The Learning Curve of the Deliberate Practice of Phacoemulsification in the Ophthalmic Training System

2021 ◽  
Vol 104 (10) ◽  
pp. 1658-1666
Keyword(s):  
Residency Training ◽  
Demographic Data ◽  
Deliberate Practice ◽  
Median Number ◽  
Training System ◽  
Grade Point ◽  
Kaplan Meier ◽  
Patient Demographic Data ◽  
Posterior Capsule Rupture ◽  
Cumulative Summation

Objective: To determine the number of surgeries needed for trainees to achieve competence in performing phacoemulsification with deliberate practice (DP). Materials and Methods: The present study was a prospective observational study, the residents were observed as they progressed through their third year of residency. Resident and patient demographic data were recorded. Complexities of the cases and surgical steps and rate of surgical complications were recorded. Self and staff assessments as to the DP learning zone attained by the trainees were collected. Risk adjusted-cumulative summation (RA-CUSUM) was used to evaluate the competency of the trainees to achieve the acceptable posterior capsule rupture (PCR) rate of 5%. Kaplan-Meier analysis was used to determine the median number of surgeries required to attain competency. Results: Eight of the 10 trainees achieved competence in performing phacoemulsification. A median of 28 cases and 278 days was required before competence was attained. There were no statistically significant associations between the achievement of competence and the gender of the trainees, perceived complexity of the cases, or the grade-point average of the residents during their tenure in medical school. A median of four cases were required for a shift in the trainees’ DP confidence levels from “panic” to “learning” from self-assessment, while the median of ten case were required from staff assessment. The PCR was 8.53% and dropped to 6% at two years after the trainees finished residency training. Conclusion: Trainees require at least 28 cases of non-complicated phacoemulsification surgery to achieve a minimum level of competency. The perceived skill in performing phacoemulsification differs between novice and experienced surgeons. Phacoemulsification skills can be further developed after graduating from the training program. Assisting staff should be attentive when trainees perform lens nucleus division and lens nucleus removal to avoid complications. Keywords: Residency training; Phacoemulsification; CUSUM; Deliberate practice; Cataract

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

scholarly journals Perceived knowledge of psychiatry and family medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia: opportunities to refine the residency training

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiangbo Ying ◽  
Jinhui Wan ◽  
Kang Sim ◽  
Ee-Jin Darren Seah ◽  
Mythily Subramaniam
Keyword(s):  
Diabetes Mellitus ◽  
Family Medicine ◽  
Residency Training ◽  
Medical Management ◽  
Demographic Data ◽  
Significant Proportion ◽  
Psychiatry Residents ◽  
Training Curriculum ◽  
Cross Sectional Survey ◽  
Family Medicine Residents

Abstract Background Psychiatry and Family Medicine residents frequently see patients with comorbid mental and physical disorders. Little is known about the difference in knowledge of Psychiatry residents and Family Medicine residents regarding management of common conditions they encounter. This study aimed to assess the knowledge of Psychiatry and Family Medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia, as the findings could help to refine the training curriculum for residency training. Methods A cross-sectional survey design was used. Psychiatry and Family Medicine residents pursuing their residency in Singapore were recruited from November 2019 to June 2020. The survey questionnaire consisted of questions which assessed the knowledge regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia. Descriptive statistics were used to describe the demographic data; T-tests or Mann-Whitney U tests to compare the differences between groups; and multiple regression analyses to assess the factors associated with Psychiatry residents’ knowledge of hypertension, diabetes mellitus, and dyslipidemia. Results Fifty-seven out of 70 (81.4%) Psychiatry residents and 58 out of 61 (95.1%) Family Medicine residents participated in the study. The majority of Psychiatry residents encountered patients with hypertension (93.0%), diabetes mellitus (87.7%) and dyslipidemia (91.2%) on a daily to weekly basis. Psychiatry residents had higher scores on questions about schizophrenia versus Family Medicine residents (mean 50.70 versus 43.28, p < 0.001). However, Psychiatry residents scored lower on questions about hypertension (mean 33.86 versus 40.98, p < 0.001), diabetes mellitus (mean 45.68 versus 49.79, p = 0.005) and dyslipidemia (mean 37.04 versus 44.31, p < 0.001). Receiving undergraduate medical education locally, compared to receiving it overseas, was associated with better knowledge of hypertension (beta = 0.515, p = 0.009) and dyslipidemia (beta = 0.559, p = 0.005); while younger age (26–30 versus > 35 and 31–35 versus > 35) was associated with better knowledge of hypertension (beta = 1.361, p = 0.002 and beta = 1.225, p = 0.003). A significant proportion of Psychiatry residents (61.4%) did not agree that the training provided to manage hypertension, diabetes mellitus, and dyslipidemia was adequate. Similarly, majority of Family Medicine residents (62.1%) did not agree that they had adequate training to manage schizophrenia. Conclusions This study raises the awareness of Psychiatry residents’ sense of discomfort in managing hypertension, diabetes mellitus, or dyslipidemia and conversely Family Medicine residents in management of schizophrenia, which can be further addressed during the training postings within the residency programs. Future studies are needed to look at local (such as training curriculum) and systemic factors (such as practice trends and culture) in order to better align residency selection criteria and training foci with real world practice factors over time.

Venous stent versus conventional stent for the treatment of central vein obstruction in hemodialysis patients: a retrospective study

2021 ◽  
pp. 028418512110051
Author(s):  
Surasit Akkakrisee ◽  
Keerati Hongsakul
Keyword(s):  
Endovascular Treatment ◽  
Patency Rate ◽  
Demographic Data ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Central Vein ◽  
Primary Patency Rate ◽  
Patient Demographic Data ◽  
Upper Thoracic ◽  
Vein Stenosis

Background Endovascular treatment is a first-line treatment for upper thoracic central vein obstruction (CVO). Few studies using bare venous stents (BVS) in CVO have been conducted. Purpose To evaluate the treatment performance of upper thoracic central vein stenosis between BVS and conventional bare stent (CBS) in hemodialysis patients. Methods Hemodialysis patients with upper thoracic central vein obstruction who underwent endovascular treatment at the interventional unit of our institution from 1 January 2008 to 31 December 2018 were enrolled in the present study. CBS was used to treat central vein obstruction in 43 patients and BVS in 34 patients. We compared the primary patency rates and complications between the two stent types. P values < 0.05 were considered statistically significant. Results The patient demographic data between the CBS and BVS groups were similar. The characteristics of the lesions, procedures, and complications were not significantly different between the two groups ( P > 0.05). There were no statistically significant differences of primary patency rates at three and six months between the BVS and CBS groups (94.1% vs. 86.0% and 73.5% vs. 58.1%, respectively; P > 0.05). The primary patency rate at 12 months in the BVS group was significantly higher than that in the CBS group (61.8% vs. 32.6%; P = 0.008). Conclusion Endovascular treatment of central vein obstruction with BVS provided a higher primary patency rate at 12 months than CBS.

Personal recollections of Walter E. Dandy and his Brain Team

2006 ◽  
Vol 105 (3) ◽  
pp. 487-493 ◽  
Author(s):  
Irving J. Sherman ◽  
Ryan M. Kretzer ◽  
Rafael J. Tamargo
Keyword(s):  
Training Program ◽  
Residency Training ◽  
Surgical Training ◽  
Residency Program ◽  
Residency Training Program ◽  
Training System ◽  
Johns Hopkins Hospital ◽  
Separate Entity ◽  
Efficient Organization ◽  
Highly Efficient

✓ Walter Edward Dandy (1886–1946) began his surgical training at the Johns Hopkins Hospital in 1910 and joined the faculty in 1918. During the next 28 years at Johns Hopkins, Dandy established a neurosurgery residency training program that was initially part of the revolutionary surgical training system established by William S. Halsted but eventually became a separate entity. Dandy’s residents were part of his “Brain Team,” a highly efficient organization that allowed Dandy to perform over 1000 operations per year, not counting ventriculograms. This team also provided rigorous training in the Halsted mold for the neurosurgical residents. Although exacting and demanding, Dandy was universally admired by his residents and staff. This article describes Dandy’s neurosurgical residency program at Johns Hopkins, and provides personal recollections of training under Walter Dandy.

Cement-in-cement femoral component revision

2021 ◽  
Vol 103-B (7) ◽  
pp. 1215-1221
Author(s):  
John W. Kennedy ◽  
Nigel Y. B. Ng ◽  
David Young ◽  
Nicholas Kane ◽  
Andrew G. Marsh ◽  
...  
Keyword(s):  
Femoral Component ◽  
Short Form ◽  
Demographic Data ◽  
Senior Author ◽  
Inclusion Criteria ◽  
Reliable Technique ◽  
Patient Demographic Data ◽  
Oxford Hip Score ◽  
Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

scholarly journals SURVIVAL OF NONAGENARIAN PATIENTS WITH HIP FRACTURES: A COHORT STUDY

2017 ◽  
Vol 25 (4) ◽  
pp. 132-136 ◽  
Author(s):  
Alexa Ovidiu ◽  
Gheorghevici Teodor Stefan ◽  
Popescu Dragos ◽  
Veliceasa Bogdan ◽  
Alexa Ioana Dana
Keyword(s):  
Internal Fixation ◽  
Hip Fractures ◽  
Survival Data ◽  
Demographic Data ◽  
Level Of Evidence ◽  
Asa Score ◽  
Kaplan Meier ◽  
Trochanteric Region ◽  
One Year ◽  
Retrospective Comparative Study

ABSTRACT Objective: The objective of this study was to assess survival and factors that may influence survival in nonagenarians with hip fracture. Methods: We retrospectively analyzed 134 nonagenarian patients admitted for hip fractures over a period of 9 years, and reviewed medical records and survival data from the National Population Register. The analysis included demographic data, ASA score, surgical delay, type of treatment, and mortality. Results: Mean patient age was 92.53 years (range 90-103 years). Of the total, 35.8% of the fractures involved the femoral neck and 64.2% were in the trochanteric region. Overall mortality was 18.7% at 30 days, and 9% at one year. Mean survival for the entire sample was 683±78.1 days, with a median of 339 days; survival in men and women was 595±136.8 days and 734±94.6 days, respectively. We found that type of fracture (p=0.026) and ASA score (p=0.004) were the main factors influencing survival. Kaplan-Meier survival analysis indicated that patients with extracapsular fractures treated by internal fixation had a better survival rate (p=0.047). There was no significant differences between sexes (p = 0.102) or diagnosis (p = 0.537) Conclusion: Although nonagenarian patients have numerous comorbidities, surgical treatment using internal fixation seems superior to a conservative approach. Level of Evidence III, Retrospective Comparative Study.

Intrapleural Antimicrobial Irrigation for Postpneumonectomy Empyema in Patients With Lung Cancer

2014 ◽  
Vol 28 (5) ◽  
pp. 469-472 ◽  
Author(s):  
Heather Torbic ◽  
Nicole Glasser ◽  
Sara E. Rostas ◽  
Mohammed Alquwaizani ◽  
Gaspar Hacobian
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Demographic Data ◽  
Descriptive Analysis ◽  
Median Number ◽  
Pleural Space ◽  
Extrapleural Pneumonectomy ◽  
Antibiotic Administration ◽  
Past Medical History ◽  
Systemic Antibiotics

Purpose: Postpneumonectomy empyema (PPE) is a possible complication after a pneumonectomy in patients with lung cancer. The use of intrapleural (IP) antibiotic irrigation to treat infections in the pleural space may be indicated after systemic antimicrobial therapy, and drainage of the pleural space has been insufficient. Methods: Adult patients ≥18 years old who received IP antibiotic irrigation between 2006 and 2011 were included. Demographic data, past medical history, surgical procedure, systemic antibiotics, and culture data were collected. Additionally, the IP antibiotic administered, the dose, and how it was prepared and administered were collected. Results: A total of 18 patients were evaluated in this retrospective descriptive analysis. The majority of patients underwent an extrapleural pneumonectomy (EPP; 72%). Most patients received systemic antibiotics before IP antibiotic administration (95%). Vancomycin was the most common antibiotic used for both systemic therapy (100%) and IP irrigation (94%). The median number of IP antibiotic doses received per patient was 5.5 (interquartile range [IQR] 1-9). Recurrence of PPE within 6 months of initial PPE resolution occurred in 28% of patients. Intrapleural antibiotic irrigation was well tolerated in all patients. Conclusion: Vancomycin is most commonly used for IP antibiotic irrigation at our institution after patients have undergone a thoracic surgery, which was most commonly an EPP.

scholarly journals Discrepency in grade between preoperative biopsy and final specimen in stage I carcinoma endometrium: an institutional review

2019 ◽  
Vol 7 (2) ◽  
pp. 568
Author(s):  
Suhaildeen Kajamohideen ◽  
Balasubramanian Venkitaraman ◽  
Sridevi V.
Keyword(s):  
Histological Grade ◽  
Tumour Size ◽  
Demographic Data ◽  
Median Number ◽  
Laparoscopic Staging ◽  
Surgical Biopsy ◽  
Carcinoma Endometrium ◽  
Duration Of Surgery ◽  
Diagnostic Biopsy ◽  
Definitive Surgery

Background: Most endometrioid endometrial cancer are well differentiated (Grade I). Grade of the tumor is an important predictor of nodal metastasis and the discordance in histological grade of endometrial cancers between diagnostic biopsy and definitive surgery specimen was analyzed in our Institute.Methods: Around 221 patients diagnosed with carcinoma endometrium between 2006 and 2014 were taken into study. Histologic differentiation of the tumour between diagnostic biopsy and definitive surgery were analysed. All demographic data, tumor factors, follow up and recurrence were recorded.Results: Of the 221 patients taken into consideration for analysis, median age of presentation was 57 years with range between 38-77 years. The overall median body mass index was 27.70kg/m2. 66 % of patients had comorbid illness, with 33% having both diabetes and hypertension. Open staging was performed in 150 patients and laparoscopic staging in 71 patients. Mean duration of surgery was 3.06 hrs in laparoscopic staging and 2.74hrs in open staging. The median tumour size was 4cm.The median number of nodes dissected were 13. Discordance in the grade of tumour between diagnostic biopsy and surgical biopsy were 58.8% of grade 1 tumour, 16.2% of grade 2 tumours and 18.9% of grade 3 tumours.Conclusions: Discrepancies in correlation of the grade of tumour in diagnostic biopsy and tissue obtained at surgery supports the need for surgical staging in all patients.

scholarly journals Clinical Anxiety among Saudi Postgraduate Pediatric Dentistry Students in Jeddah City

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Manal Almalik ◽  
Abeer Alnowaiser ◽  
Omar El Meligy ◽  
Jamal Sallam ◽  
Yusra Balkheyour
Keyword(s):  
Demographic Data ◽  
Pediatric Dentistry ◽  
Cross Sectional Study ◽  
Dental Students ◽  
Cross Sectional ◽  
Grade Point ◽  
Postgraduate Students ◽  
Jeddah City ◽  
Younger Age ◽  
Significant Difference

Objective. To determine anxiety in relation to gender, Grade Point Average (GPA), level of education and academic and clinical situations in Jeddah, Saudi Arabia. Also, to identify academic and clinical anxiety levels among postgraduate pediatric dentistry students. Methods. A cross-sectional study at governmental training hospitals was conducted. All registered postgraduate students in pediatric dental programs during the year 2015-2016 were included in the study. A self-administered questionnaire was distributed electronically to 60 postgraduate pediatric dentistry students aged between 25 and 45 years old. The questionnaire is composed of 55 questions that investigated demographic data, academic and clinical related situations including investigations, diagnosis, treatment, and complications in treatment. Results. The study showed a higher anxiety level in younger age dental students (76.7% compared to 23.3%) and Saudi board residents (60%). Comparing gender differences in anxiety revealed that a significant difference (P≤0.05) was found and anxiety seems to be more among female dental students (2% very anxious, 64% slightly anxious, and 34% not anxious) as compared to male dental students (8% very anxious, 69% slightly anxious, and 23% not anxious). Conclusions. There was increased awareness, detailed understanding, and handling of the patients by senior postgraduate pediatric dentistry students compared to junior students.

Abstract 164: Treatment Differences in Acute Stroke By Mode of Transport

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Prasanthi Govindarajan ◽  
Anisha Chandra ◽  
David Ghilarducci ◽  
Steve Shiboski ◽  
Barbara Grimes ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Demographic Data ◽  
Patient Discharge ◽  
Cross Sectional Study ◽  
Primary Diagnosis ◽  
Cross Sectional ◽  
Discharge Data ◽  
Patient Demographic Data ◽  
Mode Of Transport ◽  
Time Of Admission

Background: EMS (Emergency Medical Services) is an important component of the stroke chain of survival. While in hospital stroke time targets have shown to be better when prehospital providers provide advance notification, population-wide studies on thrombolysis rates (IV t-PA) for those who arrive by EMS is sparse. Objective: To examine differences in treatment rates for acute stroke by mode of transport. Methods: This is a cross-sectional study of all patients who were transported to hospitals in two Northern California counties by providers of a single EMS agency during a three year period. Patient demographic data, prehospital provider clinical assessment was obtained from the computerized prehospital transport records and patient location, hospital demographics, physician diagnosis and treatment rates were obtained from statewide administrative patient discharge data. The data sources were linked using probabilistic linkage methodology. Patients ≥18 years of age with validated ICD- 9 code for stroke were included. We excluded inter-facility transports and direct admissions. Results: Of 10,456 patients who had a hospital based discharge diagnosis of stroke, 3787 (36%) were transported by EMS. Mean age at the time of admission was 75 years (+/- 14); 55% (2093) were females, 65% (2471) were whites and 86% (3247) were Hispanics. Most of the patients had Medicare (72%, 2737) and 92% (3471) were transported from home. Majority of the patients were treated at stroke centers [n=3014, (80%)]) and at community hospitals [n=3664, (97%)]. Of 3757 patients with a primary diagnosis of stroke, 4% (150) were treated with IV t-PA. After controlling for covariates, patients transported by EMS had higher odds of treatment with IV t-PA (OR 2.6, 95 CI 1.9-3.3). Treatment at stroke centers (OR 1.5, 95 CI 1-2.2) and academic centers were independently associated with treatment rates (OR 2.4, 95 CI 1.6-3.6). Conclusions: Arrival by EMS to emergency department is associated with higher treatment rates with thrombolytics for acute stroke patients and efforts should be targeted to improve use of EMS for stroke.

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