RESUMO
Objective: To assess the improvement of knowledge and skills of trauma management among participant of Primary Trauma Care [PTC] workshop
Methods: A two days Primary Trauma Care [PTC] provider workshop was organized at Dow International Medical College, Karachi - Pakistan on March 5th and 6th 2011. Participant's knowledge was assessed by 30 Best Choice Questions [BCQs] and their trauma management skills were assessed by management of trauma case scenario both at pre and post workshop. All scenarios performed by participants were video recorded and marked on a 20 points check list and evaluated by two PTC trainers and graded after consensus. Percentage of participants who scored more than 70% marks on knowledge and skills component were also analyzed. Data was analyzed by SPSS version 17. Wilcoxon Sign Rank test was used to find out significant difference between pre and post workshop score
Results: A total of 20 participants attended the full workshop. Median One best question score before the workshop was 19.5 and post workshop was 25 [p < 0.0001]. Trauma skills scenario score also showed marked improvement with median score of 3.5 pre workshop and 9.5 post workshop [p < 0.0001]. Total 19 participants had >/= 70% post workshop knowledge score. However, only 4 participants had trauma skill score with >/= 70 marks
Conclusion: Primary Trauma Care workshop could be an effective course for gaining of knowledge and skills of initial management of trauma patients. However, some modifications need to be done for training of skills components to maximize the output of this interactive workshop
RESUMO
Objective: The objective of this study is to determine the per-operative factors responsible for difficulty in performing laparoscopic cholecystectomy and lead to conversion
Study Design: Prospective analysis study
Place and Duration of study: This study was carried out in General Surgery Department of Dow University Hospital Ojha Campus and Civil Hospital Karachi, from Jan 2011 to July 2012
Methodology: This study consisted of one hundred and forty six patients with gallstone disease. All patients had full clinical examination and right hypochondrium was especially examined for assessment of murphy's sign, palpable mass and visceromegaly. Base line and specific investigations were done in all patients especially ultrasound of abdomen as diagnostic modality and for assessment of gallstone disease. Inclusion criteria was that all patients diagnosed as case of gallstone disease. LC procedure was not attempted in patients with history of abdominal surgery, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder acute pancreatitis, obstructive jaundice and unfit patients for general anesthesia
Results: Out of 146 patients included in this study 133 were female [91%] and 13 male [9%]; with female to male ratio of 10.2:1. The mean age was 39.21+6.20 years. Per Operative findings were adhesions in calot's triangle 24[16.43%] cases, severe and tight adhesions around gallbladder and calot's triangle 21[14.38%] cases, obscured anatomy in calot's triangle 17[11.64%] cases, intrahepatic gallbladder 11[7.53%] cases, adhesions around gallbladder 26[17.80%] cases, empyema 13[8.90%] cases, mucocele 9[6.16%] and anatomical variation 14[9.58%] cases. We observed out of 21 patients who had Severe and tight adhesions around gallbladder and calot's triangle, lead to difficulty in performing laparoscopic cholecystectomy in 11[52.38%] cases followed by 17 cases of obscured anatomy in calot's triangle and 14 cases anatomical variation also lead to performing difficult laparoscopic cholecystectomy in 6[35.29%] and 5[35.71%] cases respectively. Four [2.73%] cases out of 146 had to be converted to the open cholecystectomy procedure
Conclusions: We conclude our study revealed that various peroperative factors which make the difficult laparoscopic procedure and lead to open cholecystectomy are severe adhesions in calot's triangle, severe and tight adhesions around gallbladder and obscured anatomy in calot's triangle