Iatrogenic Bowel Injury at Exchange of Supra-Pubic Catheter

Suprapubic catheter insertion and exchange is a common urological procedure, but it is not without risks and complications. While bowel perforation is a recognised complication at suprapubic catheter insertion, it is not commonly reported at suprapubic catheter exchange. We report our experience of recognition, diagnosis and subsequent successful management of the most important complication related to suprapubic catheters.

The development of a cultural standardized patient examination for a general surgery residency program.

BACKGROUND: Cultural competency and cross-cultural care issues in surgery resident education are areas of recognized need. The Accreditation Council for Graduate Medical Education (ACGME) has developed 6 core competencies addressing training to provide high quality care. Of these, cultural training is addressed under 3: patient care, professionalism, and interpersonal and communication skills. Our study sought to develop a measurable tool-a cultural standardized patient (SP) examination-that integrates cross-cultural care issues within the core competencies. METHODS: All first year surgery residents (PGY-1) were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were utilized to assess resident performance. On the same day, we administered a Cross-Cultural Care Survey. The SP examination was assessed by trained surgery teaching faculty using a written checklist that was developed to evaluate residents on all 6 ACGME competencies. RESULTS: Of the 26 eligible participants over 2 years, we were able to analyze the pre- and post-test results for 24 residents. The post-test score of the "attitude toward cross-cultural care" subscale of the Cross-Cultural Care Survey was significantly lower than the pre-test score (p = 0.012; Wilcoxon signed-ranks test). There were significant differences by ethnicity on all 3 subscales of the Cross-Cultural Care Survey (attitude = p < 0.05, knowledge = p < 0.01, skills = p < 0.05) on the pre-test. However, only the knowledge subscale scores remained significantly different between ethnicities on the post-test (p < 0.01). CONCLUSIONS: After additional assessment, evaluation, and refinement, our goal is to incorporate cross-cultural health care training as a permanent part of our curriculum. Our hope is that efforts to provide training in cross-cultural healthcare leads to high quality care and positive outcomes for the patient. This will not only enhance our training program, but may also become a useful tool for other surgery residency programs.

Incorporating cultural competency into the general surgery residency curriculum: a preliminary assessment.

In response to the growing diversity of the United States population and concerns with health disparities, formal training in cross-cultural care has become mandatory for all medical specialties, including surgery. The aim of this study was to assess the readiness of a general surgery residency program to incorporate cultural competency initiatives into its curriculum. Eighteen surgical teaching faculty (at a community-based hospital with a university affiliation) voluntarily participated in a qualitative study to share their views on cultural competency and to discuss ways that it could potentially be incorporated into the curriculum. Reflective of current definitions of cultural competency, faculty viewed the term culture broadly (i.e., beyond race and ethnicity). Suggested instructional methods varied, with some noting that exposure to different cultures was helpful. Others stated the importance of faculty serving as role models. Most faculty in this study appear open to cultural training, but desire a clear understanding of what that would entail and how it can be taught. They also acknowledged the lack of time to address cultural issues. Taking into consideration these and other concerns, planned curricular interventions are also presented.

Cardiac arrest outcomes at the Melbourne Cricket Ground and shrine of remembrance using a tiered response strategy-a forerunner to public access defibrillation.

The provision of medical, paramedical and first aid services at major public events is an important concern for pre-hospital emergency medical care providers. Patient outcomes of a cardiac arrest response strategy employed at the Melbourne Cricket Ground (MCG) and the Shrine of Remembrance by St John Ambulance Australia volunteers are reported. Twenty-eight consecutive events occurring between December 1989 and December 1997 have been analysed. Included are three cardiac arrests managed at ANZAC day parades utilising the same response strategy by the same unit. The incidence of cardiac arrest at the MCG was 1:500000 attendances. Of the 28 patients, 24 (86%) left the venue alive and 20 (71%) were discharged home from hospital. In all cases the initial rhythm was ventricular fibrillation (VF). All 26 patients (93%) who were defibrillated by St John teams had this intervention within 5 min from the documented time of collapse. One patient in VF spontaneously reverted during CPR. Of the eight fatalities, four died at the scene. At major public venues and events, a co-ordinated emergency life support provision strategy, tailor made for the venue, is necessary for the delivery of prompt CPR, timely defibrillation and advanced life support.

Childhood psychological trauma and chronic refractory low-back pain.

OBJECTIVE: To examine the correlation between childhood psychological trauma(s) and refractory back pain in patients with and patients without prior spine surgery. DESIGN: Retrospective chart review survey of 101 consecutive patients who had undergone multidisciplinary evaluation for refractory back pain. SETTING: Private practice, tertiary care spine center. MAIN OUTCOME MEASURES: Each psychological risk factor (physical abuse, sexual abuse, emotional neglect or abuse, abandonment, and chemically dependent caregiver) was rated as present or absent. Spinal pathology was graded as significant or not significant. RESULTS: There were 56 patients with failed back surgery syndrome, 28 men and 28 women, with a mean age of 43 and mean pain duration of 45 months. There were 45 patients with no prior surgery, 26 men and 19 women, with a mean age of 43 and mean pain duration of 33 months. In the failed back surgery syndrome group, 27 (48%) had three or more risks and 39 (70%) had two or more. When the 12 patients with significant pathology are not considered, 24 of the remaining 44 (55%) patients had three or more risks. In the group with no prior surgery, 26 (58%) had three or more risks and 38 (84%) had two or more. When the five patients with significant pathology are not considered, 24 (60%) had three or more risks. CONCLUSIONS: Multiple childhood psychological traumas may predispose a person to chronic low back pain. In patients in this setting with refractory low back pain with or without prior lumbar spine surgery, three or more childhood psychological risk factors are prevalent, especially in patients with minimal structural pathology.

The sports medicine approach to occupational low back pain.

Absenteeism caused by low back pain costs industry millions of dollars per year. Innovative approaches for the prevention and treatment of low back pain in workers are mandatory. The sports medicine approach for aggressive rehabilitation offers a possible solution.

The effect of low level lead exposure on the postnatal structuring of the rat cerebellum.

Exposure of rat pups to lead (less than 45 micrograms/dl blood) caused no alterations in the rate of cerebellar cell acquisition, migration or final number when compared with age-matched controls. The rate of DNA biosynthesis was higher in the lead-exposed animals compared to controls and remained elevated until postnatal day 10. This observation suggests lengthening of the cell cycle. The expected increase in DNA biosynthetic rate was delayed in neuron-enriched fractions obtained from lead-exposed pups. This may have been due to the isolation procedure specifically selecting internal granular layer cells which migrated precociously during a protracted G1 phase in a lead-impaired cell cycle. Morphometric studies revealed no difference in the number, viability and migration of cells within and from the external granular layer of the cerebellum of lead-exposed animals. It is concluded that chronic low level lead exposure has no significant effect on the early structuring of the developing cerebellum.

Chronic low level lead exposure precociously induces rat glial development in vitro and in vivo.

Lead has been demonstrated to induce precocious glial differentiation both in vitro and in vivo. Lead-treated rat glioma (C6) and cerebellar astrocytes exhibited cytoplasmic extensions and the presence of glial endfeet after a 3-day exposure to 10(-6) to 10(-4) M PbCl2. In similar experiments no effect was noted in neuroblastoma (Neuro-2a) or on neurite outgrowth from chick spinal cord explants. This prodifferentiative effect on glia was also seen in the cerebella of postnatal rats in which the developmental expression of glial-specific glutamine synthetase activity was significantly increased up to postnatal day 12 after chronic exposure to lead from time of birth via their dam's drinking water (400 mg PbCl2/l).