Surgery Commons^™

Enhanced Co-Registration Methods To Improve Intracranial Electrode Contact Localization., Walter A. Hinds, Amrit Misra, Michael R. Sperling, Ashwini Sharan, Joseph I. Tracy, Karen A. Moxon

Department of Neurology Faculty Papers

Background: Electrode contact locations are important when planning tailored brain surgeries to identify pathological tissue targeted for resection and conversely avoid eloquent tissue. Current methods employ trained experts to use neuroimaging scans that are manually co-registered and localize contacts within ~2 mm. Yet, the state of the art is limited by either the expertise needed for each type of intracranial electrode or the inter-modality co-registration which increases error, reducing accuracy. Patients often have a variety of strips, grids and depths implanted; therefore, it is cumbersome and time-consuming to apply separate localization methods for each type of electrode, requiring expertise across …

The Tentorium Cerebelli: A Comprehensive Review Including Its Anatomy, Embryology, And Surgical Techniques., Rabjot Rai, Joe Iwanaga, Gaffar Shokouhi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The tentorium cerebelli functions as a partition, dispelling the burden of weight from supratentorial structures upon inferior brain matter. Clinicians and neurosurgeons, when assessing pathological findings, should have knowledge regarding the tentorium cerebelli anatomy. This work of literature is a comprehensive review of the tentorium cerebelli, including its anatomy, embryology, and clinical and surgical implications. The evolutionary pattern demonstrates sequential stages to higher mammalian lineage. An understanding of the complexity of the neurovascular structures and the anatomy of the tentorium cerebelli is crucial for surgical procedures by neurosurgeons.

Epigenetics In Ovarian Cancer: Premise, Properties, And Perspectives., Qilian Yang, Yuqing Yang, Nianxin Zhou, Kexin Tang, Wayne Bond Lau, Bonnie Lau, Wei Wang, Lian Xu, Zhengnan Yang, Shuang Huang, Xin Wang, Tao Yi, Xia Zhao, Yuquan Wei, Hongjing Wang, Linjie Zhao, Shengtao Zhou

Department of Emergency Medicine Faculty Papers

Malignant ovarian tumors bear the highest mortality rate among all gynecological cancers. Both late tumor diagnosis and tolerance to available chemical therapy increase patient mortality. Therefore, it is both urgent and important to identify biomarkers facilitating early identification and novel agents preventing recurrence. Accumulating evidence demonstrates that epigenetic aberrations (particularly histone modifications) are crucial in tumor initiation and development. Histone acetylation and methylation are respectively regulated by acetyltransferases-deacetylases and methyltransferases-demethylases, both of which are implicated in ovarian cancer pathogenesis. In this review, we summarize the most recent discoveries pertaining to ovarian cancer development arising from the imbalance of histone acetylation …

An Atypical Case Of Silent Aortic Dissection In A Peritoneal Dialysis Patient: A Case Report And Review Of Literature, Waqas Javed Siddique, Ali Arif, Mohammad Harisullah Khan, Maryam Khan, Muhammad Owais Hanif, Muhammad Junaid Mehboob, Muhammad Aslam, Ayesha Aslam, Hasan Arif, Sandeep Aggarwal

Medical College Documents

Objective: Unusual clinical course
Background: Aortic dissection presents with acute chest or back pain and is associated with high mortality. We present a case of aortic dissection with an atypical presentation in a peritoneal dialysis patient, and the challenges met with peritoneal dialysis.
Case Report: A 53-year-old African American male presented with progressively worsening exertional dyspnea and orthopnea for 3 days without any history of chest pain. His chest x-ray showed mild pulmonary edema. He was admitted with a diagnosis of heart failure. Bedside echocardiogram revealed severe aortic regurgitation and concern for possible aortic dissection. Computed tomography …

Radial Artery Injury With Attempted Intravenous Catheterization On The Dorsal Hand: A Case Report., Yusuf Alimi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Intravenous (IV) access on the dorsum of the hand is of high clinical significance. As it is possible for an arterial injury during IV access on the dorsum of the hand to occur, clinicians and healthcare providers should be cognizant of regional anatomy and anatomical variations during IV placement so as to prevent injuries to the radial artery. We report a case of an injury to the radial artery with an attempted hand IV placement in a cadaver and suggest possible ways to prevent this complication.

Select Biomarkers On The Day Of Anterior Cruciate Ligament Reconstruction Predict Poor Patient-Reported Outcomes At 2-Year Follow-Up: A Pilot Study, Christian Lattermann, Caitlin E. -W. Conley, Darren L. Johnson, Emily K. Reinke, Laura J. Huston, Janet L. Huebner, Ching-Heng Chou, Virginia B. Kraus, Kurt P. Spindler, Cale A. Jacobs

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background. The majority of patients develop posttraumatic osteoarthritis within 15 years of anterior cruciate ligament (ACL) injury. Inflammatory and chondrodegenerative biomarkers have been associated with both pain and the progression of osteoarthritis; however, it remains unclear if preoperative biomarkers differ for patients with inferior postoperative outcomes. Hypothesis/Purpose. The purpose of this pilot study was to compare biomarkers collected on the day of ACL reconstruction between patients with "good" or "poor" 2-year postoperative outcomes. We hypothesized that inflammatory cytokines and chondrodegenerative biomarker concentrations would be significantly greater in patients with poorer outcomes. Study Design. Prospective cohort design. Methods. 22 …

Transplant Critical Care: Is There A Need For Sub-Specialized Units? — A Perspective, Sujit Vijay Sakpal, Suresh Kumar Agarwal, Hector Saucedo-Crespo, Christopher Auvenshine, Robert N. Santella, Steven Donahue, Jeffery Steers

Department of Surgery

The critical care involved in solid-organ transplantation (SOT) is complex. Pre-, intra- and post-transplant care can significantly impact both – patients’ ability to undergo SOT and their peri-operative morbidity and mortality. Much of the care necessary for medical optimization of end-stage organ failure (ESOF) patients to qualify and then successfully undergo SOT, and the management of peri-operative and/or long-term complications thereafter occurs in an intensive care unit (ICU) setting. The current literature specific to critical care in abdominal SOT patients was reviewed. This paper provides a contemporary perspective on the potential multifactorial advantages of sub-specialized transplant critical care units in …

Prophylactic Antibiotic Use In Female Patients With Pelvic Floor Reconstructive Surgery: A Retrospective Comparative Effectiveness Study, Courtney E. Turnbough

Dissertations

Problem: The purpose of this project was to determine the most effective prophylactic antibiotic to decrease the number of patients who have urinary tract infections (UTIs) after pelvic floor reconstructive surgery in a gynecological reconstructive surgery practice.

Methods: This was a retrospective chart review from 2015-2017 that included 732 subjects from a single practice. All patients underwent pelvic floor reconstructive surgery, with or without a midurethral sling placed. Patients also had a catheter and vaginal packing postoperatively. Patients who had a culture-proven UTI within the six-week postoperative period were noted.

Results: There were less UTIs (χ2 = 12.119, df = …

Clinicopathologic Features And Prognostic Grouping Of Gastrointestinal Stromal Tumors (Gists) In Pakistani Patients: An Institutional Perspective, Atif Ali Hashmi, Mahrukh Faraz, Zareeha Nauman, Mohammad Usman Qureshi, Shumaila Kanwal Hashmi, Hira Fatima Waseem, Muhammad Muzzammil Edh, Naveen Faridi, Amir Khan

Department of Pathology and Laboratory Medicine

Objectives: Gastrointestinal stromal tumors (GISTs) are rare tumors of gastrointestinal tract, prognosis of which largely depends upon histopathologic characteristics of resection specimens, which were not widely studied in our population. Therefore we aimed to evaluate the histopathologic characteristics of GISTs in our population and their prognostic grouping according to college of American pathologist’s guidelines.
Results: Mean age of patients was 53.4 years (18–71 years). 92% of cases were of primary GISTs and stomach was the most common site (57.7%). 75% of cases were of spindle cell morphology and 53.8% belonged to high risk prognostic group. Comparison of stomach and intestinal …

Emergent Chest Wall Reconstruction For An Incarcerated Pulmonary Hernia, Allison G. Mcnickle Md, Timonthy Dickhudt Md, Jorge A. Vega Md, Paul J. Chestovich, Douglas R. Fraser

School of Medicine Faculty Research

No abstract provided.

Sinus Of Valsalva Aneurysm Rupturing Into Main Pulmonary Artery: A Rare Paediatric Cardiac Emergency, Faiz Rasool, Muhammad Asim Khan, Muneer Amanullah

Section of Paediatric Surgery

Congenital Sinus of Valsalva aneurysm is a rare congenital cardiac disease. Most common site of origin is the right sinus. It ruptures into right ventricle or right atrium most of the times. Only in less than 2% of the cases it ruptures into the pulmonary artery. We report a rare case of right sinus of valsalva aneurysm rupturing into pulmonary artery.

Reducing The Donor Site Morbidity In Radial Forearm Free Flaps By Utilizing A Narrow Radial Forearm Free Flap, Safdar Ali Shaikh, Amber Bawa, Noman Shahzad, Zara Yousufzai, Muhammad Shahab Ghan

Section of General Surgery

Background: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site.
Methods: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor …

Role Of Radiosurgery In Arteriovenous Malformations, Syed Ijlal Ahmed, Gohar Javed, Syed Naseeb Uneeb, Syeda Benish Bareeqa, Manaal Haider, Syeda Sana Samar, Armighan Haider Ans, Muhammad Tayyab Shera

Section of Neurosurgery

Background: Intracranial arteriovenous malformations (AVMs) consist of an abnormal nidus of blood vessels that shunt blood directly from an artery to a vein and thereby bypass an intervening capillary bed. AVMs may be found as an incidental finding. They may be associated with intracranial haemorrhage, seizures, headaches or neurological deficits. There are different treatment options for AVM. These include observation, microsurgery, Stereotactic radio surgery (SRS), endovascular embolization and intensity modulated radiotherapy (IMRT).
Methods: Data was collected using searching engines like Pubmed, Google scholar, Embase, Cinahl and Medline. MeSH and Non-MeSH terms were used like Arterio-venous malformations, microsurgery, endovascular embolization.
Results: …

The Significance Of Mgmt Methylation In Glioblastoma Multiforme Prognosis, Aaida Mumtaz Rao, Ayesha Quddusi, Muhammad Shahzad Shamim

Section of Neurosurgery

Methylation of O6-methylguanine-DNA methyltransferase (MGMT) has been extensively studied as a biomarker in predicting the prognosis of patients with GBM (Glioblastoma multiforme). Its significance has been studied in various subgroups, including age, gender and even race. Correlation between prognosis with MGMT methylation and different treatment regimens has also been studied in detail. There are multiple techniques to analyze MGMT methylation in tumour specimen. We review the current evidence for the importance of MGMT methylation as a biomarker for prognosis in GBM patients, the techniques to analyze it and the effect of epidemiologic factors on its significance.

Factors Affecting Functional Outcome After Decompressive Craniectomy Performed For Traumatic Brain Injury: A Retrospective, Cross-Sectional Study, Farid Khan, Arif Villani, Abdul Rehman, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Factors affecting functional outcome after decompressive craniectomy (DC) performed for traumatic brain injury (TBI) remain poorly understood.
Methods: We conducted a retrospective study of all patients who underwent primary DC for TBI at our hospital between 2010 and 2014. Multivariate regression analyses were used to determine the predictors of functional outcome and overall survival.
Results: A total of 98 patients with severe (n = 81, 82.6%) or moderate (n = 17, 17.4%) TBI underwent primary DC and were included in this study. The 30-day and overall mortality rates were 15.3% and 25.5%, respectively. At a median follow-up …

Cardiac Mri T2* In Liver Transplant Candidates: Application And Performance Of A Novel Imaging Technique To Identify Patients At Risk For Poor Posttransplant Cardiac Outcomes., Sara M Lewin, Kimberly Kallianos, M Ilan Nevah, Susan Zhao, Oren K Fix, Gabriel C Brooks, Teresa De Marco, Atif N Qasim, Karen G Ordovas, Neil Mehta

Articles, Abstracts, and Reports

Background: In end-stage liver disease, alterations in iron metabolism can lead to iron overload and development of iron overload cardiomyopathy. In liver transplant candidates, evaluation for cardiac iron overload and dysfunction can help to identify candidates at increased risk for peritransplant morbidity and mortality, though recommendations for pretransplant evaluation of cardiac iron overload are not standardized. Cardiac Magnetic Resonance Imaging T2* (CMRI-T2*) is a validated method to quantify cardiac iron deposition, with normal T2* value of 20 ms or greater. In this study, we sought to identify the incidence and predictors of iron overload by CMRI-T2* and to evaluate the …

Trametinib Prevents Mesothelial-Mesenchymal Transition And Ameliorates Abdominal Adhesion Formation, Edward J. Macarak, Christine Lotto, Deepika Koganti, Xiaoling Jin, Pete J. Wermuth, Anna-Karin Olsson, Matthew Montgomery, Joel Rosenbloom

Department of Dermatology and Cutaneous Biology Faculty Papers

Background

Intra-abdominal adhesions are a major cause of morbidity after abdominal or gynecologic surgery. However, knowledge about the pathogenic mechanism(s) is limited, and there are no effective treatments. Here, we investigated a mouse model of bowel adhesion formation and the effect(s) of an Federal Drug Administration-approved drug (trametinib) in preventing adhesion formation.

Materials and methods

C57BL/6 mice were used to develop a consistent model of intra-abdominal adhesion formation by gentle cecal abrasion with mortality rates ofEDA) which arises from alternative splicing of the fibronectin messenger RNA resulting in different protein isoforms. Trichrome staining assessed collagen deposition. Quantitative polymerase chain reaction …

Quality Of Life After Functional Endoscopic Sinus Surgery In Patients With Chronic Rhinosinusitis, Sadaf Qadeer, Shabbir Akhtar, Montasir Junaid, Muhammad Sohail Halim

Section of Otolaryngology, Head & Neck Surgery

Chronic Rhinosinusitis (CRS) is a group of disorders characterized by the inflammation of mucosa of the nasal passages and paranasal sinuses. It includes chronic rhinosinusitis with polyps, CRS without polyps and Allergic Fungal Sinusitis (AFS). This debilitating disease causes negative impact on quality of life (QOL) of patients. Functional endoscopic sinus surgery (FESS) is the mainstay of surgical treatment for patients and improves QOL of patients. This subjective assessment of QOL can be measured by disease specific questionnaires. SNOT-22 questionnaire is widely used and validated questionnaire for this purpose. Prospective study was done on 54 patients. Data were collected using …

Restoration Of External Rotation Following Reverse Shoulder Arthroplasty Without Latissimus Dorsi Transfer., Derek D Berglund, Samuel Rosas, Jacob J Triplet, Jennifer Kurowicki, Brandon Horn, Jonathan C Levy

Surgery Articles

BACKGROUND: Latissimus dorsi transfers have been considered necessary to restore active external rotation following reverse shoulder arthroplasty (RSA). The purpose of this study was to assess the effectiveness of an RSA system that lateralizes the center of rotation in restoring active external rotation without a latissimus dorsi transfer in patients with a preoperative external rotation deficit (external rotation of < 0°).

METHODS: We retrospectively reviewed the records of patients who had undergone RSA with a lateralized center of rotation without a latissimus dorsi transfer. All patients had had a preoperative external rotation deficit (active external rotation of < 0°), and all were followed for a minimum of 2 years. Patients were stratified into 2 groups on the basis of the preoperative diagnosis: (1) those with a combined loss of active elevation and external rotation as a result of rotator cuff tear arthropathy (CLEER group) and (2) those with a combined loss of active elevation and external rotation as a result of other posttraumatic etiologies (non-CLEER group). The mean improvement of external rotation was analyzed. Subgroup analysis was performed on the basis of the Goutallier classification, glenosphere lateralization, and total prosthetic lateralization.

RESULTS: Thirty-three patients (24 in …

A Variant Of The Sciatic Nerve And Its Clinical Implications., Graham Dupont, Florence Unno, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Variants of gluteal neural anatomy are important to consider, especially during surgical approaches to the hip. During the routine dissection of the gluteal region, a variant of the sciatic nerve was found where the nerve left the pelvis fully split into its tibial and common fibular components. Intrapelvically and extrapelvically, there was no splitting of the two components by the piriformis muscle. Distally, the two parts of the nerve were draped over the medial and lateral edges of the ischial tuberosity. To avoid iatrogenic injury to the sciatic nerve during invasive or surgical approaches to this region, all possible anatomical …

The Deep Fascia Of The Forearm And The Ulnar Nerve: An Anatomical Study., Paul J Choi, Chidinma Nwaogbe, Joe Iwanaga, Georgi P Georgiev, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Introduction A reoperation for a cubital tunnel syndrome is not uncommon. Patients often complain of sensorimotor symptoms in the ulnar nerve distribution after their primary surgery. The documented etiologies for such a phenomenon include a "new" kinking of the distal ulnar nerve and a "new" compression of the ulnar nerve by the fascial septum in between or tendinous bands over the muscles of the forearm. The deep fascial plane along which the ulnar nerve travels in the forearm has had scant attention. We present an anatomical study to provide a better understanding of such etiologies to aid physicians in performing …

Cox-2 Expression Mediated By Calcium-Tonebp Signaling Axis Under Hyperosmotic Conditions Serves Osmoprotective Function In Nucleus Pulposus Cells., Hyowon Choi, Weera Chaiyamongkol, Alexandra C. Doolittle, Zariel I. Johnson, Shilpa S. Gogate, Zachary R. Schoepflin, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The nucleus pulposus (NP) of intervertebral discs experiences dynamic changes in tissue osmolarity because of diurnal loading of the spine. TonEBP/NFAT5 is a transcription factor that is critical in osmoregulation as well as survival of NP cells in the hyperosmotic milieu. The goal of this study was to investigate whether cyclooxygenase-2 (COX-2) expression is osmoresponsive and dependent on TonEBP, and whether it serves an osmoprotective role. NP cells up-regulated COX-2 expression in hyperosmotic media. The induction of COX-2 depended on elevation of intracellular calcium levels and p38 MAPK pathway, but independent of calcineurin signaling as well as MEK/ERK and JNK …

Implementation Of Attending-Supervised Ipass Handoff In The Neuro-Icu, Laura Cifrese, Md, Sonia Gill, Md, Megan Margiotta, Md, Muhammad Athar, Md, Rodney Bell, Md, Sara Hefton, Md, Fred Rincon, Md, Msc, Mbe, Syed Shah, Md, Mba, Jacqueline Urtecho, Md, Matthew Vibbert, Md, David Wyler, Md, Amandeep Dolla, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties
• These handoffs are well-known points of communication breakdown which can lead to patient safety issues
• Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture
• We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of care

Establishing Cost-Effective Management Of Postoperative Urinary Retention After Spine Surgery, Nikolaos Mouchtouris, Md, Catriona Harrop, Md, Edward Kloniecke, Md, Victoria English, Crnp, David Wyler, Md, Kamini Patel, Rn, Mba, Ashwini Sharan, Md, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Goal

Our goal is to develop evidence-based guidelines that:

1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
2. identify those at high-risk of long-term urinary retention that require further workup
3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
4. and determine the cost savings from our intervention when applied to all surgeries

Standardized Discharge Instructions And Their Impact On Post Operative Patient Knowledge, Nikolaus Hjelm, Md, Gregory Epps, Md, Ryan Rimmer, Md, Lauren Bogdan, Md, Erin Reilly, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

After every surgery, surgeons send their patients home with discharge instructions. The information is intended to educate the patients about their postoperative care and how to safely care for themselves upon returning home. Each surgeon reviews and approves the discharge instructions before they are given to their patients. This information is once again reviewed by the patient’s nurse before the patient leaves the hospital.

Within a large hospital, there are often several surgeons within each specialty that perform the same surgeries. The department of Otolaryngology at Thomas Jefferson University Hospital is no exception. Within otolaryngology there are several subspecialties. At …

Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery, Ellina Hattar, Md, Kelly Hufford, Dpt, Marie Wilson, Rn, James Harrop

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Physical therapy is imperative in achieving early mobilization, thereby reducing morbidity of immobility such as venous thrombolic events, improving postoperative pain, and facilitating appropriate disposition among patients who have recently undergone spine surgery. At TJUH, patients undergoing elective spine surgery are planned to engage in physical therapy (PT) twice a day. There are however several impediments that may limit the ability of patients to adequately participate in PT.

Prevention And Screening Of Vte In Sci Patients At Thomas Jefferson University Hospital, Erika Dillard, Md, Phd, Yusef Mosley, Md, Joshua Marks, Md, Christina Jacovides, Md, Geoffrey Ouma, Md, James Harrop, Md

Department of Neurosurgery Posters

Currently no protocol exists for thromboprophylaxis (TPx) and screening in SCI patients at TJUH. As such, often patients are either not started on TPx or are started on an inappropriate regimen depending on admitting team preference. In addition, patients often receive an admission DUS then weekly thereafter as a screening mechanism for DVT even if asymptomatic.

Our goal is to determine the effectiveness of our current method for initiating pharmacological TPx as well as efficacy and cost of our current screening method compared to national guidelines by addressing these questions:

• What is the occurrence of VTE in SCI patients at …

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Process Improvement For Endovascular Thrombectomy In Patients Presenting With Acute Ischemic Stroke, Richard F. Schmidt, Md, Michael J. Lang, Md, Robin Dharia, Md, Fred Rincon, Md, Thomas Zdanowski, Rn, Msn, Robin D'Ambrosio, Rn, Msn, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims

1. Critically evaluate the existing stroke activation and ET protocols for compliance with new 2018 metrics and guidelines.
2. Review DTP times under the existing protocol to assess for potential inefficiencies or gaps in care delivery, specifically addressing differences between processes at JHN compared to ED/Gibbon.
3. Make changes to the existing stroke alert protocol to better reflect current guidelines, streamline care, and ultimately improve process metrics (DTP times).
4. Establish a system for recursive continuous analysis of AIS patients to identify protocol gaps, inefficiencies and areas for further intervention.

The Causes And Effects Of Attrition From Post-Graduate Residency Programs At The Aga Khan University Hospital, Nairobi., Dennis Wamalwa

Master of Medicine in General Surgery

Background: Resident attrition is a global problem affecting most postgraduate residency training programs. It not only disrupts the educational and workload balance in the program but also results in loss of valuable time invested by the resident who has to leave before completion. AKUHN has similarly been affected with a worrying increase in resident attrition numbers over the last few years. There is however a lack of local studies on resident attrition which would inform measures to address modifiable risk factors for resident attrition and thus prevent future attrition. Objectives: To explore factors attributable to attrition amongst residents in Aga …