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1.
Sensors (Basel) ; 21(4)2021 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-33668544

RESUMO

Surgeons' procedural skills and intraoperative decision making are key elements of clinical practice. However, the objective assessment of these skills remains a challenge to this day. Surgical workflow analysis (SWA) is emerging as a powerful tool to solve this issue in surgical educational environments in real time. Typically, SWA makes use of video signals to automatically identify the surgical phase. We hypothesize that the analysis of surgeons' speech using natural language processing (NLP) can provide deeper insight into the surgical decision-making processes. As a preliminary step, this study proposes to use audio signals registered in the educational operating room (OR) to classify the phases of a laparoscopic cholecystectomy (LC). To do this, we firstly created a database with the transcriptions of audio recorded in surgical educational environments and their corresponding phase. Secondly, we compared the performance of four feature extraction techniques and four machine learning models to find the most appropriate model for phase recognition. The best resulting model was a support vector machine (SVM) coupled to a hidden-Markov model (HMM), trained with features obtained with Word2Vec (82.95% average accuracy). The analysis of this model's confusion matrix shows that some phrases are misplaced due to the similarity in the words used. The study of the model's temporal component suggests that further attention should be paid to accurately detect surgeons' normal conversation. This study proves that speech-based classification of LC phases can be effectively achieved. This lays the foundation for the use of audio signals for SWA, to create a framework of LC to be used in surgical training, especially for the training and assessment of procedural and decision-making skills (e.g., to assess residents' procedural knowledge and their ability to react to adverse situations).


Assuntos
Colecistectomia Laparoscópica , Competência Clínica , Cirurgia Geral , Reconhecimento Automatizado de Padrão , Cirurgia Geral/normas , Humanos , Salas Cirúrgicas , Fala
2.
Ann Glob Health ; 87(1): 17, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33633928

RESUMO

Member States at this year's World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a cross-cutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities.


Assuntos
Anestesia/normas , Cirurgia Geral , Saúde Global , Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Obstetrícia/normas , /epidemiologia , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Saúde Global/normas , Saúde Global/tendências , Humanos , Melhoria de Qualidade
3.
J Surg Res ; 257: 425-432, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892141

RESUMO

BACKGROUND: Surgical debriefs help reduce preventable errors in the operating room (OR) leading to patient injury. However, compliance with debriefs remains poor. The objective of this study was to evaluate the role of structured feedback to surgeons in improving compliance with and quality of surgical debriefs. MATERIALS AND METHODS: Surgical cases at an 875-bed urban teaching hospital from January-June 2019 were audited via audio/video recording to evaluate debrief performance. Debriefs were evaluated for clinical completeness and teamwork quality via two structured forms. Surgeons received an evaluation of their debrief performance at two time points during the study period (February and April). Univariate and mixed-effects regression analyses were used to assess changes in debrief compliance and quality over time. RESULTS: A total of 878 surgical cases performed by 61 surgeons were reviewed: 198 (22.6%) cases during Period 1 (P1), 371 (42.3%) P2, and 309 (35.1%) P3. The rate at which a debrief occurred was 62.1% in P1, 73.0% in P2, and 82.2% in P3 (P < 0.001). Debriefs were 1.96 (95% CI 1.31-2.95, P = 0.001) times more likely to be completed during P2 and 3.21 (95% CI 2.07-5.04, P < 0.001) times more likely during P3 compared to P1. The percent of debriefs initiated by the lead surgeon increased from 59.8% in P1, to 80.0% in P2, to 81.5% in P3 (P < 0.001). CONCLUSIONS: Providing structured feedback to surgeons on their debrief performance was associated with improvements in compliance and completeness with debriefing protocols, OR teamwork and communication, and leadership and accountability from the lead surgeons.


Assuntos
Feedback Formativo , Cirurgia Geral/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Humanos , Salas Cirúrgicas/normas , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade
4.
J Surg Res ; 257: 455-461, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892145

RESUMO

BACKGROUND: The preinduction checklist, part of the three-phase surgical safety checklist, is performed before induction of anesthesia. Our previous research demonstrated higher checklist adherence by perioperative staff when parents were engaged in the preinduction checklist. We hypothesized that use of a parent-centered script (PCS) during the preinduction checklist would increase parent engagement and checklist adherence. METHODS: A single-center, prospective, observational study was conducted in which parents of children (<18 y) undergoing nonemergent surgeries (June 2018-July 2019) were observed before and after PCS implementation. The PCS, developed by the health care team, engaged parents by directly asking them to contribute information relevant to parent knowledge. Parent engagement was rated using a five-point Likert scale, and adherence was scored for each relevant checkpoint completed. RESULTS: Of 270 checklists, 154 (57%) occurred before and 116 (43%) after PCS implementation. Groups were similar by primary language, patient age, and type of surgery, but more postimplementation children had a prior surgery. The overall parent engagement score did not improve with the PCS (P = 0.8); however, there was an improvement in eye contact by parents. After introduction of the PCS, checklist adherence decreased from a median score of 6 (interquartile range 5-6) to 4 (interquartile range 4-5) (P < 0.001). CONCLUSIONS: Use of a PCS did not improve parent engagement during the preinduction checklist and an unexpected decline in checklist adherence was observed. Further research, with parent and staff input, is necessary to determine how best to engage parents while ensuring high checklist adherence.


Assuntos
Lista de Checagem , Cirurgia Geral/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Pais , Segurança do Paciente , Pediatria/normas , Criança , Pré-Escolar , Cirurgia Geral/estatística & dados numéricos , Humanos , Pediatria/estatística & dados numéricos , Estudos Prospectivos
5.
Am J Surg ; 221(1): 13-18, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32665080

RESUMO

BACKGROUND: Currently, there is significant variability in the development, implementation and overarching goals of video review for assessment of surgical performance. METHODS: This paper evaluates the current methods in which video review is used for evaluation of surgical performance and identifies which processes are critical for successful, widespread implementation of video-based assessment. RESULTS: Despite the advances in video capture technology and growing interest in video-based assessment, there is a notable gap in the implementation and longitudinal use of formative and summative assessment using video. CONCLUSION: Validity, scalability and discoverability are current but removable barriers to video-based assessment.


Assuntos
Competência Clínica , Cirurgia Geral/normas , Gravação em Vídeo
6.
Am J Surg ; 221(1): 174-182, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32928540

RESUMO

INTRODUCTION: There is little consensus of quality measurements for restorative proctocolectomy with ileal pouch-anal anastomosis(RPC-IPAA) performed for ulcerative colitis(UC). The National Surgical Quality Improvement Program(NSQIP) cannot accurately classify RPC-IPAA staged approaches. We formed an IBD-surgery registry that added IBD-specific variables to NSQIP to study these staged approaches in greater detail. METHODS: We queried our validated database of IBD surgeries across 11 sites in the US from March 2017 to March 2019, containing general NSQIP and IBD-specific perioperative variables. We classified cases into delayed versus immediate pouch construction and looked for independent predictors of pouch delay and postoperative Clavien-Dindo complication severity. RESULTS: 430 patients received index surgery or completed pouches. Among completed pouches, 46(28%) and 118(72%) were immediate and delayed pouches, respectively. Significant predictors for delayed pouch surgery included higher UC surgery volume(p = 0.01) and absence of colonic dysplasia(p = 0.04). Delayed pouch formation did not significantly predict complication severity. CONCLUSIONS: Our data allows improved classification of complex operations. Curating disease-specific variables allows for better analysis of predictors of delayed versus immediate pouch construction and postoperative complication severity. SHORT SUMMARY: We applied our previously validated novel NSIP-IBD database for classifying complex, multi-stage surgical approaches for UC to a degree that was not possible prior to our collaborative effort. From this, we describe predictive factors for delayed pouch formation in UC RPC-IPAA with the largest multicenter effort to date.


Assuntos
Colite Ulcerativa/cirurgia , Proctocolectomia Restauradora , Adolescente , Adulto , Idoso , Feminino , Cirurgia Geral/normas , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Proctocolectomia Restauradora/normas , Melhoria de Qualidade , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos , Adulto Jovem
7.
Surg Clin North Am ; 100(5): 879-891, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882170

RESUMO

The article describes the barriers rural surgeons face when attempting to measure, analyze, and benchmark the quality and value of the care they provide for their patients. Examples of suboptimal care are presented as well as special geographic and resource-related circumstances for many of these disparities of care. The article includes in-depth descriptions of the American College of Surgeons (ACS) Optimal Resources for Surgical Quality and Safety Program and the ACS Rural Hospital Surgical Verification and Quality Improvement Program. The article concludes by discussing several documented clinical, economic, and social advantages of keeping surgical care local.


Assuntos
Cirurgia Geral/normas , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/normas , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Melhoria de Qualidade , Estados Unidos
9.
Can J Surg ; 63(3): E229-E230, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386472

RESUMO

Summary: The coronavirus disease 2019 (COVID-19) pandemic has accentuated the importance of leadership training for health care professionals, particularly surgeons. Surgeons are expected to lead and thrive in multidisciplinary teams. There is, however, a critical gap in teaching residents about fundamental leadership principles, such as developing productive and vision-driven teams, conflict resolution and emotional intelligence. We discuss the merits of leadership training for surgical residents and future directions for implementing a leadership curriculum for Canadian residency programs in the competency by design era.


Assuntos
Infecções por Coronavirus , Cirurgia Geral/educação , Internato e Residência/organização & administração , Liderança , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral , Canadá , Competência Clínica , Currículo , Cirurgia Geral/normas , Internato e Residência/métodos , Internato e Residência/normas , Equipe de Assistência ao Paciente/normas , Ensino
12.
Ann R Coll Surg Engl ; 102(6): 437-441, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32374217

RESUMO

INTRODUCTION: In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. We sought to establish whether local declared surgeon special interest impacts emergency laparotomy outcomes. METHODS: Adult patients having emergency laparotomy were identified from our prospective National Emergency Laparotomy Audit database from May 2016 to May 2019 and categorised as colorectal or oesophagogastric according to operative procedure. Outcomes included 30-day mortality, return to theatre and length of stay. Binomial logistic regression was used to identify any association between declared consultant specialist interest and outcomes. RESULTS: Of 600 laparotomies, 358 (58.6%) were classifiable as specialist procedures: 287 (80%) colorectal and 71 (20%) oesophagogastric. Discordance between declared specialty and operation undertaken occurred in 25% of procedures. For colorectal emergency laparotomy, there was an increased risk of 30-day mortality when performed by a non-colorectal consultant (unadjusted odds ratio 2.34; 95% confidence interval 1.10-5.00; p = 0.003); however, when adjusted for confounders within multivariate analysis declared surgeon specialty had no impact on mortality, return to theatre or length of stay. CONCLUSION: Surgeon-declared specialty does not impact emergency laparotomy outcomes in this cohort of undifferentiated emergency laparotomies. This may reflect the on-call structure at Birmingham Heartlands Hospital, where a colorectal and oesophagogastric consultant are paired on call and provide cross-cover when needed.


Assuntos
Competência Clínica/normas , Tratamento de Emergência/estatística & dados numéricos , Gastroenteropatias/cirurgia , Laparotomia/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Idoso , Certificação/normas , Competência Clínica/estatística & dados numéricos , Colo/cirurgia , Consultores/estatística & dados numéricos , Estado Terminal/mortalidade , Estado Terminal/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Esôfago/cirurgia , Feminino , Gastroenteropatias/mortalidade , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Mortalidade Hospitalar , Humanos , Laparotomia/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Reto/cirurgia , Reoperação/estatística & dados numéricos , Estômago/cirurgia , Cirurgiões/organização & administração , Cirurgiões/normas , Resultado do Tratamento
17.
J Laparoendosc Adv Surg Tech A ; 30(5): 481-484, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32339074

RESUMO

The novel coronavirus SARS-CoV-2 (COVID-19) strain has caused a pandemic that affects everyday clinical practice. Care of patients with acute surgical problems is adjusted to minimize exposing health care providers to this highly contagious virus. Our goal is to describe a specific and reproducible perioperative protocol aiming to keep health care providers safe and, simultaneously, not compromise standard of care for surgical patients.


Assuntos
Infecções por Coronavirus , Cirurgia Geral/normas , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Assistência Perioperatória/normas , Pneumonia Viral , Procedimentos Cirúrgicos Operatórios/normas , Algoritmos , Protocolos Clínicos/normas , Emergências , Humanos , Massachusetts , Equipe de Assistência ao Paciente/normas , Estados Unidos
18.
Zhonghua Wai Ke Za Zhi ; 58(3): 170-177, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187920

RESUMO

The 2019 coronavirus disease(COVID-19) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the COVID-19 as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight against COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Cirurgia Geral/normas , Pneumonia Viral , China , Humanos , Guias de Prática Clínica como Assunto
19.
Br J Surg ; 107(2): e151-e160, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903586

RESUMO

BACKGROUND: The Surgical Safety Checklist (SSC) is a patient safety tool shown to reduce mortality and to improve teamwork and adherence with perioperative safety practices. The results of the original pilot work were published 10 years ago. This study aimed to determine the contemporary prevalence and predictors of SSC use globally. METHODS: Pooled data from the GlobalSurg and Surgical Outcomes studies were analysed to describe SSC use in 2014-2016. The primary exposure was the Human Development Index (HDI) of the reporting country, and the primary outcome was reported SSC use. A generalized estimating equation, clustering by facility, was used to determine differences in SSC use by patient, facility and national characteristics. RESULTS: A total of 85 957 patients from 1464 facilities in 94 countries were included. On average, facilities used the SSC in 75·4 per cent of operations. Compared with very high HDI, SSC use was less in low HDI countries (odds ratio (OR) 0·08, 95 per cent c.i. 0·05 to 0·12). The SSC was used less in urgent compared with elective operations in low HDI countries (OR 0·68, 0·53 to 0·86), but used equally for urgent and elective operations in very high HDI countries (OR 0·96, 0·87 to 1·06). SSC use was lower for obstetrics and gynaecology versus abdominal surgery (OR 0·91, 0·85 to 0·98) and where the common or official language was not one of the WHO official languages (OR 0·30, 0·23 to 0·39). CONCLUSION: Worldwide, SSC use is generally high, but significant variability exists. Implementation and dissemination strategies must be developed to address this variability.


Assuntos
Lista de Checagem/estatística & dados numéricos , Segurança do Paciente/normas , Procedimentos Cirúrgicos Operatórios/normas , Adulto , Idoso , Feminino , Cirurgia Geral/normas , Cirurgia Geral/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
20.
Am J Gastroenterol ; 115(2): 234-243, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31738285

RESUMO

INTRODUCTION: Formative colonoscopy direct observation of procedural skills (DOPS) assessments were updated in 2016 and incorporated into UK training but lack validity evidence. We aimed to appraise the validity of DOPS assessments, benchmark performance, and evaluate competency development during training in diagnostic colonoscopy. METHODS: This prospective national study identified colonoscopy DOPS submitted over an 18-month period to the UK training e-portfolio. Generalizability analyses were conducted to evaluate internal structure validity and reliability. Benchmarking was performed using receiver operator characteristic analyses. Learning curves for DOPS items and domains were studied, and multivariable analyses were performed to identify predictors of DOPS competency. RESULTS: Across 279 training units, 10,749 DOPS submitted for 1,199 trainees were analyzed. The acceptable reliability threshold (G > 0.70) was achieved with 3 assessors performing 2 DOPS each. DOPS competency rates correlated with the unassisted caecal intubation rate (rho 0.404, P < 0.001). Demonstrating competency in 90% of assessed items provided optimal sensitivity (90.2%) and specificity (87.2%) for benchmarking overall DOPS competence. This threshold was attained in the following order: "preprocedure" (50-99 procedures), "endoscopic nontechnical skills" and "postprocedure" (150-199), "management" (200-249), and "procedure" (250-299) domain. At item level, competency in "proactive problem solving" (rho 0.787) and "loop management" (rho 0.780) correlated strongest with the overall DOPS rating (P < 0.001) and was the last to develop. Lifetime procedure count, DOPS count, trainer specialty, easier case difficulty, and higher cecal intubation rate were significant multivariable predictors of DOPS competence. DISCUSSION: This study establishes milestones for competency acquisition during colonoscopy training and provides novel validity and reliability evidence to support colonoscopy DOPS as a competency assessment tool.


Assuntos
Competência Clínica , Colonoscopia/educação , Gastroenterologia/educação , Cirurgia Geral/educação , Enfermeiras Especialistas/educação , Colonoscopia/normas , Gastroenterologia/normas , Cirurgia Geral/normas , Humanos , Enfermeiras Especialistas/normas , Observação , Reprodutibilidade dos Testes , Reino Unido
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