This document summarizes a presentation given by Dr. Jacob Perry at the University of Kentucky College of Medicine discussing why surgical residents may lack adequate operative experience. Dr. Perry reviews research showing that surgical skill is learned, not innate, and that current residents receive significantly less operative experience in essential cases than what is considered the minimum for competence. Factors that limit residents' operative experience include work hour restrictions, pressure for efficiency, and inadequate focus on teaching in the operating room. Improving resident education will require collecting better operative data, evaluating teaching skills, and prioritizing maximum resident benefit in the operating room.
The document outlines the procedures and examinations that a junior technician is expected to complete as part of a patient's eye exam work up prior to the doctor's visit. It involves preparing the patient's file, taking a history, performing various vision and eye health tests, documenting findings, and preparing notes for the doctor. The work up includes tests of visual acuity, refractive error, eye alignment and movement, eye pressure, visual fields and external and slit lamp examinations of the eyes. The technician is responsible for gathering all relevant health information and performing examinations to thoroughly assess the patient's eye health.
This study retrospectively analyzed 16 cranioplasty cases performed between 2006-2012 to reconstruct post-traumatic craniofacial defects. The main aims of cranioplasty were to protect the brain, restore aesthetics, and facilitate cranial growth in children. Clinical assessments and imaging were used to evaluate patients. Calvarial bone grafts were harvested and fixed with titanium plates through a bicoronal approach. With a minimum 2-year follow up, results showed patient satisfaction was high with 75-95% aesthetic improvement and minimum scar visibility. Complications included wound infection in 2 cases and plate exposure in 3 cases. The study aims to analyze factors and clinical outcomes of cranioplasty reconstruction of post-tra
The introduction of canaloplasty into the glaucoma surgical armamentarium was motivated by the desire of clinicians to enhance the quality of patients’ glaucoma care. Patients’ long-term adherence to topical glaucoma medical therapy is well known to be relatively poor. Laser therapy offers a safe alternative to medical therapy but often still requires the addition of topical medication. Traditionally, glaucoma filtration surgery has been reserved for more advanced, uncontrolled glaucoma for obvious reasons. Despite its definite role in glaucoma care, patients undergoing standard trabeculectomy are at significant risk for the development of postoperative infection, cataract, hypotony, bleb dysesthesia, astigmatism, and decreased visual acuity. These potential complications have driven surgeons to pursue surgical alternatives. Canaloplasty is a well-established procedure that has, for the past 3 years, demonstrated impressive efficacy and safety in peer-reviewed prospective studies. Despite growing evidence of its value and increasing performance of the procedure by ophthalmologists all over the world, misconceptions regarding its long-term efficacy as well as challenges in its adoption, surgical
technique, and patient selection persist. Several experienced and leading surgeons share their experiences and pearls for optimizing success with canaloplasty.
— Steven D. Vold, MD
This case presentation discusses a patient with normal tension glaucoma. Key details include a past ocular history of high myopia and elevated intraocular pressure in both eyes. Visual field testing over several years using Humphrey 24-2 and 24-2C grids showed progressive visual field loss. The presenter reviews visual field test patterns, parameters, and how to integrate visual field tests with ganglion cell complex scans. A journal article is summarized that compares the 24-2 and 24-2C grids' ability to detect central visual field defects and evaluate structure-function concordance in glaucoma.
Determinants Of Visual Outcomes After Small Incision Cataract Surgery In Pati...Dr. Jagannath Boramani
This study assessed the best-corrected visual acuity 6 weeks after small incision cataract surgery in 443 patients without ocular comorbidities. The results found that 39.73% of patients had visual acuity less than 6/18, while 60.27% had visual acuity greater than 6/18. The major factors affecting poor visual outcomes were biometric calculations, astigmatism, the grade of cataract, and the experience of the operating surgeon. The study concluded that controlling surgically-induced astigmatism through accurate preoperative measurements and planning incision size and position can help improve visual outcomes after small incision cataract surgery.
The document summarizes an internship at Jervey Eye Group in Greenville, South Carolina. It provides background on the internship requirements and describes the intern's experience completing tasks like patient examinations, scribing, and shadowing Dr. Myers in the glaucoma department. The internship helped the individual learn skills for a career in ophthalmology and verify their interest in medicine.
Preoperative planning is critical for surgical success. It involves considering the patient, injury details, required equipment and skills, and developing a technical drawing and written surgical plan. This ensures the necessary personnel and equipment will be available and allows the surgeon to anticipate complications and have a strategy to address potential obstacles. Effective preoperative planning can significantly improve surgical outcomes.
1) Preoperative planning is essential for surgical success as it allows the surgeon to determine the best technique, implants, and anticipate any issues before operating.
2) Proper planning involves making the correct diagnosis, identifying the desired surgical goal, and drawing out the expected surgical steps and result.
3) Planning can be done using the fracture itself, the normal anatomy as a template, or the anatomical axis, and involves selecting implants and establishing the surgical approach and technique. Advanced planning using CT scans and software can further aid the process.
The document outlines the procedures and examinations that a junior technician is expected to complete as part of a patient's eye exam work up prior to the doctor's visit. It involves preparing the patient's file, taking a history, performing various vision and eye health tests, documenting findings, and preparing notes for the doctor. The work up includes tests of visual acuity, refractive error, eye alignment and movement, eye pressure, visual fields and external and slit lamp examinations of the eyes. The technician is responsible for gathering all relevant health information and performing examinations to thoroughly assess the patient's eye health.
This study retrospectively analyzed 16 cranioplasty cases performed between 2006-2012 to reconstruct post-traumatic craniofacial defects. The main aims of cranioplasty were to protect the brain, restore aesthetics, and facilitate cranial growth in children. Clinical assessments and imaging were used to evaluate patients. Calvarial bone grafts were harvested and fixed with titanium plates through a bicoronal approach. With a minimum 2-year follow up, results showed patient satisfaction was high with 75-95% aesthetic improvement and minimum scar visibility. Complications included wound infection in 2 cases and plate exposure in 3 cases. The study aims to analyze factors and clinical outcomes of cranioplasty reconstruction of post-tra
The introduction of canaloplasty into the glaucoma surgical armamentarium was motivated by the desire of clinicians to enhance the quality of patients’ glaucoma care. Patients’ long-term adherence to topical glaucoma medical therapy is well known to be relatively poor. Laser therapy offers a safe alternative to medical therapy but often still requires the addition of topical medication. Traditionally, glaucoma filtration surgery has been reserved for more advanced, uncontrolled glaucoma for obvious reasons. Despite its definite role in glaucoma care, patients undergoing standard trabeculectomy are at significant risk for the development of postoperative infection, cataract, hypotony, bleb dysesthesia, astigmatism, and decreased visual acuity. These potential complications have driven surgeons to pursue surgical alternatives. Canaloplasty is a well-established procedure that has, for the past 3 years, demonstrated impressive efficacy and safety in peer-reviewed prospective studies. Despite growing evidence of its value and increasing performance of the procedure by ophthalmologists all over the world, misconceptions regarding its long-term efficacy as well as challenges in its adoption, surgical
technique, and patient selection persist. Several experienced and leading surgeons share their experiences and pearls for optimizing success with canaloplasty.
— Steven D. Vold, MD
This case presentation discusses a patient with normal tension glaucoma. Key details include a past ocular history of high myopia and elevated intraocular pressure in both eyes. Visual field testing over several years using Humphrey 24-2 and 24-2C grids showed progressive visual field loss. The presenter reviews visual field test patterns, parameters, and how to integrate visual field tests with ganglion cell complex scans. A journal article is summarized that compares the 24-2 and 24-2C grids' ability to detect central visual field defects and evaluate structure-function concordance in glaucoma.
Determinants Of Visual Outcomes After Small Incision Cataract Surgery In Pati...Dr. Jagannath Boramani
This study assessed the best-corrected visual acuity 6 weeks after small incision cataract surgery in 443 patients without ocular comorbidities. The results found that 39.73% of patients had visual acuity less than 6/18, while 60.27% had visual acuity greater than 6/18. The major factors affecting poor visual outcomes were biometric calculations, astigmatism, the grade of cataract, and the experience of the operating surgeon. The study concluded that controlling surgically-induced astigmatism through accurate preoperative measurements and planning incision size and position can help improve visual outcomes after small incision cataract surgery.
The document summarizes an internship at Jervey Eye Group in Greenville, South Carolina. It provides background on the internship requirements and describes the intern's experience completing tasks like patient examinations, scribing, and shadowing Dr. Myers in the glaucoma department. The internship helped the individual learn skills for a career in ophthalmology and verify their interest in medicine.
Preoperative planning is critical for surgical success. It involves considering the patient, injury details, required equipment and skills, and developing a technical drawing and written surgical plan. This ensures the necessary personnel and equipment will be available and allows the surgeon to anticipate complications and have a strategy to address potential obstacles. Effective preoperative planning can significantly improve surgical outcomes.
1) Preoperative planning is essential for surgical success as it allows the surgeon to determine the best technique, implants, and anticipate any issues before operating.
2) Proper planning involves making the correct diagnosis, identifying the desired surgical goal, and drawing out the expected surgical steps and result.
3) Planning can be done using the fracture itself, the normal anatomy as a template, or the anatomical axis, and involves selecting implants and establishing the surgical approach and technique. Advanced planning using CT scans and software can further aid the process.
This document summarizes a panel discussion on challenging cases in corneal refractive surgery. The panel discusses various complex cases involving thin corneas, high corrections, posterior corneal elevation, corneal opacities and dystrophies. For these types of cases, the panel discusses techniques like topography-guided PRK combined with corneal collagen cross-linking and evaluating factors like patient age and corneal biomechanics when determining treatment options. The document also provides examples of case studies presented to the panel and the specific considerations and approaches recommended for each case.
1) The document discusses various types of radiographs used in orthodontics including panoramic, cephalometric, intraoral, and CBCT radiographs.
2) It provides details on the uses, advantages, disadvantages and proper patient positioning for panoramic and lateral cephalometric radiographs.
3) CBCT is described as having specific indications for impacted teeth, orthognathic evaluation, pathology, TMD, and craniofacial cases. Hand wrist radiographs are noted to evaluate growth stage.
An intertrochanteric fracture for which treatment
has failed presents a difficult challenge to the orthopedic
surgeon. In younger patients, salvage typically
involves efforts to preserve the hip joint with
repeat internal fixation, whereas in older patients,
prosthetic replacement is a reliable salvage
option
oral and general manifestation of radiated patients - KellyKelly Norton
This document discusses the oral and dental manifestations of radiation therapy and their implications for prosthodontic planning and treatment. It covers topics like:
1. The different types and modalities of radiation therapy and their primary biological effects.
2. The dentist's role in managing patients before, during, and after radiation therapy, which includes fabricating stents, managing oral mucositis, and addressing issues like trismus, xerostomia, and osteoradionecrosis.
3. Prosthodontic considerations for patients who receive radiation therapy, such as special impression techniques, altered vertical dimension and occlusal schemes, and increased focus on post-insertion care due to complications from
This document provides guidance on setting up a regional anesthesia practice at a hospital. It discusses the importance of hiring anesthesiologists with good regional training, investing in anatomy education, focusing on patient outcomes and satisfaction, using pharmacology evidence-basedly, gaining surgeon buy-in, and establishing proper infrastructure and billing practices to support the regional anesthesia program. The overall message is that regional anesthesia can enhance surgical recovery when implemented through a thoughtful, multidisciplinary approach.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
The document discusses fluid strategy in the perioperative setting and whether more or less fluid is better. It summarizes that while goal-directed therapy aimed at optimizing hemodynamics has been shown to reduce mortality and morbidity in some studies, the evidence is still being questioned. Excessive fluid administration can also lead to detrimental fluid overload, and a restrictive fluid strategy may be advantageous in reducing postoperative complications and shortening hospital stay.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Este documento fornece uma ficha de trabalho sobre ciências para identificar nutrientes em rótulos de alimentos, indicar alimentos ricos em diferentes nutrientes, comentar a importância do pequeno-almoço, e discutir o número ideal de refeições por dia.
O documento descreve a quarta etapa de um projeto sobre possibilidades de uso de vídeo na escola, ocorrendo de 15 a 23 de julho de 2008 sob a coordenação da professora Edileuza Alves.
Um dia de poesias na E.E.B. Henrique Fontesfabiabpedro
Os alunos do 5° ano apresentaram seus poemas para as outras turmas na segunda-feira, dia 03 de setembro, com a ajuda das professoras Rosineide e Milena.
O documento fornece instruções para um teste de História sobre ditaduras fascistas e nazis na Europa. Os alunos devem identificar chefes de ditaduras, razões para o avanço de movimentos de extrema-direita e características do Fascismo e Nazismo. O teste conterá questões de escolha múltipla, verdadeiro/falso e respostas curtas e longas.
Um grupo de funcionários públicos requer a convocação de uma Assembleia Geral Extraordinária do Sindicato dos Funcionários Públicos da Prefeitura Municipal de Guarujá para tratar de três assuntos: 1) eleição de uma comissão de negociação salarial, 2) apreciar uma proposta de reajuste negociada sem aval da assembleia, 3) publicar apoio à luta dos professores por recomposição salarial.
O documento discute conceitos básicos de probabilidade e estatística, incluindo: 1) Experiências aleatórias, cujos resultados não podem ser previstos, em oposição a experiências deterministas; 2) Conjunto de resultados ou espaço amostral, que contém todos os resultados possíveis de uma experiência; 3) Acontecimentos, que são subconjuntos do espaço amostral e podem ser elementares, compostos, certos ou impossíveis.
To understand why a study abstract is important to scientific communication.
To understand the process by which abstracts are selected for presentation at scientific conferences.
To learn the features which unite successful abstract submissions.
Presentation slides from our first meeting, held on Tuesday 10th September 2013 at the Royal College of Surgeons.
Find us on
Twitter @STARSurgUK
Facebook.com/STARSurgUK
Email: STARSurgUK@gmail.com
The document describes how to plan and implement an objective structured clinical examination (OSCE) for assessing pediatric nursing students. It discusses:
- The OSCE model based on Miller's hierarchy of clinical competence using simulated practice.
- Skills that can be assessed including clinical skills, decision making, communication, and time management.
- Locations for the OSCE including clinical areas with real patients or simulated labs.
- Steps for planning including time allotted, staffing needs, station types and content, and evaluation criteria.
- Types of stations such as manned stations where students perform skills and unmanned stations involving cases, images, and written responses.
- Examples of station content covering various pediatric topics, skills
This document summarizes a ward round documentation audit conducted over 8 weeks. The results showed substandard documentation across several categories assessed. Discussion notes that poor documentation can negatively impact patient safety and care continuity. While electronic documentation may be ideal, pragmatic first steps include education, improving note access, utilizing ward round checklists, and addressing time pressures faced by junior doctors. The conclusion is that a multidisciplinary team approach is needed to implement stepwise improvements to documentation standards.
This document discusses the importance of using a surgical safety checklist. It notes that surgical errors can have serious consequences and that checklists are an effective way to reduce errors. The document outlines the components of the surgical safety checklist, which includes briefings before and after surgery and timeout periods. It also discusses implementation strategies, such as forming an implementation team, providing staff training, and having leadership support. Research showed that using the checklist reduced death rates after surgery from 1.5% to 0.8% and complications from 11.0% to 7.0%. With regular use, the checklist can become faster and more effective at improving safety.
This document discusses technology assessment, outcomes research, and economic analyses in healthcare. It provides background on rising healthcare costs in the US without clear improvements in health outcomes compared to other countries. The rationale for assessing new technologies and their impact is described. Key aspects of technology assessment are outlined, including technical efficacy, diagnostic accuracy, diagnostic impact, therapeutic impact, patient outcomes, and societal outcomes. Challenges with randomized controlled trials in assessing technologies are reviewed. The National Lung Screening Trial is presented as an example. Finally, computed tomography for appendicitis is analyzed as a hypothetical example of how modeling could be used to assess a technology when a randomized trial may not be feasible.
This document summarizes a panel discussion on challenging cases in corneal refractive surgery. The panel discusses various complex cases involving thin corneas, high corrections, posterior corneal elevation, corneal opacities and dystrophies. For these types of cases, the panel discusses techniques like topography-guided PRK combined with corneal collagen cross-linking and evaluating factors like patient age and corneal biomechanics when determining treatment options. The document also provides examples of case studies presented to the panel and the specific considerations and approaches recommended for each case.
1) The document discusses various types of radiographs used in orthodontics including panoramic, cephalometric, intraoral, and CBCT radiographs.
2) It provides details on the uses, advantages, disadvantages and proper patient positioning for panoramic and lateral cephalometric radiographs.
3) CBCT is described as having specific indications for impacted teeth, orthognathic evaluation, pathology, TMD, and craniofacial cases. Hand wrist radiographs are noted to evaluate growth stage.
An intertrochanteric fracture for which treatment
has failed presents a difficult challenge to the orthopedic
surgeon. In younger patients, salvage typically
involves efforts to preserve the hip joint with
repeat internal fixation, whereas in older patients,
prosthetic replacement is a reliable salvage
option
oral and general manifestation of radiated patients - KellyKelly Norton
This document discusses the oral and dental manifestations of radiation therapy and their implications for prosthodontic planning and treatment. It covers topics like:
1. The different types and modalities of radiation therapy and their primary biological effects.
2. The dentist's role in managing patients before, during, and after radiation therapy, which includes fabricating stents, managing oral mucositis, and addressing issues like trismus, xerostomia, and osteoradionecrosis.
3. Prosthodontic considerations for patients who receive radiation therapy, such as special impression techniques, altered vertical dimension and occlusal schemes, and increased focus on post-insertion care due to complications from
This document provides guidance on setting up a regional anesthesia practice at a hospital. It discusses the importance of hiring anesthesiologists with good regional training, investing in anatomy education, focusing on patient outcomes and satisfaction, using pharmacology evidence-basedly, gaining surgeon buy-in, and establishing proper infrastructure and billing practices to support the regional anesthesia program. The overall message is that regional anesthesia can enhance surgical recovery when implemented through a thoughtful, multidisciplinary approach.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
The document discusses fluid strategy in the perioperative setting and whether more or less fluid is better. It summarizes that while goal-directed therapy aimed at optimizing hemodynamics has been shown to reduce mortality and morbidity in some studies, the evidence is still being questioned. Excessive fluid administration can also lead to detrimental fluid overload, and a restrictive fluid strategy may be advantageous in reducing postoperative complications and shortening hospital stay.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Este documento fornece uma ficha de trabalho sobre ciências para identificar nutrientes em rótulos de alimentos, indicar alimentos ricos em diferentes nutrientes, comentar a importância do pequeno-almoço, e discutir o número ideal de refeições por dia.
O documento descreve a quarta etapa de um projeto sobre possibilidades de uso de vídeo na escola, ocorrendo de 15 a 23 de julho de 2008 sob a coordenação da professora Edileuza Alves.
Um dia de poesias na E.E.B. Henrique Fontesfabiabpedro
Os alunos do 5° ano apresentaram seus poemas para as outras turmas na segunda-feira, dia 03 de setembro, com a ajuda das professoras Rosineide e Milena.
O documento fornece instruções para um teste de História sobre ditaduras fascistas e nazis na Europa. Os alunos devem identificar chefes de ditaduras, razões para o avanço de movimentos de extrema-direita e características do Fascismo e Nazismo. O teste conterá questões de escolha múltipla, verdadeiro/falso e respostas curtas e longas.
Um grupo de funcionários públicos requer a convocação de uma Assembleia Geral Extraordinária do Sindicato dos Funcionários Públicos da Prefeitura Municipal de Guarujá para tratar de três assuntos: 1) eleição de uma comissão de negociação salarial, 2) apreciar uma proposta de reajuste negociada sem aval da assembleia, 3) publicar apoio à luta dos professores por recomposição salarial.
O documento discute conceitos básicos de probabilidade e estatística, incluindo: 1) Experiências aleatórias, cujos resultados não podem ser previstos, em oposição a experiências deterministas; 2) Conjunto de resultados ou espaço amostral, que contém todos os resultados possíveis de uma experiência; 3) Acontecimentos, que são subconjuntos do espaço amostral e podem ser elementares, compostos, certos ou impossíveis.
To understand why a study abstract is important to scientific communication.
To understand the process by which abstracts are selected for presentation at scientific conferences.
To learn the features which unite successful abstract submissions.
Presentation slides from our first meeting, held on Tuesday 10th September 2013 at the Royal College of Surgeons.
Find us on
Twitter @STARSurgUK
Facebook.com/STARSurgUK
Email: STARSurgUK@gmail.com
The document describes how to plan and implement an objective structured clinical examination (OSCE) for assessing pediatric nursing students. It discusses:
- The OSCE model based on Miller's hierarchy of clinical competence using simulated practice.
- Skills that can be assessed including clinical skills, decision making, communication, and time management.
- Locations for the OSCE including clinical areas with real patients or simulated labs.
- Steps for planning including time allotted, staffing needs, station types and content, and evaluation criteria.
- Types of stations such as manned stations where students perform skills and unmanned stations involving cases, images, and written responses.
- Examples of station content covering various pediatric topics, skills
This document summarizes a ward round documentation audit conducted over 8 weeks. The results showed substandard documentation across several categories assessed. Discussion notes that poor documentation can negatively impact patient safety and care continuity. While electronic documentation may be ideal, pragmatic first steps include education, improving note access, utilizing ward round checklists, and addressing time pressures faced by junior doctors. The conclusion is that a multidisciplinary team approach is needed to implement stepwise improvements to documentation standards.
This document discusses the importance of using a surgical safety checklist. It notes that surgical errors can have serious consequences and that checklists are an effective way to reduce errors. The document outlines the components of the surgical safety checklist, which includes briefings before and after surgery and timeout periods. It also discusses implementation strategies, such as forming an implementation team, providing staff training, and having leadership support. Research showed that using the checklist reduced death rates after surgery from 1.5% to 0.8% and complications from 11.0% to 7.0%. With regular use, the checklist can become faster and more effective at improving safety.
This document discusses technology assessment, outcomes research, and economic analyses in healthcare. It provides background on rising healthcare costs in the US without clear improvements in health outcomes compared to other countries. The rationale for assessing new technologies and their impact is described. Key aspects of technology assessment are outlined, including technical efficacy, diagnostic accuracy, diagnostic impact, therapeutic impact, patient outcomes, and societal outcomes. Challenges with randomized controlled trials in assessing technologies are reviewed. The National Lung Screening Trial is presented as an example. Finally, computed tomography for appendicitis is analyzed as a hypothetical example of how modeling could be used to assess a technology when a randomized trial may not be feasible.
Designing the Future, Engineering Reality: Prototyping in the Emergency Depar...ServDes
This document summarizes a case study of using service prototyping to test solutions for overcrowding in an emergency department in Italy. Researchers conducted ethnographic research and workshops to understand key issues, then prototyped an open space ambulatory concept. They tested the prototype live over 5 weeks, making iterative adjustments based on observations and feedback. Testing indicated potential to reduce waiting times and lengths of stay while improving patient satisfaction. Researchers identified principles for effective live service prototyping, including gaining authentic feedback, ensuring consistency, and creating a valid testing environment.
This document discusses OSCE (Objective Structured Clinical Examination), which is a clinical skills assessment used in medical education. OSCE involves candidates rotating through several stations to perform various clinical tasks within a time limit. Stations can be interactive, where an examiner observes and scores the candidate, or static, where the candidate answers questions without observation. Common interactive stations include history taking, clinical examination, and tag stations where the candidate interprets findings. The document provides examples of station profiles, checklists, and sample questions asked at different OSCE stations.
Some types of studies require unblinded personnel at the site and a matching unblinded monitoring and study management team. This presentation provides a little background on blinding and then reviews best practices for unblinding.
This document discusses techniques for teaching clinical skills to learners. It begins by outlining objectives of reflecting on current teaching practices, establishing skills of the "few minute preceptor" technique, and learning new teaching ideas for clinics and wards. It then discusses views of learning as information acquisition vs knowledge construction. Key principles for adult learning are outlined from Knowles and Kolb. Challenges of clinical teaching are acknowledged. Techniques like the few minute preceptor involving commitment, evidence, reinforcement, guidance, principles and follow up are covered. Models for teaching in clinics and improving teaching on wards are provided. The document concludes by assigning the homework of creating a clinical skill teaching template.
Nilofar Loladiya
MSN OBG
Simulation has been used widely in the clinical training of health-care students and
professionals. It is a valuable strategy for teaching, learning and evaluating clinical skills
at different levels of nursing and midwifery education: undergraduate, postgraduate and
lifelong education (Park et al., 2016; Martins, 2017).
Simulation has a positive impact on students, educators, and the individuals, groups
and communities they care for, as well as on education and health organizations. The
principal aims of simulation as a teaching method are to improve quality of care and
ensure patient safety.
The WHO document Transforming and scaling up health professionals’ education and training (WHO,
2013) strongly recommends the use of simulation. Recommendation 5 states:
Health professionals’ education and training institutions should use simulation methods
(high fidelity methods in settings with appropriate resources and lower fidelity methods in
resource limited settings) of contextually appropriate fidelity levels in the education of health
professionals.
A large proportion of nursing and midwifery education curricula worldwide is dedicated
to the acquisition of clinical skills. At the beginning of the learning period in clinical
settings, students should be able to develop safe and timely evidence-based interventions
without being interrupted by supervisors due to technical errors that may jeopardize
patients’ and students’ safety. In clinical practice with actual patients, students should
be self-confident and feel that others trust them; they should feel capable of performing
tasks without errors and be confident that the supervisor and other team members
believe in their abilities.
From an ethical perspective, invasive procedures should not be taught or practised on
real people; instead, trainees should be able to train in simulated, controlled and safe
environments, allowing them to make errors and learn from them with no harmful
consequences to any person. This ensures absolute respect for human rights by protecting
patients’ dignity and guarantees the quality of nursing care, even during health
professionals’ learning processes.
The Business of Genomic Testing by James CrawfordKnome_Inc
This document summarizes the key findings from a survey of 13 early adopter institutions that have implemented next-generation genomic sequencing (NGS) technologies. The survey identified common drivers for adoption including demands from clinical colleagues, anticipated efficiency gains, and acquiring institutional expertise. It also explored barriers such as lack of informatics expertise and high costs. Respondents provided lessons learned such as NGS being more complicated than expected and the importance of multidisciplinary teams. Common measures of successful outcomes included growth in test volumes and expansion of testing menus. The document concludes with recommendations for professional organizations like the College of American Pathologists, including providing educational programs and testing standards.
Technology Assessment, Outcomes Research and Economic Analysesevadew1
This document discusses technology assessment, outcomes research, and economic analyses in healthcare. It provides background on rising healthcare costs in the US and outlines a hierarchy for assessing new medical technologies from technical efficacy to patient and societal outcomes. Randomized controlled trials are described as the gold standard but limitations are noted. Alternative study designs like modeling and assessing intermediate outcomes are proposed when RCTs are not feasible. The document uses CT for appendicitis as an example to work through initial steps in outcomes research. It also discusses limitations and alternative outcomes like assessing the therapeutic value of diagnostic tests.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
This document discusses optimizing patient flow through emergency care by segmenting patients into categories based on length of stay and clinical needs. It advocates using expected date of discharge and clinical criteria for discharge as goals to coordinate care and discharge planning. Key steps include allocating patients early to specialty teams, standardizing care pathways, minimizing handovers, and conducting daily board rounds to focus on constraints and moving patients smoothly through their care. The overall aim is to get patients home safely and faster while improving outcomes.
This document summarizes a simulation model created to analyze different patient flow scenarios in an emergency department. Key aspects of the model include:
- The model simulates three different patient triage and treatment pathways: traditional triage, a provider in triage team (PITT) model, and a super fast track (SFT) model.
- Input data was collected from a case study of a real emergency department, literature reviews, and expert interviews to inform parameters like patient arrival patterns and lengths of stay.
- The model was built in FlexSim and incorporates details like staffing levels, pathways for different patient acuity levels, and variability in tasks like testing and treatment times.
- Output will be analyzed to compare
This document summarizes a simulation model created to analyze different patient flow scenarios in an emergency department. Key aspects of the simulation include:
- The model was created using FlexSim software to analyze the current triage system and alternatives like a "provider in triage team" approach.
- Extensive input data was collected on patient arrival patterns, length of stay, acuity levels and other metrics from the case study hospital and literature to inform the model.
- The model incorporates detailed process maps and assumptions about staffing, equipment, testing, and patient movement between different areas to replicate real-world ED operations.
- Initial results will be analyzed to compare performance metrics like length of stay and door to provider
This document describes a quality improvement project to develop and implement a pre-operative instructional DVD for thoracic surgery patients. Baseline data found patients lacked knowledge about post-operative care. A DVD was created covering topics like pain management, breathing exercises, and ambulation. Surveys found nurses reported low patient knowledge and engagement pre-intervention. Post-intervention patient surveys showed increased understanding and ability to participate after viewing the DVD. While distribution challenges remain, the DVD was effective in improving patient preparation for post-operative care activities.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
3. Before we get started:
• Not intended to hurt anyone’s feelings
• IS intended to be a discussion about resident education
• Some of this will sound familiar
• No personal agenda
• Discussion of 80 hour work weeks and rest periods
• If you behave, I will continue
Do NOT freak out
(I have no financial disclosures)
4. Why Johnny Cannot Operate
• Richard H. Bell Jr., MD
• Assistant Executive Director, American Board of Surgery (ABS)
• Presidential Address:
– Central Surgical Society Meeting, May 2009
• Article printed:
– Surgery, Sep 2009; 146(533-42)
*
*Now has mustache
5. Why Johnny Cannot Operate
“I CONSIDER THE PERFORMANCE OF SURGICAL
OPERATIONS to be the MOST complex psychomotor activity
that human beings are called upon to perform. In the arts,
athletics, games, and other realms of human activity, I have
found nothing that matches the difficulty of surgery.”
6. Rate of Complication
• 13% morbidity all comers in US surgery
• 2% postoperative mortality
• Spawned “Patient safety movement”
• 2/3 of death & disability due to intraoperative complication
• Intraoperative Mistakes:
– 63.5% = Error in technique
– 29% = Error in judgment
• Both types can be attributed to
LACK OF EXPERIENCE
7. Is he really going to say that we are all
going to be bad doctors?
8. “You were always a good doctor,
just had bad hair”
Source Unknown
9. Where to start?
1. Operative Skill is learned, not innate
2. Current operative experience of general surgery
residents vs. surgical expertise
3. Teaching and learning in the OR
4. Transferable skills?
5. Where do we go from here?
10. Learned Operative Skill
Operative Skill (at least):
1. Technical skills
2. Visio-spatial and tactile skills
3. Determination of pathologic vs. normal
conditions
4. Ability to make good judgments
No traits are possessed A PRIORI:
• Some may be born to BECOME surgeons, but
NO ONE IS BORN A SURGEON
11. Expert
• n. An ordinary fellow from another town - Mark Twain
• n. A man fifty miles from home with a briefcase - Will Rogers
12. Expertise
EXPERTISE: n, the mechanisms underlying the superior
achievement of an expert
i.e. "one who has acquired special skill in or knowledge of a
particular subject through professional training and
practical experience”
- K Anders Ericsson, FSU Cognitive and Expertise Lab
14. Competency (based on Dreyfus model)
• Novice
• Advanced Beginner
• Competent *BARE MINIMUM
• Proficient *GOAL @ END OF 5 YRS
• Expert
– 10,000 hours of dedicated practice
– 8 hours per day x 5 years!
16. Operative Experience of “New”
General Surgery Residents
• Hot topic at ACS/AAST
meetings this year
• Generally perceived as poor
nowadays by the “old
guard”*
• Begs the question:
Can Johnny Operate?
*Anecdotal, but just ask any of ‘em. They will tell you all about it
17. Are residents competent?
• Surgical residency program directors
• Rank 300 ACGME index cases according to
necessity for competency
A = “essential”
B = “should be”
C = “not necessary”
• 121 operations were “essential” components of
GS resident training by majority of PD’s
(n=114/254)
18. Results…
• Review of ACGME op log for 2005 graduating
chief residents
• Of 121 “essential” cases:
– #1: lap ccy; median (M) cases reported= 84/resident
– #38: M<5 cases
– #74: M< 2 cases
19. …were shocking
• 52% (63/121) “essential” cases: mode number
of cases/resident = ZERO
• Cases such as:
– CBDE
– Transanal excision
– Whipple
– Anal Fistulotomy
20. Could the data be skewed?
• Most cases reported were bottom heavy
• e.g. Parathyroidectomy mean <10, Mode 4
YIKES!!!
21. Operative Experience
• 70% agree/strongly agree they are happy with their operative
experience
• Per Dr. Bell (anecdotally)
– Chiefs & Attendings concerned about skill set and independent operative skill
of graduating residents
– Fellowship directors are “unimpressed” by the quality of applicant’s surgical
skill…
• Will residents be the source of agitation for change in the operative
experience?
– According to Bell, No. Instead increased number to pursue fellowships
– I ask, “Why not?”
22. So… we need to do more
parathyroidectomies?
Sure, why not?
23. 10,000 hours to becoming an expert
• 80hrs x 49wks x 5yrs = 19600hrs/residency
• Dr. Bell’s method:
1. 121 essential cases x hour value per case
2. Mean number of cases x hour value per case
• The global data:
– # hrs OR on “essential” cases/resident = 1,148
– 6% of 80-hour work week = ½ day in OR/wk
– Chung, et al., reported 2793 hours (14%)
in OR when ALL cases included
24. The UK data
• Caseload per M&M data
• Hours per case (my best guess)
• 80-hour work week
• Double scrub cases count for both residents
• Limitations:
– 4 residents on vacation
– 4 services not represented (SGR/TXP/STJ/MHD)
– Poor M&M recording
25. The UK Results
OR time per resident (n=16):
Overall 9.1 h/wk/res = 11.4%
PGY5 11.5 h/wk/res = 14.4%
PGY4 16.5 h/wk/res = 20.1%
PGY3 5.5h/wk/res = 6.5%
PGY2 1.16h/wk/res = 1.5%
PGY1 0.3h/wk/res = 0.4%
26. 1st annual Gabriel Bietz busiest resident award
21.5 hrs/wk = 26.9%
The Enterprise thanks Gabe for single handedly doubling
the workload at UK Good Samaritan
27. UK Data by service
• SGB 44.75 hr = 11.2%
• Caveats:
Endo 2.5 = 3.1%
- No breast “fellow”
• PDS 17.75 = 22.2% - No vascular junior
• SGG 11.5 = 4.8% - Only one Categorical on PDS
(intern vacation)
• SGO 12.5 = 15.7%
- VAGS PGY3 on vacation
• CT 4.5 = 5.6%
• VAGS 11 = 13%
• VAVASC 11.5 = 14.3%
28. Conclusions about UK
• We Own Johnny
• Overall, above average amount of time in OR
• Juniors underrepresented in data because of
Morehead, but still lacking OR time
• Does not tell us much about what is actually
going on in the OR
31. Dearth of information
• Relative lack of papers written on teaching
of residents in operating room
• Recent trend of evaluating skill acquisition
in simulation labs (minimally invasive labs,
technical skills) in the literature
• Surgical education vs. Surgical teaching
32. Ideal world
According to Bell:
– Resident comes prepared
– Practiced on simulator
– Resident briefed by attending day prior
– “Read a book”
– Post-Op debriefing
– Standardized grading tool & National
database
– Feedback analysis on attending teaching and
resident learning
– Video review and note taking post-op to
review difficult areas & improve in future
33. Current world
According to Bell:
– Unprepared resident
– Uninformed about patient
– Uneducated about steps of
operation
– Goes through motions
– Feedback: “good job” & “make
the incision look nice”
– Resident moves on to lunch,
flirting with nurses, whatever…
– Lather, rinse, repeat.
35. Obstacles to learning
• Bad timing/change in practices
• Ideas of teaching/learning at odds
• Minimal scientific studies
• Poor/useless assessment tools
• Outside influences
– Pressure to produce
• Supervision of teaching
– Who is watching those who watch the residents?
• 80 hour work week
38. Pugh et al.
• Asked Attendings @ ACS:
– Which areas do residents need to study to be better
prepared to perform an operation?
• Asked Residents @ ACS:
– What do you need to understand better to be
prepared to perform an operation?
39. The Rankings
Area of study Residents (n = 125) Attendings (n = 92)
Instrument use/selection 1 11
Selection of suture
material 2 12
Operative field exposure 3 7
Patient positioning 4 9
Sequence of procedure 5 5
Procedure choices 6 4
Postoperative care 7 8
Follow up procedures 8 10
Patient selection 9 6
Anatomy 10 2
Patient outcomes 11 3
Natural history of disease 12 1
40. So what does that mean?
a) Are we all just too incompatible?
b) Do we have to break up?
c) Are residents untrainable?
d) Are attendings bad at teaching?
e) NONE OF THE ABOVE
41. Transferable skills
• Idea that skills can be transferred between
procedures
• e.g. Ileocolic 2 layer anastamosis
esophagogastric 2 layer anastomosis
• Parathyroidectomy thyroidectomy
• Maybe it is the same…
• But what about mobilizing right vs left colon?
42. Read a book!
• Not good enough
• Research shows we need multiple
exposures to procedures to develop
rich, detailed mental models
• Even “master surgeons” can do it all
because, for the most part, they have
done it all!
43. Where do we go from here?
• National, accurate electronic data collection on resident
case loads
– Can be built into computerized case records
• Interim evaluations of resident operative experience
– UK already does this (good job, Dr. Endean)
• National standard change for case requirements
– Current index requirement >10 % of previous
– No repercussions for individuals, just programs
44. Where do we go from here?
• Make operative skill a required, testable
competency
– They actually used to do this
– Too expensive, subjective for PPPHs/administrators
– Should be the job of the residency right?
• Study and improve teaching in the operating
room
– This is a fascinating idea
– Video evidence is abundant
– Resident opinions are abundant too…
45. Where do we go from here?
• Scheme for teaching
– Briefing, intraoperative teaching, debriefing
– S.C.O.R.E. modules
• Standardized, validated resident evaluation tools
– Pay attention to them
• Simulation
– Seems to work pretty well for laparoscopy
– Don’t confuse learning with teaching
– Pie in the sky?
48. Maximum Resident Benefit
Those days are long gone…
• Hospital regulations on supervision
• Malpractice
– Has been identified as a potential factor in decreased resident
volumes
• Pressure to be efficient
– Long operative times are bad
• More infections (thanks Levi)
• More money
– Decreased operative times/staffing issues
49. MRB
• Can’t just operate on everyone who rolls in…
• Other things to do
– Lots of clinic
Do not fall asleep near this man
– 80 hours
– Call coverage
– ESS/trauma workups
– Research
50. MRB
• Resident case logs show decreasing number of 1st assist &
teaching cases
• Bell suggests, (and I personally agree) allowing modest increase
in operative times & resident autonomy in training facilities
• Supervision determined by resident operative ability
• The short term benefits of faster/”safer” surgery may be
detrimental to development of proficient surgical residents
51. MRB
• Necessary to identify and maximize good
teaching behaviors.
• Evaluations of teachings need to fulfill 4 criteria
– New Knowledge
– Value
– How to change
– Motivation
52. Characteristics of good teaching
• Answers questions clearly
• Confident in role as surgeon and teacher
• Provides feedback without belittling
• Remains calm and courteous
• Exhibits fairness toward House officers, no favorites
• Role models good interaction w/ OR staff
• Explains reasons for actions/decisions
• Allows learners to feel pathology
• Demonstrates respect for patient
• Teaches with enthusiasm
54. 80 hours
• Enacted in 2003
• Will not be reduced in near future
• Alterations in duty hours to be studied and
implemented by 2011
• Have destroyed attendings’ will to live.
• Make residents look soft
55. Does 80-hrs hurt residents?
• According to Most:
– Decreased sense of responsibility
– Decreased ownership
– Less motivation
– Weaker work ethic when entering residency
– Decreased learning due to outside lives
• According to Bell:
– Further limits time available to be in the OR
56. According to me
• Agree with some of the previous
• Changes the way we are perceived by older surgeons
• Does limit patient care time
Limits OR time, and thus experience
• Does NOT make me less motivated.
• No change in sense of patient ownership
• Duty hours not residents’ choice
– Average age of US congressman= 56.7y, senators=61.7
– Average age of ACGME task force on resident duty hours?
• Actually I don’t know, but not < 35, guaranteed!
57. Future directions
• Increasing operative exposure (esp for juniors)
• Attend to teaching in the OR
• Will everyone have to specialize?
• SCORE/Simulation
• Longer residencies?
• Maybe they should study what we do here…
58. So, Why Can’t Johnny Operate?
He is inexperienced
He didn’t come to UK
59. References
• Bell, RH, Why Johnny Cannot Operate, Surgery Sep 2009; 146(533-42)
• A.A. Gawande, M.J. Zinner, D.M. Studdert and T.A. Brennan, Analysis of
errors reported by surgeons at three teaching hospitals, Surgery 133 (2003), pp.
614–621.
• P.J. Fabri and J.L. Zayas-Castro, Human error, not communication and
systems, underlies surgical complications, Surgery 144 (2008), pp. 557–563.
• K.A. Ericsson, Deliberate practice and acquisition of expert performance: a
general overview, Acad Emerg Med 151 (2008), pp. 988–994.
• R.H. Bell Jr., T.W. Biester, A.W. Tabuenca, R.S. Rhodes, J.B. Cofer and L.D.
Britt et al., Operative experience of residents in US general surgery programs:
a gap between expectation and experience, Ann Surg 249 (2009), pp. 719–724.
• R.S. Chung, How much time do surgical residents need to learn operative
surgery?, Am J Surg 190 (2005), pp. 351–353
60. More References
• C.M. Pugh, D.A. DaRosa, D. Glenn and R.H. Bell Jr., A comparison of faculty and
resident perception of resident learning needs in the operating room, J Surg Educ 64
(2007), pp. 250–255.
• J.C. Kairys, K. McGuire, A. Crawford and C.J. Yeo, Cumulative operative experience
is decreasing during general surgery residency: a worrisome trend for surgical trainees?,
J Am Coll Surg 206 (2008), pp. 804–813.
• R.H. Bell, Surgical council on resident education: a new organization devoted to
graduate surgical education, J Am Coll Surg 204 (2007), pp. 341–346.
• .L. Larson, R.G. Williams, J. Ketchum, M.L. Boehler and G.L. Dunnington,
Feasibility, reliability and validity of an operative performance rating system for
evaluating surgical residents, Surgery 138 (2005), pp. 640–649.
• Iwaszkiewicz M, Darosa DA, Risucci DA. Efforts to enhance operating room teaching
J Surg Educ. 2008 Nov-Dec;65(6):436-40.
• S.S. Cox and M.S. Swanson, Identification of teaching excellence in operating room
and clinic settings, Am J Surg 183 (2002), pp. 251–255.
• Procter LD, Davenport DL, Bernard AC et al. General Surgical Operative Duration is
Associated with Increased-Risk Adjusted Infectious Complication Rates and Length of
Hospital Stay. JACS. In Press, January 2009.