Using 360-degree multi-source feedback to evaluate professionalism in surgery departments: an Iranian perspective

Background: Medical professionalism helps physicians adopt a proper and good healing action for the patients based on their particular circumstance. This study was conducted to assess professionalism in surgical residents, using a 360-degree evaluation technique in several teaching hospitals in Tehran, Iran. Methods: This study was conducted on all the second and third year surgery residents from three university teaching hospitals in Tehran. Multi-source feedback questionnaire contained 10 questions on the residents’ professional behavior and was completed by the faculty and staff members (nurses, operation room staff, and medical assistants) as well as other surgery residents, interns and patients to evaluate each resident. Response rates were used to determine feasibility for each of the respondent groups and the mean and standard deviation score for each question was computed to determine the viability of the items. Reliability was assessed using alpha Cronbach coefficient for each respondent group. The correlation between these scores and the residents’ final and OSCE grade was also assessed. Results: The internal consistency reliability for 360-degree rating was 0.889. There was no significant difference in the residents’ score in different hospitals. While male residents obtained higher total score, there was no significant difference between them. The residents, however, obtained lower scores compared to the staff. The highest score was recorded for question 6, suggesting that the residents treated the patients regardless of their socioeconomic status. Conclusion: This study revealed a strong agreement between the results gathered from different respondents, confirming the reliability of the questionnaire and the respondents’ unbiased response. It also revealed that the residents did well in the whole test, showing they were conscientious and learning to become medical professionals

Surgical options in the management of cystic duct avulsion during laparoscopic cholecystectomy

<p>Abstract</p> <p>Background</p> <p>Avulsion of cystic duct during laparoscopic cholecystectomy (LC) is not a common intraoperative complication, but may be encountered by any laparoscopic surgeon. Surgeons are rarely familiar with management of this condition.</p> <p>Methods</p> <p>Patients with gall stone related problems who were scheduled for LC at the minimal invasive surgery unit of a tertiary referral hospital during a 5 years period (April 2002–April 2007) were prospectively enrolled.</p> <p>Results</p> <p>12 cases were identified (incidence: 1.15%). All 12 patients had gallbladder inflammation. Five patients had acute and seven patients had chronic cholecystitis. The avulsed cystic duct (ACD) was managed by clipping in 4, intracorporeal suturing in 3, converting to open surgery with suture ligation in 2, and lonely external drainage in 3 patients. Bile leakage had ceased within 3 days in 2, 14 days in one, and 20 days in the other patient. Bile volume increased gradually in one of the patients, which stopped only after endoscopic sphincterotomy (ES) at 25^thpostoperative day. No major late complication or mortality occurred.</p> <p>Conclusion</p> <p>ACD during LC is a rare complication. Almost all standard methods of treatment yield to successful outcomes with low morbidity. According to the situation, ACD may be successfully managed laparoscopically. Available cystic stump remnant was clipped. Intracorporeal suture ligation was performed when short length of stump precluded clipping. Deeply retracted cystic duct with active bile leak led to conversion to open surgery. With minimal or no bile leak at ACD stump, closed tube drainage of sub-hepatic area was attempted. Persistent bile leak was assumed to be controlled by ES, successfully accomplished in one patient.</p

Ictal verbal help-seeking: Occurrence and the underlying etiology.

PURPOSE: Ictal verbal help-seeking has never been systematically studied before. In this study, we evaluated a series of patients with ictal verbal help-seeking to characterize its frequency and underlying etiology. METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term help in the text body. All the extracted reports were reviewed and patients with at least one episode of documented ictal verbal help-seeking in epilepsy monitoring unit (EMU) were studied. For each patient, the data were reviewed from the electronic medical records, EMU report, and neuroimaging records. RESULTS: During the study period, 5133 patients were investigated in our EMU. Twelve patients (0.23%) had at least one episode of documented ictal verbal help-seeking. Nine patients (six women and three men) had epilepsy and three patients (two women and one man) had psychogenic nonepileptic seizures (PNES). Seven out of nine patients with epilepsy had temporal lobe epilepsy; six patients had right temporal lobe epilepsy. CONCLUSION: Ictal verbal help-seeking is a rare finding among patients evaluated in epilepsy monitoring units. Ictal verbal help-seeking may suggest that seizures arise in or propagate to the right temporal lobe

Abdominal pain due to a lost guidewire: a case report

A lost guidewire is a hazardous, yet completely preventable, and rare complication associated with central venous catheter insertion. Here, we report a case of a lost guidewire in a patient presented with persistent abdominal pain. The guidewire was retrieved completely during a surgical operation after the diagnosis had been confirmed by radiologic studies. Following some tips during insertion of a central venous catheter will help to prevent this mortal complication or at least, in rapid diagnosis of its loss. Interventional radiologic techniques are now readily used to retrieve a lost guidewire

Development of de novo diabetes in long-term follow-up after bariatric surgery

Introduction: While bariatric surgery leads to significant prevention and improvement of type 2 diabetes, patients may rarely develop diabetes after bariatric surgery. The aim of this study was to determine the incidence and the characteristic of new-onset diabetes after bariatric surgery over a 17-year period at our institution. Methods: Non-diabetic patients who underwent bariatric surgery at a single academic center (1997–2013) and had a postoperative glycated hemoglobin (HbA1c) ≥ 6.5%, fasting blood glucose (FBG) ≥ 126 mg/dl, or positive glucose tolerance test were identified and studied. Results: Out of 2263 non-diabetic patients at the time of bariatric surgery, 11 patients had new-onset diabetes in the median follow-up time of 9 years (interquartile range [IQR], 4–12). Bariatric procedures performed were Roux-en-Y gastric bypass (n = 7), adjustable gastric banding (n = 3), and sleeve gastrectomy (n = 1). The median interval between surgery and diagnosis of diabetes was 6 years (IQR, 2–9). At the last follow-up, the median HbA1c and FBG values were 6.3% (IQR, 6.1–6.5) and 95 mg/dl (IQR, 85–122), respectively. Possible etiologic factors leading to diabetes were weight regain to baseline (n = 6, 55%), steroid-induced after renal transplantation (n = 1), pancreatic insufficiency after pancreatitis (n = 1), and unknown (n = 3). Conclusion: De novo diabetes after bariatric surgery is rare with an incidence of 0.4% based on our cohort. Weight regain was common (> 50%) in patients who developed new-onset diabetes suggesting recurrent severe obesity as a potential etiologic factor. All patients had good glycemic control (HbA1c ≤ 7%) in the long-term postoperative follow-up

Estudio experimental de la acumulación de partículas atmosféricas de cristales en la transmisión de luz diurna

La luz del día es una de las fuentes de luz más importantes que podría iluminar los espacios interiores al pasar a través de ventanas y colectores de luz. La acumulación de polvo y aerosoles en los cristales de las ventanas reduce la cantidad de luz que pasa a través de ellos. El objetivo principal de esta investigación es determinar el impacto de la deposición de partículas en el aire sobre la cantidad de luz pasada. En este experimento, se obtuvieron las partículas más prevalentes, como el polvo, el carbono y una mezcla de ambos examinados con vidrios comerciales comunes de 3 mm en cristales de vidrios simples y dobles y se obtuvieron varias observaciones interesantes. El resultado de este experimento ayudará a los propietarios de edificios a ajustar un programa de limpieza de ventanas para reducir el consumo y los gastos de electricidad de iluminació

Estudio experimental de la acumulación de partículas atmosféricas de cristales en la transmisión de luz diurna

Daylight is one of the most significant light source which could illuminate interior spaces by passing through windows and light collectors. Dust and aerosol accumulation on windowpanes reduce the light amount passing through it. The main objective of this research is to determine the impact of airborne particulate matters deposition on past light quantity. In this experiment the most prevalent particulate matters such as dust, carbon, and a mixture of both examined with 3 mm common commercial glasses at single and double glaze windowpanes and several interesting observations have been obtained. The result of this experiment will help building owners to adjust a window-cleaning schedule to reduce their lighting electricity consumption and expenses.La luz del día es una de las fuentes de luz más importantes que podría iluminar los espacios interiores al pasar a través de ventanas y colectores de luz. La acumulación de polvo y aerosoles en los cristales de las ventanas reduce la cantidad de luz que pasa a través de ellos. El objetivo principal de esta investigación es determinar el impacto de la deposición de partículas en el aire sobre la cantidad de luz pasada. En este experimento, se obtuvieron las partículas más prevalentes, como el polvo, el carbono y una mezcla de ambos examinados con vidrios comerciales comunes de 3 mm en cristales de vidrios simples y dobles y se obtuvieron varias observaciones interesantes. El resultado de este experimento ayudará a los propietarios de edificios a ajustar un programa de limpieza de ventanas para reducir el consumo y los gastos de electricidad de iluminación

Ileal intussusception secondary to both lipoma and angiolipoma: a case report

Lipoma and angiolipoma are common benign neoplasms that occur in the subcutaneous tissue and rarely in the gastrointestinal tract. These tumors are usually asymptomatic but may present with abdominal pain, bleeding and obstruction. We present a 53-years-old woman with abdominal discomfort for several weeks accompanied with bloody diarrhea and recurrent vomiting. Ileo-ileal invagination was diagnosed by computed tomography scan. Laparotomy revealed five intraluminal masses that caused intussusception. Histopathological study showed that one was angiolipoma and other lesions were lipoma. We have described some aspects of diagnosis and treatment of this rare cause of intestinal intussusception

Circulating levels of novel adipocytokines in patients with colorectal cancer

Objective: Adipocytokines have been reported to contribute to the pathogenesis of colorectal cancer (CRC). The aim of this matched case-control study was to explore circulating novel adipocytokines, such as serum visfatin, omentin-1 and vaspin levels in patients with CRC. Method: Serum visfatin, omentin-1, and vaspin levels were measured in 69 subjects (39 patients with colorectal cancer and 30 age- and sex-matched healthy controls) using enzyme-linked immunosorbent assay (ELISA) methods. Results: Compared with the controls, patients with CRC had significantly higher circulating omentin-1 (203.23 vs 9.12 ng/ml, p < 0.0001) visfatin (4.03 vs 2.01 ng/ml, p < 0.0001) and vaspin (0.54 vs 0.31 ng/ ml, p = 0.015) levels. After adjustment for covariates (age and body mass index), patients with CRC had significantly higher serum omentin-1 (p < 0.0001), visfatin (p < 0.0001), and vaspin (p = 0.040) levels than the control group. Furthermore, the results did not change when age and waist-to-hip ratio were considered as covariates in the general linear models. Conclusions: The observed higher levels of omentin-1, visfatin, and vaspin in patients with CRC, independent of measures of obesity, suggest that these adipocytokines may have a potential role in the development of CRC through mechanisms other than the indirect mechanisms that are active in the association between obesity and CRC