Surgical telepresence: the usability of a robotic communication platform

INTRODUCTION: The benefits of telepresence in trauma and acute surgical care exist, yet its use in a live, operating room (OR) setting with real surgical cases remains limited. METHODS: We tested the use of a robotic telepresence system in the OR of a busy, level 1 trauma center. After each case, both the local and remote physicians completed questionnaires regarding the use of the system using a five point Likert scale. For trauma cases, physicians were asked to grade injury severity according to the American Association for the Surgery of Trauma (AAST) Scaling System. RESULTS: We collected prospective, observational data on 50 emergent and elective cases. 64% of cases were emergency surgery on trauma patients, almost evenly distributed between penetrating (49%) and blunt injuries (51%). 40% of non-trauma cases were hernia-related. A varied distribution of injuries was observed to the abdomen, chest, extremities, small bowel, kidneys, spleen, and colon. Physicians gave the system high ratings for its audio and visual capabilities, but identified internet connectivity and crowding in the operating room as potential challenges. The loccal clinician classified injuries according to the AAST injury grading system in 63% (n=22) of trauma cases, compared to 54% (n=19) of cases by the remote physicians. The remote physician cited obstruction of view as the main reason for the discrepancy. 94% of remote physicians and 74% of local physicians felt comfortable communicating via the telepresence system. For 90% of cases, both the remote and local physicians strongly agreed that a telepresence system for consultations in the OR is more effective than a telephone conversation. CONCLUSIONS: A telepresence system was tested on a variety of surgical cases and demonstrated that it can be an appropriate solution for use in the operating room. Future research should determine its impact on processes of care and surgical outcomes

Duodenopancreatectomy: influence of patient's intrinsic factors on results of pancreatic cancer surgical treatment

Introduction: Pancreatic cancer is the fourth leading cause of cancer death in Western countries, with a more prevalent incidence in the elderly (1). It presents itself as a neoplasm with high lethality and low survival, surgical resection being the only treatment with curative potential. However, pancreatoduodenectomy (Kausch-Whipple technique) is one of the most difficult surgeries in the gastrointestinal system, due to the great difficulty in accessing the pancreas and its proximity to various delicate and vital structures, requiring advanced knowledge by the surgeon (6). Objective: Evaluate the profile of patients with pancreatic cancer and factors that contribute to the surgical outcome and survival after curative pancreatoduodenectomy. Method: A descriptive retrospective cross-sectional study was carried out through the analysis of records of pancreatoduodenectomy in the period May 2005 – July 2015 at Hospital Erasto Gaertner (HEG) in Curitiba/PR. Variables were analyzed using Student's t-test, non-parametric Mann-Whitney U test, and chi-squared test with Fisher's correction. Survival and disease-free survival rates were evaluated using the Kaplan-Maier method with the log-rank test and survival predictors identified with Cox regression. The SPSS 23.0 and STATA 15 programs were used, with p value being lower than 0.05 considered statistically significant. Results: 98 pancreatoduodenectomy were evaluated and 46 were in male patients and 30 were in patients aged <60 years. Ca 19-9 levels were elevated in 29% of patients before surgery and elevated in 5% after surgery. Regarding the location of the tumor, 77% were pancreatic, 14% were duodenal papilla and 8% were biliary tract. Regarding tumor histology, 81 were adenocarcinoma, 6 were cholangiocarcinoma and 5 were other diagnoses; 29% were well differentiated, 53% moderately and 17% poorly differentiated. About staging, 21% T1, 23% T2, 36% T3 and 18% T4 were found. Factors such as local tumor extension, location of the lesion and surgery time do not show a significant influence on the surgical outcome of these patients. The main postoperative complications were fistula and evisceration. The mean overall survival after surgery at 5 years was 12.24% and this was seen to be significantly higher in the <60 years group (p < 0.01). Discussion and Conclusion: It was seen that pancreatic tumors present in more advanced stages at diagnosis and are more prevalent in the elderly. These characteristics negatively impact 5-year overall survival rates, as this is higher in patients older than 60 years. Early diagnosis remains a challenge for successful treatment with curative potential, and remains a key point for the survival of these patients, as it allows for better staging and better surgical results

Extra-curricular supervised training at an academic hospital: is 200 hours the threshold for medical students to perform well in an emergency room?

Abstract Introduction Due to high number of jobs in Emergency Medicine (EM) and the lack of specialist to work in this field, recent graduates work in the emergency room straight after medical school. Additional courses on EM are available through Academic Leagues. This organizations offer lectures and supervised extra-curricular practical activities in their teaching university-affiliated hospital. The objectives of the present study are to assess the influence of hours undertaken in the extra-curricular practical activities on the performance and confidence of students in carrying out the different procedures in the emergency department, and on their own perception of how well they did. Also, to assess the influence the practical activities have on student´s future choice of specialty. Methods A Cross-sectional study conducted by collecting data through a questionnaire. 102 eligible individuals were included and divided into two groups according to the number of extra-curricular hours performed (Group 1- up to 200 hours and Group 2- over 200 hours). Results Students in Group 2 (over 200 hours) had a greater number of procedures performed on all variables evaluated, in particular, initial patient care (mean 363.8 vs.136.905 in Group 1 - p = 0.001), Simple Sutures (mean of 96.2 vs 33.980 respectively) ( p = 0.00003). To determine patient follow-up by the student, the number of initial patient care was correlated with number of discharge procedures performed (in Group 1, 49.6% of patients were not followed up and discharged by the same students who first talked to them in the hospital. While in Group 2, this value becomes 29.4 % - values for Group 1 - p = 0.011 and Group 2 - p = 0.117). Regarding the influence of the practical extra-curricular activities, 76.5% of the total reported that it had influenced their choice of future specialty. Conclusions The aptitude, confidence and skill of students are closely linked to the practice time (number of training hours served). Two hundred hours appeared to be a relatively significant time for the student to demonstrate good conduct and ability. Practical extra-curricular activities had the ability to influence the future choice of specialty, either positively or negatively.</p

Enhancing trauma education worldwide through telemedicine

Abstract Advances in information and communication technologies are changing the delivery of trauma care and education. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the world. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through videoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars, conferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as enhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine for trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across the world.</p

Enhancing trauma education worldwide through telemedicine

Advances in information and communication technologies are changing the delivery of trauma care and education. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the world. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through videoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars, conferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as enhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine for trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across the world

Perfil epidemiológico de acidentes com material biológico entre estudantes de medicina em um pronto-socorro cirúrgico

OBJECTIVE: To evaluate the accidents with biological material among medical students interning in a trauma emergency room and identify key related situations, attributed causes and prevention. METHODS: we conducted a study with a quantitative approach. Data were collected through a questionnaire applied via internet, with closed, multiple-choice questions regarding accidents with biological material. The sample comprised 100 students. RESULTS: thirty-two had accidents with biological material. Higher-risk activities were local anesthesia (39.47%), suture (18.42%) and needle recapping (15.79%). The main routes of exposure to biological material were the eyes or mucosa, with 34%, and syringe needle puncture, with 45%. After contamination, only 52% reported the accident to the responsible department. CONCLUSION: The main causes of accidents and routes of exposure found may be attributed to several factors, such as lack of training and failure to use personal protective equipment. Educational and preventive actions are extremely important to reduce the incidence of accidents with biological materials and improve the conduct of post-exposure. It is important to understand the main causes attributed and situations related, so as general and effective measures can be applied.OBJETIVO: avaliar os acidentes com material biológico entre estudantes de medicina estagiando em um pronto-socorro de trauma e identificar as principais situações relacionadas, causas atribuídas e prevenção. MÉTODOS: estudo com abordagem quantitativa. Os dados foram coletados através de um questionário, aplicado via internet, contendo perguntas fechadas de escolha múltipla, referentes a acidentes com material biológico. A amostra obtida foi 100 estudantes. RESULTADOS: trinta e dois se acidentaram com materiais biológicos. As atividades de maior risco foram anestesia local (39,47%), sutura (18,42%) e recapeamento de agulha (15,79%). As principais vias de exposição ao material biológico foram contato com olho ou mucosa, com 34%, através de seringa com agulha com 45%. Após a contaminação, apenas 52% notificaram o acidente ao setor responsável. CONCLUSÃO: as principais causas de acidente encontradas e vias de exposição podem ser atribuídas a diversos fatores, como falta de treinamento e ao não uso de equipamentos de proteção individual. Ações preventivas e educativas são de extrema importância para diminuir a incidência dos acidentes com materiais biológicos e melhorar a conduta pós-exposição. É preciso entender as principais causas atribuídas e situações relacionadas a fim de implantar medidas gerais e eficazes

Influência do local de origem do trauma nos índices de admissão de pacientes submetidos à laparotomia de emergência.

RESUMO Objetivo: avaliar a influência do local de ocorrência do trauma nos escores de trauma de pacientes submetidos à laparotomia de emergência. Métodos: estudo retrospectivo observacional analítico. Foram incluídos 212 pacientes submetidos à laparotomias exploratórias no período de janeiro de 2015 e dezembro de 2017. Informações sobre o local do acidente e dados vitais dos pacientes foram obtidas com base na coleta de dados por meio de prontuários eletrônicos e físicos. Foram analisados os índices de trauma de pacientes provenientes de Curitiba e Região Metropolitana e o local em que o paciente foi socorrido (estabelecimento físico ou via pública). Resultados: entre os 212 pacientes estudados, 184 (86,7%) foram trazidos pelo Serviço de Atendimento Pré-Hospitalar provenientes da cidade Curitiba e 28 (13,3%) provenientes de Região Metropolitana de Curitiba. Foram socorridos em estabelecimentos físicos 25 pacientes (17,6%), enquanto 117 (82,4%) foram socorridos em via pública. Observou-se maiores valores de ISS (Injurity Severity Score) dos pacientes procedentes da Região Metropolitana em relação aos procedentes de Curitiba (29,78 vs 22,46, P=0,009), enquanto valores maiores do TRISS (Trauma Trauma and Injury Severity Score) foram observados em pacientes procedentes de Curitiba em relação aos da Região Metropolitana (90,62 vs 81,30; P=0,015). Pacientes socorridos em via pública apresentaram menor valor de RTS (Revised Trauma Score) (6,96 vs 7,65; P=0,024) e TRISS (86,42 vs 97,21; P=0,012). Conclusão: pacientes vítimas de trauma procedentes de locais mais distantes do atendimento no centro de referência apresentaram pior prognóstico à admissão e foi observado pior prognóstico em pacientes socorridos em via pública