Sternal Wound Complications: Objective Reclassification and Surgical Reconsideration.

Background: Sternal wound complications pose a tremendous challenge post-cardiac surgery. There's no consensus or clear guidelines to deal with them. We propose that simple and more objective classification helps to organize the range of sternal wound complications and suggest a relevant treatment strategy. Methods: One-hundred-sixteen cases of sternal wound complications retrospectively were reviewed out of 2,391 adult patients, who underwent full sternotomy during cardiac surgery from 2006 to 2018. Eighty-six cases conservatively were managed and the remaining 30 cases required surgical intervention. More objective classification was proposed and less invasive fasciocutaneous flap was considered for nearly all reconstructive procedures. Results: The incidence of sternal wound complications was 4.8%. Conservative management was adopted for 86 cases, mean duration was 11.19 ± 9.8 days. Surgical management was performed in 30 patients (25.86%); 28 (93.3%) of whom recovered with good outcomes with less invasive fasciocutaneous flap done for 13 cases. Two cases had recurrence; one conservatively was managed and other was reoperated and healed well. The most common organisms in recurrent infections were N. coagulase (29.8%), Klebsiella (12.5%), pseudomonas (10.5%), and MRSA (10.5%). We had 4 mortalities. None of the mortalities were related to sternal wound complications; one was related to the cardiac surgery. Conclusions: Sternal wound complications are grave events. Objective classification and proper management selection will gain better outcomes.

An explanatory mixed methods study on the validity and validation of students' assessment results in the undergraduate surgery course.

BACKGROUND/PURPOSE: There is inadequate evidence of reported validity of the results of assessment instruments used to assess clinical competence. This study aimed at combining multiple lines of quantitative and qualitative evidence to support interpretation and use of assessment results. METHOD: This study is a mixed methods explanatory research set in two stages of data collection and analysis (QUAN : qual). Guided by Messick's conceptual model, quantitative evidences as reliability and correlation coefficients of various validity components were calculated using students' scores, grades and success rates of the whole population of students in 2012/2013 and 2013/2014 (n= 383; 326). The underlying values that scaffold validity evidences were identified via Focus Group Discussions (FGD) with faculty and students; sampling technique was purposive; and results were analyzed by content analysis. RESULTS: (1) Themes that resulted from content analysis aligned with quantitative evidences. (2) Assessment results showed: (a) content validity (table of specifications and blueprinting in another study); (b) consequential validity (positive unintended consequences resulted from new assessment approach); (c) relationships to other variables [a statistically significant correlation among various assessment methods; with combined score (0.64-0.86) and between mid and final exam results (r = 0.672)]; (d) internal consistency (high reliability of MCQ and OSCE: 0.81, 0.80); (3) success rates and grades distribution alone could not provide evidence to advocate an argument on validity of results. CONCLUSION: The unified approach pursued in this study created a strong evidential basis for meaningful interpretation of assessment scores that could be applied in clinical assessments.

Surgical Revascularization of Coexistent Significant Left Main and Right Coronary Artery Stenosis: A Single Center Experience.

BACKGROUND: Patients with left main coronary artery stenosis often have complex coexisting coronary artery disease. Surgical revascularization is still the standard modality of treatment. OBJECTIVE: To present our experience in surgical revascularization for patients with stenosis of both left main and right coronary artery and evaluate the impact of the latter on the outcome of surgery. METHODS: From 2006 to 2015, a total of 46 patients (38 male and 8 female, mean age 56.3 years) underwent coronary artery bypass grafts for stenosis of both left main and right coronary artery. Risk factors for coronary artery disease were identified in 93.4%. EuroSCORE II was 2.2 ± 4.29. All were operated on pump with mean grafts 3.3 ± 0.8.1 per patient. Intraaortic balloon was inserted in 11 patients. RESULTS: Early postoperative mortality was 8.7%. Regarding complications, we reported bleeding in 6 patients, sternal wound infection in 5, renal impairment in 5, respiratory complications in 2, and myocardial infarction in 4. CONCLUSION: Surgical revascularization for patients with stenosis of both left main and right coronary artery has a higher morbidity and mortality when compared to results of surgery for isolated left main disease.