Browsing by Subject "iatrogenic"

Now showing 1 - 2 of 2
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    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 Medicine
    Background 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.
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    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 Medicine
    Objective 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.