Browsing by Subject "complication"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Item Iatrogenic Critical Care Procedure Complication Boot Camp: A Simulation‐Based Pilot Study(Wiley, 2019) Riefkohl-Ortiz, Elaine; Frey, Jennifer A.; Yee, Jennifer; Gothard, M. David; Hughes, Patrick G.; Ballas, Derek A.; Ahmed, Rami A.; Emergency Medicine, School of MedicineBackground Traditional medical education strategies teach learners how to correctly perform procedures while neglecting to provide formal training on iatrogenic error management. Error management training (EMT) requires active exploration as well as explicit encouragement for learners to make and learn from errors during training. Simulation provides an excellent methodology to execute a curriculum on iatrogenic procedural complication management. We hypothesize that a standardized simulation‐based EMT curriculum will improve learner's confidence, cognitive knowledge, and performance in iatrogenic injury management. Methods This was a pilot, prospective, observational study performed in a simulation center using a curriculum developed to educate resident physicians on iatrogenic procedural complication management. Pre‐ and post‐intervention assessments included confidence surveys, cognitive questionnaires, and critical action checklists for six simulated procedure complications. Assessment data were analyzed using medians, interquartile ranges, and the paired change scores were tested for median equality to zero via Wilcoxon signed rank tests with p<0.05 considered statistically significant. Results Eighteen residents participated in the study curriculum. The median confidence increased significantly by a summed score of 12.5 (8.75 –17.25) (p<0.001). Similarly, the median knowledge significantly increased by 6 points (3 –8) from the pre‐ to post‐intervention assessment (p<0.001). For each of the simulation cases, the number of critical actions performed increased significantly (p<0.001 to p=0.002). Conclusion We demonstrated significant improvement in the confidence, clinical knowledge, and performance of critical actions after the completion of this curriculum. This pilot study provides evidence that a structured EMT curriculum is an effective method to teach management of iatrogenic injuries.Item Is Placing Prophylactic Dural Tenting Sutures a Dogma?(Elsevier, 2021-09) Eroglu, Umit; Zaimoğlu, Murat; Sayacı, Emre Yağız; Ugur, Ugur; Attar, Ayhan; Kahilogullari, Gokmen; Bozkurt, Melih; Ünlü, Mustafa Ağahan; Özgüral, Onur; Doğan, İhsan; Seçinti, Kutsal Devrim; Abbasoğlu, Bilal; Erdoğan, Koral; Gökalp, Elif; Yakar, Fatih; Çağlar, Yusuf Şükrü; Cohen-Gadol, Aaron; Neurological Surgery, School of MedicineObjective In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. Methods Results from 437 patients aged 18 to 91 years (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups, patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1), at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2), or no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. Results Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. Conclusion Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important.Item Life threatening hemobilia after endoscopic retrograde cholangiopancreatography (ERCP)(Elsevier, 2017) El Hajj, Ihab I.; Sherman, Stuart; Pyko, Maximilian; Lehman, Glen A.; Medicine, School of MedicineArterial vascular complication from endoscopic retrograde cholangiopancreatography (ERCP) is exceedingly rare. This report describes a life threatening hemobilia, from a pseudoaneurysm of the right hepatic artery (RHA), which occurred post ERCP. The pseudoaneurysm and the active bleed were diagnosed by selective angiography of the RHA, and successfully treated with stenting.Item Periprocedural safety of saccular aneurysm embolization with the Penumbra SMART Coil System: a SMART registry subset analysis(BMJ, 2021-02) Starke, Robert M.; Park, Min S.; Bellon, Richard; Bohnstedt, Bradley; Schirmer, Clemens M.; Leacy, Reade De; Fiorella, David; Yoo, Albert J.; Spiotta, Alejandro M.; Neurological Surgery, School of MedicineBackground Using data from the SMART registry, we report on periprocedural safety of the Penumbra SMART Coil System for endovascular coil embolization of saccular intracranial aneurysms. Methods The SMART registry was a prospective, multi-center registry of site standard of care endovascular coiling procedures performed using at least 75% Penumbra SMART Coil, PC400, and/or POD coils. This subset analysis reports on the periprocedural safety outcomes of the saccular intracranial aneurysm cohort. Predictors of rupture/re-rupture or perforation (RRP), thromboembolic complications, and device- or procedure-related adverse events (AEs) were determined in univariate and multivariate analysis. Results Between June 2016 and August 2018, 851 saccular aneurysm patients (31.0%, 264/851 ruptured) were enrolled across 66 North American centers. Clinically significant (ie, a serious adverse event) RRP occurred in 2.0% (17/851) of cases – 1.9% (5/264) for the ruptured cohort and 2.0% (12/587) for the un-ruptured cohort. Clinically significant thromboembolic events occurred in 3.1% (26/851) of cases – 5.3% (14/264) for the ruptured cohort and 2.0% (12/587) for the un-ruptured cohort. Multivariate predictors of periprocedural RRP were increased packing density and adjunctive treatment with a balloon. For periprocedural thromboembolic events, multivariate predictors were bifurcation location and ruptured status. For device- or procedure-related AEs, multivariate predictors were bifurcation location and adjunctive treatment with stent or balloon. Conclusion The low rates of thromboembolic complications and RRP events demonstrate the adequate safety profile of the SMART Coil System to treat cerebral aneurysms in routine clinical practice.