“Robotic fatigue?” – The impact of case order on positive surgical margins in robotic-assisted laparoscopic prostatectomy
Prostate cancer; Outcomes; Fatigue; Robotic-assisted surgery; Task performance and analysis
Highlights •Case Sequence of robotic prostatectomy was not associated with worse surgical outcomes including surgical margin rate.•Factors associated with increased rate of positive surgical margin include higher pre-operative PSA, higher percent tumor involvement, extra prostatic extension, and presence of seminal vesicle invasion.•Second case of the day did experience statistically higher blood loss compared to the first prostatectomy of the day.•Overall, a trend for a higher positive surgical margin rate in second case of the day was observed, a finding that was variable amongst institutions.
Bukavina L; Mishra K; Mahran A; Fernstrum A; Ray III Al; Markt S; Schumacher F; Conroy B; Abouassaly R; MacLennan G; Smith G; Ferry E; Wong D; Lotan Y; Chaparala H; Sharp D; Alazem K; Moinzadeh A; Adamic B; Zagaja G; Kang P; Lawry H; Lee B; Calaway A; Ponsky L
Urologic Oncology: Seminars And Original Investigations
2021
2021-06-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Robotic fatigue? - The impact of case order on positive surgical margins in robotic-assisted laparoscopic prostatectomy.
Prostate cancer; Outcomes; Fatigue; Robotic-assisted surgery; Task performance and analysis
PURPOSE: Multiple robotic-assisted surgeries are often performed within a single operating day; however, the impact of this practice on patient outcomes has not been examined. We aim to determine whether outcomes for robotic-assisted laparoscopic prostatectomy (RALP) differed when performed sequentially. MATERIALS AND METHODS: A multi-institutional, retrospective cohort study was conducted involving a total of 8 academic centers between years 2015 and 2018. Participants were adult males undergoing RALP for localized prostate cancer on operative days in which 2 RALP cases were performed sequentially by the same resident-attending team. The primary outcome of the study was presence of positive surgical margin (PSM). Secondary outcomes were lymph node yield, operative time, and estimated blood loss. The primary analysis was a random effects meta-analysis model for PSM. RESULTS: Overall, 898 RALP cases (449 sequential pairs) were included in the study. There was no significant difference in PSM rate (27.2% vs. 30.3%, P= 0.338) between first and second case groups, respectively. Utilizing random effects meta-analysis, the second case cohort had no increased risk of PSM (OR (0.76)1.23(1.97), P= 0.40). Higher blood loss was noted in the second case cohort (186.7 ml vs. 221.7 ml, P = 0.002). Additionally, factors associated with PSM were increasing prostate specific antigen, higher percent tumor involvement, extraprostatic extension, and seminal vesicle invasion. CONCLUSION: Case sequence was not associated with PSM, lymph node yield, or operative time for RALP. Disease specific factors and institutional experience are associated with increased risk for positive surgical margin which can aid providers in scheduling of patients.
Bukavina L;Mishra K;Mahran A;Fernstrum A;Ray A 3rd;Markt S;Schumacher F;Conroy B;Abouassaly R;MacLennan G;Smith G;Ferry E;Wong D;Lotan Y;Chaparala H;Sharp D;Alazem K;Moinzadeh A;Adamic B;Zagaja G;Kang P;Lawry H;Lee B;Calaway A;Ponsky L
Urologic Oncology
2020
2020-11-04
journalArticle
<a href="http://doi.org/10.1016/j.urolonc.2020.10.071" target="_blank" rel="noreferrer noopener">10.1016/j.urolonc.2020.10.071</a>
Temporal parameters of cathinone, amphetamine and cocaine.
Male; Time Factors; Animals; Rats; Task Performance and Analysis; Cocaine/*pharmacology; Discrimination (Psychology)/*drug effects; Alkaloids/*pharmacology; Amphetamines/*pharmacology; Inbred Strains; Conditioning; Operant/*drug effects
Rats were trained to discriminate intraperitoneally administered 0.8 mg/kg
Schechter M D
Pharmacology, biochemistry, and behavior
1989
1989-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0091-3057(89)90313-4" target="_blank" rel="noreferrer noopener">10.1016/0091-3057(89)90313-4</a>
Physician activities during time out of the examination room.
Adult; Female; Humans; Male; Middle Aged; Ohio; Aged; *Family Practice; *Patient Care; Task Performance and Analysis; Time and Motion Studies; Medical; *Practice Management
PURPOSE: Comprehensive medical care requires direct physician-patient contact, other office-based medical activities, and medical care outside of the office. This study was a systematic investigation of family physician office-based activities outside of the examination room. METHODS: In the summer of 2000, 6 medical students directly observed and recorded the office-based activities of 27 northeastern Ohio community-based family physicians during 1 practice day. A checklist was used to record physician activity every 20 seconds outside of the examination room. Observation excluded medical care provided at other sites. Physicians were also asked to estimate how they spent their time on average and on the observed day. RESULTS: The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records. CONCLUSIONS: If office-based, medically related activities were averaged over the number of patients seen in the office that day, the average office visit time per patient would increase by 7 minutes (40%). Care delivery extends beyond direct patient contact. Models of health care delivery need to recognize this component of care.
Gilchrist Valerie; McCord Gary; Schrop Susan Labuda; King Bridget D; McCormick Kenelm F; Oprandi Allison M; Selius Brian A; Cowher Michael; Maheshwary Rishi; Patel Falguni; Shah Ami; Tsai Bonny; Zaharna Mia
Annals of family medicine
2005
2005-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1370/afm.391" target="_blank" rel="noreferrer noopener">10.1370/afm.391</a>
Assessment of emergency medicine residents' computer knowledge and computer skills: time for an upgrade?
*Computer Literacy; *Internship and Residency/statistics & numerical data; Computer User Training; Computers/*statistics & numerical data; Cross-Sectional Studies; Emergency Medicine/*education; Humans; Prospective Studies; Surveys and Questionnaires; Task Performance and Analysis
OBJECTIVE: To describe emergency medicine residents' (EMRs') personal computer (PC) use and educational needs and to compare their perceived and actual PC skills. METHODS: This was a prospective, cross-sectional study. Subjects were all EMRs at seven midwestern Accreditation Council for Graduate Medical Education (ACGME) residency programs. The EMRs completed a questionnaire about their PC use and ability to perform 23 tasks derived from two national retail-training programs. The tasks covered word processing, slide making, and Internet use. The EMRs then took a three-part test performing the skills in the questionnaire. Two independent raters scored the tests. Frequencies with 95% confidence intervals (95% CIs) were calculated for categorical data. Positive and negative predictive values were used to report information comparing residents' performance with their self-assessment of skills. Cohen's kappa was used to test agreement between raters. RESULTS: One hundred twenty-four of 158 (79%) eligible EMRs participated. Since not all participants engaged in all parts of the study, the sample size varies between 121 and 124. One hundred one of 122 (83%; 95% CI = 75 to 89) owned a PC. The EMRs use home PCs a mean of 3.8 hours/week for physician duties and use residency PCs 1.9 hours/week (range 0-20). Ninety-six of 122 (79%; 95% CI = 70 to 86) EMRs reported no formal PC training during residency. Thirty-five percent (43/122; 95% CI = 27 to 44) passed the word-processing test and 50% (62/123; 95% CI = 41 to 60) passed the slide-making test. Reasons for failure were because of errors and not having a presentable product. Thirty-eight of 122 (31%; 95% CI = 23 to 40) failed the literature search, including 33 who said they could perform it. One hundred fifteen of 123 (94%; 95% CI = 88 to 98) EMRs were able to find an Internet address, including ten who stated they could not. Twenty-one percent of the residents who attempted any test (26/124; 95% CI = 14 to 29) passed all three tests. There was no association between year of training and success on the tests (p = 0.374). Thirty-seven of 115 (32%; 95% CI = 24 to 42) EMRs said they had insufficient PC training to meet their physician needs. CONCLUSIONS: Emergency medicine residents have much access to computer technology and possess some computer skills; however, many are unable to produce a usable product or conduct a literature search. Emergency medicine residents have not had sufficient computer training prior to residency. The computer skills of EMRs should be assessed through skills testing rather than self-assessment, and computer training during residency should be improved.
Jwayyed Sharhabeel; Park Tammy K; Blanda Michelle; Wilber Scott T; Gerson Lowell W; Meerbaum Sharon O; Beeson Michael S
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2002
2002-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2002.tb00231.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2002.tb00231.x</a>
Scopolamine-physostigmine combination does not substitute for nicotine.
Animals; Conditioning; Discrimination Learning/*drug effects; Dose-Response Relationship; Drug; Injections; Male; Nicotine/administration & dosage/*pharmacology; Nicotinic/drug effects; Operant/*drug effects; Physostigmine/administration & dosage/*pharmacology; Rats; Receptors; Scopolamine/administration & dosage/*pharmacology; Sprague-Dawley; Subcutaneous; Task Performance and Analysis
1. Male Sprague-Dawley rats were trained to discriminate 0.4 mg/kg nicotine subcutaneously administered from its saline vehicle in a food-motivated operant discrimination task. Once trained, the discriminative performance was observed to be dose-responsive with an ED50 = 0.11 mg/kg. 2. The co-administration of 0.1 or 0.2 mg/kg physostigmine with either 0.1, 0.15 or 0.2 mg/kg scopolamine produced intermediate discriminative effects, i.e., neither nicotine- nor saline-like responding. However, the physostigmine-scopolamine combination neither substituted for nor increased the discriminative effects of co-administered nicotine. 3. The theoretical/mechanistic possibility that a combination of a cholinesterase inhibitor to increase available acetylcholine plus a specific anti-muscarinic to allow that increased acetylcholine to stimulate nicotinic receptors was investigated. Results indicate that the combination does not produce nicotine-like discriminative effects and evidence the possibility that nicotine discrimination may involve non-cholinergic mechanisms.
Schechter M D
Progress in neuro-psychopharmacology & biological psychiatry
1995
1995-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0278-5846(95)00030-y" target="_blank" rel="noreferrer noopener">10.1016/0278-5846(95)00030-y</a>