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1.
Medicine (Baltimore) ; 100(4): e24346, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530228

RESUMO

ABSTRACT: To evaluate the learning curve of percutaneous endoscopic transforaminal lumbar discectomy (PETLD) from the novice stage to the proficient stage, we performed retrospective study for patients with lumbar disc herniation who underwent PETLD performed by a single surgeon and evaluated the surgeon's learning curve and the effect of surgical proficiency on outcomes.A total of 48 patients who underwent PETLD at the lower lumbar level (L3-S1) with a minimum 1-year follow-up were enrolled. The learning curve of the surgeon was assessed using cumulative study of operation time and linear regression analyses to reveal the correlation between operation time and case series number.Because the cutoff of familiarity was 25 cases according to the cumulative study of operation time, the patients were allocated into two groups: early group (n = 25) and late group (n = 23). The clinical, surgical, and radiological outcomes were retrospectively evaluated and compared between the two groups.According to linear regression analyses, the operation time was obtained using the following formula: operation time (minutes) = 69.925-(0.503 × [case number]) (P < .001).As expected, the operation time was significantly different between the two groups (mean 66.00 ±â€Š11.37 min in the early group vs 50.43 ±â€Š7.52 min in the late group, P < .001). No differences were found between the two groups in demographic data and baseline characteristics. Almost all clinical outcomes (including pain improvement and patient satisfaction), surgical outcomes (including failure, recurrence, and additional procedure rates), and radiological outcomes (including change of disc height and sagittal angles) did not differ between the two groups.However, the late group demonstrated a more favorable postoperative volume index of the remnant disc (362.91 mm3 [95% confidence interval, 272.81-453.02] in the early group vs 161.14 mm3 [95% confidence interval, 124.31-197.97] in the late group, P < .001), and a lower complication rate related to exiting nerve root (16.0% in the early group vs 0% in the late group, P = .045).The learning curve of PETLD is not as difficult as that of other minimally invasive spine surgery technique. Although the overall outcomes were not different between the groups, the risks of incomplete decompression and exiting root injury-related complication were higher in the novice stage.


Assuntos
Discotomia Percutânea/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Deslocamento do Disco Intervertebral/cirurgia , Curva de Aprendizado , Cirurgiões/estatística & dados numéricos , Adulto , Competência Clínica/estatística & dados numéricos , Discotomia Percutânea/educação , Discotomia Percutânea/métodos , Endoscopia/educação , Endoscopia/métodos , Feminino , Humanos , Modelos Lineares , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Cirurgiões/educação , Resultado do Tratamento
2.
J Pak Med Assoc ; 71(Suppl 1)(1): S18-S22, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33582717

RESUMO

OBJECTIVE: To assess the impact of coronavirus disease on surgical training. Methods: The cross-sectional study was conducted at the General Surgery Department of Liaquat National Hospital, Karachi, from August 2019 to May 2020, and comprised surgical trainees from year 1 to 4. The subjects were interviewed and inquired about their opinion regarding the impact of coronavirus disease on their training. Data was prospectively collected in two equal phases of 5 months each, separating the phases on the basis of the application of preventive measures and changes relating to coronavirus disease. Data of cases from log books was divided into major and minor cases. RESULTS: Of the 24 surgical trainees available, 18(75%) participated; 12(66.6%) females and 6(33.3%) males. There was a significant difference between the two phases, with the number of surgical case going down drastically in the second phase (p=0.005), affecting the training process. CONCLUSIONS: Considering the ongoing pandemic, it may be worthwhile to look into the possibility of increasing the duration of training.


Assuntos
Cirurgia Geral , Internato e Residência/estatística & dados numéricos , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Estudos Transversais , Feminino , Cirurgia Geral/educação , Cirurgia Geral/organização & administração , Cirurgia Geral/estatística & dados numéricos , Humanos , Masculino , Paquistão
3.
J Pak Med Assoc ; 71(Suppl 1)(1): S49-S55, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33582723

RESUMO

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected globally by the pandemic. However, the global crisis inadvertently has led to a few constructive adaptations in healthcare systems, including the development of tele-clinics, virtual academic sessions and conferences, and increased usage of simulation. The current review article was planned to highlight the impact of corona virus disease on surgical training and institutions' response to the situation in order to continue surgical training, and lessons learnt from the pandemic.


Assuntos
Cirurgia Geral , Pandemias , Cirurgiões , /prevenção & controle , Cirurgia Geral/educação , Cirurgia Geral/organização & administração , Cirurgia Geral/estatística & dados numéricos , Humanos , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos
4.
Ann R Coll Surg Engl ; 103(2): 130-133, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559548

RESUMO

INTRODUCTION: Laparoscopic pyloromyotomy is now an accepted procedure for the treatment of pyloric stenosis. However, it is clear that during the implementation period there are significantly higher incidences of mucosal perforation and incomplete pyloromyotomy. We describe how we introduced a new laparoscopic procedure without the complications associated with the learning curve. MATERIALS AND METHODS: Five consultants tasked one surgeon to pilot and establish laparoscopic pyloromyotomy before mentoring the others until they were performing the procedure independently; all agreed to use exactly the same instruments and operative technique. This involved a 5mm 30-degree infra-umbilical telescope with two 3mm instruments. Data were collected prospectively. RESULTS: Between 1 January 2013 and 31 December 2017, 140 laparoscopic pyloromyotomies were performed (median age 27 days, range 13-133 days, male to female ratio 121:19). Fifty-five per cent of procedures were performed by trainees. Complications were one mucosal perforation and one inadequate pyloromyotomy. There were no injuries to other organs, problems with wound dehiscence or other significant complications. The median time of discharge was one day (range one to six days). CONCLUSION: Our rate of perforation and incomplete pyloromyotomy was 1.4%, which is equivalent to the best published series of either open or laparoscopic pyloromyotomy. We believe that this resulted from the coordinated implementation of the procedure using a single technique to reduce clinical variability, increase mentoring and improve training. This approach appears self-evident but is rarely described in the literature of learning curves. In this age of increased accountability, new technologies should be incorporated into routine practice without an increase in morbidity to patients.


Assuntos
Laparoscopia/educação , Tutoria/organização & administração , Complicações Pós-Operatórias/epidemiologia , Estenose Pilórica/cirurgia , Piloromiotomia/educação , Consultores , Feminino , Implementação de Plano de Saúde , Humanos , Lactente , Recém-Nascido , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Curva de Aprendizado , Tempo de Internação , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Piloromiotomia/efeitos adversos , Piloromiotomia/instrumentação , Piloromiotomia/métodos , Estudos Retrospectivos , Cirurgiões/educação , Gravação em Vídeo
5.
J Pak Med Assoc ; 71(Suppl 1)(1): S83-S88, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33582729

RESUMO

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during the pandemic. Hospitals' implementation of "shift schedules" for rotations helps continue training while minimising risks. Moreover, examination boards and residency programmes must appropriately tailor their eligibility criteria and assessment processes to the current situation. Lastly, it is vital to safeguard trainees' mental wellness during the pandemic and after by ensuring readily available professional psychological support when needed.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Cirurgiões/educação , Países em Desenvolvimento , Educação a Distância , Humanos , Internato e Residência , Paquistão , Pandemias
6.
World J Pediatr Congenit Heart Surg ; 12(1): 124-127, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33407032

RESUMO

Congenital heart surgeons' training is complex and challenging. The learning curve is long and the increasing complexity of pathologies is demanding. In order to develop adequate surgical-skill competencies, "in vivo" and simulation-based practicing are paramount. Simulation can be performed either on a computer screen or animal hearts and prosthetic models. In this article, we illustrate a porcine Wet Lab simulation for the Nikaidoh operation to point out its potential advantage to learn complex congenital surgery procedures.


Assuntos
Procedimentos Cirúrgicos Cardíacos/educação , Competência Clínica , Simulação por Computador , Educação de Pós-Graduação em Medicina/métodos , Cardiopatias Congênitas/cirurgia , Cirurgiões/educação , Animais , Procedimentos Cirúrgicos Cardíacos/métodos , Modelos Animais de Doenças , Suínos
7.
J Urol ; 205(1): 271-275, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33095096

RESUMO

PURPOSE: Deconstruction of robotic surgical gestures into semantic vocabulary yields an effective tool for surgical education. In this study we disassembled tissue dissection into basic gestures, created a classification system, and showed its ability to distinguish between experts and novices. MATERIALS AND METHODS: Videos of renal hilum preparation during robotic assisted partial nephrectomies were manually reviewed to identify all discrete surgical movements. Identified dissection movements were classified into distinct gestures based on the consensus of 6 expert surgeons. This classification system was then employed to compare expert and novice dissection patterns during the renal hilum preparation. RESULTS: A total of 40 robotic renal hilum preparation videos were reviewed, representing 16 from 6 expert surgeons (100 or more robotic cases) and 24 from 13 novice surgeons (fewer than 100 robotic cases). Overall 9,819 surgical movements were identified, including 5,667 dissection movements and 4,152 supporting movements. Nine distinct dissection gestures were identified and classified into the 3 categories of single blunt dissection (spread, peel/push, hook), single sharp dissection (cold cut, hot cut and burn dissect) and combination gestures (pedicalize, 2-hand spread, and coagulate then cut). Experts completed 5 of 9 dissection gestures more efficiently than novices (p ≤0.033). In consideration of specific anatomical locations, experts used more peel/push and less hot cut while dissecting the renal vein (p <0.001), and used more pedicalize while dissecting the renal artery (p <0.001). CONCLUSIONS: Using this novel dissection gesture classification system, key differences in dissection patterns can be found between experts/novices. This comprehensive classification of dissection gestures may be broadly applied to streamline surgical education.


Assuntos
Competência Clínica , Gestos , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgiões/educação , Humanos , Rim/cirurgia , Nefrectomia/educação , Nefrectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Gravação em Vídeo
8.
J Surg Res ; 257: 169-177, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32835950

RESUMO

BACKGROUND: Few opportunities exist for surgeons to receive technical skills feedback after training. Surgeons at hospitals within the Illinois Surgical Quality Improvement Collaborative were invited to participate in a peer-to-peer video-based coaching initiative focused on improving technical skills in laparoscopic right colectomy. We present a formative qualitative evaluation of a video-based coaching initiative. METHODS: Concurrent with the implementation of our video-based coaching initiative, we conducted two focus groups and 15 individual semistructured interviews with participants; all interviews were audio-recorded and transcribed. A subset of surgeons participated in a group video-review session, which was observed by qualitative researchers. Transcripts and notes were analyzed using an organizational behavior framework adapted from executive coaching. RESULTS: Participation in the initiative was primarily motivated by the opportunity to learn from others and improve skills. Surgeons highlighted the value of self-video and peer-video assessment not only to learn new techniques but also for self-reflection and benchmarking. Barriers to participation included logistics (e.g. using the laparoscopic recording devices, coordinating schedules for peer coaching), time commitment, and a surgical culture that assumes the intent of coaching is to address deficiencies. CONCLUSIONS: Video-based peer-coaching provides a platform for surgeons to reflect, benchmark against peers, and receive personalized feedback; however, more work is needed to increase participation and sustain involvement over time. There is an opportunity to decrease logistical barriers and increase acceptability of coaching by integrating video-based coaching into existing surgical conferences and established continuous professional development efforts.


Assuntos
Tutoria/métodos , Grupo Associado , Cirurgiões/educação , Procedimentos Cirúrgicos Operatórios/educação , Competência Clínica , Feminino , Grupos Focais , Feedback Formativo , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Gravação em Vídeo
9.
J Surg Res ; 257: A1-A11, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32768197

RESUMO

The issue of burnout among surgical trainees became evident during our work on the FIRST Trial. In studying the issue, we found that burnout symptoms occurred in a relatively large proportion of surgical trainees, and burnout was associated with significant risks of having thoughts of leaving the residency program or having suicidal thoughts. The SECOND Trial seeks to reduce trainee wellbeing and mistreatment by leveraging approaches used in healthcare quality performance improvement (e.g., comparative reports, toolkits, collaboration). Importantly, the epidemic of surgical trainee wellbeing issues have worsened (i.e., fanning the burnout fire) given our misconceptions about generational differences, our delayed adaptations to shifts in healthcare, and even some of our good intentions. However, there are several things we can do to improve the situation: (1) embrace the change that comes with each generation; (2) appreciate, respect, and enjoy our trainees; (3) teach residents constructively, leaving yelling and bullying behind; (4) embrace the concept of wellness for ourselves and each other; (5) provide meaningful feedback and mentorship; and (6) give each other the benefit of the doubt (e.g., principle of charity). Despite these issues, academic surgery remains the best job in the world, and the strength of our profession, leaders, and colleagues will see us through these challenges. The Association for Academic Surgery will help lead the way on these important issues.


Assuntos
Esgotamento Profissional/epidemiologia , Cirurgiões/educação , Cirurgiões/psicologia , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Cirurgia Geral/educação , Humanos , Internato e Residência/métodos , Internato e Residência/tendências , Sociedades Médicas , Cirurgiões/tendências , Ensino/psicologia , Ensino/tendências
10.
J Surg Res ; 257: 1-8, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818777

RESUMO

BACKGROUND: In this study, we developed online interactive clinician education modules highlighting best practices to minimize opioid prescribing at discharge after surgery. The modules were implemented as part of a multicomponent quality improvement initiative across a six-hospital health system. This article describes the development and evaluation of this educational intervention. MATERIALS AND METHODS: Clinician education modules targeting surgical prescribers, nurses, and pharmacists were developed and implemented by an interdisciplinary team. Clinicians were invited to participate in an evaluation survey after completing the modules. Survey items assessed clinicians' rating of the module and intention to change clinical practice because of the module. Quantitative and qualitative survey responses were analyzed by the study team. RESULTS: A total of 2119 clinicians completed the module and 1831 of these clinicians (86.4%) completed the survey. Of clinicians completing the survey, 65.6% reported that they intend to change clinical practice after completing the module. Intended changes were related to increased knowledge and awareness, provider empowerment, opioid prescribing practices, nonopioid prescribing practices, and patient education. Many clinicians who indicated they do not intend to change practice reported that their clinical practices were already in line with module recommendations. Some clinicians did not perceive the module to be relevant to their role. CONCLUSIONS: Module completion was associated with the intention to improve clinical practice in areas related to provider empowerment, opioid prescribing, nonopioid prescribing, and patient education. Evaluation data will inform future module improvements. There is an opportunity to ensure that all clinicians, including those who are not prescribers, recognize their role in opioid stewardship.


Assuntos
Analgésicos Opioides/uso terapêutico , Educação a Distância/métodos , Educação Médica Continuada/métodos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Cuidados Pós-Operatórios/educação , Padrões de Prática Médica/estatística & dados numéricos , Atitude do Pessoal de Saúde , Humanos , Enfermeiras e Enfermeiros , Educação de Pacientes como Assunto , Farmacêuticos , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/métodos , Cirurgiões/educação , Inquéritos e Questionários
11.
PLoS One ; 15(12): e0243308, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326486

RESUMO

OBJECTIVE: As the number of female medical students and surgical residents increases, the increasing number of female academic surgeons has been disproportionate. The purpose of this brief report is to evaluate the AAMC data from 1969 to 2018 to compare the level of female academic faculty representation for surgical specialties over the past four decades. DESIGN: The number of women as a percentage of the total surgeons per year were recorded for each year from 1969-2018, the most recent year available. Descriptive statistics were performed. Poisson regression examined the percentage of women in each field as the outcome of interest with the year and specialty (using general surgery as a reference) as two predictor variables. SETTING: Data from the American Association of Medical Colleges (AAMC). PARTICIPANTS: All full-time academic faculty physicians in the specialties of obstetrics and gynecology (OB/GYN), general surgery, ophthalmology, otolaryngology (ENT), plastic surgery, plastic surgery, urology, neurosurgery, orthopaedic surgery and cardiothoracic surgery as per AAMC records. RESULTS: The percentage of women in surgery for all specialties evaluated increased from 1969 to 2018 (OR 1.04, p<0.001). Compared with general surgery, the rate of yearly percentage change increased more slowly in neurosurgery (OR 0.84; P = .004), orthopaedic surgery (OR 0.82; P = .002), urology (OR 0.59; P < .001), and cardiothoracic surgery (OR 0.38; P < .001). There was no significant difference in the rate of yearly percentage change for plastic surgery (OR 1.01; P = .840). The rate of yearly percentage change increased more rapidly in OB/GYN (OR 2.86; P < .001), ophthalmology (OR 1.79; P < .001) and ENT (OR 1.70; P < .001). CONCLUSIONS: Representation of women in academic surgery is increasing overall but is increasing more slowly in orthopaedic surgery, neurosurgery, cardiothoracic surgery and urology compared with that in general surgery. These data may be used to inform and further the discussion of how mentorship and sponsorship of female students and trainees interested in surgical careers may improve gender equity in the future.


Assuntos
Educação Médica , Internato e Residência , Médicas , Estudantes de Medicina , Cirurgiões/educação , Feminino , Humanos
12.
Can J Surg ; 63(5): E396-E408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009899

RESUMO

BACKGROUND: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. METHODS: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. RESULTS: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. CONCLUSION: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Padrões de Prática Médica/estatística & dados numéricos , Âmbito da Prática/tendências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Canadá , Competência Clínica/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Feminino , Cirurgia Geral/economia , Cirurgia Geral/educação , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/economia , Padrões de Prática Médica/tendências , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Cirurgiões/economia , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/educação
13.
Obstet Gynecol ; 136(5): 942-949, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030877

RESUMO

OBJECTIVE: To use the Messick validity framework for a simulation-based assessment of vaginal hysterectomy skills. METHODS: Video recordings of physicians at different levels of training and experience performing vaginal hysterectomy on a high-fidelity vaginal surgery model were objectively assessed using a modified 10-item Vaginal Surgical Skills Index, a one-item global scale of overall performance, and a pass-fail criterion. Participants included obstetrics and gynecology trainees and faculty from five institutions. Video recordings were independently assessed by expert surgeons blinded to the identities of the study participants. RESULTS: Fifty surgeons (11 faculty, 39 trainees) were assessed. Experience level correlated strongly with both the modified Vaginal Surgical Skills Index and global scale score, with more experienced participants receiving higher scores (Pearson r=0.81, P<.001; Pearson r=0.74, P<.001). Likewise, surgical experience was also moderately correlated with the modified Vaginal Surgical Skills Index and global scale score (Pearson r=0.55, P<.001; Pearson r=0.58, P<.001). The internal consistency of the modified Vaginal Surgical Skills Index was excellent (Cronbach's alpha=0.97). Interrater reliability of the modified Vaginal Surgical Skills Index and global scale score, as measured by the intraclass correlation coefficient, was moderate to good (0.49-0.95; 0.50-0.87). Using the receiver operating characteristic curve and the pass-fail criterion, a modified Vaginal Surgical Skills Index cutoff score of 27 was found to most accurately (area under the curve 0.951, 95% CI 0.917-0.983) differentiate competent from noncompetent surgeons. CONCLUSION: We demonstrated validity evidence for using a high-fidelity vaginal surgery model with the modified Vaginal Surgical Skills Index or global scale score to assess vaginal hysterectomy skills.


Assuntos
Competência Clínica/estatística & dados numéricos , Avaliação Educacional/normas , Histerectomia Vaginal/educação , Treinamento por Simulação , Cirurgiões/estatística & dados numéricos , Adulto , Feminino , Ginecologia/educação , Humanos , Masculino , Obstetrícia/educação , Reprodutibilidade dos Testes , Cirurgiões/educação
14.
N Z Med J ; 133(1520): 50-60, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994593

RESUMO

AIM: Therapeutic lymphadenectomy remains the gold standard for surgical management of clinically evident regional cervical disease for cutaneous malignancy. However, international consensus on adequate lymphadenectomy is lacking. Attempts have been made to establish quality measures; suggested benchmarks for minimum and average nodal yield, as well as recurrence and complication rates have been quoted. We aim to compare our key performance indicators to those benchmarks published in the literature. METHODS: This is a retrospective observational study conducted with prospectively maintained data, over an 11-year period (2007-2018). RESULTS: Of 91 cervical lymphadenectomies included, mean nodal yield for ≤3 and ≥4 dissection levels were 19.7 and 38.7 respectively. We observed a combined locoregional recurrence rate of 25%. Subgroup analysis for melanoma (60) and cSCC (28) revealing regional nodal recurrence of 15% and 11%, respectively. We observed a 38.5% complication rate; however, less than 5.5% was considered grade IIIb/IIIb(d) [Clavein-Dindo]. Median follow-up of 19.3 months, five-year survivial rate of 38% and 32% for melanoma and cSCC, respectively. CONCLUSION: Our data indicates that we are meeting quality measures, set by higher volume centres. We believe that any surgeon with subspecialty training in head and neck surgery can meet quality measures with regards to cervical lymphadenopathy for cutaneous malignancy.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Pescoço/patologia , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Metástase Linfática/patologia , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Nova Zelândia/epidemiologia , Guias de Prática Clínica como Assunto , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Neoplasias Cutâneas/secundário , Cirurgiões/educação , Taxa de Sobrevida
17.
Plast Reconstr Surg ; 146(2): 447-454, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740604

RESUMO

Plastic surgeons have the unique perspective of working with all types of patients and care teams from almost all specialties in surgery and medicine, which creates unique challenges in times of distress. As the initial epicenter of coronavirus disease 2019 cases in the United States, the University of Washington program was required to rapidly develop strategies to deal with the escalating crisis. All aspects of the program were affected, including the need to triage the urgency of plastic surgery care, safe staffing of plastic surgery teams, and the role of plastic surgery in the greater hospital community. In addition, as a residency training program, limiting the impact of resident education and maintaining a sense of community and connection among members of the program developed into important considerations. The authors hope that the narrative of their experience will provide insight into the decisions made in the University of Washington health care system but also remind others that they are not alone in dealing with the challenges of this pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Internato e Residência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/educação , Universidades/organização & administração , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/normas , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Humanos , Internato e Residência/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Procedimentos Cirúrgicos Reconstrutivos/educação , Cirurgiões/educação , Cirurgiões/organização & administração , Universidades/normas , Washington , Recursos Humanos/organização & administração , Recursos Humanos/normas
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