ABSTRACT
Paediatric penetrating chest trauma is common in conflict, but rarely seen in peacetime. We describe the successful hospital management of a five year old female civilian casualty with life threatening penetrating thoracic trauma caused by a fragment from an explosive device.
Subject(s)
Afghan Campaign 2001- , Blast Injuries/surgery , Foreign Bodies/surgery , Thoracic Injuries/surgery , Vena Cava, Superior , Wounds, Penetrating/surgery , Afghanistan/ethnology , Blast Injuries/diagnostic imaging , Child, Preschool , Female , Foreign Bodies/diagnostic imaging , Humans , Military Medicine , Thoracic Injuries/diagnostic imaging , Tomography, X-Ray Computed , United Kingdom , Wounds, Penetrating/diagnostic imagingABSTRACT
BACKGROUND: There are times during endoscopic procedures when the surgeon has to operate ahead of the camera/telescope assembly. As a result, the image displayed on the monitor will be an inverted mirror image of the operative field (reverse alignment). The present study addresses the extent of these difficulties and suggests some techniques that may be used to overcome the problem. METHODS: Eight specialist registrars participated in experiments involving the execution of a simulated dissection task under 12 different imaging conditions. These conditions included normal alignment, reverse alignment, total or partial digital correction of reverse alignment (about the horizontal and vertical axes independently and together), and a simple rotation of the camera through 180 degrees. Normal, reverse, and corrected reverse alignment were also tested with optical axes of 45 degrees and 60 degrees. The endpoints were the task execution and the errors rate. RESULTS: A marked deterioration in execution time was observed when the surgeons worked under reverse alignment rather than under normal viewing (p = 0.036). Significant improvement in execution-time errors rate was found when both the horizontal and vertical axes were digitally corrected simultaneously (p = 0.27) and when the camera was rotated 180 degrees with respect to the telescope during reverse alignment (p = 0.28). CONCLUSIONS: The effect on performance produced by reverse alignment of the endoscope and instruments can be overcome by means of digital electronic processing, or simply by turning the camera through 180 degrees.
Subject(s)
Endoscopy/methods , Adult , Dissection , Endoscopes , Humans , Time FactorsABSTRACT
BACKGROUND: This work was undertaken to evaluate the concurrent and predictive validity of the Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) for clinical competence in endoscopic manipulations. METHOD: Ten specialist registrars completed 200 structured tasks on ADEPT involving manipulation of switches and dials using standard endoscopic imaging and surgical instruments. This performance was correlated with blind ratings on clinical endoscopic operative competence by four consultant surgeons. RESULTS: The learning curve on the use of the ADEPT was quick, proficiency in using the system was achieved by all candidates after 20 tasks by the end of the first run when the individual's performance reached its peak. Individual error rates did not improve from the start. A high correlation (0.909) was observed between success rates on ADEPT tasks and error rates. The overall performance on ADEPT correlated well with independent blind assessment of clinical competence (r = 0.789) as did the number of error-free runs (r = 0.740). CONCLUSIONS: The study confirms a good correlation between performance on ADEPT and independent consultant clinical assessment of operative skills (concurrent validity). The system identifies aspects of performance that do not improve with practice (innate abilities) and thus could be used to predict ultimate level of operative skill. If confirmed by larger studies, ADEPT could be used as an aptitude tester for trainee selection in minimal access surgery and interventional radiology. By providing objective feedback on task performance, the system facilitates reflective skill acquisition and its assessment by trainees.
Subject(s)
Clinical Competence/standards , Endoscopy , General Surgery/education , Psychomotor Performance , Adult , Clinical Competence/statistics & numerical data , Feasibility Studies , Humans , Male , Predictive Value of Tests , Reproducibility of Results , Statistics, NonparametricABSTRACT
Osteolytic lesions of the skull have many causes, but magnetic resonance imaging may immediately distinguish cerebrospinal fluid intradiploic lakes from other causes. A case of a 16-year-old girl with such a lesion in relation to the sagittal sinus is presented and its aetiology is discussed.
