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PubMed2006

[Perineal regional anaesthesia: indications in gynaecologic and proctologic surgery and in obstetric].

Perineal and proctologic surgery is well known as very painful. The apparition of new specific needles, long acting and less toxic local anaesthetics and neurostimulation allowed reconsidering some old forgotten techniques. Those blocks appear really useful to optimize multimodal postoperative analgesia and postoperative rehabilitation. After anatomic review, authors describe perineal regional anaesthesia and discuss about main indications and advantages, in the eyes of their experience and bibliographic review.

Anesthesia, Conduction↗
PubMed2002

Physician empathy: definition, components, measurement, and relationship to gender and specialty.

OBJECTIVE: There is a dearth of empirical research on physician empathy despite its mediating role in patient-physician relationships and clinical outcomes. This study was designed to investigate the components of physician empathy, its measurement properties, and group differences in empathy scores. METHOD: A revised version of the Jefferson Scale of Physician Empathy (with 20 Likert-type items) was mailed to 1,007 physicians affiliated with the Jefferson Health System in the greater Philadelphia region; 704 (70%) responded. Construct validity, reliability of the empathy scale, and the differences on mean empathy scores by physicians' gender and specialty were examined. RESULTS: Three meaningful factors emerged (perspective taking, compassionate care, and standing in the patient's shoes) to provide support for the construct validity of the empathy scale that was also found to be internally consistent with relatively stable scores over time. Women scored higher than men to a degree that was nearly significant. With control for gender, psychiatrists scored a mean empathy rating that was significantly higher than that of physicians specializing in anesthesiology, orthopedic surgery, neurosurgery, radiology, cardiovascular surgery, obstetrics and gynecology, and general surgery. No significant difference was observed on empathy scores among physicians specializing in psychiatry, internal medicine, pediatrics, emergency medicine, and family medicine. CONCLUSIONS: Empathy is a multidimensional concept that varies among physicians and can be measured with a psychometrically sound tool. Implications for specialty selection and career counseling are discussed.

Adult↗
PubMed2006

Intraoperative use of recombinant activated factor VII (rFVIIa).

Recombinant activated factor VII (rFVIIa, Novoseven, Novo Nordisk, Denmark) was introduced as a prohemostatic agent in the early 80s: the only indication approved in USA by Food and Drug Administration (FDA) is the spontaneous bleeding in congenital hemophilia patients who developed inhibitors to FVIII and FIX. Recently, EMEA approved the use of rFVIIa in congenital hemophilia patients with inhibitors undergoing surgery, in subjects with congenital FVII deficiency undergoing surgical or invasive procedures, in patients with acquired hemophilia and in case of Glanzmann's thromboasthenia. Out of these approved indications, the off label use of rFVIIa is rapidly expanding, particularly in surgical patients with acquired coagulation disorders in order to manage severe, uncontrolled bleeding nonresponsive to conventional therapeutic measures or to reduce blood loss and transfusion requirements in potentially bleeding surgical procedures (major liver surgery, liver transplantation, major abdominal or obstetric surgery, trauma surgery). This paper reviews the more recent data coming from retrospective or prospective studies performed in different surgical settings: so far, the major point to be addressed is the place for rFVIIa as an adjunctive but sometimes lifesaving treatment to control haemostasis and critical bleeding in surgery and critically ill patients.

Blood Loss, Surgical↗
PubMed1990

[Study of some morphologic aspects of the human dura mater].

Dura mater of 100 Chinese adult cadavers were studied. The average total surface area of the dura mater was 0.080 m2 in male and 0.076 m2 in female. The thickness was 0.25-0.40 mm, and the tensile stress was around 37 kg/mm2. The architecture of the fibers in dura mater were chiefly in arcuate or radiated form, some running longitudinally or in oblique direction. Frozen human dura mater has been widely utilized in surgery, obstetrics, gynecology, ophthalmology, ENT and oral surgery, etc.

Anthropometry↗
PubMed2002

Teaching procedural skills to medical students: one institution's experience with an emergency procedures course.

STUDY OBJECTIVE: We examine the effect of a preclinical emergency procedures course on students' clinical procedural skills and medical knowledge. METHODS: This is a retrospective review of evaluation forms for a cohort of 86 students graduating from medical school at an academic center. A cross section of students (n=57) taking a clinical emergency medicine rotation over a 4-year period was also studied. Numeric scores (1 to 9 on a Likert scale) in procedural skills and medical knowledge categories were extracted from evaluations for internal medicine, surgery, obstetrics and gynecology, and emergency medicine rotations. Scores of students who had taken an elective course, Essential Procedures in Emergency Medicine (EPEM), were compared with scores of students who did not take this course. US Medical Licensing Examination Step I scores for both groups were also compared. RESULTS: Students who took EPEM scored significantly higher in the procedural skills category during the emergency medicine rotation (P =.04) and during both months of the internal medicine rotation (P =.02; P =.02). Students scored on average higher in the surgery and obstetrics and gynecology rotations, but these differences were not statistically significant. Students who took EPEM scored significantly higher in the medical knowledge category for emergency medicine (P =.01; P =.002), both months of internal medicine (P =.03; P =.006), and 1 of 2 months of surgery (P =.01) rotations. Students in obstetrics and gynecology rotations scored higher, although not significantly. US Medical Licensing Examination Step I scores were not different between students taking or not taking EPEM. CONCLUSION: Students taking EPEM achieved higher procedural skill and medical knowledge scores in clinical rotations. Emergency medicine is a specialty well suited to study procedures teaching and performance.

California↗
PubMed2004

Effect of different cost drivers on cost per anesthesia minute in different anesthesia subspecialties.

BACKGROUND: Little is known about differences in costs to provide anesthesia care for different surgical subspecialties and which factors influence the subspecialty-specific costs. METHODS: In this retrospective study, the authors determined main cost components (preoperative visit, intraoperative personnel costs, material and pharmaceutical costs, and others) for 10,843 consecutive anesthesia cases from a 6-month period in the 10 largest anesthesia subspecialties in their university hospital: ophthalmology; general surgery; obstetrics and gynecology; ear, nose, and throat surgery; oral and facial surgery; neurosurgery; orthopedics; cardiovascular surgery; traumatology; and urology. Using regression analysis, the effect of five presumed cost drivers (anesthesia duration, emergency status, American Society of Anesthesiologists physical status of III or higher, patient age younger 6 yr, and placement of invasive monitoring) on subspecialty-specific costs per anesthesia minute were analyzed. RESULTS: Both personnel costs for anesthesiologists and total costs calculated per anesthesia minute were inversely correlated with the duration of anesthesia (adjusted R2 = 0.75 and 0.69, respectively), i.e., they were higher for subspecialties with short cases and lower for subspecialties with longer cases. The multiple regression model showed that differences in anesthesia duration alone accounted for the majority of the cost differences, whereas the other presumed cost drivers added only little to explain subspecialty-specific cost differences. CONCLUSIONS: Different anesthesia subspecialties show significant and financially important differences regarding their specific costs. Personnel costs and total costs are highest for subspecialties with the shortest cases. Other analyzed cost drivers had little effect on subspecialty-specific costs. In the light of these cost differences, a detailed cost analysis seems necessary before the profitability of an anesthesia subspecialty can be assessed.

Adult↗
PubMed1988

Hospital privileges for family physicians. Patterns of recent residency graduates, residency director perceptions, and resident expectations.

A national mail survey was performed that examined reports of recent residency graduates about hospital privileges for family physicians, perceptions of residency program directors about the percentage of their graduates who obtain privileges, and plans of third-year residents for seeking privileges. Privileges in medicine, pediatrics, surgery, obstetrics, and coronary care/intensive care units (CCU/ICU) were examined. Questionnaires were mailed to a random sample of 308 residency graduates aged 30 to 35 years, all 383 family practice residency directors, and a random sample of 319 third-year residents. Two mailings produced an 82 percent response rate. Most recent graduates had privileges in medicine (97 percent), pediatrics (95 percent), and CCU/ICU (87 percent). A majority (64 percent) had obstetric privileges, and a minority (36 percent) had surgical privileges. Directors were accurate in their perceptions of privileges attained by graduates in medicine, pediatrics, and CCU/ICU, but underestimated the percentage who had privileges in surgery and overestimated the percentage who had privileges in obstetrics. Residents planned on seeking privileges in medicine, pediatrics, and obstetrics at a rate similar to recent graduates, with lower percentages planning on seeking them in surgery and CCU/ICU. Privileges in surgery and obstetrics were more prevalent in the Midwest and West.

Adult↗
PubMed1993

The attitudes toward psychiatry of physicians and medical students in Venezuela.

Attitudes toward psychiatry were assessed in 490 medical students and 362 physicians from two universities in Venezuela: Universidad de Los Andes (ULA) and Universidad Centro-Occidental Lisandro Alvarado (UCLA). A modified version of the Attitude Toward Psychiatry-30 scale was used. The attitude toward psychiatry of all the students and physicians was moderately positive. Students from ULA displayed a more positive attitude than UCLA students, whereas physicians from UCLA displayed a more positive attitude than ULA physicians. The most negative attitude toward psychiatry was observed in students planning to select obstetrics and gynecology (ULA + UCLA), in physicians working in Surgery, obstetrics and gynecology (ULA + UCLA) and in basic sciences (ULA). Female students tended to display a more positive attitude than male students. The attitude toward psychiatry was similar in students with low and high academic achievement in the courses in psychiatry. A large number of years in the profession did not modify the attitude of the physicians. It is recommended to improve teaching and communication with the students and physicians that displayed the most negative attitudes toward psychiatry.

Adult↗
PubMed1987

[Internal iliac arteriovenous fistulas following gynecologic surgery. Development of principles of treatment. Apropos of 2 cases].

Pelvic arterio-venous fistulae are rare. They can be congenital or acquired. If the latter they are nearly always iatrogenic following surgery for prolapsed intervertebral discs or following gynaecological or obstetrical surgery. Diagnosis is difficult because the symptoms and signs are not specific ore are deceptive. Clinical examination shows that this "tumour" is vascular in nature. Up till recently treatment was disappointing, consisting as it did of surgery which was often difficult and dangerous and possibly carrying a poor prognosis, and in most cases resulting in recurrences. Since intra-arterial embolisation techniques have been developed, either by themselves or before surgery, the results have been better. They cannot be carried out without a preliminary precise and complete arteriographic assessment.

Abortion, Induced↗