Barbara Bass - Academia.edu (original) (raw)
Papers by Barbara Bass
A robust and non-obtrusive automatic event tracking system for operating room management to improve patient care
Surgical endoscopy, Jan 30, 2015
Optimization of OR management is a complex problem as each OR has different procedures throughout... more Optimization of OR management is a complex problem as each OR has different procedures throughout the day inevitably resulting in scheduling delays, variations in time durations and overall suboptimal performance. There exists a need for a system that automatically tracks procedural progress in real time in the OR. This would allow for efficient monitoring of operating room states and target sources of inefficiency and points of improvement. We placed three wireless sensors (floor-mounted pressure sensor, ventilator-mounted bellows motion sensor and ambient light detector, and a general room motion detector) in two ORs at our institution and tracked cases 24 h a day for over 4 months. We collected data on 238 total cases (107 laparoscopic cases). A total of 176 turnover times were also captured, and we found that the average turnover time between cases was 35 min while the institutional goal was 30 min. Deeper examination showed that 38 % of laparoscopic cases had some aspect of sub...
The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regi... more The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general
Perinasal Imaging of Physiological Stress and Its Affective Potential
IEEE Transactions on Affective Computing, 2012
ABSTRACT In this paper, we present a novel framework for quantifying physiological stress at a di... more ABSTRACT In this paper, we present a novel framework for quantifying physiological stress at a distance via thermal imaging. The method captures stress-induced neurophysiological responses on the perinasal area that manifest as transient perspiration. We have developed two algorithms to extract the perspiratory signals from the thermophysiological imagery. One is based on morphology and is computationally efficient, while the other is based on spatial isotropic wavelets and is flexible; both require the support of a reliable facial tracker. We validated the two algorithms against the clinical standard in a controlled lab experiment where orienting responses were invoked on n=18 subjects via auditory stimuli. Then, we used the validated algorithms to quantify stress of surgeons (n=24) as they were performing suturing drills during inanimate laparoscopic training. This is a field application where the new methodology shines. It allows nonobtrusive monitoring of individuals who are naturally challenged with a task that is localized in space and requires directional attention. Both algorithms associate high stress levels with novice surgeons, while low stress levels are associated with experienced surgeons, raising the possibility for an affective measure (stress) to assist in efficacy determination. It is a clear indication of the methodology's promise and potential.
Laparoscopic Pancreaticoduodenectomy for Cancer: Margin Status, Adequacy of Resection and 90 Day Outcomes
Gastroenterology, 2011
PloS one, 2015
Most women with early stage breast cancer do not require removal of the entire breast to treat th... more Most women with early stage breast cancer do not require removal of the entire breast to treat their cancer; instead, up to 70% of women can be effectively and safely treated by breast conserving therapy (BCT) with surgical removal of the tumor only (lumpectomy) followed by radiation treatment of the remaining breast tissue. Unfortunately, the final contour and cosmesis of the treated breast is suboptimal in approximately 30% of patients. The ability to accurately predict breast contour after BCT for breast cancer could significantly improve patient decision-making regarding the choice of surgery for breast cancer. Our overall hypothesis is that the complex interplay among mechanical forces due to gravity, breast tissue constitutive law distribution, inflammation induced by radiotherapy and internal stress generated by the healing process play a dominant role in determining the success or failure of lumpectomy in preserving the breast contour and cosmesis. We have shown here from a ...
Somatostatin analogue treatment inhibits post-resectional adaptation of the small bowel in rats
The American Journal of Surgery, 1991
Post-resectional hyperplasia is the phenomenon in which residual small bowel increases in size an... more Post-resectional hyperplasia is the phenomenon in which residual small bowel increases in size and absorptive capacity after segmental enterectomy. This experiment studied the effect of somatostatin analogue therapy on the development of two structural parameters of post-resectional hyperplasia in rats subjected to 40% proximal small bowel resection. Octreotide acetate-treated rats failed to develop increased villus height (902 +/- 50 microns) relative to saline-treated rats (1,103 +/- 98 microns). Augmentation of residual intestinal weight was also significantly impaired in analogue-treated rats (92 +/- 3 versus 118 +/- 5 mg/cm). We conclude that somatostatin analogue treatment during the early postoperative period does impair the growth of residual bowel in rats. These findings raise concern regarding the use of this drug for postoperative patients who have undergone massive small bowel resection in whom the process of post-resectional adaptation may be critical to allow sustenance with enteral nutrition.
Current opinion on catheter-based hemorrhage control in trauma patients
Journal of Trauma and Acute Care Surgery, 2014
Detergent Properties Do Not Fully Explain the Barrier Disruption Induced by Bile Salts
Digestive Surgery, 1991
Detergent properties of bile salts are thought to account for their capacity to damage the gastro... more Detergent properties of bile salts are thought to account for their capacity to damage the gastrointestinal mucosa. Bile salts are thought to disrupt the mucosal barrier by dissolving the lipid components of cell membranes. We tested this hypothesis by comparing deoxycholate to several classes of detergents (anionic, nonionic, zwitterionic, cationic) in an in vivo perfused rabbit model of esophagitis. Barrier
A Computational Framework for Breast Surgery: Application to Breast Conserving Therapy
Computational Surgery and Dual Training, 2009
A Smart Trocar for Automatic Tool Recognition in Laparoscopic Surgery
Surgical Innovation, 2014
Background. Operating rooms have become increasingly complex environments and more prone to error... more Background. Operating rooms have become increasingly complex environments and more prone to errors because of loss of situation awareness. Adding computer intelligence to the operating room may help overcome these limitations particularly if the system can automatically track which step of an operation a surgeon is performing. To develop such a platform, it is necessary to track which laparoscopic instruments are being used and in which port they are inserted. This article describes the development and validation of a "Smart Trocar" that can automatically perform this function. Methods. A Smart Trocar system prototype was developed that uses a wireless camera attached to a standard laparoscopic port and custom software algorithms. The system recognizes color wheels attached to the handle of a laparoscopic instrument and compares the unique color pattern to an instrument library for proper tool identification. The system was tested for reliability in a box trainer environment using a variety of tool positions and levels of room light illumination. Results. Correct color classification was achieved in 96.7% of trials. There were no errors in detection of the color wheel in space. In addition, the distance of the color wheel from the camera did not influence results and correct classifications were evenly distributed among the 12 laparoscopic tool positions tested. Conclusion. This work describes a Smart Trocar system that identifies which laparoscopic tool is being used and in which port and proves its reliability. The system is an important element of a more comprehensive program being developed to automatically understand what step of an operation a surgeon is performing and use these data to improve situation awareness in the operating room.
Surgery, 1997
Pancreatic duct epithelial cells form a barrier against parenchymal injury. The capacity of these... more Pancreatic duct epithelial cells form a barrier against parenchymal injury. The capacity of these cells to respond to injury has not been investigated. We hypothesized that epidermal growth factor (EGF), normally found in pancreatic juice, could protect the duct epithelium from damage. An explant system of duct cell culture developed in our lab with the bovine main pancreatic duct was used. Explants were exposed to bile acid (taurodeoxycholic acid [TDCA] 0, 0.05, 0.5, and 1 mmol/L) in the presence or absence of EGF (0, 1, 10, and 100 nmol/L) for 48 hours. Epithelial proliferation, damage, and growth out from the explant edge were assessed histologically. Expression of ductal markers and the extent of cell proliferation were determined by immunohistochemistry using specific antibodies. Explant duct cells proliferated and demonstrated continued expression of key duct antigens in culture. TDCA produced dose-dependent mucosal damage and reduced epithelial density and growth from the edge. EGF increased cellular density in the native epithelium, but did not significantly alter growth from the edge. Mucosal damage created by TDCA exposure was significantly decreased with EGF and both growth from the edge and cell density were preserved. Explants created from the bovine main pancreatic duct serve as an excellent model for the study of duct epithelial cells in vitro. These cells proliferate in response to EGF and are damaged by TDCA at concentrations below those normally associated with detergent-like activity and below levels observed in bile and duodenal secretions. The ability of EGF to protect from this injury suggests a potential physiologic role in the maintenance of the pancreatic duct mucosal barrier.
Early Tracking Would Improve the Operative Experience of General Surgery Residents
Transactions of the ... Meeting of the American Surgical Association, 2010
High surgical complexity and individual career goals has led most general surgery (GS) residents ... more High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.
On enhancing cardiac pulse measurements through thermal imaging
2009 9th International Conference on Information Technology and Applications in Biomedicine, 2009
This paper presents methodological advances on pulse measurement through thermal imaging of the f... more This paper presents methodological advances on pulse measurement through thermal imaging of the face - a modality that recovers thermo-physiological function. Two previous methods that capitalized on heat transfer effects along and across the vessel during pulse propagation have been brought together in a fusion scheme. In addition, the quality of the extracted physiological signals has improved thanks to sophisticated
Use of the radiolabeled murine monoclonal antibody, 111In-CYT-103, in the management of colon cancer
The American Journal of Surgery, 1993
Monoclonal antibodies directed at tumor-associated antigens may be useful adjuncts for the manage... more Monoclonal antibodies directed at tumor-associated antigens may be useful adjuncts for the management of patients with colorectal cancer. The murine monoclonal antibody, B72.3, binds Tag-72, a cell-surface antigen, which is expressed by colorectal carcinoma cells. We investigated the benefit of indium-111-labeled B72.3, 111In-CYT-103, in localizing the presence and extent of disease in patients with suspected or biopsy-proven primary colorectal cancer and in patients with apparently localized recurrent colorectal adenocarcinoma. Twenty patients were enrolled in this study. Each patient received 1 mg of B72.3 labeled with 4 to 5 mCi of 111In. Patients then underwent planar and single-photon emission computed tomographic imaging 2 to 5 days after infusion. Fifteen patients underwent surgery 1 to 14 days after scanning. There were 11 true positives, 1 false positive, 2 true negatives, and 1 false negative. The 111In-CYT-103 scan correctly identified the presence or absence of tumor in the 15 patients in whom biopsies were obtained, for an accuracy rate of 87%. Overall, 111In-CYT-103 supplied clinically useful information regarding the extent of disease that was not previously reported by standard techniques in 33% (5 of 15) of patients who underwent surgical exploration. We conclude that 111In-CYT-103 is a promising imaging agent for patients with potentially resectable recurrences and for those patients with a presumed isolated primary tumor requiring preoperative staging.
Surgical intern survival skills curriculum as an intern: does it help?
The American Journal of Surgery, 2011
The transition from medical student to surgical intern is fraught with anxiety. We implemented a ... more The transition from medical student to surgical intern is fraught with anxiety. We implemented a surgical intern survival skills curriculum to alleviate this through a series of lectures and interactive sessions. The purpose of this pilot study was to evaluate its effectiveness. This was a prospective observational pilot study of our surgical intern survival skills curriculum, the components of which included professionalism, medical documentation, pharmacy highlights, radiographic interpretations, nutrition, and mock clinical pages. The participants completed pre-course and post-course surveys to assess their confidence levels in the elements addressed using a 5-point Likert scale (1 = unsatisfactory, 5 = excellent). A P value of less than .05 was considered significant. In 2009, 8 interns participated in the surgical intern survival skills curriculum. Fifty percent were female and their mean age was 27.5 ± 1.5 years. Of 33 elements assessed, interns rated themselves as more confident in 27 upon completion of the course. The implementation of a surgical intern survival skills curriculum significantly improved the confidence levels of general surgery interns and seemed to ease the transition from medical student to surgical intern.
Surgical Endoscopy, 2009
Background Diaphragm movement is essential for adequate ventilation, and when the diaphragm is ad... more Background Diaphragm movement is essential for adequate ventilation, and when the diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with diaphragm pacing stimulation (DPS) to maintain and provide diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in diaphragm function in these two groups of patients.
“Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery
Surgical Endoscopy, 2010
Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instrume... more Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with wristed instruments could overcome this limitation, but the arms often collide when working coaxially. This study tests a new technique of "chopstick" surgery to enable use of the robotic arms through a single incision without collision. Experiments were conducted utilizing the da Vinci S robot (Intuitive Surgical, Inc., Sunnyvale, CA) in a Fundamentals of Laparoscopic Surgery (FLS) box trainer with three laparoscopic ports (1 x 12 mm, 2 x 5 mm) introduced through a single "incision." Pilot work determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, five experienced robotic surgeons performed three FLS tasks utilizing either a standard robotic arm setup or the chopstick technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This results in separation of the robotic arms outside the box. To correct for the change in handedness, the robotic console is instructed to drive the "left" instrument with the right-hand effector and the "right" instrument with the left. Performances were compared while measuring time, errors, number of clutching maneuvers, and degree of instrument collision (Likert scale 1-4). Compared with the standard setup, the chopstick configuration increased surgeon dexterity and global performance through significantly improved performance times, eliminating instrument collision, and decreasing number of camera manipulations, clutching maneuvers, and errors during all tasks. Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery.
Surgical Clinics of North America, 2004
The gender and racial profile of American medical schools has changed. Twenty-five years ago, ent... more The gender and racial profile of American medical schools has changed. Twenty-five years ago, entry into medical school was primarily an opportunity available to and pursued by white American men: women made up 23% of enrolled students. A transformation began in the early 1970s, however, when women began entering medical school in increasing numbers . As of 2004, the typical American medical school entering class has equal numbers of men and women, and for the entering class of 2004, women applicants outnumbered men applicants for the first time [1].
Surgery, 2009
Background. In an era of proliferating systems of quality assessment, surgeon confidence in metri... more Background. In an era of proliferating systems of quality assessment, surgeon confidence in metric tools is essential for successful initiatives in quality improvement. We evaluated surgeons' awareness and attitudes about ACS-NSQIP, which is the only national, surgeon-developed, risk-adjusted, system of surgical outcome assessment. Methods. A 33-item survey instrument was constructed and content validity established through content expert review; test-retest reliability was assessed (weighted-kappa = 0.72). Survey administration occurred in three institutions with varying ACS-NSQIP experience. Summary statistics were generated and subgroup analyses performed (Fisher's exact test). Results. One-hundred and eight surgeons participated. Practice experience varied (27% residents, 33% < 10, 12% 10--20, and 28% > 20 years). Seventy-two percent had fellowship training. Surgeons were familiar with ACS-NSQIP structure, including prospective datacollection (70%), case-sampling (63%), and reporting as observed/expected ratios (83%). Surgeons knew some collected data-points but misidentified EKG-findings of MI (67%), surgeon case-experience (41%), and anastomotic dehiscence (79%). Most felt ACS-NSQIP would improve quality of care (79%) and identify areas for improvement (92%). Surgeons were less confident regarding utility at an individual level, with only 46% believing surgeon-specific outcomes should be reported. Few thought ACS-NSQIP data should be available publicly (45%), used for marketing (26%), or direct pay-for-performance (24%). Reservations were most pronounced among surgeons with institutional ACS-NSQIP experience. Conclusion. While surgeons accept ACS-NSQIP at an institutional level, skepticism remains surrounding measurement of individual outcomes and public reporting. Surgeons at institutions with a longer duration of experience with ACS-NSQIP tended to be more cynical about potential data applications. Ongoing education and assessment of surgeons' perceptions of quality improvement initiatives is necessary to ensure surgeons remain engaged actively in determining how quality of care data is measured and utilized. (Surgery 2009;145:27-33.)
Retroperitoneal follicular dendritic cell sarcoma presenting as secondary amyloidosis
Surgery, 2001
A robust and non-obtrusive automatic event tracking system for operating room management to improve patient care
Surgical endoscopy, Jan 30, 2015
Optimization of OR management is a complex problem as each OR has different procedures throughout... more Optimization of OR management is a complex problem as each OR has different procedures throughout the day inevitably resulting in scheduling delays, variations in time durations and overall suboptimal performance. There exists a need for a system that automatically tracks procedural progress in real time in the OR. This would allow for efficient monitoring of operating room states and target sources of inefficiency and points of improvement. We placed three wireless sensors (floor-mounted pressure sensor, ventilator-mounted bellows motion sensor and ambient light detector, and a general room motion detector) in two ORs at our institution and tracked cases 24 h a day for over 4 months. We collected data on 238 total cases (107 laparoscopic cases). A total of 176 turnover times were also captured, and we found that the average turnover time between cases was 35 min while the institutional goal was 30 min. Deeper examination showed that 38 % of laparoscopic cases had some aspect of sub...
The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regi... more The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general
Perinasal Imaging of Physiological Stress and Its Affective Potential
IEEE Transactions on Affective Computing, 2012
ABSTRACT In this paper, we present a novel framework for quantifying physiological stress at a di... more ABSTRACT In this paper, we present a novel framework for quantifying physiological stress at a distance via thermal imaging. The method captures stress-induced neurophysiological responses on the perinasal area that manifest as transient perspiration. We have developed two algorithms to extract the perspiratory signals from the thermophysiological imagery. One is based on morphology and is computationally efficient, while the other is based on spatial isotropic wavelets and is flexible; both require the support of a reliable facial tracker. We validated the two algorithms against the clinical standard in a controlled lab experiment where orienting responses were invoked on n=18 subjects via auditory stimuli. Then, we used the validated algorithms to quantify stress of surgeons (n=24) as they were performing suturing drills during inanimate laparoscopic training. This is a field application where the new methodology shines. It allows nonobtrusive monitoring of individuals who are naturally challenged with a task that is localized in space and requires directional attention. Both algorithms associate high stress levels with novice surgeons, while low stress levels are associated with experienced surgeons, raising the possibility for an affective measure (stress) to assist in efficacy determination. It is a clear indication of the methodology's promise and potential.
Laparoscopic Pancreaticoduodenectomy for Cancer: Margin Status, Adequacy of Resection and 90 Day Outcomes
Gastroenterology, 2011
PloS one, 2015
Most women with early stage breast cancer do not require removal of the entire breast to treat th... more Most women with early stage breast cancer do not require removal of the entire breast to treat their cancer; instead, up to 70% of women can be effectively and safely treated by breast conserving therapy (BCT) with surgical removal of the tumor only (lumpectomy) followed by radiation treatment of the remaining breast tissue. Unfortunately, the final contour and cosmesis of the treated breast is suboptimal in approximately 30% of patients. The ability to accurately predict breast contour after BCT for breast cancer could significantly improve patient decision-making regarding the choice of surgery for breast cancer. Our overall hypothesis is that the complex interplay among mechanical forces due to gravity, breast tissue constitutive law distribution, inflammation induced by radiotherapy and internal stress generated by the healing process play a dominant role in determining the success or failure of lumpectomy in preserving the breast contour and cosmesis. We have shown here from a ...
Somatostatin analogue treatment inhibits post-resectional adaptation of the small bowel in rats
The American Journal of Surgery, 1991
Post-resectional hyperplasia is the phenomenon in which residual small bowel increases in size an... more Post-resectional hyperplasia is the phenomenon in which residual small bowel increases in size and absorptive capacity after segmental enterectomy. This experiment studied the effect of somatostatin analogue therapy on the development of two structural parameters of post-resectional hyperplasia in rats subjected to 40% proximal small bowel resection. Octreotide acetate-treated rats failed to develop increased villus height (902 +/- 50 microns) relative to saline-treated rats (1,103 +/- 98 microns). Augmentation of residual intestinal weight was also significantly impaired in analogue-treated rats (92 +/- 3 versus 118 +/- 5 mg/cm). We conclude that somatostatin analogue treatment during the early postoperative period does impair the growth of residual bowel in rats. These findings raise concern regarding the use of this drug for postoperative patients who have undergone massive small bowel resection in whom the process of post-resectional adaptation may be critical to allow sustenance with enteral nutrition.
Current opinion on catheter-based hemorrhage control in trauma patients
Journal of Trauma and Acute Care Surgery, 2014
Detergent Properties Do Not Fully Explain the Barrier Disruption Induced by Bile Salts
Digestive Surgery, 1991
Detergent properties of bile salts are thought to account for their capacity to damage the gastro... more Detergent properties of bile salts are thought to account for their capacity to damage the gastrointestinal mucosa. Bile salts are thought to disrupt the mucosal barrier by dissolving the lipid components of cell membranes. We tested this hypothesis by comparing deoxycholate to several classes of detergents (anionic, nonionic, zwitterionic, cationic) in an in vivo perfused rabbit model of esophagitis. Barrier
A Computational Framework for Breast Surgery: Application to Breast Conserving Therapy
Computational Surgery and Dual Training, 2009
A Smart Trocar for Automatic Tool Recognition in Laparoscopic Surgery
Surgical Innovation, 2014
Background. Operating rooms have become increasingly complex environments and more prone to error... more Background. Operating rooms have become increasingly complex environments and more prone to errors because of loss of situation awareness. Adding computer intelligence to the operating room may help overcome these limitations particularly if the system can automatically track which step of an operation a surgeon is performing. To develop such a platform, it is necessary to track which laparoscopic instruments are being used and in which port they are inserted. This article describes the development and validation of a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Smart Trocar&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; that can automatically perform this function. Methods. A Smart Trocar system prototype was developed that uses a wireless camera attached to a standard laparoscopic port and custom software algorithms. The system recognizes color wheels attached to the handle of a laparoscopic instrument and compares the unique color pattern to an instrument library for proper tool identification. The system was tested for reliability in a box trainer environment using a variety of tool positions and levels of room light illumination. Results. Correct color classification was achieved in 96.7% of trials. There were no errors in detection of the color wheel in space. In addition, the distance of the color wheel from the camera did not influence results and correct classifications were evenly distributed among the 12 laparoscopic tool positions tested. Conclusion. This work describes a Smart Trocar system that identifies which laparoscopic tool is being used and in which port and proves its reliability. The system is an important element of a more comprehensive program being developed to automatically understand what step of an operation a surgeon is performing and use these data to improve situation awareness in the operating room.
Surgery, 1997
Pancreatic duct epithelial cells form a barrier against parenchymal injury. The capacity of these... more Pancreatic duct epithelial cells form a barrier against parenchymal injury. The capacity of these cells to respond to injury has not been investigated. We hypothesized that epidermal growth factor (EGF), normally found in pancreatic juice, could protect the duct epithelium from damage. An explant system of duct cell culture developed in our lab with the bovine main pancreatic duct was used. Explants were exposed to bile acid (taurodeoxycholic acid [TDCA] 0, 0.05, 0.5, and 1 mmol/L) in the presence or absence of EGF (0, 1, 10, and 100 nmol/L) for 48 hours. Epithelial proliferation, damage, and growth out from the explant edge were assessed histologically. Expression of ductal markers and the extent of cell proliferation were determined by immunohistochemistry using specific antibodies. Explant duct cells proliferated and demonstrated continued expression of key duct antigens in culture. TDCA produced dose-dependent mucosal damage and reduced epithelial density and growth from the edge. EGF increased cellular density in the native epithelium, but did not significantly alter growth from the edge. Mucosal damage created by TDCA exposure was significantly decreased with EGF and both growth from the edge and cell density were preserved. Explants created from the bovine main pancreatic duct serve as an excellent model for the study of duct epithelial cells in vitro. These cells proliferate in response to EGF and are damaged by TDCA at concentrations below those normally associated with detergent-like activity and below levels observed in bile and duodenal secretions. The ability of EGF to protect from this injury suggests a potential physiologic role in the maintenance of the pancreatic duct mucosal barrier.
Early Tracking Would Improve the Operative Experience of General Surgery Residents
Transactions of the ... Meeting of the American Surgical Association, 2010
High surgical complexity and individual career goals has led most general surgery (GS) residents ... more High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.
On enhancing cardiac pulse measurements through thermal imaging
2009 9th International Conference on Information Technology and Applications in Biomedicine, 2009
This paper presents methodological advances on pulse measurement through thermal imaging of the f... more This paper presents methodological advances on pulse measurement through thermal imaging of the face - a modality that recovers thermo-physiological function. Two previous methods that capitalized on heat transfer effects along and across the vessel during pulse propagation have been brought together in a fusion scheme. In addition, the quality of the extracted physiological signals has improved thanks to sophisticated
Use of the radiolabeled murine monoclonal antibody, 111In-CYT-103, in the management of colon cancer
The American Journal of Surgery, 1993
Monoclonal antibodies directed at tumor-associated antigens may be useful adjuncts for the manage... more Monoclonal antibodies directed at tumor-associated antigens may be useful adjuncts for the management of patients with colorectal cancer. The murine monoclonal antibody, B72.3, binds Tag-72, a cell-surface antigen, which is expressed by colorectal carcinoma cells. We investigated the benefit of indium-111-labeled B72.3, 111In-CYT-103, in localizing the presence and extent of disease in patients with suspected or biopsy-proven primary colorectal cancer and in patients with apparently localized recurrent colorectal adenocarcinoma. Twenty patients were enrolled in this study. Each patient received 1 mg of B72.3 labeled with 4 to 5 mCi of 111In. Patients then underwent planar and single-photon emission computed tomographic imaging 2 to 5 days after infusion. Fifteen patients underwent surgery 1 to 14 days after scanning. There were 11 true positives, 1 false positive, 2 true negatives, and 1 false negative. The 111In-CYT-103 scan correctly identified the presence or absence of tumor in the 15 patients in whom biopsies were obtained, for an accuracy rate of 87%. Overall, 111In-CYT-103 supplied clinically useful information regarding the extent of disease that was not previously reported by standard techniques in 33% (5 of 15) of patients who underwent surgical exploration. We conclude that 111In-CYT-103 is a promising imaging agent for patients with potentially resectable recurrences and for those patients with a presumed isolated primary tumor requiring preoperative staging.
Surgical intern survival skills curriculum as an intern: does it help?
The American Journal of Surgery, 2011
The transition from medical student to surgical intern is fraught with anxiety. We implemented a ... more The transition from medical student to surgical intern is fraught with anxiety. We implemented a surgical intern survival skills curriculum to alleviate this through a series of lectures and interactive sessions. The purpose of this pilot study was to evaluate its effectiveness. This was a prospective observational pilot study of our surgical intern survival skills curriculum, the components of which included professionalism, medical documentation, pharmacy highlights, radiographic interpretations, nutrition, and mock clinical pages. The participants completed pre-course and post-course surveys to assess their confidence levels in the elements addressed using a 5-point Likert scale (1 = unsatisfactory, 5 = excellent). A P value of less than .05 was considered significant. In 2009, 8 interns participated in the surgical intern survival skills curriculum. Fifty percent were female and their mean age was 27.5 ± 1.5 years. Of 33 elements assessed, interns rated themselves as more confident in 27 upon completion of the course. The implementation of a surgical intern survival skills curriculum significantly improved the confidence levels of general surgery interns and seemed to ease the transition from medical student to surgical intern.
Surgical Endoscopy, 2009
Background Diaphragm movement is essential for adequate ventilation, and when the diaphragm is ad... more Background Diaphragm movement is essential for adequate ventilation, and when the diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with diaphragm pacing stimulation (DPS) to maintain and provide diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in diaphragm function in these two groups of patients.
“Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery
Surgical Endoscopy, 2010
Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instrume... more Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with wristed instruments could overcome this limitation, but the arms often collide when working coaxially. This study tests a new technique of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;chopstick&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; surgery to enable use of the robotic arms through a single incision without collision. Experiments were conducted utilizing the da Vinci S robot (Intuitive Surgical, Inc., Sunnyvale, CA) in a Fundamentals of Laparoscopic Surgery (FLS) box trainer with three laparoscopic ports (1 x 12 mm, 2 x 5 mm) introduced through a single &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;incision.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Pilot work determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, five experienced robotic surgeons performed three FLS tasks utilizing either a standard robotic arm setup or the chopstick technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This results in separation of the robotic arms outside the box. To correct for the change in handedness, the robotic console is instructed to drive the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;left&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; instrument with the right-hand effector and the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;right&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; instrument with the left. Performances were compared while measuring time, errors, number of clutching maneuvers, and degree of instrument collision (Likert scale 1-4). Compared with the standard setup, the chopstick configuration increased surgeon dexterity and global performance through significantly improved performance times, eliminating instrument collision, and decreasing number of camera manipulations, clutching maneuvers, and errors during all tasks. Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery.
Surgical Clinics of North America, 2004
The gender and racial profile of American medical schools has changed. Twenty-five years ago, ent... more The gender and racial profile of American medical schools has changed. Twenty-five years ago, entry into medical school was primarily an opportunity available to and pursued by white American men: women made up 23% of enrolled students. A transformation began in the early 1970s, however, when women began entering medical school in increasing numbers . As of 2004, the typical American medical school entering class has equal numbers of men and women, and for the entering class of 2004, women applicants outnumbered men applicants for the first time [1].
Surgery, 2009
Background. In an era of proliferating systems of quality assessment, surgeon confidence in metri... more Background. In an era of proliferating systems of quality assessment, surgeon confidence in metric tools is essential for successful initiatives in quality improvement. We evaluated surgeons' awareness and attitudes about ACS-NSQIP, which is the only national, surgeon-developed, risk-adjusted, system of surgical outcome assessment. Methods. A 33-item survey instrument was constructed and content validity established through content expert review; test-retest reliability was assessed (weighted-kappa = 0.72). Survey administration occurred in three institutions with varying ACS-NSQIP experience. Summary statistics were generated and subgroup analyses performed (Fisher's exact test). Results. One-hundred and eight surgeons participated. Practice experience varied (27% residents, 33% < 10, 12% 10--20, and 28% > 20 years). Seventy-two percent had fellowship training. Surgeons were familiar with ACS-NSQIP structure, including prospective datacollection (70%), case-sampling (63%), and reporting as observed/expected ratios (83%). Surgeons knew some collected data-points but misidentified EKG-findings of MI (67%), surgeon case-experience (41%), and anastomotic dehiscence (79%). Most felt ACS-NSQIP would improve quality of care (79%) and identify areas for improvement (92%). Surgeons were less confident regarding utility at an individual level, with only 46% believing surgeon-specific outcomes should be reported. Few thought ACS-NSQIP data should be available publicly (45%), used for marketing (26%), or direct pay-for-performance (24%). Reservations were most pronounced among surgeons with institutional ACS-NSQIP experience. Conclusion. While surgeons accept ACS-NSQIP at an institutional level, skepticism remains surrounding measurement of individual outcomes and public reporting. Surgeons at institutions with a longer duration of experience with ACS-NSQIP tended to be more cynical about potential data applications. Ongoing education and assessment of surgeons' perceptions of quality improvement initiatives is necessary to ensure surgeons remain engaged actively in determining how quality of care data is measured and utilized. (Surgery 2009;145:27-33.)
Retroperitoneal follicular dendritic cell sarcoma presenting as secondary amyloidosis
Surgery, 2001