Confidence In Surgery Research Articles

Noninvasive disconnection of targeted neuronal circuitry sparing axons of passage and nonneuronal cells.

Surgery can be highly effective for the treatment of medically intractable, neurological disorders, such as drug-resistant focal epilepsy. However, despite its benefits, surgery remains substantially underutilized due to both surgical concerns and nonsurgical impediments. In this work, the authors characterized a noninvasive, nonablative strategy to focally destroy neurons in the brain parenchyma with the goal of limiting collateral damage to nontarget structures, such as axons of passage. Low-intensity MR-guided focused ultrasound (MRgFUS), together with intravenous microbubbles, was used to open the blood-brain barrier (BBB) in a transient and focal manner in rats. The period of BBB opening was exploited to focally deliver to the brain parenchyma a systemically administered neurotoxin (quinolinic acid) that is well tolerated peripherally and otherwise impermeable to the BBB. Focal neuronal loss was observed in targeted areas of BBB opening, including brain regions that are prime objectives for epilepsy surgery. Notably, other structures in the area of neuronal loss, including axons of passage, glial cells, vasculature, and the ventricular wall, were spared with this procedure. These findings identify a noninvasive, nonablative approach capable of disconnecting neural circuitry while limiting the neuropathological consequences that attend other surgical procedures. Moreover, this strategy allows conformal targeting, which could enhance the precision and expand the treatment envelope for treating irregularly shaped surgical objectives located in difficult-to-reach sites. Finally, if this strategy translates to the clinic, the noninvasive nature and specificity of the procedure could positively influence both physician referrals for and patient confidence in surgery for medically intractable neurological disorders.

SOCIUS Mentoring-A Novel Course to Encourage Students for a Career as Surgical Oncologists.

Surgical disciplines are affected by an increasing shortage of young doctors. Studies show that formerly interested students decide against a career in surgical disciplines at the end of their studies or during practical year. Measures to counteract this development are urgently needed. As a joint project between gynecology, urology, and general surgery, SOCIUS mentoring was designed to prepare and encourage students for a career in surgical oncology. The structured curriculum of SOCIUS mentoring contains six modules, including surgical skills, soft skills, mentoring, theory, clinical visitation, and congress participation and runs over one year. Effects on confidence towards physician skills and plans for a future career were evaluated with questionnaires. After participation, students reported increased confidence in surgical and soft skills. In addition, participants noted that they have specified their career goals and gained more confidence in surgery, as well as seeing more development potential for a career in surgery. We describe the implementation of a novel extracurricular program for motivated students that combines individual mentoring with surgical and soft skills training. Due to its modular structure, this concept can easily be transferred to other disciplines. SOCIUS mentoring, with its combination of mentoring and skills training, is a promising measure to prepare and motivate students for their surgical career and thus counteract the shortage of young talent.

Surgery, Success, and the Role of the Patient in Cleft Palate Operations, circa 1800–1930

In the nineteenth and early twentieth centuries, scientific and technological developments made surgery safer, more reliable, and, with the corresponding increase in experimentation permitted, more exploratory and successful than ever before. The age of the heroic surgeon, however, obscured procedures that relied on the patient’s cooperation for a final, positive outcome. This essay focuses on the debates surrounding cleft palate surgery in Britain, Europe, and North America between about 1800 and 1930, where the constancy of failure dogged the surgeon, even with improved operative surroundings. Although an anatomical correction could eventually be secured by surgery, without the patient’s participation in learning “normal” speech, the ultimate result was unsuccessful. Patient responsibility and self-control became, therefore, the key to success. By exploring what this meant for patients, their families, and surgeons, a new way of thinking about surgical outcomes, even during a period of increasing confidence in surgery, can be posited.

A malpractice: Stripping of the great saphenous vein without the division of the side-branches at the saphenofemoral junction.

To highlight the components of stripping operation of the great saphenous vein and to offer a proposal for guidelines. 7789 admissions with venous insufficiency during the period, reaching seven and a half years were evaluated. Seventy- two admissions of nineteen patients were related to the recurrent symptoms due to previous incomplete stripping surgery. Doppler ultrasonography evaluations were made. The remained venous segment from the first operation was excised in the second operation. Mean duration between two operations was 7.44 years. Preoperative clinics were changing between C2s and C5 according to CEAP classification. Only nine patients could be persuaded to undergo the second operation. The remaining six patients rejected the second operation. While the patients who were operated on for the second time regained their health, others became the epitome of hopelessness and mistrust. They lost their confidence in medicine and surgery. If a stripping operation is planned, it should be performed in full accordance with the surgical procedure of stripping as mentioned in the classical textbooks. Guidelines should contain expressions reminding of ethical issues. This will prevent the dereliction of the duty and the loss of money, labor, time, health, patients' confidence in surgery (Tab. 1, Fig. 1, Ref. 18) Keywords: ethics, malpractice, quality of life, venous, saphenous, stripping.

Do Oral and Maxillofacial Surgery (OMFS) Posts Improve Oral and Dento-Alveolar Surgery Confidence in Dental Core Trainees (DCTs)?

Do Oral and Maxillofacial Surgery (OMFS) Posts Improve Oral and Dento-Alveolar Surgery Confidence in Dental Core Trainees (DCTs)?

Truth, Trust, and Confidence in Surgery, 1890–1910: Patient Autonomy, Communication, and Consent

During the late nineteenth century, there was a dramatic rise in the number of surgical procedures that doctors were prepared to attempt. This article discusses why there was also a rise in the number of people who were prepared to submit to all of these operations. Contrary to popular assumptions, many nineteenth- century patients did not lack effective autonomy. Their consent to surgery could not be taken for granted, especially as surgery was expensive compared with many other forms of treatment. Persuading patients that surgery could help them was an active process, and patients and their friends were often provided with pertinent information, especially in cases in which the doctors themselves had doubts about an operation. Faith in the theoretical possibility of safe surgery may have been just as important in contributing to doctors' increased willingness to operate as any improvement in practical results. A key factor in the rising popularity of surgery with both doctors and patients was not so much better surgical results as it was confidence in the possibility of better surgical results and the ways in which this confidence was communicated from doctors to patients.

Analysis of patient response to preoperative computerized video imaging.

Preoperative computer-assisted video imaging was performed on 50 consecutive rhinoplasty candidates, along with routine preoperative photographs and assessment. Each patient then completed a questionnaire dealing with the imaging process. Patient acceptance of the imaging process was excellent. Responses indicated that most patients felt that video imaging improved communication between patient and surgeon, increased patient confidence in surgery and surgeon, and enhanced the patient-physician relationship. The future use of computer-assisted video imaging in teaching, preoperative planning, and improved post-operative patient satisfaction is discussed.