Evaluating narrative operative reports for endoscopic sinus surgery in a residency training program

Objective: The narrative operative report (NR) bears testimony to critical elements of patient care. Residents' NRs also provide insights into their comprehension of the procedure. NR documentation is an informal element of surgical residency training but data regarding quality of such training are scant. We aim to evaluate the NR within a residency training program. Methods: The quality of NRs for endoscopic sinus surgery (ESS) was evaluated through a retrospective analysis of 90 NRs for ESS. Thirty-four elements that the attending surgeon regards as "critical" variables, or quality indicators (QIs), that should be documented, were studied to evaluate quality. A "performance metric (PM)," defined as the average percent of QIs dictated/total word count, was determined. Subgroup analysis by the level of training was additionally performed. Results: Surgical indications, procedural steps, and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest proportion of included key elements (89% +/- 6.2%) followed by junior residents (87% +/- 5.7%) and then senior residents (80% +/- 14%) (P = .008). The attending surgeon also demonstrated the highest PM, followed by senior and then junior residents (P < .0001). Conclusions: The quality of NRs was found to be high overall, but not "perfect" for either the attending or trainee surgeon. The PM among residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs. Level of Evidence: 3Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Colorectal cancer in patients from Uganda: A histopathological study

No Abstract. Keywords: Colorectal cancer, HNPCC, Endoscopy, Uganda, Histopathology, Lynch syndrome

Introduction to Magnetic Monopoles

One of the most basic properties of magnetism is that a magnet always has two poles, north and south, which cannot be separated into isolated poles, i.e., magnetic monopoles. However, there are strong theoretical arguments why magnetic monopoles should exist. In spite of extensive searches they have not been found, but they have nevertheless played a central role in our understanding of physics at the most fundamental level.Comment: 22 pages, 7 figures. To be published in Contemporary Physic

Gasless laparoscopy may reduce the risk of port-site metastases following laparoscopic tumor surgery

Objective: To compare the incidence of port-site metastases in an experimental tumor model following tumor manipulation during laparoscopy aided by conventional insufflation with laparoscopy using a gasless technique. Setting: An experimental model applied in a research laboratory. Participants and Interventions: Malignant tumors were implanted in the abdominal wall of 24 rats. Twelve rats underwent tumor laceration at laparoscopy with carbon dioxide insufflation, and 12 rats underwent the same procedure during gasless laparoscopy achieved by abdominal wall suspension. Rats were killed 1 week later and were examined for evidence of tumor metastases. The surgical wounds were examined microscopically by a histopathologist who was unaware of the operative technique used and the site of origin of the specimens. Main Outcome Measure: Histologically confirmed tumor metastasis to laparoscopic port wounds. Results: Growth of the primary tumor was equal in both groups. Wound metastases were less likely in the gasless laparoscopy group (3 of 12 vs 10 of 12; P=.01, Fisher exact test). Conclusion: The use of laparoscopy without gas insufflation may reduce the risk of wound metastasis following laparoscopic surgery for cancer.David I. Watson, George Mathew, Tanya Ellis, Carolyn F. Baigrie, Alan M. Rofe, Glyn G. Jamieso