Interprofessional simulation-based team-training and self-efficacy in emergency medicine situations.

Teamwork quality has been shown to influence patient safety, and simulation-based team-training (SBTT) is an effective means to increase this quality. However, long-term effects are rarely studied. This study aims to investigate the long-term effects of interprofessional SBTT in emergency medicine in terms of global confidence, self-efficacy in interprofessional communication and in emergency medicine situations. Newly graduated doctors, nurses, auxiliary nurses, and medical and nursing students participated. Four emergency medicine scenarios focused on teamwork according to the A-B-C-D-E-strategy. All participants increased their global confidence from 5.3 (CI 4.9-5.8) before to 6.8 (CI 6.4-7.2; p < .0001) after SBTT. Confidence in interprofessional communication increased from 5.3 (CI 4.9-5.8) to 7.0 (CI 6.6-7.4; p < .0001). Students had the greatest gain. The self-efficacy following the A-B-C-D-E strategy increased from 4.9 (CI 4.4-5.3) to 6.6 (CI 6.2-7.0). Again, students had the steepest increase. Newly graduated doctors achieved a superior increase in global confidence as compared to nurses and auxiliary nurses (p < .0001). Their propensity to recommend SBTT to colleagues was 9.9 (CI 9.8-10.0). The positive effects were sustained over a six-month period, indicating that interprofessional SBTT had a positive impact on competence development, and a potential to contribute to increased team quality in emergency medicine care.

[Transthoracal and abdominothoracal radical operation for esophageal and cardiac carcinoma. Early results (author's transl)]. / Transthorakale und abdomino-thorakale Radikaloperation des Osophagus- und Kardiakarzinoms. Frühergebnisse

With reference to the frequency of esophageal and cardial carcinoma in the local patients of the Taj Institute for Cancer Research in Teheran, the early results following transthoracal-transdiaphragmatic (30 cases) and abdomino-right thoracal (30 cases) radical operations are compared and clinical and radiological criteria given which, from experience, indicate inoperability. In the first series postoperative mortality was 20%, in the second 10%. Non-fatal anastomosis dehiscences were five times more frequent in the first series than in the second. The average stay in hospital was about 50% shorter in the second abdomino-right thoracal operation are due, in the author's opinion, to better visibility, more accurate checking, technical facilitation of the anastomosis and less traumatization.

Lateral sinus thrombosis: diagnosis and treatment--a case report.

Lateral sinus thrombosis is a difficult diagnostic problem. Specialized computerized tomography allows non-invasive preoperative visualization of sinus contents enabling the surgeon to make a definitive diagnosis with appropriate preoperative planning. This case report details these specialized techniques and their application to a case of lateral sinus thrombosis.