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van Es LJM, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D. Analyzing Learning Curve Effects: Total Ankle Replacement Design Switch and Long-Term Survival. J Foot Ankle Surg 2024; 63:593-597. [PMID: 38909964 DOI: 10.1053/j.jfas.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024]
Abstract
Different aspects of the learning curve in total ankle replacement (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However, its impact on long-term (10- and 15-year) survival remains unclear. Therefore, we retrospectively analyzed 77 consecutive TARs performed by one orthopedic surgeon. The main outcome was long-term survival between cases 1-30 and 31-77 using the Kaplan-Meier with Competing Risk Analyses. Secondarily, we used Moving Average Method with LOESS regression to confirm the learning curve based on the perioperative complications. Thirdly, associations between perioperative complications and operation time on long-term survival were assessed using Cox proportional hazard models. The 10-year survival of cases 1-30 was 89.9% (95% CI 70.4-96.5), and of 31-77, 92.4% (95% CI 7745- 97.5) (p = .58). The 15-year survival was 81.8% (95% CI 59.5-91.8) and 74.8% (95% CI 52.4-86.6), respectively (p = .97). The long-term survival rate for the TAR that endured perioperative complication was 96.70% (95% CI 90.28-103.12), and for the uncomplicated TAR 87.50% (95% CI 77.12-97.88%) (p = .24). Operating time nor occurrence of perioperative fractures were significantly associated with long-term survival (p = .11 and 0.26, respectively). However, moving average method revealed a significant decreasing trend with a cut-off value of 33 procedures regarding the marginal probability of perioperative osseous complications (p < .01). In conclusion, surgeons should note a learning curve when adapting arthroplasty procedures. After the prosthesis design switch, the learning curve regarding perioperative osseous complications was confirmed at 33 TAR. The switch did not affect long-term survival.
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Affiliation(s)
- Laurian J M van Es
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands; Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Program Sports and Musculoskeletal Health, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports, International Olympic Committee Research Centers, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands
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Cabral S. Unlocking Transcatheter Aortic Valve Replacement Expertise in Brazil: Lessons from National Data. Arq Bras Cardiol 2024; 121:e20240302. [PMID: 39140560 PMCID: PMC11341207 DOI: 10.36660/abc.20240302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Sofia Cabral
- Centro Hospitalar Universitário de Santo AntónioPortoPortugalCentro Hospitalar Universitário de Santo António, Porto - Portugal
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Hecht CJ, Porto JR, Sanghvi PA, Homma Y, Sculco PK, Kamath AF. Contemporary analysis of the learning curve for robotic-assisted total hip arthroplasty emerging technologies. J Robot Surg 2024; 18:160. [PMID: 38578350 DOI: 10.1007/s11701-024-01928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
Robotic assisted (RA) total hip arthroplasty (THA) offers improved acetabular component placement and radiographic outcomes, but inconsistent assessment methods of its learning curves render the evaluation of adopting novel platforms challenging. Therefore, we conducted a systematic review to assess the learning curve associated with RA-THA, both tracking a surgeon's performance across initial cases and comparing their performance to manual THA (M-THA). PubMed, MEDLINE, EBSCOhost, and Google Scholar were searched on June 16, 2023, to identify studies published between January 1, 2000 and June 16, 2023 (PROSPERO registration: CRD42023437339). The query yielded 655 unique articles, which were screened for eligibility. The final analysis included 11 articles, evaluating 1351 THA procedures. Risk of bias was assessed via the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean MINORS score was 21.3 ± 0.9. RA-THA provided immediate improvements in acetabular component placement accuracy and radiographic outcomes compared to M-THA, with little to no experience required to achieve peak proficiency. A modest learning curve (12-17 cases) was associated with operative time, which was elevated compared to M-THA (+ 9-13 min). RA-THA offers immediate advantages to M-THA for component placement accuracy and radiographic outcomes. Surgeons should expect to experience increased operative times, which become less pronounced or equivalent to M-THA after a modest caseload.
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Affiliation(s)
- Christian J Hecht
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Joshua R Porto
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Parshva A Sanghvi
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Hecht Ii CJ, Porto JR, Sanghvi PA, Homma Y, Sculco PK, Kamath AF. Navigating the learning curve: assessing caseload and comparing outcomes before and after the learning curve of computer-navigated total hip arthroplasty. J Robot Surg 2024; 18:104. [PMID: 38430388 PMCID: PMC10908601 DOI: 10.1007/s11701-024-01855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Computer-navigated (CN) total hip arthroplasty (THA) offers improved acetabular component placement and radiographic outcomes, but inconsistent assessment methods of its learning curves render the evaluation of adopting a novel platform challenging. Therefore, we conducted a systematic review to assess the learning curve associated with CN-THA, both tracking a surgeon's performance across initial cases and comparing their performance to manual THA (M-THA). METHODS A search was conducted using PubMed, MEDLINE, EBSCOhost, and Google Scholar on June 16, 2023 to find research articles published after January 1, 2000 (PROSPERO registration: CRD4202339403) that investigated the learning curve associated with CN-THA. 655 distinct articles were retrieved and subsequently screened for eligibility. In the final analysis, nine publications totaling 847 THAs were evaluated. The Methodological Index for Nonrandomized Studies (MINORS) tool was utilized to evaluate the potential for bias, with the mean MINORS score of 21.3 ± 1.2. RESULTS CN-THA showed early advantages to M-THA for component placement accuracy and radiographic outcomes but longer operative times (+ 3- 20 min). There was a learning curve required to achieve peak proficiency in these metrics, though mixed methodologies made the required caseload unclear. CONCLUSIONS CN-THA offers immediate advantages to M-THA for component placement accuracy and radiographic outcomes, though CN-THA's advantages become more pronounced with experience. Surgeons should anticipate longer operative times during the learning curve for CN-THA, which lessen following a modest caseload. A more thorough evaluation of novel computer-navigated technologies would be enhanced by adopting a more uniform method of defining learning curves for outcomes of interest. Registration PROSPERO registration of the study protocol: CRD42023394031, 27 June 2023.
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Affiliation(s)
- Christian J Hecht Ii
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA
| | - Joshua R Porto
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA
| | - Parshva A Sanghvi
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA.
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Lin Z, Chen X, Xu Z, Chen L, Dai X. Comparison of post-operative pain and quality of life between total thoracoscopic surgery and conventional full-sternotomy for aortic valve replacement. BMC Cardiovasc Disord 2023; 23:580. [PMID: 38001480 PMCID: PMC10675860 DOI: 10.1186/s12872-023-03617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND To compare the post-operative pain and quality of life of patients who underwent total thoracoscopic surgery (TTS) or conventional full-sternotomy (CFS) for aortic valve replacement (AVR). METHODS We reviewed the records of 223 consecutive AVR patients with either TTS or CFS from January 2018 to December 2022. We used a visual analogue scale (VAS) and the Short Form-36 Health Survey (SF-36) to measure the post-operative pain and quality of life, respectively. We also compared the operative data and clinical outcomes between the two groups. RESULTS The TTS group had lower adjusted mean VAS scores than the CFS group at all time points after surgery (at 1 to 3 days and at 3 and 6 months, p < .001 for all comparisons), indicating less pain. The TTS group also had higher mean SF-36 scores than the CFS group up to 6 months after surgery (p < .001 for all comparisons), indicating better quality of life. The operative time was similar between the two groups (p = .224), but the TTS group had longer cardiopulmonary bypass time and aortic cross-clamp time than the CFS group (p < .001). The TTS group had more pulmonary complications than the CFS group (p = .023). However, there were no significant differences in other major complications or mortality between the two groups. CONCLUSIONS TTS is a safe and effective alternative to CFS for AVR. TTS resulted in less pain and better quality of life, especially in the early recovery period. However, further prospective randomized controlled studies are needed to confirm our findings.
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Affiliation(s)
- Zhiqin Lin
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29#, Fuzhou, 350001, P. R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, P. R. China
| | - Xiujun Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29#, Fuzhou, 350001, P. R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, P. R. China
| | - Zheng Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29#, Fuzhou, 350001, P. R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, P. R. China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29#, Fuzhou, 350001, P. R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, P. R. China
| | - Xiaofu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29#, Fuzhou, 350001, P. R. China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, P. R. China.
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Kunakornsawat W, Serichetaphongse P, Arunjaroensuk S, Kaboosaya B, Mattheos N, Pimkhaokham A. Training of novice surgeons using dynamic computer assisted dental implant surgery: An exploratory randomized trial. Clin Implant Dent Relat Res 2023. [PMID: 36958848 DOI: 10.1111/cid.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Dynamic Computer Assisted Implant Surgery (CAIS) systems have been shown to improve accuracy of implant placement, thus training in the use of such systems is becoming increasingly important. There is a scarcity of research on how to implement dynamic CAIS training in the settings of postgraduate university education. PURPOSE To determine the effectiveness of two modes of CAIS training programs on motor skill acquisition of novice surgeons. MATERIALS AND METHODS Thirty-six postgraduate students without experience in dynamic CAIS systems were randomly assigned to a distributed training program (3 training sessions over 3 days) or a massed training (3 training sessions over the same day). A post-test involving the placement of one implant was conducted for both groups, 7 days after completion of the training. Surgical time and implant accuracy were recorded and analyzed, using independent t-tests, with 0.05 significant level. RESULTS Both groups reached the accuracy benchmarks expected by current standards in the use of CAIS. No significant differences with regards to accuracy were found between the groups, but a trend was documented favoring performance of distributed (mean difference-0.4, 95% confidence interval-0.7-0.1) in the accuracy at platform level. Distributed training students performed faster than massed for the third trial (mean difference-95.0, 95% confidence interval-178.8 to -11.2). CONCLUSIONS Novice students reached the accuracy benchmarks with the use of CAIS through both a massed and a distributed training program, while there was a strong but marginally not significant trend for higher accuracy in the distributed group. Students who received the training in the distributed format over the process of different days, performed faster. Trial registered in Thai Clinical Trials Registry: https://www.thaiclinicaltrials.org/show/TCTR20230109002. This clinical trial was not registered prior to participant recruitment and randomization.
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Affiliation(s)
- Wirawat Kunakornsawat
- Esthetic Restorative and Implant Dentistry Program, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Pravej Serichetaphongse
- Esthetic Restorative and Implant Dentistry Program, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sirida Arunjaroensuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Boosana Kaboosaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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The effect of implant surgery experience on the learning curve of a dynamic navigation system: an in vitro study. BMC Oral Health 2023; 23:89. [PMID: 36782192 PMCID: PMC9926829 DOI: 10.1186/s12903-023-02792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Dynamic navigation systems have a broad application prospect in digital implanting field. This study aimed to explore and compare the dynamic navigation system learning curve of dentists with different implant surgery experience through dental models. METHODS The nine participants from the same hospital were divided equally into three groups. Group 1 (G1) and Group 2 (G2) were dentists who had more than 5 years of implant surgery experience. G1 also had more than 3 years of experience with dynamic navigation, while G2 had no experience with dynamic navigation. Group 3 (G3) consisted of dentists with no implant surgery experience and no experience with dynamic navigation. Each participant sequentially placed two implants (31 and 36) on dental models according to four practice courses (1-3, 4-6, 7-9, 10-12 exercises). Each dentist completed 1-3, 4-6 exercises in one day, and then 7-9 and 10-12 exercises 7 ± 1 days later. The preparation time, surgery time and related implant accuracy were analyzed. RESULTS Three groups placed 216 implants in four practice courses. The regressions for preparation time (F = 10.294, R2 = 0.284), coronal deviation (F = 4.117, R2 = 0.071), apical deviation (F = 13.016, R2 = 0.194) and axial deviation (F = 30.736, R2 = 0.363) were statistically significant in G2. The regressions for preparation time (F = 9.544, R2 = 0.269), surgery time (F = 45.032, R2 = 0.455), apical deviation (F = 4.295, R2 = 0.074) and axial deviation (F = 21.656, R2 = 0.286) were statistically significant in G3. Regarding preparation and surgery time, differences were found between G1 and G3, G2 and G3. Regarding implant accuracy, differences were found in the first two practice courses between G1 and G3. CONCLUSIONS The operation process of dynamic navigation system is relatively simple and easy to use. The linear regression analysis showed there is a dynamic navigation learning curve for dentists with or without implant experience and the learning curve of surgery time for dentists with implant experience fluctuates. However, dentists with implant experience learn more efficiently and have a shorter learning curve.
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Martinho FC, Aldahmash SA, Cahill TY, Gupta S, Dianat O, Mostoufi B, Price JB, Griffin I, Tordik PA. Comparison of the accuracy and efficiency of a 3D dynamic navigation system for osteotomy root-end resection performed by novice and experienced endodontists. J Endod 2022; 48:1327-1333.e1. [PMID: 35839859 DOI: 10.1016/j.joen.2022.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022]
Abstract
AIM To investigate whether the 3D-dynamic navigation system (3D-DNS) can improve experienced endodontists' (EEs') and novice endodontists' (NEs') accuracy and efficiency in osteotomy and root-end resection (RER) and to verify that the 3D-DNS enables NEs to perform osteotomy and RER as accurately and efficiently as EEs. METHODS Seventy-six roots in cadaver heads were randomly divided into four groups: 3D-DNS-NE, 3D-DNS-EE, Freehanded (FH)-NE, and FH-EE (all, n=19). CBCT scans were taken pre- and postoperatively. Osteotomy and RER were planned virtually in the X-guided software (X-Nav Technologies, Lansdale). Accuracy was calculated by measuring the 2D and 3D virtual deviations and angular deflection (AD) using superimposing software (X-Nav technologies). Efficiency was determined by time of operation and the number of mishaps. RESULTS Accuracy deviations were significantly less in the 3D-DNS-EE group than in the FH-EE group (p<.05). We found lessened 2D and 3D accuracy deviations comparing the 3D-DNS-NE group to the FH-NE group (p<.05). The time required for osteotomy and RER with the 3D-DNS was ∼ ½ of that required for the FH method for both EEs and NEs (p<.05). We found no difference in the number of mishaps between the 3D-DNS and FH groups for EEs and NEs (p>.05). CONCLUSIONS The 3D-DNS improved EEs' and NEs' accuracy and efficiency in osteotomy and RER. The NEs were as efficient as the EEs using 3D-DNS. Notably, the 3D-DNS improved the NEs' accuracy compared to FH method but the 3D-DNS did not enable the NEs to perform osteotomy and RER as accurately as the EEs.
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Affiliation(s)
- Frederico C Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland.
| | - Sara A Aldahmash
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Thomas Y Cahill
- School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Swati Gupta
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Centreville Endodontics, Centreville, Virginia
| | - Behzad Mostoufi
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland
| | - Jeffery B Price
- Clinical Professor & Director of Oral Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Ina Griffin
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Patricia A Tordik
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
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Prins JTH, Leasia K, Sauaia A, Burlew CC, Cohen MJ, Coleman JJ, Lawless RA, Platnick KB, Werner NL, Wijffels MME, Moore EE, Pieracci FM. A decade of surgical stabilization of rib fractures: the effect of study year on patient selection, operative characteristics, and in-hospital outcome. Injury 2022; 53:1637-1644. [PMID: 34953578 DOI: 10.1016/j.injury.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/11/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many centers now perform surgical stabilization of rib fractures (SSRF). This single center study aimed to investigate temporal trends by year in patient selection, operative characteristics, and in-hospital outcomes We hypothesized that, over time, patient selection, time to SSRF, operative time, and in-hospital outcomes varied significantly. METHODS A retrospective review of a prospectively maintained SSRF database (2010 to 2020) was performed. Patients were stratified by year in which they underwent SSRF. The primary outcome was operative time, defined in minutes from incision to closure. Secondary outcomes were patient and operative characteristics, and in-hospital outcomes. Multivariable regression analyses were performed to assess for temporal trends, corrected for confounders. The outcomes ventilator-, Intensive Care Unit-, and hospital-free days (VFD, IFD, and HFD, respectively) were categorized based on the group's medians, and complications were combined into a composite outcome. RESULTS In total, 222 patients underwent SSRF on a median of one day after admission (P25-P75, 0-2). Patients had a median age of 54 years (P25-P75, 42-63), ISS of 19 (P25-P75, 13-26), RibScore of 3 (P25-P75, 2-5), and sustained a median of 8 fractured ribs (P25-P75, 6-11). In multivariable analysis, increasing study year was associated with an increase in operative time (p<0.0001). In addition, study year was associated with a significantly reduced odds of complications (Odds ratio [OR], 0.76; 95% Confidence Interval [95% CI], 0.63-0.92; p=0.005), VFD < 28 days (OR, 0.77; 95% CI, 0.65-0.92; p=0.003), IFD < 24 days (OR, 0.77; 95% CI, 0.66-0.91; p=0.002), and HFD < 18 days (OR, 0.64; 95% CI, 0.53-0.76; p<0.0001). CONCLUSION In-hospital outcomes after SSRF improved over time. Unexpectedly, operative time increased. The reason for this finding is likely multifactorial and may be related to patient selection, onboarding of new surgeons, fracture characteristics, and minimally invasive exposures. Due to potential for confounding, study year should be accounted for when evaluating outcomes of SSRF.
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Affiliation(s)
- Jonne T H Prins
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Kiara Leasia
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Angela Sauaia
- Department of Surgery, Colorado School of Public Health, University of Colorado, Denver, Colorado, United States.
| | - Clay C Burlew
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Mitchell J Cohen
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Jamie J Coleman
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Ryan A Lawless
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - K Barry Platnick
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Nicole L Werner
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Mathieu M E Wijffels
- Trauma Research Unit Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Ernest E Moore
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
| | - Fredric M Pieracci
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, United States.
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Kang MK, Kang DK, Heo W, Hwang YH. The Learning Curves of Uniportal Video-Assisted Thoracoscopic Surgery Lobectomy: A Single Center Experience. J Laparoendosc Adv Surg Tech A 2021; 32:606-611. [PMID: 34714148 DOI: 10.1089/lap.2021.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Backgrounds: The aim of our study is to describe the learning curve for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy from our single center's experience for adopting it because uniportal VATS is generally considered a technically difficult procedure. Methods: A retrospective review of all 164 consecutive patients who underwent uniportal VATS lobectomy between June 2015 and February 2020 was done. A cumulative summation (CUSUM) method was applied to evaluate the learning curves of the operation time. Results: Among the 164 patients, the CUSUM value inflected at the 31st case. Ninety-five consecutive patients underwent uniportal VATS upper lobectomy. The other 69 consecutive patients underwent uniportal VATS lower lobectomy. The operation time CUSUM learning curve analysis revealed that the curves descended from the 21st case in upper lobectomy group and the 12th case in lower lobectomy group. Conclusion: Operators are required to experience at least 21 cases for upper lobectomy and 12 cases for lower lobectomy until the operation time is stabilized.
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Affiliation(s)
- Min Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woon Heo
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Youn-Ho Hwang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Galvao Neto M, Jerez J, Brunaldi VO, Cabrera D, Benavides C, Moreno M, Romero G, Guiatara D, Abu Dayyeh BK. Learning Process Effectiveness During the COVID-19 Pandemic: Teleproctoring Advanced Endoscopic Skills by Training Endoscopists in Endoscopic Sleeve Gastroplasty Procedure. Obes Surg 2021; 31:5486-5493. [PMID: 34664148 PMCID: PMC8523006 DOI: 10.1007/s11695-021-05757-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 01/29/2023]
Abstract
Background and Aims The COVID‐19 pandemic has led health institutions to cancel many of the activities including training in different fields. Most practices and training programs have been encouraged to use teleproctoring as an alternative method to enhance physician’s ability and assure training. We aimed to evaluate remote training program for endoscopy sleeve gastroplasty (ESG). Methods Ten consecutive patients underwent an endoscopic sleeve gastroplasty procedure guided by a proctor expert using an online platform. A stepwise approach was created to assure skill acquisition. Results All cases were safely performed with no serious adverse events under teleproctoring. The average surgical and suturing times significantly decreased during the training model. From the first 5 cases to the last 5 ones, the endoscopic procedure time decreased from 120 to 93.4 min while suturing time from 92.8 to 68.4 min. The effect size was large in both cases, and the changes were meaningful according to the fitted learning curves. Conclusions The proposed teleproctoring program was effective to deliver advanced endoscopic skills such as endosuturing for ESG, despite the restrictions imposed by the COVID-19 pandemic. Graphical abstract ![]()
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Affiliation(s)
- Manoel Galvao Neto
- Division of Gastrointestinal Endoscopy, ABC Medical School, São Paulo, Brazil
| | - Jonathan Jerez
- Diagnostic and Therapeutic Gastroenterology Amazon Region, Puyo, Ecuador
| | - Vitor Ottoboni Brunaldi
- Center for Digestive Endoscopy, Surgery and Anatomy Department, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, Brazil.
| | - David Cabrera
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Christian Benavides
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Monica Moreno
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Ginesio Romero
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Daniela Guiatara
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Whittaker G, Salmasi MY, Aydin A, Magouliotis D, Raja SG, Asimakopoulos G, Moorjani N, Athanasiou T. Recommendations for the use of coronary and valve simulators in cardiac surgical training: a systematic review. Eur J Cardiothorac Surg 2021; 61:1-10. [PMID: 34337649 DOI: 10.1093/ejcts/ezab350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to systematically review the simulators that are currently available for coronary artery bypass graft and valve surgery and, in addition, to review the validation evidence supporting them and to recommend several simulators for training based on the analysis of results. METHODS A systematic literature search of the MEDLINE® (1946 to May 2021) and EMBASE® (1947 to May 2021) databases was performed to identify simulators for coronary artery and valvular procedures in cardiothoracic surgery. A selection of keywords and MeSH terms was used to execute the literature search. After identification of relevant articles, data were extracted and analysed. RESULTS Thirty-seven simulators were found in 31 articles. Simulators were found for coronary artery bypass graft (n = 24) and valve surgery (n = 13). The majority of models were either benchtop (n = 28) or hybrid (n = 8) modalities. Evidence of validity was demonstrated in 15 (40.5%) simulators. Twenty-two (59.5%) simulators had no validation evidence, and 1 (2.7%) simulator had 3 or more elements of validity established. CONCLUSIONS Two simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills' development whereas high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilized in early training, at which point the learning curve of trainees is steepest.
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Affiliation(s)
- George Whittaker
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | | | - Shahzad G Raja
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - George Asimakopoulos
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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13
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Spille J, Jin F, Behrens E, Açil Y, Lichtenstein J, Naujokat H, Gülses A, Flörke C, Wiltfang J. Comparison of implant placement accuracy in two different preoperative digital workflows: navigated vs. pilot-drill-guided surgery. Int J Implant Dent 2021; 7:45. [PMID: 33928447 PMCID: PMC8085150 DOI: 10.1186/s40729-021-00322-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background The aim of the study is to evaluate the accuracy of a new implant navigation system on two different digital workflows. Methods A total of 18 phantom jaws consisting of hard and non-warping plastic and resembling edentulous jaws were used to stimulate a clinical circumstance. A conventional pilot-drill guide was conducted by a technician, and a master model was set by using this laboratory-produced guide. After cone beam computed tomography (CBCT) and 3D scanning of the master models, two different digital workflows (marker tray in CBCT and 3D-printed tray) were performed based on the Digital Imaging Communication in Medicine files and standard tessellation language files. Eight Straumann implants (4.1 mm × 10 mm) were placed in each model, six models for each group, resulting in 144 implant placements in total. Postoperative CBCT were taken, and deviations at the entry point and apex as well as angular deviations were measured compared to the master model. Results The mean total deviations at the implant entry point for MTC (marker tray in CBCT), 3dPT (3d-printed tray), and PDG (pilot-drill guide) were 1.024 ± 0.446 mm, 1.027 ± 0.455 mm, and 1.009 ± 0.415 mm, respectively, and the mean total deviations at the implant apex were 1.026 ± 0.383 mm, 1.116 ± 0.530 mm, and 1.068 ± 0.384 mm. The angular deviation for the MTC group was 2.22 ± 1.54°. The 3dPT group revealed an angular deviation of 1.95 ± 1.35°, whereas the PDG group showed a mean angular deviation of 2.67 ± 1.58°. Although there were no significant differences among the three groups (P > 0.05), the navigation groups showed lesser angular deviations compared to the pilot-drill-guide (PDG) group. Implants in the 3D-printed tray navigation group showed higher deviations at both entry point and apex. Conclusions The accuracy of the evaluated navigation system was similar with the accuracy of a pilot-drill guide. Accuracy of both preoperative workflows (marker tray in CBCT or 3D-printed tray) was reliable for clinical use.
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Affiliation(s)
- Johannes Spille
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Feilu Jin
- Department of oral and Maxillofacial Surgery, School of Medicine, 2nd Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Eleonore Behrens
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Yahya Açil
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jürgen Lichtenstein
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Hendrik Naujokat
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Christian Flörke
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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Howard NM, Cook DA, Hatala R, Pusic MV. Learning Curves in Health Professions Education Simulation Research: A Systematic Review. Simul Healthc 2021; 16:128-135. [PMID: 32675731 DOI: 10.1097/sih.0000000000000477] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
SUMMARY STATEMENT Learning curves are used in health professions education to graphically represent paths to competence and expertise. However, research using learning curves often omit important information. The authors conducted a systematic review of the reporting quality of learning curves in simulation-based education research to identify specific areas for improvement. Reviewers extracted information on graphical, statistical, and conceptual elements. The authors identified 230 eligible articles. Most learning curve elements were reported infrequently, including use of an optimal linking function, detailed description of feedback or learning intervention, use of advanced visualization techniques such as overlaying and stacking, and depiction of competency thresholds. Reporting did not improve over time for most elements. Reporting of learning curves in health professions education research is incomplete and often underutilizes their desirable properties. Recommendations for improvement of the statistical, graphical, and conceptual reporting of learning curves, as well as applications to simulation research and education, are presented.
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Affiliation(s)
- Neva M Howard
- From the University of North Carolina Chapel Hill School of Medicine (N.M.H.), Chapel Hill, NC; Center for Online Learning (D.A.C.), Mayo Clinic College of Medicine; Division of General Internal Medicine (D.A.C.), Mayo Clinic, Rochester, MN; Department of Medicine (R.H.), University of British Columbia, Vancouver, British Columbia, Canada; and Division of Learning Analytics (M.V.P.), NYU School of Medicine, New York, NY
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15
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Cassetta M, Altieri F, Giansanti M, Bellardini M, Brandetti G, Piccoli L. Is there a learning curve in static computer-assisted implant surgery? A prospective clinical study. Int J Oral Maxillofac Surg 2020; 49:1335-1342. [PMID: 32217033 DOI: 10.1016/j.ijom.2020.03.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 12/11/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
Static computer-assisted surgery (s-CAS) has been introduced to improve the results of implantology. A prospective cohort study was conducted following the STROBE guidelines to determine the presence of a learning curve in s-CAS. Six partially and six totally edentulous patients were treated by two surgeons experienced in implantology but completely inexperienced in s-CAS. Preoperative and postoperative computed tomography scans were matched to assess coronal, apical, and angular deviation and the positioning error. The accuracy data were used to evaluate the learning curve. Fifty-six implants were inserted. In partially and totally edentulous patients, the mean (range; standard deviation) coronal deviation was 0.87 (0.34-1.27; 0.35) and 1.24 (0.72-2.67; 0.79); the mean apical deviation was 1.13 (0.48-1.63; 0.39) and 1.52 (0.88-3.84; 1.15); the mean angular deviation was 2.63 (1.89-4.50; 0.98) and 3.59 (1.69-6.30; 1.65); and the mean positioning error was 0.80 (0.32-1.25; 0.35) and 1.14 (0.35-2.56; 0.77), respectively. A typical 'learning curve' effect was not identified for s-CAS.
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Affiliation(s)
- M Cassetta
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Rome, Italy.
| | - F Altieri
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Rome, Italy
| | - M Giansanti
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Rome, Italy
| | - M Bellardini
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Rome, Italy
| | - G Brandetti
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Rome, Italy
| | - L Piccoli
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Rome, Italy
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16
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Coventry CA, Dominguez L, Read DJ, Trelles M, Ivers RQ, Montazerolghaem M, Holland AJA. Comparison of Operative Logbook Experience of Australian General Surgical Trainees With Surgeons Deployed on Humanitarian Missions: What Can Be Learnt for the Future? JOURNAL OF SURGICAL EDUCATION 2020; 77:131-137. [PMID: 31451427 DOI: 10.1016/j.jsurg.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE General surgical training in Australia has undergone considerable change in recent years with less exposure to other areas of surgery. General surgeons from many high-income countries have played important roles in assisting with the provision of surgical care in low- and middle-income countries during sudden-onset disasters (SODs) as part of emergency medical teams (EMTs). It is not known if contemporary Australian general surgeons are receiving the broad surgical training required for work in EMTs. DESIGN Logbook data on the surgical procedures performed by Australian general surgical trainees were obtained from General Surgeons Australia (GSA) for the time period February 2008 to February 2017. Surgical procedures performed by Médecins sans Frontières (MSF) surgeons during 5 projects in 3 SODs (the 2010 Haiti earthquake, the 2013 Philippines typhoon and the 2015 Nepal earthquake) were obtained from previously published data for 6 months following each disaster. SETTING AND PARTICIPANTS This was carried out at the University of Sydney with input from MSF Operational Centre Brussels and GSA. RESULTS Australian general surgical trainees performed a mean of 2107 surgical procedures (excluding endoscopy) during their training (10 6-month rotations). Common procedures included abdominal wall hernia repairs (268, 12.7%), cholecystectomies (247, 11.8%), and specialist colorectal procedures (242, 11.5%). MSF surgeons performed a total of 3542 surgical procedures across the 5 projects analyzed. Common procedures included Caesarean sections (443, 12.5%), wound debridement (1115, 31.5%), and other trauma-related procedures (472, 13.3%). CONCLUSIONS Australian general surgical trainees receive exposure to both essential and advanced general surgery but lack exposure to specialty procedures including the obstetric and orthopedic procedures commonly performed by MSF surgeons after SODs. Further training in these areas would likely be beneficial for general surgeons prior to deployment with an EMT.
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Affiliation(s)
- Charles A Coventry
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - Lynette Dominguez
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, NT, Australia
| | - Miguel Trelles
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Andrew J A Holland
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
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17
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Quirke K, Aydin A, Brunckhorst O, Bultitude M, Khan MS, Dasgupta P, Sarica K, Ahmed K. Learning Curves in Urolithiasis Surgery: A Systematic Review. J Endourol 2019; 32:1008-1020. [PMID: 30039711 DOI: 10.1089/end.2018.0425] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND AIMS Procedures for urolithiasis are a core part of the development for the urologist in training. Understanding the learning curve of the procedures is important, allowing for planning in the training and assessment of trainees. The aim of this study was to systematically review the literature pertaining to learning curves in urolithiasis surgery. MATERIALS AND METHODS The review was registered on the PROSPERO database and conducted in keeping with the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. Embase, MEDLINE, and PsycINFO were systematically searched from inception to January 2018, with a reference review conducted. All empirical studies on learning curves in urolithiasis surgery were included irrespective of procedure. Articles describing pediatric surgery, nontechnical skills in surgery, or those not written in English were excluded. RESULTS Of 390 articles identified from screening, a final 18 studies were included. Fourteen studies identified the learning curve in percutaneous nephrolithotomy. These studies identified a learning curve of between 30 and 60 cases for both operative time (OT) and complication rates. Four articles focused on flexible ureteroscopy (FURS); the learning curve for FURS has been outlined as 60 cases for OT and 56 cases for fragmentation efficacy. CONCLUSIONS The complexities of determining learning curves are extensive; studies use different parameters to measure outcomes and observe skill acquisition rates of surgeons with differing prior experience. Evidence in this article can guide trainee urologists with regard to the expected rate of progress. Multi-operator multicenter research utilizing standard outcome measures should be conducted to establish definitive learning curves.
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Affiliation(s)
- Kate Quirke
- 1 MRC Centre for Transplantation, King's College London , London, United Kingdom
| | - Abdullatif Aydin
- 1 MRC Centre for Transplantation, King's College London , London, United Kingdom
| | - Oliver Brunckhorst
- 1 MRC Centre for Transplantation, King's College London , London, United Kingdom .,2 Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital Campus , London, United Kingdom
| | - Matthew Bultitude
- 3 Department of Urology, Guy's and St. Thomas' NHS Foundation Trust , London, United Kingdom
| | - M Shamim Khan
- 1 MRC Centre for Transplantation, King's College London , London, United Kingdom .,3 Department of Urology, Guy's and St. Thomas' NHS Foundation Trust , London, United Kingdom
| | - Prokar Dasgupta
- 1 MRC Centre for Transplantation, King's College London , London, United Kingdom .,3 Department of Urology, Guy's and St. Thomas' NHS Foundation Trust , London, United Kingdom
| | - Kemal Sarica
- 4 Department of Urology, Kafkas University Medical School , Kars, Turkey
| | - Kamran Ahmed
- 1 MRC Centre for Transplantation, King's College London , London, United Kingdom .,3 Department of Urology, Guy's and St. Thomas' NHS Foundation Trust , London, United Kingdom
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Tannyhill RJ, Jensen OT. Computer Simulation Training for Mandibular All-on-Four/All-on-Three Surgery. Oral Maxillofac Surg Clin North Am 2019; 31:505-511. [PMID: 31104949 DOI: 10.1016/j.coms.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mandibular all-on-4 implant reconstruction techniques are less complex than maxillary but more complex than routine dental implant surgery, requiring advanced technical skills, deeper understanding of prosthodontic principles, and more complex surgical planning. Surgical simulation may assist experienced surgeons seeking to acquire new skills through increased planning ability, improved intraspecialty communication, and enhanced technical competence. Achieving competence is different for the trainee devoted to the learning process and the practicing surgeon with limited time and balancing other roles and responsibilities. Well-constructed continuing education incorporating simulation, 3-dimensional printed models, and computer-assisted planning may offer the most efficient path to competence.
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Affiliation(s)
- R John Tannyhill
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Warren 1201, Boston, MA 02114, USA.
| | - Ole T Jensen
- Department of Oral Maxillofacial Surgery, University of Utah, School of Dentistry, 530 Wakara Way, Salt Lake City, Utah 84108, USA
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Yuan H, Zhu J, Sun Z, Zhang Z. [Comparison of effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:14-19. [PMID: 29806358 DOI: 10.7507/1002-1892.201707121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty (THA). Methods Between January 2016 and December 2016, 84 patients with hip disease were included in the study and randomly divided into 2 groups. Forty patients were treated with THA via SuperPATH approach (SuperPATH group), and 44 patients were treated with THA via posterolateral approach (PSA group). There was no significant difference in gender, age, body mass index, the type of disease, the complicating diseases, and preoperative thrombosis of lower extremity and Harris score between 2 groups ( P>0.05). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, unloaded activity time, Harris score, and short-form 36 health survey scale (SF-36) score were compared. The postoperative X-ray films were used to observe the position of joint prosthesis. Results All patients were followed up 6-18 months (mean, 10.3 months). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, and unloaded activity time in SuperPATH group were significantly superior to those in PSA group ( P<0.05). The Harris score at 2 weeks and 1 month after operation were significantly higher in SuperPATH group than that in PSA group ( P<0.05). But there was no significant difference in the Harris scores at 3 and 6 months after operation between 2 groups ( P>0.05). At last follow-up, the SF-36 scores were higher in SuperPATH group than those in PSA group ( P<0.05). Postoperative X-ray films showed the joint prosthesis was in good position. Conclusion THA via SuperPATH approach has the advantages of minimal invasion, safe, and rapid recovery, which is better than THA via posterolateral approach.
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Affiliation(s)
- Hongmou Yuan
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Shenyang Liaoning, 110032, P.R.China
| | - Jiajun Zhu
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Shenyang Liaoning, 110032, P.R.China
| | - Zhenguo Sun
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Shenyang Liaoning, 110032, P.R.China
| | - Zhiyu Zhang
- Department of Orthopedics, the Fourth Affiliated Hospital of China Medical University, Shenyang Liaoning, 110032,
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Liu X, Chen X, Shen Y, Wang H, Feng M, Tan L, D'Amico TA. Learning curve for uniportal video-assisted thoracoscopic surgery lobectomy-results from 120 consecutive patients. J Thorac Dis 2018; 10:5100-5107. [PMID: 30233885 DOI: 10.21037/jtd.2018.08.87] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Uniportal video-assisted thoracoscopic surgery (VATS) is considered a technically demanding procedure. The learning curve, which directly influences the adoption of uniportal VATS, has not been described. In this study, we aimed to describe the learning curve for uniportal VATS lobectomy from our single center's experience. Methods Uniportal VATS lobectomy was started in October 2013 in Zhongshan Hospital, Fudan University. Since then, a total of 120 consecutive patients who underwent uniportal VATS lobectomy were retrospectively enrolled. Surgical videos were reviewed to determine the operation time, to which cumulative sum (CUMSUM) method was applied to evaluate the learning phases of the procedure. Accordingly, patients' clinical features in different phases were collected and compared to determine the learning curve for uniportal VATS lobectomy. Results Among the 120 consecutive patients reviewed from October 2013 to September 2014, the CUMSUM curve showed its inflection at patient number 44: the first 30 patients were in the ascending phase, the second 30 patients were in the plateau phase, and the remaining patients were in the descending phase. Comparable CUMSUM results were recorded both from upper and not-upper lobectomy. Intra-operatively, more repeated stapler attempts (73% versus 13% and 5%, P<0.001) and higher conversion rate (17% versus 7% and 2%, P=0.028) were recorded in ascending phase vs. the plateau phase and descending phase, respectively. Post-operatively, the morbidity, mortality and the length of hospital stay were similar before and after the learning curve cases. Conclusions In a center with conventional VATS experience, the learning period of uniportal VATS lobectomy was characterized by repeated stapler attempts, and the volume requirements would be approximately 30 cases to reach the performance plateau. Upper lobectomy seemed not more difficult to learn than lower or middle lobectomy in uniportal VATS.
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Affiliation(s)
- Xiaochuan Liu
- Department of Thoracic Surgery, Guangan People's Hospital, Guangan 638000, China
| | - Xiaosang Chen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Thomas A D'Amico
- Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
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Jaffe TA, Hasday SJ, Knol M, Pradarelli J, Pavuluri Quamme SR, Greenberg CC, Dimick JB. Strategies for New Skill Acquisition by Practicing Surgeons. JOURNAL OF SURGICAL EDUCATION 2018; 75:928-934. [PMID: 28974428 DOI: 10.1016/j.jsurg.2017.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/27/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To understand how practicing surgeons utilize available training methods, which methods are perceived as effective, and important barriers to using more effective methods. DESIGN Online survey designed to characterize surgeon utilization and perception of available training methods. SETTING Two large Midwestern academic health centers. PARTICIPANTS 150 faculty surgeons. METHODS Nominal values were compared using a McNemar's Test and Likert-like values were compared using a paired t-test (IBM SPSS Statistics v. 21.0; New York, NY). RESULTS Survey response rate was 81% (122/150). 98% of surgeons reported learning a new procedure or technology after formal training. Many surgeons reported scrubbing in expert cases (78%) and self-directed study (66%), while few surgeons (6%) completed a mini-fellowship. The modalities used most commonly were scrubbing in expert cases (34%) and self-directed study (27%). Few surgeons (7%) believed self-directed study would be most effective, whereas 31% and 16% believed operating under supervision and mini-fellowships would be most effective, respectively. Surgeons believed more effective methods "would require too much time" or they had "confidence in their ability to implement safely." CONCLUSIONS Practicing surgeons use a variety of training methods when learning new procedures and technologies, and there is disconnect between commonly used training methods and those deemed most effective. Confidence in surgeon's ability was cited as a reason for this discrepancy; and surgeons found time associated with more effective methods to be prohibitive.
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Affiliation(s)
- Todd A Jaffe
- The University of Michigan Medical School, Ann Arbor, Michigan.
| | - Steven J Hasday
- The University of Michigan Medical School, Ann Arbor, Michigan
| | - Meghan Knol
- The University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason Pradarelli
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sudha R Pavuluri Quamme
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Caprice C Greenberg
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Justin B Dimick
- The University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, The University of Michigan, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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22
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Forestier G, Riffaud L, Petitjean F, Henaux PL, Jannin P. Surgical skills: Can learning curves be computed from recordings of surgical activities? Int J Comput Assist Radiol Surg 2018; 13:629-636. [PMID: 29502229 DOI: 10.1007/s11548-018-1713-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Surgery is one of the riskiest and most important medical acts that are performed today. The need to improve patient outcomes and surgeon training, and to reduce the costs of surgery, has motivated the equipment of operating rooms with sensors that record surgical interventions. The richness and complexity of the data that are collected call for new methods to support computer-assisted surgery. The aim of this paper is to support the monitoring of junior surgeons learning their surgical skill sets. METHODS Our method is fully automatic and takes as input a series of surgical interventions each represented by a low-level recording of all activities performed by the surgeon during the intervention (e.g., cut the skin with a scalpel). Our method produces a curve describing the process of standardization of the behavior of junior surgeons. Given the fact that junior surgeons receive constant feedback from senior surgeons during surgery, these curves can be directly interpreted as learning curves. RESULTS Our method is assessed using the behavior of a junior surgeon in anterior cervical discectomy and fusion surgery over his first three years after residency. They revealed the ability of the method to accurately represent the surgical skill evolution. We also showed that the learning curves can be computed by phases allowing a finer evaluation of the skill progression. CONCLUSION Preliminary results suggest that our approach constitutes a useful addition to surgical training monitoring.
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Affiliation(s)
- Germain Forestier
- IRIMAS, University of Haute-Alsace, Mulhouse, France. .,Faculty of Information Technology, Monash University, Melbourne, Australia.
| | - Laurent Riffaud
- Department of Neurosurgery, Univ. Hospital, Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image) - UMR_S 1099, 35000, Rennes, France
| | - François Petitjean
- Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Pierre-Louis Henaux
- Department of Neurosurgery, Univ. Hospital, Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image) - UMR_S 1099, 35000, Rennes, France
| | - Pierre Jannin
- Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image) - UMR_S 1099, 35000, Rennes, France
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Block MS, Emery RW, Cullum DR, Sheikh A. Implant Placement Is More Accurate Using Dynamic Navigation. J Oral Maxillofac Surg 2017; 75:1377-1386. [DOI: 10.1016/j.joms.2017.02.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 01/29/2023]
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24
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Mason KA, Theodorakopoulou E, Pafitanis G, Ghanem AM, Myers SR. Twelve tips for postgraduate or undergraduate medics building a basic microsurgery simulation training course. MEDICAL TEACHER 2016; 38:872-878. [PMID: 27071862 DOI: 10.3109/0142159x.2016.1150978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Microsurgery is used in a variety of surgical specialties, including Plastic Surgery, Maxillofacial Surgery, Ophthalmic Surgery, Otolaryngology and Neurosurgery. It is considered one of the most technically challenging fields of surgery. Microsurgical skills demand fine, precise and controlled movements, and microsurgical skill acquisition has a steep initial learning curve. Microsurgical simulation provides a safe environment for skill acquisition before operating clinically. The traditional starting point for anyone wanting to pursue microsurgery is a basic simulation training course. We present twelve tips for postgraduate and undergraduate medics on how to set up and run a basic ex-vivo microsurgery simulation training course suitable for their peers.
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Affiliation(s)
- Katrina A Mason
- a Academic Plastic Surgery Group, Centre for Cutaneous Research , Barts and The London School of Medicine and Dentistry, The Blizard Institute , London , UK
| | - Evgenia Theodorakopoulou
- a Academic Plastic Surgery Group, Centre for Cutaneous Research , Barts and The London School of Medicine and Dentistry, The Blizard Institute , London , UK
| | - Georgios Pafitanis
- a Academic Plastic Surgery Group, Centre for Cutaneous Research , Barts and The London School of Medicine and Dentistry, The Blizard Institute , London , UK
| | - Ali M Ghanem
- a Academic Plastic Surgery Group, Centre for Cutaneous Research , Barts and The London School of Medicine and Dentistry, The Blizard Institute , London , UK
| | - Simon R Myers
- a Academic Plastic Surgery Group, Centre for Cutaneous Research , Barts and The London School of Medicine and Dentistry, The Blizard Institute , London , UK
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25
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Langer JC, Gordon JS, Chen LE. Subspecialization within pediatric surgical groups in North America. J Pediatr Surg 2016; 51:143-8. [PMID: 26541313 DOI: 10.1016/j.jpedsurg.2015.10.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/09/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to assess the current status of subspecialization in North American pediatric surgical practices and to evaluate factors associated with subspecialization. METHODS A survey was sent to each pediatric surgical practice in the United States and Canada. For each of 44 operation types, ranging in complexity and volume, the respondents chose one of the following responses: 1. everyone does the operation; 2. group policy--only some surgeons do the operation; 3. group policy--anyone can do it but mentorship required; 4. only some do it due to referral patterns; 5. no one in the group does it. Association of various factors with degree of subspecialization was analyzed using nonparametric statistics with p<0.05 considered significant. RESULTS Response rate was 70%. There was significant variability in subspecialization among groups. Factors found to be significantly associated with increased subspecialization included free-standing children's hospitals, pediatric surgery training programs, higher number of surgeons, higher case volume, and greater volume of tertiary/quaternary cases. CONCLUSIONS There is wide variation in the degree of subspecialization among North American pediatric surgery practices. These data will help to inform ongoing debate around strategies that may be useful in optimizing pediatric surgical care and patient outcomes in the future.
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Affiliation(s)
- Jacob C Langer
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Jennifer S Gordon
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Li Ern Chen
- Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
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26
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Static or Dynamic Navigation for Implant Placement-Choosing the Method of Guidance. J Oral Maxillofac Surg 2015; 74:269-77. [PMID: 26452429 DOI: 10.1016/j.joms.2015.09.022] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 11/23/2022]
Abstract
The purpose of the present report is to contrast and compare 2 methods of dental implant placement. One method uses computed tomography data for computer-aided design and computer-aided manufacturing to generate static guides for implant placement. The second method is a dynamic navigation system that uses a stereo vision computer triangulation setup to guide implant placement. A review of the published data was performed to provide evidence-based material to compare each method. Finally, the indications for each type of method are discussed.
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27
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Rasuli KJ, Gofton W. Percutaneously assisted total hip (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:179. [PMID: 26366396 DOI: 10.3978/j.issn.2305-5839.2015.08.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND A new family of micro-posterior approaches, percutaneously assisted total hip (PATH), SuperCapsular (SuperCap) and Supercapsular percutaneously assisted total hip (SuperPATH) allow preservation of the short external rotators. This study assesses early outcomes and learning curves of the PATH and SuperPATH approaches. METHODS Early outcomes of the first consecutive 49 PATH and 50 SuperPATH cases performed by a non-developer surgeon were evaluated. Analysis of variance (ANOVA) was used to compare age, body mass index (BMI), and pre-operative hemoglobin. Gender was compared using a Chi-square test. Clinical outcomes were compared using a nonparametric Wilcoxon test or a Chi-square test. Learning curves were assessed using operative time as a surrogate. Acetabular cup abduction and anteversion were compared using the first post-operative radiograph and a modified protractor. RESULTS Both cohorts were similar with respect to diagnosis, gender, and BMI. Mean operative time in minutes was recorded for the PATH (114.5±17.5) and SuperPATH (101.7±18.3) cohorts (P value =0.0002). PATH operative time reached a plateau by case 40, but SuperPATH operative time continued to decrease by case 50. Transfusion rates were low in the PATH (4%) and SuperPATH (6%) cohorts. Mean length of stay (LOS) in days for the SuperPATH and PATH cohorts were 2.2 and 3.0, respectively (P value <0.0001). Complication rates were low in the SuperPATH (4.0%) and PATH (4.1%) cohorts. Acetabular cups in the SuperPATH cohort (anteversion: 23.5°±8.2°, abduction: 39.0°±8.4°) were significantly more anteverted (P value <0.0001) and less abducted (P value <0.05) than in the PATH cohort (anteversion: 13.1°±7.1°; abduction: 42.9°±7.6°). CONCLUSIONS Early results demonstrate that the PATH and SuperPATH approaches can be adopted with minimal complications and outcomes consistent with innovator outcomes, even during the learning curve. The SuperPATH technique was associated with shorter operative time that continued to decrease, suggesting that proficiency continues to decrease beyond the first 50 cases. In this author's experience, acetabular cups implanted using the SuperPATH technique were more anteverted than those implanted using the PATH technique. Greater use of the transverse acetabular ligament to guide cup alignment reduced this effect.
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Affiliation(s)
- Kevin J Rasuli
- The Ottawa Hospital-Civic Campus, Ottawa, Ontario K1Y 4E9, Canada
| | - Wade Gofton
- The Ottawa Hospital-Civic Campus, Ottawa, Ontario K1Y 4E9, Canada
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Abstract
Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.
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Affiliation(s)
- Matthew S Clifton
- Department of Surgery, Emory University School of Medicine/Children׳s Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, Georgia 30322
| | - Mark L Wulkan
- Department of Surgery, Emory University School of Medicine/Children׳s Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, Georgia 30322.
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