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1.
Instr Course Lect ; 73: 87-95, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38090889

RESUMO

The transition between medical school and residency is a complex, multifaceted process that is commonly a time of stress and uncertainty for medical students. Occupying most of a student's final year of medical school, the residency application includes a primary Electronic Residency Application Service application, a variable number of program-specific secondary applications, and interviews. The application process culminates with The Match. Orthopaedic surgery is among the more competitive specialties; thus, it is critical that all involved parties understand the complexity of the process and the numerous variables that play into such a critical decision point in the career trajectory of a future physician. It is important to provide a mentor with an overview of the residency application process, specifically with respect to orthopaedic surgery, so that they may be best prepared to guide their medical student mentee through the process and help them find success.


Assuntos
Internato e Residência , Procedimentos Ortopédicos , Ortopedia , Estudantes de Medicina , Humanos , Escolha da Profissão , Ortopedia/educação
2.
Instr Course Lect ; 72: 17-28, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36534843

RESUMO

Surgeon wellness, and the means by which it may be realized, has recently come to the forefront as awareness of burnout among orthopaedic surgeons has increased. Individual surgeons face unique challenges toward finding their own path to thrive. It is important to incorporate varying perspectives regarding potential solutions to surgeons' stresses in both work and extracurricular life. Specifically, the goal is to initiate a discussion regarding wellness by providing insight into the challenges facing surgical residents, supplemented with the perspectives of women and minorities within the field. Peer coaching plays an essential role in optimizing mental health.


Assuntos
Esgotamento Profissional , Cirurgiões Ortopédicos , Cirurgiões , Humanos , Feminino , Cirurgiões/psicologia , Cirurgiões Ortopédicos/psicologia , Esgotamento Profissional/psicologia
3.
Arthroscopy ; 38(8): 2511-2524, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35189304

RESUMO

PURPOSE: To construct an algorithm to optimize clinical outcomes in subacromial impingement based on current, high-level evidence. METHODS: A systematic review of all clinical trials on subacromial impingement published from 1999 to 2020 was performed. Demographic, clinical, range of motion (ROM), and patient-reported outcome measure (PROM) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model and treatments ranked via surface under the cumulative ranking curves with respect to 3 domains: pain, PROMs, and ROM. RESULTS: A total of 35 studies comprising 3,643 shoulders (42% female, age 50 ± 5 years) were included. Arthroscopic decompression with acromioplasty ranked much greater than arthroscopic decompression alone for pain relief and PROM improvement, but the difference in absolute PROMs was not statistically significant. Corticosteroid injection (CSI) alone demonstrated inferior outcomes across all 3 domains (pain, PROMs, and ROM) with low cumulative rankings. Physical therapy (PT) with CSI demonstrated moderate-to-excellent clinical improvement across all 3 domains whereas PT alone demonstrated excellent ROM and low-moderate outcomes in pain and PROM domains. PT with nonsteroidal anti-inflammatory drugs or alternative therapies ranked highly for PROM outcomes and moderate for pain and ROM domains. Finally, platelet-rich plasma injections demonstrated moderate outcomes for pain, forward flexion, and abduction with very low-ranking outcomes for PROMs and external rotation. CONCLUSIONS: Arthroscopic decompression with acromioplasty and PT demonstrated superior outcomes whereas CSI demonstrated poor outcomes in all 3 domains (pain, PROMs, and ROM). For patients with significant symptoms, the authors recommend PT with CSI as a first-line treatment, followed by acromioplasty and PT if conservative treatment fails. For patients with symptoms limited to 1 to 2 domains, the authors recommend a shared decision-making approach focusing on treatment rankings within domains pertinent to individual patient symptomatology. LEVEL OF EVIDENCE: I, systematic review and network meta-analysis of Level I studies.


Assuntos
Cortisona , Síndrome de Colisão do Ombro , Corticosteroides/uso terapêutico , Teorema de Bayes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Modalidades de Fisioterapia , Síndrome de Colisão do Ombro/cirurgia , Dor de Ombro , Resultado do Tratamento
4.
Neurosurg Focus ; 46(3): E9, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30835678

RESUMO

Spinal cord injury (SCI) has been associated with a dismal prognosis-recovery is not expected, and the most standard interventions have been temporizing measures that do little to mitigate the extent of damage. While advances in surgical and medical techniques have certainly improved this outlook, limitations in functional recovery continue to impede clinically significant improvements. These limitations are dependent on evolving immunological mechanisms that shape the cellular environment at the site of SCI. In this review, we examine these mechanisms, identify relevant cellular components, and discuss emerging treatments in stem cell grafts and adjuvant immunosuppressants that target these pathways. As the field advances, we expect that stem cell grafts and these adjuvant treatments will significantly shift therapeutic approaches to acute SCI with the potential for more promising outcomes.


Assuntos
Rejeição de Enxerto/prevenção & controle , Doença Enxerto-Hospedeiro/prevenção & controle , Imunossupressores/uso terapêutico , Células-Tronco Pluripotentes Induzidas/transplante , Células Precursoras de Oligodendrócitos/transplante , Traumatismos da Medula Espinal/terapia , Adjuvantes Imunológicos , Aloenxertos , Animais , Basiliximab/uso terapêutico , Células Cultivadas , Ensaios Clínicos como Assunto , Ciclosporina/uso terapêutico , Feminino , Sobrevivência de Enxerto/imunologia , Células-Tronco Embrionárias Humanas/citologia , Células-Tronco Embrionárias Humanas/imunologia , Humanos , Células-Tronco Pluripotentes Induzidas/imunologia , Masculino , Camundongos , Ácido Micofenólico/uso terapêutico , Células Precursoras de Oligodendrócitos/imunologia , Ratos , Tacrolimo/uso terapêutico , Transplante Autólogo
5.
Clin Sports Med ; 42(3): 525-538, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37208063

RESUMO

In sports, acute compartment syndrome (ACS) develops following lower limb fracture, with subsequent high intracompartmental pressures and pain out of proportion to the physical examination. A prompt diagnosis is the key to a successful outcome in patients with ACS. The goal of treatment of ACS, namely decompressive fasciotomy, is to reduce intracompartmental pressure and facilitate reperfusion of ischemic tissue before onset of necrosis. A delay in diagnosis and treatment may result in devastating complications, including permanent sensory and motor deficits, contractures, infection, systemic organ failure, limb amputation, and death.


Assuntos
Síndromes Compartimentais , Fraturas Ósseas , Humanos , Fasciotomia/efeitos adversos , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Fraturas Ósseas/complicações , Dor , Atletas
6.
Phys Sportsmed ; 51(3): 275-284, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-35587816

RESUMO

OBJECTIVES: There is a paucity of literature investigating the relationship between patellar fracture and player performance of professional soccer players following return to play (RTP). Our goal is to determine the rate of RTP, time to RTP, and effect on player performance following patellar fracture. METHODS: Twenty-one elite-level European professional soccer players who sustained a patellar fracture between 1999 and 2018 were identified via a publicly accessible database. Athletes with patellar fracture were matched to controls by age, height, years played in the league, season of injury, and position. Change in performance metrics between one season prior to injury and the following four seasons after injury were compared. RESULTS: Players with patellar fracture were absent for a mean 207.95 ± 135.55 days and 16.81 ± 31.79 games. Fifteen (71%) players returned to play after injury with 67% returning within 1 season after injury. Injured players did not demonstrate significant change in performance metrics at any of the follow-up timepoints compared to control. Subgroup analysis showed that attackers recorded approximately 1200 fewer minutes played per season than pre-injury levels 2 seasons following injury, significantly fewer (p < 0.05) than the control cohort recording similar minutes per season throughout the study period. Midfielders and defenders demonstrated similar fluctuations in performance to the control cohort for both field time and performance metrics (p > 0.05). CONCLUSION: Seventy-one percent of players RTP after patellar fracture with an associated absence of 7 months and 17 missed games. Overall, injured players did not demonstrate a significant decline in performance as demonstrated by games played, total minutes played per season, minutes per game, assists, and goals 1 season after injury. Attackers played fewer minutes during the season of and 2 seasons after the initial injury.


Assuntos
Fraturas Ósseas , Traumatismos do Joelho , Relesões , Futebol , Humanos , Futebol/lesões , Volta ao Esporte , Estudos de Coortes , Estudos de Casos e Controles
7.
World Neurosurg ; 174: 81-115, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36921712

RESUMO

OBJECTIVE: With the increasing prevalence of spine surgery, ensuring effective resident training is becoming of increasing importance. Training safe, competent surgeons relies heavily on effective teaching of surgical indications and adequate practice to achieve a minimum level of technical proficiency before independent practice. American Council of Graduate Medical Education work-hour restrictions have complicated the latter, forcing programs to identify novel methods of surgical resident training. Simulation-based training is one such method that can be used to complement traditional training. The present review aims to evaluate the educational success of simulation-based models in the spine surgical training of residents. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Web of Science, and Google Scholar databases were systematically screened for English full-text studies examining simulation-based spine training curricula. Studies were categorized based on simulation model class, including animal-cadaveric, human-cadaveric, physical/3-dimensional, and computer-based/virtual reality. Outcomes studied included participant feedback regarding the simulator and competency metrics used to evaluate participant performance. RESULTS: Seventy-two studies were identified. Simulators displayed high face validity and were useful for spine surgery training. Objective measures used to evaluate procedural performance included implant placement evaluation, procedural time, and technical skill assessment, with numerous simulators demonstrating a learning effect. CONCLUSIONS: While simulation-based educational models are one potential means of training residents to perform spine surgery, traditional in-person operating room training remains pivotal. To establish the efficacy of simulators, future research should focus on improving study quality by leveraging longitudinal study designs and correlating simulation-based training with clinical outcome measures.


Assuntos
Internato e Residência , Treinamento por Simulação , Realidade Virtual , Humanos , Modelos Educacionais , Estudos Longitudinais , Simulação por Computador , Treinamento por Simulação/métodos , Cadáver , Competência Clínica
8.
J Clin Ultrasound ; 36(7): 440-2, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18361468

RESUMO

We present a case of breast pseudoaneurysm following a blunt trauma in a 58-year-old woman. Few cases of breast pseudoaneurysm have been reported in the literature, and most of these are related to previous interventional procedures. Pseudoaneurysm was suspected on real-time sonography and confirmed with color Doppler and spectral wave analysis, which revealed a characteristic to-and-fro pattern. Unlike previously reported cases, treatmentwith ultrasound-guided compression was successful.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Artéria Torácica Interna/lesões , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Falso Aneurisma/terapia , Mama/irrigação sanguínea , Mama/lesões , Feminino , Técnicas Hemostáticas , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Ultrassonografia Doppler em Cores , Ultrassonografia Mamária , Ferimentos não Penetrantes/terapia
9.
Hepatogastroenterology ; 52(61): 5-7, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15782981

RESUMO

BACKGROUND/AIMS: Despite advances in diagnostic and therapeutic modalities, the prognosis of gallbladder carcinoma is still poor. The purpose of this study is to look for peculiarities of primary gallbladder carcinoma in Jordan regarding its incidence, clinical and pathological aspects. METHODOLOGY: A retrospective study over a period of 19 years comprising 66 patients was reviewed; only patients treated primarily in our hospital were included. There were 40 females and 26 males (ratio of 3:2). RESULTS: The main presenting symptom was abdominal pain in 54 patients (82%); correct preoperative diagnosis was made in only 20% of cases. Cholecystectomy alone was the most commonly performed operation (32 cases), cholecystectomy in combination with biliary bypass and/or hepatic resection (16 cases), biopsy of the gallbladder was performed in 12 cases and bypass with T-tube drainage in 6 cases. Postoperative morbidity and mortality were encountered in 48% and 18% respectively. CONCLUSIONS: The incidence and clinicopathological aspects of gallbladder cancer in Jordan seem to resemble that in the west, albeit with a lower age incidence. Diagnosis remains difficult and the outcome is still poor in the majority of cases.


Assuntos
Carcinoma/epidemiologia , Neoplasias da Vesícula Biliar/epidemiologia , Adulto , Distribuição por Idade , Idoso , Carcinoma/complicações , Carcinoma/patologia , Feminino , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Humanos , Incidência , Jordânia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Taxa de Sobrevida
10.
Langenbecks Arch Surg ; 392(1): 35-9, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17021792

RESUMO

BACKGROUND/AIMS: Surgery for hydatid cyst of the liver is widely practiced worldwide; this type of management is still associated with high mortality and morbidity. The aim of this study is to find out possible predictors for this high mortality and morbidity. MATERIALS AND METHODS: The medical records of 169 patients who underwent surgery for hydatid cyst of the liver were retrospectively reviewed. The mortality and the morbidity rates were assessed as well as the following eight potential predictors of mortality and morbidity: age of the patients, size of the cyst, number of cysts, other organs involved by the disease, the presence of preoperative complications, the type of surgery performed (radical or conservative), whether the disease was new or recurrent, and when surgery was performed in the first period (1973-1986) or in the second period (1987-1999). Cross-tabulation and logistic regression between mortality and morbidity (dependent variable) and the above-mentioned eight potential predictors (independent variables) were carried out. RESULTS: Of the 169 patients, 112 were female subjects and 57 male subjects, the age range was from 5 to 85 years (mean=39.2 years), the mortality rate was 6.5% (n=11), and the overall morbidity rate was 53.8% (n=91), while specific complications of liver hydatid cyst surgery were seen in 32% (n=54). Patients of age >40 years, with a cyst diameter of >10 cm, who presented with pre-operative complications, who had conservative surgery, and who had surgery before 1987 were having a significantly higher mortality and morbidity rate. CONCLUSION: Age, size of the cyst, the presence of pre-operative complications particularly cyst-biliary communication, and type of surgical procedure performed (conservative or radical) represent as significant predictors of mortality and morbidity of surgery for liver hydatid cyst.


Assuntos
Equinococose Hepática/mortalidade , Equinococose Hepática/cirurgia , Hepatectomia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Retrospectivos , Fatores de Risco
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