8 research outputs found
Basic suture technique: Instructional videos explaining suturing for medical students in a qualitative study
Background: Understanding basic surgical skills is important for medical students prior to entering residency regardless of future specialty. In these videos we provide instruction for suturing as it relates to skin closure.
Material and methods: Instructional videos were created by the senior faculty (R.A. and M.K.) to teach medical students at the University of Louisville suturing techniques.
Results: Entering and exiting the needle at an angle of 90° or greater allows for tissue eversion. Inadequate eversion of tissue or inadequate angling of the needle will lead to tissue inversion. When suturing uneven edges, a deep bite on the low side and a shallow bite on the high side will allow for appropriate tissue leveling. For buried sutures, skin eversion with substantial dermal bites and proper knot location is essential.
Conclusion: Understanding the basics of skin apposition will provide students with knowledge about primary wound healing and prepare them for residency
Performance up gradation of static VAR compensator with thyristor binary switched capacitor and reactor using model reference adaptive controller
There are various static var compensator configurations are available and listed in the literature. Their performances are evaluated based on their voltage support, dynamic response, losses, cost, and additional filter requirement, if any. In this paper, efforts are made to improve the dynamic performance parameter such as rise time, settling time, and peak overshoots. A new topology with an adaptive controller is presented, in which capacitor and reactor banks are divided in their binary values and connected in the shunt. Capacitor and reactor banks are operated by thyristorised switches. Both these banks are operated in closed-loop form as a cascade control. Amongst these, capacitor bank operates as coarse control, and reactor bank acts as fine control. For the performance enhancement, a model reference adaptive controller is used. The system identification toolbox is used to evaluate the mathematical model of the plant with Matlab. The model\u27s performance was analyzed deeply by the adaptive controller with different reference models such as critical, under, and overdamped. The performance parameters such as rise time, settling time, and peak overshoot in the form of reactive power swings, are evaluated and plotted for different adaptive gains using MIT rules
Assessment of Health Care Cost for Complex Surgical Patients: Review of Cost, Re-Imbursement and Revenue Involved in Pancreatic Surgery at a High-Volume Academic Medical Centre
AbstractBackgroundPancreatic surgery is complex with the potential for costly hospitalization.MethodsA retrospective review of patients undergoing a pancreatic resection was performed.ResultsThe median age of the study population was 64 years. Half of the cohort was female (51%), and the majority were white (62%). Most patients underwent a pancreaticoduodenectomy (PD) (69%). The pre-operative age-adjusted Charlson comorbidity index was zero for 36% (n = 50), 1 for 31% (n = 43) and ≥2 for 33% (n = 45). The Clavien–Dindo grading system for post-operative complication was grade I in 17% (n = 24), whereas 45% (n = 62) were higher grades. The medians direct fixed, direct variable, fixed indirect and total costs were 15 397, 31 631, respectively. There was a positive contribution margin of 6790. On univariate analyses, age, type of operation and complication grade were associated with total cost (P ≤ 0.05), whereas operation type and complication grade were associated with a net margin (P = 0.01). These findings remained significant on multivariate analysis (P < 0.05).ConclusionsIncreased cost, reimbursement and revenue were associated with type of operation and post-operative complications
The Short-Term Effect of Weight Loss Surgery on Volumetric Breast Density and Fibroglandular Volume
Purpose:
Obesity and breast density are both associated with an increased risk of breast cancer and are potentially modifiable. Weight loss surgery (WLS) causes a significant reduction in the amount of body fat and a decrease in breast cancer risk. The effect of WLS on breast density and its components has not been documented. Here, we analyze the impact of WLS on volumetric breast density (VBD) and on each of its components (fibroglandular volume and breast volume) by using three-dimensional methods.
Materials and Methods:
Fibroglandular volume, breast volume, and their ratio, the VBD, were calculated from mammograms before and after WLS by using Volparaâ„¢ automated software.
Results:
For the 80 women included, average body mass index decreased from 46.0 ± 7.22 to 33.7 ± 7.06 kg/m2. Mammograms were performed on average 11.6 ± 9.4 months before and 10.1 ± 7 months after WLS. There was a significant reduction in average breast volume (39.4 % decrease) and average fibroglandular volume (15.5 % decrease), and thus, the average VBD increased from 5.15 to 7.87 % (p < 1 × 10−9) after WLS. When stratified by menopausal status and diabetic status, VBD increased significantly in all groups but only perimenopausal and postmenopausal women and non-diabetics experienced a significant reduction in fibroglandular volume.
Conclusions:
Breast volume and fibroglandular volume decreased, and VBD increased following WLS, with the most significant change observed in postmenopausal women and non-diabetics. Further studies are warranted to determine how physical and biological alterations in breast density components after WLS may impact breast cancer risk.ECU Open Access Publishing Support Fun
Basic suture technique: Instructional videos explaining suturing for medical students in a qualitative study
Background: Understanding basic surgical skills is important for medical students prior to entering residency regardless of future specialty. In these videos we provide instruction for suturing as it relates to skin closure. Material and methods: Instructional videos were created by the senior faculty (R.A. and M.K.) to teach medical students at the University of Louisville suturing techniques.Results: Entering and exiting the needle at an angle of 90° or greater allows for tissue eversion. Inadequate eversion of tissue or inadequate angling of the needle will lead to tissue inversion. When suturing uneven edges, a deep bite on the low side and a shallow bite on the high side will allow for appropriate tissue leveling. For buried sutures, skin eversion with substantial dermal bites and proper knot location is essential.Conclusion: Understanding the basics of skin apposition will provide students with knowledge about primary wound healing and prepare them for residency
The Short-Term Effect of Weight Loss Surgery on Volumetric Breast Density and Fibroglandular Volume
Purpose Obesity and breast density are both associated with an increased risk of breast cancer and are potentially modifi- able. Weight loss surgery (WLS) causes a significant reduc- tion in the amount of body fat and a decrease in breast cancer risk. The effect of WLS on breast density and its components has not been documented. Here, we analyze the impact of WLS on volumetric breast density (VBD) and on each of its components (fibroglandular volume and breast volume) by using three-dimensional methods.Materials and Methods Fibroglandular volume, breast vol- ume, and their ratio, the VBD, were calculated from mammo- grams before and after WLS by using VolparaTM automated software.Mammograms were performed on average 11.6 ± 9.4 months before and 10.1 ± 7 months after WLS. There was a significant reduction in average breast volume (39.4 % decrease) and aver- age fibroglandular volume (15.5 % decrease), and thus, the av- erage VBD increased from 5.15 to 7.87 % (p < 1 × 10−9) after WLS. When stratified by menopausal status and diabetic status, VBD increased significantly in all groups but only perimeno- pausal and postmenopausal women and non-diabetics experi- enced a significant reduction in fibroglandular volume. Conclusions Breast volume and fibroglandular volume decreased, and VBD increased following WLS, with the most significant change observed in postmenopausal women and non-diabetics. Further studies are warranted to determine how physical and biological alterations in breast density components after WLS may impact breast cancer risk.Kathryn M. Verbanac [email protected] Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USAResults For the 80 women included, average body mass index 2decreased from 46.0 ± 7.22 to 33.7 ± 7.06 kg/m2