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Journal articles on the topic 'Relations with surgeons'
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Altieri, Maria S., Jie Yang, Lily Wang, Donglei Yin, Mark Talamini, and Aurora D. Pryor. "Surgeons’ perceptions on industry relations: A survey of 822 surgeons." Surgery 162, no. 1 (July 2017): 164–73. http://dx.doi.org/10.1016/j.surg.2017.01.010.
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Mack, Michael J., and Robert M. Sade. "Relations between cardiothoracic surgeons and industry." Journal of Thoracic and Cardiovascular Surgery 137, no. 5 (May 2009): 1047–49. http://dx.doi.org/10.1016/j.jtcvs.2009.02.001.
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Mack, Michael J., and Robert M. Sade. "Relations Between Cardiothoracic Surgeons and Industry." Annals of Thoracic Surgery 87, no. 5 (May 2009): 1334–36. http://dx.doi.org/10.1016/j.athoracsur.2009.02.038.
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Aebi, M., R. Gunzburg, F. Pellisé, and M. Szpalski. "Relations between surgeons and industry: the time of clarification has come." European Spine Journal 17, no. 6 (April 29, 2008): 783–84. http://dx.doi.org/10.1007/s00586-008-0683-0.
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Lesic, A. R. A., N. Petrovic-Stefanovic, I. Perunicic, P. Milenkovic, D. Lecic-Tosevski, and M. Z. Bumbasirevic. "Burnout in Belgrade orthopaedic surgeons and general practitioners: A preliminary report." Acta chirurgica Iugoslavica 56, no. 2 (2009): 53–59. http://dx.doi.org/10.2298/aci0902053l.
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Background: Burnout syndrome (BOS) is caused both by psychological-emotional and physical stress. It is associated with decreased job performance and low career satisfaction. BOS has a significance influence both to physicians' performance in health care system, and in their private life. Until now, there was no data about this aspect of orthopaedic surgeon condition and health in our community. Aim: To assess the level of the burnout syndrome in orthopaedic surgeons and general practitioners (GPs), and the relations of their demographic features, job characteristics to the burnout syndrome Design: Questionnaire-based survey Methods: The sample consisted of 30 orthopaedic surgeons from the University Clinical Centre, and 40 GPs from the primary health care centres. The Burnout syndrome was measured by the Maslach Burnout Inventory (MBI). In addition to the MBI, the demographic data were collected and analyzed (age, age of practicing, gender, marital status) in relation to BOS. Results: Both groups expressed moderate to high rate of emotional exhaustion, depersonalization and low personal accomplishment. However, statistical significance between the groups had not been demonstrated. Neither gender nor years of practice or marital status did express statistically significant impact on the BOS items, i.e. they were not predictors of the BOS. Our results showed that about 70% of the physicians were emotionally exhausted considering both groups. On the other hand, orthopaedics demonstrated slightly higher depersonalisation level (55%) than GPs (38%). While GPs expressed lower personal accomplishment (48%) comparing to orthopaedics (29%). Discussion: The obtained MBI scores in this study were similar to those registered in US among residents, but when comparing to physicians in West Europe, which have similar health care system, our results demonstrated higher rates of BOS items. Conclusion: The Burnout syndrome represents an important problem for actively practicing physicians. The results of this and other similar studies should be used to evaluate medical training, practice, professional relations and introduce necessary changes.
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Mache, Stefanie, Karin Vitzthum, Burghard F. Klapp, and Gerhard Danzer. "Surgeons' work engagement: Influencing factors and relations to job and life satisfaction." Surgeon 12, no. 4 (August 2014): 181–90. http://dx.doi.org/10.1016/j.surge.2013.11.015.
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Mache, Stefanie, Gerhard Danzer, Burghard F. Klapp, and David A. Groneberg. "Surgeons’ work ability and performance in surgical care: relations between organisational predictors, work engagement and work ability." Langenbeck's Archives of Surgery 398, no. 2 (January 6, 2013): 317–25. http://dx.doi.org/10.1007/s00423-012-1044-3.
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Marchenko, S. D. "Surgical anatomy of the aortic root." "Arterial’naya Gipertenziya" ("Arterial Hypertension") 13, no. 3 (June 28, 2007): 227–31. http://dx.doi.org/10.18705/1607-419x-2007-13-3-227-231.
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In this study a new method of clinical plastination was applied to the study of structural relations of aortic root with surrounding structures. As a result the topographo-anatomical base for aortic root reconstructive operations was created. We developed educational videolecture which displays functional and structural features of aortic root. The results of this study are designed for cardiologists, cardiac surgeons and ultrasound specialists. This study was performed at the Cardiovascular Surgery Clinic named after P.A. Kuprianov. Medical-Military academy and at the International Morphological center.
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Swain, Santosh Kumar. "Greater superficial petrosal nerve and its surgical importance: a review." International Journal of Research in Medical Sciences 9, no. 3 (February 25, 2021): 930. http://dx.doi.org/10.18203/2320-6012.ijrms20210904.
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The greater superficial petrosal nerve (GSPN) is an important but often underappreciated branch of the facial nerve. The GSPN is a mixed nerve which contains both sensory and parasympathetic fibers. It serves as the motor root of the pterygopalatine (sphenopalatine) ganglion. GSPN has a long course which passes across the middle skull base between the petrous bone and dura mater and running through the foramen lacerum. It then incorporates to the deep petrosal nerve and crosses along the pterygoid canal to the pterygopalatine ganglion. The postganglionic nerve fibers innervates the lacrimal glands, nasal mucosa and palatal mucosal glands via branches of the zygomatic nerve/zygomaticotemporal branch, sphenopalatine, greater palatine, lesser palatine nerves and pharyngeal nerve. Surgical anatomy of the GSPN nerve is often unfamiliar to many clinicians. As this nerve is usually unrecognized without use of high resolution microscope or endoscope, its anatomical knowledge is essential for surgeons basically otologists and other head and neck surgeon to minimize the risk of injury during surgical intervention. This review article surely increases the precise knowledge of the GSPN including its embryology, surgical anatomy, blood supply, relations with other structures and imaging.
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Mizusaki, Jorge Mitsuo. "We have the ability to serenely aggregate, account and reap." Scientific Journal of the Foot & Ankle 13, no. 3 (September 30, 2019): 189–90. http://dx.doi.org/10.30795/scijfootankle.2019.v13.1100.
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We are going through a political, economic and social moment when human relations are fragmented. There is an attempt to impose wills that dominate economic power over disadvantaged people, as regularly shown. The leaders of the most powerful nations try to subdue those without economic assets, blocking people's free movement through land and sea blockages, and strengthening land confinements. While others always wait for some heroic attitude. In our activity as orthopaedic doctors, surgeons or managers we also face strong economic and financial impositions, "windows close but doors open."
The speed of information in the current times will determine in the near future the quality of services that will be required, both for the ethical characterization of the information and for its credibility. Not long ago, the main complaint of ABTPé members was related to professional remuneration. We observed that the purposeful attitude of all associate members and the willingness of some members led to the beginning of change. We begin to consider the ethical views of payer and service provider, the legal aspects of adoptable attitudes, as well as the ethical attitudes of medical practice. Thus, these facts illustrate the strength and ability of fellow foot and ankle surgeons to take action that results in advantages for the entire class.
These facts illustrate the strength and ability of foot and ankle surgeons to take action that results in advantages for the entire ABTPé.
Making an analogy with the field of scientific culture we must also show how capable we are in producing useful scientific knowledge that benefits everyone. Creativity will be present with the release of new space for presentation of innovative procedures, through the technical notes in our publications.
Discussions should be stimulated.
The willingness of foot and ankle surgeon training centers to cultivate purposeful, ethical and socially comprehensive attitudes becomes extremely relevant. Thus, we will keep the flow of scientific development, improving our publications and projecting the potential of generating new knowledge compatible with our socioeconomic and cultural conditions.
Our strength in producing publications capable of summing up the various currents of thought and our cultures will set our continent on a new level. In this edition we are considering the internationalization of knowledge.
Yes, we are capable. Everyone's effort will be worth the award.
Have a great reading.
Jorge Mitsuo MizusakiEditor-in-Chief
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Hamilton, Amber A., Rena Mehta, B. Sue Epstein, Peter D. Fabricant, Austin T. Fragomen, and S. Robert Rozbruch. "Core psychosocial issues for children and adolescents in the context of limb lengthening and reconstruction surgery treatment." Journal of Children's Orthopaedics 15, no. 2 (April 19, 2021): 122–29. http://dx.doi.org/10.1302/1863-2548.15.200207.
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Purpose Addressing the psychosocial needs of adolescents can improve surgical outcomes. The aim of this retrospective comparative study was to understand the core psychosocial factors that shaped the experiences of adolescents who underwent multiple limb lengthening/reconstruction surgeries (LLRS). Methods A novel 62-question survey was developed and administered to 31 patients from the study institution. Data was obtained using a self-report inventory assessing medical care, communication/connection to doctor, peer relations, physical space, self-esteem, counselling/clergy, physical/emotional support, school issues and concerns about future. This survey and demographic questions were administered to young adults (now aged 18 to 30 years) who underwent LLRS treatment between the ages of 11 to 20 years. Results Psychosocial needs were determined to be within the categories of body image/self-esteem, subjective perception of treatment, patient-physician relationship, role of parents, peer interactions, academic performance and hospital experience. Patients valued parental involvement while also wanting their surgeon to speak directly to them. They preferred to be in private rooms on the paediatric floor and to not socialize while in the hospital. They were indifferent to keeping up with friends, speaking to a counsellor and having their surgeon inquire about their emotions. They expressed concern about pain, carrying out activities and the financial impact of surgery. Conclusions Adolescent LLRS patients value focused psychosocial support from their surgeon and caregivers. This perceived level of support influences their ability to cope with their condition. These findings helped us understand the psychological issues and preferences of adolescents who underwent LLRS and can assist orthopaedic surgeons in providing holistic care. Level of Evidence IV
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Gready, Paul, and Jeanelle de Gruchy. "District Surgeons in Apartheid South Africa: A Case Study of Dual Obligations." Health and Human Rights 7, no. 1 (2003): 112. http://dx.doi.org/10.2307/4065419.
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Romanchishen, Anatoliy F. "My way to surgery began in childhood... Autobiographic essay." Pediatrician (St. Petersburg) 10, no. 2 (June 19, 2019): 145–50. http://dx.doi.org/10.17816/ped102145-150.
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The autobiographical essay presents the history of the formation of the head of the department of hospital surgery with courses of traumatology and military surgery Anatoly Philippovich Romanchishen as a person, a surgeon, a high-class specialist in endocrine surgery. The author recalled his school years and his teachers who guided his life path, how it was decided to enter the Leningrad Pediatric Medical Institute. He was lucky to study the specialty under the guidance of such great teachers as A.A. Rusanov, F.H. Kutushev, L.N. Kamardin. The author was linked with the pediatric institute (academy, university) for 50 years and is grateful to it for his wide education, broad professional horizons, which covers the diagnostic of diseases, treatment of both children and adults. Since 1991 and today, Anatoly Philippovich heads the department of hospital surgery. Over the years of his leadership, a lot has been done, including establishing international relations with leading endocrine surgeons of many countries to exchange experience. Russian Endocrine Symposiums with international participation were held in 2003 and 2014 in St. Petersburg under the guidance of Anatoly Philippovich with the help of staff of the department. As a doctor, teacher, researcher, he performs an enormous amount of work, has hundreds of publications in domestic and foreign journals. He is an author of manuals, textbooks, and monographs on surgery of the endocrine system organs. Professor Anatoly Philippovich Romanchishen constantly works at the forefront of science and practice, charging everyone with his energy. He is a worthy surgeon of the Russian surgical school who teaches students and young professionals.
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Robertson, Jon H. "Neurosurgery and industry." Journal of Neurosurgery 109, no. 6 (December 2008): 979–88. http://dx.doi.org/10.3171/jns.2008.109.12.0979.
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The primary purpose of the relationship between neurosurgery and industry must be to improve patient care and advance medical knowledge. This relationship is desirable and can be mutually beneficial. Strict adherence to established ethical and legal guidelines is necessary to avoid financial conflicts of interest that may occur between neurosurgery and industry. The Code of Ethics established by the American Association of Neurological Surgeons (AANS) in 1986 emphasizes the physician's responsibility to always act in the best interest of his or her patients. The AANS Guidelines for Corporate Relations were developed in 2004 to address the concern of the potential growing influence of industry in the activities of our neurosurgical organization. Recognizing a need to clarify the proper relationships between neurosurgeons and industry, Guidelines on Neurosurgeon-Industry Conflicts of Interest were recently established. The AANS is committed to the highest ethical and legal standards in future relations with our industry partners. Members of the AANS are encouraged to adhere to the voluntary guidelines established by our organization.
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Gorantla, Vasavi Rakesh, Bhagath Kumar Potu, Thejodhar Pulakunta, Venkata Ramana Vollala, Pavan Kumar Addala, and Soubhagya Ranjan Nayak. "Anomalous formation of the portal vein: a case report." Jornal Vascular Brasileiro 6, no. 4 (December 2007): 399–401. http://dx.doi.org/10.1590/s1677-54492007000400016.
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The knowledge about the formation and relations of the portal vein is important for surgeons and radiologists. The variations in the level of formation and the pattern of formation of portal vein might lead to confusions during radiological and surgical procedures. Here we present a rare variation in the formation of the portal vein as found during the cadaveric dissections. The portal vein was formed by the union of splenic vein, superior mesenteric vein and inferior mesenteric veins. The abnormal termination of left gastric vein into superior mesenteric vein before the formation of portal vein was also seen in the same cadaver. Identification of these variations is useful in managing traumatic rupture of the mesentery.
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Dobransky, Johanna, Kathleen Gartke, Lissa Pacheco-Brousseau, Edward Spilg, Ashley Perreault, Mohammad Ameen, Alexandra Finless, Paul E. Beaulé, and Stéphane Poitras. "Relationship Between Orthopedic Surgeon’s Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution." Journal of Patient Experience 7, no. 6 (October 27, 2020): 1549–55. http://dx.doi.org/10.1177/2374373520968972.
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Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.
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Derogar, Maryam, Omid Sadr-Azodi, Asif Johar, Pernilla Lagergren, and Jesper Lagergren. "Hospital and Surgeon Volume in Relation to Survival After Esophageal Cancer Surgery in a Population-Based Study." Journal of Clinical Oncology 31, no. 5 (February 10, 2013): 551–57. http://dx.doi.org/10.1200/jco.2012.46.1517.
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Purpose The influence of hospital and surgeon volume on survival after esophageal cancer surgery deserves clarification, particularly the prognosis after the early postoperative period. The interaction between hospital and surgeon volume, and the influence of known prognostic factors need to be taken into account. Methods A nationwide Swedish population-based cohort study of 1,335 patients with esophageal cancer who underwent esophageal resection in 1987 to 2005, with follow-up for survival until February 2011, was conducted. The associations between annual hospital volume, annual surgeon volume, and cumulative surgeon volume and risk of mortality were calculated with multivariable parametric survival analysis, providing hazard ratios (HRs) with 95% CIs. HRs were mutually adjusted for the surgery volume variables and further adjusted for the prognostic factors age, sex, comorbidity, calendar period, tumor stage, tumor histology, and neoadjuvant therapy. Results There was no independent association between annual hospital volume and overall survival, and hospital volume was not associated with short-term mortality after adjustment for hospital clustering effects. A combination of higher annual and cumulative surgeon volume reduced the mortality occurring at least 3 months after surgery (P trend < .01); the HR was 0.78 (95% CI, 0.65 to 0.92) comparing surgeons with both annual and cumulative volume above the median with those below the median. These results remained when hospital and surgeon clustering were taken into account. Conclusion Because surgeon volume rather than hospital volume independently influences the prognosis after esophageal cancer surgery, centralization of this surgery to fewer surgeons seems warranted.
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Blagojevic, Z. B., A. S. Crnobaric, V. M. Stevanovic, I. D. Diklic, M. Glisic, and Z. Granic. "Unusual position of bone tunnels in failed ACL reconstruction." Acta chirurgica Iugoslavica 57, no. 1 (2010): 81–84. http://dx.doi.org/10.2298/aci1001081b.
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Introduction Surgery of ACL deficient knees is very frequent nowadays due to advanced surgical techniques, sophisticated implants and large number of surgeons. Therefore, the number of revisions for various reasons is growing up. There are several well known reasons for failed surgery This paper reported a case of revision surgery in a patient with previously done and failed reconstruction of ACL Case outline: Reviewing the clinical findings and X rays we found out peculiar position of the transplant and tunnels as a cause of the failure. We haven't found such complication reported in literature therefore we decided to report the case. Conclusion: Variety of implants and instruments can ease the surgery but basic anatomical knowledge of position and relations of the knee ligaments are essential for good surgical outcome.
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Rengan, Vinayak, Vinodh Duraisami, Chetna Ravindra, and Karthik Muralidharan. "Multiple scrotal epidermoid cysts: a case of cosmetic infertility." International Surgery Journal 6, no. 8 (July 25, 2019): 3026. http://dx.doi.org/10.18203/2349-2902.isj20193116.
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A 48 years old man presented to the surgical OPD with a history of multiple painless swellings on his scrotum for 20 years. He had avoided all sexual relations with his wife due to potential embarrassment. A clinical diagnosis of scrotal epidermoid cysts was made. Both testes were normal on ultrasound. Upon surgery, the scrotal skin was thoroughly excised, and primary closure of skin was done. Postoperative period was uneventful. The patient engaged in intercourse with his partner two weeks after surgery. The man and his partner were referred to the psychiatry unit for appropriate counselling. Scrotal epidermoid cysts cause significant psychological handicap. In Asian countries, the taboo of seeking medical assistance for genital conditions still exists. The treatment of scrotal epidermoid cysts requires a team of surgeons, psychologists, and psychiatrists.
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Morrow, Monica, Steven J. Katz, and Reshma Jagsi. "Mastectomy rates in relation to adoption of a margin guideline." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 508. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.508.
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508 Background: Surgery after initial lumpectomy to obtain a bigger negative margin is common and may lead to mastectomy. The impact of a 2014 consensus statement endorsing a minimal negative margin for invasive breast cancer on surgeon attitudes, re-excision rates, and final surgical procedure is uncertain. Methods: Women with stage I and II breast cancer diagnosed between 7/13–8/15 and reported to the Los Angeles and Detroit SEER registries were surveyed about 2 months post diagnosis, and 70% responded; 3729 comprise the analytic sample. All attending surgeons identified by the patients (n=489) were sent a questionnaire at the end of the patient survey period, and 376 (77%) responded. Pathology reports were reviewed for margin status. Multinomial regression models were used to assess trends. Results: The 67% initial lumpectomy rate was unchanged during the study. The final lumpectomy rate increased by 13% (to 65% from 52%) from 2013–2015, accompanied by a decrease in unilateral (to 18% from 27%) and bilateral (to 16% from 21%) mastectomy (p=0.002). Surgery after lumpectomy, both re-excision and mastectomy, declined by 16% (p<0.001). Pathology review showed no association between date of treatment and positive margins. Patient report of surgeon-recommended mastectomy after initial lumpectomy declined to 8% from 20% (p<0.001). 69% of surgeons endorsed a margin of no ink on tumor to avoid re-excision in ER+PR+ cancer and 63% for ER-PR- cancer. Surgeons treating >50 breast cancers annually were more likely to accept this margin than those treating <20 cases (p<0.001). Conclusions: Additional surgery after initial lumpectomy markedly decreased between 2013‒2015 after publication of a margin guideline endorsinga minimal negative margin. This resulted in a substantial increase in lumpectomy as the definitive surgical procedure, which illustrates that guidelines can be an effective, low-cost approach to addressing clinical controversies.
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Martin, K. W., M. Rishniw, R. H. Palmer, L. E. Selmic, and F. M. Duerr. "Treatment of canine cranial cruciate ligament disease." Veterinary and Comparative Orthopaedics and Traumatology 27, no. 06 (2014): 478–83. http://dx.doi.org/10.3415/vcot-14-03-0047.
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SummaryObjective: To describe veterinarians’ treatment recommendations and decision-making factors for dogs with cranial cruciate ligament disease (CCLD).Methods: An online survey of American College of Veterinary Surgeons (ACVS)-Diplomates (surgeon group) and primary care veterinarians (practitioner group) was performed. The survey included questions on treatment recommendations for common case scenarios (small or large breed dog with complete or partial CCLD), treatment decision factors, non-surgical treatment options, and actual treatment, if any, provided for a client-owned dog as well as one owned by their family or close friend.Results: The response rate was 42% for the surgeon group (n = 305/723) and four percent for the practitioner group (n = 1145/ 27,771). Extracapsular stabilization (ES) was the most common treatment recommendation for CCLD in small (9.1 kg) breed dogs amongst surgeons and practitioners. Tibial plateau levelling osteotomy (TPLO) was the most common treatment recommendation for CCLD in large (27.2 kg) breed dogs amongst both groups. The two most important treatment decision factors were dog size (78% of practitioners, 69% of surgeons) and activity level (63% of practitioners, 52% of surgeons). The most common treatment provided for a dog of their own or close relation in the surgeon group was TPLO (64%) followed by ES (15%), whereas in the practitioner group it was ES (38%) followed by TPLO (30%).Clinical significance: Extracapsular stabilization and TPLO are the most commonly employed surgical procedures in the surveyed population; dog size and activity level (but not age) are the major factors influencing treatment decisions.
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MAYNARD, DOUGLAS W., and PAMELA L. HUDAK. "Small talk, high stakes: Interactional disattentiveness in the context of prosocial doctor-patient interaction." Language in Society 37, no. 5 (October 16, 2008): 661–88. http://dx.doi.org/10.1017/s0047404508080986.
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ABSTRACTThe literature on “small talk” has not described the way in which this talk, even as it “oils the social wheels of work talk” (Holmes 2000), enables disattending to the instrumental tasks in which one or both participants may be engaged. Small talk in simultaneity can disattend to the movements, bodily invasions, and recording activities functional for the instrumental tasks of medicine. Small talk in sequence occurs in sensitive sequential environments. Surgeons may use small talk to focus away from psychosocial or other concerns of patients that may focus off the central complaint or treatment recommendation related to that complaint. Patients may use small talk to disattend to physician recommendations regarding disfavored therapies (such as exercise). Overall, small talk often may be used to ignore, mask, or efface certain kinds of agonistic relations in which doctor and patient are otherwise engaged. We explore implications of this research for the conversation analytic literature on doctor–patient interaction and the broader sociolinguistic literature on small talk.
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Stefanescu, Maria-Christina, Jasmina Sterz, Sebastian Herbert Hoefer, and Miriam Ruesseler. "Young surgeons’ challenges at the start of their clinical residency: a semi-qualitative study." Innovative Surgical Sciences 3, no. 4 (June 4, 2018): 235–43. http://dx.doi.org/10.1515/iss-2018-0015.
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AbstractIntroductionAccording to German regulations on licensing to practice medicine, the aim of undergraduate medical training is to produce a scientifically and practically trained physician who is able to work independently. More precisely, medical training has to impart the required knowledge and skills in diagnostics, therapy, health promotion, prevention, and rehabilitation. From the young residents’ point of view, this aim is not achieved, and they do not feel prepared to be a doctor. However, the literature on this subject relies mostly on data based on surveys, and there is a lack of deep analysis of the specific details of the topic. The aim of this study was to analyze in depth how junior doctors in their first and second years felt about their preparation for clinical practice as a doctor from their undergraduate training, as well as which teaching formats and factors influence their preparedness.MethodsThis semi-qualitative study is based on recorded interviews conducted using a structured interview manual. This serves to limit the subject matter of the interview and to target the topics. The study participants were 35 residents of general and visceral surgery, trauma surgery, and urology in their first and second years of medical specialty training. The number of participants was defined by the concept of saturation of the content. Basic data regarding age and the location and length of study were collected using a questionnaire. The audio recordings were transcribed word by word and analyzed with structured qualitative content analysis techniques.ResultsOnly 43% (n=15) of the 35 participating residents stated they were sufficiently prepared to be a doctor from undergraduate medical training, and 22.9% stated that they were not prepared for their work as a resident (8/35). However, 34.3% of the residents stated that undergraduate medical training did prepare them for some of the parts they were expected to master in daily clinical practice, but not other parts. Most of the participants described their first weeks as doctors as particularly stressful and exhausting. As major hurdles during their daily clinical work, participants described knowledge gaps regarding organizational and administrative pathways (71%), deficits in linking knowledge to clinical reasoning (71%), decision making (54%), and therapy planning (51%). Most participants stated that the practical placements during the semester, the clinical clerkships, and the last year internship were most effective as preparation for clinical residency. To be better prepared for clinical practice, participants suggested providing a clearer structure and that the course subjects bear better relations to each other. Nearly all participants proposed increasing patient encounters directly from the beginning of medical training as a longitudinal approach.DiscussionEven though we were able to demonstrate an increase in residents’ preparedness, 57% of the study participants still felt unprepared for their job to some extent. One might argue that starting a new profession will always result in a feeling of being unprepared to some extent. However, this unpreparedness can increase the risk for patients’ well being due to medical errors, which actually represents the third leading cause of death in the US after malignant tumors and cardiovascular diseases. Structured on-the-job adjustment, structured qualification training, and guided professional training are becoming increasingly important for future doctors as selection criteria for career choice and choice of employer. Thus, the surgical disciplines that are struggling with new young residents have to improve their concepts.
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Irving-Stonebraker, Sarah. "Nature, Knowledge, and Civilisation. Connecting the Atlantic and Pacific Worlds in the Enlightenment." Itinerario 41, no. 1 (April 2017): 93–107. http://dx.doi.org/10.1017/s0165115317000092.
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A central feature of Scottish Enlightenment thought was the emergence of stadial or “conjectural” theories of history, in which the development of all human societies, from those in Europe, to the Seminole Indians in Florida and the Tongans of the South Pacific, could be understood and compared according to the same universal historical criteria. This paper argues that central to this tradition was an account of the relationship between “useful knowledge” and social development. This article argues that we can map the circulation of a discourse about useful knowledge, nature, and civilisation through a network of Scottish-trained physicians and naturalists that spread to the Atlantic and to the Pacific. In the Atlantic world, physicians and naturalists used the vocabulary and categories of stadial theory to classify indigenous societies: they made comparisons between the illnesses that they thought “naturally” afflicted savage cultures, as opposed to those of civilized Europeans. In the Pacific, the Edinburgh-trained surgeons and naturalists compared Tahitians, Maoris, and Australian Aborigines to black Africans and Europeans, and they commented on the presence or absence of useful knowledge as a marker of the degree of development of each civilisation.
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DZIKOWSKI, ANDRZEJ. "Veterinary surgeons’ legal obligations in sales-related animal health status examinations." Medycyna Weterynaryjna 77, no. 06 (2021): 309–13. http://dx.doi.org/10.21521/mw.6540.
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The article presents, interprets, analyzes and examines legal obligations of veterinary surgeons who conduct animal examinations, issue decisions on animal health, and prepare opinions in connection with the contract of sale. It examines responsibilities originating from various sources and forming a complex system of relationships. A veterinary surgeon has numerous obligations in the field of civil law (including general civilian rules and norms of the law of obligations) and corporate law (including ethics and professional deontology). Moreover, he also has specific documentation, information, and explanatory duties closely related to the contract. The liability threshold of a veterinary surgeon is very low, which applies in particular to the mixed contract discussed here (an obligation of due diligence in relation to examination and an obligation of result in relation to decision-making).
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Bianco, F. J., J. A. Eastham, A. J. Vickers, A. M. Serio, J. Pontes, E. A. Kline, and P. T. Scardino. "Impact of the radical prostatectomy surgical technique and surgeon experience on freedom from cancer recurrence." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 4569. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.4569.
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4569 Background: We have shown a direct relation between positive margin (PM), morbidity outcomes and surgeon volume, technique after radical prostatectomy (RP). Significant variation occurs even among high volume providers. Our aim was to analyze the surgeon effects on cancer control after RP. Methods: We evaluated 8196 consecutive cT1–3NxMx naive men who underwent RP by one of 76 surgeons within 4 institutions between 1987 and 2003. We calculated the 5-yr probability of recurrence (BCR, PSA elevation >0.4 ng/ml × 2 or initiation of secondary therapy for a PSA rise) for each surgeon assuming a log-logistic survival distribution. A meta-analysis controlling for case mix: PSA, Gleason score, stage, PM and surgical expertise (i.e. cumulative number of surgeries performed) to evaluate for differences in BCR rates between surgeons was performed. We applied the I-square statistic to determine what proportion of the variation represented genuine differences v. chance alone. Results: 33 surgeons performed > 40 RP with 17 surgeons having > 100 procedures during the study period. BCR events were recorded in 1361 patients. The overall 5-yr freedom from BCR with 2524 patients remaining at risk was 80% (79%, 81%) . Extracapsular extension, seminal vesicle invasion, nodal metastasis, PM, Gleason score and PSA were independent predictors of BCR. The surgical volume also correlated independently with BCR. Importanntly we found significant variability on freedom from BCR between high volume surgeons. The I-squared statistic from the meta-analysis was 0.63. That is, approximately 63% of the difference in BCR rates among surgeons can be explained by genuine differences in surgical skill and approach, and approximately 37% is compatible with chance alone. For a sensitivity analysis, we repeated the analysis excluding surgeons who performed less than 100 procedures. In this sub-analysis, the I-squared statistic remained very significant at 0.48. Conclusions: Our data shows that in men treated by RP, the BCR outcomes of men are not exclusively determined by the biology and stage of prostate cancers (explained in most models), but to the surgical skill. Clinical trials evaluating BCR outcomes must prove equivalency among providers so that results are not biased by them. No significant financial relationships to disclose.
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Batra, Arvinder Pal Singh, Anupama Mahajan, and Karunesh Gupta. "Marginal mandibular branch of the facial nerve: An anatomical study." Indian Journal of Plastic Surgery 43, no. 01 (January 2010): 060–64. http://dx.doi.org/10.1055/s-0039-1699405.
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ABSTRACTSmile is one of the most natural and important expressions of human emotion. Man uses his lips mainly to register his emotions. Thus, the slightest asymmetry or weakness around the lips and mouth may transform this pleasant expression into embarrassment and distortion. The circumoral musculature, the major part of which is supplied by the marginal mandibular branch of the facial nerve, is the main factor in this expression. Therefore, an injury to this nerve during a surgical procedure can distort the expression of the smile as well as other facial expressions. This nerve often gets injured by surgeons in operative procedures in the submandibular region, like excision of the submandibular gland due to lack of accurate knowledge of variations in the course, branches and relations. In the present study, 50 facial halves were dissected to study the origin, entire course, termination, branches, muscles supplied by it, its anastomoses with other branches of facial nerve on the same as well as on the opposite side and its relations with the surrounding structures. The marginal mandibular branch of the facial nerve was found superficial to the facial artery and (anterior) facial vein in all the cases (100%). Thus the facial artery can be used as an important landmark in locating the marginal mandibular nerve during surgical procedures. Such a study can help in planning precise and accurate incisions and in preventing the unrecognized severance of this nerve during surgical procedures.
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Benditz, Achim, Florian Faber, Gabriela Wenk, Tina Fuchs, Natalie Salak, Joachim Grifka, Matthias Vogl, Matthias Menke, and Petra Jansen. "The Role of a Decision Support System in Back Pain Diagnoses: A Pilot Study." BioMed Research International 2019 (March 25, 2019): 1–5. http://dx.doi.org/10.1155/2019/1314028.
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It is the main goal of this study to investigate the concordance of a decision support system and the recommendation of spinal surgeons regarding back pain. 111 patients had to complete the decision support system. Furthermore, their illness was diagnosed by a spinal surgeon. The results showed significant medium relation between the DSS and the diagnosis of the medical doctor. Besides, in almost 50% of the cases the recommendation for the treatment was concordant and overestimation occurred more often than underestimation. The results are discussed in relation to the “symptom checker” literature and the claim of further evaluations.
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Fyfe, N. C. M. "An audit of amputation levels in patients referred for prosthetic rehabilitation." Prosthetics and Orthotics International 14, no. 2 (August 1990): 67–70. http://dx.doi.org/10.3109/03093649009080324.
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Most lower limb amputations in the United Kingdom (UK) are carried out within general surgical, orthopaedic and plastic surgical units of district hospitals. This study of patients referred for rehabilitation was undertaken to determine the number and specialty interests of surgeons referring amputees, the numbers referred by each and, as one of several possible measures of appropriateness for rehabilitation, the amputation levels in patients referred for the first time to one sub-regional Disablement Services (limb fitting) Centre (DSC) over a 14 month period. Thirty nine surgeons, referred 263 amputees. The majority (61%) of surgeons referred 5 or fewer: a nucleus of 11 vascular surgeons (28%) referred 64% of the patients. The underlying pathology, speciality interest of the surgeon or numbers referred by individual surgeons had no relation to final healed level which was below the knee in 55% of cases compared to national figures for all other DSC's ranging between 39% and 48% below-knee between 1981 and 1988. Since current practice in the UK is to refer all but the frailest patients for consideration of prosthetic rehabilitation, this study suggests that, nationally, more patients could be suited for the functionally superior below-knee level of amputation than are currently benefiting from it.
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Henderson, David K. "Position Paper: The HIV-Infected Healthcare Worker." Infection Control & Hospital Epidemiology 11, no. 12 (December 1990): 647–56. http://dx.doi.org/10.1086/646116.
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Consensus statements bearing on issues related to healthcare workers (HCWs) who are, or may be, infected by the human immunodeficiency virus (HIV) have been developed by the Centers for Disease Control (CDC), the American Medical Association (AMA), the American Academy of Pediatrics, the American Hospital Association (AHA), the American Academy of Orthopedic Surgeons, the American College of Obstetricians and Gynecologists8 and the British working groups. In general, these organizations conclude that few, if any, special procedures are required to accommodate an HIV-infected HCW. All except one oppose routine screening of HCWs for HIV infection; all except one oppose broad practice proscriptions for HIV-infected HCWs. Only one of these consensus statements focuses on the HIV-infected HCW. None address important related questions that confront hospitals and other healthcare institutions. These issues are difficult to resolve because: 1) there are insufficient data to establish a scientific basis for their solution; 2) the questions involve medicolegal, ethical or public relations issues that are beyond the usual scope of scientific consensus body recommendations; and/or 3) the situations occur infrequently. Nevertheless, in actual hospital practice, decisions about these questions, at least occasionally, must be made.
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Taylor, Irving. "Comment: ‘The Problem Surgical Colleague’." Annals of The Royal College of Surgeons of England 89, no. 5 (July 2007): 464–65. http://dx.doi.org/10.1308/003588407x202191.
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The review of ‘The problem surgical colleague’ by Mr John Mosley is both timely and relevant. All surgeons are naturally concerned about the mechanisms in place, both locally and through the General Medical Council (GMC) to deal with fitness-to-practise issues. It is inevitable that criticisms, often unfounded, are voiced by the profession. Most surgeons welcome a fair and transparent system to deal with such matters whilst maintaining the principle of self-regulation. We must accept that there are a small number of surgeons whose practice is impaired to such a degree that they represent a serious patient-safety risk and they must be dealt with appropriately. As a GMC medical case examiner since 2003, and having dealt with over 600 fitness-to-practise cases, I wish to comment on some of the important issues raised by Mr Mosley, specifically in relation to the surgeon and his or her practice. In doing so, I will set out the investigative process to be followed when fitness-to-practise concerns are brought to the attention of the GMC.
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Rahman, Md Khalilur, and Selina Anwar. "Presence of Cystic Artery in the Calots Triangle and Its Relation with Common Hepatic Duct a Postmortem Study." Bangladesh Journal of Anatomy 10, no. 2 (December 7, 2013): 50–56. http://dx.doi.org/10.3329/bja.v10i2.17282.
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Introduction: Most common disease of liver and biliary tree is cholelithiasis which needs surgical intervention. Safe execution of traditional cholecystectomy or laparoscopic surgery needs proper knowledge of the origin, course, branching pattern of the cystic artery and its relation with common hepatic duct. This study was aimed to find the presence of cystic artery in the Calots triangle and its relation with common hepatic duct to prevent any iatrogenic complications especially for newer surgeons in this field. Materials and Methods: This study was done on 60 postmortem gallbladder collected from postmortem dead bodies under the guidance of Forensic Medicine department of Rangpur Medical College, Rangpur. After collection of the specimen, the boundary of the Calot triangle was identified and course of the cystic artery was observed whether it was passing through the triangle or not. The relation of the cystic artery with the common hepatic duct was also noticed. Results: It was found from the result of the present study that out of 60 cases cystic artery was found as a content of Calots triangle in 58 (96.65%) cases. Regarding the relations of the cystic artery, out of 60 specimens, in 54 cases (90%) cystic arteries were observed to pass behind the common hepatic duct. In four cases (6.67%) cystic artery were found crossing over the common hepatic duct and in two cases (3.33%), cystic artery were found crossing below the cystic duct. In one cases, branches of cystic artery (superficial and deep branch) was found. In every specimen a Calots node was found within the Calots triangle. Discussions: The result of the present study was compared with other workers. Though many of the workers found similar results regarding the course of the cystic artery through the Calot triangle but some workers found higher number of cystic artery passing outside the triangle. Also higher percentage of cystic artery passing over the common hepatic duct was found by many workers than the present study. DOI: http://dx.doi.org/10.3329/bja.v10i2.17282 Bangladesh Journal of Anatomy, July 2012, Vol. 10 No. 2 pp 50-56
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Singh, Rajani. "An Anomalous Configuration of Coronary Artery: A Cadaveric Study." Case Reports in Cardiology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/397063.
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Anatomical variations in relation to coronary artery and its branches will help cardiac surgeons for refining imaging techniques and coronary artery bypass grafting. A heart was detected with multiple anomalies of coronary arteries in a cadaver. The anomalies of coronary arteries in terms of origin, number of ostia, courses, and presence of myocardial bridges were described, and related clinical implications were highlighted in the present study. The knowledge of variant anatomy may be of paramount importance to anatomists for variant anatomy and to cardiac surgeon for proper diagnosis and treatment of cardiac ailments including radiologists to refine image interpretation.
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Rusu, Mugurel Constantin, Adelina Maria Jianu, Bogdan Adrian Manta, and Sorin Hostiuc. "Aortic Origins of the Celiac Trunk and Superior Mesenteric Artery." Diagnostics 11, no. 6 (June 18, 2021): 1111. http://dx.doi.org/10.3390/diagnostics11061111.
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(1) Background. The vertebral level of origin (VLO) of the celiac trunk (CT) and superior mesenteric artery (SMA) has been scarcely investigated. (2) Method. This study used 107 computed tomography angiograms and an eleven type grading system to classify the VLO of the CT and SMA. Each of the T12–L2 vertebra were divided in three horizontal levels. The intervertebral discs were considered distinct levels. (3) Results. The VLO of the CT ranged from the upper third of the T12 vertebra to the lower third of the L1 vertebra. The VLO of the SMA ranged from the lower third of the T12 vertebra to the upper third of the L2 vertebra. There was a highly significant association between the VLO of the CT and SMA (Chi2 = 201, p < 0.001), usually respecting a “plus two” rule. The mean CT–SMA distance was 1.82 +/− 0.66 cm in males and 1.55 +/− 0.411 cm in females, the difference being statistically significant. The mean CT–SMA distance tended to decrease with increasing CT–SMA types, the differences being statistically significant. (4) Conclusions. These characteristics of CT and SMA origins and their relations should be known by surgeons, as they could impact operative management and should be evaluated on a case-by-case basis.
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Gautam, Ajeevan, Gulam Anwer Khan, Sameer Timilsina, Deepesh Dhungel, and Sanjib Kumar Sah. "Variation in Formation of Renal Artery." Journal of College of Medical Sciences-Nepal 16, no. 1 (March 31, 2020): 41–43. http://dx.doi.org/10.3126/jcmsn.v16i1.24472.
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Backgrounds: Renal arteries are two large blood vessels branching laterally from the abdominal aorta just below the superior mesenteric artery. The arteries vary in their level of origin and caliber, obliquity and precise relations. Each renal artery is about 6-8mm diameter. There is a varying characteristic of these arteries owing to their different course. The aim of the study was to study the variation in the formation of renal artery with its branching pattern using CT Angiography.
Methods: The study was conducted in the department of Radiology at Chitwan Medical College after obtaining ethical approval CMC-IRC. CT Angiogram was studied in 17 individuals who attended radiology department for angiography for different suspected abdominal and renal pathology.
Results: Analyzing the result of the angiography we found the usual branching pattern of renal artery in 70.58% of the individual, with variations in remaining 29.42%. On studying the number of arteries supplying kidney, artery draining directly to hilum i.e. accessory renal artery was 2.95%. We found the average length of right renal artery ranged between 3.5cm to 6.0cm.
Conclusions: The variations on this large lateral branch of abdominal aorta are common. Surgeons should exclude the possibility of presence of accessory and aberrant renal arteries obstruction prior to the surgical procedure. The awareness about the presence of such variations is important from the academic, surgical and radiological aspect.
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Bhat, Kavya, Sampath Madhyastha, and Balakrishnan R. "COURSE OF THE MAXILLARY ARTERY THROUGH THE LOOP OF THE AURICULOTEMPORAL NERVE. Recorrido de la arteria maxilar a través del bucle del nervio aurículotemporal." Revista Argentina de Anatomía Clínica 5, no. 3 (March 28, 2016): 235–39. http://dx.doi.org/10.31051/1852.8023.v5.n3.14081.
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Las variaciones en el curso de la arteria maxilar se describen a menudo, con sus relaciones con el músculo pterigoideo lateral. En el presente caso informamos una variación exclusiva en el curso de la arteria maxilar que no fue publicada antes. En un cadáver masculino de 75 años arteria maxilar derecho estaba pasando por el bucle del nervio auriculo-temporal. La arteria meníngea media provenía de la arteria maxilar con un bucle del nervio auriculo-temporal. La arteria maxilar pasaba profunda con respecto al nervio dentario inferior pero superficial al nervio lingual. El conocimiento de estas variaciones es importante para el cirujano y también serviría para explicar la posible participación de estas variaciones en la etiología del dolor mandibular. Variations in the course of the maxillary artery are often described with its relations to the lateral pterygoid muscle. In the present case we report a unique variation in the course of the maxillary artery which was not reported before. In a 75 years old male cadaver the right maxillary artery passed through the loop of the auriculotemporal nerve. The middle meningeal artery was arising from the maxillary artery within the nerve loop of auriculotemporal nerve. Further the maxillary artery passed deep to the inferior alveolar nerve but superficial to the lingual nerve. The knowledge of these variations is important for surgeons and it would also explain the possible involvement of these variations in etiology of the craniomandibular pain.
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Lalit, Monika, and Sanjay Piplani. "A cadaveric study of brachial artery and its variations with its ontogenic basis: An Anatomical Perspective." International Journal of Anatomy and Research 9, no. 9 (January 30, 2021): 7844–50. http://dx.doi.org/10.16965/ijar.2020.233.
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Introduction: Conventional knowledge of the brachial artery, the principal artery of the upper limb & its branches has played a major role in vascular surgeries. Literature along with various cadaveric & clinical studies suggest that brachial artery vary widely in origin, course and branching pattern. The great variability of this arterial pattern may be attributed to the failure of regression of some paths of embryonic arterial trunks. Anatomical knowledge of this principal artery and its variations has many clinical implications especially in surgeries related to orthopedic and vascular re-constructive procedures. MATERIALS AND METHODS: The present study was conducted on 56 upper limbs of different age group and sex (19 Male and 9 Female) The brachial arteries were identified and branching pattern and relations of the brachial artery with brachial plexus in arm was observed and presence or absence of variations were documented. Results: Out of 56 upper limbs studies, 53 (94.64%) limbs showed normal morphological pattern of brachial artery, 3 (5.35%) limbs showed superficial brachial artery, 1 limb (1.78%) showed tortuous and SBA with trifurcation into radial artery, ulnar artery and common interosseous artery in the cubital fossa. Conclusion: The study of Brachial artery and variation in its course and branching pattern is clinically important for surgeons, ortho-paedicians operating on the supracondylar fracture of humerus and radiologists performing angiographic studies on the upper limb. KEY WORDS: Common Interosseous Artery, Median Nerve, Superficial Brachial Artery, Trifurcation, Ulnar Artery.
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Paśnik, Bartosz, and Andrzej Modrzejewski. "Major vascular injury during laparoscopy." Polish Journal of Surgery 91, no. 3 (October 25, 2018): 1–5. http://dx.doi.org/10.5604/01.3001.0013.1736.
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Major Vascular injury during laparoscopy is most deadly complication of laparoscopy. This report is review major vascular injuries based on surgeon’s relation and literature. The incidence of MVI is 0,04–0,1%. Extremely important is to learn proper technique of insuflation. According to patient’s physique surgeon should consider best technique of insuflation, take caution against slim people, and induct implements with proper angle. We should avoid excesive force during trocar and Verres’s needle insertion, we also should avoid redundant movement after Verres needle is inserted in abdomen cavity. Elevation of the anterior abdominal wall at the time of Veress or primary trocar insertion is routinely recomended. Major vascular injury is seriously underestimated problem of laparoscopic operations.
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Paśnik, Bartosz, and Andrzej Modrzejewski. "Major vascular injury during laparoscopy." Polish Journal of Surgery 90, no. 5 (October 10, 2018): 1–5. http://dx.doi.org/10.5604/01.3001.0012.6659.
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Major Vascular injury during laparoscopy is most deadly complication of laparoscopy. This report is review major vascular injuries based on surgeon’s relation and literature. The incidence of MVI is 0,04 % - 0,1 %. Extremely important is to learn proper technique of insuflation. According to patient’s physique surgeon should consider best technique of insuflation, take caution against slim people, and induct implements with proper angle. We should avoid excesive force during trocar and Verres’s needle insertion, we also should avoid redundant movement after Verres needle is inserted in abdomen cavity. Elevation of the anterior abdominal wall at the time of Veress or primary trocar insertion is routinely recomended. Major vascular injury is seriously underestimated problem of laparoscopic operations.
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Luzon, Javier A., Bojan V. Stimec, Arne O. Bakka, Bjørn Edwin, and Dejan Ignjatovic. "Value of the surgeon’s sightline on hologram registration and targeting in mixed reality." International Journal of Computer Assisted Radiology and Surgery 15, no. 12 (September 28, 2020): 2027–39. http://dx.doi.org/10.1007/s11548-020-02263-3.
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Abstract Purpose Mixed reality (MR) is being evaluated as a visual tool for surgical navigation. Current literature presents unclear results on intraoperative accuracy using the Microsoft HoloLens 1®. This study aims to assess the impact of the surgeon’s sightline in an inside-out marker-based MR navigation system for open surgery. Methods Surgeons at Akershus University Hospital tested this system. A custom-made phantom was used, containing 18 wire target crosses within its inner walls. A CT scan was obtained in order to segment all wire targets into a single 3D-model (hologram). An in-house software application (CTrue), developed for the Microsoft HoloLens 1, uploaded 3D-models and automatically registered the 3D-model with the phantom. Based on the surgeon’s sightline while registering and targeting (free sightline /F/or a strictly perpendicular sightline /P/), 4 scenarios were developed (FF-PF-FP-PP). Target error distance (TED) was obtained in three different working axes-(XYZ). Results Six surgeons (5 males, age 29–62) were enrolled. A total of 864 measurements were collected in 4 scenarios, twice. Scenario PP showed the smallest TED in XYZ-axes mean = 2.98 mm ± SD 1.33; 2.28 mm ± SD 1.45; 2.78 mm ± SD 1.91, respectively. Scenario FF showed the largest TED in XYZ-axes with mean = 10.03 mm ± SD 3.19; 6.36 mm ± SD 3.36; 16.11 mm ± SD 8.91, respectively. Multiple comparison tests, grouped in scenarios and axes, showed that the majority of scenario comparisons had significantly different TED values (p < 0.05). Y-axis always presented the smallest TED regardless of scenario tested. Conclusion A strictly perpendicular working sightline in relation to the 3D-model achieves the best accuracy results. Shortcomings in this technology, as an intraoperative visual cue, can be overcome by sightline correction. Incidentally, this is the preferred working angle for open surgery.
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Mailis-Gagnon, Angela, Keith Nicholson, and Luis Chaparro. "Analysis of Complaints to a Tertiary Care Pain Clinic Over a Nine-Year Period." Pain Research and Management 15, no. 1 (2010): 17–23. http://dx.doi.org/10.1155/2010/783078.
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BACKGROUND: The present study is the result of an internal audit and examines the profiles of complainants and the sources and nature of complaints toward the staff in a tertiary care pain clinic, the Comprehensive Pain Program of the Toronto Western Hospital in Toronto, Ontario.METHODS: All sources of complaints over a nine-year period were reviewed, which included the following: Toronto Western Hospital Patient Relations (PR) records, with a subset of the files qualitatively analyzed in depth regarding the nature of complaints and complainants; complaints that bypassed PR and were addressed directly to the program director against members of the staff; complaints to the College of Physicians and Surgeons of Ontario; and complaints recorded anonymously at rateMDs.com.RESULTS: Although the prevalence of PR complaints was very low (1.73 complaints per 1000 visits), several other sources of complaints were identified. The typical complainant was a Canadian-born woman acting on her behalf or on behalf of a family member. More than one-half of the complaints were directed against the physicians regarding their opinion of psychological factors augmenting the patient’s presentation and/or inappropriate use of opioids. Defensive techniques instituted by the Comprehensive Pain Program staff in reaction to the complaints are discussed, and pertinent literature is reviewed.CONCLUSION: The present study is the first to examine the nature of complaints and complainants from a Canadian pain clinic. Further studies are needed to explore the complex issues of patient and staff interactions, and complaints in the era of ‘patient-centred care’.
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KV, Vinay, and Raghavendra AY. "Anatomical variants of profunda femoris artery : among cadavers from South India." National Journal of Clinical Anatomy 03, no. 01 (January 2014): 08–11. http://dx.doi.org/10.1055/s-0039-1700719.
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Abstract Background: The profunda femoris artery (PFA) is a branch of femoral artery which plays an important role in the arterial supply of the thigh. An extensive knowledge of the branching pattern and relations are necessary for clinicians to prevent any iatrogenic damage to these blood vessels and the surrounding structures in vascular reconstructive surgeries. Objective: To study the direction of origin of PFA from femoral artery and measure DIP- the distance between the origin of PFA from femoral artery to midpoint of inguinal ligament. Materials and Methods: Forty six femoral triangles (23 on right & 23 on left side) were dissected and studied in embalmed cadavers available in dissection hall of K. S. Hegde Medical Academy, Mangalore, India over a period of two years from July 2011 to July 2013. These cadavers were of South Indian origin. The direction of origin of PFA from femoral artery was noted. The DIP was measured using Vernier caliper. Results: The direction of origin of the PFA in majority of the cases was found to be from the posterolateral side (65.22%) of femoral artery. The DIP varies from 25 to 50 mm on the right and 24 to 60 mm on the left side. In 50 % of the cases, the DIP was in the range of 41 to 50 mm on both the sides. Conclusion: The anatomical data obtained here is of importance for surgeons and radiologists for procedures centred on the PFA and in vascular reconstructive surgeries involving the groin.
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Puia, Aida, Ion Cosmin Puia, and Paul Gabriel Cristea. "ETHICAL CONSIDERATIONS IN BARIATRIC SURGERY IN A DEVELOPING COUNTRY." Medicine and Pharmacy Reports 90, no. 3 (July 25, 2017): 268–72. http://dx.doi.org/10.15386/cjmed-733.
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Background and aims. Obesity is the fastest growing health problem worldwide. Ethical issues linked to obesity are numerous and still under debate even in countries with a long history in obesity treatment.Methods. From 2007 to 2015 we performed several types of bariatric surgical approaches on 250 patients with an average body mass index (BMI) of 42. The age range was 12-64 years. No death was recorded. Direct or phone contact was possible with 90% of them during follow-up. Starting from a specific question based approach in ethics we present aspects regarding obesity surgery in Romania. Patients’ safety, informed consent, cost cover, the role of bariatric surgery in children and bariatric surgeons’ training are discussed.Results. Co-morbidities improved or even disappeared in 90% of our patients. Informed consent is a major problem, due to the lack of public knowledge necessary. The private system in Romania offers bariatric surgery at lower prices than Western Europe but is still out of reach for a person with an average income. Lack of maturity and disharmonic family relations raise a series of challenges in assessing the best interest of children and adolescents. Ethics committees, which operate according to well-defined processes, are more and more active in universities and research centers in Romania, checking that methods and performance of scientific studies meet adequate standards.Conclusions. A detailed informed consent, thorough preoperative patient assessment and method selection are mandatory for good results in obesity surgery. Insufficient financial resources combined with the long time necessary to acquire the expertise for laparoscopic bariatric surgery may represent an additional pressure on both physicians and patients.
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Hegazy, Yasser Y., Mohamed Samy Nassar, Wael Hassanein, Moustafa Elhamami, and Juergen Ennker. "Prediction and Perception of Technical Difficulties in Adult Cardiac Surgery." Heart Surgery Forum 21, no. 4 (June 26, 2018): E294—E299. http://dx.doi.org/10.1532/hsf.1980.
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Background: Unexpected intra-operative technical difficulties are not uncommon in cardiac surgery. Our objective is to study the incidence, predictors, and consequences of unexpected difficulties in adult cardiac operations.
Methods: A total of 500 consecutive elective operations were included in the study. Before every operation, the surgeon and the assistant were asked to study the case and give a score (one to ten) for the expected technical difficulty of the operation. After every operation, the surgeon and the assistant were asked to give a score for the observed technical difficulty. The scores and perioperative data were collected and statistically analyzed.
Results: In relation to different interventions and consultant/trainee predictions, unexpected technical difficulties were encountered in 7% to 16% of cases. There was a significant difference between surgeons and trainees in the perception of level of increased difficulty, represented by the mean of differences between expected and observed score (0.084 ± 0.54 versus 0.016 ± 0.5, P = .0002). In multivariable analysis, only female gender (P < .0001) was identified as a factor associated with unexpected technical difficulties. There was no correlation between the incidence of complications and unexpected surgical difficulty. However, there was a weak positive correlation between operative times and observed difficulty score.
Conclusion: Unexpected technical difficulties are not uncommon in adult cardiac operations. Trainees tend to underestimate the difficulties perceived by the surgeon. This study can be a first step towards developing a technical difficulty score, which could be a helpful tool for medical quality management, as well as in training programs.
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Vulcani, V. A. S., L. A. F. Silva, R. E. Rabelo, O. C. Silva, L. A. Mendes, S. L. R. Freitas, A. S. Rabbers, and B. M. Assis. "Development and evaluation of accessories to improve the posture of veterinary surgeons in surgical procedures conducted in the field." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 68, no. 5 (October 2016): 1301–8. http://dx.doi.org/10.1590/1678-4162-8292.
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ABSTRACT The study was conducted based on the information collected on rural properties in the state of Goiás, during practical classes of Surgical Clinic in Large Animals at the Veterinary Hospital of the Escola de Veterinária e Zootecnia of the Universidade Federal de Goiás and during the implementation of outreach projects developed by the institution. An acropostite-phimosis surgical procedure in the bulls in the field was selected, lasting over 30 minutes and requiring movements, posture and strength on the part of the surgeon. Devices were proposed and developed to provide improved comfort and safety to surgeons. The first device was a stool to be used by the professional during the execution of the surgical intervention. The use enabled the surgeon to sit down and rest their feet on the ground, reducing knee bending and distributing the support forces in various muscle groups. For the movement restriction of the surgeon, another accessory was developed to support the foreskin of the animal. Made of wood, this other device serves as a support for keeping the foreskin away from the ground and close to the surgeon. Its length, width and thickness established a good relation with the stool height, providing minimal discomfort to the professional. The third device was designed to assist in the immobilization of the animal and increase safety for the patient and surgical team. A fourth accessory was designed to protect the scapular region and avoid the occurrence of injuries in the radial nerve, myopathies and traumas during the rollover or prolonged stay of the animal in lateral decubitus. The choice of the shape, dimensions and softness of the device was mainly based on the weight of the animal. Such devices have proven to be effective, reducing the time of surgery, making cervical and lumbar movement easier, in addition to providing better support to the surgeon, reducing risks of musculoskeletal diseases.
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Hermans, Louisa. "Supporting surgeons in the workplace." Bulletin of the Royal College of Surgeons of England 90, no. 5 (May 1, 2008): 162–63. http://dx.doi.org/10.1308/147363508x306185.
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The College is embarking on an exciting new venture to pilot a local structure to support surgeons in the workplace. Its aim is to provide a unified voice for surgery in relation to service delivery and professional standards, and to support individual surgeons through the revalidation process and with their continuing professional development (CPD). It is currently being piloted within the West Midlands and South West Strategic Health Authority (SHA) boundaries for one year. During this time it will be rigorously evaluated to determine its suitability and whether or not it will be implemented across England, Wales and Northern Ireland in the long term.
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Cohn, Kenneth H. "A Practicing Surgeon Dissects Issues in Physician-Hospital Relations." Journal of Healthcare Management 54, no. 1 (January 2009): 5–10. http://dx.doi.org/10.1097/00115514-200901000-00003.
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Morse, Bryan C., William S. Cobb, John D. Valentine, Anna L. Cass, and Richard H. Roettger. "Emergent and Elective Colon Surgery in the Extreme Elderly: Do the Results Warrant the Operation?" American Surgeon 74, no. 7 (July 2008): 614–19. http://dx.doi.org/10.1177/000313480807400708.
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With the elderly population rising continuously, surgeons are increasingly confronted by the dilemma of operative management in these patients, which frequently encompasses end-of-life issues. Increasing age and emergent surgery are known risk factors for poor outcomes in colon surgery. The purpose of this study is to delineate differences in outcomes between emergent and elective colon surgery and identify risk factors that can guide the surgeon in caring for the extreme elderly (age 80 years or older). From 2001 to 2006, a retrospective review of the resident database at Greenville Hospital System identified 104 extreme elderly patients who underwent colon surgery (65 elective, 39 emergent). Comparing elective and emergent operations, results showed substantial differences in morbidity (20% vs 51.2%, P < 0.001), 30-day mortality rate (7.7% vs 30.7%, P < 0.005), and length of stay (13.6 days vs 21.6 days, P < 0.004). Percentage of patients discharged to home was significantly less in the emergent group (13% vs 59%, P < 0.001). Evaluation of the emergent surgery group revealed male gender, history of smoking, and ischemic changes on pathologic examination were statistically significant risk factors for failure of surgery. As a result of the high-risk nature of emergent colon operations in the extreme elderly, it is important that surgeons carefully assess the benefits in relation to the risks and functional outcomes of surgery when planning patient care and providing informed consent.
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Belshaw, Zoe, Natalie Jane Robinson, Rachel Sarah Dean, and Marnie Louise Brennan. "Owner and veterinary surgeon perspectives on the roles of veterinary nurses and receptionists in relation to small animal preventive healthcare consultations in the United Kingdom." Veterinary Record 183, no. 9 (July 4, 2018): 296. http://dx.doi.org/10.1136/vr.104773.
Full textAbstract:
Veterinary receptionists and veterinary nurses rarely feature in published practice-based research, yet are integral to small animal veterinary practice in the UK. The aim of this study was to investigate the perspectives of UK-based owners and veterinary surgeons about veterinary nurses and receptionists in relation to their role in preventive healthcare. Semistructured telephone interviews were conducted with 15 dog and cat owners and 14 veterinary surgeons. Interview transcripts were thematically analysed. Reception staff were identified as having a range of important roles, from rapport building to providing healthcare information and advice. The perceived importance of those roles appeared to differ between owners and veterinary surgeons. Veterinary nurses were described as performing a diversity of roles in relation to preventive healthcare, both in the reception area and in the consulting room. Many owners, and some veterinary surgeons, expressed uncertainty about the remit and status of veterinary nurses in relation to providing veterinary advice. This study identifies for the first time the degree of responsibility for preventive healthcare given to veterinary receptionists and veterinary nurses in UK small animal practices. Further work is needed involving reception and nursing staff to fully appreciate and define their roles in small animal practice.
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Oton, T., C. Sastré, and L. Carmona. "FRI0646-HPR MAPPING THE PATIENT JOURNEY OF NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: PERSPECTIVE OF PROFESSIONALS AND PATIENTS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 927.1–927. http://dx.doi.org/10.1136/annrheumdis-2020-eular.104.
Full textAbstract:
Background:Non-radiographic axial spondyloarthritis (nr-ax-SpA) is a relatively new disease classification that has generated controversy among payers.Objectives:To explore the perspective of patients and health care professionals (HCPs) on the journey from first symptoms to a diagnosis of non-radiographic axial spondyloarthritis (nr-ax-SpA), in order to identify gaps and unmet needs.Methods:Qualitative study in two phases: (1) focus groups with HCPs and personal interviews with patients; (2) nominal group in which results were discussed with all stakeholders and possible solutions were proposed. Content analysis, patient journey mapping, and ideas generation techniques were used.Results:Five focus groups were organised with rheumatologists, GP, orthopaedic surgeons, physiotherapists, and radiologists, and six patient interviews were held.HCPs recognised poor communication among specialists and contradictory or redundant approaches. Non-rheumatologists recognise poor training on spondyloarthritis, difficulty in identifying red-flags, and biases in differential diagnosis. Rheumatologists recognise that SpA nomenclature can be confusing, nevertheless nr-ax-SpA term is defining an early stage of ankylosing spondylitis, and it could lead to over-diagnosis.Most of the patients agreed in the narrative of a very long journey with a multitude of diagnoses, mostly wrong, ineffective treatments and much frustration; acknowledging the need for psychological support during the process and the importance of receiving a diagnosis in order to cope with the disease.The participants in the nominal group meeting recognised and discussed the problems derived from the diagnostic delay and care gaps that clearly affect people with nr-ax-SpA (Table 1).Table 1.Problems recognised by the different actors involved in the journey.ProblemRecognised byPtPTOrGPRhRaNon-recognition of symptomsXXDelay first visit to doctorXCancel appointmentsXSelf-medicationXDisease denialXInvisibilityXLack of adherenceXIgnorance of medicationXUnclear symptomsXXXXNo clinical filter by back problemsXTreatments variabilityXIneffective protocolsXXLack of timeXXXXLack of resources (human and material)XXXLack of commitmentXXXXXNot outcome measurementXXXXInadequate knowledge/trainingXXXFew explanations / patient educationXXXXFocused on “our” diagnostic codesXXXXXNo relation between specialtiesXXXXXPrioritization of tests over solutionsXXXLabelling patients (prejudice)XXXXInadequate referral circuitsXXXXXDemotivating delaysXLimited medical history / little researchXTemporality of work contractsXLimited access to testsXXNon-sustainability threatXLack of specialised supportXDiagnostic dispersionXToo much weight of local issuesXAbsence of protocols or outdatedXXPoor information transmission in all directionsXXXXXXFocus on pharmacological treatmentsXIgnorance of others’ rolesXGender biasXIncomplete order formsXAbbreviations: Pt, patient; PT, physical therapist; Or, orthopaedic surgeon; GP, general practitioner; Rh, rheumatologist; Ra, radiologist.The following were indicated as possible solutions: (1) Improving relations between specialities, (2) High resolution consultations, (3) Rethinking disability scales, (4) Better information, (5) Visibility, (6) Resource maps and (7) Citizen training.Conclusion:The patient’s journey with an nr-ax-SpA is long, complicated and frustrating for both the person who experiences it and the HCPs who care for them. It is necessary to improve the knowledge about nr-ax-SpA among non-rheumatology health HCPs along with low back pain in general, among doctors and the general population, as well as other feasible measures that affect multiple levels.Disclosure of Interests:Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Carlos Sastré Employee of: YES; I´m Medical Advisor in Novartis Spain, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)