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PubMed2003

Estimating times of surgeries with two component procedures: comparison of the lognormal and normal models.

BACKGROUND: Variability inherent in the duration of surgical procedures complicates surgical scheduling. Modeling the duration and variability of surgeries might improve time estimates. Accurate time estimates are important operationally to improve utilization, reduce costs, and identify surgeries that might be considered outliers. Surgeries with multiple procedures are difficult to model because they are difficult to segment into homogenous groups and because they are performed less frequently than single-procedure surgeries. METHODS: The authors studied, retrospectively, 10,740 surgeries each with exactly two CPTs and 46,322 surgical cases with only one CPT from a large teaching hospital to determine if the distribution of dual-procedure surgery times fit more closely a lognormal or a normal model. The authors tested model goodness of fit to their data using Shapiro-Wilk tests, studied factors affecting the variability of time estimates, and examined the impact of coding permutations (ordered combinations) on modeling. RESULTS: The Shapiro-Wilk tests indicated that the lognormal model is statistically superior to the normal model for modeling dual-procedure surgeries. Permutations of component codes did not appear to differ significantly with respect to total procedure time and surgical time. To improve individual models for infrequent dual-procedure surgeries, permutations may be reduced and estimates may be based on the longest component procedure and type of anesthesia. CONCLUSIONS: The authors recommend use of the lognormal model for estimating surgical times for surgeries with two component procedures. Their results help legitimize the use of log transforms to normalize surgical procedure times prior to hypothesis testing using linear statistical models. Multiple-procedure surgeries may be modeled using the longest (statistically most important) component procedure and type of anesthesia.

Algorithms↗
PubMed1999

Patterns of use of common major procedures in medical care of older adults.

OBJECTIVES: We analyzed Medicare data to determine the influence of age, mortality during the study year, and high individual Medicare costs on the frequency of hospitalization for the most common major procedures and for general medical diagnoses. METHODS: We used 1992 Medicare data to classify the most frequent diagnosis related groups (DRGs), representing one-half of all admissions, as procedural or general medical. We studied the frequency of hospitalization for the most common procedures (bowel surgery, cardiovascular procedures, hip and femur surgery) and for general medical care in the entire Medicare population, in persons aged 65 to 74, 75 to 84, and 85 or older, in those who died, and in the 5% of persons whose annual Medicare costs were the highest. RESULTS: In the entire population, common procedures accounted for 21% of the most frequent DRGs. Among those who died, the procedures were performed in only 8% of admissions. In the 5% of persons with the highest Medicare costs, 28% of admissions involved procedures. Admissions for cardiovascular procedures and for cancer chemotherapy decreased with age and were infrequent in persons 85 years and older. Hip and femur procedures increased with age and accounted for 70% of the common procedures in persons 85 years and older. CONCLUSIONS: The most common major procedures account for a minority of hospitalizations of persons more than age 65, of persons 85 and older, of those who died, and of persons with the highest Medicare expenditures. Most hospitalizations are for general medical care. Major procedures appear to be used with restraint in the very old and in persons in their last year of life.

Aged↗
PubMed1993

Pain control during interventional biliary procedures: epidural anesthesia vs i.v. sedation.

OBJECTIVE: We performed a study designed to compare epidural anesthesia with IV sedation for the control of pain during interventional biliary procedures. MATERIALS AND METHODS: Two hundred sixty-three biliary procedures were performed in 126 patients during a 3-year period. The transhepatic approach was used for all the procedures. Epidural anesthesia was used in 140 procedures and IV sedation was used in 123. Both epidural anesthesia and IV sedation were used in 31 patients who required multiple procedures. The efficacy of each method for control of pain was determined by a subjective rating of the patients' pain during the procedure: from 0 (no pain) to +3 (severe). The ratings were compiled and compared for each of the methods to ascertain which technique best achieved the desired effect. The pain control used depended on the urgency of the procedures and the availability of an anesthesiologist to administer epidural anesthetic. When an anesthesiologist was unavailable, IV sedation was used. The type and amount of drug administered depended on the patient's preference and history. RESULTS: Of the 140 procedures done with epidural anesthesia, patients had no pain to mild pain in 127 (91%) and moderate to severe pain in 13 (9%). All instances of moderate to severe pain were the result of unsuccessful attempts to establish or maintain anesthesia. Of the 123 procedures done with IV sedation, patients had no pain to mild pain in 62 (50%) and moderate to severe pain in 61 (50%). Complications were more frequent when IV sedation was used. Six (5%) occurred, and all were related to hypotension. The hypotensive episodes occurred early in the study, before monitoring of patients was improved; now, continuous updates on vital signs are provided throughout the interventional procedure. With epidural anesthesia, hypotension developed in only one patient (< 1%) and the patient responded to fluid administration. CONCLUSION: When it is successful, epidural anesthesia can completely eliminate moderate to severe pain in patients undergoing biliary procedures. IV sedation is only 50% effective in this regard. The greater efficacy of epidural anesthesia, coupled with the significantly lower prevalence of hypotension, justifies the additional cost and time associated with epidural anesthesia for pain management in biliary procedures.

Analgesics, Opioid↗
PubMed2006

Risk factors for procedure-related fetal losses after mid-trimester genetic amniocentesis.

BACKGROUND: The objective of this study was to determine the institutional pregnancy loss rate following second-trimester genetic amniocentesis and to ascertain whether factors exist which would identify pregnancies at increased risk of having a procedure-related fetal loss. SETTING: University Teaching Hospital METHODS: Details of the procedure and pregnancy outcome of all patients who had amniocentesis planned or performed between 15-22 gestational weeks between January 1997 and June 2004 were extracted from our clinical audit database. The procedure-related fetal loss rate, defined as all unintended abortions, stillbirths and neonatal deaths without major fetal abnormalities or obvious obstetric causes, was determined and compared to a presumed background fetal loss rate of 0.8% based on a cohort of women who did not undergo the procedure. RESULTS: A total of 3468 consecutive amniocentesis were performed in 3440 patients with 3498 fetuses. The mean gestational age at amniocentesis was 17.6 +/- 1.2 weeks. The majority (98.6%) required only one puncture and a transplacental procedure was required in 2.7% cases. A total of 3465 chromosomal studies were performed. Sixty six cases (1.9%) of major chromosomal abnormalities were detected. Pregnancy outcome was ascertained in all except 26 singleton pregnancies (0.74%). There were 3285 (93.9%) livebirths, 103 (2.9%) termination of pregnancies (TOP), 6 (0.17%) fetal demises before the procedure, and 20 (0.61%) unintended fetal losses due to significant fetal abnormalities or obstetric complications. The remaining 58 fetal losses (1.66%) were classified as potentially procedure-related, which could be either background fetal losses or procedure-related. The procedure-related fetal loss rate after correcting for the background loss rate was 0.86%.Potentially procedure-related fetal losses were found to be significantly associated with a procedure at 18 weeks or beyond (odds ratio OR = 1.97), a procedure performed for abnormal second-trimester biochemical screening test (OR = 3.08), a bloody tap (OR = 6.48), and a female fetus (OR = 2.39); but not to the number of punctures (p = 0.66) nor transplacental amniocentesis (p = 0.104). CONCLUSIONS: Mid-trimester amniocentesis is associated with a small but significant risk of fetal loss of 0.86%.

Abortion, Spontaneous↗
PubMed2004

Procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios.

OBJECTIVE: To investigate the procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios. METHODS: We followed prospectively all patients with polyhydramnios treated with rapid amniodrainage under continuous ultrasound guidance using a vacuum wound-drainage system from 1995 to 2002 in the fetal medicine unit of a university teaching hospital. We recorded: maternal age, type of pregnancy (singleton/twin), cause of polyhydramnios, gestational age at amniocentesis, volume of amniotic fluid drained, duration of the procedure, other intrauterine procedures in addition to the amniodrainage, and procedure-related complications including placental abruption, premature rupture of membranes (PROM), chorioamnionitis, fetal bradycardia and preterm delivery within 48 h of amniodrainage. RESULTS: Seventy-four consecutive women had 134 rapid amniodrainage procedures during the study period. Four procedures were excluded because the women were already in labor at the time of amniodrainage and they delivered within 48 h of the procedure. The final database therefore consisted of 70 patients with 130 procedures. Sixty-two percent (80/130) of the procedures were performed for the treatment of twin-twin transfusion syndrome (TTTS). There were altogether four procedure-related complications (3.1%; 95% CI, 1.0-8.0%). Three of them occurred in the TTTS group (3/80 procedures, 3.8%; 95% CI, 1.0-11.0%): one case each of placental abruption, PROM and fetal bradycardia. One PROM occurred in the non-TTTS group (1/50 procedures, 2.0%; 95% CI, 0-11.0%). In both cases of PROM the women presented in labor. CONCLUSIONS: Rapid amniodrainage using a vacuum wound-drainage system is safe and efficient to treat severe polyhydramnios, with a 3.1% complication rate.

Amniocentesis↗
PubMed1997

Two-point calibration procedure of the forced oscillation technique.

The forced oscillation technique is usually calibrated by loading the measuring device with a known impedance. A correction function is calculated, relating the measured and reference impedances at each frequency. However, this one point calibration procedure does not account for transducer asymmetry. A procedure has previously been presented to circumvent this problem: in addition to one known reference impedance, the calibration was repeated with the system occluded (infinite impedance). The aim of the present study was to evaluate a variant of this procedure, in which instead of resorting to an extreme condition imposing high requirements on the flow measuring system, two reference loads of 4 and 50 hPal-1 s were measured, thus covering the range of impedances observed in children and infants (a two-point procedure). The calibration procedure was performed with these two impedances and evaluated with a third impedance of approximately 17 hPal-1 s. The results of three calibration procedures were compared: one-point, two-point and a previously reported calibration procedure. Impedances consisted of sintered glass and mesh wire screens mounted in glass or polyvinyl tubes. For low impedance values, in the range of 4 to 17 hPal-1 s, measured and predicted values were similar for the three calibration procedures at frequencies from 4-52 Hz, although with the one point calibration procedure there was some underestimation above 44 Hz. With the highest load, especially above 32 Hz, marked discrepancies between measured and predicted values were observed with the one-point calibration procedure and the previously reported calibration procedure. Under these circumstances the two-point procedure is preferred.

Calibration↗
PubMed2006

The impact of mitral valve surgery combined with maze procedure.

OBJECTIVE: Recent studies indicated that successful maze procedure for atrial fibrillation (AF) adjunct to mitral valve surgery provided a lower incidence of stroke and recurrence of AF. The purpose of this study is to review the 13-year experience of these combined procedures and to identify the risk factors and late outcomes of successful maze procedures compared to failed maze procedures. METHODS: At a single institution, 521 consecutive patients underwent combined maze procedures with mitral valve replacements or valvuloplasties. Three kinds of maze techniques were primarily used: Cox-maze III, Kosakai maze, and cryo-maze procedure. Three months after the operation, 394 patients were in sinus rhythm (Group S) while the remaining 116 patients were in continuous or intermittent AF (Group F), excluding 11 early death patients. Risk factors for Group F were determined by the analysis of all patient demographics. Survival, freedom from stroke, cardiac events, and AF recurrence were analyzed. RESULTS: The proportion of the patients without any other simultaneous procedures was greater in Group S (41% vs 29%, P = 0.02). The distributions of mitral valve surgery and maze procedure techniques were similar in these two groups. A left atrium larger than 70 mm [hazard ratio (HR) = 2.6; 95% confidence interval range 1.04-6.3, P = 0.043], preoperative AF history longer than 10 years (HR = 8.2; 4.5-15.1, P < 0.001) and f-wave voltage in V1 smaller than 0.1 mV (HR = 6.2; 5.0-15.2, P < 0.001) were determined to be risk factors for unsuccessful maze procedures. All the results of Cox proportional hazards models showed superiority in Group S; actuarial survival rates (HR = 2.7; 1.04-7.0, P = 0.035), freedoms from stroke (HR = 3.0; 1.1-8.1, P = 0.003) and cardiac events (HR = 4.3; 2.9-6.1, P < 0.001). Freedom from AF recurrence rate was 98.4% at 5 years and 81.0% at 12 years in Group S, and 73.0% and 60.1% in overall patients. CONCLUSIONS: Patients with successful maze procedures resulted in higher survival rate, greater freedom from stroke and cardiac events. The large left atrium, small f-wave, and long AF duration were significant risk factors for failed maze procedures, suggesting that earlier surgical interventions would result in superior results in mitral valve surgery combined with maze procedure.

Adult↗
PubMed1995

Determinants of emergency department procedure- and condition-specific universal (barrier) precaution requirements for optimal provider protection.

STUDY OBJECTIVE: To determine potential blood and body fluid (B/BF) contacts with specific body areas associated with procedures commonly performed in the emergency department and to thereby delineate appropriate procedure-specific precautions. DESIGN: Prospective, observational study assessing procedure-related B/BF contacts by use of stratified, blocked sampling of shifts. PARTICIPANTS: ED patients in an inner-city tertiary care university hospital. RESULTS: Of 2,529 procedures performed in 1,025 patients, 1,621 (64%) were associated with barrier-protected or unprotected B/BF contact; 92% involved blood or bloody BF. Chest tube placement, lumbar puncture, and examination of the bleeding patient all resulted in B/BF contact with the facial area. All of the 18 procedure categories observed, with the exception of i.m. injection, resulted in B/BF contact with hands. Many procedures resulted in contact with the body or feet. Procedure type, provider, length of time, number of procedures per patient, and successful completion were each independently associated with B/BF contact. Number of attempts, adverse conditions, and triage acuteness were not associated with increased likelihood of contact. CONCLUSION: Virtually all ED procedures require gloves. Barrier protection for the body may be appropriate for all but the simplest procedures. Protection for the face seems appropriate, especially in invasive procedures such as lumbar puncture or physical examination of the bleeding patient. This study, along with other published data, has aided development of detailed guidelines for appropriate barrier precautions to be taken for common ED procedures.

Adolescent↗
PubMed2003

Laparoscopic gastric surgery in a Japanese institution: analysis of the initial 100 procedures.

BACKGROUND: Although endoscopic surgical procedures are popular in various fields, reports on its use in gastric surgical procedures are limited. This study was designed to review our initial experience with laparoscopic gastric surgical techniques to evaluate indications and surgical results. STUDY DESIGN: We undertook a retrospective analysis of 100 patients (66 men and 34 women, mean age 63 years) who underwent laparoscopic gastric surgical procedures between 1995 and 2001. Procedures performed were distal gastrectomy (n = 76), wedge resection (n = 20), and intragastric surgical procedures (n = 4). Patients were divided into two groups according to the date of the procedure, from the earliest to the most recent. RESULTS: There were 85 patients with gastric cancers, 14 submucosal tumors, and 1 duodenal ulcer. In 8 cases conversion was made to an open surgical procedure. Operation times required for distal gastrectomy, wedge resection, and intragastric surgical procedures were 330 +/- 69, 144 +/- 34, and 298 +/- 106 min, and blood loss was 354 +/- 251, 56 +/- 94, and 33 +/- 58 g, respectively. Complications included transient anastomotic stenosis (n = 5), leakage (n = 4), and bleeding (n = 1) after distal gastrectomy, and bleeding (n = 1) after intragastric surgical procedures. There were no complications after wedge resection. Comparing the first and second halves of the series, the percentage of distal gastrectomy significantly increased from 66% to 86% (p = 0.02) and the number of dissected lymph nodes at this procedure increased from 20 +/- 13 to 33 +/- 17 (p < 0.01). CONCLUSIONS: Laparoscopic gastric surgical procedures are safe and feasible for early gastric cancers and submucosal tumors. Technical advances in lymph node dissection have made distal gastrectomy a leading and increasingly popular laparoscopic procedure for early gastric cancer.

Aged↗
PubMed2002

Classification for coding procedures in the intensive care unit.

BACKGROUND: There is no commonly accepted coding system for non-operative procedures in general, including intensive care unit (ICU) procedures. In order to create a classification of codes for ICU procedures, a system developed at the University Hospital of Bergen was evaluated in four Nordic countries. METHODS: Classification codes were constructed using seven main groups of related procedures that were given a letter from A to G. Within each group major procedures were given a number from 00 to 99, with the possibility of up to 10 subclassifications within each procedure. A simple questionnaire regarding the use of coding general ICU procedures and some specific procedures was sent to 171 ICUs in Sweden, Finland, Denmark, and Norway. They were also asked to give their comments on the new classification coding system, which was attached. RESULTS: One hundred and fifty-four questionnaires were returned (response rate 90%). Some or most of the ICU procedures were registered in the ICUs (82.2%). However 38% did not use any coding system and 24% used a specific internal system. The new classification coding system was well received, and was given a mean value of 7.5 using a VAS scale from 0 to 10 (best). Most ICUs would consider using this system if introduced at a national level. CONCLUSION: Most Nordic ICUs do register some or most of the procedures performed. Such procedures are however, registered in very different ways, using several different systems, and are often home-made. The new classification system of ICU procedures was well rated.

Critical Care↗
PubMed2001

UK doctors' attitudes to the General Medical Council's Performance Procedures, 1997-99.

OBJECTIVES: The UK General Medical Council's Performance Procedures were introduced in 1997. This study aimed to assess the changing knowledge and attitudes about the procedures in British doctors at the time of their introduction and in the following 2 years. METHODS: Three questionnaire surveys, of separate representative samples of 800 UK doctors, were carried out in November of 1997, 1998 and 1999. The surveys assessed awareness of Good Medical Practice, attitudes to the Performance Procedures, agreement with Duties of a Doctor as a basis for disciplinary procedures, and attitudes to the Performance Procedures. RESULTS: Although awareness of the procedures increased over the period 1997-99, there was no concurrent increase in agreement with the core principles of the procedures, the Duties of a Doctor, which are spelled out in Good Medical Practice. Of 12 separate attitudes to the procedures, changes were found in eight over the time period, all but two of which were negative, and not in support of the procedures. Nevertheless many doctors were changing their practice as a result of the procedures, and that proportion increased during the period 1997-99. CONCLUSIONS: Although doctors became more aware of the procedures, that increasing awareness was not accompanied by an increasing agreement with the procedures' underlying principles or their wider implications.

Attitude of Health Personnel↗
PubMed2002

The role of protective antireflux procedures in neurologically impaired children: a decision analysis.

BACKGROUND/PURPOSE: Despite normal clinical history and preoperative radiologic and pH studies, gastroesophageal reflux (GER) can become apparent in neurologically impaired (NI) children after gastrostomy tube placement. An antireflux procedure performed at the time of gastrostomy tube placement may prevent postoperative GER and help avoid the need for a subsequent surgical procedure but is associated with a high morbidity and mortality rate in NI children. The purpose of this study was to determine the role of protective antireflux procedures in NI children undergoing gastrostomy tube placement. METHODS: Decision analysis was used to evaluate the effect of a protective antireflux procedure on morbidity and mortality in NI children. The rate of postoperative GER, need for secondary antireflux procedures, and morbidity and mortality rates after gastrostomy tube placement with or without an antireflux procedure in NI children were estimated from the literature and expert opinion and used to construct decision trees. RESULTS: At baseline values, gastrostomy tube placement resulted in a lower morbidity (11% v 13%) than gastrostomy tube placement with a protective antireflux procedure. One-way sensitivity analysis showed that gastrostomy tube placement was the favored approach when the morbidity of gastrostomy tube placement was less than 11% or the morbidity of antireflux surgery was greater than 10%. At baseline values, gastrostomy tube placement resulted in a lower mortality rate (0.3% v 0.8%) than gastrostomy tube placement with a protective antireflux procedure. Using 1-way sensitivity analysis, no threshold value of any variable was found that favored the use of a protective antireflux procedure with respect to mortality. CONCLUSIONS: Although a protective antireflux procedure may reduce the need for additional surgery, inclusion of this procedure is associated with a higher morbidity and mortality rate. Initial placement of a gastrostomy tube without a protective antireflux procedure is the favored approach for NI children without preoperative evidence of GER.

Decision Trees↗
PubMed2005

Do research procedures pose relatively greater risk for healthy persons than for persons with schizophrenia?

Federal regulations governing human research suggest that potential harms and discomforts of research be considered in relation to the risks normally encountered in daily life or in routine examinations. No data regarding relative risks of research exist for persons with schizophrenia. We surveyed psychiatrists (N = 68) to assess their perceptions of the risk associated with 12 research procedures in 2 categories, that is, evaluation- and intervention-type procedures. Psychiatrists were asked to rate "risks compared to usual daily risks" for people with schizophrenia and, separately, for healthy people. For healthy research volunteers, psychiatrists rated 2 of 5 evaluation procedures and none of the intervention procedures as posing fewer risks than daily life. One evaluation procedure and 2 intervention procedures were rated as similar to daily risks for healthy research volunteers. For volunteers with schizophrenia, psychiatrists rated 4 of the 5 evaluation procedures and 1 intervention procedure as conferring less risk than everyday life. For 1 of 5 evaluation procedures and 5 of 7 intervention procedures, the risks associated with the procedures were centered close to the benchmark for those faced every day by persons with schizophrenia. Psychiatrists in this study viewed research procedure risks as closer to the daily risks encountered by persons with schizophrenia than by healthy persons. Because federal regulations benchmark research studies as "minimal risk" if they are analogous to the usual risks of everyday life, this finding may have important implications for the evaluation of psychiatric protocols.

Adult↗
PubMed2004

Patients' willingness to allow residents to learn to practice medical procedures.

PURPOSE: Consent for teaching procedures has been the focus of ethical discussion recently. Patients may consent to a procedure but be unaware that the procedure is to be performed by a resident, perhaps for the first time. In such cases, patients have not specifically consented to the practice of teaching medical procedures. The authors studied patients' awareness of resident training and willingness to allow residents to perform procedures on them. METHOD: A survey was administered to a convenience sample of 202 Vanderbilt University Medical Center emergency department patients from February to April 2000. Three procedures (intubation, lumbar puncture, and sutures) were demonstrated. Patients were asked about their awareness of residents' training and willingness to allow a resident to perform the procedures for the first time versus the tenth time. RESULTS: In all, 60% of patients did not realize they could be the first person a resident performs a procedure on. Only 49% of the patients were completely comfortable being the first patient for sutures, 29% for intubation, and 15% for a lumbar puncture. Most patients felt they should be informed if it was the resident's first time performing procedures (66% for sutures, 69% for intubation, and 82% for lumbar puncture). CONCLUSION: Not only do the majority of patients not know that they might be the first patient on whom a resident performs a procedure, more than two thirds believed they should be told if they are the first patient. Particularly for intubation and lumbar puncture, patients indicated that they would be uncomfortable being the first patient on whom these procedures were performed. These data raise ethical questions regarding physicians' obligations to inform patients about resident-performed procedures.

Adult↗
PubMed2001

Benefits and safety of CT fluoroscopy in interventional radiologic procedures.

PURPOSE: To determine the benefits and safety of computed tomographic (CT) fluoroscopy when compared with conventional CT for the guidance of interventional radiologic procedures. MATERIALS AND METHODS: Data on 203 consecutive percutaneous interventional procedures performed with use of CT fluoroscopic guidance and 99 consecutive procedures with conventional CT guidance were obtained from a questionnaire completed by the radiologists and CT technologists who performed the procedures. The questionnaire specifically addressed radiation dose measurements to patients and personnel, total procedure time, total CT fluoroscopy time, mode of CT fluoroscopic guidance (continuous versus intermittent), success of procedure, major complications, type of procedure (biopsy, aspiration, or drainage), site of procedure, and level of operator experience. RESULTS: The median calculated patient absorbed dose per procedure and the median procedure time with CT fluoroscopy were 94% less and 32% less, respectively, than those measurements with conventional CT scanning (P <.05). An intermittent mode of image acquisition was used in 97% of the 203 cases. This resulted in personnel radiation dosimetric readings below measurable levels in all cases. CONCLUSION: As implemented at the authors' institution, use of CT fluoroscopy for the guidance of interventional radiologic procedures markedly decreased patient radiation dose and total procedure time compared with use of conventional CT guidance.

Adolescent↗
PubMed2005

Does simulator training for medical students change patient opinions and attitudes toward medical student procedures in the emergency department?

OBJECTIVES: To determine how simulator training impacts patients' preferences about medical student procedures in the emergency department. METHODS: A questionnaire was administered to a convenience sample of 151 of 185 patients approached (82% participation) seen in the emergency department of a midwestern teaching hospital. The questionnaire asked how many procedures they would prefer a medical student have performed after mastering the procedure on a simulator before allowing the medical student to perform this procedure on them. The procedures included venipuncture, placement of an intravenous line, suturing the face or arm, performing a lumbar puncture, placement of a central line, placement of a nasogastric tube, intubation, and cardioversion. These results were compared with those of a similar study asking about the same procedures without the stipulation that the skill had been mastered on a simulator. RESULTS: A high of 57% (venipuncture) and a low of 11% (placement of a central line) would agree to be a student's first procedure after simulator training. Except for intubating and suturing, participants were more likely (p < 0.05) to allow a medical student to perform a procedure on them after simulator training than without simulator training. Many patients prefer not to have a medical student perform a procedure no matter how many procedures the student has done (low of 21% for venipuncture, high of 55% for placement of a central line). CONCLUSIONS: Patients are more accepting of medical students performing procedures if the skill has been mastered on a simulator. However, many patients do not want a medical student to perform a procedure on them regardless of the student's level of training.

Adolescent↗
PubMed2006

Definition of an XML markup language for clinical laboratory procedures and comparison with generic XML markup.

BACKGROUND: Clinical laboratory procedure manuals are typically maintained as word processor files and are inefficient to store and search, require substantial effort for review and updating, and integrate poorly with other laboratory information. Electronic document management systems could improve procedure management and utility. As a first step toward building such systems, we have developed a prototype electronic format for laboratory procedures using Extensible Markup Language (XML). METHODS: Representative laboratory procedures were analyzed to identify document structure and data elements. This information was used to create a markup vocabulary, CLP-ML, expressed as an XML Document Type Definition (DTD). To determine whether this markup provided advantages over generic markup, we compared procedures structured with CLP-ML or with the vocabulary of the Health Level Seven, Inc. (HL7) Clinical Document Architecture (CDA) narrative block. RESULTS: CLP-ML includes 124 XML tags and supports a variety of procedure types across different laboratory sections. When compared with a general-purpose markup vocabulary (CDA narrative block), CLP-ML documents were easier to edit and read, less complex structurally, and simpler to traverse for searching and retrieval. CONCLUSION: In combination with appropriate software, CLP-ML is designed to support electronic authoring, reviewing, distributing, and searching of clinical laboratory procedures from a central repository, decreasing procedure maintenance effort and increasing the utility of procedure information. A standard electronic procedure format could also allow laboratories and vendors to share procedures and procedure layouts, minimizing duplicative word processor editing. Our results suggest that laboratory-specific markup such as CLP-ML will provide greater benefit for such systems than generic markup.

Clinical Laboratory Information Systems↗
PubMed2006

Postoperative complications following gingival augmentation procedures.

BACKGROUND: Postoperative pain, swelling, and bleeding are the most common complications following soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to compare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial connective tissue grafting (SCTG) procedures; 2) to evaluate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these complications. METHODS: Seventy-five FSTG and 256 SCTG procedures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autogenous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regarding postoperative pain, swelling, and bleeding. Data were analyzed using the chi2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped together. RESULTS: The duration of surgical procedures was highly correlated with pain or swelling post-surgically (P = 0.001). Current smokers were three times more likely to experience post-surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post-surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively). CONCLUSIONS: Long surgical procedures and smoking may increase the severity and frequency of certain post-surgical complications after gingival augmentation procedures. FSTG procedures incur a higher likelihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding.

Adult↗