Surgery
-
Simulation-based programs allow trainees to be progressively challenged in a systematic, learner-centered and patient-focused fashion. The design of these programs requires an understanding of the individual steps that comprise the entire surgical procedure and our ability to assess the progress of the learner. We present the results of the design and validation of performance assessment checklists for a progressive simulation-based program in cardiac surgery. ⋯ We have demonstrated the feasibility of designing simulation-based program for complex operative procedures in a progressive fashion. The complexity at each level was given by the predefined training objectives and assessment checklists were designed and validated as content-specific assessment tools for each simulation scenario.
-
Despite evidence that use of a checklist during the pre-incision time out improves patient morbidity and mortality, compliance with performing the required elements of the checklist has been low. In an effort to improve compliance, a standardized time out interactive Electronic Checklist System [iECS] was implemented in all hospital operating room (OR) suites at 1 institution. The purpose of this 12-month prospective observational study was to assess whether an iECS in the OR improves and sustains improved surgical team compliance with the pre-incision time out. ⋯ Implementation of a standardized, iECS can dramatically increase compliance with preprocedural time outs in the OR, an important and necessary step in improving patient outcomes and reducing preventable complications and deaths.
-
The Leapfrog Group aims to improve patient safety by promoting hospital compliance with National Quality Forum (NQF) safe practices. It is unknown, however, whether implementation of these safety practices improve outcomes after high-risk operations. ⋯ Despite having a greater rate of postoperative complications, hospitals fully complying with safe practices were associated with less failure to rescue and decreased mortality after high-risk operations. These results highlight the importance of having hospital systems in place to promote safety and manage postoperative complications.
-
Comparative Study
Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: comparative effectiveness of treatment modalities.
Insufficient data are available on the survival of recurrent hepatocellular carcinoma after primary hepatectomy in patients receiving different treatments. We evaluated retrospectively the effects of treatment modalities on long-term survival. ⋯ Postrecurrence survival in the re-resection and radiofrequency ablation groups was significantly better than that in the transarterial chemoembolization group and similar to that of patients in the primary resection without recurrence group.