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Gao J, Chen G, O'Rourke AP, Caskey J, Carey KA, Oguss M, Stey A, Dligach D, Miller T, Mayampurath A, Churpek MM, Afshar M. Automated stratification of trauma injury severity across multiple body regions using multi-modal, multi-class machine learning models. J Am Med Inform Assoc 2024:ocae071. [PMID: 38587875 DOI: 10.1093/jamia/ocae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE The timely stratification of trauma injury severity can enhance the quality of trauma care but it requires intense manual annotation from certified trauma coders. The objective of this study is to develop machine learning models for the stratification of trauma injury severity across various body regions using clinical text and structured electronic health records (EHRs) data. MATERIALS AND METHODS Our study utilized clinical documents and structured EHR variables linked with the trauma registry data to create 2 machine learning models with different approaches to representing text. The first one fuses concept unique identifiers (CUIs) extracted from free text with structured EHR variables, while the second one integrates free text with structured EHR variables. Temporal validation was undertaken to ensure the models' temporal generalizability. Additionally, analyses to assess the variable importance were conducted. RESULTS Both models demonstrated impressive performance in categorizing leg injuries, achieving high accuracy with macro-F1 scores of over 0.8. Additionally, they showed considerable accuracy, with macro-F1 scores exceeding or near 0.7, in assessing injuries in the areas of the chest and head. We showed in our variable importance analysis that the most important features in the model have strong face validity in determining clinically relevant trauma injuries. DISCUSSION The CUI-based model achieves comparable performance, if not higher, compared to the free-text-based model, with reduced complexity. Furthermore, integrating structured EHR data improves performance, particularly when the text modalities are insufficiently indicative. CONCLUSIONS Our multi-modal, multiclass models can provide accurate stratification of trauma injury severity and clinically relevant interpretations.
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Affiliation(s)
- Jifan Gao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - John Caskey
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Kyle A Carey
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Madeline Oguss
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Anne Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Center of Health Services and Outcomes Research, Institute for Public Health and Medicine, Chicago, IL 60611, United States
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University Chicago, Chicago, IL 60660, United States
| | - Timothy Miller
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Anoop Mayampurath
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Matthew M Churpek
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Majid Afshar
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
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Buzzard L, Stepp D, Elfenbein D, O'Rourke AP. Experiential Learning of Interdisciplinary Care Skills in Surgery Assessed From Student Reflections. J Surg Res 2023; 283:783-792. [PMID: 36470204 DOI: 10.1016/j.jss.2022.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/25/2022] [Accepted: 10/15/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Interdisciplinary healthcare collaboration improves patient outcomes, increases workplace satisfaction, and reduces costs. Our medical school utilizes an experiential learning tool for teaching interprofessionalism known as the Longitudinal Patient Project (LPP). Medical students are directed to identify a surgical patient to establish continuity with by observing them throughout preoperative, intraoperative, and postoperative periods, and follow-up with the patient after their procedure. Students then write reflections on their LPP experience. This study examines the LPP as an interprofessionalism teaching tool using qualitative analysis of student reflections. METHODS NVivo 12 was used to code reflections. One researcher coded reflections for subject, depth, temporality, and confidence. Depth was assessed using Mezirow's Critical Reflection Theory, with students receiving titles of "content," "process," or "premise" reflectors based on the deepest level of reflection exhibited. Confidence was assessed by labeling reflective statements as "concrete" or "verbal." Data were coded by a second researcher for validation. Consensus was reached, the remainder of the dataset was updated to reflect codebook changes, and trends were assessed. RESULTS Inter-rater agreement was 83%. All students achieved "content" level reflection. Ninety-seven percent of students reached "process" reflection. Ninety-three percent of students reached "premise" reflection. Students provided more concrete indicators of knowledge gained from the LPP than from prior experiences. Subjects included communication, team dynamics, patient impact, and student experience. Increased depth and breadth of reflection on communication and team dynamics were observed from the LPP. CONCLUSIONS The LPP illustrates the importance of interdisciplinary care in surgery. Future iterations should emphasize the impact on patients and their families.
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Affiliation(s)
- Lydia Buzzard
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; UW Health Department of Surgery, Madison, Wisconsin.
| | - Dorothy Stepp
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; UW Health Department of Surgery, Madison, Wisconsin
| | - Dawn Elfenbein
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; UW Health Department of Surgery, Madison, Wisconsin
| | - Ann P O'Rourke
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; UW Health Department of Surgery, Madison, Wisconsin
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Lee PT, Krecko LK, Savage S, O'Rourke AP, Jung HS, Ingraham A, Zarzaur BL, Scarborough JE. Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement. J Trauma Acute Care Surg 2022; 93:446-452. [PMID: 35393378 PMCID: PMC9489599 DOI: 10.1097/ta.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prevention of hospital-acquired conditions (HACs) is a focus of trauma center quality improvement. The relative contributions of various HACs to postinjury hospital outcomes are unclear. We sought to quantify and compare the impacts of six HACs on early clinical outcomes and resource utilization in hospitalized trauma patients. METHODS Adult patients from the 2013 to 2016 American College of Surgeons Trauma Quality Improvement Program Participant Use Data Files who required 5 days or longer of hospitalization and had an Injury Severity Score of 9 or greater were included. Multiple imputation with chained equations was used for observations with missing data. The frequencies of six HACs and five adverse outcomes were determined. Multivariable Poisson regression with log link and robust error variance was used to produce relative risk estimates, adjusting for patient-, hospital-, and injury-related factors. Risk-adjusted population attributable fractions estimates were derived for each HAC-outcome pair, with the adjusted population attributable fraction estimate for a given HAC-outcome pair representing the estimated percentage decrease in adverse outcome that would be expected if exposure to the HAC had been prevented. RESULTS A total of 529,856 patients requiring 5 days or longer of hospitalization were included. The incidences of HACs were as follows: pneumonia, 5.2%; urinary tract infection, 3.4%; venous thromboembolism, 3.3%; surgical site infection, 1.3%; pressure ulcer, 1.3%; and central line-associated blood stream infection, 0.2%. Pneumonia demonstrated the strongest association with in-hospital outcomes and resource utilization. Prevention of pneumonia in our cohort would have resulted in estimated reductions of the following: 22.1% for end organ dysfunction, 7.8% for mortality, 8.7% for prolonged hospitalization, 7.1% for prolonged intensive care unit stay, and 6.8% for need for mechanical ventilation. The impact of other HACs was comparatively small. CONCLUSION We describe a method for comparing the contributions of HACs to outcomes of hospitalized trauma patients. Our findings suggest that trauma program improvement efforts should prioritize pneumonia prevention. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Patrick T Lee
- From the Department of Surgery (P.T.L., L.K.K.), University of Wisconsin School of Medicine and Public Health; and Department of Surgery (S.S., A.P.O., H.S.J., A.I., B.L.Z., J.E.S.), Division of Acute Care and Regional General Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Schwartz PB, Krecko LK, Park KY, O'Rourke AP, Greenberg J, Jung S. Our thoughts: Improving general surgery resident preparedness for dedicated research time. Am J Surg 2021; 223:1217-1219. [PMID: 34876255 DOI: 10.1016/j.amjsurg.2021.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick B Schwartz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA.
| | - Laura K Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - Keon Young Park
- Department of Surgery, University of California San Francisco, California, USA
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | | | - Sarah Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
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Kulshrestha S, Dligach D, Joyce C, Gonzalez R, O'Rourke AP, Glazer JM, Stey A, Kruser JM, Churpek MM, Afshar M. Comparison and interpretability of machine learning models to predict severity of chest injury. JAMIA Open 2021; 4:ooab015. [PMID: 33709067 PMCID: PMC7935500 DOI: 10.1093/jamiaopen/ooab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Trauma quality improvement programs and registries improve care and outcomes for injured patients. Designated trauma centers calculate injury scores using dedicated trauma registrars; however, many injuries arrive at nontrauma centers, leaving a substantial amount of data uncaptured. We propose automated methods to identify severe chest injury using machine learning (ML) and natural language processing (NLP) methods from the electronic health record (EHR) for quality reporting. Materials and Methods A level I trauma center was queried for patients presenting after injury between 2014 and 2018. Prediction modeling was performed to classify severe chest injury using a reference dataset labeled by certified registrars. Clinical documents from trauma encounters were processed into concept unique identifiers for inputs to ML models: logistic regression with elastic net (EN) regularization, extreme gradient boosted (XGB) machines, and convolutional neural networks (CNN). The optimal model was identified by examining predictive and face validity metrics using global explanations. Results Of 8952 encounters, 542 (6.1%) had a severe chest injury. CNN and EN had the highest discrimination, with an area under the receiver operating characteristic curve of 0.93 and calibration slopes between 0.88 and 0.97. CNN had better performance across risk thresholds with fewer discordant cases. Examination of global explanations demonstrated the CNN model had better face validity, with top features including “contusion of lung” and “hemopneumothorax.” Discussion The CNN model featured optimal discrimination, calibration, and clinically relevant features selected. Conclusion NLP and ML methods to populate trauma registries for quality analyses are feasible.
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Affiliation(s)
- Sujay Kulshrestha
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, Illinois, USA.,Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Dmitriy Dligach
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.,Department of Computer Science, Loyola University Chicago, Chicago, Illinois, USA
| | - Cara Joyce
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Richard Gonzalez
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, Illinois, USA.,Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Joshua M Glazer
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Anne Stey
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | | | - Matthew M Churpek
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Majid Afshar
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Jung S, Greenberg J, O'Rourke AP, Minter RM, Foley E, Voils CI. Comparison of the Perspectives of Medical Students and Residents on the Surgery Learning Environment. J Surg Res 2021; 258:187-194. [PMID: 33011450 PMCID: PMC8056838 DOI: 10.1016/j.jss.2020.08.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/14/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The learning environment plays a critical role in learners' satisfaction and outcomes. However, we often lack insight into learners' perceptions and assessments of these environments. It can be difficult to discern learners' expectations, making their input critical. When medical students and surgery residents are asked to evaluate their teachers, what do they focus on? MATERIALS AND METHODS Open-ended comments from medical students' evaluations of residents and attending surgeons and from residents' evaluations of attendings during the 2016-2017 academic year were analyzed. Content analysis was used, and codes derived from the data. A matrix of theme by learner role was created to distinguish differences between medical student and resident learners. Subthemes were grouped based on similarity into high-order themes. RESULTS Two overarching themes were Creating a positive environment for learning by modeling professional behaviors and Intentionally engaging learners in training and educational opportunities. Medical students and residents made similar comments for the subthemes of appropriate demeanor, tone and dialog, respect, effective direct instruction, feedback, debriefing, giving appropriate levels of autonomy, and their expectations as team members on a service. Differences existed in the subthemes of punctuality, using evidence, clinical knowledge, efficiency, direct interactions with patients, learning outcomes, and career decisions. CONCLUSIONS Faculty development efforts should target professional communication, execution of teaching skills, and relationships among surgeons, other providers, and patients. Attendings should make efforts to discuss their approach to clinical decision making and patient interactions and help residents and medical students voice their opinions and questions through trusting adult learner-teacher relationships.
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Affiliation(s)
- Sarah Jung
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Jacob Greenberg
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Eugene Foley
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Corrine I Voils
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin; William S Middleton Memorial Veterans Hospital, Madison, Wisconsin
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Barrett JR, Drezdzon MK, Monawer AH, O'Rourke AP, Scarborough JE. Safety in Allowing Residents to Independently Perform Appendectomy: A Retrospective Review. J Am Coll Surg 2019; 229:621-625. [DOI: 10.1016/j.jamcollsurg.2019.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022]
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Shulzhenko NO, Zens TJ, Beems MV, Jung HS, O'Rourke AP, Liepert AE, Scarborough JE, Agarwal SK. Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma. Surgery 2016; 161:1083-1089. [PMID: 27932031 DOI: 10.1016/j.surg.2016.10.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/29/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults. METHODS A retrospective review of the National Trauma Data Bank was performed for patients with blunt trauma who were ≥65 years old and had rib fractures between 2009 and 2012 (N = 67,695). Control data were collected for age, sex, injury severity score, injury mechanism, 24 comorbidities, and number of rib fractures. Outcome data included hospital mortality, hospital and intensive care unit durations of stay, duration of mechanical ventilation, and the occurrence of pneumonia. Multiple logistic and linear regression analyses were performed. RESULTS Sustaining ≥5 rib fractures was associated with increased intensive care unit admission (odds ratio: 1.14, P < .001) and hospital duration of stay (relative duration: 105%, P < .001). Sustaining ≥7 rib fractures was associated with an increased incidence of pneumonia (odds ratio: 1.32, P < .001) and intensive care unit duration of stay (relative duration: 122%, P < .001). Sustaining ≥8 rib fractures was associated with increased mortality (odds ratio: 1.51, P < .001) and duration of mechanical ventilation (relative duration: 117%, P < .001). CONCLUSION In older patients with trauma, sustaining at least 5 rib fractures is a significant predictor of worse outcomes independent of patient characteristics, comorbidities, and trauma burden.
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Affiliation(s)
- Nikita O Shulzhenko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tiffany J Zens
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Megan V Beems
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amy E Liepert
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - John E Scarborough
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Suresh K Agarwal
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Scarborough JE, Ingraham AM, Liepert AE, Jung HS, O'Rourke AP, Agarwal SK. Nonoperative Management Is as Effective as Immediate Splenectomy for Adult Patients with High-Grade Blunt Splenic Injury. J Am Coll Surg 2016; 223:249-58. [DOI: 10.1016/j.jamcollsurg.2016.03.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/25/2022]
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Kohl PA, O'Rourke AP, Schmidman DL, Dopkin WA, Birnbaum ML. The Sumatra-Andaman Earthquake and Tsunami of 2004: The Hazards, Events, and Damage. Prehosp Disaster Med 2012; 20:355-63. [PMID: 16496614 DOI: 10.1017/s1049023x00002880] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe Sumatra-Andaman Earthquake and subsequent Asian Tsunami of 26 December 2004 affected multiple countries in the Indian Ocean and beyond, creating disasters of a scale unprecedented in recorded history. Using the Conceptual Framework and terminology described in the Disaster Health Management: Guidelines for Evaluation and Research in the Utstein Style, the hazard, events, and damage associated with the Earthquake and Tsunami are described. Many gaps in the available information regarding this event are present. Standardized indicators and reporting criteria are necessary for research on future disasters and the development of best practice standards internationally.
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Affiliation(s)
- Patrice A Kohl
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Wu JY, Sun H, O'Rourke AP, Huebner SM, Rahko PS, Will JA, Webster JG. Taser Blunt Probe Dart-To-Heart Distance Causing Ventricular Fibrillation in Pigs. IEEE Trans Biomed Eng 2008; 55:2768-71. [DOI: 10.1109/tbme.2008.2002154] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Cryoablation is a minimally invasive ablation technique for primary and metastatic hepatic tumors. Inadequate freezing around large blood vessels due to the warm blood flow can lead to local recurrence, and thus, necessitates close application of a cryoprobe to the large blood vessels. In this study, we constructed a perfusion model with an ex vivo bovine liver and ablated the tissue around a large blood vessel with one or two cryoprobes applied to the side of the vessel. The finite-element computer model developed in our previous study was modified to include a blood vessel and its convective heat transfer to the vicinity of the blood vessel. We compared the predicted simulation results to those acquired from this ex vivo perfusion model. The results indicate that blood vessels act as a heat source and generate steep temperature profiles in the area next to the large blood vessel. After validation, the maximum allowable distance between the cryoprobe and the large blood vessel for successful cryoablation was presented. The results of this study should be considered when placing cryoprobes in the vicinity of large blood vessels.
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Affiliation(s)
- Cheolkyun Kim
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA.
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Schutt DJ, O'Rourke AP, Will JA, Webster JG, Mahvi DM, Haemmerich D. An electrode array that minimizes blood loss for radiofrequency-assisted hepatic resection. Med Eng Phys 2008; 30:454-9. [PMID: 17588799 PMCID: PMC2446607 DOI: 10.1016/j.medengphy.2007.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 02/20/2007] [Accepted: 05/04/2007] [Indexed: 01/07/2023]
Abstract
Hepatic resection is currently the standard treatment for liver cancer. During hepatic resection part of the liver containing the tumor is surgically removed. This type of surgery is accompanied by high blood loss of approximately 0.6-1.35 L. Blood loss is associated with increased complication rates, prolonged hospital stay, and reduced patient survival, especially when transfusion is required. Other researchers have suggested using radiofrequency (rf) or microwave ablation to coagulate a tissue slice before resection to reduce blood loss, but conventional devices typically take several hours. We developed a device consisting of a linear array of blade-shaped, 1 cm wide radiofrequency (rf) electrodes 1.5 cm apart. Bipolar rf power is applied between pairs of adjacent electrodes, leading to high tissue temperatures between the electrodes that promote coagulation of large vessels (>3 mm) in the resection plane. Rapid switching of applied power between pairs of adjacent electrodes allows simultaneous heating and coagulation of the entire resection plane within 3-6 min. In seven in vivo trials in a porcine model, resection along a plane pre-coagulated with the device resulted in little (<20 mL) to no blood loss, while coagulating all vessels (up to 4.5 mm diameter in this study). Average treatment time (from placement of the device to transection) was 6.8+/-0.5 min when four electrodes were used, and 11.3+/-1.2 min when 5-7 electrodes were used. This device may reduce blood loss related morbidity during resection and reduce treatment time by coagulating all vessels in the resection plane.
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Affiliation(s)
- D J Schutt
- Division of Pediatric Cardiology, Medical University of South Carolina, 165 Ashley Ave, Charleston, SC 29425, USA
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Abstract
The liver is a common site of disease for both primary and metastatic cancer. Since most patients have a disease that is not amenable to surgical resection, tumor ablation modalities are increasingly being used for treatment of liver cancer. This review describes the current status of ablative technologies used as alternatives for resection, clinical experience with these technologies, currently available devices and design rules for the development of new devices and the improvement of existing ones. It focuses on probe design for radiofrequency ablation, microwave ablation and cryoablation, and compares the advantages and disadvantages of each ablation modality.
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Affiliation(s)
- Ann P O'Rourke
- Department of Surgery, University of Wisconsin, Madison, WI 53792, USA.
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Abstract
Cryoablation is a widely used method for the treatment of nonresectable primary and metastatic liver tumors. A model that can accurately predict the size of a cryolesion may allow more effective treatment of tumor, while sparing normal liver tissue. We generated a computer model of tissue cryoablation using the finite-element method (FEM). In our model, we considered the heat transfer mechanism inside the cryoprobe and also cryoprobe surfaces so our model could incorporate the effect of heat transfer along the cryoprobe from the environment at room temperature. The modeling of the phase shift from liquid to solid was a key factor in the accurate development of this model. The model was verified initially in an ex vivo liver model. Temperature history at three locations around one cryoprobe and between two cryoprobes was measured. The comparison between the ex vivo result and the FEM modeling result at each location showed a good match, where the maximum difference was within the error range acquired in the experiment (< 5 degrees C). The FEM model prediction of the lesion size was within 0.7 mm of experimental results. We then validated our FEM in an in vivo experimental porcine model. We considered blood perfusion in conjunction with blood viscosity depending on temperature. The in vivo iceball size was smaller than the ex vivo iceball size due to blood perfusion as predicted in our model. The FEM results predicted this size within 0.1-mm error. The FEM model we report can accurately predict the extent of cryoablation in the liver.
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Affiliation(s)
- Cheolkyun Kim
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
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O'Rourke AP, Lazebnik M, Bertram JM, Converse MC, Hagness SC, Webster JG, Mahvi DM. Dielectric properties of human normal, malignant and cirrhotic liver tissue: in vivo and ex vivo measurements from 0.5 to 20 GHz using a precision open-ended coaxial probe. Phys Med Biol 2007; 52:4707-19. [PMID: 17634659 DOI: 10.1088/0031-9155/52/15/022] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatic malignancies have historically been treated with surgical resection. Due to the shortcomings of this technique, there is interest in other, less invasive, treatment modalities, such as microwave hepatic ablation. Crucial to the development of this technique is the accurate knowledge of the dielectric properties of human liver tissue at microwave frequencies. To this end, we characterized the dielectric properties of in vivo and ex vivo normal, malignant and cirrhotic human liver tissues from 0.5 to 20 GHz. Analysis of our data at 915 MHz and 2.45 GHz indicates that the dielectric properties of ex vivo malignant liver tissue are 19 to 30% higher than normal tissue. The differences in the dielectric properties of in vivo malignant and normal liver tissue are not statistically significant (with the exception of effective conductivity at 915 MHz, where malignant tissue properties are 16% higher than normal). Also, the dielectric properties of in vivo normal liver tissue at 915 MHz and 2.45 GHz are 16 to 43% higher than ex vivo. No statistically significant differences were found between the dielectric properties of in vivo and ex vivo malignant tissue (with the exception of effective conductivity at 915 MHz, where malignant tissue properties are 28% higher than normal). We report the one-pole Cole-Cole parameters for ex vivo normal, malignant and cirrhotic liver tissue in this frequency range. We observe that wideband dielectric properties of in vivo liver tissue are different from the wideband dielectric properties of ex vivo liver tissue, and that the in vivo data cannot be represented in terms of a Cole-Cole model. Further work is needed to uncover the mechanisms responsible for the observed wideband trends in the in vivo liver data.
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Affiliation(s)
- Ann P O'Rourke
- Department of Surgery, University of Wisconsin, Madison, WI 53792, USA
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Wu JY, Sun H, O'Rourke AP, Huebner S, Rahko PS, Will JA, Webster JG. Taser Dart-to-Heart Distance That Causes Ventricular Fibrillation in Pigs. IEEE Trans Biomed Eng 2007; 54:503-8. [PMID: 17355063 DOI: 10.1109/tbme.2006.888832] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Electromuscular incapacitating devices (EMDs), such as Tasers, deliver high current, short duration pulses that cause muscular contractions and temporarily incapacitate the human subject. Some reports suggest that EMDs can kill. To help answer the question, "Can the EMD directly cause ventricular fibrillation (VF)?", ten tests were conducted to measure the dart-to-heart distance that causes VF in anesthetized pigs [mass = 64 kg +/- 6.67 standard deviation (SD)] for the most common X26 Taser. The dart-to-heart distance that caused VF was 17 mm +/- 6.48 (SD) for the first VF event and 13.7 mm +/- 6.79 (SD) for the average of the successive VF events. The result shows that when the stimulation dart is close enough to the heart, X26 Taser current will directly trigger VF in pigs. Echocardiography of erect humans shows skin-to-heart distances from 10 to 57 mm (dart-to-heart distances of 1-48 mm). These results suggest that the probability of a dart on the body landing in 1 cm2 over the ventricle and causing VF is 0.000172.
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Affiliation(s)
- Jiun-Yan Wu
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA
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Affiliation(s)
- James Arthur Will
- Animal Health and Biomedical SciencesUniversity of Wisconsin1656 Linden Dr.MadisonWisconsin53706
| | - Hongyu Sun
- Animal Health and Biomedical SciencesUniversity of Wisconsin1656 Linden Dr.MadisonWisconsin53706
| | - Jiun‐Yan Wu
- Animal Health and Biomedical SciencesUniversity of Wisconsin1656 Linden Dr.MadisonWisconsin53706
| | - Ann P. O'Rourke
- Animal Health and Biomedical SciencesUniversity of Wisconsin1656 Linden Dr.MadisonWisconsin53706
| | - Shane M. Huebner
- Animal Health and Biomedical SciencesUniversity of Wisconsin1656 Linden Dr.MadisonWisconsin53706
| | - John Webster
- Animal Health and Biomedical SciencesUniversity of Wisconsin1656 Linden Dr.MadisonWisconsin53706
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Yang D, Bertram JM, Converse MC, O'Rourke AP, Webster JG, Hagness SC, Will JA, Mahvi DM. A floating sleeve antenna yields localized hepatic microwave ablation. IEEE Trans Biomed Eng 2006; 53:533-7. [PMID: 16532780 DOI: 10.1109/tbme.2005.869794] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a novel coaxial antenna for hepatic microwave ablation. This device uses a floating sleeve, that is, a metal conductor electrically isolated from the outer connector of the antenna coaxial body, to achieve a highly localized specific absorption rate pattern that is independent of insertion depth. This floating sleeve coaxial dipole antenna has low power reflection in the 2.4-GHz IMS band. Ex vivo experiments confirm our numerical simulation results. Index Terms-Ablation, coaxial aperture antennas, finite element methods, floating sleeve, microwave heating.
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Affiliation(s)
- Deshan Yang
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706 USA
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