Agha, Riaz A; Fowler, Alexander J; Sevdalis, Nick
Non-technical skills are of increasing importance in surgery and surgical training. A traditional focus on technical skills acquisition and competence is no longer enough for the delivery of a modern, safe surgical practice. This review discusses the importance of non-technical skills and the values that underpin successful modern surgical practice. This narrative review used a number of sources including written and online, there was no specific search strategy of defined databases. Modern surgical practice requires; technical and non-technical skills, evidence-based practice, an emphasis on lifelong learning, monitoring of outcomes and a supportive institutional and health service framework. Finally these requirements need to be combined with a number of personal and professional values including integrity, professionalism and compassionate, patient-centred care.
Riaz A. Agha
This narrative review used a number of sources including written and online, there was no specific search strategy of defined databases. Modern surgical practice requires; technical and non-technical skills, evidence-based practice, an emphasis on lifelong learning, monitoring of outcomes and a supportive institutional and health service framework. Finally these requirements need to be combined with a number of personal and professional values including integrity, professionalism and compassionate, patient-centred care.
Gjeraa, Kirsten; Mundt, Anna S; Spanager, Lene
, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure......BACKGROUND: Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived...... by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS: This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data...
Gjeraa, Kirsten; Mundt, Anna S; Spanager, Lene; Hansen, Henrik J; Konge, Lars; Petersen, René H; Østergaard, Doris
Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data analysis was deductive, and directed content analysis was used to code the text into the Oxford Non-Technical Skills system for evaluating operating teams' non-technical skills. The most important non-technical skills described by the VATS teams were planning and preparation, situation awareness, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure with complementary and overlapping scopes of practice between surgical and anesthesia subteams. This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important additions to the shared mental model construct: planning and preparation, risk assessment, and leadership. Shared mental models are crucial for patient safety because they enable VATS teams to anticipate problems through adaptive patterns of both implicit and explicit coordination. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Gjeraa, Kirsten; Spanager, Lene; Konge, Lars
in MIS compared to open surgery, mainly due to equipment- and patient-related challenges. Fixed teams improved teamwork and safety levels, while deficient planning and poor teamwork were found to obstruct workflow and increase errors. Training NTS mitigates these issues and improves staff attitudes...... towards NTS. CONCLUSIONS: MIS teams' NTS are important for workflow and prevention of errors and can be enhanced by working in fixed teams. In the technological complex sphere of MIS, communication revolves around equipment- and patient-related topics, much more so than in open surgery. In all, only a few...
Alken, Alexander; Luursema, Jan-Maarten; Weenk, Mariska; Yauw, Simon; Fluit, Cornelia; van Goor, Harry
Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training. Coaching activities of 12 surgical teachers were recorded on audio and video. Six teachers were primed on non-technical skills coaching prior to the training. Six others received no priming and served as controls. Blind observers reviewed the recordings of 2 training scenario's and scored whether the observed behaviors were directed on technical or non-technical skills. We compared the frequency of the non-technical skills coaching between the primed and the non-primed teachers and analyzed for differences according to the trainees' level of experience. Surgical teachers coached trainees during the highly realistic DSATC integrated acute trauma surgery team training. Trainees performed damage control surgery in operating teams on anesthetized porcine models during 6 training scenario's. Twelve experienced surgical teachers participated in this study. Coaching on non-technical skills was limited to about 5%. The primed teachers did not coach more often on non-technical skills than the non-primed teachers. We found no differences in the frequency of non-technical skills coaching based on the trainees' level of experience. Priming experienced surgical teachers does not increase the coaching on non-technical skills. The current DSATC acute trauma surgery team training seems too complex for integrating training on technical and non-technical skills. Patient care, Practice based learning and improvement. Copyright © 2017 Elsevier Inc. All rights reserved.
Gillespie, Brigid M; Harbeck, Emma; Kang, Evelyn; Steel, Catherine; Fairweather, Nicole; Chaboyer, Wendy
Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R 2 0.12, p<0.001) to 24% (adjusted R 2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed. Miscommunications and interruptions impact on team NTS performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Raison, Nicholas; Wood, Thomas; Brunckhorst, Oliver; Abe, Takashige; Ross, Talisa; Challacombe, Ben; Khan, Mohammed Shamim; Novara, Giacomo; Buffi, Nicolo; Van Der Poel, Henk; McIlhenny, Craig; Dasgupta, Prokar; Ahmed, Kamran
Non-technical skills (NTS) are being increasingly recognised as vital for safe surgical practice. Numerous NTS rating systems have been developed to support effective training and assessment. Yet despite the additional challenges posed by robotic surgery, no NTS rating systems have been developed for this unique surgical environment. This study reports the development and validation of the first NTS behavioural rating system for robotic surgery. A comprehensive index of all relevant NTS behaviours in robotic surgery was developed through observation of robotic theatre and interviews with robotic surgeons. Using a Delphi methodology, a panel of 16 expert surgeons was consulted to identify behaviours important to NTS assessment. These behaviours were organised into an appropriate assessment template. Experts were consulted on the feasibility, applicability and educational impact of ICARS. An observational trial was used to validate ICARS. 73 novice, intermediate and expert robotic surgeons completed a urethrovesical anastomosis within a simulated operating room. NTS were tested using four scripted scenarios of increasing difficulty. Performances were video recorded. Robotic and NTS experts assessed the videos post hoc using ICARS and the standard behavioural rating system, NOn-Technical Skills for Surgeons (NOTSS). 28 key non-technical behaviours were identified by the expert panel. The finalised behavioural rating system was organised into four principle domains and seven categories. Expert opinion strongly supported its implementation. ICARS was found to be equivalent to NOTSS on Bland-Altman analysis and accurately differentiated between novice, intermediate and expert participants, p = 0.01. Moderate agreement was found between raters, Krippendorff's alpha = 0.4. The internal structure of ICARS was shown to be consistent and reliable (median Cronbach alpha = 0.92, range 0.85-0.94). ICARS is the first NTS behavioural rating system developed for robotic
One of the more recent developments in the field of reliability and safety is the realisation that these aspects are not only a function of the product itself, but also of the organisation realising this product. A second development is a trend from an often predominantly qualitative analysis towards a quantitative analysis. In contrast to the (older) DIN 0801, the (more recent) IEC61508 requires, on product level, also a quantitative analysis and, on organisational level, an assessment of the lifecycle of a product by analysing the (maturity of the) relevant business processes (DIN V VDE 0801. Grundsaetze fuer Rechner in Systemen mit Sicherheitsaufgaben, 1990; DIN V 0801. Grundlegende Sicherheitsbetrachtungen fuer MSR-Schutzeinrichtungen, 1994; DIN V VDE 0801 A1. Grundsaetze fuer Rechner in Systemen mit Sicherheitsaufgaben, Aenderung A1, 1994; IEC 61508 Functional Safety of electrical/electronic/programmable electronic safety-related systems, draft 4.0, 1997). The IEC standard 61508 covers: (i) technical aspects, both on a quantitative and a qualitative level; (ii) organisational aspects, both on aspects of maturity of business processes (quantitative) and on aspects of the definition and application of procedures (qualitative). This paper shows the necessity for an analysis on all aspects in a safety certification process, and presents an overview of the available tools and techniques for the various quadrants. As methods and tools for especially quadrant C are currently unavailable, this paper will propose a method to assess and improve the maturity of an organisation on reliability management: the maturity index on reliability (MIR)
Siqueira-Batista, Rodrigo; Souza, Camila Ribeiro; Maia, Polyana Mendes; Siqueira, Sávio Lana
The use of robots in surgery has been increasingly common today, allowing the emergence of numerous bioethical issues in this area. To present review of the ethical aspects of robot use in surgery. Search in Pubmed, SciELO and Lilacs crossing the headings "bioethics", "surgery", "ethics", "laparoscopy" and "robotic". Of the citations obtained, were selected 17 articles, which were used for the preparation of the article. It contains brief presentation on robotics, its inclusion in health and bioethical aspects, and the use of robots in surgery. Robotic surgery is a reality today in many hospitals, which makes essential bioethical reflection on the relationship between health professionals, automata and patients. A utilização de robôs em procedimentos cirúrgicos tem sido cada vez mais frequente na atualidade, o que permite a emergência de inúmeras questões bioéticas nesse âmbito. Apresentar revisão sobre os aspectos éticos dos usos de robôs em cirurgia. Realizou-se revisão nas bases de dados Pubmed, SciELO e Lilacs cruzando-se os descritores "bioética", "cirurgia", "ética", "laparoscopia" e "robótica". Do total de citações obtidas, selecionou-se 17 artigos, os quais foram utilizados para a elaboração do artigo. Ele contém breve apresentação sobre a robótica, sua inserção na saúde e os aspectos bioéticos da utilização dos robôs em procedimentos cirúrgicos. A cirurgia robótica é uma realidade, hoje, em muitas unidades hospitalares, o que torna essencial a reflexão bioética sobre as relações entre profissionais da saúde, autômatos e pacientes.
Bierer, Joel; Memu, Eustatiu; Leeper, Robert; Fortin, Dalilah; Fréchette, Eric; Inculet, Richard; Malthaner, Richard
Our vision was to develop an inexpensive training simulation in a functional operating room (in-situ) that included surgical trainees, nursing and anesthesia staff to focus on effective interprofessional communication and teamwork skills. The simulation scenario revolved around a post-pneumonectomy airway obstruction by residual tumor. This model included our thoracic operating room with patient status displayed by an open access vital sign simulator and a reversibly modified Laerdal ® airway mannequin. The simulation scenario was run seven times. Simulations were video recorded and scored using NOTSS and TeamSTEPPS2. Latent safety threats (LST) and feedback were obtained during the post simulation debriefing. Feedback was captured using the MMMO questionnaire. Several LST were identified which included missing and redundant equipment and knowledge gaps in participants roles. Consultant surgeons received a higher overall score than thoracic surgery fellows on both NOTSS (3.8 vs. 3.3) and TeamSTEPPS2 evaluations (4.1 vs. 3.2) suggesting that the scenario effectively differentiated learners from experts with regards to non-technical skills. The MMMO overall simulation experience score was 4.7 out of 5 confirming a high fidelity model and useful experiential learning model. At the Canadian Thoracic Bootcamp, the MMMO overall experience score was 4.8 out of 5 further supporting this simulation as a robust model. An inexpensive in-situ intra-operative crisis simulation model for thoracic surgical emergencies was created, implemented, and demonstrated to be effective as a proof of concept at identifying latent threats to patient safety and differentiating the non-technical skills of trainees and consultant surgeons. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Tode, V; Voinea, F; Marin, O
They are described the main aspects of vezical risk in intraperitoneal surgery: subembilical celiostomy, haernios surgery, rectal surgery, gynecological surgery. It is shown few aspects of our experience in the treatment of haernias, vesicovaginal fistules secondary to total hysterectomy.
Guzin Mukaddes Sevincer
Full Text Available Bariatric surgery is a treatment modality which is becoming increasingly popular in the last decade in our country and around the world. Patients who treated with a conventional methods are unable to loose sufficient weight and even they regained most of their lost weight easily. The number of patients undergoing bariatric surgery are increasing day by day considering the success of bariatric surgery with regard to lose weight fast and the improvement in co-morbid conditions. Obesity and bariatric surgery are in a reciprocal relationship both with psychiatric disorders and psychosocial variables. Relations are begin with the evaluation of a patients eligibility for surgery in terms of psychiatric and psychosocial issues at a very early stage of the process. Presence of psychopathology, level of knowledge related to the surgical procedure and patients expectations about physical, psychological and social changes that may occur after surgery are the significant parts of the evaluation of bariatric surgery patients. These components should be considered in assessing capacity of patients to comply with medical advice in post-operative stage. In this article the needs for assesment of psychiatric and psychosocial aspects of obese patients who will undergo bariatric surgery is reviewed in the light of current literature . Possible medical, psychiatric and psychosocial complications of bariatric surgery and related issues are reviewed and psycosocial factors that may be predictors of the successful outcome of bariatric surgery are discussed.Discussions around the nature of specific eating disorders seen frequently in bariatric surgery patients, wheter it is a separate entities from well known eating disorders and controversial issues such as presence or absence of psychopathology like suicide as directly consequence of the surgical procedures are summarized. Discussions about performing of psychiatric and psychosocial assesment (i.e by whom, how and
Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential for scrub practice, because they facilitate anticipation of the surgeon's requirements and promote appropriate communication behaviours. This literature review analyses the factors that may influence a scrub practitioner's use of non-technical skills during surgery. Recommendations are made that are intended to improve their use by reducing behavioural variations during surgery.
Johnston, Peter W; Fioratou, Evie; Flin, Rhona
Health care is a high-risk industry, with most documented adverse incidents being associated with 'human factors' including cognitive and social skills termed 'non-technical skills'. Non-technical skills complement the diagnostic and specialist skills and professional attributes required by medical practitioners, including histopathologists, and can enhance the quality of practice and delivery of health-care services and thus contribute to patient safety. This review aims to introduce histopathologists to non-technical skills and how these pertain to everyday histopathological practice. Drawing from other domains in medicine, specifically anaesthesia and surgery, a variety of non-technical skills are identified and described in the context of histopathology to illustrate the role each plays, often collectively, in daily practice. The generic non-technical skills are defined as situation awareness, decision-making, communication, teamwork, leadership, managing stress and coping with fatigue. Example scenarios from histopathology are presented and the contributions to outcomes made by non-technical skills are explained. Consideration of these specific non-technical skills as a component in histopathology training may benefit practitioners as well as assuring patient safety. © 2011 Blackwell Publishing Limited.
Spanager, Lene; Lyk-Jensen, Helle Teglgaard; Dieckmann, Peter
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...
Manaouil, Cecile; Gignon, Maxime; Jardé, Olivier
The demand for bariatric surgery is expected to increase. It is a procedure that carries a high surgical risk, and a risk of postoperative complications due to the pathologies associated with obesity. Obesity surgery is not classified as plastic surgery, but may subsequently lead to plastic surgery-type operations. Malpractices in the field of obesity surgery are most frequently at the pre-operative stage. In the absence of any fault, a patient may obtain indemnification by "national solidarity". Physicians and surgeons have an obligation to be able to prove that they informed their patients properly.
Isac Jorge Filho
Full Text Available The development fo bariatric surgery made it necessary to define theethical an legal basis of the specialty. The bioethical principles mustbe followed: benefit the patient; do not cause prohibitive colatheraleffects; be avaible to anyone withot discrimination; the pacient haveto have the possibility to choose it´s treatment. The Ministery ofHealth and the Federal Medical Counsil have regulates the indicationsfor the surgical treatment, the techniques that are availble andnecessary of a multidisciplinary team for Bariatric Surgery Centre.
Golshani, Sanobar; Mani, Arash; Toubaei, Shahin; Farnia, Vahid; Sepehry, Amir Ali; Alikhani, Mostafa
In recent years, cosmetic surgery in Iran, which is provided almost entirely by the private sector, has gained popularity despite evidence of its potential risks. In most cases, cosmetic surgeries are done to increase self-satisfaction and self-esteem, thus seeking cosmetic surgery potentially shows an individual's psychological profile. Current evidence needs studies on the psychological profile of Asian cosmetic surgery patients. The present study investigates psychological profile and personality traits of people seeking cosmetic surgery in Iran. The present prospective observational study was conducted with a sample of 274 randomly selected persons seeking cosmetic surgery (rhinoplasty, blepharoplasty, face/jaw implant, mammoplasty, and liposuction). All participants completed the validated and reliable the Global Severity Index (GSI)-Symptom Checklist-90-Revised (SCL-90-R)-and the short Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI). The prevalence rate of psychiatric problems based on the GSI cut-off point (>63) of SCL-90-R was about 51 %, and interpersonal sensitivity and psychosis were the highest and lowest endorsed syndromes among the subjects, respectively. Openness had the lowest mean score; agreeableness and extroversion had the highest mean. The current study shows that understanding and psychological evaluation prior to surgery is necessary and screening can reduce the number of unnecessary surgeries and may enhance satisfaction with surgical results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
The non-technical skills of situational awareness and the formation of effective interpersonal relationships are essential to enhance surgical outcomes. However, most scrub practitioners demonstrate only tacit awareness of these skills and develop such qualities on an informal basis. Application of non-technical skills may be assessed formally, using a structured framework, to transform normative behaviour and to strengthen barriers against the latent threats that may result from fallible humans working in inadequate organisational systems.
Jumbe, Sandra; Hamlet, Claire; Meyrick, Jane
Little is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively. Findings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings. Reframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity.
Kang, Evelyn; Massey, Debbie; Gillespie, Brigid M
To identify and describe the factors that impact on the performance of scrub nurses' non-technical skills performance during the intra-operative phase of surgery. Non-technical skills have been identified as important precursors to errors in the operating room. However, few studies have investigated factors influencing non-technical skills of scrub nurses. Prospective observational study. Structured observations were performed on a sample of 182 surgical procedures across eight specialities by two trained observers from August 2012-April 2013 at two hospital sites. Participants were purposively selected scrub nurses. Bivariate correlations and a multiple linear regression model were used to identify associations among length of surgery, patients' acuity using the American Society of Anesthesiologists classification system, team familiarity, number of occasions scout nurses leave the operating room, change of scout nurse and the outcome, the non-technical skills performance of scrub nurses. Patient acuity and team familiarity were the strongest predictors of scrub nurses' non-technical skills performance at hospital site A. There were no correlations between the predictors and the performance of scrub nurses at hospital site B. A dedicated surgical team and patient acuity potentially influence the performance of scrub nurses' non-technical skills. Familiarity with team members foster advanced planning, thus minimizing distractions and interruptions that impact on scrub nurses' performance. Development of interventions aimed at improving non-technical skills has the potential to make a substantial difference and enhance patient care. © 2015 John Wiley & Sons Ltd.
Full Text Available Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.
Yule, Steven; Parker, Sarah Henrickson; Wilkinson, Jill; McKinley, Aileen; MacDonald, Jamie; Neill, Adrian; McAdam, Tim
To investigate the effect of coaching on non-technical skills and performance during laparoscopic cholecystectomy in a simulated operating room (OR). Non-technical skills (situation awareness, decision making, teamwork, and leadership) underpin technical ability and are critical to the success of operations and the safety of patients in the OR. The rate of developing assessment tools in this area has outpaced development of workable interventions to improve non-technical skills in surgical training and beyond. A randomized trial was conducted with senior surgical residents (n = 16). Participants were randomized to receive either non-technical skills coaching (intervention) or to self-reflect (control) after each of 5 simulated operations. Coaching was based on the Non-Technical Skills For Surgeons (NOTSS) behavior observation system. Surgeon-coaches trained in this method coached participants in the intervention group for 10 minutes after each simulation. Primary outcome measure was non-technical skills, assessed from video by a surgeon using the NOTSS system. Secondary outcomes were time to call for help during bleeding, operative time, and path length of laparoscopic instruments. Non-technical skills improved in the intervention group from scenario 1 to scenario 5 compared with those in the control group (p = 0.04). The intervention group was faster to call for help when faced with unstoppable bleeding in the final scenario (no. 5; p = 0.03). Coaching improved residents' non-technical skills in the simulated OR compared with those in the control group. Important next steps are to implement non-technical skills coaching in the real OR and assess effect on clinically important process measures and patient outcomes. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Normal 0 21 MicrosoftInternetExplorer4 Two main competence approaches are under the discussion. There is evidence that graduates do not fully perceive and/or underestimate the influence of non-technical competences on their employability. An understanding of the necessity of non-technical competences develops after a graduate has already been hired and is working at that job.
Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter
Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training.......Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training....
von Dercks, N; Gockel, I; Mehdorn, M; Lorenz, D
The incidence of esophageal carcinoma has increased in recent years in Germany. The aim of this article is a discussion of the economic aspects of oncological esophageal surgery within the German diagnosis-related groups (DRG) system focusing on the association between minimum caseload requirements and outcome quality as well as costs. The margins for the DRG classification G03A are low and quickly exhausted if complications determine the postoperative course. A current study using nationwide German hospital discharge data proved a significant difference in hospital mortality between clinics with and without achieving the minimum caseload requirements for esophagectomy. Data from the USA clearly showed that besides patient-relevant parameters, the caseload of a surgeon is relevant for the cost of treatment. Such cost-related analyses do not exist in Germany at present. Scientific validation of reliable minimum caseload numbers for oncological esophagectomy is desirable in the future.
Crossley, J; Marriott, J; Purdie, H; Beard, J D
Most surgical assessment has been aimed at technical proficiency. However, non-technical skills also affect patient safety and clinical effectiveness. The NOTSS (Non-Technical Skills for Surgeons) assessment instrument was developed specifically to assess the non-technical skills of individual surgeons in the operating theatre. This study evaluated NOTSS as a real-world assessment, with a mix of minimally trained assessors. The evaluation criteria were feasibility, validity and psychometric reliability. In a standard evaluation of NOTSS, 56 anaesthetists, 39 scrub nurses, two surgical care practitioners and three independent assessors provided 715 assessments of 404 surgical cases of 15 index procedures across six specialties performed by 85 surgical trainees. The assessment was feasible, but important implementation challenges were highlighted. Most respondents considered the method valid, but with reservations about assessing cognition. The factor structure of scores, and their positive relationships with other measures of experience and performance, supported validity. Trainees' non-technical skill scores were relatively procedure-independent and achieved good reliability (generalizability coefficient 0·8 or more) when six to eight assessors observed one case each. Minimally trained assessors, who are typically present in operating theatres, were sufficiently discriminating and consistent in their judgements of trainee surgeons' non-technical skills to provide reliable scores based on an achievable number of observations. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Yule, J; Hill, K; Yule, S
Non-technical skills are essential for safe and effective surgery. Several tools to assess surgeons' non-technical skills from the clinician's perspective have been developed. However, a reliable measurement tool using a patient-centred approach does not currently exist. The aim of this study was to translate the existing Non-Technical Skills for Surgeons (NOTSS) tool into a patient-centred evaluation tool. Data were gathered from four cohorts of patients using an iterative four-stage mixed-methods research design. Exploratory and confirmatory factor analyses were performed to establish the psychometric properties of the tool, focusing on validity, reliability, usability and parsimony. Some 534 patients were recruited to the study. A total of 24 patient-centred non-technical skill items were developed in stage 1, and reduced to nine items in stage 2 using exploratory factor analysis. In stage 3, confirmatory factor analysis demonstrated that these nine items each loaded on to one of three factors, with excellent internal consistency: decision-making, leadership, and communication and teamwork. In stage 4, validity testing established that the new tool was independent of physician empathy and predictive of surgical quality. Surgical leadership emerged as the most dominant skill that patients could recognize and evaluate. A novel nine-item assessment tool has been developed. The Patients' Evaluation of Non-Technical Skills (PENTS) tool allows valid and reliable measurement of surgeons' non-technical skills from the patient perspective. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.
Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George
Efforts to reduce adverse event rates in healthcare have revealed the importance of identifying the essential non-technical (cognitive and social) skills for safe and effective performance. Previous research on non-technical skills for operating theatre staff has concentrated on doctors rather than nursing professionals. The aim of the study was to identify the critical non-technical skills that are essential for safe and effective performance as an operating theatre scrub nurse. Experienced scrub nurses (n = 25) and consultant surgeons (n = 9) from four Scottish hospitals were interviewed using a semi-structured format. The protocols were designed to identify the main social and cognitive skills required by scrub nurses. Interviews were digitally recorded, transcribed verbatim and independently coded to extract behaviours in order to produce a list of the main non-technical skills for safe and effective scrub nurse performance. The non-technical skills of situation awareness, communication, teamwork, task management and coping with stress were identified as key to successful scrub nurse task performance. Component sets of behaviours for each of these categories were also noted. The interviews with subject matter experts from scrub nursing and surgery produced preliminary evidence that situation awareness, communication, teamwork and coping with stress are the principal non-technical skills required for effective performance as a scrub nurse. Copyright © 2010 Elsevier Ltd. All rights reserved.
Michinov, Estelle; Jamet, Eric; Dodeler, Virginie; Haegelen, Claire; Jannin, Pierre
The management of non-technical skills is a major factor affecting teamwork quality and patient safety. This article presents a behavioural marker system for assessing neurosurgical non-technical skills (BMS-NNTS). We tested the BMS during deep brain stimulation surgery. We developed the BMS in three stages. First, we drew up a provisional assessment tool based on the literature and observation tools developed for other surgical specialties. We then analysed videos made in an operating room (OR) during deep brain stimulation operations in order to ensure there were no significant omissions from the skills list. Finally, we used five videos of operations to identify the behavioural markers of non-technical skills in verbal communications. Analyses of more than six hours of observations revealed 3515 behaviours from which we determined the neurosurgeon's non-technical skills behaviour pattern. The neurosurgeon frequently engaged in explicit coordination, situation awareness and leadership behaviours. In addition, the neurosurgeon's behaviours differed according to the stage of the operation and the OR staff members with whom she was communicating. Our behavioural marker system provides a structured approach to assessing non-technical skills in the field of neurosurgery. It can also be transferred to other surgical specialties and used in surgeon training curricula. © 2014 John Wiley & Sons, Ltd.
Rashid, Prem; Gianduzzo, Troy R J
To review the emerging role of technical and non-technical simulation in urological education and training. A review was conducted to examine the current role of simulation in urology training. A PUBMED search of the terms 'urology training', 'urology simulation' and 'urology education' revealed 11,504 titles. Three hundred and fifty-seven abstracts were identified as English language, peer reviewed papers pertaining to the role of simulation in urology and related topics. Key papers were used to explore themes. Some cross-referenced papers were also included. There is an ongoing need to ensure that training time is efficiently utilised while ensuring that optimal technical and non-technical skills are achieved. Changing working conditions and the need to minimise patient harm by inadvertent errors must be taken into account. Simulation models for specific technical aspects have been the mainstay of graduated step-wise low and high fidelity training. Whole scenario environments as well as non-technical aspects can be slowly incorporated into the curriculum. Doing so should also help define what have been challenging competencies to teach and evaluate. Dedicated time, resources and trainer up-skilling are important. Concurrent studies are needed to help evaluate the effectiveness of introducing step-wise simulation for technical and non-technical competencies. Simulation based learning remains the best avenue of progressing surgical education. Technical and non-technical simulation could be used in the selection process. There are good economic, logistic and safety reasons to pursue the process of ongoing development of simulation co-curricula. While the role of simulation is assured, its progress will depend on a structured program that takes advantage of what can be delivered via this medium. Overall, simulation can be developed further for urological training programs to encompass technical and non-technical skill development at all stages, including
Jumbe, S.; Hamlet, C.; Meyrick, J.
Little is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively.\\ud \\ud Findings show that despite undisputed significant weight loss and improvements in comor...
Chalwin, R P; Flabouris, A
Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.
Irwin, A; Weidmann, A E
Non-technical skills refer to the social and cognitive factors that may influence efficient and safe job performance. Non-technical skills are an important element of patient safety in a variety of health care disciplines, including surgery, anesthesia and nursing. However, the use of non-technical skills in pharmacy practice has not yet been fully assessed. To examine attitudes toward, and use of, non-technical skills by pharmacy personnel. A mixed methods approach was used: An attitude survey explored pharmacy personnel attitudes towards non-technical skills and inter-professional collaboration, with community and hospital pharmacy staff (n = 62). Qualitative interviews were then conducted using the critical incident technique, with community pharmacists (n = 11). The survey results demonstrated differences in the opinions of community and hospital pharmacists on three non-technical skill constructs: team structure, mutual support, and situation monitoring, with community pharmacists reporting significantly more positive attitudes about all three constructs. Both groups reported low levels of collaboration with primary care physicians. The interviews identified five non-technical skills as key elements of successful pharmacist performance from the interview transcripts: teamwork; leadership; task management; situation awareness; decision-making. The survey and interviews identified the non-technical skills that are important to pharmacists. This represents the first step towards the development of a behavioral rating system for training purposes that could potentially improve the non-technical skills of pharmacists and enhance patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.
Jackson, Denise; Chapman, Elaine
Purpose: The need for "job-ready" graduates has catalysed the development of non-technical skills in higher education institutions worldwide. Continued criticism of business school outcomes has provoked this examination of non-technical skill deficiencies in Australian business graduates. The purpose of this paper is to compare findings…
Reader, T.; Flin, R.; Lauche, K.; Cuthbertson, B.H.
In high-risk industries such as aviation, the skills not related directly to technical expertise, but crucial for maintaining safety (e.g. teamwork), have been categorized as non-technical skills. Recently, research in anaesthesia has identified and developed a taxonomy of the non-technical skills
Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George
Adverse events still occur despite ongoing efforts to reduce harm to patients. Contributory factors to adverse events are often due to limitations in clinicians' non-technical skills (e.g. communication, situation awareness), rather than deficiencies in technical competence. We developed a behavioural rating system to provide a structured means for teaching and assessing scrub practitioners' (i.e. nurse, technician, operating department practitioner) non-technical skills. Psychologists facilitated focus groups (n = 4) with experienced scrub practitioners (n = 16; 4 in each group) to develop a preliminary taxonomy. Focus groups reviewed lists of non-technical-skill-related behaviours that were extracted from an interview study. The focus groups labelled skill categories and elements and also provided examples of good and poor behaviours for those skills. An expert panel (n = 2 psychologists; n = 1 expert nurse) then used an iterative process to individually and collaboratively review and refine those data to produce a prototype skills taxonomy. A preliminary taxonomy containing eight non-technical skill categories with 28 underlying elements was produced. The expert panel reduced this to three categories (situation awareness, communication and teamwork, task management), each with three underlying elements. The system was called the Scrub Practitioners' List of Intraoperative Non-Technical Skills system. A scoring system and a user handbook were also developed. A prototype behavioural rating system for scrub practitioners' non-technical skills was developed, to aid in teaching and providing formative assessment. This important aspect of performance is not currently explicitly addressed in any educational route to qualify as a scrub practitioner. © 2012 Blackwell Publishing Ltd.
G. Bol-Raap (Goris)
textabstractIn chapter 1, an outline of the thesis is given. This thesis focuses on aspects of surgical closure of a congenital ventricular septal defect. In Chapter 2, the accuracy and the potential of 3-D echocardiography in the preoperative assessment of a congenital VSD were evaluated. 3-D
Bianco, Francesco Maria; Daskalaki, Despoina; Gonzalez-Ciccarelli, Luis Fernando; Kim, Jihun; Benedetti, Enrico
Minimally invasive surgery for liver resections has a defined role and represents an accepted alternative to open techniques for selected cases. Robotic technology can overcome some of the disadvantages of the laparoscopic technique, mainly in the most complex cases. Precise dissection and microsuturing is possible, even in narrow operative fields, allowing for a better dissection of the hepatic hilum, fine lymphadenectomy, and biliary reconstruction even with small bile ducts and easier bleeding control. This technique has the potential to allow for a greater number of major resections and difficult segmentectomies to be performed in a minimally invasive fashion. The implementation of near-infrared fluorescence with indocyanine green (ICG) also allows for a more accurate recognition of vascular and biliary anatomy. The perspectives of this kind of virtually implemented imaging are very promising and may be reflected in better outcomes. The overall data present in current literature suggests that robotic liver resections are at least comparable to both open and laparoscopic surgery in terms of perioperative and postoperative outcomes. This article provides technical details of robotic liver resections and a review of the current literature. PMID:27500143
Spanager, Lene; Dieckmann, Peter; Beier-Holgersen, Randi
OBJECTIVE: This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons' non-technical skills. METHODS: Trainee surgeons and their supervisors used the Non......-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...
Gostlow, H; Marlow, N; Thomas, M J W; Hewett, P J; Kiermeier, A; Babidge, W; Altree, M; Pena, G; Maddern, G
In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees. Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared. For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score -0·015 units per year), implementing and reviewing decisions (-0·020 per year), establishing a shared understanding (-0·014 per year), setting and maintaining standards (-0·024 per year), supporting others (-0·031 per year) and coping with pressure (-0·015 per year). The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.
Jepsen, R M H G; Dieckmann, Gerhard Peter; Spanager, L
BACKGROUND: Non-technical skills (NTS) are essential for safe and efficient anaesthesia. Assessment instruments with appropriate validity evidence can be used to ensure that anaesthesiologists possess the NTS necessary to deliver high-standard patient care. The aims were to collect validity...... evidence using a contemporary validity framework for the assessment instrument Anaesthesiologists' Non-Technical Skills in Denmark (ANTSdk) regarding response process and internal structure (including reliability), and to investigate the effect of rater training on these properties. METHODS: An explorative...
Matsui, Yuko; Hikono, Masaru; Iwasaki, Mari; Morita, Mizuho
This study aimed at characterizing a non-technical skill exercise for on-site managers in charge of initial response at an emergency response center by extracting and clarifying the behavior examples of non-technical skills shown in the exercise scenario. From video observations, the non-technical skill examples were identified from seven of the eight nontechnical skill categories which had been defined when the training program was developed. Especially, they included many skills of 'Communication', 'Situation Understanding' and 'Organizational management'. At the same time, the limitation when extracting the cases by observations was identified. The extracted non-technical skill cases are expected to be used for characterizing exercise scenarios, as well as provide knowledge to raise the awareness of exercise participants. (author)
Patient safety is an increasingly recognised issue in health care. Systems-based and organisational methods of quality improvement, as well as education focusing on key clinical areas, are common, but there are few reports of educational interventions that focus on non-technical skills to address human factor sources of error. A flexible model for non-technical skills training for health care professionals has been designed based on the best available evidence, and with sound theoretical foundations. Educational sessions to improve non-technical skills in health care have been described before. The descriptions lack the details to allow educators to replicate and innovate further. A non-technical skills training course that can be delivered as either a half- or full-day intervention has been designed and delivered to a number of mixed groups of undergraduate medical students and doctors in postgraduate training. Participant satisfaction has been high and patient safety attitudes have improved post-intervention. This non-technical skills educational intervention has been built on a sound evidence base, and is described so as to facilitate replication and dissemination. With the key themes laid out, clinical educators will be able to build interventions focused on numerous clinical issues that pay attention to human factor contributors to safety. © 2013 John Wiley & Sons Ltd.
Shields, Allan; Flin, Rhona
Healthcare organisations have started to examine the impact that the human worker has on patient safety. Adopting the Crew Resource Management (CRM) approach, used in aviation, the CRM or non-technical skills of anaesthetists, surgeons, scrub practitioners and emergency physicians have recently been identified to assist in their training and assessment. Paramedics are exposed to dynamic and dangerous situations where patients have to be managed, often with life-threatening injuries or illness. As in other safety-critical domains, the technical skills of paramedics are complemented by effective non-technical skills. The aim of this paper was to review the literature on the non-technical (social and cognitive) skills used by paramedics. This review was undertaken as part of a task analysis to identify the non-technical skills used by paramedics. Of the seven papers reviewed, the results have shown very little research on this topic and so reveal a gap in the understanding of paramedic non-technical skills.
Dieckmann, Gerhard Peter; Glavin, Ronnie; Jepsen, Rikke Malene Hartvigsen Grønholm
, and simulation as a complex technique. The combination of all three aspects might overwhelm learners. To facilitate the deeper comprehension of NTS concepts, we describe an innovative video-based game, the Non-Technical Skills (NTS) Bingo. Participants get NTS Bingo cards that show five NTS elements each. While......Acquiring the concepts of non-technical skills (NTS) beyond a superficial level is a challenge for healthcare professionals and simulation faculty. Current simulation-based approaches to teach NTS are challenged when learners have to master NTS concepts, clinically challenging situations...... observing (non-medical) video clips, they try to find examples for the elements on their cards, typically observable behaviours that match a given element. After the video, participants “defend” their solution in a discussion with the game leader and other players. This discussion and the reflection aim...
This paper describes and discusses non-technical policy considerations which may improperly influence decisions on the solidification of low-level radioactive wastes (''LLW''). These policy considerations are contained principally in several State and Federal statutes which regulate various aspects of LLW disposal. One policy consideration in particular, the unqualified bias in favor of volume reduction, is shown to present a substantial potential for leading to technically suboptimal decisions on the appropriate processes for solidifying LLW. To avoid the unintended skewing of technical decisions by non-technical policy considerations, certain current policies may need to be revised to ensure that the choices of waste treatment, including decisions on solidification, are based primarily on reasonable assurance of adequate protection of public health and safety. This goal may be realized in part by basing any disposal fee structure on more than just LLW volume to include consideration of the waste's activity and its difficulty of confinement
Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F
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. Georg Thieme Verlag KG Stuttgart · New York.
Rosenthal, David A
The implementation of IT within any healthcare organization is a demanding and intense exercise in the management of both technical (systemic) and non-technical (social) influences and factors, and the project process is often fraught with unforeseen obstacles or impediments to success. Project success depends as much on a specific understanding of the non-technical project impediments such as conflicting personalities and corporate culture as it does on the performance of the applied technology or the viability of the implementation process itself.
Danielson, Jared A; Wu, Tsui-Feng; Fales-Williams, Amanda J; Kirk, Ryan A; Preast, Vanessa A
Employers of 2007-2009 graduates from Iowa State University College of Veterinary Medicine were asked to respond to a survey regarding their overall satisfaction with their new employees as well as their new employees' preparation in several technical and non-technical skill areas. Seventy-five responses contained complete data and were used in the analysis. Four technical skill areas (data collection, data interpretation, planning, and taking action) and five non-technical skill areas (interpersonal skills, ability to deal with legal issues, business skills, making referrals, and problem solving) were identified. All of the skill area subscales listed above had appropriate reliability (Cronbach's alpha>0.70) and were positively and significantly correlated with overall employer satisfaction. Results of two simultaneous regression analyses indicated that of the four technical skill areas, taking action is the most salient predictor of employer satisfaction. Of the five non-technical skill areas, interpersonal skills, business skills, making referrals, and problem solving were the most important skills in predicting employer satisfaction. Hierarchical regression analysis revealed that all technical skills explained 25% of the variation in employer satisfaction; non-technical skills explained an additional 42% of the variation in employer satisfaction.
Although technical constraints to eradication of bovine tuberculosis are well-recognised, non-technical constraints can also delay progress towards eradication, leading to inefficiency and increased programme costs. This paper seeks to analyse the main non-technical constraints that can interfere with the successful implementation of tuberculosis eradication plans, based on experiences from an area of high tuberculosis prevalence in Regione Piemonte, Italy. The main social and economic constraints faced in the past 20 years are reviewed, including a social reluctance to recognise the importance of seeking eradication as the goal of disease control, effective communication of technical issues, the training and the organization of veterinary services, the relationship between the regional authority and farmers and their representatives, and data management and epidemiological reporting. The paper analyses and discusses the solutions that were applied in Regione Piemonte and the benefits that were obtained. Tuberculosis eradication plans are one of the most difficult tasks of the Veterinary Animal Health Services, and non-technical constraints must be considered when progress towards eradication is less than expected. Organizational and managerial resources can help to overcome social or economic obstacles, provided the veterinary profession is willing to address technical, but also non-technical, constraints to eradication.
Full Text Available Background . Patient-Reported Outcomes (PROs, including psychological factors, have become an important aspect of both health research and clinical practice. Patients who have undergone cardiac surgery can constitute a large subgroup of the patients of a family physician. Postoperative distress has been observed in up to 40% of patients. Objectives. The study aimed to evaluate anxiety levels among patients who had undergone cardiac surgery, and to explore the correlations between anxiety and depression and subjective health status. Material and methods. The research group consisted of 70 patients (48 men, mean age: 65.9 years; ± 8.5. The study was conducted during consultations three months after surgery. The Hospital Anxiety and Depression Scale (HADS, including question regarding suicidal thoughts, was used. A four-point Likert scale was used to evaluate subjective effectiveness of the surgery and the Visual Analogue Scale (VAS was used to assess subjective health status. Results. An increased level of anxiety was observed in 23 patients (32.9%, and depression was seen in 12 (17.1%. 13 patients (18.6% indicated that they had had suicidal thoughts. Patients with suicidal ideation had significantly higher level of anxiety. Significant positive correlations were noted between levels of anxiety and depression. Anxiety level correlated negatively with subjective health status and assessment of surgery effectiveness. No significant connections were observed between level of anxiety and sex, age, or the type of surgery. Conclusions . 1. Increased levels of anxiety were observed in a significant percentage of patients who had undergone cardiac surgery. 2. Increased anxiety level is concomitant with depression, suicidal thoughts, and lower subjective health status assessment. 3. Health status assessment following cardiac surgery should also include the evaluation of mental health.
Gordon, Morris; Box, Helen; Halliwell, Jo-Anne; Farrell, Michael; Parker, Linda; Stewart, Alison
Training in 'non-technical skills', i.e. social (communication and teamwork) and cognitive (analytical and personal behaviour) skills, in health care have been of great interest over the last decade. Whereas the majority of publications focus on 'whether' such education can be successful, they overlook 'how' they enhance skills. We designed and piloted a theoretically robust teaching package that addresses non-technical skills in the context of medicine safety through simulation-based interprofessional learning: the Training In Non-technical Skills to Enhance Levels of Medicines Safety (TINSELS) programme. A modified Delphi process was completed to identify learning outcomes, and multi-professional teams were recruited through local publicity. The faculty staff developed a three-session simulation-based intervention: firstly, a simulated ward encounter with multiple medicine-related activities; secondly, an extended debriefing and facilitated discussion; and finally, a 'chamber of horrors', where interprofessional teams identified potential sources of error. Each session was completed in the simulation suite with between six and nine participants, lasted approximately 90 minutes and took place over 2 weeks. Full details of the course will be presented to facilitate dissemination. Training in 'non-technical skills' in health care have been of great interest over the last decade Feedback was collected on a Likert scale after the course (1, strongly disagree; 5, strongly agree). Mean scores were all greater than 4, with qualitative feedback noting the fidelity of the authentic interprofessional groups. A previously validated safety attitudes questionnaire found changes in attitudes towards handover of care and perceptions of safety in the workplace. An original, simulation-based, multi-professional training programme has been developed with learning and assessment materials available for widespread replication. © 2015 John Wiley & Sons Ltd.
Blumer, Yann B.; Stauffacher, Michael; Lang, Daniel J.; Hayashi, Kiyotada; Uchida, Susumu
There is wide agreement in the literature that non-technical factors play a decisive role in the successful implementation of bioenergy projects. One underlying reason is that such projects require the involvement of many stakeholders, such as feedstock producers, engineers, authorities and the concerned public. We analyze the role of bioenergy-specific non-technical factors for the success of bioenergy projects. In a broad literature review we first identify potential success factors belonging to the five dimensions project characteristics, policy framework, regional integration, public perception and stakeholders. Using these factors as conceptual framework, we next analyze six Japanese pilot projects for bioenergy utilization supported by Japans Agriculture, Forestry and Fisheries Research Council. We apply Rough Set Analysis, a data mining method that can be used for small sample sizes to identify patterns in a dataset. We find that, by and large, non-technical factors from all five dimensions – such as the stability of the local policy framework – co-occur with project success. Furthermore, we show that there are diverging interpretations as to what success in a bioenergy project means. This requires tradeoffs between various goals, which should be identified and addressed explicitly at early stages of such a project. - Highlights: • We collect a broad list of non-technical success factors for bioenergy projects. • These are applied to six pilot projects in Japan and shown to be relevant. • We acknowledge different aspects of project success and their potential conflicts
Tsuburaya, Akira; Soma, Takahiro; Yoshikawa, Takaki; Cho, Haruhiko; Miki, Tamotsu; Uramatsu, Masashi; Fujisawa, Yoshikazu; Youngson, George; Yule, Steven
Non-technical skills rating systems, which are designed to support surgical performance, have been introduced worldwide, but not officially in Japan. We performed a pilot study to evaluate the "non-technical skills for surgeons" (NOTSS) rating system in a major Japanese cancer center. Upper gastrointestinal surgeons were selected as trainers or trainees. The trainers attended a master-class on NOTSS, which included simulated demo-videos, to promote consistency across the assessments. The trainers thereafter commenced observing the trainees and whole teams, utilizing the NOTSS and "observational teamwork assessment for surgery" (OTAS) rating systems, before and after their education. Four trainers and six trainees were involved in this study. Test scores for understanding human factors and the NOTSS system were 5.89 ± 1.69 and 8.00 ± 1.32 before and after the e-learning, respectively (mean ± SD, p = 0.010). The OTAS scores for the whole team improved significantly after the trainees' education in five out of nine stages (p < 0.05). There were no differences in the NOTSS scores before and after education, with a small improvement in the total scores for the "teamwork and communication" and "leadership" categories. These findings demonstrate that implementing the NOTSS system is feasible in Japan. Education of both surgical trainers and trainees would contribute to better team performance.
Harvey, Rachel; Mellanby, Edward; Dearden, Effie; Medjoub, Karima; Edgar, Simon
Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an a priori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin et al. Ninety-seven per cent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum. © 2015 John Wiley & Sons Ltd.
Spanager, Lene; Dieckmann, Peter; Beier-Holgersen, Randi; Rosenberg, Jacob; Oestergaard, Doris
This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons' non-technical skills. Trainee surgeons and their supervisors used the Non-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. Six trainees and six supervisors participated in eight feedback conversations. Eighty questionnaires (response rate 83 percent) were collected from 13 trainees and 12 supervisors. Conversations lasted median eight (2-15) minutes. Supervisors used the elements and categories in the tool to structure the content of the conversations. Supervisors tended to talk about the trainees' actions and their own frames rather than attempting to understand the trainees' perceptions. Supervisors and trainees welcomed the feedback opportunity and agreed that the conversations were useful and comprehensive. The content of the feedback conversations reflected the contents of the tool and the feedback was considered useful and comprehensive. However, supervisors talked primarily about their own frames, so in order for the feedback to reach its full potential, supervisors may benefit from training techniques to stimulate a deeper reflection among trainees.
Dieckmann, Peter; Beier-Holgersen, Randi; Rosenberg, Jacob; Oestergaard, Doris
Objectives This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons’ non-technical skills. Methods Trainee surgeons and their supervisors used the Non-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 from 13 trainees and 12 supervisors. Conversations lasted median eight (2-15) minutes. Supervisors used the elements and categories in the tool to structure the content of the conversations. Supervisors tended to talk about the trainees’ actions and their own frames rather than attempting to understand the trainees’ perceptions. Supervisors and trainees welcomed the feedback opportunity and agreed that the conversations were useful and comprehensive. Conclusions The content of the feedback conversations reflected the contents of the tool and the feedback was considered useful and comprehensive. However, supervisors talked primarily about their own frames, so in order for the feedback to reach its full potential, supervisors may benefit from training techniques to stimulate a deeper reflection among trainees. PMID:25602262
Dieckmann, Peter; Glavin, Ronnie; Hartvigsen Grønholm Jepsen, Rikke Malene; Krage, Ralf
Acquiring the concepts of non-technical skills (NTS) beyond a superficial level is a challenge for healthcare professionals and simulation faculty. Current simulation-based approaches to teach NTS are challenged when learners have to master NTS concepts, clinically challenging situations, and simulation as a complex technique. The combination of all three aspects might overwhelm learners. To facilitate the deeper comprehension of NTS concepts, we describe an innovative video-based game, the Non-Technical Skills (NTS) Bingo. Participants get NTS Bingo cards that show five NTS elements each. While observing (non-medical) video clips, they try to find examples for the elements on their cards, typically observable behaviours that match a given element. After the video, participants "defend" their solution in a discussion with the game leader and other players. This discussion and the reflection aim to deepen the processing of the NTS concepts. We provide practical guidance for the conduct of NTS Bingo, including a selection of usable video clips and tips for the facilitated discussion after a clip. We use NTS in anaesthesia as example and provide guidance on how to adapt NTS Bingo to other disciplines. NTS Bingo is based on theoretical considerations on concept learning, which we describe to support the rationale for its conduct.
Irwin, Amy; Poots, Jill
Farming is a high-risk sector with up to 170,000 worldwide fatalities reported per year; it is therefore vital to identify methods of mitigating the dangers of this industry. Research within high-risk industries, such as aviation, shipping, and agriculture, has identified the importance of non-technical skills (NTS) in maintaining effective, safe performance and reducing error and injury. However, there is a lack of research evaluating factors that may contribute to NTS attitudes and behaviors. As a first step to address this literature gap, the current study evaluated a range of individual and environmental factors as potential predictors of attitudes toward NTS in agriculture. A sample of 170 farmers from within the United Kingdom and Ireland were surveyed using an online questionnaire. The questionnaire included measures of personality, stress, attitudes toward safety (safety climate, motivation, and risk), environmental stressors (workload, work-life imbalance), and non-technical skills (team and lone worker). Attitudes toward safety climate, compliance, and motivation showed a significant association with both team-based and lone worker NTS. Conscientiousness correlated positively with the majority of the NTS elements. Multiple regression analysis indicated neuroticism and conscientiousness demonstrated capacity to predict NTS attitudes. Concerns about costs and equipment, attitudes toward safety climate, and safety motivation were also found to be significant predictors of NTS attitudes. The results indicate the utility of individual characteristics and environmental factors when predicting farming NTS attitudes. As a result, these elements could be important when evaluating engagement with NTS and developing NTS training initiatives in agriculture.
VanderBrink, Brian A; Stock, Jeffrey A; Hanna, Moneer K
Long-term follow-up of patients born with classical bladder exstrophy-epispadias complex (EEC) reveals that many of them suffer from poor self-image, and the aesthetic aspects of the genitalia and lower abdomen acquire greater significance with age. In this article, we review the aesthetic outcomes in performing puboplasty, umbilicoplasty, and genitoplasty in patients born with EEC. Retrospective review of the cosmetic and functional outcomes in 116 patients born with EEC treated by puboplasty, umbilicoplasty, or genitoplasty was performed. Satisfaction with the cosmetic and functional outcomes of these three reconstructive surgeries was high following initial reconstructive efforts (> 90%). Attention to cosmesis during abdominal wall and genital reconstruction for EEC helps to improve a patient's perception of body image and self-esteem. Our experience with these procedures over the past 25 years demonstrated that the efforts directed toward aesthetics have been well worthwhile.
Kallenbach-Herbert, Beate; Brohmann, Bettina
The paper highlights that a comprehensive approach to safety affords the consideration of technology, organisation, personnel and social environment. In several safety relevant contexts of nuclear waste disposal these fields are closely interrelated. The approach for the consideration of socio-scientific aspects which is sketched in this paper supports the systematic treatment of safety relevant non-technical issues in the safety case or in safety assessments for a disposal project. Furthermore it may foster the dialogue among specialists from the technical, the natural- and the socio-scientific field on questions of disposal safety. In this way it may contribute to a better understanding among the affected scientific disciplines in nuclear waste disposal.
Wardle, M. D.
The microbiological aspects of clean room technology as applied to surgery were reviewed. The following pertinent subject areas were examined: (1) clean room technology per se and its utilization for surgery, (2) microbiological monitoring of the clean room surgical environment, (3) clean rooms and their impact on operating room environmental microbiology, and (4) the effect of the technology on surgical wound infection rates. Conclusions were drawn for each topic investigated.
Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter; Konge, Lars; Rosenberg, Jacob; Oestergaard, Doris
Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training. A 1-day course was conducted for 15 general surgeons in which they rated surgeons' nontechnical skills in 9 video recordings of scenarios simulating real intraoperative situations. Data were gathered from 2 sessions separated by a 4-hour training session. Interrater reliability was high for both pretraining ratings (Cronbach's α = .97) and posttraining ratings (Cronbach's α = .98). There was no statistically significant development in assessment skills. The D study showed that 2 untrained raters or 1 trained rater was needed to obtain generalizability coefficients >.80. The high pretraining interrater reliability indicates that videos were easy to rate and Non-Technical Skills for Surgeons dk easy to use. This implies that Non-Technical Skills for Surgeons dk (NOTSSdk) could be an important tool in surgical training, potentially improving safety and quality for surgical patients. Copyright © 2013 Elsevier Inc. All rights reserved.
Nagasaka, Akihiko; Shibue, Hisao
The purpose of this study is to systematize measures for improvement of emergency response capability focused on non-technical skills. As the results of investigation of some emergency training in nuclear power plant and referring to CRM training, following two issues were picked up. 1) Lack of practical training method for improvement of non-technical skills. 2) Lack of evaluation method of non-technical skills. Then, based on these 7 non-technical skills 'situational awareness' 'decision making' 'communication' 'teamworking' 'leadership' 'managing stress' 'coping with fatigue' are promotion factors to improve emergency response capability, we propose practical training method for each non-technical skill. Also we give example of behavioral markers as evaluation factor, and indicate approaches to introduce the evaluation method of non-technical skills. (author)
Flin, Rhona; Maran, Nikki
In this paper, we explain the conceptual background to non-technical skills and show how they can influence job performance in anaesthesia. We then describe the taxonomy of anaesthetists' non-technical skills (ANTS) and related systems, such as ANTS-AP for anaesthetic practitioners. We discuss the training courses that have been designed to teach these non-technical skills, which are called crew resource management (CRM), crisis resource management (CRM) or crisis avoidance resource management (CARMA). Finally, we discuss the application of non-technical skills assessment systems. Copyright © 2015 Elsevier Ltd. All rights reserved.
Siu, Joey; Maran, Nikki; Paterson-Brown, Simon
The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Cukiert, Arthur; Rydenhag, Bertil; Harkness, William; Cross, J Helen; Gaillard, William D
Surgical techniques may vary extensively between centers. We report on a web-based survey aimed at evaluating the current technical approaches in different centers around the world performing epilepsy surgery in children. The intention of the survey was to establish technical standards. A request was made to 88 centers to complete a web-based survey comprising 51 questions. There were 14 questions related to general issues, 13 questions investigating the different technical aspects for children undergoing epilepsy surgery, and 24 questions investigating surgical strategies in pediatric epilepsy surgery. Fifty-two centers covering a wide geographic representation completed the questionnaire. The median number of resective procedures per center per year was 47. Some important technical practices appeared (>80% of the responses) such as the use of prophylactic antibiotics (98%), the use of high-speed drills for bone opening (88%), nonresorbable material for bone flap closure (85%), head fixation (90%), use of the surgical microscope (100%), and of free bone flaps. Other questions, such as the use of drains, electrocorticography (ECoG) and preoperative withdrawal of valproate, led to mixed, inconclusive results. Complications were noted in 3.8% of the patients submitted to cortical resection, 9.9% hemispheric surgery, 5% callosotomy, 1.8% depth electrode implantation, 5.9% subdural grids implantation, 11.9% hypothalamic hamartoma resection, 0.9% vagus nerve stimulation (VNS), and 0.5% deep brain stimulation. There were no major differences across regions or countries in any of the subitems above. The present data offer the first overview of the technical aspects of pediatric epilepsy surgery worldwide. Surprisingly, there seem to be more similarities than differences. That aside many of the evaluated issues should be examined by adequately designed multicenter randomized controlled trials (RCTs). Further knowledge on these technical issues might lead to increased
Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen
Objectives The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student’s behaviour, attitudes, and performance during simulated patient treatment. Methods Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Results Non-technical skills concerning situation awareness (pteamwork (pattitude ‘handling errors’ improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. Conclusions This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student’s non-technical skills. In a next step, to improve student’s handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum. PMID:28355594
Pena, G; Altree, M; Field, J; Thomas, M J W; Hewett, P; Babidge, W; Maddern, G J
An important factor that may influence an individual's performance is self-efficacy, a personal judgement of capability to perform a particular task successfully. This prospective study explored newly qualified surgeons' and surgical trainees' self-efficacy in non-technical skills compared with their non-technical skills performance in simulated scenarios. Participants undertook surgical scenarios challenging non-technical skills in two simulation sessions 6 weeks apart. Some participants attended a non-technical skills workshop between sessions. Participants completed pretraining and post-training surveys about their perceived self-efficacy in non-technical skills, which were analysed and compared with their performance in surgical scenarios in two simulation sessions. Change in performance between sessions was compared with any change in participants' perceived self-efficacy. There were 40 participants in all, 17 of whom attended the non-technical skills workshop. There was no significant difference in participants' self-efficacy regarding non-technical skills from the pretraining to the post-training survey. However, there was a tendency for participants with the highest reported self-efficacy to adjust their score downwards after training and for participants with the lowest self-efficacy to adjust their score upwards. Although there was significant improvement in non-technical skills performance from the first to second simulation sessions, a correlation between participants' self-efficacy and performance in scenarios in any of the comparisons was not found. The results suggest that new surgeons and surgical trainees have poor insight into their non-technical skills. Although it was not possible to correlate participants' self-belief in their abilities directly with their performance in a simulation, in general they became more critical in appraisal of their abilities as a result of the intervention. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.
Full Text Available The purpose of this paper is to identify portions of the literature in the areas of Information Technology (IT management, skills development, and curriculum development that support the design of a holistic conceptual framework for instruction in non-technical skills within the IT higher education context. This article review provides a framework for understanding how the critical success factors related to IT and Information Systems (IS professional success is impacted by developing students’ non-technical skills. The article culminates in a holistic conceptual framework for developing non-technical skills within the IT higher education context. Implications for theory and research are provided.
Full Text Available Background:Patient concerns represent opportunities for improvement in orthopaedic care. Thisstudy’s objectiveis to identify the nature and prevalence of unsolicited patient complaints regarding orthopaedic care ata tertiary referral hospital. The primary null hypothesis that there are no demographic factors associatedwith complaint types was tested. Secondarily we determined if the overall complaint number and typesdifferedby year.Methods:Complaints to the hospital ombudsperson by orthopaedic patients between January 1997 and June 2013 werereviewed. All 1118 complaints were categorized: access and availability, humaneness and disrespect, communication,expectations of care and treatment, distrust, billing and research.Results:Patients between 40 and 60 years of age filed the most complaints in all categories except distrust(more common in patients over age 80 and research. Women were slightly more likely to address access andavailability, humaneness, disrespect, and billing compared to men. The overall number of complaints peakedin 1999. The most common issue was access and availability followed by communication, and humaneness/disrespect.Conclusion:Half of concerns voiced by patients addressed interpersonal issues. The largest category was related toaccess and availability. Quality improvement efforts can address technology to improve access and availability as wellas empathy and communication strategies.
Nakadate, Ryu; Arata, Jumpei; Hashizume, Makoto
At present, much of the research conducted worldwide focuses on extending the ability of surgical robots. One approach is to extend robotic dexterity. For instance, accessibility and dexterity of the surgical instruments remains the largest issue for reduced port surgery such as single port surgery or natural orifice surgery. To solve this problem, a great deal of research is currently conducted in the field of robotics. Enhancing the surgeon's perception is an approach that uses advanced sensor technology. The real-time data acquired through the robotic system combined with the data stored in the robot (such as the robot's location) provide a major advantage. This paper aims at introducing state-of-the-art products and pre-market products in this technological advancement, namely the robotic challenge in extending dexterity and hopefully providing the path to robotic surgery in the near future.
Khazir, Zahra; Dehdari, Tahereh; Majdabad, Mahmood Mahmoodi; Tehrani, Said Pournaghash
Introduction: The present study examined the favorable attitude of a sample of female university students regarding elective cosmetic surgery, body dysmorphic disorder, self-esteem and body dissatisfaction following a media literacy training intervention. Methods: This study was a quasi-experimental type. The study sample included 140 female university students who were allocated to either the intervention (n=70) or the control group (n=70). Attitude toward cosmetic surgery, body dysmorphic d...
This presentation will describe a new method for assessing non-technical site suitability criteria for the siting of stormwater capture, treatment and recharge (or stormwater CTR) facilities in Sonoma County, California, USA. "Non-technical site suitability criteria" include issues such as community acceptance, aesthetics, nuisances and hazards, and compatibility with neighboring land uses, and are distinguished from "technical criteria" such as hydrology and soil characteristics that are the traditional subject of suitability analyses. Non-technical criteria are rarely, if ever, considered in formal siting suitability studies conducted by agencies and municipalities, yet can be fatal to the prospects of a given project's construction if not identified and mitigated. The researchers developed a new method for identifying and spatially characterizing relevant non-technical criteria through interviews and questionnaires with community stakeholders, and introducing those criteria into a spatial multi-criteria decision analysis framework that assesses site suitabilty across a study watershed (the Upper Petaluma River watershed in Sonoma County).
João Simão de Melo-Neto
Full Text Available ABSTRACT OBJECTIVE: To identify the characteristics of patients with spinal cord injury (SCI undergoing surgery. METHODS: Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. RESULTS: A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n= 92. The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. CONCLUSION: These factors enable investments in prevention, rehabilitation, and treatment.
Hagemann, Vera; Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen
The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (ptechnical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.
Lyk-Jensen, H T; Jepsen, R M H G; Spanager, L; Dieckmann, P; Østergaard, D
Incident reporting and fieldwork in operating rooms have shown that some of the errors that arise in anaesthesia relate to inadequate use of non-technical skills. To provide a tool for training and feedback on nurse anaesthetists' non-technical skills, this study aimed to adapt the Anaesthetists' Non-Technical Skills (ANTS) as a behavioural marker system for the formative assessment of nurse anaesthetists' non-technical skills in the operating room. A qualitative approach with focus group interviews was used to identify the non-technical skills of nurse anaesthetists in the operating room. The interview data were transcribed verbatim. Directed content analysis was used to code and sort data deductively into the ANTS categories: task management, team working, situation awareness and decision making. The prototype named Nurse Anaesthetists' Non-Technical Skills (N-ANTS) was presented and discussed in a group of subject matter experts to ensure face validity. The N-ANTS system consists of the same four categories as ANTS and 15 underlying elements. Three to five good and poor behavioural markers for each element were identified. The headings and definitions of the categories and elements were adjusted to encompass the behavioural markers in N-ANTS. The differences that emerged mainly reflected statements regarding the establishment of role, competence, and task delegation. A behavioural marker system, N-ANTS, for nurse anaesthetists was adapted from a behavioural marker system, ANTS, for anaesthesiologists. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Pires, Sara; Monteiro, Sara; Pereira, Anabela; Chaló, Daniela; Melo, Elsa; Rodrigues, Alexandre
In nursing, non-technical skills are recognized as playing an important role to increase patient safety and successful clinical outcomes (Pearson and McLafferty, 2011). Non-technical skills are cognitive and social resource skills that complement technical skills and contribute to safe and efficient task performance (Flin et al., 2008). In order to effectively provide non-technical skills training, it is essential to have an instrument to measure these skills. An online search was conducted. Articles were selected if they referred to and/or described instruments assessing non-technical skills for nurses and/or prelicensure nursing students in educational, clinical and/or simulated settings with validation evidence (inclusion criteria). Of the 53 articles located, 26 met the inclusion criteria. Those referred to and/or described 16 instruments with validation evidence developed to assess non-technical skills in multidisciplinary teams including nurses. Although articles have shown 16 valid and reliable instruments, to our knowledge, no instrument has been published or developed and validated for the assessment of non-technical skills of only nurses in general, relevant for use in high-fidelity simulation-based training for prelicensure nursing students. Therefore, there is a need for the development of such an instrument. Copyright © 2017 Elsevier Ltd. All rights reserved.
Yim, Ho Bin; Kim, Ar Ryum; Seong, Poong Hyun
Highlights: ► We selected important non-technical skills for emergency conditions in NPPs. ► We proposed an evaluation method for the selected non-technical skills. ► We conducted two sets of training, 9 experiments each, with real plant operators. ► Teams showed consistent non-technical skills preparedness with changing scenarios. ► Non-technical skills preparedness gives plausible explanations why teams fail tasks. -- Abstract: Many statistical results from safety reports tell that human related errors are the dominant influencing factor on the safe operation of power plants. Fortunately, training operators for the technical and non-technical skills can prevent many types of human errors. In this study, four important non-technical skills in safety critical industries – medical, aviation, and nuclear – were selected to describe behaviors of operation teams in emergency conditions of nuclear power plants (NPPs): communication, leadership, situation awareness, and decision-making skills. Also, preparedness of the non-technical skills was defined, and a quantification method of those skills called NoT-SkiP (Non-Technical Skills Preparedness) was developed to represent ‘how well operation teams are prepared to deal with emergency conditions’ in the non-technical skills aspect by analyzing monitoring-control patterns and a verbal protocol. Two case studies were conducted to validate the method. The first case was applied to Loss of Coolant Accident (LOCA) and Steam Generator Tube Rupture (SGTR) training. Independent variables were scenario, training repetition, and members. Relative values of the NoT-SkiP showed a consistent trend with changing scenarios. However, when training was repeated with the same scenario, NoT-SkiP values of some team were changed. It was supposed that leaders of some teams exerted their knowledge acquired from the previous training and gave up thoroughness of using procedures. When members especially who play a dominant role
Khazir, Zahra; Dehdari, Tahereh; Mahmoodi Majdabad, Mahmood; Pournaghash Tehrani, Said
The present study examined the favorable attitude of a sample of female university students regarding elective cosmetic surgery, body dysmorphic disorder, self-esteem and body dissatisfaction following a media literacy training intervention. This study was a quasi-experimental type. The study sample included 140 female university students who were allocated to either the intervention (n=70) or the control group (n=70). Attitude toward cosmetic surgery, body dysmorphic disorder, self-esteem and, body satisfaction was measured in both groups before the intervention and 4 weeks later. Four media literacy training sessions were conducted over 4 weeks for the intervention group. The data was analyzed through analysis of covariance, student's paired-samples t test, and Pearson correlation. Our findings showed that favorable attitude, body dysmorphic disorder and body dissatisfaction scores were significantly lower (pmedia literacy intervention in decreasing female's favorable attitude towards elective cosmetic surgery, body dysmorphic disorder and body dissatisfaction as well as increasing self-esteem.
Derya Burcu Hazer
Full Text Available Aim. We discuss technical points, the safety, and efficacy of ultrasonic bone shaver in various spinal surgeries within our own series. Methods. Between June 2010 and January 2014, 307 patients with various spinal diseases were operated on with the use of an ultrasonic bone curette with microhook shaver (UBShaver. Patients’ data were recorded and analyzed retrospectively. The technique for the use of the device is described for each spine surgery procedure. Results. Among the 307 patients, 33 (10.7% cases had cervical disorder, 17 (5.5% thoracic disorder, 3 (0.9% foramen magnum disorder, and 254 (82.7% lumbar disorders. Various surgical techniques were performed either assisted or alone by UBShaver. The duration of the operations and the need for blood replacement were relatively low. The one-year follow-up with Neck Disability Index (NDI and Oswestry Disability Index (ODI scores were improved. We had 5 cases of dural tears (1.6% in patients with lumbar spinal disease. No neurological deficit was found in any patients. Conclusion. We recommend this device as an assistant tool in various spine surgeries and as a primary tool in foraminotomies. It is a safe device in spine surgery with very low complication rate.
Demontis, R; Pittau, M R; Maturo, A; Petruzzo, P; Calò, G
The purpose of this paper is to provide a forensic profile framework of neuromonitoring in thyroid surgery, regarding the information given to the patient and its classification as part of professional liability in the event of recurrent injury. Evaluation and reflections on the required behaviour of the surgeon on providing details on the operation before the informed consent is given and to outline the possible legal implications regarding professional liability as a result of recurrent injury. In particular, if it is an obligation to inform the patient about using this method and if it is possible for the surgeon to freely choose whether to employ this method, which is still burdened by a certain percentage of error and for that reason it cannot be defined a "standard of care". To recognize neuromonitoring the role of standard of care in surgery of the thyroid means attribute a role of method able to avoid the surgeon to cause iatrogenic damage to the laryngeal nerve. For the foregoing reasons that is not true, determining false positives and false negatives, and this can be a double edged sword for the surgeon. Although the progress in the field of thyroid surgery made in the last decade, currently there is no scientific reassuring evidence to completely avoid the possibility of producing an iatrogenic lesion of the laryngeal nerve. Information given to the patient prior to surgery should respect the requirements of completeness, freedom and honesty in order to allow the patient to self-determination.
Jepsen, Rikke M H G; Spanager, Lene; Lyk-Jensen, Helle T; Dieckmann, Peter; Østergaard, Doris
The objectives of the study were to identify Danish anaesthesiologists' non-technical skills and to customise the Scottish-developed Anaesthetists' Non-Technical Skills instrument for Danish anaesthesiologists. Six semi-structured group interviews were conducted with 31 operating room team members: anaes-thesiologists, nurse anaesthetists, surgeons, and scrub nurses. Interviews were transcribed verbatim and analysed using directed content analysis. Anaesthesiologists' non-technical skills were identified, coded, and sorted using the original instrument as a basis. The resulting prototype instrument was discussed with anaesthesiologists from 17 centres to ensure face validity. Interviews lasted 46-67 minutes. Identified examples of anaesthesiologists' good or poor non-technical skills fit the four categories in the original instrument: situation awareness; decision making; team working; and task management. Anaesthesiologists' leadership role in the operating room was emphasised: the original 'Task Management' category was named 'Leadership'. One new element, 'Demonstrating self-awareness' was added under the category 'Situation Awareness'. Compared with the original instrument, half of the behavioural markers were new, which reflected that being aware of and communicating one's own abilities to the team; working systematically; and speaking up to avoid adverse events were important skills. The Anaesthetists' Non-Technical Skills instrument was customised to a Danish setting using the identified non-technical skills for anaesthesiologists and the original instrument as basis. The customised instrument comprises four categories and 16 underpinning elements supported by multiple behavioural markers. Identifying non-technical skills through semi-structured group interviews and analysing them using direct content analysis proved a useful method for customising an assessment instrument to another setting.
Mitchell, Lucy; Flin, Rhona
This paper is a report of a review to identify the non-technical (cognitive and social) skills used by scrub nurses. Recognition that failures in non-technical skills contributed to accidents in high-risk industries led to the development of research programmes to study the role of cognition and social interactions in operational safety. Recently, psychological research in operating theatres has revealed the importance of non-technical skills in safe and efficient performance. Most of the studies to date have focused on anaesthetists and surgeons. On-line sources and university library catalogues, publications of the Association for Perioperative Practice, National Association of Theatre Nurses and Association of Peri-Operative Registered Nurses were searched in 2007. Studies were included in the review if they presented data from scrub nurses on one or more of their non-technical skills. These findings were examined in relation to an existing medical non-technical skills framework with categories of communication, teamwork, leadership, situation awareness and decision-making. Of 424 publications retrieved, 13 were reviewed in detail. Ten concerned communication and eight of those also had data on teamwork. In 11 papers teamwork was examined, and one focused on nurses' situation awareness, teamwork and communication. None of the papers we reviewed examined leadership or decision-making by scrub nurses. Further work is needed to identify formally the non-technical skills which are important to the role of scrub nurse and then to design training in the identified non-technical skills during the education and development of scrub nurses.
Shtin, V. I.; Novikov, V. A.; Gjunter, V. E.; Choinzonov, E. L.; Ryabova, A. I.; Sirkashev, V. A.; Surkova, P. V.; Vasilev, R. V.; Menkova, E. N.
Tumors of the nasal cavity and paranasal sinuses present a challenge to treat them. A combination of surgery and radiation therapy can improve treatment outcomes in 49-56% [1, 2] of the patients with locally advanced nasal cavity and paranasal sinus cancer. The midface reconstruction poses a formidable challenge to the reconstructive surgeon due to the region's complex skeletal and soft-tissue anatomy. The rehabilitation program including the reconstruction of the resected orbital walls using the porous and mesh implants from titanium nickelid (TiNi) was developed at the Cancer Research institute jointly with the Research Institute of Medical Materials. The technique was proven effective, allowing the natural position of the eye and visual function to be preserved in 90% [1-3] of the patients. A long period of reparative processes and risk of developing inflammation in the implant area, as well as the need to decrease length of surgery, contributed to the development of a novel approach to repairing the midface bone structures using the implant based on the microporous wire and TiNi mesh. Eighteen patients with nasal cavity and paranasal sinus cancer were treated using the combined thin implants. The novel technique allowed the time of the implant installation to be reduced to 5-10 min. The structure of the implant contributed to prevention of inflammatory processes in 97% [1, 2] of cases. Thus, the natural position of the eyeball and visual function were preserved in 100% [1, 3, 4] of patients. The use of the TiNi implants in reconstructive surgery for patients with nasal cavity and paranasal sinus cancer led to reduced time of surgery and rehabilitation, increased level of social adaptation of patients and improved cosmetic and functional results.
Khazir, Zahra; Dehdari, Tahereh; Majdabad, Mahmood Mahmoodi; Tehrani, Said Pournaghash
Introduction: The present study examined the favorable attitude of a sample of female university students regarding elective cosmetic surgery, body dysmorphic disorder, self-esteem and body dissatisfaction following a media literacy training intervention. Methods: This study was a quasi-experimental type. The study sample included 140 female university students who were allocated to either the intervention (n=70) or the control group (n=70). Attitude toward cosmetic surgery, body dysmorphic disorder, self-esteem and, body satisfaction was measured in both groups before the intervention and 4 weeks later. Four media literacy training sessions were conducted over 4 weeks for the intervention group. The data was analyzed through analysis of covariance, student’s paired-samples t test, and Pearson correlation. Results: Our findings showed that favorable attitude, body dysmorphic disorder and body dissatisfaction scores were significantly lower (pmedia literacy intervention in decreasing female’s favorable attitude towards elective cosmetic surgery, body dysmorphic disorder and body dissatisfaction as well as increasing self-esteem. PMID:26383204
Doumouras, A G; Hamidi, M; Lung, K; Tarola, C L; Tsao, M W; Scott, J W; Smink, D S; Yule, S
Deficiencies in non-technical skills (NTS) have been increasingly implicated in avoidable operating theatre errors. Accordingly, this study sought to characterize the impact of surgeon and anaesthetist non-technical skills on time to crisis resolution in a simulated operating theatre. Non-technical skills were assessed during 26 simulated crises (haemorrhage and airway emergency) performed by surgical teams. Teams consisted of surgeons, anaesthetists and nurses. Behaviour was assessed by four trained raters using the Non-Technical Skills for Surgeons (NOTSS) and Anaesthetists' Non-Technical Skills (ANTS) rating scales before and during the crisis phase of each scenario. The primary endpoint was time to crisis resolution; secondary endpoints included NTS scores before and during the crisis. A cross-classified linear mixed-effects model was used for the final analysis. Thirteen different surgical teams were assessed. Higher NTS ratings resulted in significantly faster crisis resolution. For anaesthetists, every 1-point increase in ANTS score was associated with a decrease of 53·50 (95 per cent c.i. 31·13 to 75·87) s in time to crisis resolution (P technical skills scores were lower during the crisis phase of the scenarios than those measured before the crisis for both surgeons and anaesthetists. A higher level of NTS of surgeons and anaesthetists led to quicker crisis resolution in a simulated operating theatre environment. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.
A. V. Rudakova
Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.
Willems, Anneliese; Waxman, Bruce; Bacon, Andrew K; Smith, Julian; Kitto, Simon
Natural disasters impose a significant burden on society. Current disaster training programmes do not place an emphasis on equipping surgeons with non-technical skills for disaster response. This literature review sought to identify non-technical skills required of surgeons in disaster response through an examination of four categories of literature: "disaster"; "surgical"; "organisational management"; and "interprofessional". Literature search criteria included electronic database searches, internet searches, hand searching, ancestry searching and networking strategies. Various potential non-technical skills for surgeons in disaster response were identified including: interpersonal skills such as communication, teamwork and leadership; cognitive strategies such flexibility, adaptability, innovation, improvisation and creativity; physical and psychological self-care; conflict management, collaboration, professionalism, health advocacy and teaching. Such skills and the role of interprofessionalism should be considered for inclusion in surgical disaster response training course curricula.
Jepsen, Rikke M H G; Spanager, Lene; Lyk-Jensen, Helle T
; decision making; team working; and task management. Anaesthesiologists' leadership role in the operating room was emphasised: the original 'Task Management' category was named 'Leadership'. One new element, 'Demonstrating self-awareness' was added under the category 'Situation Awareness'. Compared...... with the original instrument, half of the behavioural markers were new, which reflected that being aware of and communicating one's own abilities to the team; working systematically; and speaking up to avoid adverse events were important skills. CONCLUSIONS: The Anaesthetists' Non-Technical Skills instrument......OBJECTIVE: The objectives of the study were to identify Danish anaesthesiologists' non-technical skills and to customise the Scottish-developed Anaesthetists' Non-Technical Skills instrument for Danish anaesthesiologists. METHODS: Six semi-structured group interviews were conducted with 31...
Read, David; Ashford, Bruce
The explosion of three bombs on 12 October 2002 in Kuta, Bali resulted in mass casualties akin to those seen in war. The aim of the present report is to describe the sequence of events of Operation Bali Assist including triage, resuscitation and initial wound surgery in Bali at Sanglah Hospital in the aeromedical staging facility (ASF), Denpasar airport and the evacuation to Darwin. A descriptive report is provided of the event and includes; resuscitation, anaesthesia, initial burns surgery management including escharotomy and fasciotomy, head injury management and importance of supplies and medical records with a description of the evacuation to Darwin. Operation Bali Assist involved five C130 Hercules aircraft and aeromedical evacuation medical and nursing teams managing 66 casualties in the Denpasar area and their evacuation to Royal Darwin Hospital with ketamine the most useful anaesthetic agent and cling film the most useful burns dressing. Twelve procedures were performed at the ASF including seven escharotomies, three fasciotomies and two closed reductions. One escharotomy was performed in flight. The important lessons learnt from the exercise is the inclusion of a surgeon in the aeromedical evacuation team, the importance of debridement and delayed primary closure, the usefulness of cling film as a burns dressing and the importance of continuous assessment. Future disaster planning exercises need to consider a patient age mix that might be expected in a shopping mall, rather than the young adult encountered in Bali, a more familiar age mix for Australian Defence Force medical staff.
Mundt, Anna Sofie; Spanager, Lene; Lyk-Jensen, Helle Teglgaard
The aim of this study was to adapt the Scottish tool, Scrub Practitioners List of Intraoperative Non-Technical Skills, to Danish organisation and culture. With an explorative and qualitative approach, four group interviews with scrub practitioners, surgeons and anaesthesia staff were conducted....... The main differences found were related to communication and teamwork regarding scrub practitioners focus on the team and speaking up. Differences in the non-technical skills described in the behavioural markers are perhaps explained by cultural differences between Scotland and Denmark. A new tool...
Gjeraa, K; Jepsen, R M H G; Rewers, M
BACKGROUND: A combination of non-technical skills (NTS) and technical skills (TS) is crucial for anaesthetic patient management. However, a deeper understanding of the relationship between these two skills remains to be explored. We investigated the characteristics of trainee anaesthesiologists...... the customised version of the Anaesthetists' Non-Technical Skills System, ANTSdk, and an adapted TS checklist for calculating the correlation between NTS and TS. Written descriptions of the observed NTS were analysed using directed content analysis. RESULTS: The correlation between the NTS and the TS ratings...
Mundt, Anna Sofie; Spanager, Lene; Lyk-Jensen, Helle Teglgaard; Østergaard, Doris
The aim of this study was to adapt the Scottish tool, Scrub Practitioners List of Intraoperative Non-Technical Skills, to Danish organisation and culture. With an explorative and qualitative approach, four group interviews with scrub practitioners, surgeons and anaesthesia staff were conducted. The main differences found were related to communication and teamwork regarding scrub practitioners focus on the team and speaking up. Differences in the non-technical skills described in the behavioural markers are perhaps explained by cultural differences between Scotland and Denmark. A new tool for scrub practitioners in Denmark was adapted. Copyright the Association for Perioperative Practice.
Zizzari, Vincenzo Luca; Zara, Susi; Tetè, Giulia; Vinci, Raffaele; Gherlone, Enrico; Cataldi, Amelia
Many bone substitutes have been proposed for bone regeneration, and researchers have focused on the interactions occurring between grafts and host tissue, as the biologic response of host tissue is related to the origin of the biomaterial. Bone substitutes used in oral and maxillofacial surgery could be categorized according to their biologic origin and source as autologous bone graft when obtained from the same individual receiving the graft; homologous bone graft, or allograft, when harvested from an individual other than the one receiving the graft; animal-derived heterologous bone graft, or xenograft, when derived from a species other than human; and alloplastic graft, made of bone substitute of synthetic origin. The aim of this review is to describe the most commonly used bone substitutes, according to their origin, and to focus on the biologic events that ultimately lead to the integration of a biomaterial with the host tissue. Copyright © 2016 Elsevier Inc. All rights reserved.
Stjernholm, Christina [Karolinska Inst., Stockholm (Sweden). Soedersjukhuset
Cochlear implantation is a treatment for patients with severe sensorineural hearing loss/deafness, who get no help from ordinary hearing aids. The cochlear implant is surgically placed under the skin near the ear and a very thin electrode array is introduced into the cochlea of the inner ear, where it stimulates the remaining nerve fibers. The operation is complicated; it is performed with the aid of a microscope, and involves drilling very close to vital vessels and important nerves. High resolution computed tomography (CT) of the temporal bone is a part of the preoperative evaluation preceding cochlear implantation. It is a method for visualizing the bony structures of the middle and inner ear - to diagnose pathology and to describe the anatomy. The first work concerns CT of the temporal bone and cochlear implant surgery in children with CHARGE association. This is a rare condition with multiple congenital abnormalities, sometimes lethal. Children with CHARGE have different combinations of disabilities, of which impairments of vision and hearing, as well as balance problems and facial palsy can lead to developmental delay. There have been few reports of radiological temporal bone changes and none of cochlear implant surgery for this group. The work includes a report of the findings on preoperative CT and at surgery, as well as postimplant results in two children. A review of the latest diagnostic criteria of CHARGE and the temporal bone changes found in international literature is also included. The conclusion was that certain combinations of temporal bone changes in CHARGE are, if not specific, at least extremely rare in other materials. CT can visualize these changes and be used as a diagnostic tool. This is important, since some of the associated disabilities are not so obvious from the start. Early treatment is vital for the child's development. This work also shows that cochlear implantation may help some of these often very isolated children to
Cochlear implantation is a treatment for patients with severe sensorineural hearing loss/deafness, who get no help from ordinary hearing aids. The cochlear implant is surgically placed under the skin near the ear and a very thin electrode array is introduced into the cochlea of the inner ear, where it stimulates the remaining nerve fibers. The operation is complicated; it is performed with the aid of a microscope, and involves drilling very close to vital vessels and important nerves. High resolution computed tomography (CT) of the temporal bone is a part of the preoperative evaluation preceding cochlear implantation. It is a method for visualizing the bony structures of the middle and inner ear - to diagnose pathology and to describe the anatomy. The first work concerns CT of the temporal bone and cochlear implant surgery in children with CHARGE association. This is a rare condition with multiple congenital abnormalities, sometimes lethal. Children with CHARGE have different combinations of disabilities, of which impairments of vision and hearing, as well as balance problems and facial palsy can lead to developmental delay. There have been few reports of radiological temporal bone changes and none of cochlear implant surgery for this group. The work includes a report of the findings on preoperative CT and at surgery, as well as postimplant results in two children. A review of the latest diagnostic criteria of CHARGE and the temporal bone changes found in international literature is also included. The conclusion was that certain combinations of temporal bone changes in CHARGE are, if not specific, at least extremely rare in other materials. CT can visualize these changes and be used as a diagnostic tool. This is important, since some of the associated disabilities are not so obvious from the start. Early treatment is vital for the child's development. This work also shows that cochlear implantation may help some of these often very isolated children to communicate
Perren, S M; Regazzoni, P; Fernandez, A A
BIOLOGICAL ASPECTS OF STEEL AND TITANIUM AS IMPLANT MATERIAL IN ORTHOPEDIC TRAUMA SURGERY The following case from the ICUC database, where a titanium plate was implanted into a flourishing infection, represents the clinical experience leading to preferring titanium over steel. (Fig. 1) (6). Current opinions regarding biological aspects of implant function. The "street" opinions regarding the biological aspects of the use of steel versus titanium as a surgical trauma implant material differ widely. Statements of opinion leaders range from "I do not see any difference in the biological behavior between steel and titanium in clinical application" to "I successfully use titanium implants in infected areas in a situation where steel would act as foreign body "sustaining" infection." Furthermore, some comments imply that clinical proof for the superiority of titanium in human application is lacking. The following tries to clarify the issues addressing the different aspects more through a practical clinical approach than a purely scientific one, this includes simplifications. Today's overall biocompatibility of implant materials is acceptable but: As the vast majority of secondary surgeries are elective procedures this allows the selection of implant materials with optimal infection resistance. The different biological reactions of stainless steel and titanium are important for this segment of clinical pathologies. Biological tole - rance (18) depends on the toxicity and on the amount of soluble implant material released. Release, diffusion and washout through blood circulation determine the local concentration of the corrosion products. Alloying components of steel, especially nickel and chromium, are less than optimal in respect to tissue tolerance and allergenicity. Titanium as a pure metal provides excellent biological tolerance (3, 4, 16). Better strength was obtained by titanium alloys like TiAl6V4. The latter found limited application as surgical implants. It
Foruria, Antonio M; Augustin, Salvador; Morrey, Bernard F; Sánchez-Sotelo, Joaquín
The objectives of this study were to (1) determine the prevalence of heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna, (2) identify risk factors associated with the development of heterotopic ossification in these injuries, and (3) characterize the severity and location of the heterotopic ossification and the associated range of elbow motion. From 2004 to 2008, 142 elbow fractures and fracture-dislocations involving the proximal aspect of the radius or ulna were treated surgically at our institution. Records and radiographs of 130 elbows with adequate follow-up were retrospectively reviewed to identify cases of heterotopic ossification, characterize the ectopic bone, and analyze associated risk factors. The most frequent injuries included olecranon fractures, Monteggia fracture-dislocations, and various combinations of fractures of the radial head and coronoid with or without dislocation or subluxation. Heterotopic bone was identified on the radiographs of forty-eight elbows (37%). Heterotopic ossification interfered with motion in twenty-six elbows (20%), and thirteen elbows (10%) underwent additional surgery to remove heterotopic bone with the goal of improving motion. Risk factors associated with the development of heterotopic ossification included elbow subluxation or dislocation at the time of presentation, an open fracture, a severe chest injury, and a delay in definitive surgical treatment. Ectopic bone was preferentially located at the origin of torn soft-tissue structures or around fracture sites, and it was particularly common around the posterior aspect of the ulna and the neck of the radius. Heterotopic ossification was classified on radiographs as hazy immature in twenty-two elbows, limited mature in eighteen, extensive mature in five, and a complete bone bridge in three. Heterotopic ossification was more common in patients with an associated distal humeral fracture
Full Text Available Background: Bariatric surgery has a considerable effect on weight loss. A positive relation of exercise and weight loss has been described before. However, the mode of exercise and its timing pre- or postoperatively or a combination remains unclear. Methods: A multi-database search was conducted. Identified articles were reviewed on description of exercise, timing around a bariatric intervention, and outcome. Methodological quality of the included studies was rated using the Physiotherapy Evidence Database scale. A Cohen's kappa score assessed the level of agreement. Outcome measurements were improvement of anthropometric and physical fitness variables, operation related complications, weight regain, and quality of life. Results: A total of 8 prospective studies were included. Four focused on training before and 4 on training after a bariatric procedure. Details of exercises varied from 45 min treadmill up to full descriptive programs. Supervision was frequently included. Significant improvement was encountered for biometric results physical fitness variables. Conclusion: In the majority of reports on exercising in a (future bariatric population, positive effects on anthropometrics, cardiovascular risk factors and physical fitness were described. However, the results were not unanimous, with a wide range of exercise programs and perioperative timing, therefore hampering adequate practical guidance.
Purpose: The purpose of this paper is to explore non-technical skills from the perspective of Australian business graduates who had recently made the transition from higher education into full-time employment. Design/methodology/approach: A mixed-methods approach was applied through the use of an online survey containing closed and open-ended…
Victor Fernando PlÁcido da ConceiçÌo
Full Text Available Despite the adoption of crew resource management training for bridge teams over the last decades, the training is still heavily focussed on technical achievements. In an educational context, the situation is more problematical, since with requirement of developing the technical skills, there is a need to build and evaluate the non-technical skills of cadets with little experience in bridge team management. In parallel with the application of team leadership models, the Portuguese Naval Academy conducted a research to improve the development and assessment of non-technical skills in bridge simulators. This paper describes the method used to identify the key non-technical skills required for naval cadets and to develop a behavioural marker system for their measurement. A literature review of behavioural marker systems was supplemented with an analysis of interviews conducted with students and simulator instructors. Additionally, further analysis of Portuguese Navy accidents reports was made, applying the HFACS framework to identify the relevant non-technical skills involved in the accidents. The resulting rating system covers five skill categories (leadership, situational awareness, communication, team work and decision making, each one with three rating elements. The framework is currently under evaluation tests in bridge simulators sessions, within an educational context.
Jung, James J; Borkhoff, Cornelia M; Jüni, Peter; Grantcharov, Teodor P
To critically appraise the development and measurement properties, including sensibility, reliability, and validity of the Non-Technical Skills of Surgeons (NOTSS) system. Articles that described development process of the NOTSS system were identified. Relevant primary studies that presented evidence of reliability and validity were identified through a comprehensive literature review. NOTSS was developed through robust item generation and reduction strategies. It was shown to have good content validity, acceptability, and feasibility. Inter-rater reliability increased with greater expertise and number of assessors. Studies demonstrated evidence of cross-sectional construct validity, in that the tool was able to differentiate known groups of varied non-technical skill levels. Evidence of longitudinal construct validity also existed to demonstrate that NOTSS detected changes in non-technical skills before and after targeted training. In populations and settings presented in our critical appraisal, NOTSS provided reliable and valid measurements of intraoperative non-technical skills of surgeons. Copyright © 2018 Elsevier Inc. All rights reserved.
Pugh, Debra; Hamstra, Stanley J.; Wood, Timothy J.; Humphrey-Murto, Susan; Touchie, Claire; Yudkowsky, Rachel; Bordage, Georges
Internists are required to perform a number of procedures that require mastery of technical and non-technical skills, however, formal assessment of these skills is often lacking. The purpose of this study was to develop, implement, and gather validity evidence for a procedural skills objective structured clinical examination (PS-OSCE) for internal…
Larsen, Peter Gorm; Kristiansen, Erik Lasse; Bennedsen, Jens; Bjerge, Kim
In general engineering studies focus on the technical skills in their own discipline. However, in their subsequent industrial careers, a significant portion of their time needs to be devoted to non-technical skills. In addition, in an increasingly globalised world collaboration in teams across cultures and disciplines is paramount to the creation…
Jirativanont, T; Raksamani, K; Aroonpruksakul, N; Apidechakul, P; Suraseranivongse, S
We sought to evaluate the validity of two non-technical skills evaluation instruments, the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and the Ottawa Global Rating Scale (GRS), to apply them to anaesthesia training. The content validity, response process, internal structure, relations with other variables and consequences were described for validity evidence. Simulated crisis management sessions were initiated during which two trained raters evaluated the performance of postgraduate first-, second- and third-year (PGY-1, PGY-2 and PGY-3) anaesthesia residents. The study included 70 participants, composed of 24 PGY-1, 24 PGY-2 and 22 PGY-3 residents. Both instruments differentiated the non-technical skills of PGY-1 from PGY-3 residents ( P skills were 0.86, 0.83, 0.84, 0.87, 0.80 and 0.86, respectively. The Cronbach's alpha for internal consistency of the ANTS instrument was 0.93, and was 0.96 for the Ottawa GRS. There was a high correlation between the ANTS and Ottawa GRS. The raters reported the ease of use of the Ottawa GRS compared to the ANTS. We found sufficient evidence of validity in the ANTS instrument and the Ottawa GRS for the evaluation of non-technical skills in a simulated anaesthesia setting, but the Ottawa GRS was more practical and had higher reliability.
This report discusses in non-technical terms the overall architecture of a model that will be designed to enable the user to (1) explore systematically the political feasibility of alternative policy options and (2) to determine the set of politically feasible solutions in the global climate change negotiations. 25 refs., 2 figs., 1 tab.
Zarifi Eslami, Mohammed; Zarghami, Alireza; Sapkota, Brahmananda; van Sinderen, Marten J.
One of the conditions for the successful introduction of ICT-based homecare services is to allow non-technical persons such as home nurses to personalize these services. We refer to this process of homecare service personalization as service tailoring. Service tailoring can be done by configuring
Houlton, H. R.; Ricci, J.; Wilson, C. E.; Keane, C.
Professional development experiences, such as internships, research presentations and professional network building, are becoming increasingly important to enhance students' employability post-graduation. The practical, non-technical skills that are important for succeeding during these professional development experiences, such as public speaking, project management, ethical practices and writing, transition well and are imperative to the workplace. Thereby, graduates who have honed these skills are more competitive candidates for geoscience employment. Fortunately, the geoscience community recognizes the importance of these professional development opportunities and the skills required to successfully complete them, and are giving students the chance to practice non-technical skills while they are still enrolled in academic programs. The American Geosciences Institute has collected data regarding students' professional development experiences, including the preparation they receive in the corresponding non-technical skills. This talk will discuss the findings of two of AGI's survey efforts - the Geoscience Student Exit Survey and the Geoscience Careers Master's Preparation Survey (NSF: 1202707). Specifically, data highlighting the role played by internships, career opportunities and the complimentary non-technical skills will be discussed. As a practical guide, events informed by this research, such as AGI's professional development opportunities, networking luncheons and internships, will also be included.
Full Text Available Simon Cooper1, Ruth Endacott2, Robyn Cant11School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill, Victoria, Australia; 2School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth UKAim: To review the literature on non-technical skills and assessment methods relevant to emergency care.Background: Non-technical skills (NTS include leadership, teamwork, decision making and situation awareness, all of which have an impact on healthcare outcomes. Significant concerns have been raised about the rates of adverse medical events, many of which are attributed to NTS failures.Methods: Ovid, Medline, ProQUEST, PsycINFO and specialty websites were searched for NTS measures using applicable access strategies, inclusion and exclusion criteria. Publications identified were assessed for relevance.Results: A range of non-technical skill measures relevant to emergency care was identified: leadership (n = 5, teamwork (n = 7, personality/behavior (n = 3 and situation awareness tools (n = 1. Of these, 9 have been used with emergency care populations/clinicians. All had varying degrees of reliability and validity. In the last decade there has been some development of teamwork measures specific to emergency care with a predominantly global and collective rating of broad skills.Conclusion: A variety of non-technical skill measures are available; only a few have been used in the emergency care arena. There is a need for an increase in the focused assessment of teamwork skills for a greater understanding of team performance to enhance patient safety in medical emergency care.Keywords: non-technical skills, teamwork, medical emergency, standards
Gordon, Morris; Fell, Christopher W R; Box, Helen; Farrell, Michael; Stewart, Alison
Healthcare increasingly recognises and focusses on the phenomena of 'safe practice' and 'patient safety.' Success with non-technical skills (NTS) training in other industries has led to widespread transposition to healthcare education, with communication and teamwork skills central to NTS frameworks. This study set out to identify how the context of interprofessional simulation learning influences NTS acquisition and development of 'safety' amongst learners. Participants receiving a non-technical skills (NTS) safety focussed training package were invited to take part in a focus group interview which set out to explore communication, teamwork, and the phenomenon of safety in the context of the learning experiences they had within the training programme. The analysis was aligned with a constructivist paradigm and took an interactive methodological approach. The analysis proceeded through three stages, consisting of open, axial, and selective coding, with constant comparisons taking place throughout each phase. Each stage provided categories that could be used to explore the themes of the data. Additionally, to ensure thematic saturation, transcripts of observed simulated learning encounters were then analysed. Six themes were established at the axial coding level, i.e., analytical skills, personal behaviours, communication, teamwork, context, and pedagogy. Underlying these themes, two principal concepts emerged, namely: intergroup contact anxiety - as both a result of and determinant of communication - and teamwork, both of which must be considered in relation to context. These concepts have subsequently been used to propose a framework for NTS learning. This study highlights the role of intergroup contact anxiety and teamwork as factors in NTS behaviour and its dissipation through interprofessional simulation learning. Therefore, this should be a key consideration in NTS education. Future research is needed to consider the role of the affective non-technical
War, said Carl von Clausewitz, is a cameleon. In this century, each armed conflict has proved to be unique, particularly in its medical aspects, with its own features and teaching its won lessons. As recent events show, no conflict is a fact of the past. Medical care delivered to war casualties depend on the circumstances of the war, on the medical resources available, but also on the price that cultures or circumstances place on it. Everything separates these two paradigms; on the one hand the "precious" casualty of western armies whose medical support is organized in a concept (forward medical and surgical care, ultra-rapid medical evacuation) tailored to each case, and as close as possible to the medical care of a civilian trauma patient whose models remains the North-American ballistic wound managed in trauma centers; on the other hand, civilian victims, in large numbers, in poor and disorganized countries, often abandoned to their own fate or sorted by "epidemiological" triage, which guarantees a distribution, as efficient as possible, of limited medical care. In war, advanced medical care and precarious medicine may work side by side according to two logics which do not exclude one another and constantly improve.
Reilly, Patrick M; Schwab, C William; Haut, Elliott R; Gracias, Vicente H; Dabrowski, G Paul; Gupta, Rajan; Pryor, John P; Kauder, Donald R
To describe outcomes from a clinical trauma surgical education program that places the board-eligible/board-certified fellow in the role of the attending surgeon (fellow-in-exception [FIE]) during the latter half of a 2-year trauma/surgical critical care fellowship. National discussions have begun to explore the question of optimal methods for postresidency training in surgery. Few objective studies are available to evaluate current training models. We analyzed provider-specific data from both our trauma registry and performance improvement (PI) databases. In addition, we performed TRISS analysis when all data were available. Registry and PI data were analyzed as 2 groups (faculty trauma surgeons and FIEs) to determine experience, safety, and trends in errors. We also surveyed graduate fellows using a questionnaire that evaluated perceptions of training and experience on a 6-point Likert scale. During a 4-year period 7,769 trauma patients were evaluated, of which 46.3% met criteria to be submitted to the PA Trauma Outcome Study (PTOS, ie, more severe injury). The faculty group saw 5,885 patients (2,720 PTOS); the FIE group saw 1,884 patients (879 PTOS). The groups were similar in respect to mechanism of injury (74% blunt; 26% penetrating both groups) and injury severity (mean ISS faculty 10.0; FIEs 9.5). When indexed to patient contacts, FIEs did more operations than the faculty group (28.4% versus 25.6%; P FIEs 10.0%). Analysis of deaths using PI and TRISS data failed to demonstrate differences between the groups. Analysis of provider-specific errors demonstrated a slightly higher rate for FIEs when compared with faculty when indexed to PTOS cases (4.1% versus 2.1%; P FIE year; P FIE educational experience "great -5" or "exceptional- 6." Eighty-five percent consider the current structure of the fellowship (with FIE year) as ideal. Ninety percent would repeat the fellowship. The educational experience and training improvement offered by the inclusion of a FIE
... and sterile gloves. Before the surgery begins, a time out is held during which the surgical team confirms ... the Consumer Version. DOCTORS: Click here for the Professional Version What Participants Need to Know About Clinical ...
Matsui, Yuko; Hikono, Masaru; Iwasaki, Mari; Morita, Miduho
This study aimed at characterizing a non-technical skill exercise for on-site managers in charge of initial response at an emergency response center by extracting and clarifying the behavior examples of non-technical skills shown in the exercise scenario. From video observations, the non-technical skill examples were identified from seven of the eight non-technical skill categories which had been defined when the training program was developed. At the same time, the limitation when extracting the cases by observations was identified. The extracted non-technical skill cases are expected to be used for characterizing exercise scenarios, as well as provide knowledge to raise the awareness of exercise participants. (author)
Glauner, Patrick; Meira, Jorge Augusto; Valtchev, Petko; State, Radu; Bettinger, Franck
Detection of non-technical losses (NTL) which include electricity theft, faulty meters or billing errors has attracted increasing attention from researchers in electrical engineering and computer science. NTLs cause significant harm to the economy, as in some countries they may range up to 40% of the total electricity distributed. The predominant research direction is employing artificial intelligence to predict whether a customer causes NTL. This paper first provides an overview of how NTLs ...
Kodate, Naonori; Ross, Anthony; Anderson, Janet E.; Flin, R.
Problems in team communication and decision making have been implicated in accidents in high risk industries such as aviation, off shore oil processing, nuclear power generation. Recognition of the role that breakdowns in communication and teamwork play in patient safety incidents has led to a plethora of studies in the area of what has come to be widely known as non-technical skills (NTS); a term initially used in European aviation (1). This has led to increasing interest in i...
Gjeraa, K; Møller, T P; Østergaard, D
Trauma resuscitation is a complex situation, and most organisations have multi-professional trauma teams. Non-technical skills are challenged during trauma resuscitation, and they play an important role in the prevention of critical incidents. Simulation-based training of these is recommended. Our research question was: Does simulation-based trauma team training of non-technical skills have effect on reaction, learning, behaviour or patient outcome? The authors searched PubMed, EMBASE and the Cochrane Library and found 13 studies eligible for analysis. We described and compared the educational interventions and the evaluations of effect according to the four Kirkpatrick levels: reaction, learning (knowledge, skills, attitudes), behaviour (in a clinical setting) and patient outcome. No studies were randomised, controlled and blinded, resulting in a moderate to high risk of bias. The multi-professional trauma teams had positive reactions to simulation-based training of non-technical skills. Knowledge and skills improved in all studies evaluating the effect on learning. Three studies found improvements in team performance (behaviour) in the clinical setting. One of these found difficulties in maintaining these skills. Two studies evaluated on patient outcome, of which none showed improvements in mortality, complication rate or duration of hospitalisation. A significant effect on learning was found after simulation-based training of the multi-professional trauma team in non-technical skills. Three studies demonstrated significantly increased clinical team performance. No effect on patient outcome was found. All studies had a moderate to high risk of bias. More comprehensive randomised studies are needed to evaluate the effect on patient outcome. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Bhupatiraju, Ravi Teja; Fung, Kin Wah; Bodenreider, Olivier
We developed an easy-to-use tool for non-technical biomedical researchers to conduct Named-Entity Recognition (NER) on biomedical text, in a familiar spreadsheet environment. The system is a simple, offline, easy to install, end-user front-end to the new MetaMap Lite. Early adopters found it to be a quick starting-point to incorporate NER in their investigations.
Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George
The Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) system is a new tool for training and assessing scrub practitioner (nurse, technician) behaviours during surgical operations. The aim of the study was to test the psychometric properties including inter-rater reliability of the prototype SPLINTS behavioural rating system. Experienced scrub practitioners (n=34) attended a one-day session where they received background training in human factors and non-technical skills and were also trained to use the SPLINTS system. They then used SPLINTS to rate the scrub practitioners' non-technical skill performance in seven standardized simulated, surgical scenarios. Reliability, measured by within-group agreement (r(wg)) for the three skill categories and six out of nine elements, was acceptable (r(wg)>0.7). Participants were within one scale point of expert ratings in >90% of skill categories and elements, and could use SPLINTS to score performance with a reasonable level of accuracy. There was good internal consistency of the system: absolute mean difference was Mtechnical skills in simulated, standardized, video scenarios. On the basis of these results, the system can now move on to usability testing in the real operating theatre. Copyright © 2011 Elsevier Ltd. All rights reserved.
Tsifetakis, Emmanuel; Kontogiannis, Tom
To develop and validate a classification of non-technical skills (NTS) in military aviation, a study was conducted, using data from real operations of F16 aircraft formations. Phase 1 developed a NTS classification based on the literature review (e.g. NOTECHS) and a workshop with pilots. The Non-TEChnical-MILitary-Skills (NOTEMILS) scheme was tested in Phase 2 in a series of Principal Component Analysis with data from After-Action-Review sessions (i.e. 900 records from a wide range of operations). The NTS were found to make a good prediction of Mission Essential Components (R 2 > 0.80) above the effect of experience. Phase 3 undertook a reliability analysis where three raters assessed the NOTEMILS scheme with good results (i.e. all r wg > 0.80). To look into the consistency of classifications, another test indicated that, at least, two out of three raters were in agreement in over 70% of the assessed flight segments. Practitioner Summary: A classification scheme of Non-Technical Skills (NTS) was developed and tested for reliability in military aviation operations. The NTS scheme is a valuable tool for assessing individual and team skills of F-16 pilots in combat. It is noteworthy that the tool had a good capability of predicting Mission Essential Competencies.
Crichton, M.T.; Flin, R.
Training of the non-technical (social and cognitive) skills that are crucial to safe and effective management by teams in emergency situations is an issue that is receiving increasing emphasis in many organisations, particularly in the nuclear power industry. As teams play a major role in emergency response organisations (ERO), effective functioning and interactions within, between and across teams is crucial, particularly as the management of an emergency situation often requires that teams are extended by members from various other sections and strategic groups throughout the company, as well as members of external agencies. A series of interviews was recently conducted with members of a UK nuclear emergency response organisation to identify the non-technical skills required by team members that would be required for managing an emergency. Critical skills have been identified as decision making and situation assessment, as well as communication, teamwork, and stress management. A number of training strategies are discussed which can be tailored to the roles and responsibilities of the team members and the team leader, based on the roles within the team being defined as either Decision Maker, Evaluator, or Implementor, according to Nuclear Energy Institute (NEI) classifications. It is anticipated that enhanced learning of the necessary non-technical skills, through experience and directed practice, will improve the skills of members of emergency response teams
... surgery has several common causes, including the following: Infections at the operative site Lung problems such as pneumonia or collapsed lung ... the trauma of an operation. The risk of infections at the operative site, DVTs, and UTIs can be decreased by meticulous ...
Heaton, Samuel R; Little, Zoe; Akhtar, Kash; Ramachandran, Manoj; Lee, Joshua
To enhance non-technical skills and to analyse participant's experience of a course tailored for orthopaedic surgeons. A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents (six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire (strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants' feedback on the value and quality of the course itself. Twenty-six orthopaedic residents participated (24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showed that while the majority of candidates recognised the importance of non-technical (NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course (Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance. All agreed that the
Gordon, Morris; Fell, Christopher W. R.; Box, Helen; Farrell, Michael; Stewart, Alison
ABSTRACT Background: Healthcare increasingly recognises and focusses on the phenomena of ‘safe practice’ and ‘patient safety.’ Success with non-technical skills (NTS) training in other industries has led to widespread transposition to healthcare education, with communication and teamwork skills central to NTS frameworks. Objective: This study set out to identify how the context of interprofessional simulation learning influences NTS acquisition and development of ‘safety’ amongst learners. Methods: Participants receiving a non-technical skills (NTS) safety focussed training package were invited to take part in a focus group interview which set out to explore communication, teamwork, and the phenomenon of safety in the context of the learning experiences they had within the training programme. The analysis was aligned with a constructivist paradigm and took an interactive methodological approach. The analysis proceeded through three stages, consisting of open, axial, and selective coding, with constant comparisons taking place throughout each phase. Each stage provided categories that could be used to explore the themes of the data. Additionally, to ensure thematic saturation, transcripts of observed simulated learning encounters were then analysed. Results: Six themes were established at the axial coding level, i.e., analytical skills, personal behaviours, communication, teamwork, context, and pedagogy. Underlying these themes, two principal concepts emerged, namely: intergroup contact anxiety – as both a result of and determinant of communication – and teamwork, both of which must be considered in relation to context. These concepts have subsequently been used to propose a framework for NTS learning. Conclusions: This study highlights the role of intergroup contact anxiety and teamwork as factors in NTS behaviour and its dissipation through interprofessional simulation learning. Therefore, this should be a key consideration in NTS education. Future
Krage, Ralf; Zwaan, Laura; Tjon Soei Len, Lian; Kolenbrander, Mark W; van Groeningen, Dick; Loer, Stephan A; Wagner, Cordula; Schober, Patrick
Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary resuscitation (CPR) is increasingly emphasised. Nonetheless, the relationship between non-technical skills and technical performance is poorly understood. We hypothesise that non-technical skills become increasingly important under stressful conditions when individuals are distracted from their tasks, and investigated the relationship between non-technical and technical skills under control conditions and when external stressors are present. In this simulator-based randomised cross-over study, 30 anaesthesiologists and anaesthesia residents from the VU University Medical Center, Amsterdam, the Netherlands, participated in two different CPR scenarios in random order. In one scenario, external stressors (radio noise and a distractive scripted family member) were added, while the other scenario without stressors served as control condition. Non-technical performance of the team leader and technical performance of the team were measured using the 'Anaesthetists' Non-technical Skill' score and a recently developed technical skills score. Analysis of variance and Pearson correlation coefficients were used for statistical analyses. Non-technical performance declined when external stressors were present (adjusted mean difference 3.9 points, 95% CI 2.4 to 5.5 points). A significant correlation between non-technical and technical performance scores was observed when external stressors were present (r=0.67, 95% CI 0.40 to 0.83, ptechnical performance score (task management, team working, situation awareness, decision-making). During CPR with external stressors, the team's technical performance is related to the non-technical skills of the team leader. This may have important implications for training of
Ostheimer, C; Meyer, F; Kornhuber, C; Reese, T; Vordermark, D
Radiooncological therapies are an integral part of the multimodal oncological treatment concepts in general and abdominal surgery. These include therapeutic approaches with a curative intention such as the neoadjuvant (pre-operative) radiotherapy of locoregionally advanced and/or N+ oesophageal and rectal cancer, definitive combined chemoradiotherapy of locally advanced, unresectable oesophageal cancer or oesophageal tumour lesions of the upper third, definitive radiotherapy of anal cancer (sphincter sparing) and pre- or post-operative radiotherapy of soft tissue sarcoma on the one hand. A yT0 stage achieved as characteristic of a curative effect by radiation in oesophageal and rectal cancer (omitting subsequent surgical intervention, naturally under clinical and imaging-based controls within short-term follow-up intervals) can be considered as a very interesting set-up with regard to its reasonable integration in daily clinical practice, which needs to be further and critically discussed. By integrating radiotherapy in interdisciplinary therapy concepts, improved tumour control and survival rates with clinically acceptable toxicity can be achieved. On the other hand, non-invasive, locally ablative radiooncological therapies such as extracranial stereotactic body radiotherapy constitute an effective and feasible treatment method for liver metastases in oligometastatic colorectal cancer or other tumour entities according to the decisions by the institutional tumour board, offering high local tumour control rates which can be part of multistep, multimodal procedures with curative intention. This review aims at providing an overview for the general and abdominal surgeon, outlining relevant radiooncological treatment aspects in the multimodal cancer therapy with a focus on the treatment of rectal, oesophageal and anal cancer as well as soft tissue sarcoma and hepatic metastases in oligometastatic colorectal cancer. Georg Thieme Verlag KG Stuttgart · New York.
de Vries, Anna H; Schout, Barbara M A; van Merriënboer, Jeroen J G; Pelger, Rob C M; Koldewijn, Evert L; Muijtjens, Arno M M; Wagner, Cordula
Although simulation training is increasingly used to meet modern technology and patient safety demands, its successful integration within surgical curricula is still rare. The Dutch Urological Practical Skills (D-UPS) curriculum provides modular simulation-based training of technical and non-technical basic urological skills in the local hospital setting. This study aims to assess the educational impact of implementing the D-UPS curriculum in the Netherlands and to provide focus points for improvement of the D-UPS curriculum according to the participants. Educational impact was assessed by means of qualitative individual module-specific feedback and a quantitative cross-sectional survey among residents and supervisors. Twenty out of 26 Dutch teaching hospitals participated. The survey focussed on practical aspects, the D-UPS curriculum in general, and the impact of the D-UPS curriculum on the development of technical and non-technical skills. A considerable survey response of 95 % for residents and 76 % for supervisors was obtained. Modules were attended by junior and senior residents, supervised by a urologist, and peer teaching was used. Ninety percent of supervisors versus 67 % of residents judged the D-UPS curriculum as an important addition to current residency training (p = 0.007). Participants' aggregated general judgement of the modules showed a substantial percentage favorable score (M ± SE: 57 ± 4 %). The impact of training on, e.g., knowledge of materials/equipment and ability to anticipate on complications was high, especially for junior residents (77 ± 5 and 71 ± 7 %, respectively). Focus points for improvement of the D-UPS curriculum according to the participants include adaptation of the training level to residents' level of experience and focus on logistics. The simulation-based D-UPS curriculum has a high educational impact. Residents and supervisors consider the curriculum to be an important addition to current residency
Lane, India F; Bogue, E Grady
The development of non-technical competencies has become an important component of veterinary education. In this study, we determined faculty perspectives regarding their perceived involvement and ability in the cultivation of these competencies. A survey was administered to faculty members at five institutions. Respondents were asked whether the competency should be taught in their own courses and how prepared they felt to teach and evaluate the competency. Responses were analyzed by participant institution, gender, terminal degree and year, discipline, rank, and teaching experience. More than 90% of faculty respondents reported a personal responsibility to teach or cultivate critical thinking skills, communication skills, self-development skills, and ethical skills, with more than 85% also agreeing to a role in skills such as interpersonal skills, creativity, and self-management. The lowest percentages were seen for crisis and incident management (64%) and business skills (56%). Perceived preparedness to teach and evaluate these competencies paralleled the preceding findings, especially for the four consensus competencies and self-management. Faculty preparedness was lowest for business skills. Junior faculty were somewhat less likely than others to perceive a responsibility to teach non-technical competencies; however, instructors were more prepared to teach and evaluate business skills than were other faculty. Institutional trends were evident in faculty preparation. Although male faculty and non-DVM faculty tended to report a higher degree of preparedness, few differences reached statistical significance. Faculty perceptions of their responsibility to teach non-technical competencies vary by competency and parallel their perceived preparedness to teach and evaluate them.
Juan David Dominguez-Sánchez
Full Text Available General practitioners must constantly face challenges imposed by their profession when performing interventions that are necessary for their patients. Many of these interventions not only require proper use of theoretical knowledge, but also putting into practice non-technical and psychomotor skills developed through professional training. Given the specific characteristics of each patient, the clinical setting in the which procedure takes place and the limited skills of the professional, the management of the airway of a patient with trauma injuries in the emergency room represents a major challenge for physicians.
Krage, R.; Zwaan, L.; Tjon Soei Len, L.; Kolenbrander, M.; Groeningen, D. van; Loer, S.A.; Wagner, C.; Schober, P.
Background: Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary
Conceição, Eva; Pinto-Bastos, Ana; de Lourdes, Marta; Brandão, Isabel; Teixeira, Cristina; Machado, Paulo P P
Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. This study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. Hospital center and university in Portugal. The baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. Two hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t 387 = -5.35, P = .001), higher highest (t 387 = -3.40, P = .001) and lower lowest body mass index (t 381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t 47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F 1,216 = 8.30, Psurgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Brunckhorst, Oliver; Shahid, Shahab; Aydin, Abdullatif; McIlhenny, Craig; Khan, Shahid; Raza, Syed Johar; Sahai, Arun; Brewin, James; Bello, Fernando; Kneebone, Roger; Khan, Muhammad Shamim; Dasgupta, Prokar; Ahmed, Kamran
Current training modalities within ureteroscopy have been extensively validated and must now be integrated within a comprehensive curriculum. Additionally, non-technical skills often cause surgical error and little research has been conducted to combine this with technical skills teaching. This study therefore aimed to develop and validate a curriculum for semi-rigid ureteroscopy, integrating both technical and non-technical skills teaching within the programme. Delphi methodology was utilised for curriculum development and content validation, with a randomised trial then conducted (n = 32) for curriculum evaluation. The developed curriculum consisted of four modules; initially developing basic technical skills and subsequently integrating non-technical skills teaching. Sixteen participants underwent the simulation-based curriculum and were subsequently assessed, together with the control cohort (n = 16) within a full immersion environment. Both technical (Time to completion, OSATS and a task specific checklist) and non-technical (NOTSS) outcome measures were recorded with parametric and non-parametric analyses used depending on the distribution of our data as evaluated by a Shapiro-Wilk test. Improvements within the intervention cohort demonstrated educational value across all technical and non-technical parameters recorded, including time to completion (p technical and non-technical skills teaching is both educationally valuable and feasible. Additionally, the curriculum offers a validated simulation-based training modality within ureteroscopy and a framework for the development of other simulation-based programmes.
Porter, Joanne E; Cant, Robyn P; Cooper, Simon J
Non-technical skills (NTS) teamwork training can enhance clinicians' understanding of roles and improve communication. We evaluated a quality improvement project rating teams' NTS performance to determine the value of formal rating and debriefing processes. In two Australian emergency departments the NTS of resuscitation teams were rated by senior nurses and medical staff. Key measures were leadership, teamwork, and task management using a valid instrument: Team Emergency Assessment Measure (TEAM™). Emergency nurses were asked to attend a focus group from which key themes around the quality improvement process were identified. Main themes were: 'Team composition' (allocation of resuscitation team roles), 'Resuscitation leadership' (including both nursing and medical leadership roles) and 'TEAM™ ratings promote reflective practice' (providing staff a platform to discuss team effectiveness). Objective ratings were seen as enabling staff to provide feedback to other team members. Reflection on practice and debriefing were thought to improve communication, help define roles and responsibilities, and clarify leadership roles. Use of a non-technical skills rating scheme such as TEAM™ after team-based clinical resuscitation events was seen by emergency department nurses as feasible and a useful process for examining and improving multi-disciplinary practice, while improving team performance. Copyright © 2018 Elsevier Ltd. All rights reserved.
Hitchins, Charlotte R; Metzner, Magdalena; Edworthy, Judy; Ward, Catherine
Non-technical skills (NTS) have gained increasing recognition in recent years for their role in safe, effective team performance in healthcare. Gastrointestinal endoscopy is a procedure-based specialty with rapidly advancing technology, significant operational pressures and rapidly changing 'teams of experts'. However, to date there has been little focus on the effect of NTS in this field. This review aims to examine the existing literature on NTS in gastrointestinal endoscopy and identify areas for further research. A systematic search of MEDLINE, Embase, Cochrane Library, PsychINFO, CINAHL Plus and PubMed databases was performed using search terms Non-Technical Skills, Team Performance or Team Skills, and Endoscopy, Colonoscopy, OGD, Gastroscopy, Endoscopic Retrograde Cholangio-Pancreatography or Endoscopic Ultrasound. Eighteen relevant publications were found. NTS are deemed an essential component of practice, but so far there is little evidence of their integration into training or competency assessment. Those studies examining the effects of NTS and team training in endoscopy are small and have variable outcome measures with limited evidence of improvement in skills or clinical outcomes. NTS assessment in endoscopy is in its early phases with a few tools in development. The current literature on NTS in gastrointestinal endoscopy is limited. NTS, however, are deemed an essential component of practice, with potential positive effects on team performance and clinical outcomes. A validated reliable tool would enable evaluation of training and investigation into the effects of NTS on outcomes. There is a clear need for further research in this field.
Gjeraa, K; Jepsen, R M H G; Rewers, M; Østergaard, D; Dieckmann, P
A combination of non-technical skills (NTS) and technical skills (TS) is crucial for anaesthetic patient management. However, a deeper understanding of the relationship between these two skills remains to be explored. We investigated the characteristics of trainee anaesthesiologists' NTS and TS in a simulated unexpected difficult airway management scenario. A mixed-method approach was used to explore the relationship between NTS and TS in 25 videos of 2nd year trainee anaesthesiologists managing a simulated difficult airway scenario. The videos were assessed using the customised version of the Anaesthetists' Non-Technical Skills System, ANTSdk, and an adapted TS checklist for calculating the correlation between NTS and TS. Written descriptions of the observed NTS were analysed using directed content analysis. The correlation between the NTS and the TS ratings was 0.106 (two-tailed significance of 0.613). Inter-rater reliability was substantial. Themes characterising good NTS included a systematic approach, planning and communicating decisions as well as responding to the evolving situation. A list of desirable, concrete NTS for the specific airway management situation was generated. This study illustrates that anaesthesiologist trainees' NTS and TS were not correlated in this setting, but rather intertwined and how the interplay of NTS and TS can impact patient management. Themes describing the characteristics of NTS and a list of desirable, concrete NTS were developed to aid the understanding, training and use of NTS. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Krüger, A; Gillmann, B; Hardt, C; Döring, R; Beckers, S K; Rossaint, R
Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI). The learning objectives of the course were defined according to the key points of Gaba's CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students' self-assessment before and after the training provided the data for evaluation of the training outcome. A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved. The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.
Myers, J A; Powell, D M C; Aldington, S; Sim, D; Psirides, A; Hathaway, K; Haney, M F
The relationship between fatigue-related risk and impaired clinical performance is not entirely clear. Non-technical factors represent an important component of clinical performance and may be sensitive to the effects of fatigue. The hypothesis was that the sum score of overall non-technical performance is degraded by fatigue. Nineteen physicians undertook two different simulated air ambulance missions, once when rested, and once when fatigued (randomised crossover design). Trained assessors blinded to participants' fatigue status performed detailed structured assessments based on expected behaviours in four non-technical skills domains: teamwork, situational awareness, task management, and decision making. Participants also provided self-ratings of their performance. The primary endpoint was the sum score of overall non-technical performance. The main finding, the overall non-technical skills performance rating of the clinicians, was better in rested than fatigued states (mean difference with 95% CI, 2.8 [2.2-3.4]). The findings remained consistent across individual non-technical skills domains; also when controlling for an order effect and examining the impact of a number of possible covariates. There was no difference in self-ratings of clinical performance between rested and fatigued states. Non-technical performance of critical care air transfer clinicians is degraded when they are fatigued. Fatigued clinicians may fail to recognise the degree to which their performance is compromised. These findings represent risk to clinical care quality and patient safety in the dynamic and isolated environment of air ambulance transfer. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Doll, Claus; Hartwig, Johannes; Senger, Florian; Schade, Wolfgang [Fraunhofer-Institut fuer System- und Innovationsforschung (ISI), Karlsruhe (Germany); Maibach, Markus; Sutter, Daniel; Bertschmann, Damaris [Infrastruktur- und Entwicklungsplanung Umwelt- und Wirtschaftsfragen (INFRAS), Zuerich (Switzerland); Lambrecht, Udo; Knoerr, Wolfram; Duennebeil, Frank [ifeu-Institut fuer Energie- und Umweltforschung GmbH, Heidelberg (Germany)
Aim and methodology: This study looks at the impact of selected transport policy measures on environment, transport users, economy and society by the year 2030. Considered are shifts to cycling, walking and public transport, shorter car trips and more efficient car use in passenger travel, as well as more rail in freight transport. Out of the transport user perspective private costs, travel time, health effects, air pollutant and greenhouse gas emissions, noise and traffic safety are assessed. Macroeconomic impacts are appraised using the system-dynamics transport and economics model ASTRA-D. Results: The environmental impacts of the measures diverge widely and are dominated by the costs of greenhouse gas emissions. Measures, which include long-distance travel, achieve higher impacts than pure urban transport measures. In particular for public transport considerable potentials to reduce its external costs from air pollution were identified. Active mobility enhances personal health and reduces the risk of chronic diseases. However, the safety of cyclists and pedestrians in cities requires increased attention. The investment costs for the measures investigated differ strongly, but reach up to 10 billion Euros annually for more attractive local destinations. Accordingly, employment develops positively in almost all measures, and the gross domestic product (GDP) is slightly above the base case in 2030 in four out of the five cases. Recommendations: sensible bundles of measures may clearly enhance the effectiveness and efficiency of transport policy. Core elements are ''push-nd-pull'' approaches combining transport shift and funding policies.
Chozas, Julia Fernandez
The thesis “Technical and non-technical issues towards the commercialisation of wave energy converters” elaborates on the necessary steps and on the different difficulties that appear during the development of a wave energy converter (WEC). It focuses on seven key areas which appear when a WEC...... and a collection of papers. The first part provides a brief history of wave energy, introduces the research topic, describes the different disciplines addressed in the thesis and relates them. The eight papers comprise the core part of the work. The papers address the research topic in different ways: from a legal...... considered cover all the stages from the WEC initial concept to its final commercial reality. Experience has emphasised the importance in structuring the various development stages, due to the fact that step-by-step advancements help to mitigate financial and technical risks throughout the development...
Robertson, Eleanor R; Hadi, Mohammed; Morgan, Lauren J; Pickering, Sharon P; Collins, Gary; New, Steve; Griffin, Damian; Griffin, Damien; McCulloch, Peter; Catchpole, Ken C
We previously developed and validated the Oxford NOTECHS rating system for evaluating the non-technical skills of an entire operating theatre team. Experience with the scale identified the need for greater discrimination between levels of performance within the normal range. We report here the development of a modified scale (Oxford NOTECHS II) to facilitate this. The new measure uses an eight-point instead of a four point scale to measure each dimension of non-technical skills, and begins with a default rating of 6 for each element. We evaluated this new scale in 297 operations at five NHS sites in four surgical specialities. Measures of theatre process reliability (glitch count) and compliance with the WHO surgical safety checklist were scored contemporaneously, and relationships with NOTECHS II scores explored. Mean team Oxford NOTECHS II scores was 73.39 (range 37-92). The means for surgical, anaesthetic and nursing sub-teams were 24.61 (IQR 23, 27); 24.22 (IQR 23, 26) and 24.55 (IQR 23, 26). Oxford NOTECHS II showed good inter-rater reliability between human factors and clinical observers in each of the four domains. Teams with high WHO compliance had higher mean Oxford NOTECHS II scores (74.5) than those with low compliance (71.1) (p = 0.010). We observed only a weak correlation between Oxford NOTECHS II scores and glitch count; r = -0.26 (95% CI -0.36 to -0.15). Oxford NOTECHS II scores did not vary significantly between 5 different hospital sites, but a significant difference was seen between specialities (p = 0.001). Oxford NOTECHS II provides good discrimination between teams while retaining reliability and correlation with other measures of teamwork performance, and is not confounded by technical performance. It is therefore suitable for combined use with a technical performance scale to provide a global description of operating theatre team performance.
Bracco, Fabrizio; Masini, Michele; De Tonetti, Gabriele; Brogioni, Francesca; Amidani, Arianna; Monichino, Sara; Maltoni, Alessandra; Dato, Andrea; Grattarola, Claudia; Cordone, Massimo; Torre, Giancarlo; Launo, Claudio; Chiorri, Carlo; Celleno, Danilo
Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room). The MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected. The mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories. The MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation.
Neuschwander, A; Job, A; Younes, A; Mignon, A; Delgoulet, C; Cabon, P; Mantz, J; Tesniere, A
Sleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the operating room. The impact of sleep deprivation on non-technical skills is unknown. We tested the hypothesis that in anaesthesia residents sleep deprivation is associated with impaired non-technical skills. Twenty anaesthesia residents were randomly allocated to undergo a simulation session after a night shift [sleep-deprived (SLD) group, n =10] or after a night of rest [rested (R) group, n =10] from January to March 2015. The simulated scenario was a situation of crisis management in the operating room. The primary end point was a composite score of anaesthetists' non-technical skills (ANTS) assessed by two blinded evaluators. Non-technical skills were significantly impaired in the SLD group [ANTS score 12.2 (interquartile range 10.5-13)] compared with the R group [14.5 (14-15), P technical skills of anaesthesia residents in a simulated anaesthesia intraoperative crisis scenario. NCT02622217. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: firstname.lastname@example.org
Pearson, Eloise; McLafferty, Isabella
Understanding what non-technical skills are and their relevance for healthcare practitioners has become a new area of exploration. Although recent literature has highlighted the necessity of introducing non-technical skills training and assessment within medical education, nursing education has still to fully embrace this skills training. The purpose of this paper is to explore the use of simulated practice as a learning approach to demonstrate and assess non-technical skills for final year nursing students. An established ward simulation exercise was refocused to incorporate opportunities for these nursing students to be assessed on their ability to demonstrate application of non-technical skills. Opinions on whether this was a successful strategy were sought from the students by means of module evaluation questionnaires. Analysis of this data revealed that the majority of the students agreed that it was an effective learning approach, allowing them to demonstrate their non-technical skills, be assessed and subsequently identify further learning needs. Copyright © 2011 Elsevier Ltd. All rights reserved.
Bryant, Eleanor J; King, Neil A; Falkén, Ylva
BACKGROUND: The interaction between motivation to eat, eating behavior traits, and gut peptides after Roux-en-Y gastric bypass (RYGB) surgery is not fully understood. METHODS: Appetite and hormone responses to a fixed liquid preload were assessed in 12 obese (body mass index 45±1.9 kg/m(2......)) participants immediately before and 3 days, 2 months, and 1 year after RYGB surgery. Subjective appetite and plasma levels of ghrelin, leptin, insulin, and glucagon-like peptide-1 (GLP-1) were measured for a 3-hour postprandial period. Eating behavior traits were also measured using the Three Factor Eating...... appetite ratings, eating behavior traits, and appetite peptides in obese patients both before and at 1 year after RYGB surgery may contribute to the reduction in a propensity to overeat (as measured by TFEQR18 factors) and weight loss....
Eleanor R Robertson
Full Text Available BACKGROUND: We previously developed and validated the Oxford NOTECHS rating system for evaluating the non-technical skills of an entire operating theatre team. Experience with the scale identified the need for greater discrimination between levels of performance within the normal range. We report here the development of a modified scale (Oxford NOTECHS II to facilitate this. The new measure uses an eight-point instead of a four point scale to measure each dimension of non-technical skills, and begins with a default rating of 6 for each element. We evaluated this new scale in 297 operations at five NHS sites in four surgical specialities. Measures of theatre process reliability (glitch count and compliance with the WHO surgical safety checklist were scored contemporaneously, and relationships with NOTECHS II scores explored. RESULTS: Mean team Oxford NOTECHS II scores was 73.39 (range 37-92. The means for surgical, anaesthetic and nursing sub-teams were 24.61 (IQR 23, 27; 24.22 (IQR 23, 26 and 24.55 (IQR 23, 26. Oxford NOTECHS II showed good inter-rater reliability between human factors and clinical observers in each of the four domains. Teams with high WHO compliance had higher mean Oxford NOTECHS II scores (74.5 than those with low compliance (71.1 (p = 0.010. We observed only a weak correlation between Oxford NOTECHS II scores and glitch count; r = -0.26 (95% CI -0.36 to -0.15. Oxford NOTECHS II scores did not vary significantly between 5 different hospital sites, but a significant difference was seen between specialities (p = 0.001. CONCLUSIONS: Oxford NOTECHS II provides good discrimination between teams while retaining reliability and correlation with other measures of teamwork performance, and is not confounded by technical performance. It is therefore suitable for combined use with a technical performance scale to provide a global description of operating theatre team performance.
Clark, Harvey; Foster, Kevin T.
Briefing Products are a new NARAC/IMAAC product line designed to communicate the consequences of a radiological, nuclear, chemical or biological agent incident to non-technical decision makers and key leaders. Each Briefing Product addresses a single decision or issue focused on potential actions that should be considered when responding to a hazard, while avoiding the use of technical or regulatory jargon. Briefing Products do not make protective action recommendations, although they do concretely assist decision-makers with development of their own protective actions by quoting or paraphrasing the published guidance relevant to the decision at hand. Briefing Products are produced in sets tailored to specific types of incident which together depict the key decisions and characteristics of the incident. Each Briefing Product in the set consists of three elements: (1) Primary Effects, (2) Key Points and (3) Presenter Notes. Both the Primary Effects and Key Points are ready for direct presentation, while the Presenter Notes are designed to provide background information to the presenter and are not for direct presentation to the audience. The Briefing Products themselves are alternative presentations of results from the customary standard NARAC/IMAAC technical products. Currently, Briefing Products are available for detonation of both RDDs (Radiological Dispersal Devices) and INDs (Improvised Nuclear Devices). A new set of products tailored to nuclear power plant (NPP) accidents is currently under development. This paper describes the scope, structure and content of the Briefing Product sets. Examples from the two sets of Briefing Products now available are presented.
Arora, Sonal; Miskovic, Danilo; Hull, Louise; Moorthy, Krishna; Aggarwal, Rajesh; Johannsson, Helgi; Gautama, Sanjay; Kneebone, Roger; Sevdalis, Nick
Accurate assessment is imperative for learning, feedback and progression. The aim of this study was to examine whether surgeons can accurately self-assess their technical and nontechnical skills compared with expert faculty members' assessments. Twenty-five surgeons performed a laparoscopic cholecystectomy (LC) in a simulated operating room. Technical and nontechnical performance was assessed by participants and faculty members using the validated Objective Structured Assessment of Technical Skills (OSATS) and the Non-Technical Skills for Surgeons scale (NOTSS). Assessment of technical performance correlated between self and faculty members' ratings for experienced (median score, 30.0 vs 31.0; ρ = .831; P = .001) and inexperienced (median score, 22.0 vs 28.0; ρ = .761; P = .003) surgeons. Assessment of nontechnical skills between self and faculty members did not correlate for experienced surgeons (median score, 8.0 vs 10.5; ρ = -.375; P = .229) or their more inexperienced counterparts (median score, 9.0 vs 7.0; ρ = -.018; P = .953). Surgeons can accurately self-assess their technical skills in virtual reality LC. Conversely, formal assessment with faculty members' input is required for nontechnical skills, for which surgeons lack insight into their behaviours. Copyright © 2011 Elsevier Inc. All rights reserved.
Helikar, Tomáš; Kowal, Bryan; Madrahimov, Alex; Shrestha, Manish; Pedersen, Jay; Limbu, Kahani; Thapa, Ishwor; Rowley, Thaine; Satalkar, Rahul; Kochi, Naomi; Konvalina, John; Rogers, Jim A
Computational modeling of biological processes is a promising tool in biomedical research. While a large part of its potential lies in the ability to integrate it with laboratory research, modeling currently generally requires a high degree of training in mathematics and/or computer science. To help address this issue, we have developed a web-based tool, Bio-Logic Builder, that enables laboratory scientists to define mathematical representations (based on a discrete formalism) of biological regulatory mechanisms in a modular and non-technical fashion. As part of the user interface, generalized "bio-logic" modules have been defined to provide users with the building blocks for many biological processes. To build/modify computational models, experimentalists provide purely qualitative information about a particular regulatory mechanisms as is generally found in the laboratory. The Bio-Logic Builder subsequently converts the provided information into a mathematical representation described with Boolean expressions/rules. We used this tool to build a number of dynamical models, including a 130-protein large-scale model of signal transduction with over 800 interactions, influenza A replication cycle with 127 species and 200+ interactions, and mammalian and budding yeast cell cycles. We also show that any and all qualitative regulatory mechanisms can be built using this tool.
Willems, Anneliese; Waxman, Buce; Bacon, Andrew K; Smith, Julian; Peller, Jennifer; Kitto, Simon
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.
Krage, R. (Ralf); L. Zwaan (Laura); Tjon Soei Len, L. (Lian); Kolenbrander, M.W. (Mark W); Van Groeningen, D. (DIck); S.A. Loer (Stephan A.); C. Wagner (Cordula); P. Schober (P.)
textabstractBackground Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary
Imam, Abbas H.
Complexity of information security has become a major issue for organizations due to incessant threats to information assets. Healthcare organizations are particularly concerned with security owing to the inherent vulnerability of sensitive information assets in health informatics. While the non-technical security management elements have been at…
Jorm, Christine; Roberts, Chris; Lim, Renee; Roper, Josephine; Skinner, Clare; Robertson, Jeremy; Gentilcore, Stacey; Osomanski, Adam
There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-working environment. We evaluated the acceptability and effectiveness of a novel natural disaster simulation that enabled medical students to demonstrate their achievement of the non-technical skills of collaboration, negotiation and communication. In a mixed methods approach, survey data were available from 117 students and a thematic analysis undertaken of both student qualitative comments and tutor observer participation data. Ninety three per cent of students found the activity engaging for their learning. Three themes emerged from the qualitative data: the impact of fidelity on student learning, reflexivity on the importance of non-technical skills in clinical care, and opportunities for collaborative teamwork. Physical fidelity was sufficient for good levels of student engagement, as was sociological fidelity. We demonstrated the effectiveness of the simulation in allowing students to reflect upon and evidence their acquisition of skills in collaboration, negotiation and communication, as well as situational awareness and attending to their emotions. Students readily identified emerging learning opportunities though critical reflection. The scenarios challenged students to work together collaboratively to solve clinical problems, using a range of resources including interacting with clinical experts. A large class teaching activity, framed as a simulation of a natural disaster is an acceptable and effective activity for medical students to develop the non-technical skills of collaboration, negotiation and communication, which are essential to team working. The design could be of value in medical schools in disaster prone areas, including within low resource countries, and as a feasible intervention for learning the non-technical skills that are needed for patient safety.
Letchworth, Pippa M; Duffy, Shane P; Phillips, Dan
To determine the effect of a decision support technology on teamwork and associated non-technical (NTS) and technical skills when teams manage post-partum haemorrhage (PPH) in the simulated environment. Multidisciplinary (MDT) maternity teams were taught how to manage post partum haemorrhage. They were randomised to the intervention: using a decision support mobile digital platform or a control group. Each team managed a post-partum simulation, which was recorded and reviewed by assessors. Primary outcome measures to assess teams NTS were the validated Global Assessment of Obstetric Team Performance (GAOTP) and Clinical Teamwork Scale (CTS). Secondary outcome measures were the 'friends and family test', technical skills, and the System Usability Scale (SUS). Sample size estimation was calculated by using 80% power 5% significance two tailed test (p1=85% p2=40%) n=34. 38 teams from August 2014-February 2016, were recruited, technical issues with failure of recording equipment meant 4 teams were excluded from teamwork analysis (1 intervention 3 control). Teamwork improved across all domains with the intervention (using a decision support mobile digital platform) p technical skills were missed with the intervention (ptechnical skills were achieved. Assessors were more likely to recommend intervention teams 87.5% (77/88) than control teams 63.6% (56/88) p<0.01 to their friends or family. The SUS was 'Good' (69) becoming excellently 'Usable' (81.6) over the study period. We report a decision support system, which improved NTS when managing PPH. Lack of teamwork is often cited as the cause of failures in care and we report a usable technology that assists with and improves teamwork during an emergency. Copyright © 2017 Elsevier B.V. All rights reserved.
Poux, Adeline; Wendel, Marco; Jaudin, Florence; Hiegl, Mathias
Numerous advantages of geothermal energy like its widespread distribution, a base-load power and availability higher than 90%, a small footprint and low carbon emissions, and the growing concerns about climate changes strongly promote the development of geothermal projects. Geothermal energy as a local energy source implies needs on surface to be located close to the geothermal resource. Many European regions dispose of a good geothermal potential but it is mostly not sufficiently developed due to non-technical barriers occurring at the very early stages of the project. The GEOFAR Project carried out within the framework of EU's "Intelligent Energy Europe" (IEE) program, gathers a consortium of European partners from Germany, France, Greece, Spain and Portugal. Launched in September 2008, the aim of this research project is to analyze the mentioned non-technical barriers, focusing most particularly on economic and financial aspects. Based on this analysis GEOFAR aims at developing new financial and administrative schemes to overcome the main financial barriers for deep geothermal projects (for electricity and direct use, without heat pumps). The analysis of the current situation and the future development of geothermal energy in GEOFAR target countries (Germany, France, Greece, Spain, Portugal, Slovakia, Bulgaria and Hungary) was necessary to understand and expose the diverging status of the geothermal sector and the more and less complicated situation for geothermal projects in different Europeans Regions. A deeper analysis of 40 cases studies (operating, planned and failed projects) of deep geothermal projects also contributed to this detailed view. An exhaustive analysis and description of financial mechanisms already existing in different European countries and at European level to support investors completed the research on non-technical barriers. Based on this profound analysis, the GEOFAR project has made an overview of the difficulties met by project
Verenice Martins de Oliveira
Full Text Available A cirurgia bariátrica é o método mais eficaz no tratamento da obesidade mórbida e controle do peso em longo prazo. As cirurgias antiobesidade podem ser procedimentos que limitam a capacidade gástrica, ou que interferem na digestão ou, ainda, uma combinação de ambas as técnicas. A maneira mais objetiva para classificar a obesidade é o Índice de Massa Corpórea (IMC. Pessoas com IMC acima de 40 são portadoras de obesidade mórbida. As principais indicações para a cirurgia bariátrica são: obesos com IMC maior que 40 kg/m² ou IMC acima de 35 kg/m², associado com doenças clínicas descompensadas pela própria obesidade. O papel do psicólogo é o de avaliar se o indivíduo está apto emocionalmente para a cirurgia e auxiliá-lo quanto à compreensão de todos os aspectos decorrentes do pré e pós-cirúrgico. Quanto a possíveis contra-indicações psiquiátricas para a cirurgia antiobesidade, não há consenso na literatura.Bariatric surgery is the only proven effective therapy for long-term control of morbid obesity. This surgery can be broadly divided into procedures that limit the stomach's capacity, that interfere with digestion or a combination of both the techniques. The best way to classify the obesity is the Body Mass Index (BMI. Obesity becomes a serious disease when it is morbid, that is, when the BMI exceeds 40 kg/m². The main indications for the bariatric surgery are individuals with a BMI > 40 or those with a BMI> 35 who also present any comorbidity. Psychological aspects should be evaluated, like if the individual is emotionally prepared for the surgery. Beyond, psychiatric contraindications for bariatric surgery are not well-established.
Kemper, P.F.; van Noord, I.; de Bruijne, M.C.; Knol, D.L.; Wagner, C.; van Dyck, C.
Background A lack of non-technical skills is increasingly recognised as an important underlying cause of adverse events in healthcare. The nature and number of things professionals communicate to each other can be perceived as a product of their use of non-technical skills. This paper describes the
Kemper, P.F.; Noord, I. van; Bruijne, M. de; Knol, D.L.; Wagner, C.; Dyck, C. van
Background: A lack of non-technical skills is increasingly recognised as an important underlying cause of adverse events in healthcare. The nature and number of things professionals communicate to each other can be perceived as a product of their use of non-technical skills. This paper describes the
The IAEA attaches great importance to the dissemination of information that can assist Member States with the development, implementation, maintenance and continuous improvement of systems, programmes and activities that support the nuclear fuel cycle and nuclear applications, including the legacy of past practices and accidents. In response to this, the IAEA has initiated a comprehensive programme of work covering all aspects of environmental remediation: factors important for formulating a strategy for environmental remediation; site characterisation techniques and strategies; assessment of remediation technologies; assessment of technical options for cleanup of contaminated media; post-restoration compliance monitoring; assessment of the costs of remediation measures; remediation of low-level disperse radioactive contaminations in the environment. While this project mainly focus on technological aspects, non-technical factors will be influencing the decision making process in remediation decisively. Often their influence is only tacitly accepted and not explicitly acknowledged by the responsible decision makers. This makes it difficult to trace the decision making process in the event that it has to be revisited. The present publication attempts to make these factors explicit and to present methods to include them consciously into the decision making process
Ovretveit, John; Nelson, Eugene; James, Brent
Purpose The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems. Design/methodology/approach Case description and comparison of the development and use of clinical registries, drawing on participants' experience and published and unpublished research. Findings Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users' daily work appears to be the key to effective use of the potential afforded by digital data. Research limitations/implications The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness. Practical implications The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research. Social implications Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities. Originality/value The paper shows three real examples of clinical registers which have been developed as part of their host health systems' strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for
Ahmad, Tanveer; Ul Hasan, Qadeer
Analysis of losses in power distribution system and techniques to mitigate these are two active areas of research especially in energy scarce countries like Pakistan to increase the availability of power without installing new generation. Since total energy losses account for both technical losses (TL) as well as non-technical losses (NTLs). Utility companies in developing countries are incurring of major financial losses due to non-technical losses. NTLs lead to a series of additional losses, such as damage to the network (infrastructure and the reduction of network reliability) etc. The purpose of this paper is to perform an introductory investigation of non-technical losses in power distribution systems. Additionally, analysis of NTLs using consumer energy consumption data with the help of Linear Regression Analysis has been carried out. This data focuses on the Low Voltage (LV) distribution network, which includes: residential, commercial, agricultural and industrial consumers by using the monthly kWh interval data acquired over a period (one month) of time using smart meters. In this research different prevention techniques are also discussed to prevent illegal use of electricity in the distribution of electrical power system.
Brewin, James; Tang, Jessica; Dasgupta, Prokar; Khan, Muhammad S; Ahmed, Kamran; Bello, Fernando; Kneebone, Roger; Jaye, Peter
To evaluate the face, content and construct validity of the distributed simulation (DS) environment for technical and non-technical skills training in endourology. To evaluate the educational impact of DS for urology training. DS offers a portable, low-cost simulated operating room environment that can be set up in any open space. A prospective mixed methods design using established validation methodology was conducted in this simulated environment with 10 experienced and 10 trainee urologists. All participants performed a simulated prostate resection in the DS environment. Outcome measures included surveys to evaluate the DS, as well as comparative analyses of experienced and trainee urologist's performance using real-time and 'blinded' video analysis and validated performance metrics. Non-parametric statistical methods were used to compare differences between groups. The DS environment demonstrated face, content and construct validity for both non-technical and technical skills. Kirkpatrick level 1 evidence for the educational impact of the DS environment was shown. Further studies are needed to evaluate the effect of simulated operating room training on real operating room performance. This study has shown the validity of the DS environment for non-technical, as well as technical skills training. DS-based simulation appears to be a valuable addition to traditional classroom-based simulation training. © 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.
Maignan, Maxime; Koch, François-Xavier; Chaix, Jordane; Phellouzat, Pierre; Binauld, Gery; Collomb Muret, Roselyne; Cooper, Simon J; Labarère, José; Danel, Vincent; Viglino, Damien; Debaty, Guillaume
Evaluation of team performances during medical simulation must rely on validated and reproducible tools. Our aim was to build and validate a French version of the Team Emergency Assessment Measure (TEAM) score, which was developed for the assessment of team performance and non-technical skills during resuscitation. A forward and backward translation of the initial TEAM score was made, with the agreement and the final validation by the original author. Ten medical teams were recruited and performed a standardized cardiac arrest simulation scenario. Teams were videotaped and nine raters evaluate non-technical skills for each team thanks to the French TEAM Score. Psychometric properties of the score were then evaluated. French TEAM score showed an excellent reliability with a Cronbach coefficient of 0.95. Mean correlation coefficient between each item and the global score range was 0.78. The inter-rater reliability measured by intraclass correlation coefficient of the global score was 0.93. Finally, expert teams had higher French TEAM score than intermediate and novice teams. The French TEAM score shows good psychometric properties to evaluate team performance during cardiac arrest simulation. Its utilization could help in the assessment of non-technical skills during simulation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
As tendon transfer of the flexor hallucis longus (FHL) and the flexor digitorum longus (FDL) is an established procedure, exact knowledge of the formation of the chiasma plantare is of great interest. Although the quadratus plantae (QP) appears to play a major role, it has been rarely addressed in previous studies. The aim of the present study was to reinvestigate the formation of the chiasma plantare and the composition of the long flexor tendons in order to clarify the inexact and partly contradictory descriptions published from 1865 onward. The chiasma plantare and the long flexor tendons in both feet of 50 formalin-fixed specimens of body donors (25 men and women) were analyzed by gross anatomical dissection. It was composed of one (3%), two (69%) or three layers (28%) which were variably established by the tendinous and muscular fibers of the FHL, the FDL and the QP. In 61% the FHL gave one or more slips to the FDL, and in 39% there was a bidirectional interconnection between the two tendons. The slip from the FHL to the FDL largely reinforces the second (45%), or the second and third tendon (46%). Thus, the FHL is involved in the first tendon in all cases, in the second one in 97% of cases, and in the third tendon in about one half of cases (53%). In all instances, the FDL contributes to the third to fourth, in 98% the second, and in at least 39% to the first tendon. The QP reinforces the second to fourth tendon in nearly all cases, the fifth in about one half of cases, and even the first tendon in 14% of cases. In addition, the individual composition of the five long flexor tendons arising from the chiasma plantare was analyzed in detail. Special emphasis was placed on the evaluation of side and sex differences as well as individual symmetry. Furthermore, biomechanical, developmental and phylogenetic aspects were outlined. In terms of the outcome of this study, the FHL appears to be the better donor for tendon transfer to restore lost function, but
Wisniewska, Lidia M; Dohan Ehrenfest, David M; Galindo-Moreno, Pablo; Segovia, Jesus D; Inchingolo, Francesco; Wang, Hom-Lay; Fernandes-Cruz, Manuel
In dentistry and oral and maxillofacial surgery, the development of implantable biomaterials and the understanding of their molecular, cellular and pharmaceutical aspects are currently major fields of research and education, with a considerable impact on the daily clinical practice and the evolution of therapeutic strategies. In the era of globalized economy of knowledge and science, this scientific domain needs the development of global cooperation and a paradigm evolution in the organizational culture of the dental sciences and related dental industry. Despite political pressure and theoretical efforts, the internationalization of higher education and research today in dentistry and biomaterials remains in general quite superficial and mostly dependent on the efforts of a few leaders of internationalization working through their personal networks, as it was assessed through the FAST scores (Fast Assessment Screening Test) calculated in various dental schools and groups worldwide through the ISAIAS program (Intercultural Sensitivity Academic Index &Advanced Standards). Cooperation in a multipolar multicultural community requires the development of strong intercultural competences, and this process remains limited in most institutions. These limits of international scientific cooperation can be observed through different markers, particularly the difficult and limited production of ISO standards (International Organization for Standardization) and the relatively low SCIENTI scores (Scientific Cooperation Internationalization Effort &Network Test &Index) of the specialized dental literature, particularly in comparison to the most significant medical literature. However, as an analytical tool to assess the scientific international cooperation effort between fields and periods, the SCIENTI screening system also highlighted a significant increase of the internationalization effort in the last years in the best dental biomaterials publications. Finally, an
Hardy, Jean-Baptiste; Gouin, Antoine; Damm, Cédric; Compère, Vincent; Veber, Benoît; Dureuil, Bertrand
Anaesthesiologists may occasionally manage life-threatening operating room (OR) emergencies. Managing OR emergencies implies real-time analysis of often complicated situations, prompt medical knowledge retrieval, coordinated teamwork and effective decision making in stressful settings. Checklists are recommended to improve performance and reduce the risk of medical errors. This study aimed to assess the usefulness of the French Society of Anaesthesia and Intensive Care's (SFAR) "Malignant Hyperthermia" (MH) checklist on a simulated episode of MH crisis and management thereof by registered anesthesiologists. Twenty-four anaesthesiologists were allocated to 2 groups (checklist and control). Their technical performance in adherence with the SFAR guidelines was assessed by a 30-point score and their non-technical performance was assessed by the Anaesthetists' Non-Technical Skills (ANTS) score. Every task completion was assessed independently. Data are shown as median (first-third quartiles). Anaesthesiologists in the checklist group had higher technical performance scores (24/30 (21.5-25) vs 18/30 (15.5-19.5), P=0.002) and ANTS scores (56.5/60 (47.5-58) vs 48.5/60 (41-50.5), P=0.024). They administered the complete initial dose of dantrolene (2mg/kg) more quickly (15.7 minutes [13.9-18.3] vs 22.4 minutes [18.6-25]) than the control group (P=0.017). However, anaesthesiologists deemed the usability of the checklist to be perfectible. Registered anaesthesiologists' use of the MH checklist during a simulation session widely improved their adherence to guidelines and non-technical skills. This study strongly suggests the benefit of checklist tools for emergency management. Notwithstanding, better awareness and training for anaesthesiologists could further improve the use of this tool. Copyright © 2017 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Coggins, Andrew; Desai, Mihir; Nguyen, Khanh; Moore, Nathan
Non-technical skills are emerging as an important component of postgraduate medical education. Between 2013 and 2016, a new blended training program incorporating non-technical skills was introduced at an Australian university affiliated hospital. Program participants were medical officers in years 1 and 2 of postgraduate training. An interdisciplinary faculty trained in simulation-based education led the program. The blended approach combined open access online resources with multiple opportunities to participate in simulation-based learning. The aim of the study was to examine the value of the program to the participants and the effects on the wider hospital system. The mixed methods evaluation included data from simulation centre records, hospital quality improvement data, and a post-hoc reflective survey of the enrolled participants ( n = 68). Over 30 months, 283 junior doctors were invited to participate in the program. Enrolment in a designated simulation-based course was completed by 169 doctors (59.7%). Supplementary revision sessions were made available to the cohort with a median weekly attendance of five participants. 56/68 (82.4%) of survey respondents reported increased confidence in managing deteriorating patients. During the period of implementation, the overall rate of hospital cardiac arrests declined by 42.3%. Future objectives requested by participants included training in graded assertiveness and neurological emergencies. Implementation of a non-technical skills program was achieved with limited simulation resources and was associated with observable improvements in clinical performance. The participants surveyed reported increased confidence in managing deteriorating patients, and the program introduction coincided with a significant reduction in the rate of in-hospital cardiac arrests.
Alpherts, W.C.J. (Willem Cornelis Johan)
Only a small number of patients with epilepsy undergo a neurosurgical operation in which the area from which epileptic neurons generate seizures is removed. From a neuropsychological perspective several different assessments and outcomes are being looked at. Chapter 2 deals with research on the
Rutherford, J S; Flin, R; Irwin, A
The outcome of critical incidents in the operating theatre has been shown to be influenced by the behaviour of anaesthetic technicians (ATs) assisting anaesthetists, but the specific non-technical skills involved have not been described. We performed a review of critical incidents (n=1433) reported to the Australian Incident Monitoring System between 2002 and 2008 to identify which non-technical skills were used by ATs. The reports were assessed if they mentioned anaesthetic assistance or had the boxes ticked to identify "inadequate assistance" or "absent supervision or assistance". A total of 90 critical incidents involving ATs were retrieved, 69 of which described their use of non-technical skills. In 20 reports, the ATs ameliorated the critical incident, whilst in 46 they exacerbated the critical incident, and three cases had both positive and negative non-technical skills described. Situation awareness was identified in 39 reports, task management in 23, teamwork in 21 and decision-making in two, but there were no descriptions of issues related to leadership, stress or fatigue management. Situation awareness, task management and teamwork appear to be important non-technical skills for ATs in the development or management of critical incidents in the operating theatre. This analysis has been used to support the development of a non-technical skills taxonomy for anaesthetic assistants.
Lhotska, Lenka; Cheshire, Paul; Pharow, Peter; Macku, David
Mobile technologies are constantly evolving and with the development of Internet of Things we can expect continuous increase of various applications. Mobile technologies have undeniable opportunities to play an important role in health services. Concerning purely technical aspects, almost every problem can be solved. However, there are still many unsolved and unclear issues related with ethics and governance mechanisms for mobile phone applications. These issues are even more critical in medical and health care applications of mobile technologies. This paper tries to analyse ethical, and privacy-related challenges that may occur when introducing Personal Portable Devices (PPD) to collect and record personal health data in health care and welfare environment.
Kinnison, Tierney; May, Stephen
Generic professional capabilities (non-technical competencies) are increasingly valued for their links to patient outcomes and clinician well-being. This study explores the emotional change, and practice-related outcomes, of participants of a veterinary professional key skills (PKS) continuing professional development (CPD) module. Reflective summaries produced by participants were analysed. A change in emotion, from 'negative' to 'positive', was the focus of analysis. Sections regarding these emotions were thematically analysed. Analysis was performed on 46 summaries. Three themes were identified: 'the PKS module' (centred on reluctance becoming surprise and stimulation), 'developing non-technical competencies' (unease to confidence) and 'stress and coping through a reflective focus' (anxiety to harmony). The changing emotions were connected to positive cognitive reappraisal and often behaviour changes, benefitting self, practice, clients and patients. The PKS module teaches participants to reflect; a new and challenging concept. The consequences of this enabled participants to understand the importance of professional topics, to be appreciative as well as critical, and to enjoy their job. Importantly, the module stimulated coping responses. Better understanding of roles led to participants having more reasonable expectations of themselves, more appreciation of their work and reduced stress. This research supports more attention to professional skills CPD for health professions. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Abstract Background Trauma is the leading cause of death for young people in Norway. Studies indicate that several of these deaths are avoidable if the patient receives correct initial treatment. The trauma team is responsible for initial hospital treatment of traumatized patients, and team members have previously reported that non-technical skills as communication, leadership and cooperation are the major challenges. Better team function could improve patient outcome. The aim of this study was to obtain a deeper understanding of which non-technical skills are important to members of the trauma team during initial examination and treatment of trauma patients. Methods Twelve semi-structured interviews were conducted at four different hospitals of various sizes and with different trauma load. At each hospital a nurse, an anaesthesiologist and a team leader (surgeon were interviewed. The conversations were transcribed and analyzed using systematic text condensation according to the principles of Giorgi's phenomenological analysis as modified by Malterud. Results and conclusion Leadership was perceived as an essential component in trauma management. The ideal leader should be an experienced surgeon, have extensive knowledge of trauma care, communicate clearly and radiate confidence. Team leaders were reported to have little trauma experience, and the team leaders interviewed requested more guidance and supervision. The need for better training of trauma teams and especially team leaders requires further investigation and action.
Flowerdew, Lynsey; Gaunt, Arran; Spedding, Jessica; Bhargava, Ajay; Brown, Ruth; Vincent, Charles; Woloshynowych, Maria
To evaluate a new tool to assess emergency physicians' non-technical skills. This was a multicentre observational study using data collected at four emergency departments in England. A proportion of observations used paired observers to obtain data for inter-rater reliability. Data were also collected for test-retest reliability, observability of skills, mean ratings and dispersion of ratings for each skill, as well as a comparison of skill level between hospitals. Qualitative data described the range of non-technical skills exhibited by trainees and identified sources of rater error. 96 assessments of 43 senior trainees were completed. At a scale level, intra-class coefficients were 0.575, 0.532 and 0.419 and using mean scores were 0.824, 0.702 and 0.519. Spearman's ρ for calculating test-retest reliability was 0.70 using mean scores. All skills were observed more than 60% of the time. The skill Maintenance of Standards received the lowest mean rating (4.8 on a nine-point scale) and the highest mean was calculated for Team Building (6.0). Two skills, Supervision & Feedback and Situational Awareness-Gathering Information, had significantly different distributions of ratings across the four hospitals (ptechnical skills, especially in relation to leadership. The framework of skills may be used to identify areas for development in individual trainees, as well as guide other patient safety interventions.
Moreau, Katherine A; Eady, Kaylee; Tang, Kenneth; Jabbour, Mona; Frank, Jason R; Campbell, Meaghan; Hamstra, Stanley J
Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and (c) capturing parents' perspectives to improve the preparation of future physicians.
Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F
In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0
Scott, John; Revera Morales, Dianali; McRitchie, Andrew; Riviello, Robert; Smink, Douglas; Yule, Steven
Health care workers must possess high levels of medical knowledge, technical skills and also non-technical skills (NTS) in order to provide safe, effective and patient-centred care. Although there has been a recent proliferation of NTS assessment and training tools developed in high-income countries, little is known about NTS in low- and middle-income countries (LMICs), which face a variety of provider-level and system-level challenges. The aim of this study was to identify the NTS used by providers in LMICs that have been studied, describe how they are assessed and taught, and explain the contextual factors in LMICs that affect their use. We conducted a systematic literature review in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines for primary research publications from January 1994 to December 2013 on evaluation or teaching of NTS used by health care workers in LMICs using MEDLINE, Embase, CIHHAL and Web of Science. Bibliographies of relevant manuscripts were also hand-searched to identify all potentially eligible manuscripts. We identified 21 manuscripts from 17 LMICs involving eight types of health care providers and trainees. These studies covered five NTS categories: decision making, communication, teamwork, leadership and stress management. The most commonly used methods were questionnaires, interviews and observations, and 43% (n = 9) scored > 10 points using the Medical Education Research Study Quality Instrument. Although many studies highlighted the ways in which overburdened health care systems, lack of provider empowerment and deficiencies in provider training had an impact on providers' use of these NTS, no context-specific assessment or educational tools were identified. There is growing worldwide interest in understanding and teaching critical non-technical skills to health care providers. This review highlights several studies describing a variety of important non-technical skills. However, these
Sanayei, Ali; Shafe'Ei, Reza
As e-commerce grows across industries worldwide , business are building web sites for presence as well as for online business. It is more than transferring current business operations to a new medium. This situation requires explaining main models, changing infrastructures, and notice to customer needs as their vital rights. Whilst increasing numbers of firms have launched themselves on the Internet, they are trying to consideration of the strategic implications of developing, implementing or running a Web site. Global competition, laws, and customer preferences are among the issues being affected by e-commerce. In this study many factors that effect on e-commerce are considered these factors have no technical issue in nature. Companies related factors, customers' knowledge, customers' trust and customers' behavior are the main effective factors in development of B2C e-commerce. In this research we surveyed the mentioned aspects by offering questionnaire to experts of e-commerce for companies. The results show there is a meaningful relationship between perception, knowledge, trust and attitude of customers and the company's capabilities in the other side with B2C e-commerce development.
Cant, Robyn P; Porter, Joanne E; Cooper, Simon J; Roberts, Kate; Wilson, Ian; Gartside, Christopher
This prospective descriptive study aimed to test the validity and feasibility of the Team Emergency Assessment Measure (TEAM™) for assessing real-world medical emergency teams' non-technical skills. Second, the present study aimed to explore the instrument's contribution to practice regarding teamwork and learning outcomes. Registered nurses (RNs) and medical staff (n = 104) in two hospital EDs in rural Victoria, Australia, participated. Over a 10 month period, the (TEAM™) instrument was completed by multiple clinicians at medical emergency episodes. In 80 real-world medical emergency team resuscitation episodes (283 clinician assessments), non-technical skills ratings averaged 89% per episode (39 of a possible 44 points). Twenty-one episodes were rated in the lowest quartile (i.e. ≤37 points out of 44). Ratings differed by discipline, with significantly higher scores given by medical raters (mean: 41.1 ± 4.4) than RNs (38.7 ± 5.4) (P = 0.001). This difference occurred in the Leadership domain. The tool was reliable with Cronbach's alpha 0.78, high uni-dimensional validity and mean inter-item correlation of 0.45. Concurrent validity was confirmed by strong correlation between TEAM™ score and the awarded Global Rating (P technical skills of medical emergency teams are known to often be suboptimal; however, average ratings of 89% were achieved in this real-world study. TEAM™ is a valid, reliable and easy to use tool, for both training and clinical settings, with benefits for team performance when used as an assessment and/or debriefing tool. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Flynn, Fiona M; Sandaker, Kjersti; Ballangrud, Randi
There is increasing focus on building safety into anaesthesia practice, with excellence in anaesthesia as an aspirational goal. Non-technical skills are an important factor in excellence and improved patient safety, though there have been few systematic attempts at integrating them into anaesthesia nursing education. This study aimed to test the reliability of NANTS-no, a specially adapted behavioural marker system for nurse anaesthetists in Norway, and explore the development of non-technical skills in student nurse anaesthetists. The pre-test post-test design incorporated a 10-week simulation-based programme, where non-technical skills in 14 student nurse anaesthetists were rated on three different occasions during high-fidelity simulation, before and after taking part in a training course. NANTS-no demonstrated high overall inter-rater reliability (ICC = 0.91), high test-retest reliability (ICC = 0.94) and good internal consistency (Cronbach's α of 0.85-0.92). A significant improvement was demonstrated across all categories of non-technical skills, with greatest improvements between the first and third and second and third sessions. There was also a significant improvement in two categories between the first and second sessions. NANTS-no is therefore suitable for assessing non-technical skills during simulation training in anaesthesia nursing education. More research is needed to validate its use in clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.
Brown, Michael; Shaw, Dominick; Sharples, Sarah; Jeune, Ivan Le; Blakey, John
Objectives The skill set required for junior doctors to work efficiently and safely Out of Hours (OoH) in hospitals has not been established. This is despite the OoH period representing 75% of the year and it being the time of highest mortality. We set out to explore the expectations of medical students and experiences of junior doctors of the non-technical skills needed to work OoH. Design Survey-based cross-sectional study informed by focus groups. Setting Online survey with participants from five large teaching hospitals across the UK. Participants 300 Medical Students and Doctors Outcome measure Participants ranked the importance of non-technical skills, as identified by literature review and focus groups, needed for OoH care. Results The focus groups revealed a total of eight non-technical skills deemed to be important. In the survey ‘Task Prioritisation’ (mean rank 1.617) was consistently identified as the most important non-technical skill. Stage of training affected the ranking of skills, with significant differences for ‘Communication with Senior Doctors’, ‘Dealing with Clinical Isolation’, ‘Task Prioritisation’ and ‘Communication with Patients’. Importantly, there was a significant discrepancy between the medical student expectations and experiences of doctors undertaking work. Conclusions Our findings suggest that medical staff particularly value task prioritisation skills; however, these are not routinely taught in medical schools. The discrepancy between expectations of students and experience of doctors reinforces the idea that there is a gap in training. Doctors of different grades place different importance on specific non-technical skills with implications for postgraduate training. There is a pressing need for medical schools and deaneries to review non-technical training to include more than communication skills. PMID:25687899
Brown, Michael; Shaw, Dominick; Sharples, Sarah; Jeune, Ivan Le; Blakey, John
The skill set required for junior doctors to work efficiently and safely Out of Hours (OoH) in hospitals has not been established. This is despite the OoH period representing 75% of the year and it being the time of highest mortality. We set out to explore the expectations of medical students and experiences of junior doctors of the non-technical skills needed to work OoH. Survey-based cross-sectional study informed by focus groups. Online survey with participants from five large teaching hospitals across the UK. 300 Medical Students and Doctors Participants ranked the importance of non-technical skills, as identified by literature review and focus groups, needed for OoH care. The focus groups revealed a total of eight non-technical skills deemed to be important. In the survey 'Task Prioritisation' (mean rank 1.617) was consistently identified as the most important non-technical skill. Stage of training affected the ranking of skills, with significant differences for 'Communication with Senior Doctors', 'Dealing with Clinical Isolation', 'Task Prioritisation' and 'Communication with Patients'. Importantly, there was a significant discrepancy between the medical student expectations and experiences of doctors undertaking work. Our findings suggest that medical staff particularly value task prioritisation skills; however, these are not routinely taught in medical schools. The discrepancy between expectations of students and experience of doctors reinforces the idea that there is a gap in training. Doctors of different grades place different importance on specific non-technical skills with implications for postgraduate training. There is a pressing need for medical schools and deaneries to review non-technical training to include more than communication skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Uramatsu, Masashi; Fujisawa, Yoshikazu; Mizuno, Shinya; Souma, Takahiro; Komatsubara, Akinori; Miki, Tamotsu
We sought to clarify how large a proportion of fatal medical accidents can be considered to be caused by poor non-technical skills, and to support development of a policy to reduce number of such accidents by making recommendations about possible training requirements. Summaries of reports of fatal medical accidents, published by the Japan Medical Safety Research Organization, were reviewed individually. Three experienced clinicians and one patient safety expert conducted the reviews to determine the cause of death. Views of the patient safety expert were given additional weight in the overall determination. A total of 73 summary reports of fatal medical accidents were reviewed. These reports had been submitted by healthcare organisations across Japan to the Japan Medical Safety Research Organization between April 2010 and March 2013. The cause of death in fatal medical accidents, categorised into technical skills, non-technical skills and inevitable progress of disease were evaluated. Non-technical skills were further subdivided into situation awareness, decision making, communication, team working, leadership, managing stress and coping with fatigue. Overall, the cause of death was identified as non-technical skills in 34 cases (46.6%), disease progression in 33 cases (45.2%) and technical skills in two cases (5.5%). In two cases, no consensual determination could be achieved. Further categorisation of cases of non-technical skills were identified as 14 cases (41.2%) of problems with situation awareness, eight (23.5%) with team working and three (8.8%) with decision making. These three subcategories, or combinations of them, were identified as the cause of death in 33 cases (97.1%). Poor non-technical skills were considered to be a significant cause of adverse events in nearly half of the fatal medical accidents examined. Improving non-technical skills may be effective for reducing accidents, and training in particular subcategories of non-technical skills may be
Cooper, Simon J; Cant, Robyn P
Medical emergency team performance including non-technical skills, is receiving increased attention due to the influences on patient safety. The Team Emergency Assessment Measure (TEAM) was developed to enable standardized performance assessment and structured team debriefing. From several studies, the TEAM has demonstrated a substantial body of normative data confirming its validity and reliability. This includes high uni-dimensional validity, significant subscale relationships between Teamwork and Leadership and between Teamwork and Task Management (pteam training to improve team's non-technical performance. Further testing is required in 'real' clinical settings. Copyright © 2013. Published by Elsevier Ireland Ltd.
Full Text Available ... their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may ... front, or side Facial injury Birth defects Receding lower jaw and ...
Alvand, Abtin; Gill, Harinderjit S; Price, Andrew J; Dodd, Christopher A F; Murray, David W; Rees, Jonathan L
To determine whether a mixed course on the Oxford unicompartmental knee arthroplasty (UKA) could improve the non-technical (cognitive) skills of performing UKA. 120 delegates consisting of consultant orthopaedic surgeons and advanced surgical trainees attended a 2-day course. 104 (87%) of the delegates had performed total knee arthroplasties, whereas 79 (66%) had performed UKAs. The course consisted of didactic lectures, interactive surgical demonstrations, and practical dry-bone skills workshops. Cognitive skills were assessed at the start (day 1) and end (day 2) of the course using 10 multiple-choice questions. The maximum test score was 10. Multilevel modelling was used to compare the pre- and post-course test scores. The pairings of pre- and post-course scores were not known because of a confidentiality clause. Of the 120 delegates, 71 (59%) took the pre-course test and 120 (100%) took the post-course test. The median score improved significantly from 2 (interquartile range [IQR], 0.5-3.5) to 6 (IQR, 4.5- 7.5) [bootstrap ptechnical (cognitive) skills for UKA.
Goldenbeld, C. & Noordzij, P.C.
This paper discusses engineering, education and enforcement in relation to hazardous road situations. If a high risk road or road site has been identified, the question is which selection of technical and non-technical measures should be taken to prevent or reduce the danger. The main argument is
Liu, Chang; Zhong, Ying; Ozercan, Sertac; Zhu, Qing
This paper presents a template-based solution to overcome technical barriers non-technical computer end users face when developing functional learning environments in three-dimensional virtual worlds (3DVW). "iVirtualWorld," a prototype of a platform-independent 3DVW creation tool that implements the proposed solution, facilitates 3DVW…
Slusher, Wendy L.; Robinson, J. Shane; Edwards, M. Craig
Non-technical, employability skills are in high demand for entry-level job-seekers. As such, this study sought to describe the perceptions of Oklahoma's animal science industry leaders as it related to the employability skills needed for entry-level employment of high school graduates who had completed coursework in Oklahoma's Agricultural, Food…
Ben-Haim, Menahem; Nakache, Richard; Klausner, Joseph M
EstabLishment of hepato-pancreato-biliary (HPB) surgery and abdominal organ transplantation as defined subspecialties of general surgery has been boosted over the Last decade. However, the affiliation (independent service vs. integration within the division of surgery), the training course (transplantation vs. surgical oncology) and the referral patterns are still controversial. Dedicated HPB and transplantation units were defined within the surgical division of the Tel Aviv Medical Center. The principles of operation included muttidisciplinary expert teams, unified and standard treatment protocols, exposure and involvement of all residents and attending surgeons of the division to patients, decision-making and perioperative care, peer review and periodic publication of clinical results. Between the years 2003-2007, 870 major HPB procedures were performed: 70 Liver transplants (9 from live donors), 100 organ procurements, 165 kidney and kidney-pancreas transplants (30% from Live donors), 250 hepatic resections of various types and indications, 35 complex biliary reconstructions and 250 pancreatectomies. The short- (morbidity and mortality) and long-term (survival and disease free survival) rates are compatible with the reported results from Centers of Excellence around the world. Operating HPB and transplantation surgery by trained experts and defined professional units, but within an academic surgical division, promotes the achievement of high volume and excellent results together with optimal exposure, education and training of the surgical residents.
Groenendaal, B.J.; De Lange, T.J.; Lako, P.; Van Roosmalen, J.A.M.; Tool, C.J.J.; De Wild-Scholten, M.J.
The differences in Significance and Status of 15 factors that might be of decisive influence in achieving a large-scale market introduction of grid-connected photovoltaic (PV) systems are analyzed. As a research method the opinions of PV experts and persons involved in the implementation of PV have been surveyed. A questionnaire was sent to about 300 persons all over the world (America, Europe and Asia). The methods applied to analyze the returned questionnaires can be divided into a comparing method (Mann-Whitney test) and ranking methods (Friedman test and the Medal-Classification test). One of the main conclusion is that the ranking of the main critical success factors on Significance shows no large differences between the American and European respondents. The answers from the American and European respondents show that the technical and financial factors are the most Significant: RD and D, technical reliability, financing and cost reduction. The Asian ranking does differ from the American and European ranking. The answers from the Asian respondents show that the international factors: global developments and internationalisation together with specialist knowledge and image are the most Significant success factors. Another main conclusion is that the three regions differ in the ranking of the actual Status of the factors. A comparison of the American ranking with the Asian ranking show the largest differences, whereas Europe is taking an intermediary position. Another interesting observation is that the Status of factors, e.g. internationalisation, global developments and the technical/commercial network, are considered more positive in America, whereas Asia and Europe are more positive about the factors RD and D, image and financing. More specific conclusions show that there is a significant difference in answers between the American and European respondents about the Significance of the factor cost reduction. There is also a significant difference between the answers from the Asian respondents versus the American and European answers about the factor technical reliability. It also occurs that there is a significant difference about the Status of the factor financing between the American and European respondents versus the Asian respondents. In addition, all the respondents have their own idea about the Status of RD and D in their region. Also, the Status of the factor technical/commercial network is significantly different for Asia and America. 13 refs
Wager, Michel; Du Boisgueheneuc, Foucaud; Pluchon, Claudette; Bouyer, Coline; Stal, Veronique; Bataille, Benoit; Guillevin, Carole Menuel; Gil, Roger
Awake brain surgery allows extensive intraoperative monitoring of not only motor and sensory functions and language but also executive functions. To administer the Stroop test intraoperatively to avoid dramatic side effects such as akinetic mutism and to monitor executive functions in an attempt to optimize the benefit/risk balance of surgery. A series of 9 adult patients with frontal glioma were operated on for gross tumor resection under local anesthesia. All procedures involved the anterior cingulate cortex (ACC). Three types of response to the Stroop test were observed: 3 patients had a Stroop effect only for stimulation of the contralateral ACC; 3 patients had a Stroop effect for stimulation of the ipsilateral ACC; and 3 patients had no Stroop effect. Preoperative and postoperative neuropsychological and surgical results are presented and discussed. Stimulation sites eliciting a Stroop effect are compared with published image-based data, and insight provided by these surgical data regarding ACC function and plasticity is discussed. No operative complication related to intraoperative administration of the Stroop test was observed. Administration of the Stroop test during resection of gliomas involving the ACC in adult patients is an option for intraoperative monitoring of executive functions during awake surgery. Globally, these results suggest functional compensation, mediated by plasticity mechanisms, by contralateral homologous regions of the ACC in adult patients with frontal glioma.
Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...
Hikono, Masaru; Matsui, Yuko; Kanayama, Masaki
Since the Great East Japan Earthquake of 2011, there have been increasing calls for developing the leadership capabilities of managers who are in charge of command and control of the on-site emergency response center at nuclear power plants. Training programs to improve non-technical skills are being developed and introduced. The authors developed an active learning exercise 'TAIKAN Training' that can be repeatedly performed on-site, targeting on-site commander teams in charge of the initial response in an emergency situation. The exercise forms the core element of a non-technical skills training curriculum. This paper outlines the developed exercise, evaluates the stress on the participants caused by the exercise, and identifies any issues before actually introducing it to a site. (author)
Khan, Rishad; Scaffidi, Michael A; Walsh, Catharine M; Lin, Peter; Al-Mazroui, Ahmed; Chana, Barinder; Kalaichandran, Ruben; Lee, Woojin; Grantcharov, Teodor P; Grover, Samir C
Non-technical skills (NTS), such as communication and professionalism, contribute to the safe and effective completion of procedures. NTS training has previously been shown to improve surgical performance. Moreover, increases in NTS have been associated with improved clinical endoscopic performance. Despite this evidence, NTS training has not been tested as an intervention in endoscopy. The aim of this study is to evaluate the effectiveness of a simulation-based training (SBT) curriculum of NTS on novice endoscopists' performance of clinical colonoscopy. Novice endoscopists were randomized to 2 groups. The control group received 4 hours of interactive didactic sessions on colonoscopy theory and 6 hours of SBT. Hours 5 and 6 of the SBT were integrated scenarios, wherein participants interacted with a standardized patient and nurse, while performing a colonoscopy on the virtual reality (VR) simulator. The NTS (intervention) group received the same teaching sessions but the last hour was focused on NTS teaching. The NTS group also reviewed a checklist of tasks relevant to NTS concepts prior to each integrated scenario case and was provided with dedicated feedback on their NTS performance during the integrated scenario practice. All participants were assessed at baseline, immediately after training, and 4 to 6 weeks post-training. The primary outcome measure is colonoscopy-specific performance in the clinical setting. In total, 42 novice endoscopists completed the study. Data collection and analysis is ongoing. We anticipate completion of all assessments by August 2017. Data analysis, manuscript writing, and subsequent submission for publication is expected to be completed by December 2017. Results from this study may inform the implementation of NTS training into postgraduate gastrointestinal curricula. NTS curricula may improve attitudes towards patient safety and self-reflection among trainees. Moreover, enhanced NTS may lead to superior clinical performance and
Allen, H. M.; Giardino, J. R.
Each year people seek respite from their busy lifestyles by traveling to state or national parks, national forests or wilderness areas. The majority of these parks were established in order to help preserve our natural heritage, including wildlife, forests, and the beauty of landscapes formed from thousands of years of geologic/geomorphologic processes. Whilst being able to enjoy the tranquility of nature, tourists are being robbed of a more in-depth experience as a result of the lack of a geologic background. One such location that attracts a large number of summer tourists is the perimeter trail in Ouray, Colorado. Located in the Southwestern portion of Colorado, Ouray is situated in the beautiful San Juan Mountain range along the "Million Dollar Highway." The Perimeter trail is a six-mile trail loop that circles the city of Ouray. The city is a very popular place for summertime tourism because of its unparalleled scenery. Ouray is situated in an area that is riddled with textbook angular unconformities, metasedimentary, sedimentary, and volcanic rocks. In the study area, The San Juans have been beautifully sculpted by an array of major faulting events, glacial activity and volcanics. With the understanding that technology is ever expanding, we think there is no better way to experience the Perimeter Trail than to have an interactive application that will be both educational as well as interesting. This application is a non-technical way of looking at the geology and geomorphology of the perimeter trail. Additionally, a paper brochure shows the most noteworthy points of interest. The brochure contains a brief geologic history of the San Juan Mountains accompanied with annotated photographs to illustrate the complex geology/geomorphology encountered on the trail. The application is based on an interactive three-dimensional map, which can be zoomed to various scales. The app hosts a locational service that uses the phone's GPS to communicate location of the hiker
Kemper, Peter F; van Noord, Inge; de Bruijne, Martine; Knol, Dirk L; Wagner, Cordula; van Dyck, Cathy
A lack of non-technical skills is increasingly recognised as an important underlying cause of adverse events in healthcare. The nature and number of things professionals communicate to each other can be perceived as a product of their use of non-technical skills. This paper describes the development and reliability of an instrument to measure and quantify the use of non-technical skills by direct observations of explicit professional oral communication (EPOC) in the clinical situation. In an iterative process we translated, tested and refined an existing checklist from the aviation industry, called self, human interaction, aircraft, procedures and environment, in the context of healthcare, notably emergency departments (ED) and intensive care units (ICU). The EPOC comprises six dimensions: assertiveness, working with others; task-oriented leadership; people-oriented leadership; situational awareness; planning and anticipation. Each dimension is specified into several concrete items reflecting verbal behaviours. The EPOC was evaluated in four ED and six ICU. In the ED and ICU, respectively, 378 and 1144 individual and 51 and 68 contemporaneous observations of individual staff members were conducted. All EPOC dimensions occur frequently, apart from assertiveness, which was hardly observed. Intraclass correlations for the overall EPOC score ranged between 0.85 and 0.91 and for underlying EPOC dimensions between 0.53 and 0.95. The EPOC is a new instrument for evaluating the use of non-technical skills in healthcare, which is reliable in two highly different settings. By quantifying professional behaviour the instrument facilitates measurement of behavioural change over time. The results suggest that EPOC can also be translated to other settings.
Yule, S; Gupta, A; Gazarian, D; Geraghty, A; Smink, D S; Beard, J; Sundt, T; Youngson, G; McIlhenny, C; Paterson-Brown, S
Surgeons' non-technical skills are an important part of surgical performance and surgical education. The most widely adopted assessment tool is the Non-Technical Skills for Surgeons (NOTSS) behaviour rating system. Psychometric analysis of this tool to date has focused on inter-rater reliability and feasibility rather than validation. NOTSS assessments were collected from two groups of consultant/attending surgeons in the UK and USA, who rated behaviours of the lead surgeon during a video-based simulated crisis scenario after either online or classroom instruction. The process of validation consisted of assessing construct validity, scale reliability and concurrent criterion validity, and undertaking a sensitivity analysis. Central to this was confirmatory factor analysis to evaluate the structure of the NOTSS taxonomy. Some 255 consultant surgeons participated in the study. The four-category NOTSS model was found to have robust construct validity evidence, and a superior fit compared with alternative models. Logistic regression and sensitivity analysis revealed that, after adjusting for technical skills, for every 1-point increase in NOTSS score of the lead surgeon, the odds of having a higher versus lower patient safety score was 2·29 times. The same pattern of results was obtained for a broad mix of surgical specialties (UK) as well as a single discipline (cardiothoracic, USA). The NOTSS tool can be applied in research and education settings to measure non-technical skills in a valid and efficient manner. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.
Gordon, Morris; Baker, Paul; Catchpole, Ken; Darbyshire, Daniel; Schocken, Dawn
Non-technical skills are a subset of human factors that focus on the individual and promote safety through teamwork and awareness. There is no widely adopted competency- or outcome-based framework for non-technical skills training in healthcare. The authors set out to devise such a framework using a modified Delphi approach. An exhaustive list of published and team suggested items was presented to the expert panel for ranking and to propose a definition. In the second round, a focused list was presented, as well as the proposed definition elements. The finalised framework was sent to the panel for review. Sixteen experts participated. The final framework consists of 16 competencies for all and eight specific competencies for team leaders. The consensus definition describes non-technical skills as "a set of social (communication and team work) and cognitive (analytical and personal behaviour) skills that support high quality, safe, effective and efficient inter-professional care within the complex healthcare system". The authors have produced a new competency framework, through the works of an International expert panel, which is not discipline specific that can be used by curriculum developers, educational innovators and clinical teachers to support developments in the field.
Full Text Available Background: Obesity is a known prevalent major health issue. The aim of this study is to assay Iranian patients' problems with obesity and their expectations of bariatric surgery. Materials and Methods: In this study, we included patients who have used different medical noninvasive treatments and were unsuccessful in losing weight from the obesity clinic in Al Zahra Hospital, Isfahan, from 2014 to 2015. Morbidly obese patients were interviewed using some open-ended questions, and then, directional content analysis of data was done. Results: Analysis of data showed five main categories including (1 physical health, (2 psychological health, (3 social relationships, (4 environment, and (5 “about the causes of obesity” with some subcategories for each category. Conclusion: This study is the first step of designing a quality of life questionnaire while we focused on spiritual and cultural states of Iranian people.
Keleidari, Behrouz; Jamalouee, Samira Davashi; Mahmoudieh, Mohsen; Zolfaghari, Behzad; Gharzi, Mahsa
Obesity is a known prevalent major health issue. The aim of this study is to assay Iranian patients' problems with obesity and their expectations of bariatric surgery. In this study, we included patients who have used different medical noninvasive treatments and were unsuccessful in losing weight from the obesity clinic in Al Zahra Hospital, Isfahan, from 2014 to 2015. Morbidly obese patients were interviewed using some open-ended questions, and then, directional content analysis of data was done. Analysis of data showed five main categories including (1) physical health, (2) psychological health, (3) social relationships, (4) environment, and (5) "about the causes of obesity" with some subcategories for each category. This study is the first step of designing a quality of life questionnaire while we focused on spiritual and cultural states of Iranian people.
The goal of the Annals of African Surgery is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region to keep abreast of ...
Choua, Ouchemi; Rimtebaye, Kimassoum; Yamingue, Ngueidjo; Moussa, Kalli; Kaboro, Mignagnal
Blunt abdominal traumas are common. We retrospectively reviewed the medical records of 49 patients with blunt abdominal trauma who underwent surgery at the General Hospital of National Reference of N'Djamena, Chad over a period of 5 years. Epidemiological, clinical and therapeutic parameters of patients were studied. The study included 42 men and 7 women, mean age 21.3 years. The causes of blunt abdominal traumas were: road traffic accidents in 61.2% of cases; wall collapses (14.3%); assaults (8.2%). Blunt abdominal traumas were more frequent in August (14.28%) and October (16.32%). The waiting time for admission in hospital was 6-12h in 43% of cases. At discharge, wounded patients used private car in 85.7% of cases. Clinically, patients were often hemodynamically stable (55.1%). Medical imaging was dominated by direct radiography of the abdomen (57.1%). The most observed lesions were those located only in the small intestine (16.32%) or related to that of the bladder (8.16%) and spleen (2.04%). Laparotomy was negative in 6.12% of cases. Morbidity (12.2%) was dominated by abdominal wall abscess. Mortality rate was 6.1%. Road traffic accidents are the leading cause of blunt abdominal traumas. It is important to minimize delays in diagnosis, and treatment. Road safety measures should be implemented to prevent accidents.
Stoop, A E; van der Heijden, H A; Biewenga, J; van der Baan, S
Clinical parameters of 72 patients who were operated upon for nasal polyps were evaluated as well as biopsy specimens of the mucosa of the middle and inferior turbinates of 41 of these patients. Biopsies were taken at the time of endoscopic sinus surgery (ESS), after 6 months and after 1 year in 23 patients. During the follow-up period the patients were treated with topical corticosteroids (budesonide). At the time of ESS significantly more CD8+ (suppressor/cytotoxic) cells than CD4+ (helper/inducer) cells were found in the middle and inferior turbinates. At 6 months significantly more CD4+ cells were found than at the time of ESS, whereas at 1 year the number of CD4+ cells had decreased and was lower than at 6 months. These data support the theory that the occurrence of nasal polyps is associated with T-cell-dependent disturbances. Clinical evaluation revealed that most of the patients with chronic airway obstruction had better pulmonary functions postoperatively or required less medication for lung disease. These findings show that ESS combined with topical corticosteroids has a positive effect on upper and lower respiratory tract pathology.
... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...
Lewis, Robin; Strachan, Alasdair; Smith, Michelle McKenzie
To review the literature on the use of simulation in the development of non-technical skills in nursing The potential risks to patients associated with learning 'at the bedside' are becoming increasingly unacceptable, and the search for innovative education and training methods that do not expose the patient to preventable errors continues. All the evidence shows that a significant proportion of adverse events in health care is caused by problems relating to the application of the 'non-technical' skills of communication, teamwork, leadership and decision-making. Simulation is positively associated with significantly improved interpersonal communication skills at patient handover, and it has also been clearly shown to improve team behaviours in a wide variety of clinical contexts and clinical personnel, associated with improved team performance in the management of crisis situations. It also enables the effective development of transferable, transformational leadership skills, and has also been demonstrated to improve students' critical thinking and clinical reasoning in complex care situations, and to aid in the development of students' self-efficacy and confidence in their own clinical abilities. High fidelity simulation is able to provide participants with a learning environment in which to develop non-technical skills, that is safe and controlled so that the participants are able to make mistakes, correct those mistakes in real time and learn from them, without fear of compromising patient safety. Participants in simulation are also able to rehearse the clinical management of rare, complex or crisis situations in a valid representation of clinical practice, before practising on patients.
Bamford, R; Langdon, L; Rodd, C A; Eastaugh-Waring, S; Coulston, J E
The transition to surgical training can be a stressful time for trainees and is most evident during national handover periods where new graduates start and senior trainees rotate to new programmes. During this time, patient mortality can increase and Hospital efficiency reduces. This influence is compounded by the impact of working time directives. Intensive, simulation rich training programmes or "Boot Camps" have been postulated as a solution. This article highlights the development of a surgical boot camp for novice surgical trainees and the impact this can have on training. A novel surgical boot camp was developed for all trainees within a surgical training region including nine acute NHS trusts. Participating cohort of trainees completed pre and post course questionnaires to assess technical and non-technical skills. 25 trainees attended and completed the pre and post boot camp questionnaire. Significant improvements were seen with technical skills (p = 0.0429), overall non-technical skills (p skills (p = 0.005) and outpatient skill (p = 0.002). Trainees reported significantly increased ability to assess and manage a critically unwell patient (p = 0.001) and a trauma patient (p = 0.001). 96% of trainees have utilised the skills they learnt on Boot Camp and all trainees would recommend it as an induction programme. Surgical Boot Camps offer a timely chance to develop technical and non-technical skills whilst enhancing a trainee's confidence and knowledge and reduce the patient safety impact of the handover period. Copyright © 2018. Published by Elsevier Ltd.
Hikono, Masaru; Sakuda, Hiroshi; Matsui, Yuko; Goto, Manabu; Kanayama, Masaki
The Government Investigation Committee on the Accident at the Fukushima Nuclear Power Stations interviewed individuals concerned. The hearing records, published in 2014, are considered to have valuable lessons for power station managers who encounter severe accidents. In this study, descriptions from the hearing records were extracted as lessons for managers. The extractions were classified by the subject (for whom the lessons are intended), and the category of the non-technical skills. The results showed the possibility of pointing out the lessons in accordance with responsibilities. (author)
Reng, Lars; Schoenau-Fog, Henrik
of Medialogy, we employ problem based learning and game design to engage these students in learning the technical elements. This paper will describe our approach and exemplify the method by introducing various examples of student projects, where the interest in game design combined with problem based learning...... technology, a broader segment of students are consequently enrolled. One of the challenges of these new educations is to motivate the artistic minded students in learning the technical aspects of the curriculum, as they need these qualifications to work in the industry. At Aalborg University’s department...... have engaged and motivated artistic students to learn technical topics on their own....
Gundrosen, Stine; Solligård, Erik; Aadahl, Petter
Nursing competence affects quality of care in intensive care units (ICUs). Team competence is particularly important for preventing errors. This paper focuses on the feasibility of using an in situ simulation model to explore team competence in the ICU, and on using parts of the Anaesthetists' Non-Technical Skills (ANTS) taxonomy for assessing Non-Technical Skills (NTS) in nursing teams. Seventy-two nurses were randomised into two groups and introduced to a new guideline via either lecture-based or simulation-based teaching. A preprogrammed patient simulator and a video camera were installed inside the ICU, and a scenario was enacted to simulate the admission of a patient with septic shock. All available facilities in the ICU were used. Two blinded raters evaluated "Team Working" and "Situation Awareness" via video recordings using the ANTS taxonomy. Due to high activity in the ICU, 54 nurses completed the in situ simulation. Assessments of the video recordings revealed moderate agreement between the two raters. Observations revealed issues deviating from expected standards of competence. In situ simulation may be feasible for assessing competence in ICUs. The ANTS appears to be a promising foundation for developing a team assessment tool for ICUs. Copyright © 2014 Elsevier Ltd. All rights reserved.
Murray, Kara; McKenzie, Karen; Kelleher, Michael
The importance of non-technical skills (NTS) to patient outcomes is increasingly being recognised, however, there is limited research into how such skills can be taught and evaluated in student nurses in relation toward rounds. This pilot study describes an evaluation of a NTS framework that could potentially be used to measure ward round skills of student nurses. The study used an observational design. Potential key NTS were identified from existing literature and NTS taxonomies. The proposed framework was then used to evaluate whether the identified NTS were evident in a series of ward round simulations that final year general nursing students undertook as part of their training. Finally, the views of a small group of qualified nurse educators, qualified nurses and general nursing students were sought about whether the identified NTS were important and relevant to practice. The proposed NTS framework included seven categories: Communication, Decision Making, Situational Awareness, Teamwork and Task Management, Student Initiative and Responsiveness to Patient. All were rated as important and relevant to practice. The pilot study suggests that the proposed NTS framework could be used as a means of evaluating student nurse competencies in respect of many non-technical skills required for a successful ward round. Further work is required to establish the validity of the framework in educational settings and to determine the extent to which it is of use in a non-simulated ward round setting. Copyright © 2016 Elsevier Ltd. All rights reserved.
... Center > Maze Surgery Menu Topics Topics FAQs Maze Surgery Article Info En español Electrical impulses in your ... called an arrhythmia. Why do I need Maze surgery? Maze surgery is also called the Maze procedure. ...
Tao, P. K.
This paper reports on an investigation into Hong Kong students' comprehension of English non-technical words used in science. The investigation was conducted in a context in which English, a foreign language to students, is the medium of instruction, in that textbooks and examinations are all in English but the classroom language used is mainly Chinese, with frequent Chinese-English code-switching. A total of 4644 Secondary 4, 5 and 6 students participated in the study. Many students did not correctly comprehend a large proportion of the words, confused them with words that were graphologically or phonetically similar, and even took them for their antonyms. Such poor performance raises doubts as to whether the majority of Hong Kong students have attained a ‘threshold level’ of competence in English to benefit from learning science in English.
Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...
... in the bathroom and prevent falls at home. Wound care Your health care provider will explain how ... Kennedy EP, Yeo CJ. Pancreatic cancer: Clinical aspects, assessment, and management. In: Jarnagin WR, ed. Blumgart's Surgery ...
markdownabstract__Abstract__ Colorectal surgery is an important aspect of our current health system, due to the high incidence of colorectal cancer combined with an ageing population, improved long-term outcomes after colorectal surgery, and the perfectioning of the operative and postoperative aspects through laparoscopy and enhanced recovery programs. However, postoperative complications painfully remain, despite efforts of amelioration of perioperative care. Research for molecular pathways ...
Yim, Ho Bin; Kim, Ar Ryum; Seong, Poong Hyun [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)
Human reliability is one of the important determinants for the system safety. Nuclear Energy Agency reported that approximately half of events reported by foreign nuclear industry were related with inappropriate human actions. The human error problems can be viewed in two ways: the person approach and the system approach. Other terms to represent each approach are active failures and latent conditions. Active failures are unsafe acts committed by people who are in direct contact with systems whereas latent conditions are the inevitable 'resident pathogens' within the system. To identify what kinds of non-technical skills were needed to cope with emergency conditions, a method to evaluate preparedness of task management in emergency conditions based on monitoring patterns was presented. Five characteristics were suggested to evaluate emergency task management and communication: latent mistake resistibility, latent violation resistibility, thoroughness, communication, and assertiveness. Case study was done by analyzing emergency training of 9 different real operation teams in the reference plant. The result showed that the 9 teams had their own emergency task management skills which resulted in good and bad performances
Yim, Ho Bin; Kim, Ar Ryum; Seong, Poong Hyun
Human reliability is one of the important determinants for the system safety. Nuclear Energy Agency reported that approximately half of events reported by foreign nuclear industry were related with inappropriate human actions. The human error problems can be viewed in two ways: the person approach and the system approach. Other terms to represent each approach are active failures and latent conditions. Active failures are unsafe acts committed by people who are in direct contact with systems whereas latent conditions are the inevitable 'resident pathogens' within the system. To identify what kinds of non-technical skills were needed to cope with emergency conditions, a method to evaluate preparedness of task management in emergency conditions based on monitoring patterns was presented. Five characteristics were suggested to evaluate emergency task management and communication: latent mistake resistibility, latent violation resistibility, thoroughness, communication, and assertiveness. Case study was done by analyzing emergency training of 9 different real operation teams in the reference plant. The result showed that the 9 teams had their own emergency task management skills which resulted in good and bad performances
D'Elia, I.; Bencardino, M.; Ciancarella, L.; Contaldi, M.; Vialetto, G.
The Italian Air Quality legislation underwent sweeping changes with the implementation of the 1996 European Air Quality Framework Directive when the Italian administrative Regions were entrusted with air quality management tasks. The most recent Regional Air Quality Management Plans (AQMPs) highlighted the importance of Non-Technical Measures (NTMs), in addition to Technical Measures (TMs), in meeting environmental targets. The aim of the present work is to compile a list of all the TMs and NTMs taken into account in the Italian Regional AQMPs and to give in the target year, 2010, an estimation of SO 2, NO x and PM 10 emission reductions, of PM 10 concentration and of the health impact of PM 2.5 concentrations in terms of Life Expectancy Reduction. In order to do that, RAINS-Italy, as part of the National Integrated Modeling system for International Negotiation on atmospheric pollution (MINNI), has been applied. The management of TMs and NTMs inside RAINS have often obliged both the introduction of exogenous driving force scenarios and the control strategy modification. This has inspired a revision of the many NTM definitions and a clear choice of the definition adopted. It was finally highlighted that only few TMs and NTMs implemented in the AQMPs represent effective measures in reaching the environmental targets.
... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...
Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...
Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...
Malnutrition is a risk that is associated with all bariatric surgeries. Malnutrition is largely preventable after these surgeries if proper patient selection, thorough preoperative nutrition education, and postoperative nutritional follow-up take place along with patient compliance. Bariatric surgery is divided into 2 major categories: restrictive or malabsorptive (with or without the restrictive aspect). The more dramatic weight loss is generally associated with procedures that are malabsorptive in nature. There is an increased risk of specific nutritional deficiencies associated with these surgeries. With proper supplementation these deficiencies are largely avoidable. This article reviews the more common bariatric surgeries and the nutritional considerations associated specifically with each surgery. The article then summarizes the typical diet advancement schedule and reviews critical care nutrition in regards to total parenteral nutrition administration for the morbidly obese individual, following bariatric surgery.
Tzur, Tamar; Sheiner, Eyal
Recent research has put the spotlight on two different aspects of pregnancy after bariatric surgery: safety of the mother and fetus, and the procedure's effectiveness in preventing the complications surrounding reproduction and pregnancy often seen in the obese woman. To evaluate the pregnancy outcome foLlowing bariatric surgery. Although there are severaL reports documenting poor perinatal outcomes and late surgical complications during pregnancies subsequent to bariatric surgery, systematic studies have generaLLy not proven such an association. Pregnancy after bariatric surgery appears to be safe, and in general perinatal outcome is better when compared to pregnancies of obese women. Providers should be familiar with potential complications related to postoperative pregnancies and be prepared to provide appropriate interventions such as nutritional supplementation and band adjustment when necessary.
Tapia Herrera, Andres
General aspects of breast cancer were described from the epidemiological point of view, clinical and pathological, as well as its impact at global and national levels. Parenchyma conservative surgery and/or breast skin was analyzed exhaustively as a cancer treatment analyzed exhaustively, to your specifications, requirements, technical aspects, risks, benefits, degree of oncological safety and benefits for patients [es
Cake, Martin A; Bell, Melinda A; Williams, Julie C; Brown, Fiona J L; Dozier, Marshall; Rhind, Susan M; Baillie, Sarah
Despite the growing prominence of professional (non-technical) competencies in veterinary education, the evidence to support their importance to veterinary graduates is unclear. To summarize current evidence within the veterinary literature for the importance of professional competencies to graduate success. A systematic search of electronic databases was conducted (CAB Abstracts, Web of Science, PubMed, PsycINFO, ERIC, Australian and British Education Index, Dissertations & Theses) from 1988 to 2015 and limited to the veterinary discipline (veterinar* term required). Evidence was sought from consensus-based competence frameworks, surveys of stakeholder perceptions, and empirical evidence linked to relevant outcomes (e.g. employability, client satisfaction or compliance). Data extraction was completed by two independent reviewers and included a quality assessment of each source. Fifty-two sources were included in the review, providing evidence from expert frameworks (10 sources), stakeholder perceptions (30 sources, including one from the previous category), and empirical research (13 sources). Communication skills were the only competency to be well-supported by all three categories of evidence. Other competencies supported by multiple sources of empirical evidence include empathy, relationship-centered care, self-efficacy, and business skills. Other competencies perceived to be relatively more important included awareness of limitations, professional values, critical thinking, collaboration, and resilience. This review has highlighted the comparatively weak body of evidence supporting the importance of professional competencies for veterinary graduate success, with the exception of communication skills. However we stress this is more indicative of the scarcity of high-quality veterinary-based education research in the field, than of the true priority of these competencies.
An independent study was conducted to address the public concern regarding airborne emissions from Manitoba Hydro's coal-fired electricity generating station located in the Selkirk area. This document is a non-technical summary of the report issued by Ecostem Ltd. Since there are no air quality monitoring stations in the study area which covers more than 1,000 square km, Ecostem used lichens as biological indicators of historical deposition of airborne dust and gases. The sources of airborne dust and gases include urban centres, agriculture, pesticides, fertilizers, waste burning, vehicle use and manufacturing. Lichens have been commonly used as indicators since 1866. They provide useful information because they are long-lived, are not mobile, acquire most of their nutrients from the atmosphere, retain the airborne deposition they initially trap, and they can accumulate airborne particles year round. It is possible to obtain a record of the chemicals that have been present in the air by simply analyzing the lichen tissue. This study used the concentrations of various chemical elements in lichen tissue and the distribution and abundance of lichen species to see if airborne particulates were substantially elevated in the Selkirk area and if so, to determine if the coal-fired generating station was the apparent source of the pollution. A total of 62 stations and lichens on more than 400 trees were sampled. Sulphur, a fingerprint for gaseous emissions from the generating station, had tissue concentrations that were 1.32 times higher. Statistical analysis suggests that barium, boron and strontium were the clearest fingerprint elements for generating station emissions. Tissue concentrations of antimony, arsenic, cadmium, chromium, copper, iron, lead, manganese, mercury, molybdenum, nickel, selenium, silver, thallium, tin, vanadium and zinc were examined further because they are considered to be toxic. It was noted that a conclusion regarding human health cannot be made
Abrahamsen, Håkon B; Sollid, Stephen J M; Öhlund, Lennart S; Røislien, Jo; Bondevik, Gunnar Tschudi
Human error and deficient non-technical skills (NTSs) among providers of ALS in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. To document the current level of simulation-based training and assessment of seven generic NTSs in crew members in the Norwegian HEMS. A cross-sectional survey, either electronic or paper-based, of all 207 physicians, HEMS crew members (HCMs) and pilots working in the civilian Norwegian HEMS (11 bases), between 8 May and 25 July 2012. The response rate was 82% (n=193). A large proportion of each of the professional groups lacked simulation-based training and assessment of their NTSs. Compared with pilots and HCMs, physicians undergo statistically significantly less frequent simulation-based training and assessment of their NTSs. Fifty out of 82 (61%) physicians were on call for more than 72 consecutive hours on a regular basis. Of these, 79% did not have any training in coping with fatigue. In contrast, 72 out of 73 (99%) pilots and HCMs were on call for more than 3 days in a row. Of these, 54% did not have any training in coping with fatigue. Our study indicates a lack of simulation-based training and assessment. Pilots and HCMs train and are assessed more frequently than physicians. All professional groups are on call for extended hours, but receive limited training in how to cope with fatigue. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... surgery. Hemorrhoid surgery may involve: Putting a small rubber band around a hemorrhoid to shrink it by blocking blood flow. Stapling a hemorrhoid to block blood flow, causing it to shrink. Using a ...
... idea for teens? As with everything, there are right and wrong reasons to have surgery. Cosmetic surgery is unlikely to change your life. Most board-certified plastic surgeons spend a lot of time ... the right reasons. Many plastic surgery procedures are just that — ...
Amphibian surgery has been especially described in research. Since the last decade, interest for captive amphibians has increased, so have the indications for surgical intervention. Clinicians should not hesitate to advocate such manipulations. Amphibian surgeries have no overwhelming obstacles. These patients heal well and tolerate blood loss more than higher vertebrates. Most procedures described in reptiles (mostly lizards) can be undertaken in most amphibians if equipment can be matched to the patients' size. In general, the most difficult aspect would be the provision of adequate anesthesia. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Oncoplastic breast conservation surgery has given a new light to the options of performing breast conserving surgery by combining oncological principles of breast cancer surgery with plastic surgery techniques. The ultimate oncoplastic achievement would be the conversion of what normally would be considered as an oncologic and/or cosmetic failure when using standard techniques of breast conserving surgery into both oncological and cosmetic success and to avoid mastectomy where possible. Most Techniques are fairly well established. However surgical techniques may also need to be adjusted based on the cohorts that the treatment is offered to. For example, for larger breasts, the technique is more forgiving. However for smaller breast, there is still a limitation of the cosmetic outcome when a high percentage of breast volume has been excised no matter how good the technique or the surgeon is. Various aspects of oncoplastic breast surgery technique will be discussed and its applicability to Asian Cohorts.
As in the rest of the United Kingdom, day surgery in Bristol is on the increase. In the Bristol Royal Infirmary day surgery unit (DSU) we treat approximately 3,500 patients a year. We have recently opened a second operating theatre. This has shifted the proportion of cases from our general theatres. This has also improved our case mix, less minor surgery under local anaesthetics, to more of the recommended 'basket type' surgery ie hernia repair, varicose vein surgery, excision of breast lumps etc. We have recently introduced an appointment booking system that is progressing. Such changes have to be introduced with good preparation, communication and a lot of diplomacy. I would like to outline the management aspects that help to expand and improve on the service we give, including patient selection and the appointment booking system we have introduced. I will describe how we drew up a policy involving the organisation of operation lists and staff involvement in day surgery management and accountability for patient care from admission through to discharge including our latest care plan. Finally I will outline the methods we have developed for evaluating the care we give.
Information systems are designed, constructed, and used by people. Therefore, a software design process is not purely a technical task, but a complex psycho-socio-technical process embedded within organizational, cultural, and social structures. These structures influence the behavior and products of the programmer's work such as source code and documentation. This chapter (1) discusses the non-technical (organizational, social, cultural, and psychological) aspects of software development reflected in program source code; (2) presents a taxonomy of the social disciplines of computer science; and (3) discusses the socio-technical software analysis methods for discovering the human, organizational, and technical aspects embedded within software development artifacts.
Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan
Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading ...
Recurrence after inguinal hernia surgery is a considerable clinical problem, and several risk factors of recurrence such as surgical technique, re-recurrence, and family history have been identified. Non-technical patient related factors that influence the risk of recurrence after inguinal hernia surgery are sparsely studied. The purpose of the studies included in this PhD thesis, was to describe the epidemiologic characteristics of inguinal hernia occurrence and recurrence, as well as investigating the patient related risk factors leading to recurrence after inguinal hernia surgery. Four studies were included in this thesis. Study 1: The study was a nationwide register-based study combining the Civil Registration System and the Danish National Hospital Register during a five-year period. We included a total of 46,717 persons operated for a groin hernia from the population of 5,639,885 people (2,799,105 males, 2,008,780 females). We found that 97% of all groin hernia repairs were inguinal hernias and 3% femoral hernias. Data showed that inguinal hernia surgery peaked during childhood and old age, whereas femoral hernia surgery increased throughout life. Study 2: Using data from the Danish Hernia Database (DHDB), we included all male patients operated for elective primary inguinal hernia during a 15-year period (n = 85,314). The overall inguinal hernia reoperation rate was 3.8%, and subdivided into indirect inguinal hernias and direct inguinal hernias, the reoperation rates were 2.7% and 5.2%, respectively (p thesis have studies the natural history of groin hernias on a nationwide basis; have identified the epidemiologic distribution of groin hernias and the non-technical risk factors associated with recurrence. Data showed that non-technical patient-related risk factors have great impact on the risk of recurrence after inguinal hernia surgery. The reason to why inguinal hernias recur is most likely multifactorial and lies in the span of technical and non-technical
3 Department of Paediatric Surgery, Sophia's Children Hospital/Erasmus Medical Centre, Rotterdam, The Netherlands. 4 Department of Paediatric Surgery, Emma's Children Hospital/Academic Medical Centre, Amsterdam, The Netherlands. 5 Department of Radiology, Red Cross War Memorial Children's Hospital, ...
Gastroschisis in a developing country: poor resuscitation is a more significant predictor of mortality than postnatal transfer time. PAEDIATRIC SURGERY. P Stevens,1 E Muller,1 P Becker2. 1 Department of Paediatric Surgery, Steve Biko Academic Hospital, University of Pretoria. 2 South African Medical Research Council.
Gabriel Ferreira Da Fonseca
Full Text Available Resumo O presente trabalho procura, mediante premissas da teoria da hipermodernidade de Gilles Lipovetsky, estudar as cirurgias plásticas estéticas no estágio atual da modernidade. Faz breve revisão bibliográfica sobre o consumo, que se volta, cada vez mais, para o corpo humano, como forma de alcançar a felicidade e o sucesso pessoal. Assim, em meio à eterna ansiedade, incentivada pelo mercado, os avanços técnico-científicos propiciam uma busca sem fim da inalcançável boa forma. Portanto, numa sociedade da moda, em que imperam as técnicas do efêmero, da renovação e da sedução permanentes, não se pode deixar de questionar os conflitos éticos, que decorrem de tais intervenções cirúrgicas estéticas. Palavras-chave: Cirurgia plástica. Bioética. Narcisismo. Abstract This paper seeks, through some assumptions of the theory of hyper modernity Gilles Lipovetsky, to study the plastic surgeries in the current stage of the modernity. In this sense, it was done a brief review of the literature about the consumption, which turns, in creasingly, to the human body as a way to achieve happiness and personal success. Thus, in the midst of perpetual anxiety, encouraged by the market, the technical-scientific advances provide an endless pursuit of the unattainable "good shape". Therefore, a "society of fashion" in which reign the techniques of short-lived, seduction and permanent renewal, we must question the ethical conflicts that arise from such aesthetic surgeries. Key words: Plastic Surgery. Bioethics. Narcissism.
Educational and training aspects of new surgical techniques: experience with the endoscopic–laparoscopic interdisciplinary training entity (ELITE) model in training for a natural orifice translumenal endoscopic surgery (NOTES) approach to appendectomy.
Gillen, Sonja; Gröne, Jörn; Knödgen, Fritz; Wolf, Petra; Meyer, Michael; Friess, Helmut; Buhr, Heinz-Johannes; Ritz, Jörg-Peter; Feussner, Hubertus; Lehmann, Kai S
Natural orifice translumenal endoscopic surgery (NOTES) is a new surgical concept that requires training before it is introduced into clinical practice. The endoscopic–laparoscopic interdisciplinary training entity (ELITE) is a training model for NOTES interventions. The latest research has concentrated on new materials for organs with realistic optical and haptic characteristics and the possibility of high-frequency dissection. This study aimed to assess both the ELITE model in a surgical training course and the construct validity of a newly developed NOTES appendectomy scenario. The 70 attendees of the 2010 Practical Course for Visceral Surgery (Warnemuende, Germany) took part in the study and performed a NOTES appendectomy via a transsigmoidal access. The primary end point was the total time required for the appendectomy, including retrieval of the appendix. Subjective evaluation of the model was performed using a questionnaire. Subgroups were analyzed according to laparoscopic and endoscopic experience. The participants with endoscopic or laparoscopic experience completed the task significantly faster than the inexperienced participants (p = 0.009 and 0.019, respectively). Endoscopic experience was the strongest influencing factor, whereas laparoscopic experience had limited impact on the participants with previous endoscopic experience. As shown by the findings, 87.3% of the participants stated that the ELITE model was suitable for the NOTES training scenario, and 88.7% found the newly developed model anatomically realistic. This study was able to establish face and construct validity for the ELITE model with a large group of surgeons. The ELITE model seems to be well suited for the training of NOTES as a new surgical technique in an established gastrointestinal surgery skills course.
Ramirez, Juan Camilo
The paper includes aspects as selection approaches, functional evaluation, imagenologic evaluation, cardiovascular evaluation, technical aspects and results among other topics related with the reducing surgery of volume of the pulmonary emphysema
... usually undertaken as a scheduled elective procedure. An optimal age for a first rodding surgery has not ... which may prevent or postpone the need for replacement. The smallest diameter expanding rods are still too ...
... the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to ... Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed ...
... action of certain hormones, such as ghrelin —“the hunger hormone.” People have these types of surgery if ... organizations to further patient education on hormone related issues. Network Sponsors The Hormone Health Network is supported ...
... and the portion of your brain that's involved: Memory problems. The temporal lobe handles memory and language functions, so surgery on this part ... computerized tomography (SPECT). The scan image varies in color depending on the amount of blood flow in ...
After any operation, you'll have some side effects. There is usually some pain with surgery. There ... anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions. ...
Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... Barnett J, Mohanty A, Desai SK, Patterson JT. Neurosurgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, ...
Aspectos psicossociais em cirurgia bariátrica: a associação entre variáveis emocionais, trabalho, relacionamentos e peso corporal Psychosocial aspects in bariatric surgery: the association among emotional variables, job, relationships and body weight
Graziela A Nogueira de Almeida
Full Text Available RACIONAL: Operações bariátricas têm sido consideradas alternativa para o tratamento de obesidade mórbida. Alguns eventos adversos que as pessoas experimentam após o tratamento frequentemente são consequência da falta de conhecimento consistente associada a fatores psicossociais que estão relacionadas ao status pré-operatório dos pacientes. OBJETIVO: Avaliar as variáveis ?psicossociais de 414 candidatos ? cirurgia bari?trica do Hospital de Cl?nicas da Faculdade de Medicina da Universidade de S?o Paulo, Ribeir?o Preto, SP, Brasil. psicossociais de 414 candidatos à cirurgia bariátrica do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP, Brasil. MÉTODOS: Foram utilizados entrevista semi-estruturada, Inventário de Depressão de Beck (BDI, Inventário de Ansiedade de Beck (BAI e Binge Eating Scale (BES. RESULTADOS: IMC foi maior entre os pacientes que não tinham emprego (p = 0,019, do sexo feminino, os que tinham um parceiro e os pacientes com IMC 50 kg / m² (p 50 kg / m² foram mais propensos a apresentar sintomas de ansiedade.BACKGROUND: Bariatric surgeries have been considered an alternative for treatment of morbid obesity. Some adverse events that people experience after the treatment frequently are the consequence of the lack of consistent knowledge associated with psychosocial factors that are related to the pre-surgery status of the patients. AIM: To evaluate psychosocial variables of 414 candidates for bariatric surgery from Clinical Hospital of Medical School at University of São Paulo, Ribeirão Preto, SP, Brazil. METHODS: Semi-structured interview, Beck Depression Inventory (BDI, Beck Anxiety Inventory (BAI and Binge Eating Scale (BES were used. RESULTS: BMI was higher among patients who had no employment (p = 0.019. Female, patients who had a partner and patients with a BMI 50 kg/m² (p 50 kg / m² were more likely to experience anxiety symptoms.
Karmali, Shahzeer; Stoklossa, Carlene Johnson; Sharma, Arya; Stadnyk, Janet; Christiansen, Sandra; Cottreau, Danielle; Birch, Daniel W.
Abstract OBJECTIVE To review the management of bariatric surgical patients. QUALITY OF EVIDENCE MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III. MAIN MESSAGE Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient’s weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential. CONCLUSION Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term. PMID:20841586
Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ...
Steenwyk, Brad; Lyerly, Ralph
Advancements in robotic-assisted thoracic surgery present potential advantages for patients as well as new challenges for the anesthesia and surgery teams. This article describes the major aspects of the surgical approach for the most commonly performed robotic-assisted thoracic surgical procedures as well as the pertinent preoperative, intraoperative, and postoperative anesthetic concerns. Copyright © 2012. Published by Elsevier Inc.
Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...
Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...
Full Text Available Background: In almost six decades different surgical techniques have been developed to treat patients with morbid obesity. Various surgical techniques are generally divided with respect to their effect into restrictive, malabsorbtive and humoral and a combination of these. Surgically modified human metabolism ameliorates metabolic diseases, particularly diabetes, even in nonobese patients. The understanding of metabolic effects changed the traditional paradigm of bariatric surgery from simple weight-loss procedure to metabolic surgery affecting whole-body metabolism. Proper surgical technique for individual patient is the most important factor influencing long- term results, comorbidities and quality of life. Recommendations for patient selection, surgical methods and pre- and postoperative patient management are to be respected. Metabolic surgery principles and current concepts are presented.
textabstractIn this thesis clinical aspects of perioperative feeding in gastrointestinal surgery are discussed in several clinical studies. The main goal is to obtain insight in the influence of enteral feeding and
Psychosocial aspects of the treatment of disorders of sex development (DSDs) concern gender assignment, information management and communication, timing of medical interventions, consequences of surgery, and sexuality. Although outcome is often satisfactory, a variety of medical and psychosocial
FAB - Underwater and underground electric connection between France and Great Britain via Aurigny. File of presentation of the project and of its investigation area. Project synthesis. Impact study constituting an incidence document under the Law on Water. Ground brochure + Sea brochure. Non technical summary. Deliberated opinion of the Environmental Authority on the underwater and underground electrical interconnection between France and Great-Britain via Aurigny (FAB)
This document gathers several reports. The first one indicates the actors involved in the project of electrical interconnection between France and Great-Britain via Aurigny, presents various technical aspects and works of this project, and proposes a definition and a description of the concerned area. The second report proposes a synthetic presentation of the project: agreement process, project interest, project definition and equipment locations, project technical components and aspects, onshore and offshore environmental aspects, project status and planning. The third report analyses the various onshore aspects of the interconnection project: project description, initial situation of the environment, analysis of the project effects on the environment and on health, analysis of cumulated effects with other known projects, sketches of examined substitution solutions and reasons for the selection of the project, elements of analysis of compliance with land uses and various planning documents, measures aimed at avoiding, reducing or compensating project effects, methods to assess initial status and effects, faced difficulties. The fourth report addresses the same issues as the previous one but for offshore aspects. The fifth report is a non technical summarised presentation of the project which presents the French side, describes the elaboration approach, the offshore and onshore legs of the project, an assessment of impacts on Natura 2000 sites. It notably contains several detailed geographical and geological maps to illustrate and to highlight the various environmental, geological, economic, social, urban or landscape impacts. The last document is the detailed opinion of the Environmental Authority on this project. It addresses the context, the project principle, implementation and cost, environmental stakes and challenges, and impacts
Harris, D. L.
The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks.
surgery or subcutaneous mastectomy utilizing a periareolar or circumareolar ... old. Informed consent was obtained. The height of the patients was measured from heel to vertex with a standard height measuring device. The chest circumference was ... The procedure was followed with liposuction 3-6 months later if required.
Summary: The multidisciplinary management of Breast Cancer (BC) has evolved over the past 50 years: the patient is offered a choice of .... Choice of procedure. – For women with early BC, there is essentially a choice between 2 procedures: mastectomy or breast conserving surgery with radiation (BCT). The standard.
Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...
We plan to protocolise earlier surgery and blood conservation strategies intraoperatively in addition to a restrictive strategy in ..... Marshall JC. Review Transfusion trigger: when to transfuse? Crit Care. 2004;8(Suppl 2):S31-3. 11. Hofmann A, Farmer S, Towler SC. Strategies to preempt and reduce the use of blood products: ...
... http://www.mayoclinic.com/health/cosmetic-surgery/SN00006 Medical Tourism (Copyright © American Society of Plastic Surgeons) — People considering ... in exotic vacation spots. This publication talks about "medical tourism" and whether it's safe. http://www.plasticsurgery.org/ ...
Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...
after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113(2):188-193. http:// dx.doi.org/10.1002/jso.24125. 2. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): An international study group of pancreatic surgery (ISGPS) definition. Surg. 2007;142(1):20-25. http://.
Pareek, Manan; Schauer, Philip R; Kaplan, Lee M
the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity...
deaths due to other trauma types (gunshot wounds, road traffic fatalities and assault) ... the axillary artery was ligated during surgery. Type of ... Left axillary artery. Ischaemic left upper limb. 3. Fifth intercostal space on the left. Bilateral pneumothorax and haemothorax still present at autopsy. (intercostal drain only inserted on ...
Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...
Piromchai, Patorn; Avery, Alex; Laopaiboon, Malinee; Kennedy, Gregor; O'Leary, Stephen
Virtual reality simulation uses computer-generated imagery to present a simulated training environment for learners. This review seeks to examine whether there is evidence to support the introduction of virtual reality surgical simulation into ear, nose and throat surgical training programmes. 1. To assess whether surgeons undertaking virtual reality simulation-based training achieve surgical ('patient') outcomes that are at least as good as, or better than, those achieved through conventional training methods.2. To assess whether there is evidence from either the operating theatre, or from controlled (simulation centre-based) environments, that virtual reality-based surgical training leads to surgical skills that are comparable to, or better than, those achieved through conventional training. The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 6); PubMed; EMBASE; ERIC; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 July 2015. We included all randomised controlled trials and controlled trials comparing virtual reality training and any other method of training in ear, nose or throat surgery. We used the standard methodological procedures expected by The Cochrane Collaboration. We evaluated both technical and non-technical aspects of skill competency. We included nine studies involving 210 participants. Out of these, four studies (involving 61 residents) assessed technical skills in the operating theatre (primary outcomes). Five studies (comprising 149 residents and medical students) assessed technical skills in controlled environments (secondary outcomes). The majority of the trials were at high risk of bias. We assessed the GRADE quality of evidence for most outcomes across studies as 'low'. Operating theatre environment (primary outcomes) In
Lorenz, David Harel; Ernst, Erik
There are two important points of view on inclusion or subtype polymorphism in object-oriented programs, namely polymorphic access and dynamic dispatch. These features are essential for object-oriented programming, and it is worthwhile to consider whether they are supported in aspect......-oriented programming (AOP). In AOP, pieces of crosscutting behavior are extracted from the base code and localized in aspects, losing as a result their polymorphic capabilities while introducing new and unexplored issues. In this paper, we explore what kinds of polymorphism AOP languages should support, using Aspect......J as the basis for the presentation. The results are not exclusive to AspectJ---aspectual polymorphism may make aspects in any comparable AOSD language more expressive and reusable across programs, while preserving safety....
Full Text Available ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ...
Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...
Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Soon after surgery, severe pain will decrease, but you may have mild soreness for 3 to 6 months.
Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ...
Kjærgaard Larsen, Marie; Thygesen, Torben Henrik
on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were......The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... to sex, age, and somatosensory change. High satisfaction and improvement in facial esthetic after OS were seen. Young patients (16-25 years) and men indicated a higher degree of satisfaction than old (>25 years) patients and women. The use of social media seems to be an interesting platform...
Weber, Rainer K.; Hosemann, Werner
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282
Background: Fast Track Surgery is synonymous with Enhanced Recovery after Surgery. It was started in the 1990's initially for colorectal surgery, but later became applicable to other aspects of surgery. Its core elements include epidural or regional anaesthesia, perioperative fluid management, minimally invasive surgical ...
de Blacam, Catherine; Kilmartin, Darren; Mc Dermott, Clodagh; Kelly, Jack
Public perception of Plastic Surgery is strongly influenced by the media and may not reflect the broad scope of work within the speciality. The aim of this study was to provide an assessment of the general public's perception of plastic surgical practice and to report the perceived importance of Plastic Surgery relative to other specialities working within a large tertiary referral centre. 899 members of the public who attended our Emergency Department completed a questionnaire where they matched eight surgical specialities with 30 operative procedures and ranked the importance of 30 different hospital specialities using a Likert scale. The majority of respondents correctly identified plastic surgeons as performing each of the cosmetic procedures listed (abdominoplasty 63.7%; breast augmentation 59.1%; facelift 61.35%; liposuction 59.7%). Plastic Surgery was identified as the primary speciality involved in breast reconstruction (49.3%) and burns surgery (43.0%). There was poor understanding of the role of plastic surgeons in hand surgery, with only 4.7% of respondents attributing tendon repair to plastic surgeons. Plastic Surgery ranked lowest of 30 specialities in terms of importance in providing care for patients within the hospital. Plastic Surgery is often misunderstood within the wider community and misconceptions reflect the influence of the media in highlighting certain aspects of the speciality. It behoves our professional organisations to highlight the importance of Plastic and Reconstructive Surgery within major tertiary referral centres. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Stoneham, M; Murray, D; Foss, N
undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...... to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients....
Bahls, Thomas; Fröhlich, Florian; Albu-Schäffer, Alin
Papachristou and Bartes  first used a waterjet in the medical context. By using a waterjet in ablative liver surgery intrahepatic parenchyma could be washed away whereas vessels and ducts stay undamaged and intact which leads to less interoperative loss of blood. The aspect of tissue selectivity is one of the major advantages of using a waterjet to prepare soft tissue. This work first explains the physical basics of this method and differs between relevant properties which are res...
Baniassad, E.; Clements, P.; Araujo, J.; Moreira, A; Rashid, A.; Tekinerdogan, B.
Traditionally, aspect-oriented software development (AOSD) has focused on the software life cycle's implementation phase: aspects are identified and captured mainly in code. But aspects are evident earlier in the life cycle, such as during requirements gathering and architecture development.
Adriana Tomoko Nishiya
Full Text Available Melanomas are malignant neoplasms originating from melanocytes. They occur in most animal species, but the dog is considered the best animal model for the disease. Melanomas in dogs are most frequently found in the buccal cavity, but the skin, eyes, and digits are other common locations for these neoplasms. The aim of this review is to report etiological, epidemiological, pathological, and molecular aspects of melanomas in dogs. Furthermore, the particular biological behaviors of these tumors in the different body locations are shown. Insights into the therapeutic approaches are described. Surgery, chemotherapy, radiotherapy, immunotherapy, and the outcomes after these treatments are presented. New therapeutic perspectives are also depicted. All efforts are geared toward better characterization and control of malignant melanomas in dogs, for the benefit of these companion animals, and also in an attempt to benefit the treatment of human melanomas.
Ara A. Salibian
Full Text Available Smartphones have the capability of enhancing many aspects of the continuum of surgical care by providing an efficient means of multimedia communication among surgeons and healthcare personnel. The ability for mobile Internet and email access, along with features such as built-in cameras and video calling, allow surgeons to rapidly access, send and receive patient information without being restricted by issues of connectivity. Smartphones create an unrestricted network of data sharing, improving the flexibility of patient consultation, timeliness of preoperative preparation, efficiency of post-operative care and the effectiveness of a surgical team. Furthermore, smartphones provide mobile access to a multitude of surgical resources to bolster continued surgical education. This article presents a review of the current literature on the utilizations of smartphones in surgery, discusses their benefits and limitations, and addresses the possibility of incorporating smartphones into the protocol of surgical care.
Thorstensson, Carina; Lohmander, L; Frobell, Richard
-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed...... and many patients said that they joined the RCT in order to bypass waiting lists. Patients who chose to cross-over described training as time consuming, boring and as unable to provide sufficient results within a reasonable timeframe. Some said their injured knees had given-way; others experienced new knee...... a variety of views and beliefs about those treatments, and trial participation happens in the absence of equipoise. Furthermore, opting for surgical reconstruction does not necessarily provide patients with satisfactory outcomes. Definition of successful outcome may require an individualised approach...
AALDERS, JG; NEIJT, JP
In ovarian cancer and endometrial cancer the surgeon plays an important role in both the staging procedure and in the removal of as much of the tumour as possible. Although uniform treatment policies have not been developed, a better understanding of the pattern of spread in both tumours allows for
CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure
Yang, Fan; Masuhara, Hidehiko; Aotani, Tomoyuki
mechanism for pointcuts, so that pointcuts can uniformly specify join points based on both static and dynamic information about the program. Our implementation strategy performs fundamental static analysis at load-time, so as to retain runtime overheads minimal. We implemented a compiler for Aspect......Enforcing security policies to distributed systems is difficult, in particular, when a system contains untrusted components. We designed AspectKE*, a distributed AOP language based on a tuple space, to tackle this issue. In AspectKE*, aspects can enforce access control policies that depend...... on future behavior of running processes. One of the key language features is the predicates and functions that extract results of static program analysis, which are useful for defining security aspects that have to know about future behavior of a program. AspectKE* also provides a novel variable binding...
Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...
Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...
Full Text Available ... Other Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons ...
... Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB Download ... What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or diseased ...
... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...
Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...
... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...
Full Text Available ... Surgery Dental Implant Surgery Facial Cosmetic Surgery Head, Neck and Oral Pathology Obstructive Sleep Apnea TMJ and Facial Pain Treatment of Facial Injury Wisdom Teeth Management Procedures ...
Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... Ginther RM, Forbess JM. Pediatric cardiopulmonary bypass. In: ... Care . 5th ed. Philadelphia, PA: Elsevier; 2017:chap 37. LeRoy S, ...
Full Text Available ... Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and ... Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries ...
... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...
... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...
Full Text Available ... surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on ... without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, including snoring) Your dentist, orthodontist and ...
Bergmans, Lodewijk; Videira Lopes, Cristina; Moreira, Ana; Demeyer, Serge
Aspect-oriented programming is a promising idea that can improve the quality of software by reduce the problem of code tangling and improving the separation of concerns. At ECOOP'97, the first AOP workshop brought together a number of researchers interested in aspect-orientation. At ECOOP'98, during
van Hout, Angeliek; Lidz, Jeffrey; Snyder, William; Pater, Joe
The temporality of a given situation ‘out there in the world’ can be described in many ways. Tense and aspect offer the essential parameters. Lexical aspect characterizes event descriptions; a situation with a sleeping child can be referred to as a state of affairs (be asleep) or as a happening
Nath, Soumya Sankar; Roy, Debashis; Ansari, Farrukh; Pawar, Sundeep T
Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients' experience and surgical outcome.
Soumya Sankar Nath
Full Text Available Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist′s concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients′ experience and surgical outcome.
D.D. Satoer (Djaina); E.G. Visch-Brink (Evy); C.M.F. Dirven (Clemens); A. Vincent (Audrey)
markdownabstract__Background:__ Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded
Satoer, Djaina; Visch-Brink, Evy; Dirven, Clemens; Vincent, Arnaud
BACKGROUND: Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to the lack of
... gastrointestinal system Death (rare) Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They ... room, where medical staff monitors you for any complications. Your hospital stay may ... of bariatric surgery Each type of bariatric surgery has pros and ...
... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...
Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...
... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...
Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We Are Find a Surgeon News Videos Contact Anesthesia Cleft Lip/Palate and Craniofacial Surgery Corrective Jaw Surgery Dental Implant Surgery Extractions and Other Oral Surgeries Facial Cosmetic ...
Full Text Available ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ...
... Procedures Who is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery Life ... Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, FL, ...
Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ...
Zafar, Syed Nabeel; McQueen, K A Kelly
Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.
Full Text Available The need for extended liver resection is increasing due to the growing incidence of liver tumors in aging societies. Individualized surgical planning is the key for identifying the optimal resection strategy and to minimize the risk of postoperative liver failure and tumor recurrence. Current computational tools provide virtual planning of liver resection by taking into account the spatial relationship between the tumor and the hepatic vascular trees, as well as the size of the future liver remnant. However, size and function of the liver are not necessarily equivalent. Hence, determining the future liver volume might misestimate the future liver function, especially in cases of hepatic comorbidities such as hepatic steatosis. A systems medicine approach could be applied, including biological, medical, and surgical aspects, by integrating all available anatomical and functional information of the individual patient. Such an approach holds promise for better prediction of postoperative liver function and hence improved risk assessment. This review provides an overview of mathematical models related to the liver and its function and explores their potential relevance for computational liver surgery. We first summarize key facts of hepatic anatomy, physiology, and pathology relevant for hepatic surgery, followed by a description of the computational tools currently used in liver surgical planning. Then we present selected state-of-the-art computational liver models potentially useful to support liver surgery. Finally, we discuss the main challenges that will need to be addressed when developing advanced computational planning tools in the context of liver surgery.
Gender reassignment surgery for male primary transsexuals. DERK CRICHTON. 347. Abstract This article describes certain innovations and aspects of surgical technique together with SODle stirgical asseSSDlents of results in a series of 58 operations for gender reassignDIent undertaken by the author over the past 24 ...
... Surgery Menu Topics Topics FAQs Limited-Access Heart Surgery Article Info En español Thousands of heart surgeries ... with cardiovascular disease. What is minimally invasive heart surgery? In minimally invasive heart surgery, surgeons take steps ...
Hathway, D. E
The subject matter of this book is organized into chapters that deal wwith separate subjects and, whilst this treatment reveals the structure of molecular aspects of toxicology, it inevitably incurs...
In this part next aspects are described: (1) Priority to safety; (2) Financial and human resources;; (3) Human factor; (4) Operator's quality assurance system; (5) Safety assessment and Verification; (6) Radiation protection and (7) Emergency preparedness
Chatzikokolakis, Konstantinos; Mödersheim, Sebastian Alexander; Palamidessi, Catuscia
This Special Issue of the Journal of Computer Security focuses on foundational aspects of security, which in recent years have helped change much of the way we think about and approach system security.......This Special Issue of the Journal of Computer Security focuses on foundational aspects of security, which in recent years have helped change much of the way we think about and approach system security....
Lauszus, Finn F; Petersen, Astrid Christine; Neumann, Gudrun
in postmenopausal women was associated with surgery including hysterectomy and bilateral oophorectomy (pcarcinoma was found 138 times (95% CI: 48, 275) more prevalent than the expected rate. CONCLUSION......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...
Weber, Walter P; Soysal, Savas D; Zeindler, Jasmin; Kappos, Elisabeth A; Babst, Doris; Schwab, Fabienne; Kurzeder, Christian; Haug, Martin
Oncoplastic breast conserving surgery is increasingly used to treat patients with breast cancer. In the absence of randomized data, a large body of observational evidence consistently indicates low rates of recurrence and high rates of survival, but points to a higher rate of complications compared to conventional breast conserving surgery. Established goals of oncoplastic breast conserving surgery are to broaden the indication for breast conservation towards larger tumors, and to improve esthetic outcomes. The benefit from the patient's perspective, however, remains largely to be confirmed. There is a growing demand to standardize various aspects of oncoplastic breast conserving surgery for implementation in clinical research and practice. Several classification systems and outcomes measurement tools have been proposed, but to the present day, none of them has achieved international acceptance. Copyright © 2017 Elsevier Ltd. All rights reserved.
de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid
Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.
de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E.; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid
Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole. PMID:25477839
Martina eDe Zwaan
Full Text Available Background: Massive weight loss (MWL following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image and physical functioning.Methods: In this cross-sectional study 3 groups were compared: 1 patients prior to bariatric surgery (n=79, 2 patients after bariatric surgery who had not undergone BCS (n=252, and 3 patients after bariatric surgery who underwent subsequent body contouring surgery (BCS (n=62. All participants completed self-report questionnaires assessing body image (MBSRQ, quality of life (IWQOL-Lite, symptoms of depression (PHQ-9 and anxiety (GAD-7.Results: Overall, 62 patients (19.2% reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%, thigh lifts (24.2%, and breast lifts (16.1%. Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients; however, there were fewer differences between patients with and without BCS. Patients after BCS reported better appearance evaluation, body area satisfaction, and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better appearance evaluation and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.
Mosquera Betancourt, Gretel; Hernández González, Erick Héctor
Background: tumors arising from sacrococcygeal region are weird and represent from one to seven percent of primary spinal tumors. However diagnosis and treatment are a challenge for the surgical staff because of the anatomic relations complexity and the more frequent lesions biological features. Objective: a review of the literature was done to update and systematize the knowledge about general aspects of sacrococcygeal tumors. Development: they are more frequent in male young adults, unspecific low back pain is the onset symptom and muscle weakness, sense deficit and sphincter disturbances join up later progressively. They can be epidural or intradural, primary or secondary, neoplastics or not and they could arise from soft tissues or bone structure. Age and location most be considered to evaluate malignant potential. CT scan and magnetic resonance imaging are the confirmatory tests and allow surgical approach selection. The most frequent affections are chordoma, aneurismal bone cyst and giant cell tumor. Radiotherapy and chemotherapy can support surgery according to histology. Conclusions: precocious diagnosis needs to be suspected before unspecific symptoms. Sacrococcygeal tumors treatment most be multidisciplinary and multimodal to assure better prognosis and patient´s life expectancy increasing. (author)
Bloomfield, Jacqueline; Pegram, Anne
Organisational aspects of care, the second essential skills cluster, identifies the need for registered nurses to systematically assess, plan and provide holistic patient care in accordance with individual needs. Safeguarding, supporting and protecting adults and children in vulnerable situations; leading, co-ordinating and managing care; functioning as an effective and confident member of the multidisciplinary team; and managing risk while maintaining a safe environment for patients and colleagues, are vital aspects of this cluster. This article discusses the roles and responsibilities of the newly registered graduate nurse. Throughout their education, nursing students work towards attaining this knowledge and these skills in preparation for their future roles as nurses.
... Surgery for Stress Urinary Incontinence Page Navigation ▼ ACOG Pregnancy Book Surgery for Stress Urinary Incontinence Patient Education FAQs Surgery for Stress Urinary Incontinence Patient Education ...
Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António
Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.
Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you ... caused by obesity. There are different types of weight loss surgery. They often limit the amount of food ...
Full Text Available ... administer local anesthesia, all forms of sedation and general anesthesia. Click here to find out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft ...
Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...
... FAQs Preparing for Surgery Page Navigation ▼ ACOG Pregnancy Book Preparing for Surgery Patient Education FAQs Preparing for ... the person who is in charge of giving anesthesia and checking its effects. What can I do ...
... Global Affairs and Humanitarian Efforts Log In Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Laparoscopic Spine Surgery Your spine surgeon has determined that you ...
... techniques are used: Percutaneous surgery (through the skin) Robot-assisted surgery If your surgeon can repair your ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...
Full Text Available ... by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, bone and ...
Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...
Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...
Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities The information provided here is not intended as a substitute ...
Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...
Full Text Available ... Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the ... are not uncommon. Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, ...
Full Text Available ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ...
Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty ... Most of the time, this surgery is an elective or cosmetic procedure because it is an operation you choose to have. It is not usually needed for health reasons. Cosmetic abdomen repair ...
... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...
Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...
... after surgery, it should be OK to use artificial tears. Check with your provider. DO NOT wear contact lenses on the eye that had surgery, even if you have blurry vision. DO NOT use any makeup, creams, or lotions ...
Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking ... Tar, nicotine, and other chemicals from smoking can increase your risk of many health problems. These include heart and blood vessel problems, such as: Blood clots and aneurysms in ...
Garcia Puertas, P.
Different toxicological aspects of water have been studied, remarking the activity of various chemical substances in the organism. These substances are divided in: trace metals (Sb, As, Cd, Zn, Cu, Cr, Fe, Mn, Hg, Ni, Pb, Se), other contaminants (CN-, polycyclic aromatic hydrocarbons, phenols, pesticides, detergents) and radioactivity. Finally, some considerations on this subject are made [es
Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840
Ovadia, Steven A; Gishen, Kriya; Desai, Urmen; Garcia, Alejandro M; Thaller, Seth R
Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Dr. S.A. Adewuyi
of radical surgical procedures, surgery remains the only potential curative treatment for many cancer patients ... catheter, 'Toilet' procedure, e.g. simple mastectomy or amputation of a limb, for fungating tumours. Debulking .... that tumour is irradiated prior to surgery and post- operative implies after surgery. 10. Pre-operative.
... Toes All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A cavus or high-arched foot may have ... related problems. What are the goals of cavus foot surgery? The main goal of surgery is to ...
FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the whole tumor from the breast. Some lymph nodes ... might still be in the body. Types of breast cancer surgery There are two types of breast cancer ...
Emiroğlu, Mustafa; Sert, İsmail; İnal, Abdullah
The aim of this study is to discuss indications, advantages, disadvantages, oncologic and aesthetic results of Oncoplastic Surgery (OBS). Pubmed and Medline database were searched for articles published between 1998 and 2014 for keywords: oncoplastic breast surgery, therapeutic mammoplasty, oncoplastic breast reduction, synchrenous reconstructions. Role of OBS in breast cancer surgery, its aspects to be considered, its value and results have been interpreted. This technique has advantages by providing more extensive tumourectomy, yielding better aesthetic results compared with breast conserving surgery, allowing oncoplastic reduction in breast cancer patients with macromastia, with higher patient satisfaction and quality of life and by being inexpensive due to single session practice. As for its disadvantages are: re-excision is more difficult, risk for mastectomy is higher, it is depent on the Surgeron's experience, it has a risk for delay in adjuvant therapies and its requirement for additional imaging studies during management. Main indications are patients with small tumour/breast volume, macromastia, multifocality, procedures which can disrupt breast cosmesis such as surgeries for upper inner breas tquadrient tumours. Contraindications are positive margin problems after wide excision, diffuse malign microcalsifications, inflammatory breast cancer, history of radiotherapy and patients' preferences. Despite low evidence level, Oncoplastic Breast Surgery seems to be both reliable and acceptable in terms of oncologic and aesthetic aspects. Oncoplastic Breast Surgery increase the application rate of breast conserving surgery by obviating practical limitations and improve the results of breast conserving surgery. Correct patient and technique choice in OBS is vital for optimization of post surgical.
Full Text Available Improving the outcomes in reconstructive surgery of the anterior cruciate ligament (ACL requires a rigorous and permanent assessment of specific parameters. Therefore, we can increase the degree of reproducibility of the procedure and identify particular aspects in order to achieve an adequate and individualized therapeutic approach for each case. In order to accomplish this goal, the use of complex means (scores of quantifying results is required. That includes objective means of verifying the parameters in knee surgery, and a subjective evaluation of the patient in order to compare the results.
There is the need to adequately inform patients about their disease, treatment options, surgery and post-operative complications. Adequate pain relief after surgery leads to less morbidity. Two important aspects of surgical practice are being addressed in this paper, the need for informed consent and post operative pain ...
Leistedt, Samuel J
Behavioural and social sciences are useful in collecting and analysing intelligence data, understanding terrorism, and developing strategies to combat terrorism. This article aims to examine the psychopathological concepts of terrorism and discusses the developing roles for behavioural scientists. A systematic review was conducted of studies investigating behavioural aspects of terrorism. These studies were identified by a systematic search of databases, textbooks, and a supplementary manual search of references. Several fundamental concepts were identified that continue to influence the motives and the majority of the behaviours of those who support or engage in this kind of specific violence. Regardless of the psychological aspects and new roles for psychiatrists, the behavioural sciences will continue to be called upon to assist in developing better methods to gather and analyse intelligence, to understand terrorism, and perhaps to stem the radicalisation process. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Aim of article is to analyze marketing mix theoretical aspects. The article discusses that marketing mix is one of the main objectives of the marketing mix elements for setting objectives and marketing budget measures. The importance of each element depends not only on the company and its activities, but also on the competition and time. All marketing elements are interrelated and should be seen in the whole of their actions. Some items may have greater importance than others; it depends main...
Kostić Aleksandar V.
The author examines futurological aspects of globalization having in mind various models of historical processes. He describes the changes as "futuroshock", thus presenting a dilemma whether the changes are only a momentum or a pre-planned concept. He especially stresses the Toffler’s conclusion that turns a new page in futurology - examining the dangers that follow the changes. According to him, predictions are made with the help of practically all the sciences in two basic directions: explo...
Various aspects of weak decays are commented on. Probing of the standard model and of phenomena beyond the standard model are discussed, followed by a theoretical view of B mesons and some experimental observations on B mesons. The point is made that any data on B decay would be interesting in that it would provide powerful new constraints in analyses of the standard model and extensions thereof. (LEW)
Criminal Aspects of Pornography Summary The main purpose of this thesis is to introduce the phenomenon of pornography in terms of criminal law, to point out flaws in the current relevant criminal legislation in the Czech Republic and to propose a possible solution in a form of potential legislative changes. The thesis is composed of five chapters. The first chapter deals with definition issue of vague legal term of "pornography" and other related terms ("child pornography", "hardcore pornogra...
Ethics can be defined as a reflection on nature and a definition of “the good”. Individuals value qualities and things dissimilarly, most visibly, but they also value their goods in different ways, in different relations to each other, for different reasons, and to different ends. These differences are very applicable to sustainability. In other words, sustainability cannot be achieved without attention to its ethical dimensions. The aim of this research is to examine the ethical aspects of s...
Goncalves, Bruno Almeida
This paper intends to provide from the legal point of view an outline of the main challenges of a LNG project in the upstream, regulatory aspects, liquefaction, financing and midstream through a basic checklist; an overview of the contractual complexity of a LNG project; some basic discussion of particular LNG contract clauses; and a comparative analysis between the classic clauses of a Gas Transportation Agreement (GTA) through a gas pipeline and LNG logistic. (author)
Beck, Amy R
This article is the sixth in a series of the comorbidities of childhood obesity and reviews psychosocial aspects with a focus on weight-based victimization and discrimination stemming from weight bias and stigma. Outcomes from these bullying and discriminatory experiences are pervasive and impact youth across all settings, including school. Lastly, this article provides recommendations on how to reduce bias and stigma to better serve these students in the school environment. © 2015 The Author(s).
Full Text Available In recent years, laparoscopic surgery has gained popularity in clinical practice. The key element in laparoscopic surgery is creation of pneumoperitoneum and carbon dioxide is commonly used for insufflation. This pneumoperitoneum perils the normal cardiopulmonary system to a considerable extent. Every laparoscopic surgeon should understand the consequences of pneumoperitoneum; so that its untoward effects can be averted. Pneumoperitoneum increases pressure on diaphragm, leading to its cephalic displacement and thereby decreasing venous return, which can be aggravated by the position of patient during surgery. There is no absolute contraindication of laparoscopic surgery, though we can anticipate some problems in conditions like obesity, pregnancy and previous abdominal surgery. This review discusses some aspects of the pathophysiology of carbon dioxide induced pneumoperitoneum, its consequences as well as strategies to counteract them. Also, we propose certain guidelines for safe laparoscopic surgery.
Bensoussan, Jean-Charles; Bolton, Michael A; Pi, Sarah; Powell-Hicks, Allycin L; Postolova, Anna; Razani, Bahram; Reyes, Kevin; IsHak, Waguih William
This article reviews the literature regarding the impact of cosmetic surgery on health-related quality of life (QOL). Studies were identified through PubMed/Medline and PsycINFO searches from January 1960 to December 2011. Twenty-eight studies were included in this review, according to specific selection criteria. The procedures and tools employed in cosmetic surgery research studies were remarkably diverse, thus yielding difficulties with data analysis. However, data indicate that individuals undergoing cosmetic surgery began with lower values on aspects of QOL than control subjects, and experienced significant QOL improvement post-procedurally, an effect that appeared to plateau with time. Despite the complexity of measuring QOL in cosmetic surgery patients, most studies showed an improvement in QOL after cosmetic surgery procedures. However, this finding was clouded by measurement precision as well as heterogeneity of procedures and study populations. Future research needs to focus on refining measurement techniques, including developing cosmetic surgery-specific QOL measures.
Nanavati, Aditya J; Nagral, Sanjay; Prabhakar, Subramaniam
Fast-track surgery or 'enhanced recovery after surgery' or 'multimodal rehabilitation after surgery' is a form of protocol-based perioperative care programme. It is an amalgamation of evidence-based practices that have been proven to improve patient outcome independently and exert a synergistic effect when applied together. The philosophy is to treat the patient's pathology with minimal disturbance to the physiology. Several surgical subspecialties have now adopted such protocols with good results. The role of fast-track surgery in colorectal procedures has been well demonstrated. Its application to other major abdominal surgical procedures is not as well defined but there are encouraging results in the few studies conducted. There has been resistance to several aspects of this programme among gastrointestinal and general surgeons. There is little data from India in the available literature on the application of fast-tracking in gastrointestinal surgery. In a country such as India the existing healthcare structure stands to gain the most by widespread adoption of fast-track methods. Early discharge, early ambulation, earlier return to work and increased hospital efficiency are some of the benefits. The cost gains derived from this programme stand to benefit the patient, doctor and government as well. The practice and implementation of fast-track surgery involves a multidisciplinary team approach. It requires policy formation at an institutional level and interdepartmental coordination. More research is required in areas like implementation of such protocols across India to derive the maximum benefit from them. Copyright 2014, NMJI.
Criminal Aspects of Artificial Abortion This diploma thesis deals with the issue of artificial abortion, especially its criminal aspects. Legal aspects are not the most important aspects of artificial abortion. Social, ethical or ideological aspects are of the same importance but this diploma thesis cannot analyse all of them. The main issue with artificial abortion is whether it is possible to force a pregnant woman to carry a child and give birth to a child when she cannot or does not want ...
Pećanac, Marija Đ
Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.
A guide to aspect-oriented programming and the AspectJ language, this book provides code examples that enable quick implementation of functionality in a system. Thorough introductions to AOP and AspectJ will help developers learn or advance their knowledge of AspectJ. Examples of everyday situations in which AspectJ solutions can be applied, such as logging, policy enforcement, resource pooling, business logic, thread-safety, authentication and authorization, and transaction management are provided. In addition, design patterns and idioms are covered, as is business rule implementation. The latest technologies, such as JEES, JAAS, and log4j, are explained and connected with AspectJ.
The increase of bundle supply has become widespread in several sectors (for instance in telecommunications and energy fields). This paper review relates strategic aspects of bundling. The main purpose of this paper is to analyze profitability of bundling strategies according to the degree of competition and the characteristics of goods. Moreover, bundling can be used as price discrimination tool, screening device or entry barriers. In monopoly case bundling strategy is efficient to sort consumers in different categories in order to capture a maximum of surplus. However, when competition increases, the profitability on bundling strategies depends on correlation of consumers' reservations values. (author)
Rao, G.U.V.; Fatouros, P.P.
The quality of a conventional radiographic image can be characterized in terms of five basic parameters; density, contrast, latitude, resolution and noise. Since xeroradiographic images exhibit very limited broad area contrasts, and image formation is predominantly due to edge enhancement, a straightforward description of image quality using the same five parameters is not adequate. A detailed study was made of the radiographic aspects of xeroradiography with special reference to mammography, and a summary of major findings to date with appropriate references to published papers is presented
Colesanti, Andrea; Gronchi, Paolo
This book presents the proceedings of the international conference Analytic Aspects in Convexity, which was held in Rome in October 2016. It offers a collection of selected articles, written by some of the world’s leading experts in the field of Convex Geometry, on recent developments in this area: theory of valuations; geometric inequalities; affine geometry; and curvature measures. The book will be of interest to a broad readership, from those involved in Convex Geometry, to those focusing on Functional Analysis, Harmonic Analysis, Differential Geometry, or PDEs. The book is a addressed to PhD students and researchers, interested in Convex Geometry and its links to analysis.
Garcia, Sara Eugenia; Barragan, John Henry; Narvaez, Jorge Andres
The development of new surgical techniques, of new prosthetic materials, and the increase in life expectancy with greater coverage of health services has ugmented the performance of hip replacements in our country. The radiologist should be familiar with the different surgical techniques and prosthetic devices, the evaluation of its components and associated complications. The most frequently performed arthroplasties are: shoulder, elbow, hip and knee replacement. This article reviews the most frequent prosthetic devices used, the radiological aspects of arthroplasties and their most common complications.
Eckert, J; Thompson, R C A
Echinococcosis is a zoonosis whose history dates back to antiquity. This article provides an overview on the general history of echinococcosis, including the elucidation of Echinococcus life cycles and the long controversy on the aetiology of the cystic and alveolar forms of echinococcosis (CE and AE), lasting about 100years since the middle of the 19th century. Furthermore, selected historical aspects of some fields of echinococcosis research are discussed and compared with our current knowledge, such as geographic distribution and epidemiology of CE (Echinococcus granulosus) and AE (Echinococcus multilocularis), clinical aspects and pathology, diagnosis in humans and animals, treatment (with focus on chemotherapy), control and basic research. A short paragraph is devoted to the neotropical forms of echinococcosis, caused by Echinococcus vogeli and Echinococcus oligarthrus. In this context the achievements of some ancestral pioneers of echinococcosis research are particularly highlighted and appreciated. Finally, the role of associations, international organizations (World Health Organization and others) and international working groups in echinococcosis research and control is briefly outlined. The retrospective reveals both the admirable achievements of our ancestors and the scientific progress of more recent times. But, it also shows the gaps in our knowledge, skills and resources that we need to control or even eradicate echinococcosis. Copyright © 2017 Elsevier Ltd. All rights reserved.
Adili, Fatemeh; Larijani, Bagher; Haghighatpanah, Mohammadreza
This study was undertaken to consider the psychological aspect of diabetes with regard to improving clinical outcomes. The review was limited to literature reports on the causes, solutions, and treatments of some common psychological problems known to complicate diabetes management. A literature search was undertaken using Pub-Med, CINAHL, Proquest, Elsevier, Blackwell Synergy, Ovid, Ebsco, Rose net, and Google websites, including studies published in English journals between 1995 and 2006. Therefore about 88 articles were selected based on the inclusion criteria. In earlier studies, relatively little empirical research was found to substantiate the effect of psychological counseling in complicated diabetes. The greatest deficits were seen in areas of mental health, self-esteem parent impact, and family cohesion. There were some different factors, which influence the psychological aspect of diabetic patients, such as age, gender, place of living, familial and social support, motivation, energy, life satisfaction, and lifestyle. There are various types of solutions for coping with the psychological problems in diabetic clients. The most essential solution lies in educating the patients and healthcare providers on the subject. Before initiating each educational intervention, a thorough assessment would be crucial. Treatment plans may benefit from cognitive behavior therapy (CBT), behavior family therapy, improving family communication, problem-solving skills, and providing motivation for diabetic patients. Moreover, it seems that the close collaboration between diabetologists and psychologists would be fruitful.
Vlastos, Georges; Berclaz, Gilles; Langer, Igor; Pittet-Cuenod, Brigitte; Delaloye, Jean-François
Breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. For patients who choice or need a mastectomy, breast reconstruction provides an acceptable alternative. Breast cancer surgery has been evolving through minimally invasive approaches. Sentinel node biopsy has already remplaced axillary lymph node dissection in the evaluation of the axilla. Local ablation of the tumor may be a valuable alternative to surgery in the future.
Fossum, Theresa W; Hedlund, Cheryl S
Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.
Full Text Available Aims and Objectives: We evaluated the factors which affect patient satisfaction and their expectations toward “surgery first” and conventional orthognathic surgery. Materials and Methods: Questionnaires consisting of 17 questions were given to the subjects postoperatively who had undergone Le fort 1 maxillary superior impaction for skeletal gummy smile correction with conventional orthognathic surgery and “surgery first” approach. Eleven-point rating scale based on a (visual analog scale; 0 = poor; 10 = excellent were used to answer six questions. Ten closed-form questions were also included as well as one open question for “further remarks.” Results: Nineteen patients (12 females, 07 males; mean age, 23.4 ± 4.9 [standard deviation] years gave their consent to participate in the study. The intention to undergo surgery only for esthetics was noted in 42.11% of patients; only improvement of chewing function in 21.05% and both in 36.84%. Conclusion: The most common factor for patient satisfaction after “surgery first” and conventional orthognathic surgery was facial esthetics, but masticatory function and even psychological aspects should be considered equally when planning surgery. The patient satisfaction was more in “surgery first” than conventional orthognathic surgery. The timing of treatment and immediate results are important factors toward patient satisfaction.
Includes the transactions of the American Surgical Association, New York Surgical Society, Philadelphia Academy of Surgery, Southern Surgical Association, Central Surgical Association, and at various...
Bondarenko, V O; Ermolov, A S; Kovalenko, T I; Kondratiev, A V
From 1983 to 2003 examination and surgical treatment were performed in 463 patients with different adrenal tumors. Hormone-active tumors were revealed in 249 of them, non-active - in 214. Combination of CT or MRT with study of adrenal hormones is the basis of the diagnosis. In different cases multispiral computed tomography, angiography, selected taking of blood from inferior caval vein, US- or CT-guided biopsy were used. Open surgery through thoracofrenolumbotomy was performed in 392 patients, videolaparoscopic surgery - in 71. Expediency of laparoscopic surgery in line with open surgery is demonstrated.
Asplin, John R.
Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.
Pillarisetti, Raghu Ram; Querci Della Rovere, Guidubaldo
Breast Surgery is now a recognized subspecialty of General Surgery abroad with structured training for designated 'Oncoplastic Breast Surgeons'. Oncoplastic Breast surgery is probably one of the most interesting and challenging new developments over the past 20 years. The aims of Oncoplastic surgery are wide local excision of the cancer coupled with partial reconstruction of the defect to achieve a cosmetically acceptable result. Avoidance of mastectomy and consequent reduction of psychological morbidity are the principal goals in the development of various oncoplastic techniques. The use of plastic surgical techniques not only ensures good cosmetic outcome, but also allows the cancer surgeon to remove the tumour with greater volume of surrounding tissue, thus extending the boundaries of breast conserving surgery. Proper patient selection and careful planning after proper radiological and clinical assessment are the two essential prerequisites before undertaking oncoplastic breast surgery. Oncoplastic surgery involves both volume displacement and volume replacement techniques. Some commonly used volume displacement procedures are described in the article. The need for adjustment of contralateral breast should also be anticipated at the time of planning breast conserving surgery, which can be done either at the same time as breast cancer surgery or as a delayed setting.
Gefke, K; Schroeder, T V; Thisted, B
The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....
Includes the transactions of the American Surgical Association, New York Surgical Society, Philadelphia Academy of Surgery, Southern Surgical Association, Central Surgical Association, and at various...
Kala, Zdeněk; Marek, Filip; Válek, Vlastimil A; Bartušek, Daniel
Surgery of Crohns disease is an important part of the general treatment algorithm. The role of surgery is changing with the development of conservative procedures. The recent years have seen the return to early treatment of patients with Crohns disease. Given the character of the disease and its intestinal symptoms, a specific approach to these patients is necessary, especially regarding the correct choice of surgery. The paper focuses on the luminal damage of the small and large intestine including complications of the disease. We describe the individual indications for a surgical solution, including the choice of anastomosis or multiple / repeated surgeries.
The lack of success, not to say failure, of seismic microzonation projects in the Latin America and Caribbean nations-and for that matter elsewhere in the world-should not be attributed to the lack of technical and scientific expertise of our engineers and scientists as there exists in our continent sufficient knowledge and information about the techniques and procedures that have been successfully used elsewhere in the world in the implementation of seismic microzonation projects. The main constrains to the implementation of seismic microzonation projects in Latin America and the Caribbean are of an economic, social, political, and cultural aspects rather than the purely scientific and engineering aspects. Another very important factor contributing to this lack of success has been the apparent failure of the scientific and technical community to convince decision makers (both official and private) that the sound implementation of seismic microzonation projects are a valid instrument to mitigate the negative effects that earthquakes have on the population, on the physical infrastructure and on the environment. An attempt will be made in this paper to analyze these "non technical" aspects and try to arrive at some conclusions as well as to some possible lines of action for the successful implementation of seismic microzonation projects in the seismic risk prone Latin American and Caribbean nations.
Tekinerdogan, B.; Moreira, Ana; Araújo, João; Clements, Paul
This paper reports on the third Early Aspects: Aspect-Oriented Requirements Engineering and Architecture Design Workshop, which has been held in Lancaster, UK, on March 21, 2004. The workshop included a presentation session and working sessions in which the particular topics on early aspects were
Full Text Available In the process of globalization of world economic processes, the role of individual national economies increases, comparative advantages of the development of a country are formed, and their competitiveness is ensured. That is why it is worth emphasizing the importance of increasing the competitiveness of each individual country, based on its internal capacity. In a broad aspect, the competitiveness of the national economy is perceived as the ability of the country to ensure the balance of its external proportions and to avoid those constraints imposed by the foreign economic sphere, to self-organizing the improvement of their world economic ties. The competitiveness of the economy at the macro level is associated with the duration of the cycle of reproduction of the main productive assets and, accordingly, the jobs, productive forces of society and determined by the overall economic efficiency of investment. The criteria of competitiveness of the national economy are the growth of social productivity of labor, increase of social and economic efficiency of production and standard of living of the population. The competitiveness of the national economy determines sustainable socio-economic development of the country, as well as sustainable development predetermines the competitiveness of not only the country, but also all its levels. Scientific results are obtained using special methods of research of economic objects and phenomena, that is, based on the correlation and regressive, comparative analysis (establishing the relationship between the indicator factor, as well as economic modeling. Findings. Generalizing analysis and the importance of the macroeconomic aspect of competitiveness were used in the research paper, which will allow to better respond to the economic situation, in accordance with the trends of the “green” transformation of the economy; which in turn will solve important problems of the development and implementation of its
Full Text Available Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. The psychological aspects of burn injury have been researched in different parts of the world, producing different outcomes. Studies have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. The concept of allostatic load is presented as a potential explanation for the relationship between acute pain and subsequent psychological outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.
The political and socio-economic aspects of oil and gas exploration in Canada's Arctic and the Beaufort Sea were reviewed. The federal government was very interested in developing the North because they saw oil and gas development in the North as a means of strengthening sovereignty claims. The projected profits from Northern oil and gas development were also very attractive, and after dealing with environmental and social concerns, the government granted the necessary drilling permits. The federal government also made allowances for huge tax incentives for the oil and gas companies to encourage exploration. Although oil has been found, large-scale production in the Beaufort Sea never materialized. During the period from 1984 to 1988, world prices for oil fell and it was no longer economical to undertake frontier production. Beaufort Sea operation were shut down as the oil industry changed its focus to more cost-effective reservoirs in southern Canada. 1 fig
Beside the technical problems of ADTT which remain to be solved it is crucial for the ADTT progress that safety and economical aspects are considered already during the research and planning phases. Safety here stands for the converse of risk, negative consequences for human life and health and the environment together with the corresponding probabilities. The system to be considered includes all phases of an ADTT plant, a life cycle analysis (LCA). The risk analysis is useful for two purposes: comparison with other ways of handling nuclear waste, e.g. geological repository and for valuation of different construction designs. Due to lack of precise plans and adequate data the analysis will be more of a qualitative than quantitative type. The main risks appear in connection with repair and replacement work. 2 refs., 1 fig
Full Text Available The concept of resilience has represented during the recent years a leading concern both in Romania, within the European Union and worldwide. Specialists in economics, management, finance, legal sciences, political sciences, sociology, psychology, grant a particular interest to this concept. Multidisciplinary research of resilience has materialized throughout the time in multiple conceptualizations and theorizing, but without being a consensus between specialists in terms of content, specificity and scope. Through this paper it is intended to clarify the concept of resilience, achieving an exploration of the evolution of this concept in ecological, social and economic environment. At the same time, the paper presents aspects of feedback mechanisms and proposes a formalization of resilience using the logic and mathematical analysis.
What do combustion engines, fusion reactors, weather forecast, ocean flows, our sun, and stellar explosions in outer space have in common? Of course, the physics and the length and time scales are vastly different in all cases, but it is also well known that in all of them, on some relevant length scales, the material flows that govern the dynamical and/or secular evolution of the systems are chaotic and often unpredictable: they are said to be turbulent. The interdisciplinary aspects of turbulence are brought together in this volume containing chapters written by experts from very different fields, including geophysics, astrophysics, and engineering. It covers several subjects on which considerable progress was made during the last decades, from questions concerning the very nature of turbulence to some practical applications. These subjects include: a basic introduction into turbulence, statistical mechanics and nonlinear dynamics, turbulent convection in stars, atmospheric turbulence in the context of nume...
Full Text Available Customer loyalty - is a voluntary user solution for a long time to build relationships with the company. Loyalty is the user's desire for a long time to continue their relationship with a particular company, because loyal customers are those who purchase goods/services of the company from time to time. Loyalty can be treated as a customer desire, willingness to be a regular customer for a long time, buying and using the goods of the chosen companies by recommending them to friends and colleagues. Loyalty can be seen as a multi-dimension, covering behavioral and positional components, where positional aspect reflects customers' approach to business, while the behavioral dimension reveals a frequent and regular shopping, purchase quantity, size, range, availability, etc.
Obese patients have many physical limitations and much psychiatric burden to overcome. Several studies have shown that the prevalence of psychiatric morbidity in the obese is similar to those with normal weight. However, in obese patients seeking treatment there is an increased prevalence (40-60%) of psychiatric morbidity, most commonly depression. It is difficult to separate the effects of depression on obesity and, on the contrary, the neuroendocrine changes associated with stress and depression may cause metabolic changes that predispose and perpetuate obesity. The stigma associated with obesity causes bullying in school as well as childhood psychiatric morbidity. Prejudice is not limited to the general public but exists among health professionals too. This chapter discusses the treatment of depression in obesity and the psychiatric evaluation of the pre-bariatric surgery patient. Education of society, starting with schools and including healthcare professionals will reduce bias and stigma as well as assist this vulnerable group of patients to seek help for their obesity and the many problems that come with it. Given that by the year 2025 obesity will be the world's number one health problem with the US leading the way, it is very important that we pursue preventive measures as well as encourage research for treatments of obesity.
Lanzing, J.W.A.; Lanzing, J.W.A.; Stanchev, I.S.
This contribution focuses on visualisation of information in courseware and in courseware engineering. An overview of advantages and disadvantages of visualisation is given, considering psychological and instructional, cross-cultural, and technical aspects of visualisation. Cross-cultural aspects
Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.
Frikke-Schmidt, H.; O’Rourke, R. W.; Lumeng, C. N.; Sandoval, D. A.; Seeley, R. J.
Summary Bariatric surgery is currently the most effective treatment for obesity. Not only do these types of surgeries produce significant weight loss but also they improve insulin sensitivity and whole body metabolic function. The aim of this review is to explore how altered physiology of adipose tissue may contribute to the potent metabolic effects of some of these procedures. This includes specific effects on various fat depots, the function of individual adipocytes and the interaction between adipose tissue and other key metabolic tissues. Besides a dramatic loss of fat mass, bariatric surgery shifts the distribution of fat from visceral to the subcutaneous compartment favoring metabolic improvement. The sensitivity towards lipolysis controlled by insulin and catecholamines is improved, adipokine secretion is altered and local adipose inflammation as well as systemic inflammatory markers decreases. Some of these changes have been shown to be weight loss independent, and novel hypothesis for these effects includes include changes in bile acid metabolism, gut microbiota and central regulation of metabolism. In conclusion bariatric surgery is capable of improving aspects of adipose tissue function and do so in some cases in ways that are not entirely explained by the potent effect of surgery. PMID:27272117
Rubinstein, Richard; Torabinejad, Mahmoud
During the past decade, endodontics has seen a dramatic shift in the application of periradicular surgery and the role it plays in endodontic treatment. With the introduction of enhanced magnification, periradicular ultrasonics and other associative technologies, teeth that might otherwise be extracted now have a chance for retention. This article describes the role of these advances in contemporary endodontic surgery.
The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. The Annals of Pediatric Surgery has the responsibility to serve not only pediatric surgeons in the Middle East and North Africa but also should be an important conduit for scientific ...
Hans, Elias W.; Wullink, Gerhard; van Houdenhoven, Mark; Kazemier, Geert
We consider the robust surgery loading problem for a hospital’s operating theatre department, which concerns assigning surgeries and sufficient planned slack to operating room days. The objective is to maximize capacity utilization and minimize the risk of overtime, and thus cancelled patients. This
The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for
Prehabilitation is a new term for preoperative rehabilitation before major surgery. Some authors use the short form 'Prehab', though it is not so widely used. Prehabilitation involves measures to improve the physical, physiological, metabolic and psychosocial reserves in preparation for an elective surgery. This involves exercise, nutrition, education and psychosocial interventions.
Full Text Available Objective: Surgical decision-making is a complex process. First, a medical decision is made to determine if surgery is necessary. Second, another medical decision is made to determine the type of surgery. Third, a corporate decision is made if such a surgery is financially feasible. Finally, a legal decision is made to proceed or refuse the chosen surgery. This paper examines these issues in the case of surgery for medically intractable epilepsy and proposes a method of decision analysis to guide epilepsy surgery. Materials and Methods: A stochastic game of imperfect information using techniques of game theory and decision analysis is introduced as an analytical tool for surgical decision-making. Results: Surgery for appropriately chosen patients suffering from medically intractable epilepsy may not only be feasible, but may be the best medical option and the best financial option for the patient, families, society and the healthcare system. Such a situation would then make it legally or ethically difficult to reject or postpone surgery for these patients. Conclusions: A process to collect data to quantify the parameters used in the decision analysis is hereby proposed.
... this page: //medlineplus.gov/ency/patientinstructions/000273.htm Cosmetic breast surgery - discharge To use the sharing features on this ... Editorial team. Related MedlinePlus Health Topics Plastic and Cosmetic Surgery Browse the Encyclopedia A.D.A.M., Inc. ...
Steinmetz, J.; Rasmussen, L.S.
Delirium and postoperative cognitive dysfunction are important and common complications after surgery. Risk factors are first of all increasing age and type of surgery, whereas the type of anaesthesia does not seem to play an important role. Mortality is higher among patients with cognitive...
Shah, Divya K; Ginsburg, Elizabeth S
Bariatric surgery is the most reliable way to sustain weight loss in the morbidly obese. Reproductive age women comprise the majority of bariatric patients, and many may be interested in conceiving after surgery. The purpose of this review is to synthesize the recent literature on bariatric surgery and fertility to assist providers in patient counseling. Obesity adversely impacts fecundability and IVF outcomes through a variety of mechanisms. The body of literature on reproductive outcome after bariatric surgery is sparse and of mixed quality. Bariatric surgery has been shown to improve menstrual cyclicity in anovulatory women, but little is published on the impact of surgical weight loss on spontaneous or IVF-treatment-related pregnancy rates. The increased risk of miscarriage in obese women may decline after bariatric surgery. There are currently insufficient data to support recommendations regarding the ideal timing for pregnancy after bariatric surgery. Obesity has been shown to adversely impact fertility, and weight loss is associated with significant improvement in many parameters of reproductive function. Further research is required as to the specific impact of surgical weight loss on pregnancy and miscarriage rates, as well as the optimal timing of pregnancy after bariatric surgery.
Terzi, E; Kern, T; Kohnen, T
In this article a retrospective analysis of patients presenting at a German university following refractive surgery abroad is presented. A total of 20 cases of patients who had undergone treatment between 1998 and 2006 in China (1 case), Greece (1 case), Iran (1 case), Russia (2 cases), Switzerland (1 case), Slovakia (1 case), Spain (2 cases), South Africa (3 cases), Turkey (6 cases) and the USA (2 cases) were analyzed retrospectively. The following complications were observed: epithelial ingrowth into the interface with or without melting of the flap (6 cases), corneal ectasia (2 cases), dislocation of a phakic posterior chamber intraocular lens and prolapse into the anterior chamber with endothelial cell loss (1 case), secondary increase of intraocular pressure following implantation of a phakic intraocular lens (1 case), flap-related complications following laser-in-situ keratomileusis (LASIK) (2 cases), keratitis (1 case), dislocation of the complete flap (1 case), diffuse lamellar keratitis (DLK) grade IV (1 case), hyperopia as a consequence of radial keratotomy (1 case), and under correction/over correction and poor optical quality following laser epithelial keratomileusis (LASEK) and LASIK for high myopia (5 cases) with possible early corneal ectasia. There are four important problems arising from refractive surgery abroad, often referred to as "LASIK tourism": wrong indications, insufficient management of complications, lack of postoperative care and the health economic aspect.
Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan
Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients' expectations. This article aims to clarify the aspects of causes leading to these legal claims. We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients' demographic data, surgeons' specialty and experience, and method of anesthesia were also collected. One hundred twenty six patients entered the study among which 77 (61%) were female and 49 (39%) male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients' age and sex, and also with the surgeons' experience. There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians' malpractice and some to the patients' social and personal circumstances.
Full Text Available Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading to these legal claims. Materials and Methods: We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients’ demographic data, surgeons’ specialty and experience, and method of anesthesia were also collected. Results: One hundred twenty six patients entered the study among which 77 (61% were female and 49 (39% male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients’ age and sex, and also with the surgeons’ experience. Conclusion: There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians’ malpractice and some to the patients’ social and personal circumstances.
Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan
Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading to these legal claims. Materials and Methods: We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients’ demographic data, surgeons’ specialty and experience, and method of anesthesia were also collected. Results: One hundred twenty six patients entered the study among which 77 (61%) were female and 49 (39%) male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients’ age and sex, and also with the surgeons’ experience. Conclusion: There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians’ malpractice and some to the patients’ social and personal circumstances. PMID:24303371
Robertson, Eleanor; Morgan, Lauren; New, Steve; Pickering, Sharon; Hadi, Mohammed; Collins, Gary; Rivero Arias, Oliver; Griffin, Damian; McCulloch, Peter
Background To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic theatre team acting as a control. Study Design We used a 3 month intervention with 3 months data collection period before and after it. A combined teamwork training and lean process improvement intervention was delivered by an experienced specialist team. Before and after the intervention we evaluated team non-technical skills using NOTECHS II, technical performance using the glitch rate and WHO checklist compliance using a simple 3 point scale. We recorded complication rate, readmission rate and length of hospital stay data for 6 months before and after the intervention. Results In the active group, but not the control group, full compliance with WHO Time Out (T/O) increased from 14 to 71% (p = 0.032), Sign Out attempt rate (S/O) increased from 0% to 50% (pteamwork training and systems improvement enhanced both technical and non-technical operating team process measures, and were associated with a trend to better safety outcome measures in a controlled study comparison. We suggest that approaches which address both system and culture dimensions of safety may prove valuable in reducing risks to patients. PMID:26381643
Fokkens, Wytske J.
Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness
Egan, Katie G; Israel, Jacqueline S; Ghasemzadeh, Rezvaneh; Afifi, Ahmed M
Social media have been used to study many aspects of health and human behavior. Although social media present a unique opportunity to obtain unsolicited patient-reported outcomes, its use has been limited in plastic and reconstructive surgical procedures, including migraine nerve surgery. The goal of this study was to utilize the most popular social media site, Facebook, to evaluate patients' experience with migraine surgery. Six months of data regarding nerve surgery, nerve stimulators, and radiofrequency nerve ablation were collected from posts and comments written by members of 2 Facebook groups. Outcomes were classified by degree of resolution of symptoms. A total of 639 posts related to migraine surgery. Of 304 posts commenting on postoperative success of nerve surgery, 16% reported elimination of headaches and 65% significant improvement (81% with complete or significant improvement), 5% partial improvement, 11% no change, and 3% worsening symptoms. Nerve surgery had a higher success rate than nerve stimulators and radiofrequency ablation. Nerve surgery was recommended by 90% of users. The 81% rate of complete or significant improvement of symptoms in this study is close to the 79% to 84% shown in current literature. Similar to the findings of a recent systematic review, surgery is more efficacious compared with nerve stimulators and ablation. This study adds to evidence favoring migraine surgery by removing evaluator bias and demonstrates that surgical outcomes and satisfaction data may be obtained from social media.
Cantillano, Pablo; Rubio, Fabián; Naser, Alfredo; Nazar, Rodolfo
Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.
Gorczyca, Rafał; Filip, Rafał; Walczak, Ewa
Pain is defined "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Pain is a sensation of the body, and is always an unpleasant emotional experience. The role of psychology is auxiliary and supplemental to medicine. This is an aid addressed to the patient, physician and patient's caregivers: professional caregivers, family members and significant others. At each stage of the diagnostic and therapeutic process, psychology offers help, both from the cognitive and practical aspects. The objective of the article is to present important psychological aspects of studies concerning pain, and the psychological methods and techniques of pain treatment. Pain is the leading reason for patients seeking medical care and is one of the most disabling, burdensome, and costly conditions. Pain accompanies many diseases, each one of which generates unique/separate diagnostic, therapeutic and research problems. DEPRESSION AND RELATED PSYCHICAL DISORDERS: There is a significant relationship between depression and pain symptoms, as well as between pain and suicidal thoughts. Patients with a long history of pain disorders also have increased depression and anxiety symptoms, as well as suicidal thoughts. Patients with more severe depression and anxiety symptoms also have an increase in pain problems. The intensity of pain correlates with the intensity of psychopathological symptoms - both with mood lowering and with anxiety symptoms and worry. Active pain coping strategies strive to function in spite of pain, or to distract oneself from pain, are associated with adaptive functioning. Passive strategies involve withdrawal or relinquishing control to an external force or agent and are related to greater pain and depression. Pain catastrophizing is a negatively distorted perception of pain as awful, horrible and unbearable. Catastrophizing is strongly associated with depression and pain. Studies in which
... valve surgery. Techniques include min-thoracotomy, min-sternotomy, robot-assisted surgery, and percutaneous surgery. To perform the ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...
... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...
Before surgery - tests; Before surgery - doctor visits ... Pre-op is the time before your surgery. It means "before operation." During this time, you will meet with one of your doctors. This may be your surgeon or primary care ...
Prasad, D.; Steiner, M.; Steiner, L.
We present our results of Gamma Knife surgery for craniopharyngioma in nine patients. The current status of surgery, radiation therapy, intracavitary instillation of radionuclides and Gamma Knife surgery in the management of craniopharyngiomas is discussed. (author)
... 3 months after certain surgeries (joint replacement or heart valve surgery). So be sure to schedule your dental ... Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice . 20th ed. Philadelphia, ...
Halsner, U E; Lucas, M W
In the overall spectrum of plastic surgery, hair transplantation for females still plays a marginal role. Previously applied standard methods (standard grafts) could not produce aesthetically satisfying results, so that many female patients who could have benefitted from an operation were discouraged from doing so. It was not until the method of using minigrafts exclusively to cover large areas of androgenetic alopecia in men was developed that acceptable treatment possibilities were also made available to women. The main applications of hair transplantation for females are: androgenetic alopecia, hereditary changes in the hairline, traumatic alopecia, and cosmetic indications. Since 1986 all female patients were exclusively treated with mini- and micrografts in one to two or three sessions. Performing hair transplantation calls for a high degree of sensitivity on the part of the surgeon with respect to the woman and her expectations. With the mini- and micrograft technique new aspects in hair transplantation for females can be offered.
Full Text Available Innovation in assisted reproductive technologies together with increased infertility and new family structures are increasing the use of gestational surrogacy as a means to have children. Before, during and after the process, it is necessary to study the psychosocial characteristics of triad members: the gestational surrogate, intended parents, and offspring. Research has indicated positive adaptation to the process and benefits for all members of the triad. Altruism is the main motivation of surrogates. Notably, psychological well-being has been found to be higher in individuals who have become parents through surrogacy than in those who have used egg donation or have followed a natural process of conception. Moreover, no differences in psychosocial characteristics have been observed in the offspring, compared with children born through natural conception or egg donation. Results highlight the positive aspects of surrogacy. Future research should investigate psychosocial factors that modulate the process, acting as risk and protective factors for well-being of the triad members, and identify the optimal profiles of surrogates for the process to be a success.
Rainout commonly denotes the aggregate of phenomena associated with precipitation scavenging of radioactivity from a cloud of nuclear debris that is within a natural rain cloud. (In contrast, the term, washout, is applicable when the nuclear cloud is below the rain cloud and the term, fallout, commonly denotes the direct gravitational settling of contaminated solid material from a nuclear cloud.) Nuclear debris aerosols may be scavenged within natural clouds by a variety of different physical processes which may involve diffusion, convection, impaction, nucleation, phoresis, turbulence, and/or electricity among others. Processes which involve electrical aspects are scrutinized for their susceptibility to the intimate presence of the radioactive-cloud environment. This particular choice of electrical processes is not accidental. Nearly all of the listed processes were examined earlier by Williams. His rough estimates suggested that electrical effects, and to a lesser extent turbulence, could enhance the scavenging of those submicron aerosols which reside in the size-range that bridges the minimum in the scavenging rate coefficient which is commonly called the Greenfield gap. This minimum in the scavenging-rate coefficient is created by the simultaneous reduction of scavenging via diffusion and the reduction of scavenging via inertial impaction. However, Williams omitted the specific influence of a radioactive environment. This report aims to remedy this omission
Full Text Available The paper considers risk in the context of the main characteristics of non-classical epistemology. It states that non-classical epistemology is characterized by transformation, according to which the major priority of cognitive activity shifts the focus from the present to the past. In this situation a subject is keen not on what he or she has learnt but on what can be learnt. Truth being a crucial criterion of scientific knowledge is becoming of less priority, while risk is becoming more and more significant and acts as one of the major epistemology measurements. Risk is gaining the status of epistemological phenomenon, which shows a growing degree of uncertainty as a cognitive process background and the necessity for a subject to learn the world (make decisions under the conditions of uncertainty degree strengthening. The author states that risk is a comprehensive notion and it obtains a base value for all other aspects of its application, specifically, in the role of epistemological phenomenon.
Maharajh, Hari D; Abdool, Petal S
Undefined cultural factors cannot be dismissed and significantly contribute to the worldwide incidence of death by suicide. Culture is an all embracing term and defines the relationship of an individual to his environment. This study seeks to investigate the effect of culture on suicide both regionally and internationally. Culture-bound syndrome with suicidal behaviours specific to a particular culture or geographical region are discussed. Opinions are divided as to the status of religious martyrs. The law itself is silent on many aspects of suicidal behaviour and despite decriminalization of suicide as self-murder, the latter remains on the statutes of many developing countries. The Caribbean region is of concern due to its steady rise in mean suicide rate, especially in Trinidad and Tobago where socio-cultural factors are instrumental in influencing suicidal behaviour. These include transgenerational cultural conflicts, psycho-social problems, media exposure, unemployment, social distress, religion and family structure. The methods used are attributed to accessibility and lethality. Ingestion of poisonous substances is most popular followed by hanging. The gender differences seen with regard to suicidality can also be attributed to gender related psychopathology and psychosocial differences in help-seeking behaviour. These are influenced by the cultural environment to which the individual is exposed. Culture provides coping strategies to individuals; as civilization advances many of these coping mechanisms are lost unclothing the genetic predisposition of vulnerable groups. In the management of suicidal behaviour, a system of therapeutic re-culturation is needed with an emphasis on relevant culture- based therapies.
Full Text Available Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict, gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 165-185
Thomas, J.B. [CEA Centre d`Etudes de Saclay, 91 - Gif-sur-Yvette (France). Dept. de Mecanique et de Technologie; Bergeonneau, P. [CEA Centre d`Etudes de Cadarache, 13 - Saint-Paul-lez-Durance (France). Dept. d`Etudes des Reacteurs
Precise computation of neutron flux in the core of a nuclear reactor represents one of the basic aspects of reactor design and operation. Neutron flux is computed by solving Boltzmann`s linear equation. Anyway, the direct solution of the equation involves too great a number of operations for practical application, leading up to TeraFlops or even PetaFlops supercomputing capabilities. Physical and mathematical models are then required to handle the extensive variety of configurations encountered. Numerical methods must be adapted to the rapid evolution of computer power, as also computer architecture: sequential, vector or parallel. Physical and mathematical models must allow for very fast estimation for online control and monitoring, adequate quantification for industrial studies and high-precision, best estimate computations. Coupling of neutronics to mechanics and two-phase flow thermohydraulics must be implemented in order to improve the accuracy in best-estimate computation schemes and to take into account the transient behaviour of the plant during normal operation or incidents. In this field of continuous improvement, the new methods applied in Reactor Physics lead obviously to good results and provide the improvements required in the future for the needs of efficiency, safety and advanced fuel cycle. This trend and the ``evolutionary`` implementation in large and modular software systems will be illustrated by the example of the SAPHYR system. (authors). 3 tabs.
Pinto-Bastos, Ana; Conceição, Eva M; Machado, Paulo P P
Reoperative surgery following the failure of primary bariatric surgery is increasing due to the significant rates of patients experiencing poor weight loss or medical complications. This literature review was conducted to organize the emerging, but scattered, literature regarding the reasons for undergoing surgery, the best available options, the predictors of success, and the psychological characteristics of patients submitted to reoperative surgeries. Reoperative procedures are technically challenging, but the possible benefits of reoperation supplant the increased risks associated with these procedures. The etiology of reasons for undergoing a second surgery includes medical (e.g., fistula, ulcer disease) and behavioral aspects. Factors that may compromise outcomes have not been much studied. Particular attention should be paid to candidates with a history of difficulties in engaging in healthy eating patterns.
Nishiyama, Tomoki; Kohno, Yumiko; Koishi, Keiko
Bariatric surgery has a lot of problems in anesthesia. We retrospectively compared anesthesia for bariatric surgery in yellow race with that in normal weight patients. Twenty patients who received bariatric surgery and 20 normal body weight patients who received abdominal surgery in Japan were enrolled. Induction condition, depth of epidural space, dose of anesthetics, duration of the effects of muscle relaxants, ventilation, and fluid management in bariatric surgery were analyzed and compared with those in normal body weight patients. An epidural catheterization was successful under ultrasound guide in the bariatric group. The depth epidural space was significantly larger in the bariatric group. Cormack and Lehane classification and the number of intubation attempt were not different between the two groups, while one bariatric case was once awakened to intubate blindly. Pressure-controlled ventilation was used in the bariatric group. Four bariatric patients were continuously ventilated after surgery. The doses of anesthetics and fluid infusion rate were not different between the two groups when calculated by ideal body weight in the bariatric group. The duration of the effects of rocuronium and pancuronium were shorter in the bariatric group. For anesthesia of yellow race patients undergoing bariatric surgery, intravenous anesthetics and acetate Ringer's solution with 1% glucose could be administered per ideal body weight, the effects of muscle relaxants lasted shorter, pressure-controlled ventilation could keep oxygenation with adequate carbon dioxide, and ultrasound assist was useful in epidural catheterization in the bariatric patients.
Kostić Aleksandar V.
Full Text Available The author examines futurological aspects of globalization having in mind various models of historical processes. He describes the changes as "futuroshock", thus presenting a dilemma whether the changes are only a momentum or a pre-planned concept. He especially stresses the Toffler’s conclusion that turns a new page in futurology - examining the dangers that follow the changes. According to him, predictions are made with the help of practically all the sciences in two basic directions: exploratory and normative. In his work the author considers the problem of the future not having perspective as a sequel to the present. The idea to build the world as a dualistic society of the "golden billion" and the exploited crowd is but new kind of fascism. In his opinion it is necessary to answer the question of who will indicate the qualitatively distinctive future and by which means this will be achieved. The traditional western science considers an anomaly everything that deviates a bit from it. Such a scientific paradigm projects conflicts, war, violence, which was the case in Yugoslavia, Iraq, Afghanistan, Libya, Syria etc. The author asserts three hypotheses of the possible future world order, while noticing that globalization transforms the whole regions into neo-totalitarian version of the order that spreads in concentric circles on the most of the world. According to the author, global totalitarian government is responsible for dual moral and double standards that provide limitless freedom for themselves and just the opposite for others. Within the given context, the conditions are being created on the East for a unique bloc that will consist of Chinese, Russian and Hindu-Buddhist civilization. This will serve as an alternative to the aggressive West.
Hari D. Maharajh
Full Text Available Undefined cultural factors cannot be dismissed and significantly contribute to the worldwide incidence of death by suicide. Culture is an all embracing term and defines the relationship of an individual to his environment. This study seeks to investigate the effect of culture on suicide both regionally and internationally. Culture-bound syndrome with suicidal behaviours specific to a particular culture or geographical region are discussed. Opinions are divided as to the status of religious martyrs. The law itself is silent on many aspects of suicidal behaviour and despite decriminalization of suicide as self-murder, the latter remains on the statutes of many developing countries. The Caribbean region is of concern due to its steady rise in mean suicide rate, especially in Trinidad and Tobago where socio-cultural factors are instrumental in influencing suicidal behaviour. These include transgenerational cultural conflicts, psycho-social problems, media exposure, unemployment, social distress, religion and family structure. The methods used are attributed to accessibility and lethality. Ingestion of poisonous substances is most popular followed by hanging. The gender differences seen with regard to suicidality can also be attributed to gender related psychopathology and psychosocial differences in help-seeking behaviour. These are influenced by the cultural environment to which the individual is exposed. Culture provides coping strategies to individuals; as civilization advances many of these coping mechanisms are lost unclothing the genetic predisposition of vulnerable groups. In the management of suicidal behaviour, a system of therapeutic re-culturation is needed with an emphasis on relevant culture- based therapies.
Klimova A. V.
Full Text Available One of the most important conditions of the existence of every organization, every enterprise is to insure the long-term sustainable development, one of the conditions of which is the increase of an organizational competitiveness. In modern economic conditions, social aspects of competitiveness are now in the foreground of interest, because just the strategy of social responsibility (SSR of modern enterprises can assure some commercial benefits, in responding, at the same time, to the social demands and in creating its well-being. Such an approach is in the basis of the notion of competitiveness. Along with «rigid parameters», such as price characteristics, the capability to deal with competitors, effective financial and production policies, «flexible factors» of competitiveness are of a big importance: a personnel potential, individual and collective competencies, organizational and managerial capabilities. As a result, we have formulated a research hypothesis: the organizational competitiveness is defined by individual and collective competencies of an organization, is based on socially responsible actions, confirms the demand for the object and insures its sustainable long-term development. Any organization should base all its actions aimed to increase its competitiveness on its intellectual potential, or on the management of individual and collective competencies that assure the sustainable development and the goal achievement. For every organizational strategic action, an effective combination of these competencies exists. So, we suggest a new definition of competitiveness: it is a social and economic category of understanding of the social responsibility, having as a central element individual and collective competencies, based on socially responsible actions of an enterprise, insuring its long-term sustainable development.
Cappell, Sylvain; Rosenberg, Jonathan
Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. There have been some extraordinary accomplishments in that time, which have led to enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source that surveys surgery theory and its applications. Indeed, no one person could write such a survey. The sixtieth birthday of C. T. C. Wall, one of the leaders of the founding generation of surgery theory, provided an opportunity to rectify the situation and produce a
Cappell, Sylvain; Rosenberg, Jonathan
Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. The sixtieth birthday (on December 14, 1996) of C.T.C. Wall, a leading member of the subject''s founding generation, led the editors of this volume to reflect on the extraordinary accomplishments of surgery theory as well as its current enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source surveying surgery theory and its applications. Because no one person could write such a survey, the editors ask
Mendicute, J; Orbegozo, J; Ruiz, M; Sáiz, A; Eder, F; Aramberri, J
To evaluate cases and results of keratomycosis that developed after cataract surgery. Hospital de Guipúzcoa, San Sebastián, Spain. This retrospective study comprised 8 patients who developed keratomycosis soon after cataract surgery. Culture analysis revealed 7 cases of Aspergillus fumigatus and 1 of Aspergillus flavus. After medical treatment with antifungal agents, 6 cases resolved and 2 required evisceration. The presence of fungi in corneal ulcers that develop after cataract surgery should be considered. Initiation of early treatment determines the prognosis. Among the therapeutic options, collagen shields soaked in amphotericin B may be effective.
Springborg, Henrik; Istre, Olav
potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark, in which 40 patients have been treated for benign gynecologic conditions......LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique, however, its large-scale adoption awaits results of prospective randomized controlled studies confirming...
von Soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar; Skolleborg, Knut Chr
There are few data on the frequency of cosmetic surgery among Norwegian women. A random sample of 2000 Norwegian women aged 22 to 55 received a questionnaire on cosmetic surgery, demographic data, self-esteem, and to what extent people around them accepted cosmetic surgery. The response rate was 46% (907 women). Of these, 7.7% indicated that they had undergone cosmetic surgery, while 22.6% wished to do so. Other people's degree of acceptance predicted both the wish to undergo cosmetic surgery and already conducted surgery. Low self-esteem was correlated with a wish to undergo surgery, though women who had done surgery had no lower self-esteem than non-patients. Although the response rate was relatively low, this study gives the first reliable data on the frequency of cosmetic surgery in Norway. The results indicate that other people's degree of acceptance of cosmetic surgery is a predictor of such surgery being chosen.
Reid, R.L.; Holmes, J.A.; Houlberg, W.A.; Peng, Y.K.M.; Strickler, D.J.; Brown, T.G.; Wiseman, G.W.
The Large Aspect Ratio Tokamak Study (LARTS) at Oak Ridge National Laboratory (ORNL) investigated the potential for producing a viable longburn tokamak reactor by enhancing the volt-second capability of the ohmic heating transformer through the use of high aspect ratio designs. The plasma physics, engineering, and economic implications of high aspect ratio tokamaks were assessed in the context of extended burn operation. Using a one-dimensional transport code plasma startup and burn parameters were addressed. The pulsed electrical power requirements for the poloidal field system, which have a major impact on reactor economics, were minimized by optimizing the startup and shutdown portions of the tokamak cycle. A representative large aspect ratio tokamak with an aspect ratio of 8 was found to achieve a burn time of 3.5 h at capital cost only approx. 25% greater than that of a moderate aspect ratio design tokamak
Videler, Ward J. M.; Wreesmann, Volkert B.; van der Meulen, Freerk W.; Knegt, Paul P.; Fokkens, Wytske J.
OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the
Piras, Mauro; Delbon, Paola; Conti, Adelaide; Graziano, Vincenzo; Capasso, Emanuele; Niola, Massimo; Bin, Paola
Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB) was also analyzed. The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.
... regular exercise has family members who will provide emotional and practical support (like driving to every doctor's visit or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this ...
... care - open Images Breast lift (mastopexy) - series Breast reduction (mammoplasty) - series Breast augmentation - series References Maxwell GP, Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013: ...
... symptoms, such as hot flashes and vaginal dryness Depression or anxiety Heart disease Memory problems Decreased sex drive Osteoporosis Premature death Taking low doses of hormone replacement drugs after surgery and until about age ...
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Pepe, Franco; DE Luca, Francesco; Stracquadanio, Mariagrazia; Garraffo, Claudia; Santonocito, Veronica C; Privitera, Agata
Pregnancy after bariatric surgery has some peculiarities related to obesity, type of surgery, amount of weight loss, time elapsed from the surgery and adherence to medical prescriptions. Pregnant woman is at risk of nutritional deficiencies and it is unclear whether there is an increased incidence of intestinal complications during pregnancy after bariatric surgery and whether this kind of complications are more frequent during cesarean section. The fetus is at high risk of prematurity and fetal growth restriction, but they seem not at increased risk of birth defects (DTN) except in individual cases of folic acid deficiency (DTN) or vitamin K defect (similar abnormalities in patients receiving oral anticoagulants). In addition, the incidence of gestational diabetes and hypertension results to be decreased. Other postnatal outcomes from possible epigenetic modifications need to be evaluated in the long-term postnatal follow-up.
... quality of life than someone who is normal weight. Bariatric surgery results in highly significant improvement in psychosocial well- ... affecting an individual’s weight, such as psychological issues. Weight gain generally occurs when there is an energy imbalance ...
... page: //medlineplus.gov/ency/patientinstructions/000440.htm Deep breathing after surgery To use the sharing features on ... way to do so is by doing deep breathing exercises. Deep breathing keeps your lungs well-inflated ...
Full Text Available ... and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced ... make the lips meet without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, including snoring) ...
Fernandes, Julio Wilson; Metka, Susanne
The roots of science and art of plastic surgery are very antique. Anatomy, drawing, painting, and sculpting have been very important to the surgery and medicine development over the centuries. Artistic skills besides shape, volume, and lines perception can be a practical aid to the plastic surgeons' daily work. An overview about the interactions between art and plastic surgery is presented, with a few applications to rhinoplasty, cleft lip, and other reconstructive plastic surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... very safe, some people choose to use a method called autologous blood donation. Autologous blood is blood donated by you, which you later receive if you need a transfusion during or after surgery. You can have blood ...
Comparative efficacy of amoxicillin/clavulanic acid and levofloxacin in the reduction of postsurgical sequelae after third molar surgery: A randomized, double blind, clinical trial in a Nigerian University Teaching Hospital.
... 简体中文) Expand Section Biopsy - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Getting Your Skin Ready for Surgery - 简体中文 (Chinese, ...
... Coronary Artery Bypass Surgery - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Pacemaker - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF ...
... After Total Joint Replacement - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Home Care Instructions After Surgery - 简体中文 (Chinese, Simplified ( ...
Full Text Available ... can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ ...
Weaver, Allison; Steele, Scott
Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.
... lid blepharoplasty is almost always done just for cosmetic reasons. Risks Possible risks of eyelid surgery include: Infection and bleeding Dry, irritated eyes Difficulty closing your eyes or other eyelid problems Noticeable scarring Injury to eye muscles Skin discoloration ...
... the epithelial cells. Once the epithelial flap is created and moved aside, the procedure is the same ... Sites EyeWiki International Society of Refractive Surgery * Required * First Name: * Last Name: Member ID: * Phone Number: * Email: * ...
Full Text Available ... jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do ... out more. Who We Are Find a Surgeon News Videos Contact Administration of Anesthesia Cleft Lip/Palate ...
... your eye. Overcorrections may be more difficult to fix than undercorrections. Astigmatism. Astigmatism can be caused by ... back into place. The flap usually heals without stitches. During the surgery, you'll be asked to ...
emergency patients for a surgical procedure, returning home the same day (1). Ambulatory orthopaedics happens to have double meaning, so in this communication day surgery will be the preferred term. In Kenya the three models of day.
Full Text Available Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB was also analyzed. Conclusion: The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.
... Breast reduction surgery might also help improve your self-image and your ability to participate in physical activities. ... under the breasts Nerve pain Restricted activity Poor self-image related to large breasts Difficulty fitting into bras ...
Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 1 (2011) >. Log in or Register to get access to full text downloads.
Annals of Pediatric Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 1 (2018) >. Log in or Register to get access to full text downloads.
Full Text Available ... in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively ...
... ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... reduce the pressure in your nose. Avoid strenuous exercise for the first 2 weeks after surgery. Also ...
Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who ... surgeons surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and ...
... repair Shoulder arthroscopy Shoulder CT scan Shoulder MRI scan Shoulder ... by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. ...
... vitamins, herbal remedies, and spices including vitamin E, garlic, ginger, gingko, and ginseng may increase the risk of bleeding. Some patients may be asked to take antibiotics and/or steroids prior to sinus surgery. This ...
Michel, L; Lang, J-P
Adverse effects of benzodiazepines are well known since the first one was used in 1958 (chlordiazepoxide). The literature collects study-cases or rarely controlled studies concerning side effects or paradoxical reactions to benzodiazepines. They mostly described drowsiness and behavioral disinhibition, including increased well-being feeling but also hostility, rage access with feeling of invulnerability, serious crimes and sometimes homicides. Delusional, manic, confusional or depressive states are also pointed out. Rate for aggressive behaviour is 0.3 to 0.7% but distinction should be done between accidental or "idiosyncratic" reaction and voluntary sought disinhibition, clearly more frequent. No benzodiazepine has any specificity for these adverse effects but pharmacology, doses, associated drugs (or alcohol) and psychopathology interact to produce hazardous psychic states. Pharmacology: GABA induces a decrease in serotonin compound and vigilance. Pharmacokinetic: first dose effect or over-dose effect, short half-life, lipophily, affinity, digestive absorption, active metabolites interact. Psychopathology: age, alcohol association, psychological status (high initial level of hostility, impulsivity, frustration, personality disorder and depressive status). External conditions: chronic illness, affective and professional frustrations, physical or psychic exhaustion contribute also. Some benzodiazepines (flunitrazepam, diazepam, clorazepate, triazolam, alprazolam, lorazepam, for example) are more often concerned for pharmacokinetics characteristics but also prescription habits. Forensic aspects should be considered in case of homicide. Especially, reality of benzodiazepines consumption and awareness of the potential paradoxical reaction should be precisely evaluated. Special focus on voluntary induced disinhibition has to be done for forensic considerations. Relationship but also crime facilitations are sometimes consciously sought. Some benzodiazepines have already
Flechtenmacher, Johannes; Sabo, Desiderius
The book on X-ray diagnostics in orthopedics and trauma surgery includes the following chapters: 1. Introduction: radiation protection, equipment technology radiological diagnostics of skeleton carcinomas, specific aspects of trauma surgery, special aspects of skeleton radiology for children. 2. X-ray diagnostics of different anatomical regions: ankle joint, knee, hips and pelvis, hand and wrist joint, elbow, shoulder, spinal cord. 3. Appendix: radiation protection according to the X-ray regulations.
Criminological aspects of criminal recidivism The topic of this thesis are the criminological aspects of criminal recidivism and goal is to present a complete outline of some of the basic ideas related to the concept of criminal recidivism and to introduce the reader to its selected criminological aspects. This thesis is divided into four chapters. The introductory chapter is focused on the concept of criminal recidivism itself, and similarly defines the various concepts with emphasis on the ...
le Roux, Carel W; Heneghan, Helen M
In this review, the authors discuss the indications for and the published outcomes of commonly performed bariatric procedures, including weight loss, perioperative morbidity and mortality, late complications, as well as the impact of bariatric surgery on comorbidities, cardiovascular risk, and mortality. They also briefly discuss the mechanisms by which bariatric/metabolic surgery causes such significant weight loss and health gain. Copyright © 2017 Elsevier Inc. All rights reserved.
Majholm, Birgitte; Engbæk, J; Bartholdy, Jens
Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort.......Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort....
Wall, James; Chandra, Venita; Krummel, Thomas
In summary, robotics has made a significant contribution to General Surgery in the past 20 years. In its infancy, surgical robotics has seen a shift from early systems that assisted the surgeon to current teleoperator systems that can enhance surgical skills. Telepresence and augmented reality surgery are being realized, while research and development into miniaturization and automation is rapidly moving forward. The future of surgical robotics is bright. Researchers are working to address th...
As a founding member of the physician-owned insurance carrier The Doctors' Company, the author has reviewed many plastic surgery policy claims. In this article, he presents an overview of the plastic surgery procedures that produce the most severe losses. He then offers suggestions on how to proceed with these "medical malpractice favorites." The author discusses potential antitrust traps and legal recourse for plastic surgeons.
Richardson, William S.; Carter, Kristine M.; Fuhrman, George M.; Bolton, John S.; Bowen, John C.
In the last decade, laparoscopy has been the most innovative surgical movement in general surgery. Minimally invasive surgery performed through a few small incisions, laparoscopy is the standard of care for the treatment of gallbladder disease and the gold standard for the treatment of reflux disease. The indications for a laparoscopic approach to abdominal disease continue to increase, and many diseases may be treated with laparoscopic techniques. At Ochsner, laparoscopic techniques have dem...
Navadgi, Suresh; Pandanaboyana, Sanjay; Windsor, John A.
Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the ...
Desserud, K F; Veen, T; Søreide, K
Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.
In this presentation the following aspects of NPPs decommissioning are discussed: Requirements and purpose of decommissioning costing; Decommissioning costing methodologies; Standardised decommissioning cost structure; Input data for cost estimate process; Waste management in cost estimate process; Grading aspects in cost estimating; Cost control in decommissioning projects; Summary of the cost estimation process; Conclusions and recommendations.
Gettman, Matthew; Rivera, Marcelino
Developments in robotic surgery have continued to advance care throughout the field of urology. The purpose of this review is to evaluate innovations in robotic surgery over the past 18 months. The release of the da Vinci Xi system heralded an improvement on the Si system with improved docking, the ability to further manipulate robotic arms without clashing, and an autofocus universal endoscope. Robotic simulation continues to evolve with improvements in simulation training design to include augmented reality in robotic surgical education. Robotic-assisted laparoendoscopic single-site surgery continues to evolve with improvements on technique that allow for tackling previously complex pathologic surgical anatomy including urologic oncology and reconstruction. Last, innovations of new surgical platforms with robotic systems to improve surgeon ergonomics and efficiency in ureteral and renal surgery are being applied in the clinical setting. Urologic surgery continues to be at the forefront of the revolution of robotic surgery with advancements in not only existing technology but also creation of entirely novel surgical systems.
Ramos-Leví, Ana M; Rubio Herrera, Miguel A
The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.
Valentino, Daniel; Sriram, Krishnan; Shankar, Padmini
Obesity is a growing worldwide epidemic. Obese patients are often deficient in micronutrients despite macronutrient excess. Bariatric surgery is an increasingly utilized modality in the treatment of obesity and obesity-related conditions. Bariatric surgery itself may cause or exacerbate micronutrient deficiencies with serious sequelae. This review will focus on perioperative strategies to detect, prevent and treat micronutrient deficiencies in patients undergoing bariatric surgery, and will highlight practical and clinical aspects of these nutritional problems. Micronutrient deficiency is common in obese patients undergoing bariatric surgery both preoperatively and postoperatively. Bariatric procedures with a malabsorptive component are more likely to result in postoperative micronutrient deficiency. A system-based approach will facilitate clinical suspicion of specific or combined micronutrient deficiencies, leading to appropriate laboratory tests for confirmation. Supplementation by the oral route is always tried first, reserving parenteral administration for specific situations. Clinicians should be aware that micronutrient deficiencies are common in obese patients who may have macronutrient excess. Micronutrient deficiency may exist preoperatively or be caused by bariatric procedures themselves. A systematic and team-based approach will decrease morbidity associated with delays in diagnosis and treatment.
Smith, Darren M; Aston, Sherrell J; Cutting, Court B; Oliker, Aaron
Virtual reality has a long history in plastic and reconstructive surgery, with uses ranging from anatomical demonstration to craniofacial surgical planning. The purpose of this article is to add to the literature a computer graphics-based resource for aesthetic surgery. Deformation tools, virtual cameras, and other components of Alias's Maya 4.0 were used to perform virtual surgical procedures on a detailed model of superficial facial anatomy. This three-dimensional model of superficial facial anatomy, derived from the National Library of Medicine's Visible Human Project, was also "aged" in Maya at key depths of anatomical dissection. Adobe's After Effects 5.5 was used for animation postproduction work for all animations. Three-dimensional computer animations were developed to illustrate techniques in aesthetic surgery. Another animation was created that simulates facial aging at various levels of anatomical dissection. Computer modeling and animation have the potential to play an important role in education, surgical planning, development, and other aspects of aesthetic surgery.
Moreno-Sanz, Carlos; Tenías-Burillo, Jose María; Morales-Conde, Salvador; Balague-Ponz, Carmen; Díaz-Luis, Hermógenes; Enriquez-Valens, Pablo; Manuel-Palazuelos, Juan Carlos; Martínez-Cortijo, Sagrario; Olsina-Kissler, Jorge; Socas-Macias, María; Toledano-Trincado, Miguel; Vidal-Pérez, Oscar; Noguera-Aguilar, Juan Francisco; Salvador-Sanchís, José Luis; Feliu-Pala, Xavier; Targarona-Soler, Eduard M
The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.
... Colonic Enema (ACE) Surgery Antegrade Colonic Enema (ACE) Surgery Antegrade colonic enema surgery (ACE) is a procedure ... Risks / Benefits What is antegrade colonic enema (ACE) surgery? Antegrade colonic enema surgery (ACE) or Malone antegrade ...
Surgery and surgeons have a direct relationship to publicity. In the media, the entertainment aspect prevails over information (infotainment), and scandal also dominates because of negative reports. The cause in many cases is a lack of information, which is always a problem when transmitting scientific information to the public. Economic pressures and diminished resources as well as a simultaneous increase in the demands made on medicine make it mandatory that surgeons communicate properly. They are being degraded more and more to "delivering" medicine, and the relationship between the surgeon and his patient has been reduced to a collision of greediness on both sides. We are in continuous conflict with the power of the media and are being challenged to improve our public relations. The public image of surgery today is determined by surgical performance and competence in communication.
Tillaart, Sabrina Ada Hendrika Maria van den
The thesis describes studies on practical aspects of cervical cancer, concering surgical considerations, and aspects of tumour behaviour and tumour spread. The thesis comprises studies on: the comparison of nerve-sparing and non-nerve-sparing radical hysterectomy for cervical cancer; a new surgical
In the 1990's the author cooperated with Carl Bache on a grammar of English. It turned out that the views they had previously arrived at individually on tense and aspect could be combined by operating with a fused system involving four ordered choices resulting in sixteen tense-aspect forms...
van Leeuwen, Rene; Tiesinga, Lucas J.; Jochemasen, Henk; Post, Doeke
The spiritual dimension of illness, health and care may be seen as a unique aspect in addition to the physical, mental and social dimension. This contribution describes experiences of patients, nurses and hospital chaplains in relation to the spiritual aspects of being ill. Qualitative research was
Lee, Jandee; Chung, Woong Youn
Robotic surgery is an innovation in thyroid surgery that may compensate for the drawbacks of conventional endoscopic surgery. A surgical robot provides strong advantages, including three-dimensional imaging, motion scaling, tremor elimination, and additional degrees of freedom. We review here recent adaptations, experience and applications of robotics in thyroid surgery. Robotic thyroid surgeries include thyroid lobectomy, total thyroidectomy, central compartment neck dissection, and radical ...
Neurosurgical aspects of Neurogenic Bladder , Urological aspects of Neurogenic Bladder , Sympathetic Blockade, An Acute Cervical Cord Syndrome, Autonomic Hyperreflexia, Physical and Vocational Rehabilitation....Hematomas Associated with Penetrating Wounds, Infection Complicating Penetrating Craniocerebral trauma, Tangential Wounds of Scalp and Skull, Through and
Zhu, Catherine; Pryor, Aurora D
Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.