Arthroscopy Volume in United States Residency Programs: Are New Trainees Prepared?

2019 ◽  
Vol 03 (03) ◽  
pp. 124-129
Author(s):  
Christopher N. Carender ◽  
Alan G. Shamrock ◽  
Kyle R. Duchman ◽  
Natalie A. Glass ◽  
T. Sean Lynch ◽  
...  
Keyword(s):  
United States ◽  
Hip Arthroscopy ◽  
Orthopaedic Surgery ◽  
Knee Arthroscopy ◽  
The United States ◽  
Median Number ◽  
Published Data ◽  
Diagnostic Arthroscopy ◽  
Case Logs ◽  
Arthroscopic Procedures

AbstractArthroscopy is a technically demanding procedure with a prolonged learning curve. The purpose of this study is to determine if current arthroscopic case volume over the course of an orthopaedic surgery residency is sufficient to meet the number of cases required to achieve competence and/or mastery in complex arthroscopic tasks as well as hip arthroscopy. Publicly available Accreditation Council for Graduate Medical Education case log data for arthroscopic procedures from accredited orthopaedic residencies were reviewed from 2007 to 2017. Linear and segmental regression analyses were used to identify temporal trends, with significance set to p < 0.05. From 2007 to 2013, there was a significant increase in the median number of shoulder and knee arthroscopy case logs (p < 0.001). A sharp decline in the median number of shoulder and knee arthroscopy case logs was seen in 2013 to 2014 (p < 0.001), and the number remained low from 2014 to 2017 (p = 0.02, p = 0.03). The median number of hip arthroscopy procedures logged increased significantly from zero cases in 2012 (range: 0–48 cases) to five cases in 2017 (range: 0–76 cases) (p = 0.02). Over the study period, the median number of total arthroscopic procedures decreased from 301 to 186 (p = 0.01). In the United States, the majority of orthopaedic surgery residents graduate with case log numbers that meet theoretical minimum requirements for competence in basic diagnostic arthroscopy of the shoulder, hip, and knee. Resident experience with hip arthroscopy has increased; however, the majority of residents are graduating with little to no hip arthroscopy experience. Moreover, the median number of total arthroscopic procedures has declined to the point where the average graduate may not be able to perform complex hip or shoulder arthroscopy tasks based on previously published data. These findings support the need for further investigation into the best methods for training residents interested in performing arthroscopy as part of their careers. This was a level of evidence III, retrospective cohort study.

scholarly journals Global variability in orthopedic surgery training

2019 ◽  
Author(s):  
Andrew D. Sobel ◽  
Davis Hartnett ◽  
David Hernandez ◽  
Adam E. M. Eltorai ◽  
Alan H. Daniels
Keyword(s):  
United States ◽  
Orthopedic Surgery ◽  
Orthopaedic Surgery ◽  
Educational Development ◽  
The United States ◽  
Surgery Training ◽  
Orthopaedic Care ◽  
The World ◽  
Orthopaedic Training ◽  
And Training

Medical and orthopaedic training varies throughout the world. The pathways to achieve competency in orthopaedic surgery in other countries differ greatly from those in the United States. This review summarizes international educational requirements and training pathways involved in the educational development of orthopaedic surgeons. Understanding the differences in training around the world offers comparative opportunities which may lead to the improvement in education, training, and competency of individuals providing orthopaedic care.

scholarly journals Aluminum in Pediatric Parenteral Nutrition Products: Measured Versus Labeled Content

2011 ◽  
Vol 16 (2) ◽  
pp. 92-97
Author(s):  
Robert L. Poole ◽  
Kevin P. Pieroni ◽  
Shabnam Gaskari ◽  
Tessa K. Dixon ◽  
KT Park ◽  
...  
Keyword(s):  
United States ◽  
Parenteral Nutrition ◽  
Clinical Setting ◽  
Aluminum Content ◽  
The United States ◽  
Published Data ◽  
Measured Concentration ◽  
Aluminum Exposure ◽  
Product Release

ABSTRACT OBJECTIVE Aluminum is a contaminant in all parenteral nutrition solutions. Manufacturers currently label these products with the maximum aluminum content at the time of expiry, but there are no published data to establish the actual measured concentration of aluminum in parenteral nutrition solution products prior to being compounded in the clinical setting. This investigation assessed quantitative aluminum content of products commonly used in the formulation of parenteral nutrition solutions. The objective of this study is to determine the best products to be used when compounding parenteral nutrition solutions (i.e., those with the least amount of aluminum contamination). METHODS All products available in the United States from all manufacturers used in the production of parenteral nutrition solutions were identified and collected. Three lots were collected for each identified product. Samples were quantitatively analyzed by Mayo Laboratories. These measured concentrations were then compared to the manufacturers' labeled concentration. RESULTS Large lot-to-lot and manufacturer-to-manufacturer differences were noted for all products. Measured aluminum concentrations were less than manufacturer-labeled values for all products. CONCLUSIONS The actual aluminum concentrations of all the parenteral nutrition solutions were significantly less than the aluminum content based on manufacturers' labels. These findings indicate that 1) the manufacturers should label their products with actual aluminum content at the time of product release rather than at the time of expiry, 2) that there are manufacturers whose products provide significantly less aluminum contamination than others, and 3) pharmacists can select products with the lowest amounts of aluminum contamination and reduce the aluminum exposure in their patients.

Variation in pediatric stereoelectroencephalography practice among pediatric neurosurgeons in the United States: survey results

2021 ◽  
pp. 1-9
Author(s):  
Benjamin C. Kennedy ◽  
Joshua Katz ◽  
Jacob Lepard ◽  
Jeffrey P. Blount
Keyword(s):  
United States ◽  
The United States ◽  
Median Number ◽  
Pediatric Epilepsy ◽  
Case Volume ◽  
Median Response ◽  
Younger Patients ◽  
Electronic Survey ◽  
Survey Results ◽  
Survey Responses

OBJECTIVE Stereoelectroencephalography (SEEG) has become widespread in the United States during the past decade. Many pediatric neurosurgeons practicing SEEG may not have had experience with this technique during their formal training, and the literature is mostly limited to single-center series. As a result, implementation of this relatively new technique may vary at different institutions. The authors hypothesized that aspects of SEEG experience, techniques, and outcomes would vary widely among programs across the country. METHODS An electronic survey with 35 questions addressing the categories of training and experience, technique, electrode locations, and outcomes was sent to 128 pediatric epilepsy surgeons who were potential SEEG users. RESULTS Sixty-one pediatric fellowship-trained epilepsy surgeons in the United States responded to the survey. Eighty-nine percent were actively using SEEG in their practice. Seventy-two percent of SEEG programs were in existence for less than 5 years, and 68% were using SEEG for > 70% of their invasive monitoring. Surgeons at higher-volume centers operated on younger patients (p < 0.001). Most surgeons (70%) spent 1–3 hours per case planning electrode trajectories. Two-thirds of respondents reported a median implant duration of 5–7 days, but 16% reported never having an implant duration > 5 days, and 16% reported having had implants stay in place for > 4 weeks. The median response for the median number of electrodes initially implanted was 12 electrodes, although 19% of respondents reported median implants of 5–8 electrodes and 17% reported median implants of 15–18 electrodes. Having a higher volume of SEEG cases per year was associated with a higher median number of electrodes implanted (p < 0.001). Most surgeons found SEEG helpful in defining an epileptic network and reported that most of their SEEG patients undergo focal surgical treatment. CONCLUSIONS SEEG has been embraced by the pediatric epilepsy surgery community. Higher case volume is correlated with a tendency to place more electrodes and operate on younger patients. For most parameters addressed in the survey, responses from surgeons clustered around a norm, though additional findings of substantial variations highlight differences in implementation and philosophy among pediatric epilepsy programs.

Patient preferences for interferon alfa in multiple myeloma.

1997 ◽  
Vol 15 (4) ◽  
pp. 1672-1679 ◽  
Author(s):  
H Ludwig ◽  
E Fritz ◽  
J Neuda ◽  
B G Durie
Keyword(s):  
United States ◽  
Multiple Myeloma ◽  
Overall Survival ◽  
Patient Preferences ◽  
Maintenance Treatment ◽  
The United States ◽  
Interferon Alfa ◽  
Medical Decision ◽  
Published Data ◽  
Financial Cost

PURPOSE Interferon alfa treatment in multiple myeloma marginally improves relapse-free and overall survival. Often it does so at the expense of toxicity and financial cost. If patients are unwilling or unable to participate in the decision of whether to initiate such treatment, known patient preferences can serve as guidelines for the physician. We interviewed myeloma patients in the United States to obtain information that might facilitate medical decision-making. PATIENTS AND METHODS Three hundred fifty-five myeloma patients throughout the United States were interviewed by telephone. Without identifying interferon alfa as the treatment agent, interviewers described potential adverse effects, financial cost, and self-injection procedures. The potential benefits of four treatment choices, derived from a meta-analysis of published data, were presented as gains in remission rate (+10%), remission duration (an additional 4 and 7 months, respectively, for induction and maintenance treatment), and overall survival (an additional 3 and 6 months, respectively, for induction and maintenance treatment). Patients' choices for or against use of the unidentified substance were recorded, and interferon was subsequently disclosed as the treatment. The profiles of patients making different choices were determined using multivariate regression techniques. RESULTS Approximately half of the patients accepted the unidentified treatment if remission and/or survival improved by at least 6 months. Accepters were younger and more likely to have used interferon. Of patients who rejected the unidentified treatment, 25% to 50% would have been willing to accept it if the benefits were > or = 12 months. Test/retest reliability of all choices, determined in 36 cancer patients, was 0.896. CONCLUSION In multiple myeloma, interferon therapy and, by inference, other treatments with comparable features are acceptable to approximately half of the patients if a 6-month gain in relapse-free or overall survival can be expected.

scholarly journals Current Trends Among US Surgeons in the Identification, Treatment, and Time of Repair for Medial Meniscal Ramp Lesions at the Time of ACL Surgery

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982726 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Lars Engebretsen ◽  
Robert F. LaPrade
Keyword(s):  
United States ◽  
Acl Reconstruction ◽  
Sports Medicine ◽  
Orthopaedic Surgery ◽  
Cruciate Ligament ◽  
Treatment Strategies ◽  
The United States ◽  
Cross Sectional ◽  
Current Trends ◽  
Acl Surgery

Background: Given the potential hidden nature of medial meniscal ramp lesions and the controversy regarding treatment, it is important to understand the current trends regarding the identification and treatment strategies of meniscal ramp lesions by the leading surgeons and educators in the field of sports medicine. Purpose: To better understand the current trends in orthopaedic surgery regarding arthroscopic identification and treatment of medial meniscal ramp lesions at the time of anterior cruciate ligament (ACL) surgery. Study Design: Cross-sectional study. Methods: An electronic questionnaire was sent in a blinded fashion to 91 directors of orthopaedic sports medicine fellowship training programs in the United States. Participants’ email addresses were obtained through the American Orthopaedic Society for Sports Medicine directory of current fellowship program directors. Inclusion criteria were only those surgeons who currently performed ACL reconstruction surgery. Exclusion criteria were those surgeons who did not perform ACL reconstruction or who chose to opt out of the survey. Results: Overall, 19 surgeons opted out of the survey; 36 responded from the remaining 72 surveys (50%). The majority (n = 31, 86%) reported routinely checking for a medial meniscal ramp lesion via inspection of the posteromedial meniscocapsular junction during an ACL reconstruction. The most common repair technique cited was all-inside (n = 24, 66.7%), followed by inside-out (n = 8, 22.2%). Three (8%) surgeons indicated that they did not repair meniscal ramp lesions. Regarding surgical treatment (repair vs no treatment), the majority reported using the extent of the tear (89%; partial vs full thickness) and the stability of the tear upon probing (81%) as the main criteria for intraoperative decision making. Nineteen (52.8%) surgeons required a mean time of <15 minutes for meniscal ramp repair; 16 surgeons (44.4%), 15 to 30 minutes; and 1 surgeon (2.8%), 30 to 45 minutes. Conclusion: This study provides insight regarding meniscal ramp tear identification, treatment, and repair strategies from the fellowship directors of sports medicine orthopaedic surgery in the United States. Such information may be useful for current orthopaedic surgeons to advance their practice according to the current trends surrounding ACL reconstruction and medial meniscal ramp repair.

Preliminary Results from the Air Mass Transformation Experiment (AMTEX)

1976 ◽  
Vol 57 (11) ◽  
pp. 1346-1355 ◽  
Author(s):  
D. H. Lenschow ◽  
E. M. Agee
Keyword(s):  
United States ◽  
Experimental Period ◽  
The United States ◽  
Published Data ◽  
Data Set ◽  
Air Mass ◽  
Preliminary Results ◽  
Cold Air Outbreak ◽  
Transformation Experiment ◽  
Transformation Processes

The field phases of AMTEX, a GARP subprogram on air-sea interaction implemented by Japan, were conducted over the East China Sea in the environs of Okinawa, Japan, during the last two weeks of February in 1974 and 1975. Investigators from Australia, Canada, and the United States also participated in this experiment. The weather was generally very favorable for this study of air mass transformation processes in 1975 because of an extensive cold air outbreak during most of the experimental period. A basic synoptic data set was obtained from 6 h soundings from an array of aerological stations centered at Okinawa. In addition, satellite, hourly surface and surface marine, oceanographic, boundary layer, radiation, radar, cloud physics, and aircraft data were obtained and have been or will be available in published data reports or on magnetic tape. Preliminary results from 1974 and 1975 reported at the Fourth AMTEX Study Conference and joint United States–Japan Cooperative Science Program Seminar, “Air Mass Transformation Processes over the Kuroshio in Winter,” held in Tokyo, 26–30 September 1975, are presented and discussed.

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