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At least 1,333 records · Page 74Linked to original sources
PubMed2005

Radiation-reducing planning of cardiac catheterisation.

Any radiation exposition for medical purposes should be kept as low as is reasonably achievable. Mean patient radiation exposure of diagnostic cardiac catheterisation is high (16-106 Gy x cm2) and for this reason the International Commission on Radiological Protection (ICRP) recommends credentialing radiation protection training programmes. Twenty cardiologists each documented various dose parameters of 10 cardiac catheterisations, before and after a 90-minute mini-course of the ELICIT study group ("Encourage to Less Irradiating Cardiologic Interventional Techniques"), and could achieve a reduction of the mean dose-area product by 15.9+/-9.0 Gy x cm2, equivalent to 47%. The presented radiation-reducing planning of invasive cardiac catheterisation for this reason is the first one validated in clinical routine and consists of 6 standard runs--one for the left ventricle, 3 and 2 for the left (LCA) and right coronary artery (RCA), respectively--depending on anatomy and findings supplemented by 1...4 special projections. The caudal posteroanterior (PA) view documents the left coronary main stem, proximal and distal left anterior descending artery (LAD), and proximal and mid circumflex segments. The cranial PA view however is suitable for the left coronary orifice, circumflex periphery, LAD, all diagonal bifurcations, and collateral pathways towards the RCA. LCA standard angiography is completed by lateral 90 degrees/0 degrees left anterior oblique (LAO) angulation. The 60 degrees/0 degrees LAO angulation visualises the right posterolateral artery (RPL) and the RCA to its bifurcation. The more proximal one finds the bifurcation, the more the second standard cranial PA view for RCA should vary towards the cranial right anterior oblique (RAO) and finally 30 degrees/0 degrees RAO view. The efficiency of these less-irradiating angulations are improved by radiation-reducing techniques as follows: restriction to essential radiographic frames and runs, consistent collimation to the region of interest--particularly during coronary intubation--, adequate instead of best possible image quality, short skin-to-image-intensifier distance, inspiration during radiography, preference for projections that rotate out the spine, optimisation of fluoroscopy time, well-experienced and well-rested interventionists.

Body Burden↗
PubMed2002

Metrics for objective Assessment.

As the need for improved methods of assessing surgical competence grows, it is imperative to establish the basic infrastructure to ensure the ability to communicate among educators, education researchers, responsible training bodies, and credentialing boards. A workshop was conducted to provide a foundation for communication and a standardization of definitions, measurements, and criteria. Future conferences and workshops will be needed to review and refine this initial framework.

Australia↗
PubMed2004

Robotic surgery update.

BACKGROUND: Minimally invasive surgical techniques have revolutionized the field of surgery. Telesurgical manipulators (robots) and new information technologies strive to improve upon currently available minimally invasive techniques and create new possibilities. METHODS: A retrospective review of all robotic cases at a single academic medical center from August 2000 until November 2002 was conducted. A comprehensive literature evaluation on robotic surgical technology was also performed. RESULTS: Robotic technology is safely and effectively being applied at our institution. Robotic and information technologies have improved upon minimally invasive surgical techniques and created new opportunities not attainable in open surgery. CONCLUSIONS: Robotic technology offers many benefits over traditional minimal access techniques and has been proven safe and effective. Further research is needed to better define the optimal application of this technology. Credentialing and educational requirements also need to be delineated.

Analysis of Variance↗
PubMed2001

Automated high-frequency posture sampling for ergonomic assessment of laparoscopic surgery.

BACKGROUND: Despite widespread acknowledgement that strain injuries do occur to surgeons, ergonomic assessments in minimally invasive surgery are comparatively rare. Current assessment techniques rely on labor-intensive manual recording techniques, so there is a need for an automated system. METHODS: We used an optoelectronic measurement system to make postural measurements at frequencies of ~5 Hz and then converted these measurements to ergonomic stress scores using a modified Rapid Upper Limb Assessment (RULA) method. RESULTS: We successfully recorded postures at least once per second during 96% of the time the surgeon was performing tissue manipulation tasks. We found that the ergonomic stress scores were comparatively high throughout the procedure, particularly for the wrist. CONCLUSION: An automated high-frequency postural measurement system is feasible for making ergonomic assessments in an intraoperative setting. Such a system will also be a critical component in validating surgical simulations for use in training and credentialing surgeons and in designing and evaluating equipment.

Biomechanical Phenomena↗
PubMed1997

Telesurgical mentoring. Initial clinical experience.

BACKGROUND: Minimally invasive surgical techniques yield significant individual, economic, and social benefits when performed by experienced surgeons. Unfortunately, many of these techniques, such as laparoscopy, are associated with steep learning curves, and the incidence of complications has clearly been shown to be inversely related to experience. The initial high complication rate and the dearth of experienced endoscopic surgeons have raised concerns over training, granting of hospital privileges, and most importantly patient safety. The goal of this study was to employ current telecommunications technology in a system for the mentoring of relatively inexperienced surgeons. Therefore, we created a telesurgical system that would allow an endoscopic specialist at a central site to offer guidance and assistance to a surgeon during a laparoscopic procedure. METHODS: We developed a system that connected a central site and an operative site, a distance of approximately 3.5 miles, via a single T1 (1.54 Mbs) point-to-point communications link. The system provided real-time video display from either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, control of a robotic arm that manipulated the laparoscope, and access to electrocautery for tissue cutting or hemostasis. RESULTS: Seven patients underwent laparoscopic procedures using the telesurgical consultation system over the communications link. In all cases, the primary surgeon had limited experience with the laparoscopic approach but still had the basic skills required to obtain intraperitoneal access. All seven cases were completed successfully without complications. CONCLUSION: These initial studies have demonstrated the feasibility, effectiveness, and safety of telementoring. Telesurgical applications have the potential to greatly improve surgical education credentialing, and patient care by offering patients and their surgeons global access to surgical specialists.

Humans↗
PubMed2005

How do connectionist networks compute?

Although connectionism is advocated by its proponents as an alternative to the classical computational theory of mind, doubts persist about its computational credentials. Our aim is to dispel these doubts by explaining how connectionist networks compute. We first develop a generic account of computation-no easy task, because computation, like almost every other foundational concept in cognitive science, has resisted canonical definition. We opt for a characterisation that does justice to the explanatory role of computation in cognitive science. Next we examine what might be regarded as the "conventional" account of connectionist computation. We show why this account is inadequate and hence fosters the suspicion that connectionist networks are not genuinely computational. Lastly, we turn to the principal task of the paper: the development of a more robust portrait of connectionist computation. The basis of this portrait is an explanation of the representational capacities of connection weights, supported by an analysis of the weight configurations of a series of simulated neural networks.

Cognitive Science↗
PubMed2005

Use and abuse of bioethics: integrity and professional standing.

This paper sets out to examine the integrity and professional standing of "Bioethics." It argues that professions have certain responsibilities that start with setting criteria for and credentialing those that have met the criteria and goes on to ultimately have social responsibilities to the community. As it now stands we claim that Bioethics--while it certainly has achieved some progress in the way medicine has developed--has failed to become a profession and has to a large extent failed in its social responsibility. We feel that Bioethics has to define itself, set criteria for membership in the profession, police itself and--above all--meet its social responsibility to become a profession meriting that name.

Attitude of Health Personnel↗
PubMed2005

Intraoperative monitoring using somatosensory evoked potentials. A position statement by the American Society of Neurophysiological Monitoring.

OBJECTIVE: To provide an educational service to the intraoperative neurophysiologist community by publishing a position statement by the American Society of Neurophysiological Monitoring on the recommended appropriate and correct use of somatosensory evoked potentials as an intraoperative neurophysiological monitoring tool to protect patient well-being during surgery. This position statement presents the somatosensory evoked potential utilization basis, relevant anatomy, patient preparation, important systemic factors, anesthesia considerations, safety and technical considerations, documentation requirements, neurophysiologist credentials and staffing practice patterns, and monitoring applications for protecting brain, spinal nerve root, peripheral nerve, plexus and spinal cord function. In conclusion, a summary of major recommendations regarding the use of somatosensory evoked potentials in intraoperative neurophysiological monitoring is presented.

Electric Stimulation↗
PubMed2026

Structured robotic colorectal training in a non-tertiary NHS hospital: a 502-case consecutive cohort implementation study.

Robotic-assisted colorectal surgery has expanded rapidly across NHS practice in the UK. Structured unit-wide training pathways are essential for safe technology adoption, yet published outcome data from non-tertiary hospitals remain limited. This study describes the implementation and feasibility of a unit-wide robotic colorectal program at a high-volume non-tertiary hospital, reporting outcomes across 502 consecutive resections performed by eight consultant surgeons and presenting these in the context of nationally published benchmarks. A retrospective cohort study of 502 consecutive robotic colorectal resections performed at York Teaching Hospital between May 2022 and December 2025. Eight consultant surgeons (A-H) participated in a structured four-phase training pathway incorporating simulation training, proctored cases, complexity-based case progression, and formal credentialing. Primary outcomes were 30-day mortality, unplanned return to theatre (RTT), and anastomotic leak (AL). Anastomotic leak was calculated using only patients who underwent anastomosis as the denominator. Procedure-stratified and individual surgeon outcomes with 95% confidence intervals were reported. Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to evaluate learning curves. Outcomes are presented descriptively alongside nationally published reference data; no formal statistical comparison against national benchmarks was performed. 502 robotic colorectal resections were performed. Mean patient age was 70.0 ± 11.3 years; 58.4% were male. Median ASA grade was III. The indication was malignancy in 89.2% of cases. Length of stay was non-normally distributed and is therefore reported using median and interquartile range in the revised analysis. Key outcomes: - 30-day mortality: 1.0% (5/502; 95% CI 0.4-2.3%) - Unplanned return to theatre (RTT): 5.2% (26/502; 95% CI 3.6-7.5%) - Anastomotic leak (AL): 3.3% (15/450; 95% CI 2.0-5.5%; denominator = patients with anastomosis) - 30-day unplanned readmission: 5.0% (25/502; 95% CI 3.4-7.2%) - Conversion to open surgery: 3.6% (18/502; 95% CI 2.3-5.6%) - Lymph node yield ≥12: 91.3% of cancer resections - R0 resection rate: 95.1% of cancer resections All primary outcomes fell within or below the published reference ranges used for descriptive context. RA-CUSUM trajectories were heterogeneous: no surgeon crossed the predefined upper control limit, but several curves showed later upward movement. Accordingly, the analysis is interpreted as safety surveillance rather than evidence of uniform performance improvement. RA-CUSUM monitoring showed that no surgeon crossed the predefined upper control limit; however, heterogeneous trajectories precluded a claim of uniform performance improvement.

Humans↗
PubMed2003

Future prospects in cardiac magnetic resonance imaging.

To appreciate the impact that key developments will have on the future of cardiovascular magnetic resonance (CMR) imaging, it is instructive to consider its present status. CMR has passed the threshold of being used primarily by innovators, and is now in the early adopter stage. To reach this threshold has taken many years, but its adoption by early majority users is expected to accelerate the growth of CMR. A number of factors govern its natural growth potential, including physician education and credentialing, scanner availability, technology, and reimbursement policies. The intrinsic dimensional accuracy of CMR, coupled with its high level of reproducibility, make it ideal for inclusion in trials, potentially with dramatic reductions in trial duration and the number of subjects required. Clinically, there are a number of applications for which CMR is widely regarded as being the diagnostic test of choice. Software and hardware developments that speed up the basic CMR procedure are being incorporated into scanners, extending the functionality of routine applications such as flow imaging and tag visualization. Exciting areas that are close to routine application include coronary artery imaging, and evaluation of myocardial perfusion and viability status.

Heart Diseases↗
PubMed1991

Traditional versus laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is a minimally invasive procedure whereby the gallbladder is removed using laparoscopic techniques. The indications are similar to those for elective traditional cholecystectomy, but selection of patients is important for success. Contraindications are currently evolving. Patients with advanced cholecystitis, abdominal sepsis, ileus, bleeding disorders, pregnancy, and morbid obesity should not undergo this procedure. The procedure requires good traditional surgical skills, as well as additional laparoscopic (and laser) skills. Operative time is slightly longer than for traditional cholecystectomy, but decreases with experience. Morbidity is low, but there is a concern about bile duct injuries. Mortality is very low (0%) and is comparable to traditional cholecystectomy (0.4%). The major advantages of laparoscopic cholecystectomy are the short hospital stay (average: 2 days) and early return to normal activity (7 days). This results in a reduction in hospital costs. Adequate training and credentialing are important processes to foster good patient outcomes.

Cholecystectomy↗
PubMed1988

The seed stock concept and quality control for cell lines.

Procedures for the characterization of cell culture lines are reviewed. It is recommended that seed stocks be developed and that major quality-control efforts be applied first to those holdings, with essential tests repeated on cultures from working or distribution stocks prepared subsequently. Steps are taken throughout to ensure absence of microbial contaminants. Mycoplasma are especially troublesome. Investigators need also to be aware of potential endogenous viruses which may be hazardous or interfere with interpretation of results. Cell line species and absolute identities are established by fluorescent antibody staining, by determination of isoenzyme profiles, and by cytogenetic analyses. Additional characterizations will vary with cell type but may include tests for specific products, cytoskeletal proteins, tissue specific antigens, or immunoglobulins. Credentials of lines added to a collection plus representative cultures can be returned to the originators for concurrence before distribution. Advisory committees may be established as circumstance dictates to provide additional expertise regarding quality control for the specific collection being developed.

Cell Line↗
PubMed1993

Different vascular reactivity of human internal mammary and inferior epigastric arteries in vitro.

Vascular responses to endogenous agonists may determine patency rates of bypass graft conduits. The effect of constrictors (noradrenaline, phenylephrine, serotonin, histamine, angiotensin II) and dilators (acetylcholine, substance P, bradykinin, nitroglycerin) were compared in human internal mammary and inferior epigastric arteries in vitro. The latter vessel type has been recently advocated as an additional conduit for coronary artery bypass grafting. Whereas the alpha-adrenoceptor- (noradrenaline, phenylephrine) and serotonin receptor-mediated contractions were similar in both vessels, histamine-induced contractions were greatly enhanced in internal mammary arteries (maximal responses in percent of 80 mmol/L KCl, 131% +/- 15% versus 59% +/- 8%). Maximal contractions in response to angiotensin II were greater in inferior epigastric arteries (50% +/- 6% versus 25% +/- 5%). The endothelium-independent relaxations in response to nitroglycerin were identical in both vessels. In contrast, the endothelium-dependent relaxations in response to acetylcholine, substance P, and bradykinin were significantly greater in the inferior epigastric than in the internal mammary arteries (maximal relaxations expressed as percent of prostaglandin F2 alpha-induced precontraction: acetylcholine, 94% +/- 5% versus 77% +/- 5%; substance P, 85% +/- 4% versus 24% +/- 5%; bradykinin, 77% +/- 5% versus 26% +/- 3%). It is concluded that the inferior epigastric artery has a high endothelial capacity to release endothelium-derived relaxing factor. It appears that the inferior epigastric artery possesses credentials to be successfully used for coronary artery bypass grafting.

Abdominal Muscles↗
PubMed1992

Quality assurance and morbidity and mortality conference.

Many surgeons assert that Morbidity and Mortality (M & M) conference in itself assures an effective quality assurance (QA) program. Recent emphasis on QA in other sectors has resulted in other processes for evaluating quality of care. The goals of QA programs are to identify adverse patient care events, relate these to specific physicians and use this information to improve patient care, and for credentialing and privileging physicians. Our aim was to determine the role of surgical M & M conference in a QA program which also includes occurrence screening, wound infection surveillance, and surgical case review. The weekly M & M conference is a discussion of identified complications and deaths submitted voluntarily by surgeons. During a 2-year period 5755 procedures were associated with 255 complications and 82 deaths. Only 74% of events identified by occurrence screening, 35% of cases identified by surgical case review, and 54% of wound infections had been submitted to M & M conference. Seventy-four percent of surgical residents and 33% of staff surgeons were present at M & M conference when their complications were discussed. Level of care (I, accepted practice; II, may have managed differently; and III, would have managed differently) was assessed for each complication at M & M conference and by peer review of the medical record for occurrence screening.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMedDate not supplied

Mandatory advanced degrees for CNMs. Developing compromise.

Higher education is seen as a step in the right direction for credentialing health care provides. The difficulty lies in the continuation of nurse-midwifery certificate programs to increase the number of practicing certified nurse-midwives while maintaining high-quality care. The author offers some pragmatic solutions to this dilemma.

Education, Nursing, Graduate↗
PubMedDate not supplied

Guide to the use of the vacuum extractor by nurse-midwives.

The vacuum extractor has become a widely used instrument in many settings. It has proven to be a reliable method of ensuring safe passage of the fetus and/or enhancing maternal effort during the second stage of labor. The principles of vacuum-assisted birth are learned relatively easily and have been incorporated into many nurse-midwifery practices. This article reviews the principles of vacuum extraction as they apply to the practice of nurse-midwifery. Vacuum extractors available to nurse-midwives are compared. Nurse-midwives are familiarized with vacuum extraction so that they can make an informed choice concerning the vacuum extractor as an appropriate tool within their practice. This article is not intended to teach nurse-midwives to use the vacuum extractor. It does, however, provide guidelines for credentialing those nurse-midwives choosing to incorporate the principles of vacuum extraction into their practice.

Clinical Protocols↗
PubMedDate not supplied

Criteria for accreditation of direct-entry midwifery education.

The American College of Nurse-Midwives' Division of Accreditation criteria for accreditating direct-entry midwifery education call for programs to require baccalaureate degrees for entry or award them at conclusion of the program and require faculty to be midwives certified by the ACNM Certification Council. Neither criteria can be met by any existing direct-entry program. The authors argue against these criteria, based in part on familiarity with the Seattle Midwifery School. The paper describes the development of the Seattle Midwifery School, summarizes reasons for and against requiring degrees for midwifery education, argues against excluding faculty of existing direct-entry schools who are not certified by the ACNM Certification Council, notes other efforts to develop credentials for direct-entry midwives, and concludes that professional direct-entry midwifery must be based on widely respected, rigorous national standards.

Accreditation↗
PubMed1994

Survey of home visiting programs for abused and neglected children and their families.

This study reports on home visitation programs that provide services for abused and neglected children and their families. Data were collected as part of a national survey of home visiting programs. Of the 1,904 programs participating in the survey, 224 had as their primary focus services for children who were abused or neglected. For this group, data are presented on program characteristics, characteristics of home visits, credentials of home visitors, and program documentation procedures. The survey data showed that over 70% of the 224 programs identified social service as their organization affiliation which, in contrast to other providers, offered a broad range of services for the abused or neglected children and their families. The most frequently identified purpose for providing services was the social and emotional development of the child. Parenting skills and parent coping were considered the most important services. Stress management was considered more important by respondents of programs for maltreating families than by those providing services to nonmaltreating families. Approximately half the respondents reported that they required a bachelor's or master's degree for employment. Results are discussed in relation to research and practice implications.

Child↗