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Plastic and Reconstructive Surgery.... Jan 2022Residents can achieve distinction by discerning which areas of achievement are worth additional focus at each stage in training. Our survey examines the perspectives of...
BACKGROUND
Residents can achieve distinction by discerning which areas of achievement are worth additional focus at each stage in training. Our survey examines the perspectives of faculty members affiliated with Accreditation Council for Graduation Medical Education-accredited plastic surgery residency programs regarding qualities indicative of resident excellence.
METHODS
A survey including Likert scales and rank-ordering was distributed to plastic surgery program directors and faculty with the intent to assess perspectives regarding resident excellence at each stage of training. Responses were analyzed using marginal homogeneity tests and summary tables.
RESULTS
In total, 90 respondents completed the survey. An estimated 94.5% believe it is possible for residents to achieve excellence at any stage of clinical training, and 87.7% report their definition of excellence differs by training level. Top three metrics indicative of resident excellence for interns and junior residents were preparation for operative cases, bedside manner, and personality. For seniors: preparation for operative cases, leadership capability, and bedside manner. For chief residents: preparation for operative cases, leadership capability, and technical operative expertise.
CONCLUSIONS
A resident who displays excellence inspires mentorship, which can propel future career success. Faculty agree excellence can be achieved by residents of any stage, although the qualities that define this evolve by training year. Preparation for operative cases is considered a critical component of resident performance at all levels. Bedside manner and personality are ways intern and junior level residents excel, whereas leadership ability and technical expertise in the operating room become significant in senior and chief trainees.
PubMed: 35070602
DOI: 10.1097/GOX.0000000000004061 -
Scandinavian Journal of Trauma,... Sep 2018The hybrid emergency room (hybrid ER) system was first established in 2011 in Japan. It is defined as an integrated system including an ER, emergency computed tomography... (Review)
Review
The hybrid emergency room (hybrid ER) system was first established in 2011 in Japan. It is defined as an integrated system including an ER, emergency computed tomography (CT) and interventional radiology (IVR) rooms, and operating rooms. Severe trauma patients can undergo emergency CT examinations and therapies (surgeries) without being transferred. The hybrid ER system is attracting attention because trauma resuscitation using this system has been reported to potentially improve the mortality rate in severe trauma patients. In August 2017, we established a new table-rotated-type hybrid ER to facilitate surgical functions. Herein, we introduce a new table-rotated-type hybrid ER consisting of an IVR-CT-operating room system and discuss its efficiency and feasibility for trauma resuscitation, including surgery and IVR. This system includes four new concepts: (1) to secure a wide working space during trauma resuscitation by reconsidering the arrangement of the C-arm, (2) ensure an air-conditioned operating room in the hybrid ER, (3) adopt an operating table but not interventional radiology table, and (4) prepare a trauma bay with three additional beds for multiple victims. This hybrid ER system also adopted the rotated-type table to secure a wide working space during the resuscitation phase. The C-arm was located away from the patients and placed on the wall opposite to the CT gantry, in contrast to that in previous systems. If patients needed an emergency IVR, the table was just rotated, and the IVR could be conducted immediately. This improvement can secure a wide working space in the hybrid ER. Moreover, the patient table was also a surgical operating table, and the hybrid ER system had an air-conditioned operating room (class 10,000). In the anticipation of many trauma patients being transported to the ER, a new trauma bay with three additional beds next to the hybrid ER was established, which also had an air-conditioned operating room. This new rotated-type hybrid ER system facilitates efficient surgical functions during trauma resuscitation and can secure a wide working space for the medical team to immediately perform resuscitative procedures and IVRs without delay.
Topics: Emergency Service, Hospital; Equipment Design; Humans; Japan; Operating Rooms; Operating Tables; Resuscitation
PubMed: 30223859
DOI: 10.1186/s13049-018-0532-z -
Scientific Reports May 2022This paper aims to promote a quantum framework that analyzes Industry 4.0 cyber-physical systems more efficiently than traditional simulations used to represent...
This paper aims to promote a quantum framework that analyzes Industry 4.0 cyber-physical systems more efficiently than traditional simulations used to represent integrated systems. The paper proposes a novel configuration of distributed quantum circuits in multilayered complex networks that enable the evaluation of industrial value creation chains. In particular, two different mechanisms for the integration of information between circuits operating at different layers are proposed, where their behavior is analyzed and compared with the classical conditional probability tables linked to the Bayesian networks. With the proposed method, both linear and nonlinear behaviors become possible while the complexity remains bounded. Applications in the case of Industry 4.0 are discussed when a component's health is under consideration, where the effect of integration between different quantum cyber-physical digital twin models appears as a relevant implication.
PubMed: 35562377
DOI: 10.1038/s41598-022-11691-x -
Nanoscale Research Letters Apr 2021Nanobiosensors are convenient, practical, and sensitive analyzers that detect chemical and biological agents and convert the results into meaningful data between a... (Review)
Review
Nanobiosensors are convenient, practical, and sensitive analyzers that detect chemical and biological agents and convert the results into meaningful data between a biologically active molecule and a recognition element immobilized on the surface of the signal transducer by a physicochemical detector. Due to their fast, accurate and reliable operating characteristics, nanobiosensors are widely used in clinical and nonclinical applications, bedside testing, medical textile industry, environmental monitoring, food safety, etc. They play an important role in such critical applications. Therefore, the design of the biosensing interface is essential in determining the performance of the nanobiosensor. The unique chemical and physical properties of nanomaterials have paved the way for new and improved sensing devices in biosensors. The growing demand for devices with improved sensing and selectivity capability, short response time, lower limit of detection, and low cost causes novel investigations on nanobiomaterials to be used as biosensor scaffolds. Among all other nanomaterials, studies on developing nanobiosensors based on metal oxide nanostructures, graphene and its derivatives, carbon nanotubes, and the widespread use of these nanomaterials as a hybrid structure have recently attracted attention. Nanohybrid structures created by combining these nanostructures will directly meet the future biosensors' needs with their high electrocatalytic activities. This review addressed the recent developments on these nanomaterials and their derivatives, and their use as biosensor scaffolds. We reviewed these popular nanomaterials by evaluating them with comparative studies, tables, and charts.
PubMed: 33877478
DOI: 10.1186/s11671-021-03519-w -
Academic Radiology Apr 2022To assess key trends, strengths, and gaps in validation studies of the Food and Drug Administration (FDA)-regulated imaging-based artificial intelligence/machine... (Review)
Review
RATIONALE AND OBJECTIVES
To assess key trends, strengths, and gaps in validation studies of the Food and Drug Administration (FDA)-regulated imaging-based artificial intelligence/machine learning (AI/ML) algorithms.
MATERIALS AND METHODS
We audited publicly available details of regulated AI/ML algorithms in imaging from 2008 until April 2021. We reviewed 127 regulated software (118 AI/ML) to classify information related to their parent company, subspecialty, body area and specific anatomy type, imaging modality, date of FDA clearance, indications for use, target pathology (such as trauma) and findings (such as fracture), technique (CAD triage, CAD detection and/or characterization, CAD acquisition or improvement, and image processing/quantification), product performance, presence, type, strength and availability of clinical validation data. Pertaining to validation data, where available, we recorded the number of patients or studies included, sensitivity, specificity, accuracy, and/or receiver operating characteristic area under the curve, along with information on ground-truthing of use-cases. Data were analyzed with pivot tables and charts for descriptive statistics and trends.
RESULTS
We noted an increasing number of FDA-regulated AI/ML from 2008 to 2021. Seventeen (17/118) regulated AI/ML algorithms posted no validation claims or data. Just 9/118 reviewed AI/ML algorithms had a validation dataset sizes of over 1000 patients. The most common type of AI/ML included image processing/quantification (IPQ; n = 59/118), and triage (CADt; n = 27/118). Brain, breast, and lungs dominated the targeted body regions of interest.
CONCLUSION
Insufficient public information on validation datasets in several FDA-regulated AI/ML algorithms makes it difficult to justify clinical applications since their generalizability and presence of bias cannot be inferred.
Topics: Algorithms; Artificial Intelligence; Humans; Machine Learning; ROC Curve; United States; United States Food and Drug Administration
PubMed: 34969610
DOI: 10.1016/j.acra.2021.09.002 -
Journal of Population Therapeutics and... 2022The modular operating theater (MOT) system is often used in operating rooms since it is incorporated into a single control panel, enabling its operation more effectively...
The modular operating theater (MOT) system is often used in operating rooms since it is incorporated into a single control panel, enabling its operation more effectively and efficiently. The MOT in the present study's operating room employs analytical techniques, and moreover has complicated space needs. Any hospital that wants to implement MOT in the operating room must adhere to the regulations of the Indonesian Ministry of Health, as everything must adhere to a specific criteria. Additionally, MOT must fulfill the primary components required to ensure that the operational process proceeds properly and without technological difficulties. The criteria also includes the use of insulated doors (swing or sliding) to control the pathogens, bacteriostatic floors with corner covings, the operating table must be set in such a way that the laminar airflow reaches it, the use of modern operating tables, the adequate filtration of the air conditioning system and the air distribution system, and use of sterile corridors. The MOT in the operating room must also include the medical gas pipeline system (MGPS), flexible arm light pendants, precise indications on surgeon control panels and electrical panels, scrub stations, comprehensive utility pendants, as well as static/dynamic clean/dirty boxes. The operating room MOT requirements are specified in PERMENKES RI No. 1204/MENKES/SK/X/2004, and any hospital that wishes to construct one must adhere to them. Several requirements are outlined in the study that must be adhered to while manufacturing MOT. For example, walls and ceilings must be insulated with PUF, EPS, or stainless steel panels.
Topics: Air Microbiology; Hospitals; Humans; Operating Rooms
PubMed: 35848203
DOI: 10.47750/jptcp.2022.936 -
Anesthesia and Analgesia Apr 2018Collaboration of the surgical and anesthesia teams for patient positioning is essential to assure patient comfort and safety, preventing systemic and ophthalmic... (Review)
Review
Collaboration of the surgical and anesthesia teams for patient positioning is essential to assure patient comfort and safety, preventing systemic and ophthalmic complications. The goals and rationales of positioning for intraocular surgery are discussed including placing the head above the heart, elevating the chin, using a head rest that is sufficiently firm, maximizing anesthesia care team access and minimizing fire risk, and taping the patient's head to the operating table to reduce unexpected movement with intraocular injury.
Topics: Anesthetists; Cooperative Behavior; Humans; Interdisciplinary Communication; Operating Tables; Ophthalmologic Surgical Procedures; Patient Care Team; Patient Positioning; Postoperative Complications; Risk Factors; Surgeons; Treatment Outcome
PubMed: 28759486
DOI: 10.1213/ANE.0000000000002319 -
Medicine Jun 2018Weaning failure is common in mechanically ventilated patients. Whether ultrasound can predict weaning outcome remains controversial. This meta-analysis was performed to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Weaning failure is common in mechanically ventilated patients. Whether ultrasound can predict weaning outcome remains controversial. This meta-analysis was performed to assess the accuracy of diaphragmatic ultrasonography for predicting reintubation within 48 hours of extubation.
METHODS
Literature search was performed in PubMed, Embase, and Cochrane Library to identify all the relevant papers, published in English up to July 16, 2017. Eligible studies were included if data were in adequate details to rebuild 2 × 2 contingency tables. Methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) in Review Manager 5.3. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were pooled using the fixed or random effects model, meanwhile, the heterogeneity was evaluated using Cochran Q test and I statistics in Meta-DiSc 1.4. Publication bias was assessed using Deeks funnel plot in Stata 12.0.
RESULTS
Thirteen studies with 742 subjects were included in this meta-analysis. The pooled sensitivities for diaphragm excursion (DE) and diaphragm thickness fraction (DTF) were 0.786 and 0.893, and the pooled specificities were 0.711 and 0.796, respectively. The area under curve (AUC) for DE and DTF were 0.8590 and 0.8381. The DORs for DE and DTF were 10.623 and 32.521. No publication bias was observed among these studies.
CONCLUSIONS
Diaphragmatic ultrasonography is a promising tool for predicting reintubation within 48 hours of extubation. However, due to heterogeneities among the included studies, large-scale studies are warranted to confirm our findings.
Topics: Airway Extubation; Diaphragm; Female; Humans; Intubation, Intratracheal; Male; Predictive Value of Tests; ROC Curve; Sensitivity and Specificity; Ultrasonography; Ventilator Weaning
PubMed: 29851847
DOI: 10.1097/MD.0000000000010968 -
Journal of Tissue Engineering 2021The aim of this review is to provide a systematic design guideline to users, particularly engineers interested in developing and deploying lung models, and biologists... (Review)
Review
The aim of this review is to provide a systematic design guideline to users, particularly engineers interested in developing and deploying lung models, and biologists seeking to identify a suitable platform for conducting in vitro experiments involving pulmonary cells or tissues. We first discuss the state of the art on lung in vitro models, describing the most simplistic and traditional ones. Then, we analyze in further detail the more complex dynamic engineered systems that either provide mechanical cues, or allow for more predictive exposure studies, or in some cases even both. This is followed by a dedicated section on microchips of the lung. Lastly, we present a critical discussion of the different characteristics of each type of system and the criteria which may help researchers select the most appropriate technology according to their specific requirements. Readers are encouraged to refer to the tables accompanying the different sections where comprehensive and quantitative information on the operating parameters and performance of the different systems reported in the literature is provided.
PubMed: 33996022
DOI: 10.1177/20417314211008696 -
Operative Orthopadie Und Traumatologie Aug 2021Direct anterior approach total hip arthroplasty (DAA THA) has gained significant popularity in the last decade as it is a muscle-sparing procedure. Modern techniques... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Direct anterior approach total hip arthroplasty (DAA THA) has gained significant popularity in the last decade as it is a muscle-sparing procedure. Modern techniques for DAA THA utilize both a standard operating table and an orthopedic traction table. As the use of an orthopedic traction table shows technical ease and predictability, this article will focus on the use of the orthopedic table or table extension to facilitate DAA THA.
INDICATIONS
Primary or secondary arthritis requiring THA; revision surgery-both acetabular and femoral.
CONTRAINDICATIONS
Posterior wall hardware requiring removal; posterior mass (tumor) to be removed at surgery: large, overhanging pannus; need for gluteal tendon reconstruction; anterior skin envelope not conducive to DAA.
SURGICAL TECHNIQUE
The incision is made over the tensor fascia latae. Capsulotomy is performed exposing the hip joint. After osteotomy of the femoral neck, traction is placed on the leg utilizing the orthopedic table and the head is removed. The acetabular cup is inserted. Traction, flexion, and internal reduction are used simultaneously while directing the femoral head into the acetabulum.
RESULTS
In a meta-analysis, operative time (100 vs. 71 min), blood loss (531 vs. 382 ml), and intraoperative fracture rate (1.7 vs. 1.3%) were increased in the traction table cohort. All other complications and outcome measurements were the same. Traction-table related complications such as pudendal nerve palsy and ankle fractures were not found. An assessment of the senior author's initial 855 DAA THAs (2008-2014) showed a mean operative time of 65 min with a mean blood loss of 238 ml. Operative times decreased to average 56 min. Intraoperative fracture rate was 0.8%. Infection rate was 2.1%. Finally, 1.5% femoral implants did not osseointegrate and required revision after an average of 3.0 years.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Humans; Retrospective Studies; Traction; Treatment Outcome
PubMed: 34374790
DOI: 10.1007/s00064-021-00722-x