The Surgical clinics of North America
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With recent concerns regarding patient safety, and legislation regarding resident work hours, it is accepted that a certain amount of surgical skills training will transition to the surgical skills laboratory. Virtual reality offers enormous potential to enhance technical and non-technical skills training outside the operating room. ⋯ These systems can act as training and assessment tools, with the learned skills effectively transferring to an analogous clinical situation. Recent developments include expanding the role of virtual reality to allow for holistic, multidisciplinary team training in simulated operating rooms, and focusing on the role of virtual reality in evidence-based surgical curriculum design.
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Surg. Clin. North Am. · Jun 2010
ReviewEmerging trends that herald the future of surgical simulation.
For the first time in over 100 years, there is a revolution in surgical education. One of the most important core technologies generating this revolution is simulation science, which includes not only the technology of simulators but new curricula, objective assessment methods, and criterion-based requirements. By reviewing the current status of simulation and making comparisons with the emerging technologies, an analysis of the gaps can demonstrate the necessary direction for the future.
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The role of simulation in certification by the American Board of Surgery is in flux. Until 2010, there was no formal requirement for simulation of any kind in the certification process. Starting in 2010, successful completion of Fundamentals of Laparoscopic Surgery as well as Advanced Trauma Life Support and Advanced Cardiovascular Life Support is required for certification. Development of additional simulation measures is desirable, but standardization, validation, accessibility, and affordability all need to be addressed.
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Thoracic great vessel and cardiac trauma are characterized by anatomic location and mechanism of injury: blunt or penetrating. Management strategies are also directed by the extent and mechanism of injury. ⋯ Given the increasing sophistication of these technologies and the demonstrated usefulness of a disease-oriented approach toward patient management, trauma centers have adopted a multidisciplinary team model for management of multitrauma victims. In this review, the authors detail the diagnosis and management of blunt aortic, nonaortic great vessel, blunt cardiac, and penetrating cardiac injuries.
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Cardiovascular complications are infrequent but can result in significant morbidity following noncardiac surgery, especially in patients with peripheral vascular disease or increased age. All patients require some level of preoperative screening to identify and minimize immediate and future risk, with a careful focus on known coronary artery disease or risks for coronary artery disease and functional capacity. The 2007 American College of Cardiology/American Heart Association Guidelines are clear that noninvasive and invasive testing should be limited to circumstances in which results will clearly affect patient management or in which testing would otherwise be indicated. beta-Blocker therapy has become controversial in light of recent publications but should be continued in patients already on therapy, and started in patients with high cardiac risk undergoing intermediate- or high-risk surgery.