Surgery
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Obesity has been identified as one of the most important public health concerns in both children and adolescents. Unfortunately, even the most comprehensive and aggressive multidisciplinary weight management programs have shown only modest weight loss results. There has been increasing enthusiasm for bariatric surgery for adolescent patients with morbid obesity. Because of the relatively high morbidity and mortality associated with gastric bypass surgery, we have begun to explore laparoscopic sleeve gastrectomy as an alternative. We hypothesized that it would be a safe and effective short-term strategy. ⋯ Laparoscopic sleeve gastrectomy is a safe operation for adolescent patients with morbid obesity and represents an effective early treatment strategy with approximately 40% excess weight loss at 6 months and 1 year of follow-up. Because of the minimal morbidity associated with laparoscopic sleeve gastrectomy, it may be the optimal non-device surgical option for this select group of adolescent patients.
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Comparative Study
Can skills coaches be used to assess resident performance in the skills laboratory?
The purpose of this study was to compare faculty ratings between live versus video-recorded resident performances and faculty versus skills coaches' ratings of video-recorded resident performances. ⋯ When assessing residents' performances, use of video-recorded performance ratings and skills coaches may be viable alternatives to live ratings performed by surgical faculty.
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Major trauma is an independent risk factor for developing venous thromboembolism. While increases in thrombin generation and/or procoagulant microparticles have been detected in other patient groups at greater risk for venous thromboembolism, such as cancer or coronary artery disease, this association has yet to be documented in trauma patients. This pilot study was designed to characterize and quantify thrombin generation and plasma microparticles in individuals early after traumatic injury. ⋯ Patients with blunt trauma have greater numbers of circulating procoagulant microparticles and increased in vitro thrombin generation. Future studies to characterize the cell-specific profiles of microparticles and changes in thrombin generation kinetics after traumatic injury will determine whether microparticles contribute to the hypercoagulable state observed after injury.
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Laparoscopic bariatric surgery is a safe and effective way of treating morbid obesity. However, the operations are technically challenging and training opportunities for junior surgeons are limited. This study aims to assess whether virtual reality (VR) simulation is an effective adjunct for training and assessment of laparoscopic bariatric technical skills. ⋯ This study shows that the bariatric module on a VR simulator demonstrates construct and content validity. VR simulation appears to be an effective method for training of advanced bariatric technical skills for surgeons at the start of their bariatric training. However, assessment of technical skills should still take place on cadaveric tissue.
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Comparative Study
Residents' perspectives of the value of a simulation curriculum in a general surgery residency program: a multimethod study of stakeholder feedback.
Simulation has altered surgical curricula throughout residency programs. The purpose of this multimethod study was to explore residents' perceptions of simulation within surgical residency as relevant stakeholder feedback and program evaluation of the surgery simulation curriculum. ⋯ Residents acknowledge the value of simulation in patient safety, quality, and exposure to procedures before clinical experience, but remain divided on efficacy and requirement of simulation within curricula. The greater challenge to residency programs may be strategic implementation of simulation curricula within the right training context.