Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review

<p>Abstract</p> <p>Background</p> <p>Work-hour limitations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME) in July 2003 in order to minimize fatigue related medical adverse events. The effects of this regulation are still under intense debate. In this literature review, data of effects of limited work-hours on the quality of life, surgical education, and patient care was summarized, focusing on surgical subspecialities.</p> <p>Methods</p> <p>Studies that assessed the effects of the work-hour regulation published following the implementation of ACGME guidelines (2003) were searched using PubMed database. The following search modules were selected: work-hours, 80-hour work week, quality of life, work satisfaction, surgical education, residency training, patient care, continuity of care. Publications were included if they were completed in the United States and covered the subject of our review. Manuscrips were analysed to identify authors, year of publication, type of study, number of participants, and the main outcomes.</p> <p>Review Findings</p> <p>Twenty-one articles met the inclusion criteria. Studies demonstrate that the residents quality of life has improved. The effects on surgical education are still unclear due to inconsistency in studies. Furthermore, according to several objective studies there were no changes in mortality and morbidity following the implementation.</p> <p>Conclusion</p> <p>Further studies are necessary addressing the effects of surgical education and studying the objective methods to assess the technical skill and procedural competence of surgeons. In addition, patient surveys analysing their satisfaction and concerns can contribute to recent discussion, as well.</p

Antibiotic coated nails: Rationale, development, indications and outcomes

The concept of antibiotic-coated implants, mainly coated intramedullary nails, has become increasingly used for the treatment of fracture related infections. After a long period of hand-made implants, commercially fabricated implants combine several benefits. Antibiotic-coated nails constitute a solid treatment option for unstable diaphyseal infections with fractures or non-unions. They release high concentrations of antibiotics locally, while retaining reduction and providing axial stability. This review aims to provide an overview about the background, the development, the indications, the treatment strategies and the outcomes of antibiotic-coated intramedullary nails

Perforating foreign body causing incomplete facial paralysis

Facial nerve trauma is a common cause of facial paralysis; both blunt and penetrating forces may compromise the facial nerve. A comprehensive primary and secondary survey is essential for diagnosis and treatment of the injury. Here we report on a young patient who sustained a quad bike accident, leading to an perforating injuries of the face from a bough, causing facial paralysis. Keywords: Facial muscle weakness; Facial nerve trauma; Facial paralysis; Foreign body; Perforating injuries; Traumatic facial paralysis

Early Career Support for Biomedical Exchange Students with an International Mentor-to-Mentor Concept - The Biomedical Education Program (BMEP)

In medicine, many international exchange opportunities exist, yet often only towards the end of the course of study. Opportunities for students to gain high-level international research experience early during the studies are rare. A good student-mentor relationship during a research stay abroad is a key factor for scientific success. The aims of this paper are to report on an international exchange and education program that has funded more than 700 students and has been carefully developed and advanced over more than 40 years, its mentor-to-mentor concept and potential success factors for building and maintain such programs. A summary of the history, the concept and the experiences of students is provided, along with a discussion of evaluation results and success factors. The Biomedical Education Program (BMEP) team has - within the last seven years of leadership by the authors - selected and funded 83 German students from different biomedical studies who went abroad for research projects. Preliminary evaluation results show a high degree of satisfaction with the program and its mentor-to-mentor concept, which we deem to be the key to success. Further factors include continued funding, determination, self-organization and assertiveness, an excellent alumni network and a meticulous selection process for both, students and hosts. Further, more detailed evaluation of survey results has to follow. Our results may support the build-up of similar exchange programs

Основные направления снижения себестоимости продукции предприятия (на примере ООО «Фалько»)

Целью работы является разработка основных направлений снижения себестоимости продукции предприятия ООО "Фалько". В процессе исследования проводились расчеты себестоимости продукции, расчеты затрат на производство. В результате исследования предложена автоматизация производства для уменьшения себестоимости и увеличения объемов.Tsel'yu raboty yavlyayetsya razrabotka osnovnykh napravleniy snizheniya sebestoimosti produktsii predpriyatiya OOO "Fal'ko". V protsesse issledovaniya provodilis' raschety sebestoimosti produktsii, raschety zatrat na proizvodstvo. V rezul'tate issledovaniya predlozhena avtomatizatsiya proizvodstva dlya umen'sheniya sebestoimosti i uvelicheniya ob"yemov

Литология и условия формирования отложений пласта Ю12 Казанского нефтегазоконденсатного месторождения (Томская область)

Магистерская диссертация направлена на выявление литологических особенностей и выяснение условий формирования продуктивного пласта Ю1/2 Казанского нефтегазоконденсатного месторождения (Томская область). На основе комплексной интерпретации кернового материала и микроскопического исследования шлифов уточнены фациальные условия осадкообразования песчаных пород пласта Ю1/2 Казанского месторождения. С учетом данных электронной микроскопии и кристаллооптических характеристик охарактеризовано пустотно-поровое пространство коллекторов. Проведено макроскопическое описание керна, микроскопическое описание шлифов, гранулометрический анализ пород, дана литолого-фациальная характеристика пласта. Установлен и обоснован генезис песчаных отложений изучаемого пласта.The master's thesis is aimed at identifying lithological features and elucidating the conditions for the formation of the productive formation J1/2 of the Kazan oil and gas condensate field (Tomsk region). Based on a comprehensive interpretation of core material and microscopic studies, grinding wells refine the phase conditions of sedimentation of sandstone strata J1/2 of the Kazan field. Based on electron microscopy data and crystal-optical characteristics, the hollow-pore space of the collectors is characterized. A macroscopic description of the core, a microscopic description of sections, a grain-size analysis of the rock, a lithological-facies characterization of the reservoir are given. The genesis of sand deposits of the studied formation is established and justified

The impact of fasciotomy on inpatient outcomes in lower leg fracture management.

BACKGROUND While lower extremity fractures are common injuries, concomitant compartment syndrome can lead to significant implications and surgical release (fasciotomy) is essential. The aim of this study was to identify potential predictors of compartment release and risk factors related to complications. Using a large nationwide cohort, this study compared patients suffering from lower extremity fractures with and without compartment syndrome during their primary in-hospital stay following trauma. METHODS A retrospective analysis was conducted using the prospective surgical registry of the working group for quality assurance in surgery in Switzerland, which collects data from nearly 85% of all institutions involved in trauma surgery. Inclusion criteria Patients who underwent surgical treatment for tibia and/or fibula fractures between January 2012 and December 2022 were included in the study. Statistics Statistical analysis was performed using Chi-square, Fisher's exact test, and t test. Furthermore, a regression analysis was conducted to determine the independent risk factors for fasciotomy and related complications. In the present study, a p value less than 0.001 was determined to indicate statistical significance due to the large sample size. RESULTS The total number of cases analyzed was 1784, of which 98 underwent fasciotomies and 1686 did not undergo the procedure. Patients with fasciotomies were identified as significantly younger (39 vs. 43 years old) and mostly male (85% vs. 64%), with a significantly higher American Society of Anesthesiologists (ASA) score (ASA III 10% vs. 6%) and significantly more comorbidities (30% vs. 20%). These patients had significantly longer duration of surgeries (136 vs. 102 min). Furthermore, the total number of surgical interventions, the rate of antibiotic treatment, and related complications were significantly higher in the fasciotomy group. Sex, age, comorbidities, and fracture type (both bones fractured) were identified as relevant predictors for fasciotomy, while ASA class was the only predictor for in-hospital complications. Outcomes Patients who underwent fasciotomy had a significantly longer hospital stay (18 vs. 9 days) and a higher complication rate (42% vs. 6%) compared to those without fasciotomy. While fasciotomy may have played a role, other factors such as variations in patient characteristics and injury mechanisms may also contribute. Additionally, in-house mortality was found to be 0.17%, with no patient death recorded for the fasciotomy group. CONCLUSIONS Fasciotomy is vital. The knowledge about the further course is, however, helpful in resource allocation. We found significant differences between patients with and without fasciotomy in terms of age, sex, complication rate, length of stay, comorbidities, duration of operations, and use of antibiotics during their primary in-hospital stay. While the severity of the underlying trauma could not be modulated, awareness of the most relevant predictors for fasciotomy and related complications might help mitigate severe consequences and avoid adverse outcomes

Научная инициатива иностранных студентов и аспирантов. Т. 1

Сборник представляет интерес для специалистов и исследователей в области математики, механики, электротехники, информатики и вычислительных систем, физики, химии, геологии, гуманитарных наук и экономики