Perspectives of faculty and residents while overlapping were different in emphasis. Better understanding faculty-resident interactions, individual behaviors, contextual influences, and national regulations that influence intraoperative education have the potential to significantly affect progressive entrustment in training paradigms.
This study demonstrated an increasing incidence of metopic craniosynostosis over time, which ascended to the second most common type of synostosis in an analysis outside of an urban environment. In our study, male sex and multiple gestation were positively associated with an increased risk of metopic craniosynostosis. Prospective studies are needed to further delineate the evolving characteristics of this patient population.
Statistically significant trends in screening and testing for OSA in the setting of VPD were identified by this survey. Notably, older surgeons were less likely to investigate OSA in their patients, and not all specialties equally refer for postoperative sleep studies.
Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.
Thurner syndrome in prescheduled abdominal contrastenhanced CTs, performed for reasons unrelated to venous disease. Patients with history of deep venous thrombosis were excluded. Three measurement techniques were employed: 1) diameter measurement in axial CT images 2) diameter measurement in multiplanar reconstructions (MPR) orthogonal to the line of blood flow 3) manual measurement of the cross-sectional area in reconstructions orthogonal to the line of blood flow. The percentage of compression of the common iliac vein was measured by comparing it with the diameter/cross sectional area measured above the ipsilateral confluence of the external and internal iliac vein. Differences among the three methods of assessment were assessed by analysis of variance (ANOVA). Results: ANOVA showed statistically significant differences among the three methods of assessment (F¼121.7, p<0.001). More specifically, mean percentage of stenosis assessed by axial imaging (54.8+/-12.9%) was significantly higher compared to mean percentage of stenosis assessed by area (20.2+/-14.2%); p<0.001. Similarly, mean percentage of stenosis assessed by MPR (51.5+/-9.1%) was also higher than mean percentage of stenosis assessed by area (p<0.001). No statistically significant difference was found between mean degree of stenosis assessed by axial imaging and MPR (p¼0.54). Conclusion: Diameter measurements in CT scans for assessment of May Thurner syndrome tend to overestimate stenoses when compared to area measurements. Area measurements in reconstructions orthogonal to the line of blood flow may provide a more accurate method of assessing these lesions and should be validated against other methods, such as IVUS. Based on our findings, the use of diameter measurements as a method of assessing iliac venous lesions should be reconsidered.
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