10 results on '"Al Mahroos M"'
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2. Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway
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Barry Stein, Patrick Charlebois, Nadia Safa, Juan Mata, Mohsen Alhashemi, Nicolò Pecorelli, Nandini Dendukuri, Julio F. Fiore, Liane S. Feldman, Franco Carli, Gabriele Baldini, A. Sender Liberman, Mohammed Al Mahroos, Alhashemi, M., Fiore, J. F., Safa, N., Al Mahroos, M., Mata, J., Pecorelli, N., Baldini, G., Dendukuri, N., Stein, B. L., Liberman, A. S., Charlebois, P., Carli, F., and Feldman, L. S.
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Male ,medicine.medical_specialty ,Postoperative ileus ,Blood Loss, Surgical ,Context (language use) ,030230 surgery ,03 medical and health sciences ,Colonic Diseases ,0302 clinical medicine ,Ileus ,Postoperative Complications ,Enhanced recovery ,Risk Factors ,Internal medicine ,medicine ,Humans ,Colorectal ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Incidence ,Bayes Theorem ,Hepatology ,Middle Aged ,Colorectal surgery ,Analgesia, Epidural ,Analgesics, Opioid ,Rectal Diseases ,Critical Pathways ,Defecation ,Fluid Therapy ,030211 gastroenterology & hepatology ,Surgery ,Female ,Laparoscopy ,business ,Abdominal surgery - Abstract
Background: Prolonged postoperative ileus (PPOI) is common after colorectal surgery but has not been widely studied in the context of enhanced recovery pathways (ERPs) that include interventions aimed to accelerate gastrointestinal recovery. The aim of this study is to estimate the incidence and predictors of PPOI in the context of an ERP for colorectal surgery. Methods: We analyzed data from an institutional colorectal surgery ERP registry. Incidence of PPOI was estimated according to a definition adapted from Vather (intolerance of solid food and absence of flatus or bowel movement for ≥ 4days) and compared to other definitions in the literature. Potential risk factors for PPOI were identified from previous studies, and their predictive ability was evaluated using Bayesian model averaging (BMA). Results are presented as posterior effect probability (PEP). Evidence of association was categorized as: no evidence (PEP < 50%), weak evidence (50–75%), positive evidence (75–95%), strong evidence (95–99%), and very strong evidence (> 99%). Results: There were 323 patients analyzed (mean age 63.5years, 51% males, 74% laparoscopic, 33% rectal resection). The incidence of PPOI was 19% according to the primary definition, but varied between 11 and 59% when using other definitions. On BMA analysis, intraoperative blood loss (PEP 99%; very strong evidence), administration of any intravenous opioids in the first 48h (PEP 94%; strong evidence), postoperative epidural analgesia (PEP 56%; weak evidence), and non-compliance with intra-operative fluid management protocols (3ml/kg/h for laparoscopic and 5ml/kg/h for open; PEP 55%, weak evidence) were predictors of PPOI. Conclusions: The incidence of PPOI after colorectal surgery is high even within an established ERP and varied considerably by diagnostic criteria, highlighting the need for a consensus definition. The use of intravenous opioids is a modifiable strong predictor of PPOI within an ERP, while the role of epidural analgesia and intraoperative fluid management should be further evaluated.
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- 2019
3. Effect of video-based self-reflection on intraoperative skills: A pilot randomized controlled trial.
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Balvardi S, Kaneva P, Semsar-Kazerooni K, Vassiliou M, Al Mahroos M, Mueller C, Fiore JF Jr, Schwartzman K, and Feldman LS
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- Humans, Male, Female, Pilot Projects, Video Recording, Clinical Competence, Laparoscopy education, Cholecystectomy, Laparoscopic education, Surgeons, Internship and Residency
- Abstract
Background: The value of video-based self-assessment in enhancing surgical skills is uncertain. This study investigates the feasibility and estimates sample size for a full-scale randomized controlled trial to evaluate the effectiveness of video-based self-assessment to improve surgical performance of laparoscopic cholecystectomy in trainees., Methods: This parallel pilot randomized controlled trial included general surgery trainees performing supervised laparoscopic cholecystectomy randomized 1:1 to control (traditional intraoperative teaching) or intervention group (traditional teaching plus video-based self-assessment). Operative performance was measured by the attending surgeon blinded to group assignment at the time of surgery using standardized assessment tools (Global Operative Assessment of Laparoscopic Skills and Operative Performance Rating System). The intervention group had access to their video recordings on a web-based platform for review and self-assessment using the same instruments. The primary outcome for the estimation of sample size was the difference in faculty-assessed final operative performance (third submitted case). Feasibility criteria included >85% participation, >85% adherence to case submission and >85% completion of self-assessment., Results: Of 37 eligible trainees approached, 32 consented and were randomized (86%). There were 16 in the intervention group, 15 in the control group (55% male, 55% junior trainees), and 1 was excluded for protocol violation. Twenty-four (75%) of participants submitted 3 cases. Thirteen trainees (81%) accessed the platform and completed 26 (63.2%) case self-assessments. Fifty-five trainees per arm will be needed to power a full-scale laparoscopic cholecystectomy with Global Operative Assessment of Laparoscopic Skills and 130 trainees per arm with Operative Performance Rating System as the assessment tool., Conclusion: This pilot study contributes important data to inform the design of an adequately powered randomized controlled trial of video-based self-assessment to improve trainee performance of laparoscopic cholecystectomy. Although a priori trial feasibility criteria were not achieved, automated video capture and storage could significantly improve adherence in future trials., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2024
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4. 2023 Canadian Surgery Forum: Sept. 20-23, 2023.
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Brière R, Émond M, Benhamed A, Blanchard PG, Drolet S, Habashi R, Golbon B, Shellenberger J, Pasternak J, Merchant S, Shellenberger J, La J, Sawhney M, Brogly S, Cadili L, Horkoff M, Ainslie S, Demetrick J, Chai B, Wiseman K, Hwang H, Alhumoud Z, Salem A, Lau R, Aw K, Nessim C, Gawad N, Alibhai K, Towaij C, Doan D, Raîche I, Valji R, Turner S, Balmes PN, Hwang H, Hameed SM, Tan JGK, Wijesuriya R, Tan JGK, Hew NLC, Wijesuriya R, Lund M, Hawel J, Gregor J, Leslie K, Lenet T, McIsaac D, Hallet J, Jerath A, Lalu M, Nicholls S, Presseau J, Tinmouth A, Verret M, Wherrett C, Fergusson D, Martel G, Sharma S, McKechnie T, Talwar G, Patel J, Heimann L, Doumouras A, Hong D, Eskicioglu C, Wang C, Guo M, Huang L, Sun S, Davis N, Wang J, Skulsky S, Sikora L, Raîche I, Son HJ, Gee D, Gomez D, Jung J, Selvam R, Seguin N, Zhang L, Lacaille-Ranger A, Sikora L, McIsaac D, Moloo H, Follett A, Holly, Organ M, Pace D, Balvardi S, Kaneva P, Semsar-Kazerooni K, Mueller C, Vassiliou M, Al Mahroos M, Fiore JF Jr, Schwartzman K, Feldman L, Guo M, Karimuddin A, Liu GP, Crump T, Sutherland J, Hickey K, Bonisteel EM, Umali J, Dogar I, Warden G, Boone D, Mathieson A, Hogan M, Pace D, Seguin N, Moloo H, Li Y, Best G, Leong R, Wiseman S, Alaoui AA, Hajjar R, Wassef E, Metellus DS, Dagbert F, Loungnarath R, Ratelle R, Schwenter F, Debroux É, Wassef R, Gagnon-Konamna M, Pomp A, Richard CS, Sebajang H, Alaoui AA, Hajjar R, Dagbert F, Loungnarath R, Sebajang H, Ratelle R, Schwenter F, Debroux É, Wassef R, Gagnon-Konamna M, Pomp A, Santos MM, Richard CS, Shi G, Leung R, Lim C, Knowles S, Parmar S, Wang C, Debru E, Mohamed F, Anakin M, Lee Y, Samarasinghe Y, Khamar J, Petrisor B, McKechnie T, Eskicioglu C, Yang I, Mughal HN, Bhugio M, Gok MA, Khan UA, Fernandes AR, Spence R, Porter G, Hoogerboord CM, Neumann K, Pillar M, Guo M, Manhas N, Melck A, Kazi T, McKechnie T, Jessani G, Heimann L, Lee Y, Hong D, Eskicioglu C, McKechnie T, Tessier L, Archer V, Park L, Cohen D, Parpia S, Bhandari M, Dionne J, Eskicioglu C, Bolin S, Afford R, Armstrong M, Karimuddin A, Leung R, Shi G, Lim C, Grant A, Van Koughnett JA, Knowles S, Clement E, Lange C, Roshan A, Karimuddin A, Scott T, Nadeau K, Macmillan J, Wilson J, Deschenes M, Nurullah A, Cahill C, Chen VH, Patterson KM, Wiseman SM, Wen B, Bhudial J, Barton A, Lie J, Park CM, Yang L, Gouskova N, Kim DH, Afford R, Bolin S, Morris-Janzen D, McLellan A, Karimuddin A, Archer V, Cloutier Z, Berg A, McKechnie T, Wiercioch W, Eskicioglu C, Labonté J, Bisson P, Bégin A, Cheng-Oviedo SG, Collin Y, Fernandes AR, Hossain I, Ellsmere J, El-Kefraoui C, Do U, Miller A, Kouyoumdjian A, Cui D, Khorasani E, Landry T, Amar-Zifkin A, Lee L, Feldman L, Fiore J, Au TM, Oppenheimer M, Logsetty S, AlShammari R, AlAbri M, Karimuddin A, Brown C, Raval MJ, Phang PT, Bird S, Baig Z, Abu-Omar N, Gill D, Suresh S, Ginther N, Karpinski M, Ghuman A, Malik PRA, Alibhai K, Zabolotniuk T, Raîche I, Gawad N, Mashal S, Boulanger N, Watt L, Razek T, Fata P, Grushka J, Wong EG, Hossain I, Landry M, Mackey S, Fairbridge N, Greene A, Borgoankar M, Kim C, DeCarvalho D, Pace D, Wigen R, Walser E, Davidson J, Dorward M, Muszynski L, Dann C, Seemann N, Lam J, Harding K, Lowik AJ, Guinard C, Wiseman S, Ma O, Mocanu V, Lin A, Karmali S, Bigam D, Harding K, Greaves G, Parker B, Nguyen V, Ahmed A, Yee B, Perren J, Norman M, Grey M, Perini R, Jowhari F, Bak A, Drung J, Allen L, Wiseman D, Moffat B, Lee JKH, McGuire C, Raîche I, Tudorache M, Gawad N, Park LJ, Borges FK, Nenshi R, Jacka M, Heels-Ansdell D, Simunovic M, Bogach J, Serrano PE, Thabane L, Devereaux PJ, Farooq S, Lester E, Kung J, Bradley N, Best G, Ahn S, Zhang L, Prince N, Cheng-Boivin O, Seguin N, Wang H, Quartermain L, Tan S, Shamess J, Simard M, Vigil H, Raîche I, Hanna M, Moloo H, Azam R, Ko G, Zhu M, Raveendran Y, Lam C, Tang J, Bajwa A, Englesakis M, Reel E, Cleland J, Snell L, Lorello G, Cil T, Ahn HS, Dube C, McIsaac D, Smith D, Leclerc A, Shamess J, Rostom A, Calo N, Thavorn K, Moloo H, Laplante S, Liu L, Khan N, Okrainec A, Ma O, Lin A, Mocanu V, Karmali S, Bigam D, Bruyninx G, Georgescu I, Khokhotva V, Talwar G, Sharma S, McKechnie T, Yang S, Khamar J, Hong D, Doumouras A, Eskicioglu C, Spoyalo K, Rebello TA, Chhipi-Shrestha G, Mayson K, Sadiq R, Hewage K, MacNeill A, Muncner S, Li MY, Mihajlovic I, Dykstra M, Snelgrove R, Wang H, Schweitzer C, Wiseman SM, Garcha I, Jogiat U, Baracos V, Turner SR, Eurich D, Filafilo H, Rouhi A, Bédard A, Bédard ELR, Patel YS, Alaichi JA, Agzarian J, Hanna WC, Patel YS, Alaichi JA, Provost E, Shayegan B, Adili A, Hanna WC, Mistry N, Gatti AA, Patel YS, Farrokhyar F, Xie F, Hanna WC, Sullivan KA, Farrokhyar F, Patel YS, Liberman M, Turner SR, Gonzalez AV, Nayak R, Yasufuku K, Hanna WC, Mistry N, Gatti AA, Patel YS, Cross S, Farrokhyar F, Xie F, Hanna WC, Haché PL, Galvaing G, Simard S, Grégoire J, Bussières J, Lacasse Y, Sassi S, Champagne C, Laliberté AS, Jeong JY, Jogiat U, Wilson H, Bédard A, Blakely P, Dang J, Sun W, Karmali S, Bédard ELR, Wong C, Hakim SY, Azizi S, El-Menyar A, Rizoli S, Al-Thani H, Fernandes AR, French D, Li C, Ellsmere J, Gossen S, French D, Bailey J, Tibbo P, Crocker C, Bondzi-Simpson A, Ribeiro T, Kidane B, Ko M, Coburn N, Kulkarni G, Hallet J, Ramzee AF, Afifi I, Alani M, El-Menyar A, Rizoli S, Al-Thani H, Chughtai T, Huo B, Manos D, Xu Z, Kontouli KM, Chun S, Fris J, Wallace AMR, French DG, Giffin C, Liberman M, Dayan G, Laliberté AS, Yasufuku K, Farivar A, Kidane B, Weessies C, Robinson M, Bednarek L, Buduhan G, Liu R, Tan L, Srinathan SK, Kidane B, Nasralla A, Safieddine N, Gazala S, Simone C, Ahmadi N, Hilzenrat R, Blitz M, Deen S, Humer M, Jugnauth A, Buduhan G, Kerr L, Sun S, Browne I, Patel Y, Hanna W, Loshusan B, Shamsil A, Naish MD, Qiabi M, Nayak R, Patel R, Malthaner R, Pooja P, Roberto R, Greg H, Daniel F, Huynh C, Sharma S, Vieira A, Jain F, Lee Y, Mousa-Doust D, Costa J, Mezei M, Chapman K, Briemberg H, Jack K, Grant K, Choi J, Yee J, McGuire AL, Abdul SA, Khazoom F, Aw K, Lau R, Gilbert S, Sundaresan S, Jones D, Seely AJE, Villeneuve PJ, Maziak DE, Pigeon CA, Frigault J, Drolet S, Roy ÈM, Bujold-Pitre K, Courval V, Tessier L, McKechnie T, Lee Y, Park L, Gangam N, Eskicioglu C, Cloutier Z, McKechnie T (McMaster University), Archer V, Park L, Lee J, Patel A, Hong D, Eskicioglu C, Ichhpuniani S, McKechnie T, Elder G, Chen A, Logie K, Doumouras A, Hong D, Benko R, Eskicioglu C, Castelo M, Paszat L, Hansen B, Scheer A, Faught N, Nguyen L, Baxter N, Sharma S, McKechnie T, Khamar J, Wu K, Eskicioglu C, McKechnie T, Khamar J, Lee Y, Tessier L, Passos E, Doumouras A, Hong D, Eskicioglu C, McKechnie T, Khamar J, Sachdeva A, Lee Y, Hong D, Eskicioglu C, Fei LYN, Caycedo A, Patel S, Popa T, Boudreau L, Grin A, Wang T, Lie J, Karimuddin A, Brown C, Phang T, Raval M, Ghuman A, Candy S, Nanda K, Li C, Snelgrove R, Dykstra M, Kroeker K, Wang H, Roy H, Helewa RM, Johnson G, Singh H, Hyun E, Moffatt D, Vergis A, Balmes P, Phang T, Guo M, Liu J, Roy H, Webber S, Shariff F, Helewa RM, Hochman D, Park J, Johnson G, Hyun E, Robitaille S, Wang A, Maalouf M, Alali N, Elhaj H, Liberman S, Charlebois P, Stein B, Feldman L, Fiore JF Jr, Lee L, Hu R, Lacaille-Ranger A, Ahn S, Tudorache M, Moloo H, Williams L, Raîche I, Musselman R, Lemke M, Allen L, Samarasinghe N, Vogt K, Brackstone M, Zwiep T, Clement E, Lange C, Alam A, Ghuman A, Karimuddin A, Phang T, Raval M, Brown C, Clement E, Liu J, Ghuman A, Karimuddin A, Phang T, Raval M, Brown C, Mughal HN, Gok MA, Khan UA, Mughal HN, Gok MA, Khan UA, Mughal HN, Gok MA, Khan UA, Mughal HN, Gok MA, Khan UA, James N, Zwiep T, Van Koughnett JA, Laczko D, McKechnie T, Yang S, Wu K, Sharma S, Lee Y, Park L, Doumouras A, Hong D, Parpia S, Bhandari M, Eskicioglu C, McKechnie T, Tessier L, Lee S, Kazi T, Sritharan P, Lee Y, Doumouras A, Hong D, Eskicioglu C, McKechnie T, Lee Y, Hong D, Dionne J, Doumouras A, Parpia S, Bhandari M, Eskicioglu C, Hershorn O, Ghuman A, Karimuddin A, Brown C, Raval M, Phang PT, Chen A, Boutros M, Caminsky N, Dumitra T, Faris-Sabboobeh S, Demian M, Rigas G, Monton O, Smith A, Moon J, Demian M, Garfinkle R, Vasilevsky CA, Rajabiyazdi F, Boutros M, Courage E, LeBlanc D, Benesch M, Hickey K, Hartwig K, Armstrong C, Engelbrecht R, Fagan M, Borgaonkar M, Pace D, Shanahan J, Moon J, Salama E, Wang A, Arsenault M, Leon N, Loiselle C, Rajabiyazdi F, Boutros M, Brennan K, Rai M, Farooq A, McClintock C, Kong W, Patel S, Boukhili N, Caminsky N, Faris-Sabboobeh S, Demian M, Boutros M, Paradis T, Robitaille S, Dumitra T, Liberman AS, Charlebois P, Stein B, Fiore JF Jr, Feldman LS, Lee L, Zwiep T, Abner D, Alam T, Beyer E, Evans M, Hill M, Johnston D, Lohnes K, Menard S, Pitcher N, Sair K, Smith B, Yarjau B, LeBlanc K, Samarasinghe N, Karimuddin AA, Brown CJ, Phang PT, Raval MJ, MacDonell K, Ghuman A, Harvey A, Phang PT, Karimuddin A, Brown CJ, Raval MJ, Ghuman A, Hershorn O, Ghuman A, Karimuddin A, Raval M, Phang PT, Brown C, Logie K, Mckechnie T, Lee Y, Hong D, Eskicioglu C, Matta M, Baker L, Hopkins J, Rochon R, Buie D, MacLean A, Ghuman A, Park J, Karimuddin AA, Phang PT, Raval MJ, Brown CJ, Farooq A, Ghuman A, Patel S, Macdonald H, Karimuddin A, Raval M, Phang PT, Brown C, Wiseman V, Brennan K, Patel S, Farooq A, Merchant S, Kong W, McClintock C, Booth C, Hann T, Ricci A, Patel S, Brennan K, Wiseman V, McClintock C, Kong W, Farooq A, Kakkar R, Hershorn O, Raval M, Phang PT, Karimuddin A, Ghuman A, Brown C, Wiseman V, Farooq A, Patel S, Hajjar R, Gonzalez E, Fragoso G, Oliero M, Alaoui AA, Rendos HV, Djediai S, Cuisiniere T, Laplante P, Gerkins C, Ajayi AS, Diop K, Taleb N, Thérien S, Schampaert F, Alratrout H, Dagbert F, Loungnarath R, Sebajang H, Schwenter F, Wassef R, Ratelle R, Debroux É, Cailhier JF, Routy B, Annabi B, Brereton NJB, Richard C, Santos MM, Gimon T, MacRae H, de Buck van Overstraeten A, Brar M, Chadi S, Kennedy E, Baker L, Hopkins J, Rochon R, Buie D, MacLean A, Park LJ, Archer V, McKechnie T, Lee Y, McIsaac D, Rashanov P, Eskicioglu C, Moloo H, Devereaux PJ, Alsayari R, McKechnie T, Ichhpuniani S, Lee Y, Eskicioglu C, Hajjar R, Oliero M, Fragoso G, Ajayi AS, Alaoui AA, Rendos HV, Calvé A, Cuisinière T, Gerkins C, Thérien S, Taleb N, Dagbert F, Sebajang H, Loungnarath R, Schwenter F, Ratelle R, Wassef R, Debroux E, Richard C, Santos MM, Kennedy E, Simunovic M, Schmocker S, Brown C, MacLean A, Liberman S, Drolet S, Neumann K, Stotland P, Jhaveri K, Kirsch R, Alnajem H, Alibrahim H, Giundi C, Chen A, Rigas G, Munir H, Safar A, Sabboobeh S, Holland J, Boutros M, Kennedy E, Richard C, Simunovic M, Schmocker S, Brown C, MacLean A, Liberman S, Drolet S, Neumann K, Stotland P, Jhaveri K, Kirsch R, Bruyninx G, Gill D, Alsayari R, McKechnie T, Lee Y, Hong D, Eskicioglu C, Zhang L, Abtahi S, Chhor A, Best G, Raîche I, Musselman R, Williams L, Moloo H, Caminsky NG, Moon JJ, Marinescu D, Pang A, Vasilevsky CA, Boutros M, Al-Abri M, Gee E, Karimuddin A, Phang PT, Brown C, Raval M, Ghuman A, Morena N, Ben-Zvi L, Hayman V, Hou M (University of Calgary), Nguyen D, Rentschler CA, Meguerditchian AN, Mir Z, Fei L, McKeown S, Dinchong R, Cofie N, Dalgarno N, Cheifetz R, Merchant S, Jaffer A, Cullinane C, Feeney G, Jalali A, Merrigan A, Baban C, Buckley J, Tormey S, Benesch M, Wu R, Takabe K, Benesch M, O'Brien S, Kazazian K, Abdalaty AH, Brezden C, Burkes R, Chen E, Govindarajan A, Jang R, Kennedy E, Lukovic J, Mesci A, Quereshy F, Swallow C, Chadi S, Habashi R, Pasternak J, Marini W, Zheng W, Murakami K, Ohashi P, Reedijk M, Hu R, Ivankovic V, Han L, Gresham L, Mallick R, Auer R, Ribeiro T, Bondzi-Simpson A, Coburn N, Hallet J, Cil T, Fontebasso A, Lee A, Bernard-Bedard E, Wong B, Li H, Grose E, Brandts-Longtin O, Aw K, Lau R, Abed A, Stevenson J, Sheikh R, Chen R, Johnson-Obaseki S, Nessim C, Hennessey RL, Meneghetti AT, Bildersheim M, Bouchard-Fortier A, Nelson G, Mack L, Ghasemi F, Naeini MM, Parsyan A, Kaur Y, Covelli A, Quereshy F, Elimova E, Panov E, Lukovic J, Brierley J, Burnett B, Swallow C, Eom A, Kirkwood D, Hodgson N, Doumouras A, Bogach J, Whelan T, Levine M, Parvez E, Ng D, Kazazian K, Lee K, Lu YQ, Kim DK, Magalhaes M, Grigor E, Arnaout A, Zhang J, Yee EK, Hallet J, Look Hong NJ, Nguyen L, Coburn N, Wright FC, Gandhi S, Jerzak KJ, Eisen A, Roberts A, Ben Lustig D, Quan ML, Phan T, Bouchard-Fortier A, Cao J, Bayley C, Watanabe A, Yao S, Prisman E, Groot G, Mitmaker E, Walker R, Wu J, Pasternak J, Lai CK, Eskander A, Wasserman J, Mercier F, Roth K, Gill S, Villamil C, Goldstein D, Munro V, Pathak A (University of Manitoba), Lee D, Nguyen A, Wiseman S, Rajendran L, Claasen M, Ivanics T, Selzner N, McGilvray I, Cattral M, Ghanekar A, Moulton CA, Reichman T, Shwaartz C, Metser U, Burkes R, Winter E, Gallinger S, Sapisochin G, Glinka J, Waugh E, Leslie K, Skaro A, Tang E, Glinka J, Charbonneau J, Brind'Amour A, Turgeon AF, O'Connor S, Couture T, Wang Y, Yoshino O, Driedger M, Beckman M, Vrochides D, Martinie J, Alabduljabbar A, Aali M, Lightfoot C, Gala-Lopez B, Labelle M, D'Aragon F, Collin Y, Hirpara D, Irish J, Rashid M, Martin T, Zhu A, McKnight L, Hunter A, Jayaraman S, Wei A, Coburn N, Wright F, Mallette K, Elnahas A, Alkhamesi N, Schlachta C, Hawel J, Tang E, Punnen S, Zhong J, Yang Y, Streith L, Yu J, Chung S, Kim P, Chartier-Plante S, Segedi M, Bleszynski M, White M, Tsang ME, Jayaraman S, Lam-Tin-Cheung K, Jayaraman S, Tsang M, Greene B, Pouramin P, Allen S, Evan Nelson D, Walsh M, Côté J, Rebolledo R, Borie M, Menaouar A, Landry C, Plasse M, Létourneau R, Dagenais M, Rong Z, Roy A, Beaudry-Simoneau E, Vandenbroucke-Menu F, Lapointe R, Ferraro P, Sarkissian S, Noiseux N, Turcotte S, Haddad Y, Bernard A, Lafortune C, Brassard N, Roy A, Perreault C, Mayer G, Marcinkiewicz M, Mbikay M, Chrétien M, Turcotte S, Waugh E, Sinclair L, Glinka J, Shin E, Engelage C, Tang E, Skaro A, Muaddi H, Flemming J, Hansen B, Dawson L, O'Kane G, Feld J, Sapisochin G, Zhu A, Jayaraman S, Cleary S, Hamel A, Pigeon CA, Marcoux C, Ngo TP, Deshaies I, Mansouri S, Amhis N, Léveillé M, Lawson C, Achard C, Ilkow C, Collin Y, Tai LH, Park L, Griffiths C, D'Souza D, Rodriguez F, McKechnie T, Serrano PE, Hennessey RL, Yang Y, Meneghetti AT, Panton ONM, Chiu CJ, Henao O, Netto FS, Mainprize M, Hennessey RL, Chiu CJ, Hennessey RL, Chiu CJ, Jatana S, Verhoeff K, Mocanu V, Jogiat U, Birch D, Karmali S, Switzer N, Hetherington A, Verhoeff K, Mocanu V, Birch D, Karmali S, Switzer N, Safar A, Al-Ghaithi N, Vourtzoumis P, Demyttenaere S, Court O, Andalib A, Wilson H, Verhoeff K, Dang J, Kung J, Switzer N, Birch D, Madsen K, Karmali S, Mocanu V, Wu T, He W, Vergis A, Hardy K, Zmudzinski M, Daenick F, Linton J, Zmudzinski M, Fowler-Woods M, He W, Fowler-Woods A, Shingoose G, Vergis A, Hardy K, Lee Y, Doumouras A, Molnar A, Nguyen F, Hong D, Schneider R, Fecso AB, Sharma P, Maeda A, Jackson T, Okrainec A, McLean C, Mocanu V, Birch D, Karmali S, Switzer N, MacVicar S, Dang J, Mocanu V, Verhoeff K, Jogiat U, Karmali S, Birch D, Switzer N, McLennan S, Verhoeff K, Purich K, Dang J, Kung J, Mocanu V, McLennan S, Verhoeff K, Mocanu V, Jogiat U, Birch DW, Karmali S, Switzer NJ, Jeffery L, Hwang H, Ryley A, Schellenberg M, Owattanapanich N, Emigh B, Nichols C, Dilday J, Ugarte C, Onogawa A, Matsushima K, Martin MJ, Inaba K, Schellenberg M, Emigh B, Nichols C, Dilday J, Ugarte C, Onogawa A, Shapiro D, Im D, Inaba K, Schellenberg M, Owattanapanich N, Ugarte C, Lam L, Martin MJ, Inaba K, Rezende-Neto J, Patel S, Zhang L, Mir Z, Lemke M, Leeper W, Allen L, Walser E, Vogt K, Ribeiro T, Bateni S, Bondzi-Simpson A, Coburn N, Hallet J, Barabash V, Barr A, Chan W, Hakim SY, El-Menyar A, Rizoli S, Al-Thani H, Mughal HN, Bhugio M, Gok MA, Khan UA, Warraich A, Gillman L, Ziesmann M, Momic J, Yassin N, Kim M, Makish A, Walser E, Smith S, Ball I, Moffat B, Parry N, Vogt K, Lee A, Kroeker J, Evans D, Fansia N, Notik C, Wong EG, Coyle G, Seben D, Smith J, Tanenbaum B, Freedman C, Nathens A, Fowler R, Patel P, Elrick T, Ewing M, Di Marco S, Razek T, Grushka J, Wong EG, Park LJ, Borges FK, Nenshi R, Serrano PE, Engels P, Vogt K, Di Sante E, Vincent J, Tsiplova K, Devereaux PJ, Talwar G, Dionne J, McKechnie T, Lee Y, Kazi T, El-Sayes A, Bogach J, Hong D, Eskicioglu C, Connell M, Klooster A, Beck J, Verhoeff K, Strickland M, Anantha R, Groszman L, Caminsky NG, Watt L, Boulanger N, Razek T, Grushka J, Di Marco S, Wong EG, Livergant R, McDonald B, Binda C, Luthra S, Ebert N, Falk R, and Joos E
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- 2023
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5. Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy.
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Balvardi S, Semsar-Kazerooni K, Kaneva P, Mueller C, Vassiliou M, Al Mahroos M, Fiore JF Jr, Schwartzman K, and Feldman LS
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- Humans, Female, Male, Self-Assessment, Clinical Competence, Education, Medical, Graduate, Cholecystectomy, Laparoscopic, Internship and Residency, Laparoscopy
- Abstract
Introduction: Self-review of recorded surgical procedures offers new opportunities for trainees to extend technical learning outside the operating-room. Valid tools for self-assessment are required prior to evaluating the effectiveness of video-review in enhancing technical learning. Therefore, we aimed to contribute evidence regarding the validity of intraoperative performance assessment tools for video-based self-assessment by general surgery trainees when performing laparoscopic cholecystectomies., Methods and Procedures: Using a web-based platform, general surgery trainees in a university-based residency program submitted recorded laparoscopic cholecystectomy procedures where they acted as the supervised primary surgeon. Attending surgeons measured operative performance at the time of surgery using general and procedure-specific assessment tools [Global Operative Assessment of Laparoscopic Skills (GOALS) and Operative Performance Rating System (OPRS), respectively] and entrustability level (O-SCORE). Trainees self-evaluated their performance from video-review using the same instruments. The validity of GOALS and OPRS for trainee self-assessment was investigated by testing the hypotheses that self-assessment scores correlate with (H1) expert assessment scores, (H2) O-SCORE, and (H3) procedure time and that (H4) self-assessment based on these instruments differentiates junior [postgraduate year (PGY) 1-3] and senior trainees (PGY 4-5), as well as (H5)simple [Visual Analogue Scale (VAS) ≤ 4] versus complex cases (VAS > 4). All hypotheses were based on previous literature, defined a priori, and were tested according to the COSMIN consensus on measurement properties., Results: A total of 35 videos were submitted (45% female and 45% senior trainees) and self-assessed. Our data supported 2 out of 5 hypotheses (H1 and H4) for GOALS and 3 out of 5 hypotheses (H1, H4 and H5) for OPRS, for trainee self-assessment., Conclusions: OPRS, a procedure-specific assessment tool, was better able to differentiate between groups expected to have different levels of intraoperative performance, compared to GOALS, a general assessment tool. Given the interest in video-based learning, there is a need to further develop valid procedure-specific tools to support video-based self-assessment by trainees in a range of procedures., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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6. Optimizing discharge decision-making in colorectal surgery: a prospective cohort study of discharge practices in a recently implemented enhanced recovery pathway.
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Caminsky NG, Hamad D, He BH, Zhao K, Al Mahroos M, Feldman LS, Lee L, Boutros M, and Fiore JF Jr
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- Adult, Aged, Aged, 80 and over, Female, Humans, Length of Stay, Male, Middle Aged, Patient Discharge, Postoperative Complications, Prospective Studies, Colorectal Surgery, Digestive System Surgical Procedures
- Abstract
Aim: The objectives of this project were (1) to compare time to readiness for discharge by set criteria and actual length of stay (LOS) in a newly implemented colorectal enhanced recovery pathway and (2) to identify reasons for delayed hospital discharge., Method: We conducted a prospective cohort study of 73 adult patients (age 67 ± 14 years, 56% men, 51% laparoscopic, 13% stoma creation) undergoing elective colorectal surgery in a university hospital with a recently implemented recovery pathway (<2 years). Time to readiness for discharge (oral intake, flatus, pain control, ability to walk, and no complications) was compared to actual LOS using a correlation-adjusted log-rank test. The treating team was interviewed, and thematic analysis was used to identify reasons for patients remaining in hospital after discharge criteria (DC) were achieved., Results: Median LOS was 6 (4-8) days and median time to readiness for discharge was 5 (3-8) days (P < 0.001). Twenty-eight patients (37%) remained in hospital after DC were achieved. Although some delayed discharges were medically justified (e.g., workup [13%] or treatment of complications not captured by DC [2.6%]), unnecessary hospital stays were common (e.g., perceived need for observation [16%], or patients not willing to be discharged [11%])., Conclusions: Unnecessary hospital stays were common within a recently implemented enhanced recovery pathway and represent a target for quality improvement. Efforts should be directed at optimizing patient education regarding discharge expectations, early consultation of the discharge planning team and improving discharge decision-making using standardized DC., (© 2021 The Association of Coloproctology of Great Britain and Ireland.)
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- 2021
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7. Assessment of surgical performance of laparoscopic benign hiatal surgery: a systematic review.
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Bilgic E, Al Mahroos M, Landry T, Fried GM, Vassiliou MC, and Feldman LS
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- Cognition, Humans, Psychomotor Performance, Reproducibility of Results, Video Recording, Clinical Competence, Digestive System Surgical Procedures methods, Digestive System Surgical Procedures standards, Laparoscopy methods, Laparoscopy standards
- Abstract
Background: Operative skills correlate with patient outcomes, yet at the completion of training or after learning a new procedure, these skills are rarely formally evaluated. There is interest in the use of summative video assessment of laparoscopic benign foregut and hiatal surgery (LFS). If this is to be used to determine competency, it must meet the robust criteria established for high-stakes assessments. The purpose of this review is to identify tools that have been used to assess performance of LFS and evaluate the available validity evidence for each instrument., Methods: A systematic search was conducted up to July 2017. Eligible studies reported data on tools used to assess performance in the operating room during LFS. Two independent reviewers considered 1084 citations for eligibility. The characteristics and testing conditions of each assessment tool were recorded. Validity evidence was evaluated using five sources of validity (content, response process, internal structure, relationship to other variables, and consequences)., Results: There were six separate tools identified. Two tools were generic to laparoscopy, and four were specific to LFS [two specific to Nissen fundoplication (NF), one heller myotomy (HM), and one paraesophageal hernia repair (PEH)]. Overall, only one assessment was supported by moderate evidence while the others had limited or unknown evidence. Validity evidence was based mainly on internal structure (all tools reporting reliability and item analysis) and content (two studies referencing previous papers for tool development in the context of clinical assessment, and four listing items without specifying the development procedures). There was little or no evidence supporting test response process (one study reporting rater training), relationship to other variables (two comparing scores in subjects with different clinical experience), and consequences (no studies). Two tools were identified to have evidence for video assessment, specific to NF., Conclusion: There is limited evidence supporting the validity of assessment tools for laparoscopic foregut surgery. This precludes their use for summative video-based assessment to verify competency. Further research is needed to develop an assessment tool designed for this purpose.
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- 2019
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8. Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway.
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Alhashemi M, Fiore JF Jr, Safa N, Al Mahroos M, Mata J, Pecorelli N, Baldini G, Dendukuri N, Stein BL, Liberman AS, Charlebois P, Carli F, and Feldman LS
- Subjects
- Aged, Analgesia, Epidural, Analgesics, Opioid therapeutic use, Bayes Theorem, Blood Loss, Surgical, Female, Fluid Therapy, Humans, Incidence, Laparoscopy adverse effects, Male, Middle Aged, Postoperative Complications epidemiology, Retrospective Studies, Risk Factors, Colonic Diseases surgery, Critical Pathways, Digestive System Surgical Procedures adverse effects, Ileus epidemiology, Rectal Diseases surgery
- Abstract
Background: Prolonged postoperative ileus (PPOI) is common after colorectal surgery but has not been widely studied in the context of enhanced recovery pathways (ERPs) that include interventions aimed to accelerate gastrointestinal recovery. The aim of this study is to estimate the incidence and predictors of PPOI in the context of an ERP for colorectal surgery., Methods: We analyzed data from an institutional colorectal surgery ERP registry. Incidence of PPOI was estimated according to a definition adapted from Vather (intolerance of solid food and absence of flatus or bowel movement for ≥ 4 days) and compared to other definitions in the literature. Potential risk factors for PPOI were identified from previous studies, and their predictive ability was evaluated using Bayesian model averaging (BMA). Results are presented as posterior effect probability (PEP). Evidence of association was categorized as: no evidence (PEP < 50%), weak evidence (50-75%), positive evidence (75-95%), strong evidence (95-99%), and very strong evidence (> 99%)., Results: There were 323 patients analyzed (mean age 63.5 years, 51% males, 74% laparoscopic, 33% rectal resection). The incidence of PPOI was 19% according to the primary definition, but varied between 11 and 59% when using other definitions. On BMA analysis, intraoperative blood loss (PEP 99%; very strong evidence), administration of any intravenous opioids in the first 48 h (PEP 94%; strong evidence), postoperative epidural analgesia (PEP 56%; weak evidence), and non-compliance with intra-operative fluid management protocols (3 ml/kg/h for laparoscopic and 5 ml/kg/h for open; PEP 55%, weak evidence) were predictors of PPOI., Conclusions: The incidence of PPOI after colorectal surgery is high even within an established ERP and varied considerably by diagnostic criteria, highlighting the need for a consensus definition. The use of intravenous opioids is a modifiable strong predictor of PPOI within an ERP, while the role of epidural analgesia and intraoperative fluid management should be further evaluated.
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- 2019
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9. The natural history of trauma-related coagulopathy: implications for treatment.
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Engels PT, Rezende-Neto JB, Al Mahroos M, Scarpelini S, Rizoli SB, and Tien HC
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- Adolescent, Adult, Aged, Aged, 80 and over, Blood Coagulation Disorders epidemiology, Blood Coagulation Disorders etiology, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Ontario epidemiology, Prognosis, Retrospective Studies, Survival Rate trends, Trauma Severity Indices, Wounds and Injuries diagnosis, Wounds and Injuries epidemiology, Young Adult, Blood Coagulation Disorders therapy, Hemostatic Techniques, Resuscitation methods, Wounds and Injuries complications
- Abstract
Background: Hemorrhage is a leading cause of death in trauma patients and coagulopathy is a significant contributor. Although the exact mechanisms of trauma-associated coagulopathy (TAC) are incompletely understood, hemostatic resuscitation strategies have been developed to treat TAC. Our study sought to identify which trauma patients develop TAC and the factors associated with its development, to describe the natural history of TAC, and to identify patients with TAC who may not require hemostatic resuscitation., Methods: Patients with early coagulopathy (International Normalized Ratio >1.3) who were admitted directly from the scene within 1 hour of injury were identified in our institutional trauma registry. We analyzed these data for the presence of TAC, predictors of early and delayed TAC, and evolution of TAC during the first 24 hours of admission., Results: Of 2,473 patients, 290 (12%) had early TAC (International Normalized Ratio >1.3) and 271 (11%) developed delayed TAC. Multivariate analysis identified female gender (odds ratio [OR] 1.25 [1.11-1.41]), lower pH (OR 0.08 [0.015-0.47]), lower hemoglobin (OR 0.96 [0.95-0.97]), lower temperature (OR 0.82 [0.70-0.95]), and blunt mechanism (OR 0.49 [0.33-0.71]) as factors significantly associated with development of early TAC. Progression of early TAC occurred in 64%, and these patients had more severe abdominal injury and received more emergency room crystalloid. Of patients with early TAC who did not receive fresh frozen plasma, only 49% developed worsening coagulopathy. Patients with isolated intracranial hemorrhage had higher rates of bleeding progression (75% vs. 20%, p < 0.005) in the presence of early TAC., Conclusions: TAC may appear in an early or delayed form and its presence and progression are associated with a number of identifiable factors. Although TAC commonly progresses, it also resolves spontaneously in many patients. Further research is required to identify which patients with TAC require hemostatic treatment, although those with intracranial hemorrhages seem to warrant aggressive therapy.
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- 2011
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10. Effect of sunscreen application on UV-induced thymine dimers.
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Al Mahroos M, Yaar M, Phillips TJ, Bhawan J, and Gilchrest BA
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- Administration, Topical, Adult, Biopsy, Needle, Female, Humans, Immunohistochemistry, Middle Aged, Prospective Studies, Reference Values, Sensitivity and Specificity, Pyrimidine Dimers metabolism, Pyrimidine Dimers radiation effects, Sunscreening Agents pharmacology, Ultraviolet Rays adverse effects
- Abstract
Background: Exposure to UV radiation is a major risk factor for skin cancer, including malignant melanoma. Photocarcinogenesis is caused largely by mutations at sites of incorrectly repaired DNA photoproducts, of which the most common is the thymine dimer. Over the past decade, controversy has arisen over the use of sunscreens to prevent UV-induced skin cancer., Objectives: To determine if daily application of a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 protects human skin against UV-induced DNA damage as determined by the formation of thymine dimers after repeated exposures to simulated solar light and, if so, to determine whether daily applications are required to achieve this protective effect., Methods: Over 4 consecutive days, an SPF 15 sunscreen was applied homogeneously to each of 4 buttock sites of 18 women 30 minutes before exposure to 2 minimum erythemal doses of UV radiation. Of these 4 sites, 1 was treated with SPF 15 daily, and the remaining 3 were treated on 3 of the 4 irradiation days, skipping application on day 2, 3, or 4. A fifth site served as the untreated control and was also not irradiated. The number of cells per square millimeter positive for thymine dimer formation was determined using immunohistochemical and image analyses., Results: There was no significant difference in thymine dimer formation between nonirradiated and irradiated skin when application of sunscreen preceded each irradiation. However, when sunscreen application was omitted even once prior to irradiation, a statistically significant increase in thymine dimer formation was apparent. At 48 hours after irradiation of unprotected skin, 50% of epidermal dimers present 24 hours after irradiation had been removed; at 72 hours, more than 75% were gone., Conclusions: Our study indicates that regular use of a broad-spectrum sunscreen is effective in preventing a major form of UV-induced DNA damage. Irregular and inadequate use of sunscreen during exposure to UV radiation results in thymine dimer formation, which may lead to mutation and subsequent cancer development.
- Published
- 2002
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