1
|
Haque TF, Knudsen JE, You J, Hui A, Djaladat H, Ma R, Cen S, Goldenberg M, Hung AJ. Competency in Robotic Surgery: Standard Setting for Robotic Suturing Using Objective Assessment and Expert Evaluation. J Surg Educ 2024; 81:422-430. [PMID: 38290967 PMCID: PMC10923136 DOI: 10.1016/j.jsurg.2023.12.002] [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] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Surgical skill assessment tools such as the End-to-End Assessment of Suturing Expertise (EASE) can differentiate a surgeon's experience level. In this simulation-based study, we define a competency benchmark for intraoperative robotic suturing using EASE as a validated measure of performance. DESIGN Participants conducted a dry-lab vesicourethral anastomosis (VUA) exercise. Videos were each independently scored by 2 trained, blinded reviewers using EASE. Inter-rater reliability was measured with prevalence-adjusted bias-adjusted Kappa (PABAK) using 2 example videos. All videos were reviewed by an expert surgeon, who determined if the suturing skills exhibited were at a competency level expected for residency graduation (pass or fail). The Contrasting Group (CG) method was then used to set a pass/fail score at the intercept of the pass and fail cohorts' EASE score distributions. SETTING Keck School of Medicine, University of Southern California. PARTICIPANTS Twenty-six participants: 8 medical students, 8 junior residents (PGY 1-2), 7 senior residents (PGY 3-5) and 3 attending urologists. RESULTS After 1 round of consensus-building, average PABAK across EASE subskills was 0.90 (Range 0.67-1.0). The CG method produced a competency benchmark EASE score of >35/39, with a pass rate of 10/26 (38%); 27% were deemed competent by expert evaluation. False positives and negatives were defined as medical students who passed and attendings who failed the assessment, respectively. This pass/fail score produced no false positives or negatives, and fewer JR than SR were considered competent by both the expert and CG benchmark. CONCLUSIONS Using an absolute standard setting method, competency scores were set to identify trainees who could competently execute a standardized dry-lab robotic suturing exercise. This standard can be used for high stakes decisions regarding a trainee's technical readiness for independent practice. Future work includes validation of this standard in the clinical environment through correlation with clinical outcomes.
Collapse
Affiliation(s)
- Taseen F Haque
- Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - J Everett Knudsen
- Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Jonathan You
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alvin Hui
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hooman Djaladat
- Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Runzhuo Ma
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Steven Cen
- Department Radiology, University of Southern California, Los Angeles, California
| | - Mitchell Goldenberg
- Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Andrew J Hung
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
| |
Collapse
|
2
|
Cao Q, Goldenberg M, Aron M, Wang T. Urinary Bladder "Melanosis": A Case Report and Review of the Literature. Int J Surg Pathol 2024; 32:104-108. [PMID: 37016968 DOI: 10.1177/10668969231166301] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Melanosis of the urinary bladder, so-called melanosis vesicae, is a rare condition characterized by dark, velvety bladder mucosa observed by cystoscopy examination. Up to 20 examples have been reported in the English literature, and the etiology of this disease still needs to be discovered. We present an 82-year-old woman with a history of pelvic organ prolapse-associated urinary symptoms. The patient was found to have pigmented urinary bladder mucosa on cystoscopy and underwent a total hysterectomy and bladder mucosal biopsy. Histologically, pigmented granules were evident in the bladder stroma and epithelium, highlighted by Periodic Acid-Schiff (PAS) stain, suggestive of lipofuscin in nature. We outline the diagnostic features of bladder melanosis, discuss the diagnostic mimickers, and thoroughly review the literature on the subject.
Collapse
Affiliation(s)
- Qi Cao
- Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mitchell Goldenberg
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tiannan Wang
- Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
3
|
Sayegh AS, Eppler M, Ballon J, Hemal S, Goldenberg M, Sotelo R, Cacciamani GE. Strategies for Improving the Standardization of Perioperative Adverse Events in Surgery and Anesthesiology: “The Long Road from Assessment to Collection, Grading and Reporting”. J Clin Med 2022; 11:jcm11175115. [PMID: 36079044 PMCID: PMC9457420 DOI: 10.3390/jcm11175115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
|
4
|
Sholklapper T, Goldenberg M, Lebastchi A, Abreu A, Desai M, Sotelo R, Gill I, Cacciamani G. Intraoperative adverse event reporting in urology: Global ICARUS survey results. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01136-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
5
|
Goldenberg M, Amigo M, Krishna SG, Milani-Nejad N, Trinidad JC, Kaffenberger BH. Validation of generalized drug-related rash diagnoses using International Classification of Diseases 9th and 10th Revision codes. Br J Dermatol 2021; 186:583-585. [PMID: 34726268 DOI: 10.1111/bjd.20868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/02/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- M Goldenberg
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - M Amigo
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - S G Krishna
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - N Milani-Nejad
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J C Trinidad
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - B H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
6
|
Bart Y, Mohr-Sasson A, Yousefi S, Goldenberg M, Meyer R, Toussia-Cohen S, Eyal Y, Mazaki-Tovi S, Mashiach R. Adnexal torsion recurrence-is the adnexal twist degree a risk factor? A retrospective cohort study. BJOG 2021; 128:1511-1516. [PMID: 33978295 DOI: 10.1111/1471-0528.16738] [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] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether the adnexal twist degree is related to torsion recurrence and whether there is a dose-dependent correlation. DESIGN A retrospective cohort study. SETTING Single tertiary medical centre. POPULATION The study includes non-pregnant patients operated, for the first time, for adnexal torsion, between 2011 and 2018. METHODS Information regarding the degree of adnexal twist was collected from surgical reports. Recurrence was identified using a computerised database and ascertained via telephone with a response rate of 87.2% (253/290). MAIN OUTCOME MEASURES Adnexal torsion recurrence rate. RESULTS A total of 182 women who had undergone laparoscopic detorsion met the inclusion criteria. Twenty-two had torsion recurrence (12.1%). Adnexal twist degree in the primary event was associated with a higher recurrence risk: 4.3% of women with twist degree ≤360 (n = 3/70), 14.5% of women with twist degree of 361-720 (n = 9/62) and 20% of women with twist degree >720 (n = 10/50) (P = 0.03). The median twist degree was 540 (interquartile range [IQR] 360-855) and 720 (IQR 675-1080) degrees in the control and study groups, respectively (P = 0.005). Additional possibly associated factors for recurrence were evaluated. Age emerged as a possible risk factor, with a median age of 19 years in the recurrence group (IQR 14-27 years) versus 28.5 (IQR 19-36 years) in the non-recurrence group (P < 0.01). Logistic regression analysis revealed that together with age, adnexal twist degree remained significantly associated with torsion recurrence (odds ratio [OR] 1.98, 95% CI 1.09-3.61; P = 0.02). CONCLUSION Adnexal twist degree was found to be positively associated with the risk of torsion recurrence. TWEETABLE ABSTRACT Adnexal twist degree was found to be positively associated with the risk of torsion recurrence.
Collapse
Affiliation(s)
- Y Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Mohr-Sasson
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Yousefi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - M Goldenberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - R Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Toussia-Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Eyal
- Kaplan Medical Center, Rehovot, Israel
| | - S Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Mashiach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Goldenberg M, Ly N, Spaccarelli N, Korman A, Chung C, Kaffenberger B. 287 A retrospective study of cellulitis outcomes in Ohio hospitals with or without access to dermatology residency programs. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Kedar I, Walsh L, Levi GR, Lieberman S, Shtaya AA, Nathan SN, Lagovsky I, Tomashov-Matar R, Goldenberg M, Basel-Salmon L, Katz L, Aleme O, Peretz TY, Hubert A, Rothstein D, Castellvi-Bel S, Walsh T, King MC, Pritchard CC, Levi Z, Half E, Laish I, Goldberg Y. A novel founder MSH2 deletion in Ethiopian Jews is mainly associated with early-onset colorectal cancer. Fam Cancer 2021; 21:181-188. [PMID: 33837488 DOI: 10.1007/s10689-021-00249-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
Lynch syndrome is an inherited cancer predisposition syndrome caused by germline defects in any of the mismatch repair (MMR) genes. Diagnosis of carriers makes precision prevention, early detection, and tailored treatment possible. Herein we report a novel founder deletion of 18,758 bp, mediated by Alu repeats on both sides, detected in Ethiopian Jews. The deletion, which encompasses exon 9-10 of the MSH2 coding sequence, is associated mainly with early-onset MSH2/MSH6-deficient colorectal cancer (CRC) and liposarcoma. Testing of 35 members of 5 seemingly unrelated families of Ethiopian origin yielded 10/21 (48%) carriers, of whom 9 had CRC. Age at first tumor diagnosis ranged from 16 to 89 years. Carriers from the oldest generations were diagnosed after age 45 years (mean 57), and carriers from the younger generation were diagnosed before age 45 years (mean 30). Awareness of this founder deletion is important to improve patient diagnosis, institute surveillance from an early age, and refer patients for genetic counseling addressing the risk of bi-allelic constitutional MMR deficiency syndrome.
Collapse
Affiliation(s)
- I Kedar
- The Raphael Recanati Genetics Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
| | - L Walsh
- Departments of Medicine and Genome Sciences, University of Washington, Seattle, WA, USA
| | - G Reznick Levi
- The Genetics Institute, Rambam Health Care Campus, Haifa, Israel
| | - S Lieberman
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - A Abu Shtaya
- Department of Internal Medicine, Carmel Medical Center, Haifa, Israel
| | - S Naftaly Nathan
- The Raphael Recanati Genetics Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
| | - I Lagovsky
- The Raphael Recanati Genetics Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
| | - R Tomashov-Matar
- The Raphael Recanati Genetics Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
| | - M Goldenberg
- The Raphael Recanati Genetics Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
| | - L Basel-Salmon
- The Raphael Recanati Genetics Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Katz
- Department of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
| | - O Aleme
- Genetics Institute, Emek Medical Center, Afula, Israel
| | - T Yablonski Peretz
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - A Hubert
- Gastrointestinal Cancer Center, Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | | | - S Castellvi-Bel
- Gastroenterology Department, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - T Walsh
- Departments of Medicine and Genome Sciences, University of Washington, Seattle, WA, USA
| | - M C King
- Departments of Medicine and Genome Sciences, University of Washington, Seattle, WA, USA
| | - C C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Z Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Gastroenterology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - E Half
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - I Laish
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y Goldberg
- The Raphael Recanati Genetics Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
9
|
van Dalen ASHM, Goldenberg M, Grantcharov TP, Schijven MP. Assessing the team's perception on human factors in the operating environment. Am J Surg 2020; 221:1295-1297. [PMID: 33189308 DOI: 10.1016/j.amjsurg.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Marlies P Schijven
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Canada; Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
| |
Collapse
|
10
|
Mohr-Sasson A, Timor I, Mashiach R, Goldenberg M. Pregnancy Following Cesarean Scar Defect (niche) Repair. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
Neu S, Locke J, Goldenberg M, Herschorn S. Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review. Can Urol Assoc J 2020; 15:E276-E280. [PMID: 33119501 DOI: 10.5489/cuaj.6786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. METHODS All patients diagnosed with UVF at our center from 1988-2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. RESULTS A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35-62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4-72). CONCLUSIONS UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.
Collapse
Affiliation(s)
- Sarah Neu
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer Locke
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
12
|
Lawson KA, Daignault K, Abouassaly R, Khanna A, Martin L, Goldenberg M, Hamilton RJ, Loblaw A, Warde P, Saarela O, Finelli A. Hospital-level Effects Contribute to Variations in Prostate Cancer Quality of Care. Eur Urol Oncol 2020; 4:494-497. [PMID: 32938571 DOI: 10.1016/j.euo.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/07/2020] [Accepted: 08/21/2020] [Indexed: 12/01/2022]
Abstract
A paucity of real-world data exists highlighting whether variations in prostate cancer quality of care occur at a hospital level, independent of differences in case mix. To overcome this knowledge gap, we benchmarked hospital-level quality (n = 1245 hospitals) across a broad multidisciplinary panel of previously reported disease-specific, expert-defined quality indicators (QIs), adjusting for differences in patient case mix by indirect standardization. A composite measure of prostate cancer quality-the prostate cancer quality score (PC-QS)-was derived, and associations between PC-QS and hospital volume, academic status, and location as well as patient all-cause mortality were determined. After adjusting for the case mix, of the total of 1245 hospitals evaluated, 2-37% were identified as those performing significantly below the national average for a given QI. Hospitals with a higher PC-QS displayed larger patient volumes, were more commonly academic affiliated, and had lower overall mortality. Collectively, our data-driven benchmarking analysis reveals that widespread hospital-level variations exist in prostate cancer quality of care after adjusting for differences in case mix, with the PC-QS serving as a novel, validated, quality benchmarking tool. PATIENT SUMMARY: Our statistical benchmarking method shows that the quality of prostate cancer care varies between hospitals, after accounting for differences in patient characteristics. The prostate cancer quality score is a novel, validated, quality benchmarking tool.
Collapse
Affiliation(s)
- Keith A Lawson
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Katherine Daignault
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Robert Abouassaly
- Division of Urology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Abhinav Khanna
- Division of Urology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Martin
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Mitchell Goldenberg
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
13
|
Goldenberg M, Reynolds M, Smart S, Kaffenberger J, Raman S, Kaffenberger B. 475 A retrospective study of myocardial abnormalities detected on cardiac magnetic resonance imaging among patients with psoriasis compared to inflammatory skin disease controls. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
Goldenberg M, Reynolds M, Smart S, Kaffenberger J, Raman SV, Kaffenberger BH. A retrospective study of myocardial abnormalities detected on cardiac magnetic resonance imaging among patients with psoriasis compared to inflammatory skin disease controls. J Eur Acad Dermatol Venereol 2020; 34:e606-e608. [PMID: 32299143 DOI: 10.1111/jdv.16486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- M Goldenberg
- Medical Student Research Program, The OSU College of Medicine, The OSU Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M Reynolds
- The OSU College of Medicine, The OSU Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Smart
- The OSU College of Medicine, The OSU Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S V Raman
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - B H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
15
|
McAllister M, Ryan C, Dodd L, Goldenberg M, Brien DL. A thematic literature review of innovative strategies to prepare nursing students for aged-care. Nurse Educ Today 2020; 87:104355. [PMID: 32062413 DOI: 10.1016/j.nedt.2020.104355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/30/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The exponential rise in people living longer but requiring residential care is adding pressure to already overstretched aged care nurses. Consequently, a person-centred care culture in residential care remains aspirational, rather than a reality. For nursing students in Australia and elsewhere, clinical placements in aged care facilities are under-utilised due to negative perceptions about the likelihood for learning. Creative strategies to engage students to safely challenge ageist thinking and to inspire enthusiasm for learning in this context are needed. OBJECTIVES The purpose of this thematic review of the literature is to better understand challenges related to learning in aged care settings and identify innovative strategies to enhance nursing student learning experiences in residential aged care placements. REVIEW METHODS A literature review was undertaken in 2019 using CINAHL, PUBMED, Elsevier, Medline, ProQuest and Google Scholar. The search was limited to papers that were peer reviewed, in English, and published between 2001 and the date of review (mid-2019) in order to situate the review in the new millennium. RESULTS 47 articles and books were included in the review that introduce solutions and innovative strategies that could be used to improve students' attitudes to learning in aged care and from older people. The literature review was categorized into three main themes, including: barriers to working with older people; the need for pedagogical change to foster empathy; and innovative strategies to address barriers. CONCLUSION These themes are useful to consider in designing engaging learning and teaching for nursing students to be effective in working in aged care.
Collapse
Affiliation(s)
- M McAllister
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Australia.
| | - C Ryan
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Australia
| | - L Dodd
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Australia
| | - M Goldenberg
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Australia
| | - D L Brien
- School of Education and the Creative Arts, Central Queensland University, Australia
| |
Collapse
|
16
|
Abstract
IMPORTANCE When evaluating surgeons in the operating room, experienced physicians must rely on live or recorded video to assess the surgeon's technical performance, an approach prone to subjectivity and error. Owing to the large number of surgical procedures performed daily, it is infeasible to review every procedure; therefore, there is a tremendous loss of invaluable performance data that would otherwise be useful for improving surgical safety. OBJECTIVE To evaluate a framework for assessing surgical video clips by categorizing them based on the surgical step being performed and the level of the surgeon's competence. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study assessed 103 video clips of 8 surgeons of various levels performing knot tying, suturing, and needle passing from the Johns Hopkins University-Intuitive Surgical Gesture and Skill Assessment Working Set. Data were collected before 2015, and data analysis took place from March to July 2019. MAIN OUTCOMES AND MEASURES Deep learning models were trained to estimate categorical outputs such as performance level (ie, novice, intermediate, and expert) and surgical actions (ie, knot tying, suturing, and needle passing). The efficacy of these models was measured using precision, recall, and model accuracy. RESULTS The provided architectures achieved accuracy in surgical action and performance calculation tasks using only video input. The embedding representation had a mean (root mean square error [RMSE]) precision of 1.00 (0) for suturing, 0.99 (0.01) for knot tying, and 0.91 (0.11) for needle passing, resulting in a mean (RMSE) precision of 0.97 (0.01). Its mean (RMSE) recall was 0.94 (0.08) for suturing, 1.00 (0) for knot tying, and 0.99 (0.01) for needle passing, resulting in a mean (RMSE) recall of 0.98 (0.01). It also estimated scores on the Objected Structured Assessment of Technical Skill Global Rating Scale categories, with a mean (RMSE) precision of 0.85 (0.09) for novice level, 0.67 (0.07) for intermediate level, and 0.79 (0.12) for expert level, resulting in a mean (RMSE) precision of 0.77 (0.04). Its mean (RMSE) recall was 0.85 (0.05) for novice level, 0.69 (0.14) for intermediate level, and 0.80 (0.13) for expert level, resulting in a mean (RMSE) recall of 0.78 (0.03). CONCLUSIONS AND RELEVANCE The proposed models and the accompanying results illustrate that deep machine learning can identify associations in surgical video clips. These are the first steps to creating a feedback mechanism for surgeons that would allow them to learn from their experiences and refine their skills.
Collapse
Affiliation(s)
- Shuja Khalid
- Surgical Safety Technologies, Toronto, Ontario, Canada
| | | | | | - Babak Taati
- Surgical Safety Technologies, Toronto, Ontario, Canada
| | - Frank Rudzicz
- Surgical Safety Technologies, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Goldenberg M, Ordon M, Honey JRD, Andonian S, Lee JY. Objective Assessment and Standard Setting for Basic Flexible Ureterorenoscopy Skills Among Urology Trainees Using Simulation-Based Methods. J Endourol 2020; 34:495-501. [PMID: 32059622 DOI: 10.1089/end.2019.0626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective: To objectively assess the performance of graduating urology residents performing flexible ureterorenoscopy (fURS) using a simulation-based model and to set an entrustability standard or benchmark for use across the educational spectrum. Methods: Chief urology residents and attending endourologists performed a standardized fURS task (ureterorenoscopy and repositioning of stones) using a Boston Scientific© Lithovue ureteroscope on a Cook Medical© URS model. All performances were video-recorded and blindly scored by both endourology experts and crowd-workers (C-SATS) using the Ureteroscopic Global Rating Scale, plus an overall entrustability score. Validity evidence supporting the scores was collected and categorized. The Borderline Group (BG) method was used to set absolute performance standards for the expert and crowdsourced ratings. Results: A total of 44 participants (40 chief residents, 4 faculties) completed testing. Eighty-three percent of participants had performed >50 fURS cases at the time of the study. Only 47.7% (mean score 12.6/20) and 61.4% (mean score 12.4/20) of participants were deemed "entrustable" by experts and crowd-workers, respectively. The BG method produced entrustability benchmarks of 11.8/20 for experts and 11.4/20 for crowd-worker ratings, resulting in pass rates of 56.9% and 61.4%. Conclusion: Using absolute standard setting methods, benchmark scores were set to identify trainees who could safely carry out fURS in the simulated setting. Only 60% of residents in our cohort were rated as entrustable. These findings support the use of benchmarks to earlier identify trainees requiring remediation.
Collapse
Affiliation(s)
- Mitchell Goldenberg
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - John R D'A Honey
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Sero Andonian
- Division of Urology, McGill University Health Centre, McGill University, Quebec, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
18
|
Sainsbury B, Łącki M, Shahait M, Goldenberg M, Baghdadi A, Cavuoto L, Ren J, Green M, Lee J, Averch TD, Rossa C. Evaluation of a Virtual Reality Percutaneous Nephrolithotomy (PCNL) Surgical Simulator. Front Robot AI 2020; 6:145. [PMID: 33501160 PMCID: PMC7805868 DOI: 10.3389/frobt.2019.00145] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 07/19/2019] [Accepted: 12/11/2019] [Indexed: 12/31/2022] Open
Abstract
Percutaneous Nephrolithotomy is the standard surgical procedure used to remove large kidney stones. PCNL procedures have a steep learning curve; a physician needs to complete between 36 and 60 procedures, to achieve clinical proficiency. Marion Surgical K181 is a virtual reality surgical simulator, which emulates the PCNL procedures without compromising the well-being of patients. The simulator uses a VR headset to place a user in a realistic and immersive operating theater, and haptic force-feedback robots to render physical interactions between surgical tools and the virtual patient. The simulator has two modules for two different aspects of PCNL kidney stone removal procedure: kidney access module where the user must insert a needle into the kidney of the patient, and a kidney stone removal module where the user removes the individual stones from the organ. In this paper, we present user trials to validate the face and construct validity of the simulator. The results, based on the data gathered from 4 groups of users independently, indicate that Marion's surgical simulator is a useful tool for teaching and practicing PCNL procedures. The kidney stone removal module of the simulator has proven construct validity by identifying the skill level of different users based on their tool path. We plan to continue evaluating the simulator with a larger sample of users to reinforce our findings.
Collapse
Affiliation(s)
- Ben Sainsbury
- Faculty of Science, Ontario Tech University, Oshawa, ON, Canada
| | - Maciej Łącki
- Faculty of Engineering and Applied Science, Ontario Tech University, Oshawa, ON, Canada
| | - Mohammed Shahait
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | | | | | - Lora Cavuoto
- University of Buffalo, Buffalo, NY, United States
| | - Jing Ren
- Faculty of Engineering and Applied Science, Ontario Tech University, Oshawa, ON, Canada
| | - Mark Green
- Faculty of Science, Ontario Tech University, Oshawa, ON, Canada
| | - Jason Lee
- St. Michael's Hospital, Toronto, ON, Canada
| | - Timothy D Averch
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Carlos Rossa
- Faculty of Engineering and Applied Science, Ontario Tech University, Oshawa, ON, Canada
| |
Collapse
|
19
|
Krakowsky Y, Millman A, Goldenberg M, Grober E. 016 Establishing a Multidisciplinary, Academic Program in Penile Inversion Vaginoplasty. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
20
|
Cohen SB, Shapira M, Baron A, Bouaziz J, Mashiach R, Goldenberg M, Orvieto R. Ultrasonography-guided hysteroscopic tubal catheterization of proximally occluded tubes - reproductive outcomes. CLIN EXP OBSTET GYN 2019. [DOI: 10.12891/ceog4871.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
21
|
Levin M, McKechnie T, Khalid S, Grantcharov TP, Goldenberg M. Automated Methods of Technical Skill Assessment in Surgery: A Systematic Review. J Surg Educ 2019; 76:1629-1639. [PMID: 31272846 DOI: 10.1016/j.jsurg.2019.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The goal of the current study is to systematically review the literature addressing the use of automated methods to evaluate technical skills in surgery. BACKGROUND The classic apprenticeship model of surgical training includes subjective assessments of technical skill. However, automated methods to evaluate surgical technical skill have been recently studied. These automated methods are a more objective, versatile, and analytical way to evaluate a surgical trainee's technical skill. STUDY DESIGN A literature search of the Ovid Medline, Web of Science, and EMBASE Classic databases was performed. Articles evaluating automated methods for surgical technical skill assessment were abstracted. The quality of all included studies was assessed using the Medical Education Research Study Quality Instrument. RESULTS A total of 1715 articles were identified, 76 of which were selected for final analysis. An automated methods pathway was defined that included kinetics and computer vision data extraction methods. Automated methods included tool motion tracking, hand motion tracking, eye motion tracking, and muscle contraction analysis. Finally, machine learning, deep learning, and performance classification were used to analyse these methods. These methods of surgical skill assessment were used in the operating room and simulated environments. The average Medical Education Research Study Quality Instrument score across all studies was 10.86 (maximum score of 18). CONCLUSIONS Automated methods for technical skill assessment is a growing field in surgical education. We found quality studies evaluating these techniques across many environments and surgeries. More research must be done to ensure these techniques are further verified and implemented in surgical curricula.
Collapse
Affiliation(s)
- Marc Levin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Tyler McKechnie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shuja Khalid
- Surgical Safety Technologies, Li Ka Shing International Knowledge Institute, Toronto, Ontario, Canada
| | - Teodor P Grantcharov
- Surgical Safety Technologies, Li Ka Shing International Knowledge Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Goldenberg
- Surgical Safety Technologies, Li Ka Shing International Knowledge Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
22
|
van Dalen AS, Goldenberg M, Grantcharov TP, Schijven MP. Assessing Human Factors in the Operating Theatre: Differences in Perceptions within the Surgical Team. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Prasad A, Brehm C, Goldenberg M, Ghodsizad A, Koerner M, Banayosy AE, Singbartl K. Assessing Left Ventricular Unloading and Wall Tension to Predict the Need for Durable Mechanical Circulatory Support after Peripheral VA-ECMO. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
24
|
Alsubaie H, Goldenberg M, Grantcharov T. Quantifying recall bias in surgical safety: a need for a modern approach to morbidity and mortality reviews. Can J Surg 2019; 62:39-43. [PMID: 30693745 DOI: 10.1503/cjs.017317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Despite recent investments into reducing errors and adverse events in health care, methods for quality improvement in surgery are outdated and ineffective. Most current efforts in this field are centred around morbidity and mortality
conferences (MMCs), which have remained unchanged for over 100 years. The present study aimed to quantify the recall bias associated with details from surgical cases. Methods We gathered immediate postoperative questionnaires from 1 surgeon, 1 fellow and 11 trainees following 25 routine surgical cases. Information elicited included their perceived level of concentration, mental preparedness and assessment
of whether the procedure deviated from its expected course, including any intraoperative adverse events. We readministered the questionnaire 7−9 days later to assess participants’ ability to recall important aspects of the procedure. Results After 1 week, members of the surgical team were universally inaccurate in their recollection of even major details from the operating room. Although most participants felt mentally prepared and perceived no issues with concentration during the case, all participants misclassified operations as having been performed with or without adverse events in almost every included case. Conclusion Our findings show that recall bias regarding surgical safety events is exceedingly common. This likely has a major impact on the integrity of data presented at MMCs.
Collapse
Affiliation(s)
- Hamad Alsubaie
- From the International Centre for Surgical Safety, St. Michael’s Hospital, Toronto, Ont. (Alsubaie, Goldenberg, Grantcharov)
| | - Mitchell Goldenberg
- From the International Centre for Surgical Safety, St. Michael’s Hospital, Toronto, Ont. (Alsubaie, Goldenberg, Grantcharov)
| | - Teodor Grantcharov
- From the International Centre for Surgical Safety, St. Michael’s Hospital, Toronto, Ont. (Alsubaie, Goldenberg, Grantcharov)
| |
Collapse
|
25
|
Mohr Sasson A, Machtinger R, Mashiach R, Nir O, Inbar Y, Maliyanker N, Goldenberg M, Rabinovici J. Long-Term Outcome of MR-Guided Focused Ultrasound Treatment and Laparoscopic Myomectomy for Symptomatic Uterine Fibroids. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
26
|
Shapira M, Cohen S, Bouaziz J, Mashiach R, Orvieto R, Goldenberg M. Ultrasonography Guided Hysteroscopic Tubal Catheterization of Proximally Occluded Tubes- Reproductive Outcomes. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
27
|
Grober E, Goldenberg M, Elfassy M, Lorenzo A, Roberts M, Domes T, Mahdi M, AS Jewett M. PD58-02
VALIDATION OF REAL-TIME, INTRA-OPERATIVE, SURGICAL COMPETENCE (RISC)
ASSESSMENTS LINKED TO CLINICALLY RELEVANT PATIENT OUTCOMES: A MODEL OF COMPETENCY ASSESSMENT IN UROLOGY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
28
|
Goldenberg M, Shahait M, Averch T, Lee J. MP01-10 CONTENT VALIDITY EVIDENCE FOR A NOVEL MIXED REALITY PERCUTANEOUS NEPHROLITHOTOMY SIMULATOR. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
29
|
Goldenberg M, Elfassy M, Jewett M, Lorenzo A, Roberts M, Domes T, Mahdi M, Grober E. PD58-05 REAL-TIME INTRAOPERATIVE SURGICAL COMPETENCY (RISC) ASSESSMENTS: DEVELOPMENT AND VALIDATION OF A PROCEDURE-SPECIFIC EVALUATION TOOL FOR TRANSURETHRAL RESECTION OF BLADDER TUMORS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
30
|
Goldenberg M, Sadat H, Garbens A, Lee J, Finelli A, Grantcharov T. PD58-06 INCORPORATING MEASURES OF PATIENT SAFETY INTO TECHNICAL SKILL ASSESSMENTS IN ROBOTIC ASSISTED RADICAL PROSTATECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Garbens A, Goldenberg M, Wallis CJD, Tricco A, Grantcharov TP. The cost of intraoperative adverse events in abdominal and pelvic surgery: A systematic review. Am J Surg 2017; 215:163-170. [PMID: 28709625 DOI: 10.1016/j.amjsurg.2017.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/21/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The assessment of intra-operative adverse events (iAEs) is a vastly under researched area with the potential to provide new methods on how to improve patient outcomes and hospital costs. Our objective was to determine the relationship between iAEs and total hospital costs in abdominal and pelvic surgery. DATA SOURCES We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Embase, MEDLINE and EBM Reviews online databases were searched to identify all studies that reported iAE rates and total hospital costs. We then analyzed the costing approach used in each article using the Drummond tool and evaluated articles quality using the GRADE method. CONCLUSIONS In total, 1709 unique references were identified through our literature search. After review, 23 were included. All studies that reported iAE rates and cost as the primary outcome found that iAEs significantly increased total hospital costs. We identified a relationship between iAEs and increased hospital costs. Future studies need to be performed to further evaluate the relationship between iAEs and cost as current studies are of low quality.
Collapse
Affiliation(s)
- A Garbens
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - M Goldenberg
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - C J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - A Tricco
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, ON, Canada.
| | - T P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
| |
Collapse
|
32
|
Affiliation(s)
- Mitchell Goldenberg
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
33
|
Bar Shavit Y, Mazaki-Tovi S, Bouaziz J, Goldenberg M, Mashiach RJ. Thinner Patients Suffer More Post-Laparoscopy Pain. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
34
|
Mashiach R, Kislev I, Gilboa D, Seidman DS, Afek S, Bar SY, Buaziz J, Goldenberg M. Initial Rise of Serum hCG Levels After Methotrexate Therapy Is Associated with a Lower Success Rate of Medical Treatment in Patient Diagnosed with Ectopic Pregnancy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
Shah P, Glueck CJ, Goldenberg N, Jetty V, Kumar A, Goldenberg M, Wang P, Motayar N, Prince M, Lee K. ID: 19: ELIGIBILITY FOR PCSK9 TREATMENT IN 734 HYPERCHOLESTEROLEMIC PATIENTS REFERRED TO A REGIONAL CHOLESTEROL TREATMENT CENTER WITH LDL CHOLESTEROL ≥70 MG/DL DESPITE MAXIMAL TOLERATED CHOLESTEROL LOWERING THERAPY. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLDL cholesterol (LDLC) lowering has been revolutionized by PCSK9 inhibitors, Alirocumab (Praluent) and Evolocumab (Repatha), which have approved indications as an adjunct to diet-maximally tolerated cholesterol lowering therapy in heterozygous (HeFH) or homozygous (HoFH) familial hypercholesterolemia, and/or clinical atherosclerotic cardiovascular disease (CVD) where LDLC lowering is insufficient despite maximal tolerated therapy.MethodsWe applied FDA approved and commercial insurance eligibility criteria for PCSK9 inhibitor use in 734 patients serially referred over 3 years who then received ≥2 months maximally tolerated LDLC lowering diet-drug therapy with follow up LDLC ≥70 mg/dl, as well as in 37 patients approved by commercial insurance for PCSK9 inhibitors. We obtained estimates of the percentage of patients with HeFH and/or CVD who meet FDA and commercial insurance eligibility for PCSK9 inhibitors using LDLC goal-based guidelines.ResultsOf the 734 patients with LDLC ≥70 mg/dl after ≥2 months maximally tolerated LDLC lowering therapy, 220 (30%) had HeFH and/or CVD events with LDLC >100 mg/dl, meeting both FDA and commercial insurance criteria for PCSK9 inhibitor therapy. Sixty-six (9%) patients were statin intolerant, without HeFH or CVD events. Of the 37 patients whose PCSK9 inhibitor therapy was approved for coverage by medical insurance carriers, 34 (92%) had LDLC>100 mg/dl after ≥2 months on maximally tolerated LDLC lowering therapy. Sixteen (43%) of these 37 patients had HeFH without CVD (LDLC on maximally tolerated conventional treatment 181±48 mg/dl), 11 (30%) had CVD without HeFH (LDLC on maximally tolerated conventional treatment 122±22 mg/dl), and 8 (22%) had both HeFH and CVD (LDLC on maximally tolerated conventional treatment 204±56 mg/dl).ConclusionOf the 734 patients referred for high LDLC treatment, with LDLC ≥70 mg/dl after ≥2 months on maximally tolerated therapy, 220 (30%) had HeFH and/or CVD with LDLC >100 mg/dl, meeting both FDA and insurance criteria for PCSK9 inhibitor therapy. If 30% of patients with high LDLC and HeFH-CVD are eligible for PCSK9 inhibitors, then specialty pharmaceutical pricing models (∼$14,300/year) will collide with an estimated 16–21 million HeFH-CVD patients. Although the costs for PCSK9 inhibitors given to an estimated 16 to 21 million patients are extraordinary ($228–300 billion), we speculate that, when weighed against direct and indirect costs of CVD, on balance, the cost to society might be either none, or that society would, in fact, save money by an anticipated 50% reduction of CVD events with PCSK9 inhibitors. Whether the health care savings arising from the anticipated reduction of CVD on the PCSK9 inhibitors justify the broad population use of these agents remains to be determined.
Collapse
|
36
|
Rothschild M, Vijaykumar A, Goldenberg M, Motayar N, Weber J, Prince M, Glueck CJ, Wang P. ID: 20: HOSPITALIZATION FOR PULMONARY EMBOLISM ASSOCIATED WITH ANTECEDENT TESTOSTERONE OR ESTROGEN THERAPY IN PATIENTS FOUND TO HAVE FAMILIAL THROMBOPHILIA. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn patients hospitalized over a 4 year period for pulmonary embolism (PE), and subsequently found to have familial-acquired thrombophilia, we assessed relationships of thrombophilia with testosterone (TT) and estrogen therapy (ET) anteceding PE.MethodsFrom 2011 through 2014, 347 patients were hospitalized in Cincinnati Mercy Hospitals with PE. Retrospective chart review was used to document TT or ET anteceding PE in patients subsequently found to have familial or acquired thrombophilia.ResultsPreceding hospitalization for PE, of the 154 men and 193 women, 8 men (5% of men) used TT, 24 women (12% of women) used ET (16 birth control pills, 6 hormone replacement therapy, 2 progesterone). Median age in the 8 men was 56 and for the 24 women 38. After excluding 45 women with cancer preceding PE, 24 of 148 (16%) women with PE had used ET, and after excluding 33 men with cancer, 8/121 men (7%) used TT. Of these 8 men, 6 used TT gels, 50 mg/day, and 2 had intra muscular TT 50 mg/week.Of the 8 men, 5 (63%) smoked, 2 had a history of thrombotic events, and 2 had type 2 diabetes. The median number of months from the initiation of TT to development of PE was 7 months.Coagulation evaluations were done in 6 of the 8 men. All 6 had ≥1 thrombophilia; 1 heterozygous for the G20210A prothrombin gene (PTG) mutation, 1 with high factor VIII, 3 with high homocysteine (1 of whom had MTHFR C677T homozygosity), 2 with low protein C, 2 with low protein S, and 2 with low free protein S. Two of 8 men had Klinefelter's syndrome.Of the 24 women, 2 were diabetic, 1 had a history of thrombosis, and 7 (29%) smoked. The median time between initiation of ET and the PE was 18 months.In 18 out of the 24 women, coagulation evaluations were performed. 15 had ≥1 thrombophilia; 4 were factor V Leiden heterozygotes, 1 PTG heterozygote, 2 high Factor VIII, 1 high Factor XI, 2 with the lupus anticoagulant, 3 low protein S, 2 low Free S, 3 low antithrombin III, 3 high anticardiolipin antibodies.ConclusionAfter excluding antecedent cancer, 24/148 women (16%) had ET before PE, and TT was taken by 8/121 (7%) men. PE is an important complication of TT in men and ET in women, in part reflecting an interaction between familial and acquired thrombophilia and exogenous hormone use.
Collapse
|
37
|
Jetty V, Duhon G, Shah P, Prince M, Lee K, Goldenberg M, Kumar A, Glueck CJ, Wang P. ID: 86: SAFETY OF 50,000-100,000 UNITS OF VITAMIN D3 PER WEEK IN VITAMIN D DEFICIENT, HYPERCHOLESTEROLEMIC PATIENTS, WITH STATIN INTOLERANCE. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn ∼85–90% of statin intolerant patients, vitamin D deficiency (serum 25 (OH) D <32 ng/ml) is a reversible cause of statin intolerance, usually requiring 50,000 to 100,000 units of vitamin D/week continuously to normalize serum vitamin D, and thus successfully allow reinstitution of statins which previously could not be tolerated because of myalgia-myositis.Specific AimIn 274 statin intolerant patients, all with low entry serum vitamin D (<32 ng/ml, median 21 ng/ml), we assessed safety and efficacy of vitamin D supplementation (50,000–100,000 units/week) over treatment periods of 3 months (n=274), 3 and 6 months (n=161), 3, 6, and 9 months (n=58), and 3, 6, 9, and 12 months (n=22).ResultsIn the 385 patients with 3 month follow-up, taking mean 61,000 and median 50,000 IU of vitamin D3/week, median serum vitamin D rose from 20 to 42 ng/ml (p<0.0001); vitamin D became high (>100 ng/ml) but not toxic-high (>150 ng/ml) in 4 patients (1.0%) (101, 102, 106, 138 ng/ml). Median serum calcium was unchanged from entry (9.6 mg/dl) to 9.6 at 3 months. On vitamin D supplementation, the trend of change in serum calcium from normal-to-high or from high-to-normal did not significantly differ (McNemar S=1.0, p=0.32), and there was no significant trend in change of the calculated glomerular filtration rate (eGFR) from entry to follow-up (McNemar S=2.6, p=0.11).In the 161 patients with 3 and 6 month follow-up, taking mean 67,000 and median 50,000 IU of vitamin D3/week, median entry serum vitamin D rose from 21 to 42 to 44 ng/ml (p<0.0001), serum vitamin D was high (>100 but <150 ng/ml) in 2 patients at 3 months (1.2%, 101, 102 mg/ml) and in 3 (1.9%) at 6 months (101, 140, 140 ng/ml). Median serum calcium was unchanged from entry (9.7 mg/dl), at 3 and 6 months (9.7, 9.6 mg/dl, p>0.05). On vitamin D supplementation, the change in serum calcium from normal-to-high or high-to-normal was no significant trend (McNemar S=0.7, p=0.41), and no trend in change of eGFR (McNemar S=1.3, p=0.26).In the 58 patients with 3, 6, and 9 month follow-up on mean and median 71,000 and 100,000 IU of D3/week, median entry vitamin D rose from 20 to 37, 41, and 44 ng/ml (p<0.0001), with 1 (1.7%, 102 ng/ml), 2 (3.5%, 140, 140 ng/ml), and 0 (0%) patients high. Median serum calcium was unchanged from entry, median 9.7, 9.8, 9.6, and 9.6 mg/dl. On vitamin D supplementation, the trend of change in serum calcium from normal-to-high or high-to-normal was not significant (McNemar S=1.8, p=0.18), and no trend in change of eGFR (McNemar S=2, p=0.16).In the 22 patients with follow-up at 3, 6, 9, and 12 months on mean and median 70,000 and 75,000 IU of D3/week, median serum vitamin D rose from 20 to 37, to 41, to 44, and to 43 ng/ml (p<0.0001), with 1 (5%, 102 ng/ml) high, 2 (9%, 140, 140) high, 0 (0%) high, and 1 (5%, 126 ng/ml) high. Serum calcium was unchanged, median at entry 9.6, and then at 3, 6, 9, and 12 months 9.7, 9.7, 9.5, and 9.7 mg/ml. At entry serum calcium was normal in 21, none high, and one became high at 12 month follow-up. The trend of change in eGFR was insignificant, McNemar S=1.0, p=0.32.When serum D rose above 100 ng/ml in the few cases, as above, it fell into the normal range within 2 weeks by reducing the vitamin D dose by 50%.ConclusionsWhen 50,000–100,000 units of vitamin D/week are given to reverse statin intolerance in statin intolerant patients with low entry vitamin D (<32 ng/ml), it appears to be safe over up to 1 year follow-up, without toxic high serum vitamin D levels >150 ng/ml, and levels rarely >100 ng/ml, and without changes in serum calcium or eGFR.
Collapse
|
38
|
Abstract
When solving instances of problem domains that feature a large branching factor, A* may generate a large number of nodes whose cost is greater than the cost of the optimal solution. We designate such nodes as surplus. Generating surplus nodes and adding them to the OPEN list may dominate both time and memory of the search. A recently introduced variant of A* called Partial Expansion A* (PEA*) deals with the memory aspect of this problem. When expanding a node n, PEA* generates all of its children and puts into OPEN only the children with f = f (n). n is re-inserted in the OPEN list with the f -cost of the best discarded child. This guarantees that surplus nodes are not inserted into OPEN.
In this paper, we present a novel variant of A* called Enhanced Partial Expansion A* (EPEA*) that advances the idea of PEA* to address the time aspect. Given a priori domain- and heuristic- specific knowledge, EPEA* generates only the nodes with f = f(n). Although EPEA* is not always applicable or practical, we study several variants of EPEA*, which make it applicable to a large number of domains and heuristics. In particular, the ideas of EPEA* are applicable to IDA* and to the domains where pattern databases are traditionally used. Experimental studies show significant improvements in run-time and memory performance for several standard benchmark applications. We provide several theoretical studies to facilitate an understanding of the new algorithm.
Collapse
|
39
|
Mashiach R, Bar-On S, Boiko V, Stockheim D, Goldenberg M, Schiff E, Seidman D. Sudden/Nocturnal Onset of Acute Abdominal Pain, Lasting Less Than a Day and Accompanied by Vomiting: A Tell-Tale Sign of Ovarian Torsion. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
40
|
van Bemmelen PS, Choudry RG, Salvatore MD, Goldenberg M, Goldman BI, Blebea J. Long-term Intermittent Compression Increases Arteriographic Collaterals in a Rabbit Model of Femoral Artery Occlusion. Eur J Vasc Endovasc Surg 2007; 34:340-6. [PMID: 17582795 DOI: 10.1016/j.ejvs.2007.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 04/17/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the effects of intermittent limb compression on arterial collateral formation in a rabbit-model. DESIGN Animal study. MATERIAL AND METHODS New Zealand rabbits (n=11), aged 2-years, weight of at least 4.0 kg, underwent bilateral superficial femoral artery ligation. In ten of these, the experimental leg underwent 60 minutes of daily intermittent compression for a ten week period with 3 sec/90 mmHg pressure inflation and a cycle of 3 times per minute. The contra-lateral limbs were not treated. At the end of the ten-week period, high-resolution angiograms were obtained by barium infusion into the aorta. The angiograms were analyzed in a blinded manner and the number of collateral arteries larger than 100 microns, was counted. Following perfusion-fixation, histological specimens of transverse sections of the compressed semi-membranous muscle were examined. RESULTS The compressed limbs demonstrated a significantly (8.1+/-.87 vs 6.0+/-.97; p<0.005) greater number of collateral vessels, ranging in size from 100-700 microns, as compared to the control sides. The mean size of collaterals in the compressed limbs was not significantly different (0.33+/-0.17 vs 0.31+/-0.16). Microscopic examination of the collaterals confirmed remodeling by a typical neo-intima consisting of 6-7 cell-layers. CONCLUSIONS Intermittent limb compression increases the number of angiographical collateral arteries.
Collapse
Affiliation(s)
- P S van Bemmelen
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
| | | | | | | | | | | |
Collapse
|
41
|
Martens M, Kumar MM, Kumar S, Goldenberg M, Kawata M, Pennycooke O, Strande L, Hadeed J, Camacho J, Hewitt C, Slotman GJ. Quantitative analysis of organ tissue damage after septic shock. Am Surg 2007; 73:243-8. [PMID: 17375779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The objective of this study was to quantify end-organ damage caused by bacteremic sepsis. Twelve adult swine were divided into two groups. The anesthesia control group (n = 6) received general anesthesia for 4 hours. The septic shock group (n = 6) received an infusion of Aeromonas hydrophila under general anesthesia for 4 hours. Swine were sacrificed at the end of the 4-hour procedure. Tissues from lungs, kidneys, livers, and hearts were stained with hematoxylin and eosin. Images of tissues were studied with digital image analysis. In lungs, cytoplasmic area (CA), nuclear area (NA), intra-alveolar hemorrhage (IAH), total airspace (TAS), and alveolar septum thickness (ST) were measured. Nuclear and cytoplasmic intensities (NI and CI) were measured in integrated optical density units (IOD). In kidneys, livers, and hearts, CA, CI, NA, and NI were measured similarly. Sinusoidal blood in the liver and vacuolization (VAC) in the kidney were also measured. In septic lungs, CI, NA, NI, ST, IAH, TAS, and ratios of NA/CA, NI/CI, and IAH/TAS were significantly increased compared with the control (P < 0.02). In septic kidneys, CI, NA, VAC, NA/CA, and NI/CI were significantly increased (P < 0.0005). In livers, CA, CI, and NI/CI were significantly increased (P < 0.005). In hearts, the ratios of NA/CA and NI/CI were statistically significant. End organs from septic swine, with exception of the heart, showed significantly higher levels of cellular damage. Digital image analysis provides an objective, precise, and accurate method of quantifying image characteristics. Automating these tasks is a high priority in the research and clinical community in providing a reproducible method for longitudinal analysis of various biological studies.
Collapse
Affiliation(s)
- M Martens
- UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Martens M, Kumar MM, Kumar S, Goldenberg M, Kawata M, Pennycooke O, Strande L, Hadeed J, Camacho J, Hewitt C, Slotman GJ. Quantitative Analysis of Organ Tissue Damage after Septic Shock. Am Surg 2007. [DOI: 10.1177/000313480707300309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to quantify end-organ damage caused by bacteremic sepsis. Twelve adult swine were divided into two groups. The anesthesia control group (n = 6) received general anesthesia for 4 hours. The septic shock group (n = 6) received an infusion of Aeromonas hydrophila under general anesthesia for 4 hours. Swine were sacrificed at the end of the 4-hour procedure. Tissues from lungs, kidneys, livers, and hearts were stained with hematoxylin and eosin. Images of tissues were studied with digital image analysis. In lungs, cytoplasmic area (CA), nuclear area (NA), intra-alveolar hemorrhage (IAH), total airspace (TAS), and alveolar septum thickness (ST) were measured. Nuclear and cytoplasmic intensities (NI and CI) were measured in integrated optical density units (IOD). In kidneys, livers, and hearts, CA, CI, NA, and NI were measured similarly. Sinusoidal blood in the liver and vacuolization (VAC) in the kidney were also measured. In septic lungs, CI, NA, NI, ST, IAH, TAS, and ratios of NA/CA, NI/CI, and IAH/TAS were significantly increased compared with the control ( P < 0.02). In septic kidneys, CI, NA, VAC, NA/CA, and NI/CI were significantly increased ( P < 0.0005). In livers, CA, CI, and NI/CI were significantly increased ( P < 0.005). In hearts, the ratios of NA/CA and NI/CI were statistically significant. End organs from septic swine, with exception of the heart, showed significantly higher levels of cellular damage. Digital image analysis provides an objective, precise, and accurate method of quantifying image characteristics. Automating these tasks is a high priority in the research and clinical community in providing a reproducible method for longitudinal analysis of various biological studies.
Collapse
Affiliation(s)
- M. Martens
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - M. M. Kumar
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - S. Kumar
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - M. Goldenberg
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - M. Kawata
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - O. Pennycooke
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - L. Strande
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - J. Hadeed
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - J. Camacho
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - C. Hewitt
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| | - G. J. Slotman
- From UMDNJ-RWJMS/Cooper Health System, Camden, New Jersey 08103
| |
Collapse
|
43
|
Machtinger R, Korach J, Padoa A, Fridman E, Zolti M, Segal J, Yefet Y, Goldenberg M, Ben-Baruch G. Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy. Int J Gynecol Cancer 2005; 15:325-8. [PMID: 15823120 DOI: 10.1111/j.1525-1438.2005.15224.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 12/01/2022] Open
Abstract
The aim of this study is to assess accuracy of transvaginal ultrasound (TVUS) and diagnostic hysteroscopy in diagnosing endometrial polyps and to determine premalignancy and malignancy rates in asymptomatic women. The study was designed to retrospectively analyze 438 women who underwent operative hysteroscopy in a day-care unit when endometrial polyp was suspected after TVUS and diagnostic hysteroscopy. Multivariate logistic regression modeling showed effects of age, previous breast cancer with tamoxifen treatment, and menopause with or without bleeding on pathologic results. The results indicate that positive predictive value of TVUS with diagnostic hysteroscopy was 79.9%. Premalignancy or malignancy occurred in 3.2% and was significantly related to menopause with abnormal bleeding (P < 0.001), which carried a 20-fold higher risk of pathology than any other group. Age was also a risk factor. It was concluded that TVUS with diagnostic hysteroscopy reliably evaluates endometrial polyps. The low incidence of endometrial tumors in asymptomatic (especially premenopausal) women suggests that their operative evaluation may not be cost effective. Larger studies are needed to support this tentative conclusion.
Collapse
Affiliation(s)
- R Machtinger
- Gynecology Oncology Department, Division of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Machtinger R, Korach J, Padoa A, Fridman E, Zolti M, Segal J, Yefet Y, Goldenberg M, Ben-Baruch G. Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy. Int J Gynecol Cancer 2005. [DOI: 10.1136/ijgc-00009577-200503000-00023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The aim of this study is to assess accuracy of transvaginal ultrasound (TVUS) and diagnostic hysteroscopy in diagnosing endometrial polyps and to determine premalignancy and malignancy rates in asymptomatic women. The study was designed to retrospectively analyze 438 women who underwent operative hysteroscopy in a day-care unit when endometrial polyp was suspected after TVUS and diagnostic hysteroscopy. Multivariate logistic regression modeling showed effects of age, previous breast cancer with tamoxifen treatment, and menopause with or without bleeding on pathologic results. The results indicate that positive predictive value of TVUS with diagnostic hysteroscopy was 79.9%. Premalignancy or malignancy occurred in 3.2% and was significantly related to menopause with abnormal bleeding (P < 0.001), which carried a 20-fold higher risk of pathology than any other group. Age was also a risk factor. It was concluded that TVUS with diagnostic hysteroscopy reliably evaluates endometrial polyps. The low incidence of endometrial tumors in asymptomatic (especially premenopausal) women suggests that their operative evaluation may not be cost effective. Larger studies are needed to support this tentative conclusion.
Collapse
|
45
|
Machtinger R, Goldenberg M, Soriano D, Zolti M, Atlas M, Seidman DS. [Medical termination of pregnancy with mifepristone--initial experience at the Sheba Medical Center]. Harefuah 2003; 142:666-8, 719. [PMID: 14565062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To assess the early implementation of medical termination of pregnancy as an alternative treatment option for women in early pregnancy who wish to avoid a surgical procedure. METHODS The use of mifepristone (RU-486) for medical termination was recently approved in Israel. We performed a prospective follow-up study of the 189 women who underwent medical termination of pregnancy with mifepristone and misoprostol in our center between January 2000 and April 2001. RESULTS Complete outcome data was obtained for 176 women. Within this group 152 women (86.4%) did not need any surgical procedure to complete the abortion. Uterine curettage was performed in 17 (9.6%) and operative hysteroscopy in 7 (4.0%) of the women because of incomplete abortion or suspected residua of pregnancy. CONCLUSION Medical abortion offers an efficient and safe treatment option to women who wish to avoid surgical evacuation.
Collapse
Affiliation(s)
- R Machtinger
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
The objective of this paper is to examine the outcome of pregnancies with extreme weight-discordant twins. Percentage of birth weight discordancy was defined as the birth weight difference between the twins divided by the larger twin's weight and multiplied by 100. Discordancy was calculated for all twin births in which both fetuses were live born. In 33 pairs, the discordancy was defined as extreme (>35%) and they constituted the study group. Thirty-three pairs of twin defined with mild weight discordancy (15-25%), and 33 pairs defined as concordant to birth weight (<15% difference) were matched to the study group patients based on gestational age at delivery (+/- 7 days) and on the mode of delivery, and constituted the control groups. The records of all the patients were reviewed for pregnancy complications and for major and minor neonatal outcome variables. Significantly more parturients in the study groups were primiparous undergoing in vitro fertilization treatments to conceive. Significantly more women in the study group had severe preeclampsia compared with women with mild discordancy or concordant twins (12.1 vs. 3.0% and 0%, respectively, p <0.025). No significant differences were encountered between the groups in neonatal mortality or morbidity factors except an increased rate of hyperbilirubinemia in the study group, p = 0.006. Using logistic regression analysis, discordancy was not defined as an efficient predictor for adverse neonatal outcome. Twin pregnancies with extreme discordancy have a favorable neonatal outcome in correlation with gestational age and not with the percentage of discordancy.
Collapse
Affiliation(s)
- S B Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | | | | | | |
Collapse
|
47
|
Cohen SB, Wattiez A, Stockheim D, Seidman DS, Lidor AL, Mashiach S, Goldenberg M. The accuracy of serum interleukin-6 and tumour necrosis factor as markers for ovarian torsion. Hum Reprod 2001; 16:2195-7. [PMID: 11574515 DOI: 10.1093/humrep/16.10.2195] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [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: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate a possible role for interleukin-6 (IL-6) and tumour necrosis factor (TNF-alpha) as pre-operative markers for the diagnosis of ovarian torsion. METHODS Twenty consecutive patients admitted to the gynaecological emergency room with suspected clinical diagnosis of ovarian torsion were prospectively assigned to the study. Blood samples were drawn pre-operatively and examined for serum concentrations of IL-6 and TNF-alpha. Surgeons were blinded to laboratory results prior to laparoscopy. RESULTS The pre-operative diagnosis of ovarian torsion was confirmed during an urgent diagnostic laparoscopy in 8 (40%) patients. The surgical diagnosis among the remaining 12 patients was a large ovarian cyst not in torsion. In six out of eight (75.0%) patients with ovarian torsion serum IL-6 concentrations were elevated. None of the 12 patients without torsion had elevated serum IL-6 concentrations. This difference was statistically significant (P < 0.001). There was no significant difference in the proportion of women with elevated serum TNF-alpha concentrations, two of eight (25.0%) patients with torsion and four of 12 (33.3%) control cases. CONCLUSIONS Elevated serum IL-6 concentrations, but not serum TNF-alpha concentrations, were significantly associated with the occurrence of ovarian torsion. In patients with vague clinical signs of ovarian torsion, serum IL-6 might help to distinguish which patients should undergo diagnostic laparoscopy.
Collapse
Affiliation(s)
- S B Cohen
- J. Buchman Maternity Center, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, 52621 Israel.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
OBJECTIVE The aim of this study was to compare the use of a cervical vacuum cap cannula with the traditional metal cannula. DESIGN A prospective, randomised, single-blinded comparative study. SAMPLE Fifty consecutive infertile women undergoing hysterosalpingography for evaluation of infertility METHODS Hysterosalpingography was performed either with the traditional metal cannula (n = 25) or a cervical vacuum cap cannula (n = 25). MAIN OUTCOME MEASURES Length of procedure, fluoroscopic time, amount of contrast medium, pain to the patient while applying the cannula and injecting the contrast medium, level of difficulty to the performer, the need to reapply the cannula, complications, and results of the hysterosalpingography. RESULTS Using the cervical vacuum cap cannula, compared with the metal cannula, the duration of the procedure was significantly shorter (5.3 vs 9.3 minutes; P < 0.001), less fluoroscopic time was needed (0.9 vs 1.8 minutes; P < 0.001), a smaller amount of contrast medium was used (4.6 vs 15.7 mL; P < 0.001), the procedure caused less pain to the patient (3.2 vs 6.8, respectively; on a scale of 1-10; P < 0.001), and was easier for the physician to perform (1.4 vs 3.4; on a scale of 1-10; P < 0.001). No significant differences were encountered between the two groups in the need to reapply the cannula, in the rate of complications or in the results of the hysterosalpingography. CONCLUSIONS The cervical cap cannula appears to be superior to the traditional metal cannula for performing hysterosalpingography.
Collapse
Affiliation(s)
- S B Cohen
- Department of Obstetrics and Gynaecology, Chaim Sheba Medical Centre, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | | | | | | |
Collapse
|
49
|
Zalel Y, Cohen SB, Oren M, Seidman DS, Zolti M, Achiron R, Goldenberg M. Sonohysterography for the diagnosis of residual trophoblastic tissue. J Ultrasound Med 2001; 20:877-881. [PMID: 11503924 DOI: 10.7863/jum.2001.20.8.877] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the efficacy, safety, and associated complications of sonohysterography for the diagnosis of residual trophoblastic tissue. METHODS We conducted a prospective study of 23 consecutive patients admitted to our ultrasonography unit with clinical and ultrasonographic signs of retained intrauterine tissue. RESULTS Twelve patients had hydrosonographic features suggestive of residual trophoblastic tissue (i.e., an intrauterine lesion not detachable from the uterine wall after instillation of saline), whereas in 11 cases the hydrosonographic findings were negative for retained tissue. Blood flow was detected within abnormal intrauterine masses in 4 of 12 patients with trophoblastic tissue, whereas it was not detected in any patient without retained tissue (P = .093). No complications were encountered during the procedure or the postprocedure period. None of the patients had anesthetic complications, perforation of the uterus, fluid overload, or any other surgical complication. All 12 patients underwent hysteroscopic removal of the suspected residual trophoblastic tissue, and histologic confirmation of residual trophoblastic tissue was obtained in all cases. CONCLUSIONS Sonohysterography for detection and diagnosis of residual trophoblastic tissue is an accurate and safe procedure. Further studies comparing the efficacy of sonohysterography with that of diagnostic hysteroscopy are warranted.
Collapse
Affiliation(s)
- Y Zalel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | | | | | | |
Collapse
|
50
|
Cohen SB, Kalter-Ferber A, Weisz BS, Zalel Y, Seidman DS, Mashiach S, Lidor AL, Zolti M, Goldenberg M. Hysteroscopy may be the method of choice for management of residual trophoblastic tissue. J Am Assoc Gynecol Laparosc 2001; 8:199-202. [PMID: 11342724 DOI: 10.1016/s1074-3804(05)60577-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To assess the efficacy of and reproductive outcome after selective curettage of residual trophoblastic tissue directed by hysteroscopy compared with conventional, nonselective, blind curettage. DESIGN Retrospective analysis (Canadian Task Force classification II-1). SETTING Tertiary care medical center. PATIENTS Seventy patients after curettage or delivery, with clinical and ultrasonographic signs of suspected residual trophoblastic tissue. MEASUREMENTS AND MAIN RESULTS Twenty-four women underwent traditional curettage and 46 underwent hysteroscopic selective curettage. Five (20.8%) patients who underwent traditional curettage later required operative hysteroscopy due to persistent residual tissue. None of those who underwent hysteroscopic selective curettage needed a second operation. No patient in either group experienced anesthetic complications, perforation of the uterus, fluid overload, or other surgical complication. Reproductive outcome was similar in both groups, with tendency to conceive earlier in the hysteroscopy group, but no difference in overall pregnancy rates. CONCLUSION Operative hysteroscopy for selective curettage of residual trophoblastic tissue should be considered an alternative to nonselective, blind curettage.
Collapse
Affiliation(s)
- S B Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|