ABSTRACT
INTRODUCTION: Traditional percutaneous nephrolithotomy (PCNL) training involved subjective award of cases to the trainee. We restructured this according to the Guy's stone score (GSS) such that each trainee stepwise completed 25 cases of each grade before progressing. This study compares the outcomes of training with traditional versus stepwise approach. METHODS: Four hundred consecutive cases equally distributed for two trainees in each group were compared in terms of complications (Clavien-Dindo), stone free rate (SFR), operative and fluoroscopy time. External comparison was also done against a benchmark surgeon. Multivariable regression model was created to compare SFR and complications while adjusting for comorbidity, Amplatz size, access tract location, number of punctures, body mass index, stone complexity, and training approach. RESULTS: The distribution of cases in terms of calculus complexity was similar. Overall, in comparison to traditional training, stepwise training had significantly shorter median operative time (100 vs. 120 min, P < 0.05), fluoroscopy time (136 vs. 150 min, P < 0.05) and fewer overall (29.5% vs. 43.5%, P < 0.005) as well as major complications (3% vs. 8.5%, P - 0.029), though initial SFR was higher but not statistically significant (77% vs. 71.5%). On multivariable analyses, stepwise training was independently associated with lower complications (odds ratio 0.46 [0.20-0.74], P - 0.0013) along with GSS grade, number of punctures, and Amplatz size. Stepwise training had similar fluoroscopy time, major complications and final clearance rate compared to expert surgeon. CONCLUSIONS: PCNL has a learning curve specific for each grade of calculus complexity and stepwise training protocol improves outcomes.
ABSTRACT
INTRODUCTION: One of the main aims of orthodontic treatment is the improvement of esthetics along with enhancement of functions of the orofacial regions. Complications are observed even after final completion of the orthodontic treatment due to relapse and loss of stability. Hence, we retrospectively analyzed angle class I malocclusion cases to study the correlation of outcome of orthodontic treatment and posttreatment stability. MATERIALS AND METHODS: A total of 100 patients were included in this retrospective analysis, which accounted for the patients reporting to the department of orthodontics from 2013 to 2015 with angle class I malocclusion. Pretreatment, posttreatment, and postretention casts of the patients were made and analyzed. The Richmond et al criteria was used to evaluate peer assessment rating (PAR) index and Little irregularity index, followed by scoring with American weight. Measurement of Pearson's coefficient was done to calculate the p-value. p-value of less than 0.05 was considered as significant. RESULTS: No significant amount of alteration was seen in the systematic errors of Little index and PAR index, while casual errors were also within the normal range. While comparing the PAR index at pretreatment and posttreatment phases, statistically significant results were obtained, whereas in case of Little index at same time intervals, scores showed nonsignificant results. CONCLUSION: Even after delivering ideal orthodontic treatment, stability of the treatment is still not ensured until unless posttreatment follow-up is properly maintained.
