Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Vasc Surg Cases Innov Tech ; 9(2): 101035, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37013065

RESUMO

A 67-year-old woman with endometrial adenocarcinoma had sustained an aortic injury during robotically assisted retroperitoneal lymphadenectomy. Repair could not be performed laparoscopically; however, graspers were used to maintain hemostasis while conversion to open surgery was initiated. Safety mechanisms locked the graspers in place, preventing tissue release, but resulting in additional aortic injury. Forceful removal of the graspers was eventually successful, and definitive aortic repair was then performed. Vascular surgeons who are not familiar with robotic surgery techniques should be aware that removal of robotic hardware requires the use of stepwise algorithms, which, if performed out of order, can introduce significant challenges.

2.
Womens Midlife Health ; 8(1): 12, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36333765

RESUMO

High recidivism rates indicate that current forms of imprisonment may be an ineffective response to problems that mainly burden those ensconced in poverty and marginalization. Homelessness, unemployment, racial disparities, drug use, and mental illness, disappear from public view when the afflicted individuals are relegated to a life behind bars. Women are the fastest growing prison population and most incarcerated women are from Black and Latinx groups. Structural racism encompasses the many ways in which society fosters racial discrimination through mutually reinforcing unfair systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. In turn, this behavior reinforces discriminatory beliefs, values, and distribution of resources. Structural racism pervades every aspect of society, including the carceral system, from policing to prosecutorial decisions, pretrial release processes, sentencing, correctional discipline, and even reentry. Women constitute a minority within the carceral system, and as a result, their unique health care needs, especially during the midlife period, are inadequately addressed and often overlooked. There is also a general lack of gender sensitivity and special considerations in existing jail and prison policies and practices. This commentary highlights the impact of structural racism on the arrests and incarceration of women, and discusses their special health and wellness needs, with emphasis on midlife women. It also illuminates the need to address structural racism and its ripple effects within the carceral system.

3.
J Perinat Med ; 49(7): 830-836, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34167182

RESUMO

OBJECTIVES: This review examined prenatal care provided to incarcerated women to identify areas where improvement is needed, and examined current legislative gaps such that they can be addressed to ensure uniform templates of care be instituted at women's prisons. METHODS: Data were compiled from 2000-2021 citations in PubMed and Google Scholar using the keywords: prison AND prenatal care AND pregnancy. RESULTS: Although the right to health care of inmates is protected under the Eight Amendment to the United States Constitution, the literature suggests that prenatal care of incarcerated individuals is variable and would benefit from uniform federal standards. Inconsistency in reporting requirements has created a scarcity of data for this population, making standardization of care difficult. Although incarceration may result in improved access to care that women may not have had in their community, issues of shackling, inadequate prenatal diet, lack of access to comprehensive mental health management, and poor availability of opioid use disorder (OUD) management such as Medication Assisted Therapy (MAT) amd Opioid Treatment Programs (OTP), history of post-traumatic stress disorder (PTSD) are just a few areas that must be focused on in prenatal care. After birth, mother-baby units (MBU) to enhance maternal-fetal bonding also should be a prison standard. CONCLUSIONS: In addition to implementing templates of care specifically directed to this subgroup of women, standardized state and federal legislation are recommended to ensure that uniform standards of prenatal care are enforced and also to encourage the reporting of data regarding pregnancy and neonatal outcomes in correctional facilities.


Assuntos
Cuidado Pós-Natal/normas , Cuidado Pré-Natal/normas , Prisioneiros , Prisões/normas , Feminino , Humanos , Recém-Nascido , Saúde Materna , Transtornos Mentais/terapia , Relações Mãe-Filho , Apego ao Objeto , Cuidado Pós-Natal/legislação & jurisprudência , Cuidado Pós-Natal/métodos , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/legislação & jurisprudência , Cuidado Pré-Natal/métodos , Prisioneiros/legislação & jurisprudência , Prisioneiros/psicologia , Prisões/legislação & jurisprudência , Melhoria de Qualidade , Estados Unidos
4.
J Surg Educ ; 75(4): 1082-1086, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29361508

RESUMO

OBJECTIVE: The objective of this communication is to provide an evolutionary description of an attempt to replicate the success of the Rampahl Cardiac Simulator using perfused abdominal organ blocks the way that the Rampahl Simulator uses ex vivo porcine hearts. DESIGN: This descriptive paper makes no attempt to prove the effectiveness of the described educational tool, but rather, outlines the successes and failures in development. The proven value of a perfused organ teaching tool, as the Rampahl Simulator, suggests that others can build upon the work described in this paper so that, in the future, perfused abdominal organs will be available to students of general surgery as a routine part of their pre-operative preparation. SETTING: The Animal Resource Facility of the University of Utah, under the oversight of the University Institutional Animal Use and Care Committee (IACUC), provided the animals, operating suites and technical support. PARTICIPANTS: During each development phase, General Surgery Residents and Medical Students from all levels participated. In addition, operating room staff with an interest in either medical school or perfusion were invited to participate. RESULTS: The efforts described in this paper eventually resulted in a reliable teaching tool for abdominal procedures in that viability of the porcine abdominal organs for up to three hours after euthanasia was regularly achieved. CONCLUSIONS: General Surgery Teaching Programs of a size similar to the University of Utah may have access to the resources necessary to replicate this teaching tool in a cost-effective manner. However smaller teaching programs, such as those without a research facility, may not be able to adapt the procedures described in this paper.


Assuntos
Abdome/cirurgia , Educação Médica/métodos , Cirurgia Geral/educação , Treinamento por Simulação/métodos , Animais , Ponte Cardiopulmonar , Competência Clínica , Desenvolvimento de Programas , Suínos , Utah
5.
J Vasc Surg ; 66(2): 642-648.e4, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28506475

RESUMO

OBJECTIVE: This report describes a novel simulator, euthanized pigs on cardiopulmonary bypass, and validates this simulator with a controlled trial in general surgery residents learning aortic anastomosis. We evaluated this novel simulator with the following hypothesis: our porcine perfused simulator is as good as or better than the standard rubber tubing, low-fidelity models used for vascular anastomotic training. METHODS: Euthanized pigs were placed on cardiopulmonary bypass, creating a perfused, ex vivo model on which to perform surgical procedures. The participants in the study were postgraduate year 2, 3, and 4 general surgery residents. Residents were randomized to practice aortic anastomosis in the pig laboratory (PL) simulator or in a dry laboratory. The PL residents and control residents performed a first vascular anastomosis on the rubber tube model. Anastomosis creation was filmed. The anastomosis and video were stored for later grading. Next, all residents underwent an ungraded, one-on-one training session with the attending vascular surgeon. After the training session, all residents completed a second videotaped rubber tubing anastomosis. The grading scales used were validated by other authors: Global Assessment Score, Final Product Score, and Checklist Scoring Instrument. Survey data describing this experience were collected using a 13-question prelaboratory and 16-question postlaboratory questionnaires consisting of yes/no, multiple selection, and 5-point Likert-type scale questions. RESULTS: All residents had a statistically significant improvement in time to completion and in the Global Assessment Score with tutored practice. The PL residents showed statistically significant improvement in completion time between the first and second videotaped anastomosis; however, there was no statistically significant improvement in the scoring metrics. The control residents showed statistically significant improvement in all three scoring metrics, but no statistically significant difference was found in completion time. The survey data showed a statistically significant shift in considering vascular surgery as a career after the experience in the PL group (P = .05) compared with the control group, who had no change in interest (P = .91). CONCLUSIONS: Our prospective, randomized clinical trial shows that the porcine cardiopulmonary bypass model achieves similar results to a previously validated bench top model while improving general surgery resident interest in vascular surgery as a career.


Assuntos
Aorta/cirurgia , Ponte Cardiopulmonar , Escolha da Profissão , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Treinamento com Simulação de Alta Fidelidade/métodos , Procedimentos Cirúrgicos Vasculares/educação , Anastomose Cirúrgica/educação , Animais , Competência Clínica , Currículo , Humanos , Internato e Residência , Curva de Aprendizado , Modelos Anatômicos , Modelos Animais , Modelos Cardiovasculares , Estudos Prospectivos , Sus scrofa , Análise e Desempenho de Tarefas , Fatores de Tempo , Utah , Gravação em Vídeo
8.
9.
Am Surg ; 72(11): 1082-7; discussion 1126-48, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17120951

RESUMO

Many surgeons are also pilots; the two activities demand similar skill sets. Surgeons have developed an interest in aviation models for managing risk and reducing adverse events, such as Crew Resource Management training. This article provides seven suggestions from aviators that might be adopted by surgeons in an effort to improve surgical care and mitigate patient harm. Each suggestion is offered based on the value added to aviation, with an acknowledgment that the suggestion may be more or less applicable in surgery. The suggestions for dealing with the changing roles for surgeons are: Crew Resource Management-type training to improve teamwork should be required for hospital credentialing, surgeons should brief the operating room team before an operation, surgeons should write standards specific to their organization, surgeons should recognize fatigue and age as factors in performance, surgeons should have "check-rides" as a part of the credentialing process, surgeons should abandon the mortality and morbidity conference in favor of a data collection system that effectively examines adverse events for root causes of error, and all members of the surgical team should be subject to mandatory, random drug testing.


Assuntos
Cirurgia Geral/organização & administração , Guias como Assunto , Auditoria Administrativa/métodos , Garantia da Qualidade dos Cuidados de Saúde/tendências , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Estados Unidos
10.
Surgery ; 139(2): 274-5; discussion 274, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16455337
12.
J Surg Res ; 111(1): 38-44, 2003 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-12842446

RESUMO

BACKGROUND: We examined the usefulness of a new agent in the mapping and dissection of inguinal lymph nodes in the pig. Cy5-cobalamin bioconjugate is blue under visible light and fluoresces brilliant red with laser stimulation. The wavelength of the emitted red light is sufficiently long that it is visible through blood, subcutaneous fat, and fascia. Currently available surgical techniques of minimally invasive dissection are well suited for using fluorescent detection in a dark operating field with minimal modification of an existing Hopkins surgical telescope. MATERIALS AND METHODS: We tested this concept in the live post-adolescent, female, nonlactating pig (30 kg). We insufflated the subcutaneous tissue over the groin and inserted three ports (1 x 10 mm and 2 x 5 mm) for dissection. We injected the Cy5-cobalamin bioconjugate in a dermal location on the hind limb. A HeNe laser stimulated the CobalaFluor in the lymphatics and the emitted fluorescence passed through a holographic notch filter to a three-chip camera. RESULTS: Under white light, the lymphatic trunks and the sentinel node were visualized within minutes of injection. Both the lymphatic trunks and the node fluoresced bright red under stimulation with red laser light. CONCLUSIONS: These preliminary studies establish the potential usefulness of this new agent in lymphatic mapping. This novel technology might be useful in visualizing cancers that spread to regional lymph nodes. This technique has the potential to map the lymphatic drainage and to identify the presence of malignant cells in that drainage with currently available minimally invasive technology.


Assuntos
Carbocianinas , Corantes Fluorescentes , Sistema Linfático/anatomia & histologia , Vitamina B 12 , Animais , Feminino , Virilha , Laparoscopia , Lasers , Linfonodos/anatomia & histologia , Biópsia de Linfonodo Sentinela , Suínos
14.
Am J Surg ; 184(2): 121-5, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12169354

RESUMO

BACKGROUND: We used the Revised NEO Personality Inventory (Psychological Resources, Inc.) to test for a distinct surgical personality. METHODS: The NEO-PI-R is a compilation of 240 statements. Subjects agree or disagree with the statements, generating a score in five personality traits according to the five factor theory: neuroticism (N), extraversion (E), openness (O), agreeableness (A), and conscientiousness (C). Each score is compared with that for the general population. RESULTS: Twenty-four male and 15 female surgical residents voluntarily took the inventory. Compared to the general population, males scored lower in N (p <0.05), higher in E (P <0.001), O (P <0.05) and C (p <0.001), and average in A (no significant difference). Females scored average in N and A (no significant difference), and higher in E (p <0.001), O (P <0.05), and C (P <0.001). CONCLUSIONS: The similarity of trait variance from the general population in both male and female surgical residents supports the concept of a surgical personality.


Assuntos
Atitude do Pessoal de Saúde , Escolha da Profissão , Cirurgia Geral , Internato e Residência , Inventário de Personalidade , Adulto , Estudos de Casos e Controles , Extroversão Psicológica , Feminino , Cirurgia Geral/educação , Humanos , Masculino , Transtornos Neuróticos/epidemiologia , Probabilidade , Valores de Referência , Projetos de Pesquisa , Fatores Sexuais , Recursos Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...