Medicine and Health Sciences Commons^™

Development Of An On-Call Assessment Tool For Competency-Based Surgical Training, Eric C. Mitchell

Electronic Thesis and Dissertation Repository

Introduction: A central tenet of competency-based medical education is formative assessment of trainees. There are no assessments examining resident competence on-call, despite this being a significant component of resident training and characterized by less supervision compared to daytime.

Methods: A national survey was conducted to evaluate the state of assessment in Canadian Plastic and Reconstructive Surgery programs. An on-call assessment tool was developed based on a consensus group and was piloted over six months. Validity of the tool was examined through qualitative and quantitative methods.

Results: There were 63 tools completed across ten residents and seven staff physicians. Tool reliability …

A Rheumatoid Nodule At The Sternoclavicular Joint: An Uncommon Presentation Of A Common Problem, Patrick M. Thomas, Nathan J. Cockerill, Christina M. Arcand, Alan R. Koester, Mark H. Cooper Md, Phd

Marshall Journal of Medicine

Most rheumatoid nodules are found at joints or pressure points. They rarely require medical intervention and even fewer require surgery. A 78-year-old female developed a 7.2 x 3.2 x 2.8 cm rheumatoid nodule originating at the right sternoclavicular joint, a novel site for a common pathology. Management involved a complex differential diagnosis and surgical treatment was resection from adjacent vascular and neural structures. Following surgical excision, the patient maintained good mobility and sensation of the neck and surrounding areas.

Nasal Surgery Versus Pharyngeal Surgery In The Treatment Of Obstructive Sleep Apnea, Ruxandra Oana Alius, Viorel Zainea, Catalina Voiosu, Irina Gabriela Ionita, Andreea Rusescu, Oana Denisa Balalau, Catalin Alius, Raluca Oana Pulpa, Razvan Hainarosie

Journal of Mind and Medical Sciences

The endemic spread of obesity and unhealthy behaviors of modern society led to revisiting the real prevalence related to obstructive sleep apnea. Recent data support a paradigm shift towards individually tailored treatments which include functional surgery of the upper airways. This paper presents the results of a randomized interventional, prospective study on 68 patients referred by the general practitioner for obstructive sleep apnea. The eligible cohort consisted of 28 patients who were offered functional surgery for definitive relief of obstructive symptoms. After topographic diagnosis of the obstruction site and grading of the severity of the obstructive sleep apnea, the eligible …

Clinical And Biological Factors With Prognostic Value In Acute Pancreatitis, Mihai Faur, Dan Dumitrescu, Dan Sabau, Ciprian Tanasescu, Dan Cretu, Denisa Tanasescu, Vlad Denis Constantin, Calin Mohor

Journal of Mind and Medical Sciences

Acute pancreatitis is an acute inflammatory process of the pancreas, which can remain localized at the level of the gland or can extend to the peripancreatic and retroperitoneal tissues. The use and interpretation of paraclinical examinations at the onset can predict the form of evolution of acute pancreatitis (mild or severe). Depending on the evolution, these data are useful in determining the type of surgical intervention that might be necessary based on severity.

We present a retrospective study consisting of 118 patients diagnosed and hospitalized with acute pancreatitis during 2016-2020 in the Surgery I section of the Sibiu County Emergency …

Modern Therapeutic Options In Diabetic Foot Ulcer, Denisa Tanasescu, Andrei Moisin, Radu Fleaca, Carmen Popa, Ciprian Bacila, Cosmin Mohor, Claudia Diana Gherman, Bogdan Gaspar, Ciprian Tanasescu

Journal of Mind and Medical Sciences

Diabetic foot is a severe complication of diabetes that occurs as a result of poor glycemic control, being associated with significant morbidity and mortality. Mortality associated with this disease is estimated at 5% in the first 12 months, and about 42% in the next 5 years. On average, it affects about 15% of people with diabetes during their lifetime, including as possible manifestations neuropathy, peripheral vascular disease, and subsequent ulceration which, if treated incorrectly, can lead to amputation.

This paper presents a retrospective and descriptive study of patients diagnosed and treated for diabetic foot ulcers in the Proctoven Clinic. The …

A Retrospective Review Of Genital Fistula Occurrence In Nine African Countries, Carrie J. Ngongo, Thomas J. I. P. Raassen, Marietta Mahendeka, Ladeisha Lombard, Jos Van Roosmalen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development.

Methods: This retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia.

Results: Most women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery …

Lymph Node Dissections And Survival In Sublobar Resection Of Non-Small Cell Lung Cancer ≤ 20 Mm., Shinkichi Takamori, Takefumi Komiya Md, Mototsugu Shimokawa, Emily Powell Phd

PCI Publications and Projects

BACKGROUND: A randomized trial of lobectomy versus segmentectomy for small-sized (≤ 20 mm) non-small cell lung cancer (NSCLC) showed that patients who had undergone segmentectomy had a significantly longer overall survival (OS) than those who had lobectomy. More attention is needed regarding the required extent of thoracic lymphadenectomy in patients with small-sized NSCLC who undergo sublobar resection.

METHODS: The National Cancer Database was queried for patients with clinically node-negative NSCLC ≤ 20 mm who had undergone sublobar resection between 2004 and 2017. OS of NSCLC patients by the number of lymph node dissections (LNDs) was analyzed using log-rank tests and …

Measuring Surgical Patient Engagement: A Scoping Review, Rebecca Law, Dawn Wong Lit Wan, Sonja Cleary, Wanda Stelmach, Krinal Mori, Zhen Zheng

Journal of Perioperative Nursing

Background

Patient engagement is a patient’s capacity and willingness to participate and collaborate in their own health care. This scoping review aimed to identify tools used to measure engagement among surgical patients, the levels of engagement and the association between engagement and surgical outcomes. We hypothesise that highly engaged patients are more likely to achieve better surgical outcomes.

Review methods

MEDLINE/PubMed, CINAHL, SCOPUS and Embase were searched for studies that assessed adult perioperative patients for engagement. Analysis from charting the data identified the measurement tools, levels of capacity to engage and relationships between engagement and surgical outcomes.

Results

Twelve studies …

Periodontal Outcomes Of Impacted Maxillary Central Incisors In 80 Patients Treated With A Combined Surgical-Orthodontic Approach, Kwok-Hing Ho, Yu-Fang Liao

Taiwanese Journal of Orthodontics

Background: Impaction of maxillary central incisors can result in aesthetic problems. The aim of this retrospective study was to examine the periodontal outcomes of impacted maxillary central incisors after surgical exposure and orthodontic extrusion compared to naturally erupted, contralateral incisors (control). Methods: Patients (N=80, 80 central incisors), who had been treated by a surgical-orthodontic approach, underwent a periodontal examination after 6 to 146 months. Periodontal parameters (crown length, keratinized gingival width, gingival scar, and bone loss) of the orthodontically extruded incisors were scored and compared with those of the naturally erupted contralateral incisors (control) in a masked set-up. Results: The …

Perioperative Management Of The Patient With Obesity, Trevor Mack

Nursing Student Class Projects (Formerly MSN)

Abstract

Obesity has become a problem worldwide during the past few decades. The prevalence of obesity worldwide has led to an increase in the number of obese surgical patients to whom perioperative care needs to be delivered. Hence, surgeons and nurse anesthetists will care for an increasing number of obese patients in the foreseeable future and should be prepared to provide optimal management for these individuals. This poster considers preparing for and managing the obese surgical patient by explaining underlying pathophysiology, implications of nursing care, perioperative considerations, diagnosis, and various treatments. This review provides updated evidence regarding perioperative management for …

Hybrid Laparoscopic And Endoscopic Management Of Gastric Band Erosion Resulting In Bowel Obstruction, Katie Marrero Md, Michael Nolte Md, John Kim Do, Facs, Christian Perez Md, Facs, Fasmbs

Graduate Medical Education Research Journal

While laparoscopic gastric banding is not as prevalent, the management of patients with a history of gastric banding remains a concern. Gastric bands have been noted to erode and can migrate through the bowel leading to a variety of issues. We were able to successfully manage this almost completely endoscopically without the need for a bowel enterotomy for retrieval. This allowed for enhanced patient recovery and avoided the morbidity associated with bowel enterotomy which is commonly done in these settings.

Preoperative Education For Cardiac Surgical Patients Benchmark Study, Jackson W. Payne

MSN Capstone Projects

Heart surgery is a term that scares a lot of people and rightfully so, as the heart is one of, if not the, most vital organ in the human body. So naturally, one can imagine the amount of fear and anxiety that patients feel when they are told they need heart surgery. This fear and anxiety is not unwarranted, either. Heart surgery, in most cases, is a major and highly complex operation with a lot of potential complications and negatives. Despite this, the majority of the time the benefits do outweigh the risks and patients elect to go forward with …

Mini-Review: Omental Patch Repair Of Giant Perforated Peptic Ulcer, Ridho A. Syaiful, Muhammad F. Agustian

The New Ropanasuri Journal of Surgery

Introduction. A perforated giant peptic ulcer is an emergency that requires surgery. Closure of the perforation with an omental patch has been reported in several cases of perforated giant peptic ulcers. However, there is insufficient evidence regarding the option of preferred treatment. This review to discuss published reports of a perforated giant peptic ulcer closed with an omental patch that focused on the complications

Method. The literature search was conducted through the Cochrane, PubMed, Scopus, and EBSCO data sites. The articles obtained were screened for duplication, title, abstracts, and full-text based on inclusion and exclusion criteria.

Result: Two articles were …

Oral Drug Dosing Following Bariatric Surgery: General Concepts And Specific Dosing Advice, Jurjen S. Kingma, Desirée M. T. Burgers, Valerie M. Monpellier, Marinus J. Wiezer, Heleen J. Blussé Van Oud‐Alblas, Janelle D. Vaughns, Catherine M. T. Sherwin, Catherijne A. J. Knibbe

Pediatrics Faculty Publications

Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide …

Surgical Site Infections: Reducing Excessive Foot Traffic In The Surgical Room To Minimize The Risk Of Surgical Site Infections, Christopher D. Pobre

Master's Projects and Capstones

Problem: In 2021, a perioperative unit experienced 21 different surgical site infections (SSIs). SSIs are associated with increased medical complications and financial costs. One risk factor for SSIs is the increased or excessive operating room (OR) foot traffic, which increases airborne contaminants within the OR.

Context: A seven-room operating department performing 5,800 surgical procedures annually. The unit specializes in general, elective, and emergent procedures for the adult population predominately in the East Bay Area. A diverse mix of surgical procedures was observed throughout this project.

Assessment: A microsystem assessment was conducted to determine the causes and patterns that lead to …

Trends In Patient Outcome Scores In Orthopaedic Oncology: A Systematic Review, David Le, Kelsey Martin, Sean C. Clark, Tae Won B. Kim

Research Day

Introduction: The field of orthopaedic oncology has trailed in defining trends in reported outcome measures (ROMs) over the last decade. Although the Musculoskeletal Tumor Society (MSTS) Score is a well-recognized ROM, new ROMs developed and established in literature have created difficulty in identifying the standard ROM within the field. The aim of our study is to identify trends in the use of ROMs in orthopaedic oncology over time, as well as the frequency and distribution among specific pathologies and orthopaedic journals.

Methods: A systematic review was conducted of all original articles reporting on topics relating to orthopaedic oncology in five …

Acrometastasis As A Rare Presentation Of Diffuse Malignancy, Jeremy Reich, Jonathan Boyce, Lee Kripke

Research Day

Cancer metastasis to the bone distal to the knee or elbow, also known as acrometastasis, is a rare but known finding in diffuse malignancy. We report a case of acrometastasis to the left second phalanx in a 70-year-old woman with a history of invasive breast carcinoma that was in remission for four years. On initial encounter in the emergency department, she had pain and swelling over the proximal (PIP) and distal interphalangeal (DIP) joints with a lytic appearance on radiographs. A subsequent Adler PET scan demonstrated previously unknown metastatic disease in the right lower lung, mediastinal and hilar lymph nodes, …

Improving Patient Outcomes One Warm Patient At A Time, Lindsey King, Marcus Austin Robison, Julie Bonom Dnp, Michael Godbold Md

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Patient Temperature measurement postoperatively reveals that hypothermia occurs in surgical patients 25-90% of the time. Unintended perioperative hypothermia can be linked to many negative patient outcomes such as increased incidence of surgical site infection (SSI), delayed wound healing and increased length of hospital stay, to mention a few. Any single or combination of the aforementioned issues can eventually lead to an increase in patient morbidity and mortality. The purpose of this proposed quality practice improvement project is to increase the compliance of hypothermia prevention strategies, specifically forced air warming, at the implementation site. The targeted practice improvement is aimed at …

Evaluation Of Trenguard Patient Positioning System, Joshua Volin, Patrick Herndon, Michelle Jankowski, Deborah Hasenau, Jason Hafron

Posters

INTRODUCTION
The TrenGuard™ patient positioning device is a comprehensive patient restraint system for patient positioning when in Trendelenburg position during robotic surgery. This study aims to compare patient migration with the TrenGuard™ patient restraint system (TGPRS) to traditional patient restraint with surgical tape and egg crate foam bolsters (STECFB).

In Adults With Gastroesophageal Reflux Disease, What Is The Efficacy Of Surgical Versus Pharmacotherapy In Reducing Symptoms?, Travis Cook

Physician Assistant Scholarly Project Papers

The purpose of this systematic review is to explore the efficacy of pharmacotherapeutics and surgical interventions for the treatment of gastroesophageal reflux disease (GERD). In this systematic review, five electronic databases were used including AccessMedicine, PubMed, Cochrane library, Dynamed, and Clinical Key. Research criteria included work after 2010, peer reviewed, and only randomized control trials, systematic reviews, and meta-analyses were considered. Studies that were excluded included any that were before 2010, poor study design, and those that looked at other conditions or treatments outside of the research question in study. A total of 9 studies were selected for this systematic …

Spin And Distortion In Surgical Trials, Andrea Mataruga

Electronic Thesis and Dissertation Repository

Research problem: Randomized controlled trials (RCTs) are essential; however, their validity can be threatened through distortion or spin. This study quantifies publication bias and distorted outcome reporting.

Methodology: All surgical RCTs registered on ClinicalTrials.gov from 1997-2017 were identified and a sample was obtained through random and intentional selection. Failure to publish (proportion of studies that remain unpublished), outcome distortion (changing intended outcomes), and spin (distorted presentation) were explored. Comparisons were made for positive versus negative studies and for high-income (HICs) versus low-middle income countries (LMICs).

Results: In total, 13,761 RCTs were registered (median enrollment size = 96, 94% from …

Roles In Preoperative Planning, Joetta Combs

Epsilon Sigma at-Large Research Conference

This project represents the ever-changing methods surrounding Enhanced Recovery after Surgery and the protocols that compose it. The purpose of this study is to expand education of ERAS guidelines and improve patient outcomes through furthering staff education. Enhanced Recovery After Surgery has been a part of perioperative departments worldwide after being introduced in the 1990s by Northern European general surgeons and has been adapted and modified since its introduction (ERAS Society History, 2022). The preoperative and postoperative process is ever-changing and is difficult for staff to keep up with. Many staff members find it difficult to stay on top of …

Surgery In Advanced Ovary Cancer: Primary Versus Interval Cytoreduction, Mackenzie Cummings, Olivia Nicolais, Mark S. Shahin

Department of Obstetrics and Gynecology Faculty Papers

Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical …

18 Fdg Pet/Ct Imaging In Carcinoma Cesophagus, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Capstone: Burn Surgery Education Module, Sophie J. Weber

IPS/BAS 495 Undergraduate Capstone Projects

I chose to solve a training and continuing education problem in my workplace, by creating a manual on burn surgery. This manual will later be turned into a computer education module, but will always be available in a hard copy as a reference material. I had to find an approach that reflected how my peers wanted to be educated and on what education points they felt were the most important to their success in surgery.

Influence Of Free-End Distal Extension On The Accuracy Of Guided Implant Placement: An In Vitro Study, Geoffrey Ganzman

Master's Theses (2009 -)

Purpose: The aim of this study was to evaluate the influence of type of tooth-support (bounded edentulous space versus unbounded edentulous spaces) on the accuracy of fully-guided implant placement using static computer-assisted implant surgery (sCAIS) in partially-dentate patients. Methods: Four different clinical scenarios were simulated; (a) bounded single-tooth edentulous space (BES), and three different free-end distal extensions with (b) unbounded single-tooth edentulous space (UBES1), (c) unbounded two-teeth edentulous space (UBES2), and (d) unbounded three-teeth edentulous space (UBES3). An implant planning software was used to design 3D-printed stereolithographic surgical guides for the respective clinical scenarios. In total n=140 implants with dimensions …

Catastrophic Perforation In Streptococcus Pneumoniae Aortitis: Complications Of Infective Endocarditis In The Current Antimicrobial Era, Sana Shaikh, Jorge Isaac Peña Garcia, Michelle Shieh, Alexandre Lacasse

Journal of Community Hospital Internal Medicine Perspectives

Infectious aortitis is an uncommon but life-threatening cause of aortitis. Given the lack of specific symptoms, establishing the diagnosis is often a challenge. When it is associated with an endovascular infection, such as infective endocarditis, blood cultures may be diagnostic although often limited by low positive predictive value. Imaging studies may reveal characteristic findings, with computerized tomography angiography being the most sensitive. Management includes prompt initiation of antimicrobial therapy followed by surgical intervention, keeping in mind that operative mortality is high due to weakened arterial wall integrity. Here we describe a 25-year-old woman without relevant medical history, who presented to …

Perceptions And Behaviors Of Learner Engagement With Virtual Educational Platforms., K J Dickinson, K E Caldwell, E A Graviss, D T Nguyen, M M Awad, J Olasky, S Tan, J H Winer, Kevin Y. Pei Md, Mhsed, Facs

Other Specialties

BACKGROUND: The COVID-19 pandemic has increased utilization of educational technology for surgical education. Our aim was to determine attitudes and behaviors of surgical education champions towards virtual educational platforms and learner engagement.

METHODS: An electronic survey was distributed to all Association of Surgical Education members addressing i) methods of engagement in virtual learning ii) ways to improve engagement and iii) what influences engagement. Stratified analysis was used to evaluate differences in responses by age, gender, level of training and specialty.

RESULTS: 154 ASE members completed the survey (13% response rate). 88% respondents accessed virtual learning events at home. Most (87%) …

Path To Publication: A Peer Mentorship Model For Student-Lead Surgical Research, Usama Waqar, Hareem Rauf, Muskaan Abdul Qadir, Hina Inam

Medical College Documents

Early and sustained involvement in research is imperative for medical students to ensure better career prospects in addition to provision of high-quality, evidence-based care to patients. However, involvement of students in surgical research still remains limited, owing to inadequate research training. The current paper was planned to describe the structure of the "Path to Publication" series, incorporating peer mentorship with capacity-building research workshops for medical students. A total of 25 students were grouped into 8 surgical subspecialty groups to conduct research, supervised by experienced student research and faculty mentors. In addition, a series of research workshops were organized in synchronization …

Analysing The Trends In Breast Surgery Practice During Covid-19 Pandemic: A Comparative Study With The Pre-Covid Era, Lubna M. Vohra, Dua Jabeen, Nargis Khan, Azmeena Nizar, Anum Jamil, Tariq Siddiqui

Section of General Surgery

Background: The emergence of coronavirus disease 2019 (COVID-19) pandemic has crippled the healthcare systems all over the world. Cancer treatment is indispensable and disruption in its provision can lead to unanticipated consequences. No local data exists that has quantified the impact of COVID-19 pandemic on breast cancer surgery in a lower middle-income country (LMIC), therefore, the present retrospective comparative cohort study is directed to determine the trends in breast surgery operative volumes and its outcomes at our institution in Pakistan.
Materials and methods: Data was collected retrospectively from Pre-COVID-19 and COVID-19 era to determine impact of the current pandemic on …