Computed Tomography Morphometrics and Pulmonary Intolerance in Endometrial Cancer Robotic Surgery.

STUDY OBJECTIVES: To identify morphometric characteristics of obese patients that best predict pulmonary intolerance to robotic pelvic surgery using a novel method for quantifying adipose distribution. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Fifty-nine patients with endometrial cancer who underwent robotic hysterectomy and lymphadenectomy between April 2008 and May 2014 and also underwent perioperative computed tomography (CT) imaging within 1 year. INTERVENTION: Visceral fat volume (VFV) and subcutaneous fat volume (SFV) were quantified through waist circumference measurements along with average volume estimation of slices taken at 3 levels: mid-waist, L2-L3, and L4-L5. Mean and maximum values were obtained for intraoperative physiological data. MEASUREMENTS AND MAIN RESULTS: The patients' mean body mass index (BMI) was 34 (range, 20-59). Along with waist circumference, VFV and SFV quantified by CT at the mid-waist, L2-L3, and L4-L5 levels were all significant independent predictors for peak airway pressure (PAP; average and maximum) and plateau airway pressure (Pplat; average and maximum) on multivariate regression analysis after adjustment for age, ethnicity, diabetes, hypertension, pulmonary disease, smoking, obstructive sleep apnea, American Society of Anesthesiologists classification, and duration of anesthesia. Compared with the other CT parameters, L2-L3 VFV was the best predictor of average PAP (ß = 0.398; p = .002), maximum PAP (ß = 0.493; p < .001), average Pplat (ß = 0.536; p < .001), and maximum Pplat (ß = 0.573; p < .001). CONCLUSION: These novel CT morphometric measurements represent valid predictors of pulmonary intolerance to robotic surgery in obese patients. Of the measures analyzed, VFV at L2-L3 best predicts pulmonary tolerance in obese patients.

Transforming the nursing curriculum to promote critical thinking online.

With the expansion of online nursing courses and programs, many nurse educators are faced with the challenge of designing online courses. This article provides an example of how traditional face-to-face nursing content was transformed into an online problem-based learning experience. A framework and specific course examples are provided to help with the redesign process. The article concludes with the instructor and instructional designer sharing lessons learned from this experience and recommendations for future course designers.

Integrated lower extremity trauma simulator.

Severe limb trauma is prevalent in deployed U.S. Military forces since the advent of body armor. To improve outcomes, improved pre-deployment training is urgently needed. To meet this need, Simuluition Inc. and Melerit Medical AB are expanding the capabilities of the TraumaVision Simulator, originally designed for training surgeons in internal fixation procedures, to include training in battlefield relevant trauma care for fractured femurs and compartment syndrome. Simulations are being implemented for fractured femur reduction, external fixation, measuring intercompartment pressure (ICP), and performing fasciotomies. Preliminary validation work has begun to demonstrate content and construct validity of the TraumaVision simulator. Future work will include developing a SCORMs-compliant curriculum and completing the validation studies.

Extraneous tissue: a potential source for diagnostic error in surgical pathology.

"Floaters" represent a potential cause of diagnostic error and may arise during tissue processing and slide preparation. Our objective was to determine the frequency of floaters in slides and features useful in their recognition. We reviewed quality assurance (QA) records for floaters in slides and prospectively examined 1,000 additional slides for floaters and documented floater size, location, and presence in 1 or more sections. In the 521,661 slides reviewed for QA, 65 floaters were detected: 28 were present in the tissue block, and 37 were found only in a single level. In the 1,000 prospectively examined slides, 12 floaters were detected; 9 were only in a single section. Floaters represent a potential source of diagnostic error and occur in 0.01% to 1.2% of slides. Pick up of floaters from the water bath appears most common (∼60%). Floaters in only 1 level and mismatch with the specimen tissue type are clues to the extraneous nature of the floater.

Specimen labeling errors in surgical pathology: an 18-month experience.

Elimination of medical errors is important for pathologists. Errors occurring in surgical pathology involve specimen defects, specimen labeling, processing, diagnosis, and reporting defects. Errors occur during prelaboratory, laboratory, and postlaboratory phases. We reviewed our experience with mislabeled specimens in the laboratory for an 18-month period. The percentage of error was calculated on a per case, block, and slide basis. Errors were characterized by site and as incorrect patient or site. The study involved 75 labeling errors (0.25% of cases) that were detected. Of the 75 errors, 55 (73%) involved patient name, and 18 (24%) involved site. The majority of mislabelings (52 [69%]) occurred in the gross room. Although infrequent, labeling errors involved misidentification of patient or specimen source. Of the errors, 73% (55/75) of errors resulted in slides assigned to an incorrect patient. Most errors occurred in the gross room. Newer technologies such as bar coding and radio frequency chip methods may reduce the frequency of specimen labeling errors.