A Study of Surgical Residents' Self-Assessment of Open Surgery Skills Using Gap Analysis.

BACKGROUND: Surgical residents need structured and objective feedback to develop their skills and become capable of performing surgical procedures autonomously. A shortage of experienced surgical staff has prompted residents to seek feedback from self-assessment and peer assessments. OBJECTIVES: We investigated whether surgical residents can reliably rate their own and their peers' basic surgical skills using the Global Rating Scale (GRS) from the Objective Structured Assessment of Technical Skills. METHODS: The study was a prospective and descriptive study conducted using gap analysis at the Copenhagen Academy for Medical Education and Simulation (Copenhagen, Denmark) from 2016 to 2017. Surgical residents were recruited during a course in basic open surgical skills. Among 102 course participants, 53 met the inclusion criteria and 22 participated in the study. RESULTS: We recruited surgical residents based in the Capital Region and Zealand Region of Demark, and 42% of eligible residents participated in the study. Surgical residents underestimated their own surgical performance (median, 17 [range, 15-18] vs. 20 [range, 19.75-22]; P < 0.001). They also rated their peers lower than an experienced rater did (median 10 [range, 8.75-14] vs. 15 and median 20.5 [range, 19-22] vs. 23; both P < 0.001). Gap analysis revealed residents had unrecognized strengths (ie, self-underappraisal) in most GRS domains. CONCLUSIONS: Ratings are unreliable when surgical residents assess their own and their peers' performances using GRS. A gap analysis revealed unrecognized strengths in time and motion, instrument handling, knowledge of instruments and sutures, and knowledge of specific procedure as well as unrecognized weaknesses in flow of operation and forward planning.

Atrial Na,K-ATPase increase and potassium dysregulation accentuate the risk of postoperative atrial fibrillation.

BACKGROUND: Postoperative atrial fibrillation is a common complication to cardiac surgery. Na,K-ATPase is of major importance for the resting membrane potential and action potential. The purpose of the present study was to evaluate the importance of Na,K-ATPase concentrations in human atrial biopsies and plasma potassium concentrations for the development of atrial fibrillation. METHODS: Atrial myocardial biopsies were obtained from 67 patients undergoing open chest cardiac surgery. Na,K-ATPase was quantified using vanadate-facilitated 3H-ouabain binding. Plasma potassium concentration was measured with ion-selective electrode. RESULTS: In patients with preoperative sinus rhythm, 3H-ouabain-binding site concentration was 16% higher in patients developing postoperative atrial fibrillation compared to patients maintaining sinus rhythm [302 +/- 15 pmol/g wet weight (n = 20) vs. 261 +/- 11 mmol/g wet weight (n = 33), p = 0.03]. Also with multivariable analysis, 3H-ouabain-binding site concentration was significantly associated with the development of atrial fibrillation. High increase in plasma potassium concentration during the perioperative period and surgery was associated with postoperative atrial fibrillation. CONCLUSIONS: The present study supports the increasing evidence of dysregulation of the potassium homeostasis as an important factor in the development of cardiac arrhythmias. High atrial Na,K-ATPase and sudden plasma potassium concentration increase may contribute to precipitate atrial fibrillation.

Basic open surgical training course.

INTRODUCTION: Fewer open surgical procedures are performed, and thus a need to learn open surgical techniques outside the operating room has emerged. Simulation training offers the possibility to train in a safe environment before operating on patients. The purpose of this study is to evaluate the effect of a simulation-based course in basic open surgical skills and to describe its pedagogical foundation, content and organisation. METHODS: Surgical trainees at the beginning of their surgical career participated in a basic open surgical skills course and were assessed before the course, after the course and during a one-day course operating on live sedated pigs using the Objective Structures Assessment of Technical Skills (OSATS) instrument. RESULTS: We found that the course participants matched the target group. The participants' OSATS score increased from 12.1 in the pre-test to 19.9 points (p < 0.0001) in the post-test. The completion rate was 99% and the failure rate was 11%. The course met 13 out of 14 requirements for a simulation-based course. CONCLUSIONS: The basic open surgical skills course teaches trainees the basic skills for open surgery including knot tying, suturing, dissection and surgical assistance. The course significantly increases the participants' surgical abilities and meets requirements for a well-structured simulation course. FUNDING: Equipment was provided by Copenhagen Academy for Medical Education and Simulation, Capital Region, Copenhagen, Denmark. The authors have no conflicts of interest or financial ties to disclose. TRIAL REGISTRATION: The study did not require registration as this is a retrospective quality control study using anonymised participant data.

[Streptococcus pneumoniae endocarditis diagnosed with polymerase chain reaction]. / Dyrkningsnegativ Streptococcus pneumoniae endokarditis diagnosticeret med polymerasekaedereaktion.

A 60-year old man was admitted with sepsis and meningitis of unknown aetiology. Underlying aortic valve endocarditis was diagnosed by echocardiography and severe insufficiency led to aortic valve replacement. Application of broad-range PCR to cusp tissue revealed a DNA product, and a diagnosis of Streptococcus pneumoniae endocarditis was obtained by DNA sequencing.