Core Professionalism Education in Surgery: A Systematic Review.

BACKGROUND: Professionalism education is one of the major elements of surgical residency education. AIMS: To evaluate the studies on core professionalism education programs in surgical professionalism education. STUDY DESIGN: Systematic review. METHODS: This systematic literature review was performed to analyze core professionalism programs for surgical residency education published in English with at least three of the following features: program developmental model/instructional design method, aims and competencies, methods of teaching, methods of assessment, and program evaluation model or method. A total of 27083 articles were retrieved using EBSCOHOST, PubMed, Science Direct, Web of Science, and manual search. RESULTS: Eight articles met the selection criteria. The instructional design method was presented in only one article, which described the Analysis, Design, Development, Implementation, and Evaluation model. Six articles were based on the Accreditation Council for Graduate Medical Education criterion, although there was significant variability in content. The most common teaching method was role modeling with scenario- and case-based learning. A wide range of assessment methods for evaluating professionalism education were reported. The Kirkpatrick model was reported in one article as a method for program evaluation. CONCLUSION: It is suggested that for a core surgical professionalism education program, developmental/instructional design model, aims and competencies, content, teaching methods, assessment methods, and program evaluation methods/models should be well defined, and the content should be comparable.

Intestinal perforation caused by multiple magnet ingestion.

Multiple magnet ingestion is rare, but can cause serious gastrointestinal complications. We report a case of 7-year-old girl with multiple intestinal perforations caused by multiple magnet ingestion. The aim of this report is to draw attention to magnetic toys, results of magnet ingestion and the importance of timing of operation.

Knowledge, attitude and behaviour of boys and parents about circumcision.

AIM: To determine the knowledge, attitude and behaviour of parents and previously circumcised early adolescent boys about circumcision. METHODS: Half of the boys attending the sixth class of the primary school in our city centre and their parents were included in this cross-sectional, descriptive study. Questionnaires were prepared by the authors, which include 38 questions for parents and 25 questions for boys. RESULTS: Sixty-six per cent of the students were circumcised at the age of 7 years and above, 26% between three and 6 years and 8% below 3 years of age. Forty-two per cent of boys were circumcised by a traditional circumciser and 64% were circumcised at home. Main reasons of circumcision for parents were religious purposes (79%) and health issues (51%). When the boys were asked about their thoughts during circumcision, they mostly stated that 'it was necessary to become a man' (58%) and 'it would hurt much' (50%). Thirty-eight per cent of boys were frightened during circumcision and 46% were worried. Boys circumcised in the 7 years and above age group were most content about their age of circumcision. CONCLUSIONS: We consider that it is reasonable to wait up to an age at which the child could understand and participate in the decision of the concept and timing of circumcision.

A rare presentation of crush injury: transanal small bowel evisceration. Case report and review of the literature.

Evisceration of the small intestine through the anus is an extremely rare event in children. We report a 2-year-old boy who sustained transanal small bowel evisceration associated with bilateral diaphragmatic rupture, left diaphragmatic herniation, and spinal cord injury without radiographic abnormality which happened after crushing by motor vehicle. We reviewed children with transanal small bowel evisceration and discussed etiological differences between children and adult. We also discussed the basic principles of management and follow up in these patients.

Effects of retinoic acid and zinc on the treatment of caustic esophageal burns.

PURPOSE: An experimental study was carried out to investigate the efficacy of an anti-inflammatory and antiproliferative agent all-trans retinoic acid (ATRA) and an antioxidant agent zinc sulphate (ZnSO(4)) in the prevention of stricture after caustic esophageal burn in rats. METHODS: Esophageal burn was induced using 50% NaOH. Rats were divided into four groups as follows: group A (sham; n = 8), group B (control; n = 8), group C (treated with ATRA; n = 8) and group D (treated with ZnSO(4); n = 8). All rats were killed on the 28th day and esophageal tissues were evaluated for histopathologic damage score, hydroxyproline (HP) content and TGF-beta1 expression. RESULTS: Significant difference was detected in terms of histopathologic damage score between groups B and C (p = 0.002). Although mean HP levels of groups C and D were lower than group B, statistical comparison was not significant. TGF-beta1 expression in group C was significantly lower than group B. CONCLUSION: Zinc has not been found effective in the prevention of stricture formation. The results indicate that ATRA has a preventive effect in the development of fibrosis in an experimental model of caustic esophageal burns in rats.

Association of rare intestinal malformations: colonic atresia and intestinal neuronal dysplasia.

A single case of colonic atresia (CA) associated with type A intestinal neuronal dysplasia has been reported in the literature. This article describes a newborn with CA associated with diffuse type B intestinal neuronal dysplasia. A 2-day-old fullterm boy presented with marked abdominal distention, milk intolerance, and bilious vomiting. Type III CA was detected at laparotomy, and a mucous fistula colostomy was performed. The colostomy functioned poorly postoperatively, so an ileostomy was performed. Pathology reported that ganglion cells were evident in the specimens, however, the ileostomy did not function adequately. A second laparotomy was performed, and a re-stoma was fashioned. All previous pathology slides were reviewed, and diffuse type B intestinal neuronal dysplasia was detected. The patient died of septicemia at 34 d old. Specimens of patients with CA should be examined carefully so that dysganglionoses can be ruled out.

A different aspect of corrosive ingestion in children: socio-demographic characteristics and effect of family functioning.

OBJECTIVE: Corrosive ingestion is thoroughly investigated in terms of its complications and treatment modalities but to date family functioning, behavior, attitude and knowledge of mothers of children who ingested corrosives has not been investigated and socio-demographic data has rarely been mentioned. Therefore a study was planned to investigate the socio-demographic data, family functioning, knowledge, behavior and attitude of mothers of children who ingested corrosive materials. METHODS: The mothers of 50 children who ingested corrosive materials and 60 controls were asked to answer a questionnaire which included socio-demographic data and questions about their attitude, behavior and knowledge of corrosive ingestion. The mothers were also asked to reply family assessment device (FAD) and parental attitude research instrument (PARI). RESULTS: The average ages of the children were 5.31+/-2.32 in the corrosive group with an M:F ratio of 1:1. The level of education of both mothers (p=0.000) and fathers (p=0.000) in the corrosive group were lower than that of the controls. There was no difference between the two groups in terms of number of working mothers (p=0.085). In the corrosive group the families used to have three or more children (42%) and the socioeconomic status of this group was lower than the controls (p=0.001). In the corrosive group these substances were purchased unlabeled (64%) and kept mainly in coke bottles. The affective involvement dimension of the FAD and the attitude of over-parenting and democratic attitude dimensions of the PARI tests were significantly different in the corrosive group among mothers from lower educational level whereas no difference was detected among mothers from higher educational level in this regard. CONCLUSION: It was found that both level of education of the parents and socioeconomic factors played important role in shaping the habits that might lead to corrosive ingestion in children. For the prevention of corrosive ingestion broad based strategies including education are required.

Cost factors in pediatric trauma.

INTRODUCTION: There is a lack of information on the cost of treating trauma in children in developing countries. Therefore, in the pediatric emergency unit of a university hospital in Turkey, we prospectively investigated the cost factors of pediatric trauma and attempted to identify cost predictors. METHODS: We prepared questionnaires and charts for 91 children (50 boys, 41 girls) admitted with multiple trauma to obtain data on age, gender, date and mechanism of injury, site of injury, type of the treatment and length of hospital stay. We studied the physical findings, Pediatric Trauma Score (PTS), Revised Trauma Score (RETS) and pediatric Glasgow Coma Scale (GCS) score, and we totalled all hospital-based costs according to Ministry of Health guidelines. RESULTS: The mean (and standard deviation [SD]) age of the children was 79.4 (52.3) months. Motor vehicle crashes accounted for 45% of the injuries, followed by falls (41%) and bicycle accidents (14%). The mean (and SD) total cost of care was US dollar 376.60 (dollar 428.20) (range from dollar 20-dollar 1995). The cost associated with motor vehicle crashes was higher than that for the other injury types (p < 0.05). Seventeen patients required major and 27 patients required minor surgical treatment, whereas 44 patients were treated conservatively; 3 died. Forty-eight percent of patients were referred from another hospital, and the cost of care of referred patients was significantly higher than for those admitted directly (p < 0.001). The mean (and SD) duration of hospital stay was 98 (150) hours. Total cost correlated directly with the duration of hospital stay and distance of the referred hospital or accident scene from our hospital (p < 0.001, r = 0.827 and 0.374 respectively), but the cost correlated inversely with the PTS, the RETS and the pediatric GCS score (p < 0.001, r = -0.339, -0.301 and -0.453 respectively). CONCLUSION: Our findings indicate that the cost of pediatric trauma is high and may be predicted from admission data and trauma scores.

The role of elevated liver transaminase levels in children with blunt abdominal trauma.

The role of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels on intra-abdominal injury in children has not been adequately studied. In this report, the accuracy of these tests in predicting the degree and extend of intra-abdominal and hepatic injury in children with blunt abdominal trauma was investigated.Eighty-seven haemodynamically stable children with multiple trauma were prospectively evaluated. The SGOT and SGPT of patients with and without abdominal trauma (Groups I and II) were compared. Patients with and without radiologically verified intra-abdominal injury were further compared (Groups Ib and Ia). There was significant difference in SGOT and SGPT levels of Groups I and II. SGOT and SGPT levels were 333.6+/-283.8 and, 197.5+/-192.5 U/l, respectively in Group Ib; but 84.2+/-55.9, 43+/-29.8 U/l in Group Ia (P<0.001). In all patients with radiologically detected intra-abdominal pathology SGOT and SGPT levels were above 110.5 and 63.5 U/l, respectively. In patients with hepatic injury SGOT level was above 500 U/l and, SGPT level was above 300 U/l. Statistically significant positive correlation was found between radiologically detected intra-abdominal pathology and increased SGOT (above 110.5 U/l) and SGPT (above 63.5 U/l) levels (P<0.05). These data indicated that the SGOT and SGPT levels were significantly higher in patients with intra-abdominal injury even in the absence of hepatic injury. We suggest that liver function tests may be used as screening tests in children with blunt abdominal trauma in addition to physical abdominal examination. A sudden rise up to 110.5 U/l in SGOT and 63.5 U/l in SGPT indicate an intra-abdominal injury and severe hepatic injury should be suspected with higher levels of SGOT and SGPT.

[Epidemiologic evaluation of trauma cases admitted to a pediatric emergency service]. / TRAVMA NEDENIYLE COCUK ACIL SERVISE BASVURAN HASTALARIN EPIDEMIYOLOJIK DEGERLENDIRMESI.

BACKGROUND: This study was performed to contribute epidemiological data about pediatric trauma registry in our country. METHODS: Ninety-four children with trauma who were admitted to the Pediatric Emergency Clinic of our hospital were prospectively evaluated. RESULTS: Forty-five percent patients were female and 55% were male with a mean age of 79+52 months. Traffic accidents were the primary cause of trauma (46%). The education level of the mothers were above high school in only 30.4 % patients. Forty-four percent of trauma took place during daytime, the incidence of trauma was high in summer and autumn (p<0.05). Eighteen percent of patients required major and 31 % of patients required minor surgical treatment whereas 48% of patients were conservatively treated and 3% died. Forty-seven percent of patients were referred to our hospital from another hospital and surgical intervention requirement for referred patients were found to be higher than the others (p<0.05). CONCLUSION: Increasing the education level if mothers will contribute to the prevention of childhood trauma. KEYWORDS: Pediatric trauma, childhood, epidemiology