demographics, use of staging investigations, and local policy on pre/postoperative staging investigations. Several patient scenarios were also presented. Results. 123 of 474 (25.9% recipients completed the survey. Investigations routinely employed for patients diagnosed with early breast cancer included serological/haematological tests (72% respondents, axillary ultrasound (67%, liver ultrasound (2%, chest radiograph (36%, and computed tomography (CT (1%. Three areas contributed to decisions to undertake staging by CT scan: tumour size, axillary nodal status, and plan for chemotherapy. There was widespread variation as to criteria for CT staging based on tumour size and nodal status, as well as the choice of staging investigation for the clinical scenarios presented. Conclusions. There remains variation in the use of staging investigations for distant disease in early breastcancer despite available guidelines.

  6. Staging Investigations in Breast Cancer: Collective Opinion of UK Breast Surgeons.

    Science.gov (United States)

    Chand, N; Cutress, R I; Oeppen, R S; Agrawal, A

    2013-01-01

    Introduction. Certain clinicopathological factors are associated with a higher likelihood of distant metastases in primary breast cancer. However, there remains inconsistency in which patients undergo formal staging for distant metastasis and the most appropriate investigation(s). Aims. To identify UK surgeon preferences and practice with regard to staging investigations for distant metastases. Methods. A survey was disseminated to members of the Association of Breast Surgery by e-mail regarding surgeon/breast unit demographics, use of staging investigations, and local policy on pre/postoperative staging investigations. Several patient scenarios were also presented. Results. 123 of 474 (25.9%) recipients completed the survey. Investigations routinely employed for patients diagnosed with early breast cancer included serological/haematological tests (72% respondents), axillary ultrasound (67%), liver ultrasound (2%), chest radiograph (36%), and computed tomography (CT) (1%). Three areas contributed to decisions to undertake staging by CT scan: tumour size, axillary nodal status, and plan for chemotherapy. There was widespread variation as to criteria for CT staging based on tumour size and nodal status, as well as the choice of staging investigation for the clinical scenarios presented. Conclusions. There remains variation in the use of staging investigations for distant disease in early breastcancer despite available guidelines.

  7. 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

  8. 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

  9. 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.

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

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    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.

  11. 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

  12. 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.

  13. 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

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

    Science.gov (United States)

    Saadat, Ehsan; Curry, Emily J; Li, Xinning; Matzkin, Elizabeth G

    2014-10-27

    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. PMID:25568728

  15. Stick to Merton and Surpass Him-Bernard Barber's Sociology of Science Theory%守护默顿与超越默顿——伯纳德·巴伯的科学社会学理论评析

    Institute of Scientific and Technical Information of China (English)

    罗永仕

    2009-01-01

    Many people have paid more and more attention to the interaction between science,technology and society since the Industrial Revolution,because science and technology have shown up their strong power.They try to identify the essence of science and technology from many perspectives.Sociology of science is one of the schools of thought which study science.And it still has great influence nowadays.Bernard Barber is one of most prominent experts in this domain except Robert K Merton who we all know.Though Barber has done a lot for the development of sociology of science and made brilliant achievement in this field,he is not noticed and well studied by many of the experts in China.In fact,Barber's theory in sociology of science may be of great value for those who want to make better understanding to the relation between science and society.%作为默顿学派的重要代表之一,伯纳德·巴伯一方面遵循了默顿的科学社会学研究范式,促使科学社会学走向成熟;另一方面,巴伯在"默顿范式"的基础上进一步拓展了科学与社会关联的维度,超越了默顿对科学的社会学理解.与默顿不同的是,巴伯所提到的科学精神特质本质上是一种先在的客观的社会文化,这种文化先于科学而存在,这与默顿的被视为是一种科学社会共同体内生物的科学精神价值有着本质的区别,巴伯的这一社会文化指向也是科学社会学研究的一种新视野.

  16. Investigation of health status of beauty shops and barber shops in urban district%洛阳市老城区美容理发店卫生状况调查

    Institute of Scientific and Technical Information of China (English)

    李惠敏; 常明洛

    2011-01-01

    Objective To understand the health status of beauty shops and barber shops in Luoy-ang central urban district, find some questions in time, and provide evidence for hygiene supervision. Methods Sampling inspected the hygiene status of the air quality and public goods appliances by random samples in 120 beauty shops and barbershops in central urban district. Evaluated according to the related hygienic standards. Results Totally 120 units all hold hygiene licences. The qualified rates of employees healthy certificates, general hygiene status, sanitation facilities, cosmetics record keepings are 90. 00% ,96. 67% ,98. 33% and 82. 50% ; The qualified rate of the air quality is 96. 22% , among all indexes,the lowest is CO2(91. 71% ); The qualified rate of public goods appliances is 87. 41% , scissorst94. 67% )is much higher than combs' (86. 67% ) and towels' (83. 33% ) , the diference was significant(x2 =5. 438, P 0. 05 ). Conclusions The qualified rate of hygiene licences is higher in Luoyang urban district. The main problems are employees health certificates, cosmetics record keepings , CO2 content indoor and sterilization to public goods appliances.%目的 了解城市区美容理发店的卫生状况,及时发现问题,为卫生监督工作提供依据.方法 采用随机抽样的方法,对洛阳市城市区120家美容理发店的空气及公共用品用具进行抽样检测,按国家有关卫生标准评价.结果 120家单位均持有卫生许可证,从业人员健康证合格率为90.00%,一般卫生状况合格率为96.67%,卫生设施合格率为98.33%,化妆品索证合格率为82.50%;空气卫生质量总合格率为96.22%,其中C02合格率最低(91.71%);公共用品用具总合格率为87.41%,其中剪刀合格率(94.67%)高于梳子(86.67%)和毛巾(83.33%),三者差异有统计学意义(P<0.05);美容店内公共用品用具合格率(91.11%)高于理发店(87.18%)和美容理发兼营店(86.11%),但

  17. Navigating the Strait of Magellan: mapping a new paradigm for neurosurgical residency training. Presidential address to the Society of Neurological Surgeons, May 7, 2007.

    Science.gov (United States)

    Popp, A John

    2008-10-01

    At the conclusion of his year as 81st president of the Society of Neurological Surgeons, the author delivered the following address at the 2007 annual meeting of the Society of Neurological Surgeons in San Francisco. In his address, Dr. Popp used the voyage of Ferdinand Magellan to illustrate the present climate affecting residency training and why the current training paradigm must be examined and, where necessary, changed. Based on this call to action the leaders of the American Association of Neurological Surgeons, The American Board of Neurological Surgeons, The Congress of Neurological Surgeons, The Council of State Neurosurgical Societies, The Residency Review Committee for Neurosurgery, The Society of Neurological Surgeons, and the Washington Committee for Neurosurgery agreed to hold an unprecedented Education Summit meeting to investigate a comprehensive approach to evaluating and changing the current neurosurgical residency training model.

  18. ICD 10: "what orthopedic surgeons should know, how it will affect them and the cost of implementation?".

    Science.gov (United States)

    Henley, M Bradford

    2013-09-01

    Orthopedic surgeons will be required to use ICD-10-CM codes for reimbursement and to substantiate the medical necessity for their services beginning October 1, 2014. Implementation of ICD10 will require significant changes in the clinical and administrative processes of orthopedic offices and hospital practices. As in other countries, implementation added costs and resulted in disruptions in physician practices with concomitant decreases in productivity and practice revenue. Through education and planning, orthopedic surgeons can mitigate the anticipated changes and reduce the potential impact these changes will have on their practices. Changes anticipated in the diagnostic part of the ICD10 coding system are reviewed with examples pertinent to orthopedic surgeons. Many will need to improve the accuracy and specificity of their documentation by using anatomically precise nomenclature and obtaining a more detailed history and physical examination. This will require eliciting external causes of patients' problems, the precise activity of causation, and the place of occurrence.

  19. 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.

  20. Mentoring during surgical training: consensus recommendations for mentoring programmes from the Association of Surgeons in Training.

    Science.gov (United States)

    Sinclair, P; Fitzgerald, J E F; McDermott, F D; Derbyshire, L; Shalhoub, J

    2014-11-01

    Mentoring has been present within surgical training for many years, albeit in different forms. There is evidence that formal mentoring can improve patient outcomes and facilitate learning and personal growth in the mentee. The Association of Surgeons in Training (ASiT) is an independent educational charity working to promote excellence in surgical training. This document recommends the introduction of a structured mentoring programme, which is readily accessible to all surgical trainees. A review of the available evidence--including an ASiT-led survey of its membership--highlights the desire of surgical trainees to have a mentor, whilst the majority do not have access to one. There is also limited training for those in mentoring roles. In response, ASiT have implemented a pilot mentoring scheme, with surgical trainees acting both as mentors and mentees. Based on the existing literature, survey data and pilot experience, ASiT formalises in this document consensus recommendations for mentoring in surgical training.

  1. Clinical impact of the new IASLC/ATS/ERS lung adenocarcinoma classification for chest surgeons.

    Science.gov (United States)

    Nakamura, Haruhiko; Takagi, Masayuki

    2015-11-01

    In 2011, a new pathological classification of lung adenocarcinoma was proposed by the International Association for the Study of Lung Cancer, the American Thoracic Society and the European Respiratory Society. The new criteria classify adenocarcinomas into eight subtypes according to their histological features. The criteria introduce a new concept of early stage lung cancer, consisting of adenocarcinoma in situ and minimally invasive adenocarcinoma, and categorize invasive adenocarcinomas by the predominant histological pattern. In addition to morphological differences among subtypes, the classification also considers the tumor behavior based on the genetic background within each subtype. We herein review the clinical impact of this new classification for chest surgeons based on the data from several recent validation studies from various institutions.

  2. 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

  3. [Louis Ombrédanne (1871-1956) pediatric and plastic surgeon].

    Science.gov (United States)

    Glicenstein, J

    2015-04-01

    One of the fathers of pediatric surgery in France, Louis Ombrédanne (1871-1956) was a great plastic surgeon. During his residency he was initiated to plastic surgery by Charles Nélaton (1851-1911). Both wrote two books: "La rhinoplastie" and "Les autoplasties", taking stock of these techniques in the early 20th century. In 1906, he was the first to describe the pectoral muscle flap for immediate breast reconstruction after mastectomy. He used this flap in conjunction with an axillo thoracic flap. From 1908 to 1941, Louis Ombrédanne practised pediatric surgery, most of which was devoted in reconstruction of congenital and acquire anomalies. From 1924 to 1941, he was Professor of pediatric surgery at the hospital Enfants-Malades in Paris. In 1907, Louis Ombrédanne created a prototype of an ether inhaler as a safe anesthetic device. The device was successfully used for fifty years in Europe.

  4. Outcome Management in Cardiac Surgery Using the Society of Thoracic Surgeons National Database.

    Science.gov (United States)

    Halpin, Linda S; Gallardo, Bret E; Speir, Alan M; Ad, Niv

    2016-09-01

    Health care reform has helped streamline patient care and reimbursement by encouraging providers to provide the best outcome for the best value. Institutions with cardiac surgery programs need a methodology to monitor and improve outcomes linked to reimbursement. The Society of Thoracic Surgeons National Database (STSND) is a tool for monitoring outcomes and improving care. This article identifies the purpose, goals, and reporting system of the STSND and ways these data can be used for benchmarking, linking outcomes to the effectiveness of treatment, and identifying factors associated with mortality and complications. We explain the methodology used at Inova Heart and Vascular Institute, Falls Church, Virginia, to perform outcome management by using the STSND and address our performance-improvement cycle through discussion of data collection, analysis, and outcome reporting. We focus on the revision of clinical practice and offer examples of how patient outcomes have been improved using this methodology.

  5. 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.

  6. 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.  

  7. 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

  8. 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.

  9. Making the End as Good as the Beginning: Financial Planning and Retirement for Women Plastic Surgeons.

    Science.gov (United States)

    Johnson, Debra J; Shenaq, Deana; Thakor, Manisha

    2016-10-01

    Financial planning is critically important to ensure financial security both during a plastic surgical career and in retirement. Unfortunately, plastic surgery training includes very little in the way of financial planning. The information that is available in the literature is mostly geared toward men. Women, with longer lifespans and more family care responsibilities, have unique needs when it comes to financial planning. Adequate attention must also be paid to life after retirement. A plastic surgical career can be all-encompassing, and thus women need to carefully plan volunteer activities, new hobbies, and even a second career to make their retirement years fulfilling and enjoyable. Key points regarding financial planning during the various phases of a woman plastic surgeon's career are discussed. Options for retirement are presented.

  10. Joseph Lovell, MD (1788-1836): First US army surgeon general.

    Science.gov (United States)

    Craig, Stephen C

    2016-08-01

    Joseph Lovell, trained in medicine at Harvard and in military medicine/surgery by the War of 1812, became the first Surgeon General to sit on the reorganised army staff at the tender age of 29 in 1818. With a keen intellect, medical acumen, and wartime experiences for his tools and a close supporting relationship with Commanding General Jacob Jennings Brown and Secretary of War John C Calhoun (1728-1850), Lovell constructed an efficient and effective organisational and administrative framework for the new Medical Department of the US Army. Moreover, he not only redefined the role of the American military physician but also established the professional dignity, respectability and value of the medical officer among line officers and staff. Lovell's 18-year tenure came to an abrupt end, but the operational framework he created became both foundation and legacy for his successors.

  11. 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

  12. Final visual outcome following re exploration of cataracts performed by trainee surgeons in India

    Directory of Open Access Journals (Sweden)

    Mehul A Shah

    2011-01-01

    Full Text Available Objective: To investigate the outcome of secondary intraocular lens implantation, compare final visual outcome between different categories of surgeon, and evaluate care provided by teaching hospitals to patients with capsular complications. Materials and Methods: Setting: Teaching hospital. Design: Retrospective study. Subjects were recruited by examination of electronic medical records. All patients operated for corrective surgery following capsular complications during cataract surgery were included. All patient medical records were reviewed, and data were collected for 359 eyes. Main outcome measures: Visual acuity and major complications. All collected data were entered into Microsoft Excel and analyzed by SPSS 17 software using cross tabulation and Chi-squared tests. Results: Surgical intervention made a significant difference to the final visual outcome (P < 0.001. The category of the trainee had a significant effect on the final visual outcome (P = 0.021. Conclusion: Capsular complications during cataract surgery should be surgically treated to improve outcome.

  13. Plastic surgeons and the management of trauma: from the JFK assassination to the Boston Marathon bombing.

    Science.gov (United States)

    Luce, Edward A; Hollier, Larry H; Lin, Samuel J

    2013-11-01

    The fiftieth anniversary of the death by assassination of President John Kennedy is an opportunity to pay homage to his memory and also reflect on the important role plastic surgeons have played in the management of trauma. That reflection included a hypothetical scenario, a discussion of the surgical treatment of Kennedy (if he survived) and Governor Connally. The scenario describes the management of cranioplasty in the presence of scalp soft-tissue contracture, reconstruction of the proximal trachea, reconstitution of the abdominal wall, and restoration of a combined radius and soft-tissue defect. The development of diagnostic and therapeutic advances over the past 50 years in the care of maxillofacial trauma is described, including the evolution of imaging, timing of surgery, and operative techniques. Finally, contemporary measures of triage in situations involving mass casualties, as in the Boston Marathon bombings, complete the dedication to President Kennedy.

  14. 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

  15. 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.

  16. General versus vascular surgeon: impact of a vascular fellowship on clinical practice, surgical case load, and lifestyle.

    Science.gov (United States)

    Franz, Randall W

    2010-02-01

    An applicant shortage for vascular surgery (VS) residencies exists despite an increase in available training positions created to meet the growing demands for vascular surgeons. After 3 years of practice as an American Board of Surgery (ABS)-certified/board-eligible general surgeon, the author of this study attended an accredited 1-year VS training fellowship and received an ABS certificate of Added Qualifications in VS. The purpose of this review was to investigate the implications completing a vascular fellowship has had on VS procedure patterns, vascular procedure competency, clinical practice, career, and lifestyle with the aim of attracting trainees to the field of VS. The author's operative logs were reviewed retrospectively to summarize vascular procedures performed before and after the vascular fellowship. Statistical analysis was performed comparing the types and volume of vascular procedures before and after the vascular fellowship. Changes in professional career and personal life also were examined. The author performed 401 vascular procedures during 2.8 years as a general surgeon. In the first 3.4 years after the vascular fellowship, vascular procedure volume increased to 1563. The mean number of vascular procedures performed per year increased from 143.2 as a general surgeon to 459.7 as a vascular surgeon. The three major differences in vascular procedures occurring after the vascular fellowship were (1) a threefold increase in the number of vascular procedures performed, (2) a shift from major open to venous and endovascular procedures, and (3) an increase in case complexity. Specializing in VS also has resulted in increased career opportunities, more career satisfaction, a direct financial benefit, and more flexibility for lifestyle and family. Because of these positive changes, the author encourages medical students and residents interested in VS to explore the specialty early, seek vascular surgeons to serve as mentors, and enter one of the new VS

  17. 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

  18. Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy.

    Science.gov (United States)

    Stern, Joshua; Sharma, Saurabh; Mendoza, Pierre; Walicki, Mary; Hastings, Rachel; Monahan, Kelly; Sheikh, Baber; Wedmid, Alexei; Lee, David I

    2011-12-01

    Surgeons have always used their cognitive intuition for the execution of skilled tasks and real-time perception of intra-operative outcomes. We attempted to measure the overall accuracy of intra-operative surgeon perception on the functional outcome of early continence after robot-assisted radical prostatectomy (RARP). A single experienced surgeon (D.I.L.) used a scoring sheet to prospectively capture his subjective opinion of how well a particular portion of the RARP procedure was completed. Surgeon perception of factors affecting post-operative continence such as quality of bladder neck preservation, nerve sparing, urethral length, anastomosis, striated sphincter thickness, quality of Rocco repair and bladder neck plication suture (total 7 variables) were graded as "poor", "average" or "good". Urinary continence was graded as either total continence [0 pads per day (PPD) or social continence (security pad or one PPD)]. A total of 273 (39 patients × 7 variables) responses were recorded: 58.6% were rated as "good", 32.2% as "average" and 8.4% as "poor". A log-rank test for all perception variables showed no significant differences in subsequent achievement of continence (either 0 or 1 PPD) (P > 0.05) at both the 1- and 3-month time points. In the case of some perception variables, patients with "bad" scores gained continence a median of 3 weeks sooner than patients with "good" scores. Surgeon perception of intra-operative performance during RARP is a poor predictive indicator of subsequent functional outcome in terms of urinary continence. Inter-surgeon variability of perception may vary and needs further investigation. PMID:27628118

  19. 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

  20. 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.

  1. 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

  2. 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)

  3. Post-tonsillectomy hemorrhage in children: a single surgeon's experience with coblation compared to diathermy.

    Science.gov (United States)

    Kim, Jeong-Whun; Mun, Sue Jean; Lee, Woo-Hyun; Mo, Ji-Hun

    2013-01-01

    The aim of this study was to compare coblation and diathermy techniques with respect to secondary post-tonsillectomy hemorrhage (PTH). A total of 1,397 children underwent tonsillectomies with or without adenoidectomy by a single surgeon in a single center from June 2005 through December 2011. A diathermy tonsillectomy was performed on 315 patients for the first 2 years, while a coblation tonsillectomy was performed on 1,082 for the next 5 years. All patients were followed-up within 28 days of surgery by the same surgeon. The characteristics of primary and secondary PTH were analyzed with a retrospective chart review. Primary PTH did not occur in both surgical technique groups. Secondary PTH occurred in 9 patients (2.9 %) in the diathermy group and in 30 patients (2.8 %) in the coblation group. The secondary PTH rates were 1.2, 2.5, 3.8, 3.1 and 4.5 % in the first, second, third, fourth and fifth years after employment of the coblation tonsillectomy, respectively (P = 0.243). Sex, age, tonsil size and severity of tonsillar embedding were not significant factors for PTH. The coblation technique was associated more with late secondary PTH than diathermy technique (odds ratio 9.14, P = 0.049). Analysis of the time of onset of PTH showed that secondary PTH occurred most commonly between 6 p.m. and 6 a.m. In summary, coblation technique has similar secondary PTH rate with diathermy technique although it has increased late secondary PTH rate in children. Coblation technique can be a good alternative to the diathermy technique.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. Building Effective Partnerships Between Vascular Surgeons and Podiatric Physicians in the Effective Management of Diabetic Foot Ulcers.

    Science.gov (United States)

    Wu, Timothy; Chaer, Rabih A; Salvo, Nichol L

    2016-07-01

    Both vascular surgeons and podiatric physicians care for patients with diabetic foot ulcerations (DFUs), one of today's most challenging health-care populations in the United States. The prevalence of DFUs has steadily increased, along with the rising costs associated with care. Because of the numerous comorbidities affecting these patients, it is necessary to take a multidisciplinary approach in the management of these patients. Such efforts, primarily led by podiatric physicians and vascular surgeons, have been shown to effectively decrease major limb loss. Establishing an interprofessional partnership between vascular surgery and podiatric medicine can lead to an improvement in the delivery of care and outcomes of this vulnerable patient population.

  10. The 2014 Surgeon General's report: commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and updating the evidence on the health consequences of cigarette smoking.

    Science.gov (United States)

    Alberg, Anthony J; Shopland, Donald R; Cummings, K Michael

    2014-02-15

    The question of whether cigarette smoking was associated with lung cancer was central to the expansion of epidemiology into the study of chronic diseases in the 1950s. The culmination of this era was the 1964 report of the Advisory Committee to the Surgeon General, a landmark document that included an objective synthesis of the evidence of the health consequences of smoking according to causal criteria. The report concluded that cigarette smoking was a cause of lung cancer in men and sufficient in scope that "remedial action" was warranted at the societal level. The 2014 Surgeon General's report commemorates the 50th anniversary of the 1964 report. The evidence on the health consequences of smoking has been updated many times in Surgeon General's reports since 1964. These have summarized our increasingly greater understanding of the broad spectrum of the deleterious health effects of exposure to tobacco smoke across most major organ systems. In turn, this evidence has been translated into tobacco control strategies implemented to protect the public's health. The Surgeon General report process is an enduring example of evidence-based public health in practice. Substantial progress has been made, but cigarette smoking remains one of the most pressing global health issues of our time.

  11. 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.

  12. 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

  13. 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...

  14. 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

  15. 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.

  16. 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

    ... glove, they are counted as one defect. Visual defects and leaks that are observed in the top 40... observed in the top 40 mm of a glove will not be counted as a defect for the purpose of this part. Visually... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Patient examination gloves and surgeons'...

  17. The importance of team work of cytologist and surgeon in preoperative diagnosis of intraoral minor salivary gland tumours.

    Science.gov (United States)

    Ostović, Karmen Trutin; Luksić, Ivica; Virag, Miso; Macan, Darko; Müllers, Danko; Manojlović, Spomenka

    2012-11-01

    Tumours arising from oral minor salivary glands may exhibit an overlap of clinical and morphological features that may produce diagnostic and therapeutic dilemmas. The aim of this study is to asses the value of fine needle aspiration cytology (FNAC) in differentiation of benign and malignant tumours and to render a specific diagnosis. We evaluated the team work of surgeon and cytologist to improve diagnostic accuracy. Two steps are important for accuracy: sampling aspirate that should be done together by surgeon and cytologist and cytological microscopic analysis of the smears that should be performed by an experienced cytologist. The study included 132 patients with intraoral minor salivary gland tumours between 2002 and 2011. Adequate material was obtained from 121 (91.7%) patients. FNAC was usually performed by cytologist in a team with maxillofacial surgeon at cytology department that is more convenient for preparing the samples and especially for ROSE procedure (rapid-on site evaluation) of smears. In such a way the cytologist checked the adequacy of samples and decided whether some ancillary techniques should be used and therefore repeat FNAC. A total of 82 patients underwent surgery, 40 with malignant and 42 with benign tumours. Preoperative cytological diagnoses were compared with histopathological ones using histopathology as a gold standard. The most common benign tumour was pleomorphic adenoma and among malignant tumours adenoid cystic carcinoma. The most commonly affected site was the palate. The team work of surgeon and cytologist achieved specificity of 95.1%, sensitivity of 97.6% and diagnostic accuracy of 96.3%. We can conclude that although subclassification of some tumour types of salivary glands remains poor, FNAC is invaluable in patient triage and therefore should be considered in the first line investigations of these lesions by the cytologist and surgeon.

  18. The registry of anomalous aortic origin of the coronary artery of the Congenital Heart Surgeons' Society.

    Science.gov (United States)

    Brothers, Julie A; Gaynor, J William; Jacobs, Jeffrey P; Caldarone, Christopher; Jegatheeswaran, Anusha; Jacobs, Marshall L

    2010-12-01

    The anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva with interarterial, intramural, and/or intraconal course is a rare congenital anomaly that is associated with a high risk of sudden death in children. The Congenital Heart Surgeons' Society established the Registry of Anomalous Aortic Origin of the Coronary Artery to help determine the outcome of children and young adults managed with surgical intervention versus observation and to test the hypothesis that subsets of patients with anomalous aortic origin of a coronary artery can be identified in whom the risk of intervention is less than the risk of observation. All institutional members of the Congenital Heart Surgeons' Society were recruited for participation. The registry consists of a retrospective cohort of patients diagnosed between 1 January, 1998 and 20 January, 2009 and a prospective, population-based cohort of patients newly diagnosed from 21 January, 2009 onwards. Baseline demographics, diagnoses, and results of tests will be obtained through a review of the medical records. Annual follow-up data will be collected. Data will be analysed for different factors of risk at diagnosis, different strategies of treatment, and the impact of both on the outcomes of the patients. As of June 2010, 28 institutions had applied for approval from their institutional review board and 16 institutions had received approval from their institutional review board. Seventy-four patients have enrolled to date. We hope to use the established Pediatric Cardiomyopathy Registry as a guide to successful implementation, with a cooperative effort between institutions. The overall purpose of the Registry of Anomalous Aortic Origin of the Coronary Artery is to determine the outcome of surgical intervention versus observation in children and young adults with anomalous aortic origin of a coronary artery, and to describe the natural and "unnatural" history of these patients over the course of their lifetime

  19. 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.

  20. 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

  1. Proactive dairy cattle disease control in the UK: veterinary surgeons' involvement and associated characteristics.

    Science.gov (United States)

    Higgins, H M; Huxley, J N; Wapenaar, W; Green, M J

    2013-09-14

    Characteristics of 94 veterinary surgeons associated with delivering preventive herd-level strategies to control mastitis, lameness and Johne's disease were investigated using two multinomial models. The response variables were 'Gold Standard Monitoring' (including on-going data analysis, risk assessments and laboratory testing), and a lower level of involvement called 'Regular Control Advice'. Although the sample was biased towards those who spend the majority of their time with dairy cows, 69 per cent currently had no involvement in Gold Standard Monitoring for lameness, 60 per cent no involvement with Johne's, and 52 per cent no involvement with mastitis. The final model predicted that an assistant without a postgraduate cattle qualification, who had spent no time on dairy cattle continuous professional development (CPD) in the last year, had an 88 per cent chance of having no involvement with Gold Standard Monitoring for any disease, versus Gold Standard Monitoring of all three diseases on one or more farms, versus a 58 per cent chance for this partner. CPD and employment status were also associated with markedly different probabilities for delivering Regular Control Advice. Increased postgraduate education may further veterinary involvement of this nature.

  2. 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

  3. 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

  4. 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)

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. Implementation of fluorescence confocal mosaicing microscopy by "early adopter" Mohs surgeons: a review of recent progress

    Science.gov (United States)

    Jain, Manu; Rajadhyaksha, Milind; Nehal, Kishwer

    2016-03-01

    Confocal mosaicing microscopy (CMM) enables rapid imaging of large areas of fresh tissue ex vivo without the processing that is necessary for conventional histology. When performed with fluorescence mode using acridine orange (nuclear specific dye) it enhances nuclei-to-dermis contrast that enables detection of all types of BCCs including thin strands of infiltrative basal cell carcinomas (BCCs). Thus far, this technique has been mostly validated in research setting for the analysis of BCC tumor margins. Recently, CMM has been adopted and implemented in real clinical settings by some surgeons as an alternative tool to frozen section (FS) during Mohs surgery. In this review article we summarize the development of CMM guided imaging of ex vivo tissues from bench to bedside. We also present its current state of application in routine clinical workflow not only for the assessment of BCC margin but also for other skin cancers such as melanoma, SCC, and some infectious diseases where FS is not routinely performed. Lastly, we also discuss the potential limitations of this technology as well as future developments. As this technology advances further, it may serve as an adjunct to standard histology and enable rapid surgical pathology of skin cancers at the bedside.

  10. 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)

  11. 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

  12. 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

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

    Science.gov (United States)

    Rodríguez-Luna, María Rita; Fernández-Rivera, Enrique; Guarneros-Zárate, Joaquín E.; Tueme-Izaguirre, Jorge; Hernández-Méndez, José Roberto

    2015-01-01

    Introduction Since 1961 the use of Cation Exchange Resins has been the mainstream treatment for chronic hyperkalemia. For the past 25 years different kind of complications derived from its clinical use have been recognized, being the colonic necrosis the most feared and lethal of all. Presentation of case We report a case of a 72-year-old patient with chronic kidney disease, treated with calcium polystyrene sulfonate for hyperkalemia treatment who presented in the emergency department with constipation treated with hypertonic cathartics. With clinical deterioration 48 h later progressed with colonic necrosis requiring urgent laparotomy, sigmoidectomy and open abdomen management with subsequent rectal stump perforation and dead. The histopathology finding: calcium polystyrene sulfonate embedded in the mucosa, consistent with the cause of perforation. Discussion Lillemoe reported the first case series of five uremic patients with colonic perforation associated with the use of SPS in sorbitol in 1987 and in 2009 the FDA removed from the market the SPS containing 70% of sorbitol. The pathophysiologic change of CER goes from mucosal edema, ulcers, pseudomembranes, and the most severe case transmural necrosis. Up to present day, some authors have questioned the use of CER in the setting of lowering serum potassium. Despite its worldwide use in hyperkalemia settings, multiple studies have not demonstrated a significant potassium excretion by CER. 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. PMID:26439420

  14. 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

  15. 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

  16. 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.

  17. A novel dosimeter for measuring the amount of radiation exposure of surgeons during percutaneous nephrolithotomy: Instadose™

    Science.gov (United States)

    Yuruk, Emrah; Gureser, Gokhan; Tuken, Murat; Ertas, Kasim

    2016-01-01

    Introduction The aim of this study was to demonstrate the efficacy of Instadose™, a novel dosimeter designed for radiation workers to provide a measurement of the radiation dose at any time from any computer; to determine the amount of radiation exposure during percutaneous nephrolithotomy (PNL); and to evaluate the factors that affect the amount of radiation exposed. Material and methods Two experienced surgeons wore Instadose™ on the outer part of their lead aprons during the PNL procedures performed between December 2013 and July 2014. Patient demographics and stone characteristics were noted. Factors affecting radiation dose were determined. Fluoroscopic screening time was compared with the amount of radiation in order to validate the measurements of Instadose™. Results Overall, 51 patients with a mean age of 43.41 ±18.58 (range 1–75) years were enrolled. Male to female ratio was 35/16. The amount of radiation was greater than 0.01mSv in only 19 (37.25%) cases. Stone location complexity (p = 0.380), dilation type (p = 0.584), stone size (p = 0.565), dilation size (p = 0.891) and access number (p = 0.268) were not associated with increased radiation exposure. Instadose™ measurements were correlated with fluoroscopic screening time (r = 0.519, p = 0.001). Conclusions Instadose™ is a useful tool for the measurement of radiation exposure during PNL. The advantage of measuring the amount of radiation exposure after each PNL operation is that it may aid urologists in taking appropriate precautions to minimize the risk of radiation related complications. PMID:27551558

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. The role of other stakeholders than the surgeon in relation to surgical site infections following total joint replacement.

    Science.gov (United States)

    Stuyts, Bart; Van den Eeden, Elke; Fennema, Peter

    2015-12-01

    In contemporary orthopaedics, surgical site infections (SSIs) can have significant negative consequences for both patients and the healthcare system overall. To date, most efforts at combating the risk of SSIs have focused on the role of the surgeon, yet recent data suggest that a more expansive approach is warranted. The current review offers an overview of the most-relevant factors associated with SSIs in orthopaedic surgery, and the crucial role that the full surgical staff can play in addressing them.

  7. 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...

  8. “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.

  9. “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...

  10. 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

  11. 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.

  12. Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons-Pro and Con Arguments.

    Science.gov (United States)

    Rudnicki, Marek; Armstrong, John H; Clark, Clancy; Marcus, Stuart G; Sacks, Lee; Moser, A James; Reid-Lombardo, K Marie

    2016-02-01

    The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or "ObamaCare" for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the "pro" and "con" arguments for the expected and unexpected consequences of the ACA on society and surgeons.

  13. Surgeon point-of-view recording: Using a high-definition head-mounted video camera in the operating room

    Science.gov (United States)

    Nair, Akshay Gopinathan; Kamal, Saurabh; Dave, Tarjani Vivek; Mishra, Kapil; Reddy, Harsha S; Rocca, David Della; Rocca, Robert C Della; Andron, Aleza; Jain, Vandana

    2015-01-01

    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. PMID:26655001

  14. Perception of differences between trauma care and other surgical emergencies: results from a national survey of surgeons.

    Science.gov (United States)

    Esposito, T J; Kuby, A M; Unfred, C; Young, H L; Gamelli, R L

    1994-12-01

    A national sample of 2500 surgeons was surveyed. Thirteen variables were analyzed to ascertain perceived differences between trauma care and other surgical emergencies, as well as to identify factors contributing to a preferential reluctance to treat trauma. The response rate was 60%. Trauma was perceived as most likely to occur at inconvenient times by 67% of respondents, more often complex (44%), and more demanding of specialized knowledge (39%). Trauma was viewed as less likely to be reimbursed by 35% and most often litigious by 30%. Fewer respondents perceived differences for risk of exposure to lethal pathogens and violence (26% and 9%) and personal or professional rewards (25%). Surgeons who prefer to treat trauma view it as more often demanding of specialized knowledge and more complex than other surgical emergencies. Surgeons who prefer not to treat trauma or take trauma call perceive it as never personally or professionally rewarding, more often disruptive to personal life, emotionally taxing, litigious, and inconvenient compared with other emergencies. Perception of dissimilar reimbursement and personal health risk are less often associated factors. Perceived differences in the litigious nature of cases are not based on fact. We conclude that the individual degree of reluctance or enthusiasm for trauma care in comparison with other emergencies is influenced by perception, personality, and myth rather than by logic and facts.

  15. 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...

  16. 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.

  17. 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

  18. 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.

  19. 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

  20. How Social Are We? A Cross-Sectional Study of the Website Presence and Social Media Activity of Canadian Plastic Surgeons.

    Science.gov (United States)

    McEvenue, Giancarlo; Copeland, Andrea; Devon, Karen M; Semple, John L

    2016-10-01

    The internet and social media are increasingly being used by patients not only for health-related research, but also for obtaining information on their surgeon. Having an online presence via a website and social media profile is one-way plastic surgeons can meet this patient driven demand. The authors sought to document current website and social media usage of Canadian plastic surgeons and to determine if this usage correlated with years in practice. A Google search was performed using publicly available lists of all plastic surgeons registered with the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Canadian Society for Aesthetic Plastic Surgery (CSAPS). This search found 42% (268/631) of RCPSC plastic surgeons had a website and 85% (536/631) had a profile on social media. Younger RCPSC surgeons (registered for less years) were significantly more likely to have a website (12.8 vs. 21.9 years, P social media profile (16.2 vs. 23.9 years, P social media platform most used was RateMDs (81%) followed in decreasing order by: LinkedIn (28%), RealSelf (22%), Facebook (20%), Google+ (17%) and Twitter (16%). Dual RCPSC-CSAPS members were more likely than RCPSC-only members to have a website (56 vs. 36%, P social media profile (P social media presence by Canadian plastic surgeons is comparable to counterparts in the US and UK. It may be possible to better optimize online presence through education of current search engine technology and becoming active on multiple social media platforms.

  1. Reducing Tobacco Use. A report of the Surgeon General. Executive Summary.

    Science.gov (United States)

    2000-12-22

    This report of the Surgeon General on smoking and health, Reducing Tobacco Use, appears at a time of considerable upheaval in the arena of tobacco use control and prevention. Legal and legislative efforts to protect children from tobacco initiation and to diminish the prevalence of smoking among adults are in a state of flux, with some important gains and some sobering setbacks. Major changes in the public stance of the tobacco industry have evoked a reevaluation of strategies for controlling and preventing tobacco uptake. Enormous monetary settlements have provided the resources to fuel major new comprehensive antitobacco efforts, but the ultimate cost and benefit of these resources are still to be determined. Into this changing landscape, the report introduces an assessment of information about the value and efficacy of the major approaches that have been used--educational, clinical, regulatory, economic, and comprehensive--to reduce tobacco use. The report evaluates the scientific evidence for each approach, attempts to place the approaches in the larger context of tobacco control, and provides a vision of the trajectory for tobacco use prevention and control based on these available tools. Thus, although our knowledge about tobacco control remains imperfect, we know more than enough to act now. Widespread dissemination of the approaches and methods shown to be effective in each modality and especially in combination would substantially reduce the number of young people who will become addicted to tobacco, increase the success rate of young people and adults trying to quit using tobacco, decrease the level of exposure of nonsmokers to environmental tobacco smoke, reduce the disparities related to tobacco use and its health effects among different population groups, and decrease the future health burden of tobacco-related disease and death in this country. These achievable improvements parallel the health objectives set forth in Healthy People 2010, the national

  2. 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.

  3. 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

  4. 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

  5. [Three tragic destinies of surgeon-dentists: Bernard Holstein, Danielle Casanova and Dr. Rene Maheu during World War II

    Science.gov (United States)

    Riaud, Xavier

    2005-12-01

    Three tragic and anonymous fates. Three dental surgeons who came under the yoke of the Nazis. A Jew. a communist and a Resistance fighter. All three were victims of Hitler's regime, like so many others. The Jewish man died in a gas chamber. The communist woman died of typhus in Auschwitz concentration camp. The Resistance fighter emerged from concentration camp imprisonment, disabled because of his many scars. These three striking lives are symbols that must strengthen our duty to remember, especially in this year of the 60th anniversary of the liberation of the camps and the end of the war.

  6. Evaluation of Effective Factors on the Clinical Performance of General Surgeons in Tehran University of Medical Science, 2015

    Science.gov (United States)

    Farzianpour, Fereshteh; Mohamadi, Efat; najafpour, Zhila; Yousefinezhadi, Taraneh; Forootan, Sara; Foroushani, Abbas Rahimi

    2016-01-01

    Background and Objective: Existence of doctors with high performance is one of the necessary conditions to provide high quality services. There are different motivations, which could affect their performance. Recognizing Factors which effect the performance of doctors as an effective force in health care centers is necessary. The aim of this article was evaluate the effective factors which influence on clinical performance of general surgery of Tehran University of Medical Sciences in 2015. Methods: This is a cross-sectional qualitative-quantitative study. This research conducted in 3 phases-phases I: (use of library studies and databases to collect data), phase II: localization of detected factors in first phase by using the Delphi technique and phase III: prioritizing the affecting factors on performance of doctors by using qualitative interviews. Results: 12 articles were analyzed from 300 abstracts during the evaluation process. The output of assessment identified 23 factors was sent to surgeons and their assistants for obtaining their opinions. Quantitative analysis of the findings showed that “work qualification” (86.1%) and “managers and supervisors style” (50%) have respectively the most and the least impact on the performance of doctors. Finally 18 effective factors were identified and prioritized in the performance of general surgeons. Conclusion: The results showed that motivation and performance is not a single operating parameter and it depends on several factors according to cultural background. Therefore it is necessary to design, implementation and monitoring based on key determinants of effective interventions due to cultural background. PMID:27157161

  7. [Role of the ordinary surgeon Yvan beside Napoleon I on the night of April 12 to 13, 1814].

    Science.gov (United States)

    Goldcher, Alain

    2014-01-01

    Alexandre-Urbain Yvan was born on April 28th, 1765 in Toulon, where he entered the military hospital as a student at 14. He got acquainted with Napoleon Bonaparte during the campaigns of Italy. On May 6th, 1800 the Secretary of the war appointed him to the care of the First Consul. He became a close friend of the Bonaparte family and obtained the post of ordinary surgeon of the Emperor. He was going to follow his illustrious patient as his shadow until April 1814. Several arguments evoke Napoleon Ist's suicide attempt, during the night from 12 to 13 April, in Fontainebleau, after the abdication. He absorbed a poison with opium but his menservants thwarted his plan, especially Caulaincourt. Baron Yvan was called at the bedside of the dying sovereign and managed to save him by making him vomit. For fear of being accused of murder, or for some other reason, the surgeon ran away without telling the Emperor. This episode ended definitively the relation between Napoleon and Yvan.

  8. Two-Person Technique of Peroral Endoscopic Myotomy for Achalasia with an Advanced Endoscopist and a Thoracic Surgeon: Initial Experience

    Directory of Open Access Journals (Sweden)

    Madhusudhan R. Sanaka

    2016-01-01

    Full Text Available Background and Aims. We initiated peroral endoscopic myotomy (POEM utilizing a two-person technique with combination of an advanced endoscopist and a thoracic surgeon with complementary skills. Our aim was to determine the feasibility and outcomes in initial 20 patients. Methods. In this observational study, main outcomes measured were therapeutic success in relieving symptoms (Eckardt score < 3, decrease in lower esophageal sphincter (LES pressures, improvement in emptying on timed barium esophagogram (TBE, and complications. Results. POEM was successful in all 20 patients with a mean operative time of 140.1+32.9 minutes. Eckardt symptom scores decreased significantly at two-month follow-up (6.4+2.9 versus 0.25+0.45, p<0.001. Both basal and residual LES pressures decreased significantly (28.2+14.1 mmHg versus 12.8+6.3 and 22.4+11.3 versus 6.3+3.4 mmHg, p=0.025 and <0.001, resp.. Barium column height at 5 minutes on TBE reduced from 6.8+4.9 cm to 2.3+2.9 cm (p=0.05. Two patients (10% had mucosal perforations and one had delayed bleeding (5%. Conclusions. Two-person technique of POEM with combination of an advanced endoscopist and a thoracic surgeon is highly successful with low risk of complications.

  9. 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.

  10. U.S. plastic surgeons who contributed to the Revue de Chirurgie Plastique and the Revue de Chirurgie Structive (1931-1938): "Giants" in our specialty.

    Science.gov (United States)

    Rogers, B O

    1999-01-01

    The Revue de Chirurgie Plastique and the Revue de Chirurgie Structive, Brussels (1931-1938), edited by Maurice Coelst, M.D. from Brussels, were the first, full-fledged medical publications specifically devoted to plastic, reconstructive, and aesthetic surgery. Publishing original articles by J.W. Maliniac, J. Eastman Sheehan, and brief summaries of papers read at plastic surgery societies by C.R. Straatsma, L.A. Peer, G. Aufricht, and other well-known American plastic surgeons, these Revues drew attention to surgeons, most of whom were responsible for organizing the American Society of Plastic and Reconstructive Surgeons in 1931, the same year in which the Revue de Chirurgie Plastique first appeared.

  11. The use of a resource-based relative value scale (RBRVS) to determine practice expense costs: a novel technique of practice management for the vascular surgeon.

    Science.gov (United States)

    Mabry, C D

    2001-03-01

    Vascular surgeons have had to contend with rising costs while their reimbursements have undergone steady reductions. The use of newer accounting techniques can help vascular surgeons better manage their practices, plan for future expansion, and control costs. This article reviews traditional accounting methods, together with activity-based costing (ABC) principles that have been used in the past for practice expense analysis. The main focus is on a new technique-resource-based costing (RBC)-which uses the widely available Resource-Based Relative Value Scale (RBRVS) as its basis. The RBC technique promises easier implementation as well as more flexibility in determining true costs of performing various procedures, as opposed to more traditional accounting methods. It is hoped that RBC will assist vascular surgeons in coping with decreasing reimbursement. PMID:11239383

  12. Appearance of urology at the beginining of xxth century -from the general surgeon up to the highly trained specialist

    Directory of Open Access Journals (Sweden)

    Ignjatović Ivan M.

    2003-01-01

    Full Text Available Evolvement of urology as a separate scientific discipline depends on several factors. Endoscopic diagnostics, radiological diagnostics, and operative techniques in general surgery, had provided an ability to perform more complex and longer operations. Urology had evolved from the great schools of surgery in Germany and France, and their the most important surgeons, who were intersted in urological surgery. The first endoscope was introduced in 1806, and received today’s form in 1879. Application of "X" rays in medicine started in 1895, and it was later applied as a cystography, retrograde pyelography as well as intravenous urography. The most important thing for the operative technique evolution were application of anhestesia, asepsis and new hemostatic devices. During the one century long development, urology had passed the way from completely unknown field, up to the discipline with the best diagnostic preciseness.

  13. Dealing with sickness certification – a survey of problems and strategies among general practitioners and orthopaedic surgeons

    Directory of Open Access Journals (Sweden)

    Nilsson Gunnar

    2007-10-01

    Full Text Available Abstract Background In order to get sickness benefit a sick-listed person need a medical certificate issued by a physician; in Sweden after one week of self-certification. Physicians experience sick-listing tasks as problematic and conflicts may arise when patients regard themselves unable to work due to complaints that are hard to objectively verify for the physician. Most GPs and orthopaedic surgeons (OS deal regularly with sick-listing issues in their daily practice. The aim of this study was to explore perceived problems and coping strategies related to tasks of sickness certification among general practitioners (GP and orthopaedic surgeons (OS. Methods A cross-sectional study about sickness certification in two Swedish counties, with 673 participating GPs and 149 OSs, who answered a comprehensive questionnaire. Frequencies together with crude and adjusted (gender and working years Odds ratios were calculated. Results A majority of the GPs and OSs experienced problems in sickness certification every week. To assess the patient's work ability, to handle situations when they and the patient had different opinions about the need for sickness absence, and to issue prolongation certificates when the previous was issued by another physician were reported as problematic by a majority in both groups. Both GPs and OSs prolonged sickness certifications due to waiting times in health care or at Social Insurance Office (SIO. To handle experienced problems they used different strategies; OSs issued sickness certificates without personal appointment more often than the GPs, who on the other hand reported having contact with SIO more often than the OSs. A higher rate of GPs experienced support from management and had a common strategy for handling sickness certification at the clinic than the OSs. Conclusion Most GPs and OSs handled sickness certification weekly and reported a variety of problems in relation to this task, generally GPs to a higher extent

  14. Comparison of the Temperament and Character of Patients Referred to Cosmetic Nasal Surgeon in Shiraz Hospitals, 2015

    Directory of Open Access Journals (Sweden)

    Farkhondeh Sharif

    2016-04-01

    Full Text Available 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.

  15. 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

  16. 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.

  17. 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

  18. The importance of staff in the facial plastic surgical practice: dynamic staff interface with patients in support of the surgeon's objectives.

    Science.gov (United States)

    Patseavouras, Louie L

    2008-05-01

    This article addresses how staff can support surgeons in practical terms, making a business more efficient, seamless, and less costly (in terms of emotional and time components). This article addresses (1) using staff as a first line of defense against misperceptions, false expectations, and general problems; (2) recognizing that effective staff are highly intuitive and can be trained to troubleshoot and intervene; (3) encouraging staff to rely on gut instinct; (4) learning that body language and the nonverbal are powerful indicators; (5) training staff concerning nonverbal communication; and (6) realizing that a great deal of communication is within surgeon and staff control.

  19. British plastic surgeons who contributed to the Revue de Chirurgie Plastique and the Revue de Chirurgie Structive (1931-1938): "the Big Four" in their Speciality.

    Science.gov (United States)

    Rogers, B O

    2001-01-01

    The Revue de Chirurgie Plastique and the Revue de Chirurgie Structive, Brussels (1931-1938), edited by Maurice Coelst, M.D. from Brussels, were the first, full-fledged medical publications devoted specifically to plastic, reconstructive, and aesthetic surgery. Publishing original articles by H.D. Gillies, P.T. Kilner, A.H. McIndoe, and R. Mowlem--the "Big Four" as they were known to both English and American plastic surgeons--the Revues drew attention to these four surgeons who were mainly responsible for developing the prestige of English plastic surgery in the early 1930s.

  20. 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...

  1. Incidence of Complications During Initial Experience with Revision of the Agility and Agility LP Total Ankle Replacement Systems: A Single Surgeon's Learning Curve Experience.

    Science.gov (United States)

    Roukis, Thomas S; Simonson, Devin C

    2015-10-01

    As the frequency in which foot and ankle surgeons are performing primary total ankle replacement (TAR) continues to build, revision TAR will likely become more commonplace, creating a need for an established benchmark by which to evaluate the safety of revision TAR as determined by the incidence of complications. Currently, no published data exist on the incidence of intraoperative and early postoperative complications during revision of the Agility or Agility LP Total Ankle Replacement Systems during the surgeon learning curve period; therefore, the authors sought to determine this incidence during the senior author's learning curve period.

  2. 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

  3. The arterial switch operation in Europe for transposition of the great arteries : A multi-institutional study from the European Congenital Heart Surgeons Association

    NARCIS (Netherlands)

    Sarris, George E.; Chatzis, Andrew C.; Giannopoulos, Nicolas M.; Kirvassilis, George; Berggren, Hakan; Hazekamp, Mark; Carrel, Thierry; Comas, Juan V.; Di Carlo, Duccio; Daenen, Willem; Ebels, Tjark; Fragata, Jose; Hraska, Victor; Ilyin, Vladimir; Lindberg, Harald L.; Metras, Dominique; Pozzi, Marco; Rubay, Jean; Sairanen, Heikki; Stellin, Giovanni; Urban, Andreas; Van Doorn, Carin; Ziemer, Gerhard

    2006-01-01

    Objectives: This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association. Methods: The records of 613 patients who underwent primary arterial switch operations in each of 19 parti

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. Optical Coherence Tomography of Retinal Degeneration in Royal College of Surgeons Rats and Its Correlation with Morphology and Electroretinography

    Science.gov (United States)

    Yamauchi, Kodai; Mounai, Natsuki; Tanabu, Reiko; Nakazawa, Mitsuru

    2016-01-01

    Purpose To evaluate the correlation between optical coherence tomography (OCT) and the histological, ultrastructural and electroretinography (ERG) findings of retinal degeneration in Royal College of Surgeons (RCS-/-) rats. Materials and Methods Using OCT, we qualitatively and quantitatively observed the continual retinal degeneration in RCS-/- rats, from postnatal (PN) day 17 until PN day 111. These findings were compared with the corresponding histological, electron microscopic, and ERG findings. We also compared them to OCT findings in wild type RCS+/+ rats, which were used as controls. Results After PN day 17, the hyperreflective band at the apical side of the photoreceptor layer became blurred. The inner segment (IS) ellipsoid zone then became obscured, and the photoreceptor IS and outer segment (OS) layers became diffusely hyperreflective after PN day 21. These changes correlated with histological and electron microscopic findings showing extracellular lamellar material that accumulated in the photoreceptor OS layer. After PN day 26, the outer nuclear layer became significantly thinner (P pigment epithelium and choroid did not differ significantly between RCS-/- and RCS+/+ rats. Conclusion Our results suggest that OCT demonstrates histologically validated photoreceptor degeneration in RCS rats, and that OCT findings partly correlate with ERG findings. We propose that OCT is a less invasive and useful method for evaluating photoreceptor degeneration in animal models of retinitis pigmentosa. PMID:27644042

  11. Assessment of online visibility of the British Association of Oral and Maxillofacial Surgeons (BAOMS): a strategic study.

    Science.gov (United States)

    Abu-Serriah, M; Wong, L; Dhariwal, D; Banks, R J

    2014-02-01

    The Internet is a powerful method of acquiring and sharing information. In marketing and business, online visibility is vital for publicity and the reputation of an organisation. To our knowledge, the importance of such visibility in medicine in general, and in Oral and Maxillofacial Surgery (OMFS) services in the UK, has not previously been investigated. We aimed to provide a better understanding of the way that patients use the Internet by asking 450 patients to complete a questionnaire when they attended outpatient OMFS departments at 2 centres. We also assessed the online visibility of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and investigated the correlation between the strength of online visibility and professional reputation. Results from the self-administered, anonymous, validated questionnaires showed that 82% of patients agreed that the Internet was a powerful source of information, and two-thirds associated online visibility with a good reputation. However, the perceived online visibility of the BAOMS was poor (2%). This study mirrors findings in business publications, and confirms the link between online visibility and professional reputation. It also shows that there is a gap between patients' perceptions and the level of uptake of professional resources. We propose various strategies to bridge this gap and to promote the online visibility and professional reputation of the BAOMS and of OMFS services in the UK.

  12. 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.

  13. The high-risk recipient: the Eighth Annual American Society of Transplant Surgeons' State-of-the-Art Winter Symposium.

    Science.gov (United States)

    Sung, Randall S; Pomfret, Elizabeth A; Andreoni, Kenneth A; Baker, Talia B; Peters, Thomas G

    2010-01-01

    The evolution of organ transplantation has produced results so successful that many transplant programs commonly see recipients with medical risks, which in the past, would have prohibited transplantation. The Eighth Annual American Society of Transplant Surgeons State-of-the-Art Winter Symposium focused on the high-risk recipient. The assessment of risk has evolved over time, as transplantation has matured. The acceptance of risk associated with a given candidate today is often made in consideration of the relative value of the organ to other candidates, the regulatory environment, and philosophical notions of utility, equity, and fairness. In addition, transplant programs must balance outcomes, transplant volume, and the costs of organ transplantation, which are impacted by high-risk recipients. Discussion focused on various types of high-risk recipients, such as those with coronary artery disease, morbid obesity, and hepatitis C; strategies to reduce risk, such as down-staging of hepatocellular carcinoma and treatment of pulmonary hypertension; the development of alternatives to transplantation; and the degree to which risk can or should be used to define candidate selection. These approaches can modify the impact of recipient risk on transplant outcomes and permit transplantation to be applied successfully to a greater variety of patients.

  14. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

    Science.gov (United States)

    Ghonge, Nitin P; Gadanayak, Satyabrat; Rajakumari, Vijaya

    2014-10-01

    As Laparoscopic Donor Nephrectomy (LDN) offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know. PMID:25489130

  15. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

    Directory of Open Access Journals (Sweden)

    Nitin P Ghonge

    2014-01-01

    Full Text Available As Laparoscopic Donor Nephrectomy (LDN offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know.

  16. Looking back at the John Mitchell Crouch Fellowship: the most prestigious research award of the Royal Australasian College of Surgeons.

    Science.gov (United States)

    Boult, Margaret; Babidge, Wendy; Pleass, Susan; Scott, David

    2015-10-01

    The John Mitchell Crouch Fellowship is a generous endowment made to the Royal Australasian College of Surgeons (RACS) by the young neurosurgeon's family, following his death from a brain tumour. In this article, we examine the significance and legacy of the grant since its inception in 1979. This is the highest level of research fellowship awarded by the RACS recognizing early career excellence, as part of its significant research funding programme (over $1.7 million in 2015). John Mitchell Crouch recipients have been pioneers in various areas of medicine where they have developed new technologies, established research centres, improved patient safety and military surgery and embraced evidence-based medicine. The funds they received have directly contributed to research published in numerous highly respected peer-reviewed journals such as The New England Journal of Medicine; established new laboratories, helped fund clinical trials and allowed new directions of research to be pursued. Recipients of the John Mitchell Crouch Fellowship have been recognized with many awards including 11 Australian and New Zealand Honours to date. Many other significant research funds have been subsequently bestowed, including over 120 National Health Medical Research Council (NHMRC) grants to Australian and New Zealand recipients subsequent to their Fellowship. This article also shows the range of disciplines in which the award has supported cutting-edge research leading to benefits for patients and health care.

  17. 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.

  18. 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

  19. 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.

  20. 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 & ...

  1. Society of Thoracic Surgeons

    Science.gov (United States)

    ... Training Experience Potentially Deadly Heart Condition Plagues Family Members Around Same Age STS Comments on CMS Plan to Bundle Payments for Heart Bypass Surgery Diabetic Patients Experience Superior Survival with Less Conventional CABG Surgery Rep. Larry ...

  2. Find a Dermatologic Surgeon

    Science.gov (United States)

    ... Myths Debunked Sun Safe Soccer Sun Safe Surfing Stylists Against Skin Cancer Skin Care Children Adolescence Ages ... Myths Debunked Sun Safe Soccer Sun Safe Surfing Stylists Against Skin Cancer Skin Care Children Adolescence Ages ...

  3. 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.

  4. 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.

  5. [What do general, abdominal and vascular surgeons need to know on plastic surgery - aspects of plastic surgery in the field of general, abdominal and vascular surgery].

    Science.gov (United States)

    Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F

    2015-02-01

    There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.

  6. 外科医师职业倦怠的现状调查与分析%Investigation and analysis of the status of occupational burnout among surgeons

    Institute of Scientific and Technical Information of China (English)

    沈迪文; 张宁

    2015-01-01

    目的:了解临床外科医师职业倦怠的总体现状。方法依据随机抽样原则,采用工作倦怠问卷中国版量表对中国东部、中部、西部三个地区不同省市的9家医院602名临床外科医师进行职业倦怠调查及分析。结果外科医师中有33.89%(204/602)轻度倦怠,32.06%(193/602)中度倦怠,5.48%(33/602)重度倦怠;各维度,27.41%(165/602)情感耗竭,45.18%(272/602)人格解体,41.86%(252/602)成就感降低。外科医师的职业倦怠在性别、年龄、职称、工作年限之间差异无统计学意义(P ﹥0.05);而在地区、婚姻、学历、医院等级之间差异有统计学意义(P ﹤0.05)。结论外科医师的总体职业倦怠情况严重,防治工作应关注高学历、三级医院及离婚、丧偶的单身外科医师,并根据不同地区的外科医师特点制定相关政策。%Objective To measure the status of occupational burnout among surgeons in China in a cross-sectional survey. Methods According to random sampling methods,602 cases of clinical surgeons selected from different 9 hospitals in regions of east China and mid-west China were assessed and analyzed with the Chinese Maslach Burnout Inventory(CMBI). Results 33. 89% of all surgeons(204 / 602) experienced mild occupational burnout,and 32. 06%(193 / 602)experienced moderate burnout,5. 48%(33 / 602)severe burnout. Among all surgeons,27. 41%(165 / 602)were with high scores on emotional exhaustion(EE),and 45. 18%(272 / 602)with high scores on deper-sonalization(DP),41. 86%(252 / 602)on reduced personal accomplishment(RPA). There was no significant difference in the characteris-tic factors of sex,age,technical title,working seniority with regard to occupational burnout among surgeons(P ﹥ 0. 05). On the contrary, there were significant differences among region,marriage,educational background and hospital grade of these surgeons(P ﹤ 0. 05). Conclu-sion The status of

  7. 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...

  8. 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.

  9. Dominique-Jean Larrey, chief surgeon of the French Army with Napoleon in Egypt: notes and observations on Larrey's medical memoirs based on the Egyptian campaign.

    Science.gov (United States)

    Wood, Mary Mendenhall

    2008-01-01

    Dr. Dominique-Jean Larrey wrote memoirs of 12 diseases he encountered while serving as chief surgeon of the French army during Napoleon's Egyptian campaign. He describes symptoms and treatments, evaluates remedies used by the Egyptians, and the effects of the climate. Of interest are his original though misguided explanations of causes of sickness or complications from wounds as well as descriptions of medications--now known to be dangerous--but all balanced by his common sense and efforts to ameliorate suffering.

  10. Characteristics of evidence-based medicine training in Royal College of Physicians and Surgeons of Canada emergency medicine residencies - a national survey of program directors

    OpenAIRE

    Bednarczyk, Joseph; Pauls, Merril; Fridfinnson, Jason; Weldon, Erin

    2014-01-01

    Background Recent surveys suggest few emergency medicine (EM) training programs have formal evidence-based medicine (EBM) or journal club curricula. Our primary objective was to describe the methods of EBM training in Royal College of Physicians and Surgeons of Canada (RCPSC) EM residencies. Secondary objectives were to explore attitudes regarding current educational practices including e-learning, investigate barriers to journal club and EBM education, and assess the desire for national coll...

  11. Sentinel lymph node biopsy for breast cancer using methylene blue dye manifests a short learning curve among experienced surgeons: a prospective tabular cumulative sum (CUSUM analysis

    Directory of Open Access Journals (Sweden)

    Valentine Christopher SP

    2009-01-01

    Full Text Available Abstract Background The benefits of sentinel lymph node biopsy (SLNB for breast cancer patients with histologically negative axillary nodes, in whom axillary lymph node dissection (ALND is thereby avoided, are now established. Low false negative rate, certainly with blue dye technique, mostly reflects the established high inherent accuracy of SLNB and low axillary nodal metastatic load (subject to patient selection. SLN identification rate is influenced by volume, injection site and choice of mapping agent, axillary nodal metastatic load, SLN location and skill at axillary dissection. Being more subject to technical failure, SLN identification seems to be a more reasonable variable for learning curve assessment than false negative rate. Methylene blue is as good an SLN mapping agent as Isosulfan blue and is much cheaper. Addition of radio-colloid mapping to blue dye does not achieve a sufficiently higher identification rate to justify the cost. Methylene blue is therefore the agent of choice for SLN mapping in developing countries. The American Society of Breast Surgeons recommends that, for competence, surgeons should perform 20 SLNB but admits that the learning curve with a standardized technique may be "much shorter". One appropriate remedy for this dilemma is to plot individual learning curves. Methods Using methylene blue dye, experienced breast surgeons performed SLNB in selected patients with breast cancer (primary tumor Results The CUSUM plot crossed the SPRT limit line after 8 consecutive, positively identified SLN, signaling achievement of an acceptable level of competence. Conclusion Tabular CUSUM charting, based on a justified choice of parameters, indicates that the learning curve for SLNB using methylene blue dye is completed after 8 consecutive, positively identified SLN. CUSUM charting may be used to plot individual learning curves for trainee surgeons by applying a proxy parameter for failure in the presence of a mentor (such as

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. Using a Surgeon-modified Iliac Branch Device to Preserve the Internal Iliac Artery during Endovascular Aneurysm Repair: Single-center Experiences and Early Results

    Directory of Open Access Journals (Sweden)

    Wei-Wei Wu

    2015-01-01

    Full Text Available 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.

  17. 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

  18. 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.

  19. 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.)

  20. 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.