Purpose of reviewIn the last decade, video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with unstable vital signs who require larger surgical incisions to check bleeding, this endoscopic surgery could be emp

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Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma.

Introduction Predictors of student performance on clerkship rotations are limited. In this study, we aim to identify predictors of success on the surgery clerkship. Methods 62 third-year medical students completed an institution-specific clerkship survey. Students were grouped according to clerkship grade of honors (HG) versus high-pass or pass (PG). Statistical analyses were performed using Student's t-test, Pearson's Chi-square/Fisher's exact test, and linear regression analysis. Multivariate logistic regression was performed to identify predictors of achieving an honors on the clerkship. Results HG students were more likely to be individual-based learners with higher grit and USMLE Step 1 scores compared with PG students. Moreover, USMLE Step 1 score was associated with quiz, shelf examination, and final clerkship grades, but not clinical evaluations. There were few differences with regard to preferred learning modalities, but overall, medical students favored active learning activities. Conclusions We found that higher USMLE Step 1 score, higher grit score, and an individual-based learning style were associated with a higher grade on the surgery clerkship. However, these factors may not fully capture the less objective components of high performance. Additional methods by which educators can measure students’ clinical competency are needed.

Predictors of medical student success on the surgery clerkship.

Lytic Therapy for Retained Traumatic Hemothorax: A Systematic Review and Meta-analysis.

Background Despite increasing usage since their introduction, there exist no evidence-based guidelines on all-terrain vehicles (ATVs) and injury prevention. While the power and speed of these vehicles has increased over time, advancements in ATV safety have been rare. Methods A priori questions about ATV injury pattern and the effect of helmet and safety equipment use and legislation mandating use were developed. A query of MEDLINE, PubMed, Cochrane Library, and Embase for all-terrain vehicle injury was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. Grading of Recommendations Assessment, Development, and Evaluation methodology was used to perform a systematic review and create recommendations. Results Twenty-eight studies were included. Helmet use reduced traumatic brain injury (TBI). However, studies examining whether legislation mandating helmet use reduced TBI had mixed results. When ATV safety legislation was enforced, overall injury rates and mortality decreased. However, enforcement varied widely and lack of enforcement led to decreased compliance with legislation and mixed results. There was not enough evidence to determine the effectiveness of non-helmet-protective equipment. Conclusion Helmet use when riding an ATV reduced the rate of TBI. ATV safety legislation, when enforced, also reduced morbidity and mortality. Compliance with laws is often low, however, possibly due to poor enforcement. We recommend helmet use when riding on an ATV to reduce TBI. We conditionally recommend implementing ATV safety legislation as a means to reduce ATV injuries, noting that enforcement must go hand in hand with enactment to ensure compliance.

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Prevention of all-terrain vehicle injuries: A systematic review from The Eastern Association for the Surgery of Trauma.

Objective:To identify clinical or demographic variables that influence long-term mortality, as well as in-hospital mortality, with a particular focus on the effects of age.Summary and Background Da...

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Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture.

Background When retained hemothorax occurs, video-assisted thoracoscopy or thoracotomy is performed, but recently, tissue plasminogen activator (tPA) has been used. This study evaluated intrapleural tPA use for retained traumatic hemothoraces. Methods A retrospective review was conducted of trauma patients treated with intrapleural tPA for retained hemothorax. Data included demographics, past medical and surgical histories, injury details, treatment details, and outcomes. Results Seven patients (median age=47 years, male=6, blunt trauma=6) met study criteria. All patients received a chest tube. Six patients later received computed tomography-guided drains for tPA infusion. Number of tPA treatments per patient varied from 1 to 5. Median total tPA dosage was 24 mg. Median time from injury to chest tube placement was 11 days and from chest tube placement to first tPA treatment was 4 days. No patients required a video-assisted thoracoscopy; however, 1 patient required thoracotomy. There were no deaths or bleeding complications attributed to intrapleural tPA. Conclusion Although future studies are needed to identify optimum treatment guidelines, intrapleural tPA appears to be a safe and efficacious treatment option.

http://lib.ajaums.ac.ir/booklist/497AJ_surgery.pdf

Evaluation of chest tube administration of tissue plasminogen activator to treat retained hemothorax

Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5%) had a sensory deficit alone, 4 (2.9%) had a motor deficit alone, and 4 (2.9%) had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6%) underwent formal swallow evaluation, and 4 (2.9%) had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9%) had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%), or to home or home with home health (n = 48, 35.3%). Seven patients (5.1%) died in the hospital, and eight more (5.9%) were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.

Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia.

Background In 2006, the Residency Review Committee for Surgery increased the total number of required endoscopy cases for graduating residents. Our goal was to evaluate general surgery resident competency in endoscopy, focusing on quality measures. Methods A 9-year retrospective review was conducted of 29 residents. Total number of endoscopies performed throughout residency was recorded. Procedures performed as fifth-year residents with indirect supervision were evaluated for quality measures. Results An average of 76 esophagogastroduodenoscopies and 147 colonoscopies were performed through their first 4 years of residency. Chief residents performed an average of 16 esophagogastroduodenoscopies and 22 colonoscopies. Of colonoscopies performed during their fifth year, 191 were performed while the resident had only indirect supervision. During these cases, cecal intubation was achieved in 90.6% of cases, an average of .48 polyps were identified, and average scope withdrawal time was 13.4 ± 7.1 minutes. Conclusions Our data indicate that surgery residents achieve competency in colonoscopy before performing 140 colonoscopies, supporting the concept that surgery residencies can function as an excellent training ground for endoscopy.

Achieving endoscopic competency in a general surgery residency

All-terrain vehicle accidents in children.

BACKGROUND: Some medical school training consists of oral examinations. METHODS: We conducted a 9-year review of third-year medical student examinations including oral examinations, National Board of Medical Examiners Surgery Subject Examination (SSE, ie, shelf), and United States Medical Licensing Examinations Step 1 and Step 2. RESULTS: Step 1 showed a moderate to strong association with Period 1 orals (Somers’ D 5 .297, P ,.001), but not Period 2 orals (Somers’ D 5 .048, P 5.053). Period 1 orals (percentage) had a strong association with SSE (Somers’ D 5 .356, P ,.001) and Step 2 (Somers’ D 5 .368, P ,.001). Period 2 orals (pass/fail) suggested a positive, but not statistically significant, association with SSE (Somers’ D 5 .334, P 5 .085) and Step 2 (Somers’ D 5 .370, P 5 .055). Step 1 shows a strong association with SSE (Somers’ D 5 .490, P , .001). SSE showed a strong association with Step 2 (Somers’ D 5 .506, P , .001). CONCLUSIONS: Orals can be used to identify students who may have difficulty passing the SSE. Step 1 can be used to identify students at risk of poor performance on the SSE, and SSE can be used

http://lib.ajaums.ac.ir/booklist/665AJ_surgery.pdf

Rachel M. Drake

Papers

Evaluation of chest tube administration of tissue plasminogen activator to treat retained hemothorax

Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia.

Achieving endoscopic competency in a general surgery residency

All-terrain vehicle accidents in children.

Do medical student's surgical examination scores correlate with performance markers?