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Surgery Apr 2018Surgery is a performing art-each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience.... (Review)
Review
BACKGROUND
Surgery is a performing art-each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience. Surgeons operate with surgical instruments, whereas musicians perform with musical instruments. Both perform in high-stress, high-risk work environments, where small errors in motor performance or judgment can have immediate negative consequences. While there is abundant literature on musical performance and their impact on outcome, little similar research has been published in the field of surgery. We aimed at identifying expert musicians' practice and performance strategies that may aid surgeons to enhance their surgical performance.
METHODS
In the study, 82 relevant English-language articles from 1974 to 2017 matched applicable search terms. Nominal Group Technique was applied to identify 5 key domains that comprise important parallels between surgical and expert musical performance.
RESULTS
The 5 key domains identified were: (1) extensive training and deliberate practice, (2) dexterity and ambidexterity, (3) performance evaluation and competition, (4) performance-related injuries, and (5) performance anxiety. We found focused and mindful training in motor performance, not performing immediately after a hiatus from practice, training to improve the precision and responsiveness of the nondominant hand, continuous and critical self-evaluation, training in injury recognition and prevention, and pharmacologic factors to be of utmost importance.
CONCLUSION
Critical parallels exist between surgical and expert musical performance that may improve surgical outcomes by adopting musicians' strategies for combating physiological and psychologic performance-related issues. Raising surgeons' awareness for this subject content may improve surgical performance and patient outcomes, as well as help prevent occupational injuries.
Topics: Clinical Competence; Competitive Behavior; Humans; Music; Performance Anxiety; Practice, Psychological; Surgeons; Surgical Procedures, Operative; Work Performance
PubMed: 29336812
DOI: 10.1016/j.surg.2017.09.011 -
BMJ Open Jul 2019Worldwide, there are at least 230 million invasive procedures performed annually and most of us will undergo several in our lifetime. There is therefore a need for...
Worldwide, there are at least 230 million invasive procedures performed annually and most of us will undergo several in our lifetime. There is therefore a need for high-quality evidence to underpin this clinical area. Currently, however, there is no widely accepted definition of an invasive procedure and the terms 'surgery' and 'interventional procedure' are characterised inconsistently. We propose a definition for invasive procedures which addresses the limitations of those currently available. Our definition was developed from an analysis of the 3946 papers from the last decade. A preliminary definition was created based on existing definitions and applied to a variety of papers reporting all types of procedures. This definition was continuously updated and applied iteratively to all articles. The definition has three key components: (1) method of access to the body, (2) instrumentation and (3) requirement for operator skill. It therefore encapsulates all types of invasive procedure regardless of the method of access to the body (incision, natural orifice or percutaneous access), and is relevant whatever the clinical discipline (eg, obstetric, cardiac, dental, interventional cardiology or radiology). Crucially, the definition excludes medicinal products, except where their administration occurs within an invasive procedure (and thereby involves operator skill). The application of a universal definition of an invasive procedure will (1) inform the selection of relevant methods for study design, (2) streamline evidence synthesis and (3) improve research tracking, helping to identify evidence gaps and direct research funds.
Topics: Biomedical Research; Humans; Research Design; Surgical Procedures, Operative; Terminology as Topic
PubMed: 31366651
DOI: 10.1136/bmjopen-2018-028576 -
International Urogynecology Journal Dec 2010Sacral neuromodulation involves a staged process, including a screening trial and delayed formal implantation for those with substantial improvement. The advent of the...
Sacral neuromodulation involves a staged process, including a screening trial and delayed formal implantation for those with substantial improvement. The advent of the tined lead has revolutionized the technology, allowing for a minimally invasive outpatient procedure to be performed under intravenous sedation. With the addition of fluoroscopy to the bilateral percutaneous nerve evaluation, there has been marked improvement in the placement of these temporary leads. Thus, the screening evaluation is now a better reflection of possible permanent improvement. Both methods of screening have advantages and disadvantages. Selection of a particular procedure should be tailored to individual patient characteristics. Subsequent implantation of the internal pulse generator (IPG) or explantation of an unsuccessful staged lead is straightforward outpatient procedure, providing minimal additional risk for the patient. Future refinement to the procedure may involve the introduction of a rechargeable battery, eliminating the need for IPG replacement at the end of the battery life.
Topics: Electric Stimulation Therapy; Fluoroscopy; Humans; Implantable Neurostimulators; Minimally Invasive Surgical Procedures; Patient Selection; Sacrum; Spinal Nerve Roots; Urination Disorders
PubMed: 20972542
DOI: 10.1007/s00192-010-1280-4 -
Journal of the American Podiatric... Mar 1989The authors present a modified method for treating painful cicatrix nerve entrapments. A series of three high-volume injections of local anesthetic, steroid, and... (Review)
Review
The authors present a modified method for treating painful cicatrix nerve entrapments. A series of three high-volume injections of local anesthetic, steroid, and hyaluronidase are used to perform percutaneous adhesiotomies and extraneural fibrosis decompression. If special attention is given to the tissue plane level in performing the sequential injections, circumferential neural trunk decompression or cicatrix adhesiotomy can be obtained. The procedure may decrease or eliminate pain sufficiently to circumvent surgical intervention.
Topics: Cicatrix; Combined Modality Therapy; Foot Diseases; Humans; Injections; Methods; Nerve Compression Syndromes; Tissue Adhesions
PubMed: 2656992
DOI: 10.7547/87507315-79-3-121 -
Journal of Pediatric Ophthalmology and... 2006Refractive surgery in children is controversial; it is mainly performed when conventional treatment has failed. The primary indications are anisometropic amblyopia and... (Review)
Review
Refractive surgery in children is controversial; it is mainly performed when conventional treatment has failed. The primary indications are anisometropic amblyopia and bilateral high myopia. The major areas of concern are unstable refraction due to ongoing growth of the eye, and long-term implications. The most popular procedures are photorefractive keratectomy or laser-assisted subepithelial keratomileusis followed by laser-assisted in situ keratomileusis. There are technical difficulties involved in performing these procedures because of smaller palpebral apertures and the need for general anesthesia in younger children. Reports of minimal haze and regression in children who have undergone photorefractive keratectomy for high myopia are of interest, as this is contrary to what occurs in adults. Additional study may result in better long-term data and further indications for refractive surgery in children.
Topics: Child; Humans; Ophthalmologic Surgical Procedures; Patient Selection; Refractive Surgical Procedures
PubMed: 17162968
DOI: 10.3928/01913913-20061101-01 -
Current Opinion in Otolaryngology &... Dec 2006Cricopharyngeal muscle myotomy to treat swallowing disorders has a definite role in the management of cervical dysphagia. Several reports emphasize the benefits of the... (Review)
Review
PURPOSE OF REVIEW
Cricopharyngeal muscle myotomy to treat swallowing disorders has a definite role in the management of cervical dysphagia. Several reports emphasize the benefits of the endoscopic approach compared with the transcervical technique. This review examines recent surgical management of cricopharyngeus dysmotility.
RECENT FINDINGS
Several investigations have provided pertinent information on selecting patients for cricopharyngeal myotomy. Manofluorography appears to be more accurate in detecting intrabolus pressure anomalies during swallowing. Isolated cricopharyngeus dyscoordination, however, is not easily identified using this method. Electromyographic activity of the inferior pharyngeal constrictor and cricopharyngeus recorded by transcutaneous electrodes at rest and during deglutition has shown different dysfunction patterns. Ambulatory 24 h double probe pH monitoring and the triple sensor combination pH test demonstrate clinical correlation between pH results and symptoms in patients suffering from dysphagia related to laryngopharyngeal reflux. Transoral cricopharyngeal myotomy for the treatment of cricopharyngeus dysmotility is now established as a safe and effective method. The development of new devices has enhanced the procedure's efficacy and the overall success rate without major complications.
SUMMARY
Diagnosis of cricopharyngeus dysfunction is based on anamnesis and videoradiograph findings. In doubtful cases manofluorography and electromyography should be performed. Endoscopic cricopharyngeal myotomy is a safe and effective treatment option for patients with cricopharyngeus dysphasia.
Topics: Deglutition Disorders; Endoscopy; Esophageal Sphincter, Upper; Humans; Otorhinolaryngologic Surgical Procedures; Patient Selection
PubMed: 17099353
DOI: 10.1097/MOO.0b013e3280106314 -
Minerva Cardiology and Angiology Dec 2021Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Preprocedural... (Review)
Review
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Preprocedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for preprocedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Patient Selection; Transcatheter Aortic Valve Replacement
PubMed: 33703862
DOI: 10.23736/S2724-5683.21.05573-0 -
PloS One 2021Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning...
BACKGROUND
Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning process to ensure trainee proficiency, it is necessary to determine objective differences between the expert's and the novice's performance to guide novice practitioners during their training process. This study compares experts' and novices' biomechanical variables during a simulated CVA performance.
METHODS
Seven experts and seven novices were part of this study. The participants' motion data during a CVA simulation procedure was collected using the Vicon Motion System. The procedure was divided into four stages for analysis, and each hand's speed, acceleration, and jerk were obtained. Also, the procedural time was analyzed. Descriptive analysis and multilevel linear models with random intercept and interaction were used to analyze group, hand, and stage differences.
RESULTS
There were statistically significant differences between experts and novices regarding time, speed, acceleration, and jerk during a simulated CVA performance. These differences vary significantly by the procedure stage for right-hand acceleration and left-hand jerk.
CONCLUSIONS
Experts take less time to perform the CVA procedure, which is reflected in higher speed, acceleration, and jerk values. This difference varies according to the procedure's stage, depending on the hand and variable studied, demonstrating that these variables could play an essential role in differentiating between experts and novices, and could be used when designing training strategies.
Topics: Adult; Anesthesiologists; Biomechanical Phenomena; Clinical Competence; Female; Humans; Internship and Residency; Male; Motion; Patient Simulation; Simulation Training; Task Performance and Analysis
PubMed: 33930076
DOI: 10.1371/journal.pone.0250941 -
Psychological Methods Aug 2021Psychological science would become more efficient if researchers implemented sequential designs where feasible. Miller and Ulrich (2020) propose an independent segments...
Psychological science would become more efficient if researchers implemented sequential designs where feasible. Miller and Ulrich (2020) propose an independent segments procedure where data can be analyzed at a prespecified number of equally spaced looks while controlling the Type I error rate. Such procedures already exist in the sequential analysis literature, and in this commentary, I reflect on whether psychologists should choose to adopt these existing procedures instead. I believe limitations in the independent segments procedure make it relatively unattractive. Being forced to stop for futility based on a bound not chosen to control Type II errors, or reject a smallest effect size of interest in an equivalence test, limits the inferences one can make. Having to use a prespecified number of equally spaced looks is logistically inconvenient. And not having the flexibility to choose α and β spending functions limits the possibility to design efficient studies based on the goal and limitations of the researcher. Recent software packages such as rpact (Wassmer & Pahlke, 2019) make sequential designs equally easy to perform as the independent segments procedure. While learning new statistical methods always takes time, I believe psychological scientists should start on a path that will not limit them in the flexibility and inferences their statistical procedure provides. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Topics: Humans; Research Design
PubMed: 34726466
DOI: 10.1037/met0000400 -
Pharmaceutical Statistics 2006Fisher's least significant difference (LSD) procedure is a two-step testing procedure for pairwise comparisons of several treatment groups. In the first step of the...
Fisher's least significant difference (LSD) procedure is a two-step testing procedure for pairwise comparisons of several treatment groups. In the first step of the procedure, a global test is performed for the null hypothesis that the expected means of all treatment groups under study are equal. If this global null hypothesis can be rejected at the pre-specified level of significance, then in the second step of the procedure, one is permitted in principle to perform all pairwise comparisons at the same level of significance (although in practice, not all of them may be of primary interest). Fisher's LSD procedure is known to preserve the experimentwise type I error rate at the nominal level of significance, if (and only if) the number of treatment groups is three. The procedure may therefore be applied to phase III clinical trials comparing two doses of an active treatment against placebo in the confirmatory sense (while in this case, no confirmatory comparison has to be performed between the two active treatment groups). The power properties of this approach are examined in the present paper. It is shown that the power of the first step global test--and therefore the power of the overall procedure--may be relevantly lower than the power of the pairwise comparison between the more-favourable active dose group and placebo. Achieving a certain overall power for this comparison with Fisher's LSD procedure--irrespective of the effect size at the less-favourable dose group--may require slightly larger treatment groups than sizing the study with respect to the simple Bonferroni alpha adjustment. Therefore if Fisher's LSD procedure is used to avoid an alpha adjustment for phase III clinical trials, the potential loss of power due to the first-step global test should be considered at the planning stage.
Topics: Analysis of Variance; Biometry; Clinical Trials as Topic; Clinical Trials, Phase III as Topic; Data Interpretation, Statistical; Endpoint Determination; Humans; Models, Statistical; Multivariate Analysis; Placebos; Research; Research Design; Sample Size; Technology, Pharmaceutical
PubMed: 17128424
DOI: 10.1002/pst.210