Surgery Commons^™

Relationship Between Preoperative Frailty And Postoperative Outcomes After Lvad Implantation, Katherine L. Wilhelm

DNP Projects

Abstract

Background: Frailty is common in many patients with advanced heart failure, including those who undergo left ventricular assist device (LVAD) implantation. Frailty has been associated with worse outcomes after other cardiac surgeries; however, little is known about the effect of frailty on postoperative outcomes after LVAD implant.

Purpose: The purpose of this project was to evaluate whether preoperative frailty [as determined by either short physical performance battery (SPPB) score ≤ 7/12 or 6-minute walk test (6-MWT) <200 >meters] is associated with poorer postoperative outcomes after LVAD implantation than non-frailty in adults with advanced heart failure.

Setting and Sample: This project …

Complications In Cardiac Surgery, Christine Williamitis

Theses and Dissertations--Nursing

Quality of care and outcomes from cardiac surgery have always been of primary importance to providers and the entire health care team when caring for cardiac surgical patients. Providers in cardiac surgery have had a long history of tracking procedural morbidity and mortality rates in programs nationally and internationally. Morbidity and mortality rates vary widely among hospitals. In most studies in which procedural outcomes from cardiac surgery are evaluated, the focus has been on operative morbidity and mortality and the probability of death after a cardiac surgical procedure. Less attention has been paid to predictors of perioperative complications, and sample …

Telementoring For Breast Surgeons Practicing In Remote Areas, Fatima Mubarik, Hania Shahzad, Syeda Sakina Abidi, Sana Zeeshan, Lubna Mushtaque Vohra, Sadaf Khan, Abida Khalil Sattar

Medical College Documents

Telementorship allows an expert surgeon to mentor another surgeon through an advanced procedure from a remote location via 2-way audio-visual communication. The current article was planned to review the existing literature and evaluate the utility of telementorship regarding educating rural surgeons in Pakistan about multidisciplinary breast cancer care. Publications from 2016 to 2020 were searched on PubMed and GoogleScholar and 10 most recent publications were selected. Review of literature revealed that even though telementorship in this context might be comparable to onsite mentorship, multiple concerns need to be addressed before its implementation. These include lack of concrete evidence regarding its …

Surgical Education And Training During The Covid-19 Pandemic: Strategies And Solutions For Pakistan, Edward Anthony Joseph, Russell S. Martins, Javeria Tariq, Namrah Aziz, Hina Inam, Mahim Malik

Medical College Documents

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during …

Seasonal Impact In Admissions And Burn Profiles In A Desert Burn Unit, Syed F. Saquib, Joseph T. Carroll, Paul J. Chestovich

Department of Surgery Faculty Research

In much of the world, pattern of burn injuries can vary depending on the season. This study examines the seasonal impact of admissions, acuity, mortality, and resource utilization at an accredited burn center located in a desert climate. It is a retrospective analysis of patients admitted from March 1, 2014 to February 28, 2019 for acute burns. Patients were categorized into four groups according to each season based on their date of admission: Spring (March, April, May), Summer (June, July, August), Fall (September, October, November), and Winter (December, January, February).

A total of 1519 patients were included. 1016 were male …

Outcomes And Complications Of Scfe Surgery, Tyler Sanda

Scholarship in Medicine - All Papers

Objective: Slipped capital femoral epiphysis (SCFE) is a common hip disorder affecting children and adolescents. There is much debate concerning best treatment with regards to adverse outcomes, specifically avascular necrosis (AVN). This study analyzed the rates of adverse outcomes after the surgical treatment of SCFEs. It examined risk factors which may lead to the development adverse outcomes. This research will aid clinical decision-making, helping determine optimal surgical treatment of SCFEs and adding to external datasets of SCFE treatment.

Methods: This was a retrospective review of patient health records at a level 2 pediatric trauma hospital. The study included all SCFE …

Determining The Appropriate Technique For Appendix Stump Closure, Cynthia White

Scholarship in Medicine - All Papers

Background In a laparoscopic appendectomy, closure of the appendeceal stump can be done using an endostapler or endoloop. We compared outcome data of the two techniques in patients who underwent laparoscopic appendectomy.

Method We included all patient > 18 years who underwent laparoscopic appendectomy for acute appendicitis at a single institution over a 4-year period. Demographic and outcome data were compared between both groups. Results 501 patients, with no significant differences in age, gender or BMI, were identified for the study. No differences were noted in procedure length, readmission rates, complication rates (including intra-abdominal abscess) or hospital charges. There was a …

Local Impact Of Implementing Multimodal Anesthesia For Total Joint Arthroplasty, Mary Christine Gilliland

Doctor of Nursing Practice Projects

The opioid epidemic is at a critical point in the United States. This quality improvement project aims to determine which anesthesia strategies lessen the use of opioids in the surgical setting to reduce this raging epidemic. The process included total knee replacement record reviews. Reviews used general linear models to compare two multimodal anesthetic plans, including pre-medications in addition to an adductor canal and subarachnoid nerve block. The researcher reviewed the records for these patients comparing those receiving only an adductor canal and those receiving a subarachnoid nerve block. The record reviews identified postoperative pain level documentation and hospital inpatient …

Anterior-Based Muscle Sparing Approach For Total Hip Arthroplasty, Callahan M. Sturgeon, George M. Babikian, Brian J. Mcgrory, Adam J. Rana

Costas T. Lambrew Research Retreat 2021

A high value, high quality and low cost surgery: a 7.5 year single-center, retrospective case series

Simulation Based Team Training In Surgery - A Review, Syed Muhammad Nazim, Qamar Riaz

Section of Urology

The healthcare environment in surgery is complex, dynamic and often ambiguous. Besides subject knowledge and technical skills, other competencies, such as team work, communication skills and situation awareness, are required to ensure better patient-related outcome. Teams that demonstrate poor non-technical skills make more technical errors, often resulting in patient morbidity or mortality. Different hospital-based locations, such as operating rooms, intensive care units, emergency rooms and surgical wards, are the areas where poor team dynamics prevail. Simulation-based team training is a strategy to provide inter-professional training and experiential learning opportunities for surgeons, anaesthetists and allied health professionals. It helps them to …

Aesthetic Rehabilitation In A Patient With Skeletal Mandibular Deficiency And Open Bite: Journey From Splinted Metalloceramic Prosthesis To All-Ceramic Crowns, Rizwan Nazeer, Shizrah Jamal, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high …

Inculcating Research Curriculum In Operative Dentistry - Endodontics Residency Programme: Experience And Outcomes, Farhan Raza Khan, Rabia Ghafoor, Fahad Umer, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

Incorporating research education and training in residency curriculum increases the understanding of evidence-based decision-making among doctors in training. Evidence suggests that the addition of research is linearly associated with improvement in clinical competence, and encourages the residents to shape their career as clinical investigators. The current paper was planned to share the experience of adding research into the core curriculum of Operative Dentistry-Endodontics residency programme at a tertiary care university hospital, and to evaluate the outcome achieved with that change.

Innovation In Surgical Training: Simulating Prosthetic Heart Valves And Annuloplasty Rings Using Pacifiers For Cardiac Surgery Wet-Labs In A Resource Limited Setting, Sara Iqbal, Waris Ahmad

Section of Cardiothoracic Surgery

Conducting a hands-on cardiac wet-lab on valvular surgeries in a resource-limited setting is restricted by the lack of prosthetic heart valves and annuloplasty rings for developing cognitive and technical skills required to understand and protect the three-dimensional cardiac anatomy. In recent times, simulation is regarded as an effective tool in surgical education and has proven to improve the technical skills of trainees. The current short report presents a novel simulator to mimic heart valve replacement surgeries by using a pacifier as a prosthetic valve and annuloplasty ring. Considering resource-constraints in the local context, pacifier-based valve simulators can be usedful as …

Paradigm Shift In The Surgical Training: The Era Of Innovation, Simulation And Beyond, Syed Shahabuddin, Shiraz Hashmi, Yasir Khan, Shahid Ahmed Sami

Section of Cardiothoracic Surgery

This is an era of transformation of surgical education and training. Modern methods of training are being introduced at a rapid pace and are being adopted in surgical practice not only to improve the outcomes and patient satisfaction, but also to provide an opportunity to develop a new well-structured training curriculum by integrating both traditional and modern approaches to teach and learn surgical skills. Various surgical simulators are in use as training aids and are constantly undergoing further refinement and development. To achieve a smooth transition in surgical training to modern methods, a structured programme has to be developed and …

Surgical Education And Training, Ather Enam, Hammad Ather, Nadeem Ahmed Siddiqui

Section of Neurosurgery

No abstract provided.

Laparoscopic Partial Splenectomy For A Splenic Hamartoma, Vashisht Madabhushi, Timothy Horrell, John M. Draus

Surgery Faculty Publications

Objective

We discuss current knowledge and management of splenic hamartoma, an uncommon form of benign tumor.

Summary background data

A splenic hamartoma is a rare form of benign splenic mass, often found incidentally while working up other complaints, and is typically treated by surgical resection of the mass. In this case, we discuss the management of an incidentally found splenic hamartoma that was treated with laparoscopic partial splenectomy.

Methods

The patient presented in the Emergency Department complaining of periumbilical pain after having been struck in the abdomen with a soccer ball the previous day. Following a physical exam and blood …

Impact Of A Global Pandemic On Surgical Education And Training- Review, Response, And Reflection, Sabah Uddin Saqib, Omair Saleem, Amna Riaz, Qamar Riaz, Hasnain Zafar

Section of General Surgery

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected …

Thymectomy, Bryan Bennett, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Excerpt

Thymectomy is the resection of the thymus gland. This anterior mediastinal organ can enlarge as in myasthenia gravis and thymoma and harbor malignant cells such as in thymic carcinoma or neuroendocrine tumors. The first thymectomies were performed incidentally in conjunction with thyroidectomies for Grave disease by Garre and Sauerbruch, but it was not until Blalock and colleagues that multiple series were performed with adequate results.

This also included patients with myasthenia gravis but without thymomas. The gold standard approach for thymectomy is a median sternotomy or transsternal approach, but this has evolved to less invasive techniques such as upper …

Tisagenlecleucel Infusion In Patients With Relapsed/Refractory All And Concurrent Serious Infection., Erin Hall, Dwight E. Yin, Rakesh K. Goyal, Atif Ahmed, Grace S. Mitchell, Shawn D. St Peter, Terrie Flatt, Ibrahim A. Ahmed, Weijie Li, Richard J. Hendrickson, Keith August, Douglas Myers

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Tisagenlecleucel, an anti-CD19 chimeric antigen receptor T (CAR-T) cell therapy, has demonstrated durable efficacy and a manageable safety profile in pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) in the ELIANA pivotal trial and real-world experience. Experience from investigator-led studies prior to ELIANA suggests that infections and inflammatory conditions may exacerbate the severity of cytokine release syndrome (CRS) associated with CAR-T cell therapy, leading to extreme caution and strong restrictions for on-study and commercial infusion of tisagenlecleucel in patients with active infection. CRS intervention with interleukin (IL)-6 blockade and/or steroid therapy was introduced late in …

Apixaban Discontinuation For Invasive Or Major Surgical Procedures (Adios): A Prospective Cohort Study., Geno J. Merli, Walter K. Kraft, Luis H. Eraso, Taki Galanis, Lynda J. Thomson, Geoffrey O. Ouma, Eugene Viscusi, Jerald Z. Gong, Edwin Lam

Department of Medicine Faculty Papers

Background

Apixaban pharmacokinetic properties and some clinical reports suggest cessation 48 hours prior to surgery is safe, but this has not been demonstrated in a naturalistic setting. We sought to measure the residual apixaban exposure in patients who had apixaban held as part of standard of care peri-operative management.

Methods

This was a prospective, observational study of patients in whom apixaban plasma concentration and anti-Xa activity were measured while at steady state apixaban dosing and again immediately prior to surgery. Clinical management of cessation and resumption of apixaban was at the discretion of the treating physician.

Results

One hundred and …

Peer-Led Surgery Education: A Model For A Surgery Interest Group, Muhammad Ali, Shahmir Chauhan, Ayesha Noor, Sadaf Khan, Ather Enam, Sig Core

Medical College Documents

We present a systematic, sustainable, student-led model for a Surgery Interest Group in a low and middle-income country setting to encourage other medical students to establish similar groups in their institutions. Our model was developed at the Aga Khan University Medical College, Karachi, and is comprised of medical students, teaching associates, residents, faculty and alumni. The group focuses on connecting medical students with an interest in surgery with opportunities to help them match in surgery training programs. The opportunities include, but are not limited to, skill development, personal development, mentorship and research. Our model has shown growth and expansion over …

The Role Of Simulators In Improving Vitreoretinal Surgery Training - A Systematic Review, Taha Muneer Ahmed, Rehman Siddiqui

Medical College Documents

Objective: To conduct an appraisal of current evidence regarding the effectiveness of EyeSi®-based training of vitreoretinal surgery.
Methods: The systematic review was conducted in July 2020, and comprised literature search on Cochrane Library, PubMed and Embase for articles regarding simulation training in vitreoretinal surgery. The shortlisted articles were subjected to qualitative analysis. Existing evidence was assessed, and predictions on how outcomes may be applied to improve vitreoretinal surgery training were made. The risk of bias of each study was calculated in line with the guidelines of the Cochrane Handbook.
Results: Of the 124 articles identified, 7(5.6%) were shortlisted; 5(71.4%) established …

Teaching The 'Comprehensive Dental Care' In Formative Years Of Education And Training: A New Model For Dental Internship, Farhan Raza Khan, Syed Murtaza Raza Kazmi, Syed Sheeraz Hussain, Syed Mahmood Haider

Section of Dental-Oral Maxillofacial Surgery

There is a need of a new model of education and training to be implemented in the Bachelors of Dental Surgery curriculum in the relevant Pakistani institutions. The current review article was planned to suggest such a model in the light of literature aimed at building the capacity of dental graduates in a competency-driven approach with the objective of offering safe, efficient and comprehensive care to dental patients. The outcome of the reforms suggested shall prepare dental graduates suitably geared towards providing community-oriented family dental care right from their formative years. Moreover, the suggested internship model can also help to …

Augmented Reality In Clinical Dental Training And Education, Zainab Haji, Aysha Arif, Shizrah Jamal, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Dentistry is a profession that requires coordinated motor skills in addition to acquired knowledge for ideal execution of any treatment plan for patients. Learning experiences have been modified over a period of time for students as well as for the healthcare providers. Conventional pre-clinical training employed the use of cadavers, but financial, ethical and supervisory constraints have become a major shortcoming. With the adaptation of technology in dentistry, pre-clinical training has now employed simulation. It provides the opportunity for students to develop psychomotor skills for procedures by practising pre-clinical, standardised learning competencies before they engage in patient-management. Simulation involves computer-aided …

Development And Validation Of Scale For Self Evaluation Of Soft Skills In Postgraduate Dental Students, Muhammad Haseeb, Muhammad Waheed Azfar, Myra Ahmed, Amina Tariq, Muhammad Sohaib Nawaz, Ali Sadiq

Section of Dental-Oral Maxillofacial Surgery

Objective: To develop and validate a soft skills questionnaire, and to use it for self-evaluation by postgraduate dentistry students.
Methods: The cross-sectional descriptive study was conducted at University College of Dentistry, , University of Lahore, Lahore, Pakistan, from February 2020 to April 2020 and comprised of residents from first to final year of training for either Masters in Dental Surgery or Fellowship of the College of Physicians and Surgeons Pakistan programmes. A soft skills questionnaire was generated and was validated through exploratory factor analysis of the elements and items of the questionnaire using SPSS 23.
Results: Of the 60 subjects, …

Post-Residency Fellowship Training In Maxillofacial Prosthetics Is Needed In Pakistan, Syed Murtaza Raza Kazmi, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Objective: To determine the spectrum of maxillofacial prosthetics services in Pakistan, to explore the need of a relevant fellowship training programme in the country, and to determine whether they contribute to tumour board of head and neck oncology.
Methods: The cross-sectional online survey was conducted from March to June 2020 and comprised all prosthodontists registered on the portal of the Pakistan Prosthodontics Association. Using Google Forms, the survey questionnaire was sent via email. The survey form was self-generated. Data was analysed using SPSS 23.
Results: Of the 84 prosthodontists approached, 44(52.4%) responded. The overall median age was 39 years (range: …

Melanotic Neuroectodermal Tumor Of Infancy, Mohammad H. Almomani, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Melanotic neuroectodermal tumor of infancy (MNTI) is a rapidly growing benign tumor that arises from the neural crest. It typically occurs in infants in the head and neck region. It was described for the first time in 1918 by Krompecher, and since the origin was unknown, it was described as congenital melanocarcinoma. Until 1966, this tumor was characterized by variable names (e.g., retinal anlage tumor, pigmented congenital epulis, melanotic progonoma, pigmented teratoma, atypical melanoblastoma, etc.). However, Borello and Gorlin found that the tumor produces vanillylmandelic acid (VMA), which is produced by other types of tumors that arise from the neural …

Carotid Artery Dissections From Tcar As Reported By The Food And Drug Administration, Dongjin Suh Bs, Yuchi Ma Bs, Daniel H. Newton Md, Michael F. Amendola Md, Kedar S. Lavingia Md

Graduate Research Posters

BACKGROUND: Transcarotid artery revascularization (TCAR) is hybrid procedure that allows carotid stenting using direct surgical access of the carotid artery to restore blood flow through the carotid artery. It has shown the lowest perioperative stroke rate when compared with any prospective trial of transfemoral carotid artery stenting. However, intraoperative injuries related to the procedure and its management are not well characterized. We anticipate that this analysis will add qualitative insight in further characterizing adverse outcomes of this novel technology.

METHODS: The FDA maintains a database called the MAUDE (Manufacturer and User Facility Device Experience) for surveillance of all medical devices …

Patterns Of Lumbar Disc Degeneration: Magnetic Resonance Imaging Analysis In Symptomatic Subjects, Monchai Ruangchainikom, Michael D. Daubs, Akinobu Suzuki, Chengjie Xiong, Tetsuo Hayashi, Trevor P. Scott, Kevin Phan, Jeffrey C. Wang

School of Medicine Faculty Research

Study Design: Cross-sectional study. Purpose: To evaluate lumbar disc degeneration (LDD) on magnetic resonance imaging (MRI) in symptomatic subjects to accumulate baseline data on the pattern of degeneration. Overview of Literature: LDD plays an important role in the diagnosis and treatment of low-back pain in patients. Few studies have focused on the pattern of LDD to understand how the lumbar spine ages. Methods: This study included 1,095 patients (mean age, 44.29 years; range, 16–85 years) who underwent upright lumbar MRI. LDD was graded into five categories (I–V). Positive LDD was defined as grade III or greater. The prevalence and pattern …

The Key To Simplified Management Of An Undescended Parathyroid Adenoma [La Clave Para El Manejo Simplificado De Un Adenoma Paratiroideo No Descendido], Humberto Ruiz-Hernández, Joyce Meza-Venegas, Samuel K. Snyder

School of Medicine Publications

Undescended parathyroid adenoma is a rare cause of primary hyperparathyroidism that happens < 1% of cases. If not suspected, it can lead to a negative bilateral parathyroid exploration and extensive iatrogenic trauma. We propose that with proper imaging the correct diagnosis can be established to simplify surgical management. We describe two cases of patients who underwent a targeted neck exploration due to an undescended parathyroid adenoma diagnosed with an appropriate preoperative imaging protocol. With an appropriate imaging protocol for primary hyperparathyroidism and parathyroid hormone aspirates, an undescended parathyroid adenoma can be primarily diagnosed to guide a focused parathyroidectomy

-

El adenoma paratiroideo no descendido ocasiona hiperparatiroidismo primario en <1% de los casos. Si no se sospecha, puede llevar a exploraciones negativas y trauma iatrogénico extenso. Proponemos que, con un protocolo imagenológico adecuado, se puede realizar un diagnóstico correcto, simplificando el abordaje quirúrgico. Describimos dos casos en que se realizó una exploración de cuello dirigida debido a un adenoma paratiroideo no descendido diagnosticado con un protocolo de imagen preoperatorio apropiado. Un protocolo de imagen apropiado para hiperparatiroidismo primario y aspirados de PTH pueden diagnosticar de manera inicial un adenoma paratiroideo no descendido para guiar una paratiroidectomía dirigida.