American journal of surgery
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Virtual reality (VR) is a potential tool for technical skills training. We tested the validity and instructional effectiveness of a prototype VR module for learning intravenous (i.v.) catheter placement. ⋯ Significant differences between groups were observed in performance of i.v. insertion in physical reality. However, no significant difference was observed in performance in VR. Thus, performance in VR demonstrated neither construct nor concurrent validity. While performance improved in VR, transfer of skill from VR to physical reality was not observed. Additional development and testing of VR as a training tool is warranted before its widespread use can be recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
Assessment of technical skills transfer from the bench training model to the human model.
This study examines whether technical skills learned on a bench model are transferable to the human cadaver model. ⋯ Training on a bench model transfers well to the human model, suggesting strong potential for transfer to the operating room.
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Randomized Controlled Trial Clinical Trial
The duration of antibiotic administration in penetrating abdominal trauma.
The epidemiology of penetrating abdominal trauma is changing to reflect an increasing incidence of multiple injuries. Not only do multiple injuries increase the risk of infection, a very high risk of serious infection is conferred by immunosuppression from hemorrhage and transfusion and the high likelihood of intestinal injury, especially to the colon. Optimal timing and choice of presumptive antibiotic therapy has been established for penetrating trauma, but duration has not been studied extensively in such seriously injured patients. The purpose of this study was to test the hypothesis that 24 hours of antibiotic therapy remains sufficient to reduce the incidence of infection in penetrating abdominal trauma. ⋯ Twenty-four hours of presumptive intravenous cefoxitin versus 5 days of therapy made no difference in the prevention of postoperative infection or length of hospitalization. Infection was associated with shock on admission to the emergency department, the number of intra-abdominal organs injured, colon injury specifically, and injury to the central nervous system. Intra-abdominal infection was predicted only by colon injury. Prolonged hospitalization was associated with intraoperative shock and injuries to the chest, colon, or central nervous system.
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Randomized Controlled Trial Clinical Trial
Effects of a protease inhibitor on reduction of surgical stress in esophagectomy.
To evaluate the efficacy of gabexate mesilate (GM) in reducing surgical stress after esophagectomy. ⋯ Reduction of systemic inflammatory response syndrome duration after esophagectomy by the continuous administration of gabexate mesilate started before operation may be through the suppression of TNF-alpha production capacity and Mac-1 expression on monocytes immediately after operation, and to suppression of increase in serum IL-6 level.
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The clinical advantages of laparoscopic procedures result from a minimized surgical trauma. The present study was performed to investigate immunosupression following laparoscopic operations as compared with open surgery. Our analysis focused on the T cell secretion of cytokines that regulate the critical balance of either T helper type-1 (Th1)- and Th2-mediated immune responses on pro- and antiinflammatory activities. ⋯ The present study shows that open, but not laparoscopic cholecystectomy is associated with a marked suppression of T lymphocytes functions as indicated by deregulation of both the Th1/Th2 and the pro-/anti-inflammatory cytokine balance. The results therefore suggest that downregulation of Th1 cell-mediated immune response and pro-inflammatory activity of T cells is a hallmark of open, but not laparoscopic surgery.