An Overview of Analysis of Learning Curve of Laproscopic Procedures in General Surgery Residents in Khyber Teaching Hospital, Peshawar

Aim: An Overview of Analysis of Learning Curve of Laparoscopic Procedures in General Surgery Residents in Khyber Teaching Hospital, Peshawar. Methodology: A descriptive KAP (knowledge attitude and practice) study was conducted in Khyber teaching hospital (KTH) from January 2021 to March 2021. A total of 24 surgical residents of 3rd and 4th year residency working in different surgical units were part of the study. Experience of residents performing procedures under supervision, assistance or by means of observation was recorded by a self administered questionnaire. Results: A number of 24 surgical residents of 3rd and 4th year residency of general surgery were part of the study. Frequency of 3rd yr residents was 13(54.2%) and that of 4th yr was 11(45.8%). Number of 6(25%) observed basic laparoscopy, 8(33%) advanced procedures and 10(41.7%) observed both types of procedure. 23(95.8%) participants were regularly briefed on principles of laparoscopy and 21(87.5%) strongly agreed upon the need of video simulation sessions. According to 22(91.7%) participants instrument handling was the most difficult part to learn. And 17(70.8%) participants laparoscopy enhances visualization of disease process. 18(75%) participants said that it improves postoperative recovery and 20(83.3%) were of opinion that it minimizes hospital stay. 16(66.7%) residents stated it has a steep learning curve. All participants agreed that it is necessary to assist large number of procedures to attain confidence of performing laparoscopic procedures. Conclusion: The study showed that almost all residents were in favor of the use of laparoscopic procedures rather than open surgeries. Keywords: Laparoscopy, learning curve

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The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

Open Medicine ◽

10.1515/med-2016-0086 ◽

2016 ◽

Vol 11 (1) ◽

pp. 489-496 ◽

Cited By ~ 3

Author(s):

Alessia Ferrarese ◽

Valentina Gentile ◽

Marco Bindi ◽

Matteo Rivelli ◽

Jacopo Cumbo ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Learning Curve ◽

General Surgery ◽

Training Model ◽

Influential Factors ◽

Case Volume ◽

Surgical Trainee ◽

Acceptable Error ◽

Surgical Residents ◽

Curve Model

AbstractA well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient.Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy.Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress.Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.

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845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

British Journal of Surgery ◽

10.1093/bjs/znab134.171 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S A Joiya ◽

M Hamid ◽

Z Siddiqui

Keyword(s):

Learning Curve ◽

Skill Acquisition ◽

Postoperative Recovery ◽

Task Completion ◽

Complication Rates ◽

Novice Group ◽

Surgical Trainees ◽

Long Duration ◽

Hospital Stays ◽

Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

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Updates in Diabetic Wound Healing, Inflammation, and Scarring

Seminars in Plastic Surgery ◽

10.1055/s-0041-1731460 ◽

2021 ◽

Author(s):

Nina Dasari ◽

Austin Jiang ◽

Anna Skochdopole ◽

Jayer Chung ◽

Edward Reece ◽

...

Keyword(s):

Wound Healing ◽

Disease Process ◽

Wound Dehiscence ◽

Diabetic Patients ◽

Wound Infections ◽

Diabetic Wound ◽

Complex Process ◽

Diabetic Wound Healing ◽

Almost All ◽

Diabetic Wounds

AbstractDiabetic patients can sustain wounds either as a sequelae of their disease process or postoperatively. Wound healing is a complex process that proceeds through phases of inflammation, proliferation, and remodeling. Diabetes results in several pathological changes that impair almost all of these healing processes. Diabetic wounds are often characterized by excessive inflammation and reduced angiogenesis. Due to these changes, diabetic patients are at a higher risk for postoperative wound healing complications. There is significant evidence in the literature that diabetic patients are at a higher risk for increased wound infections, wound dehiscence, and pathological scarring. Factors such as nutritional status and glycemic control also significantly influence diabetic wound outcomes. There are a variety of treatments available for addressing diabetic wounds.

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Near-miss Obstetric Events in a Tertiary Care Teaching Hospital in Nepal: An Audit

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v10i1.13191 ◽

2015 ◽

Vol 10 (1) ◽

pp. 30-32 ◽

Cited By ~ 1

Author(s):

BS Gurung ◽

RB Koju ◽

Y Dongol

Keyword(s):

Blood Transfusion ◽

Teaching Hospital ◽

Tertiary Care ◽

Near Miss ◽

Coagulation Disorder ◽

Hypertensive Disorder ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Obstetric Haemorrhage ◽

Almost All

Aims: This study aims to determine the frequency of near-miss obstetric events and analyze its nature such as reasons for near-miss, organ dysfunction associated and critical management required among pregnant women managed over a 3-year period in a Tertiary Care Teaching Hospital in Nepal. Methods: This hospital based prospective, descriptive study was done from August 2011 to February 2015. Case eligibility was defined by WHO Near-Miss Guidelines. Medical records of the patients and the interview with the patient, accompanying family members and health workers from referral centres were used to generate the data which were filled in the pre-designed questionnaire. The data generated and analyzed included age and gestation weeks, parity, mode of intervention, associated organ dysfunctions, reasons for near-miss and critical intervention accompanied to manage the near-miss cases. Results were presented in mean ± SD and percentages, wherever applicable. Results: There were 4617 deliveries with 28 near-miss cases. The major factors contributing near-miss events were obstetric haemorrhage followed by hypertensive disorder. Three fourth (n=21) of cases required blood transfusion and almost all cases (n=26) required ICU management. Coagulation disorder was observed in majority of cases (n=23) followed by cardiovascular, respiratory and uterine atony. Conclusions: In this study, maternal near-miss event was mainly attributable to obstetric haemorrhage followed by hypertension and sepsis. Major organ-system disorders observed were coagulation disorder, cardiovascular, respiratory and uterine disorders. Almost all the cases were managed in ICU and majority of them required blood transfusion.

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Emociones del cuidador primario ante su enfermo con diagnóstico de Cáncer

Revista CuidArte ◽

10.22201/fesi.23958979e.2012.1.1.69062 ◽

2012 ◽

Vol 1 (1) ◽

pp. 22 ◽

Cited By ~ 1

Author(s):

José Antonio Nicolaz García ◽

Deyanira Vega Montes ◽

Ana Gabriel Castañeda Castro ◽

Eunice Olguín Vega

Keyword(s):

Qualitative Study ◽

Life Quality ◽

Disease Process ◽

Human Being ◽

Font Size ◽

Calidad De Vida ◽

Toma De Decisiones ◽

Almost All

Estudio cualitativo que tiene como objetivo analizar las emociones que presenta el cuidador primario ante el diagnóstico de cáncer de un ser querido, fue realizado en el Hospital Juárez de México en el servicio de pediatría.El cuidador primario tiende a desarrollar emociones, y en casi todas las circunstancias, influyen en la toma de decisiones; muchas de las grandes o pequeñas decisiones que toman los cuidadores están influenciadas por las emociones que son básicas e innatas del ser humano.Uno de los trastornos presentes y que conlleva al surgimiento de las emociones es el estrés ante la incertidumbre que desencadena el no saber el rumbo de la enfermedad.El llevar un proceso de enfermedad es difícil, aun más cuando hablamos de una enfermedad incurable en la cual sólo se puede dar una “mejor calidad de vida”. SUMMARY The present work is a qualitative study, which has as aim analyze the emotions that the primary keeper presents before the diagnosis of cancerof a dear being, it was realized in the Hospital Juárez of Mexico in the service of pediatrics. The primary keeper tends to develop emotions and in almost all the circumstances, they influence the capture of decisions; many of the big or small decisions that take the keepers are influenced by the emotions that are basic and innate of the human being. One of the present disorders and that he carries to the emergence of the emotions is the stress before the uncertainty that unleashes ignorance about the course of the disease. Facing a disease process is difficult, furthermore when talking about an incurable one, in which it is only possible to provide a better life quality.

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RN4Cast Study in Portugal: Nurses and care left undone

Journal of Hospital Administration ◽

10.5430/jha.v7n2p58 ◽

2018 ◽

Vol 7 (2) ◽

pp. 58

Author(s):

Clara Braga ◽

Élvio Jesus ◽

Beatriz Araújo

Keyword(s):

Direct Patient Care ◽

Cross Sectional ◽

The Past ◽

The North ◽

Demographic Questionnaire ◽

Surgical Units ◽

Healthcare Quality Indicators ◽

Almost All ◽

Inpatient Units

Background: Over the past decades, nursing in Portugal has evolved greatly both academically and professionally and this evolution brought along growing concerns about the quality of the healthcare provided. Due to lack of time or poor organization of the workload, nurses are often faced with the need to choose between what must be done and what will have to be postponed or even not be done at all.Objective: To investigate the care activities that are most frequently left undone or are postponed by nurses working in medical and surgical inpatient units in Portugal.Methods: A descriptive, cross-sectional, quantitative study that follows the RN4CAST (Nurse Forecasting in Europe) methodology was carried out from October 2013 to April 2014. A total of 31 hospitals and a random sample of adult medical-surgical units were involved. The data were collected using a socio-demographic questionnaire and a nursing questionnaire that included the identification of the nursing activities of surveillance and direct patient care that were necessary but postponed or not performed by nurses in their most recent shift.Results: A total of 2,235 nurses participated. Almost all participants had a nursing bachelor degree (98.2%). The most frequently left undone or postponed care items were “Educating patients and family” (50.2%) and “Comfort/talk with patients” (50.1%); the least frequently left undone items were “Treatments and procedures” (3.9%) and “Pain management” (5.6%). Nurses in the North and Center regions of the country were the ones who reported less care left undone due to lack of time. Nurses under the age of 40 were those who reported a highest number of activities left undone.Conclusions: Nurses make selective choices about the care activities that are crucial for the patient. Some activities that may not have an immediate impact on the health of the patients are sidelined, although they may have an impact on other important healthcare quality indicators.

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Impact of the COVID-19 pandemic on core surgical training

Scottish Medical Journal ◽

10.1177/0036933020949217 ◽

2020 ◽

Vol 65 (4) ◽

pp. 133-137 ◽

Cited By ~ 1

Author(s):

Khurram Shahzad Khan ◽

Rona Keay ◽

Morag McLellan ◽

Sajid Mahmud

Keyword(s):

Surgical Training ◽

Teaching Hospital ◽

General Surgery ◽

Negative Impact ◽

Outpatient Clinics ◽

Box Trainer ◽

Surgical Trainees ◽

Long Term Impact ◽

The Impact

Background and aims COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. Methods All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. Results 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. Conclusion COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen.

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IMPACT OF A SIMULATED LAPAROSCOPIC TRAINING PROGRAM IN A THREE-YEAR GENERAL SURGERY RESIDENCY

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1436 ◽

2019 ◽

Vol 32 (2) ◽

Cited By ~ 1

Author(s):

Rodrigo TEJOS ◽

Rubén AVILA ◽

Martin INZUNZA ◽

Pablo ACHURRA ◽

Richard CASTILLO ◽

...

Keyword(s):

Training Program ◽

General Surgery ◽

Learning Curves ◽

Control Group ◽

Clinical Exposure ◽

General Surgery Residency ◽

Laparoscopic Procedures ◽

Group 5 ◽

Surgery Residency Program ◽

Simulated Training

ABSTRACT Background: A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents’ surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by residents in a three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of graduated surgeons were included. Only abdominal procedures in which the graduated surgeons were the primary surgeon were described and analyzed. The control group was of graduated surgeons from 2012 without the laparoscopic simulated training program. Surgical procedures per program year, surgical technique, emergency/elective intervention and hospital-site (main/community hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5; laparoscopic simulated training program=23). Graduated surgeons performed a mean of 372 abdominal procedures, with a higher mean number of medium-to-complex procedures in laparoscopic simulated training program group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic simulated training program performed a higher number of total abdominal procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148, p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the number and complexity of total and laparoscopic procedures in a three-year General Surgery Residency.

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Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0147 ◽

2020 ◽

Vol 102 (6) ◽

pp. 457-462 ◽

Cited By ~ 1

Author(s):

R Patel ◽

AJ Hainsworth ◽

K Devlin ◽

JH Patel ◽

A Karim

Keyword(s):

Teaching Hospital ◽

General Surgery ◽

Trauma Centre ◽

Early Warning Score ◽

Emergency General Surgery ◽

Number Of Patients ◽

Major Trauma Centre ◽

Significant Difference ◽

Group 2 ◽

Group 1

Introduction The COVID-19 pandemic has put significant stress on healthcare systems globally. This study focuses on emergency general surgery services at a major trauma centre and teaching hospital. We aimed to identify whether the number of patients and the severity of their presentation has significantly changed since the implementation of a national lockdown. Materials and methods This study is a retrospective review of acute referrals (from general practice and accident and emergency) to the emergency general surgery team over a 14-day period before (group 1) and during (group 2) lockdown. Results A total of 151 patients were reviewed by the general surgical team in group 1 and 75 in group 2 (a 50.3% reduction). The number of days with symptoms prior to presentation was significantly shorter in group 1 compared with group 2 (3 vs 4, p = 0.04). There was no significant difference in the National Early Warning Score, white blood cell count, lymphocytes and C-reactive protein on admission between the two groups of patients. There were significantly fewer patients admitted after lockdown compared with pre-lockdown (66% vs 48%, p = 0.01). Length of hospital stay was significantly shorter during lockdown compared with pre-lockdown (5 days vs 4 days, p = 0.04). Conclusion Fewer patients were referred and admitted during lockdown compared with pre-lockdown, and the length of stay was also significantly reduced. There was also a delay in presentation to hospital, although these patients were not more unwell based on the scoring criteria used within this study.

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STUDY OF POTENTIAL DRUG INTERACTIONS AMONG EIGHT MAJOR DEPARTMENTS-GENERAL MEDICINE, ORTHOPEDICS, GYNECOLOGY, PULMONOLOGY, GENERAL SURGERY, PSYCHIATRY, OTOLARYNGOLOGY AND DERMATOLOGY OF A TERTIARY CARE TEACHING HOSPITAL IN SOUTHERN INDIA

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2020v12i6.37704 ◽

2020 ◽

pp. 59-67

Author(s):

TALHA JABEEN ◽

MOHD ABDUL KHADER ◽

A. V. KISHORE BABU ◽

A. SRINIVASA RAO

Keyword(s):

Drug Interactions ◽

Teaching Hospital ◽

General Surgery ◽

Tertiary Care ◽

General Medicine ◽

Potential Drug ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Study Population ◽

The Mean

Objective: To identify frequency, type, severity and predictors of potential drug-drug interactions(pDDIs), potential drug-food interactions(pDFIs), potential drug-alcohol interactions(pDAIs) and potential drug-tobacco interactions(pDTIs) and most frequently interacting drug combination pairs in hospitalized patients from departments(depts) of General Medicine(GM), Orthopedic(Ortho), Gynecology(OBG), Pulmonology(Pulmo), General Surgery (GS), Psychiatry (Psych), Otolaryngology(ENT) and Dermatology (Derm) of study population. Methods: A Prospective Observational Study was conducted in eight major dept's of a tertiary care teaching hospital for a period of 6 mo. A sample size of 650 prescriptions reflecting admission no's for each department were used. Results: A total of 650 patients were included in the study. Among them, 282(43.4%) were males and 368(56.6%) were females. The mean age of the study population was 39.67±15.23. A total of 487 pDDIs, 734 pDFIs, 586 pDAIs and 159 pDTIs were found out of 650 hospitalized episodes. OBG showed the highest pDDIs and pDAIs. Highest pDFIs and pDTIs were seen in Pulmo. The majority of DDIs were minor, DFIs and DAIs were moderate and DTIs were of major in severity. Pharmacokinetic types of interactions were seen in the majority of the depts. Logistic regression analysis showed that Polypharmacy was associated with the occurrence of DIs. Most of the DIs repeated several times in particular depts and a list of these combinations was prepared. Conclusion: With the high occurrence of overall DIs and characteristic patterns of DIs combination pairs among different departments of the hospital, the presence of clinical pharmacists in hospitals can play a great role, especially in developing nations like India where their role in hospitalized settings is always controversial.

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