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Wilmington, NC, United States

Stefanidis D.,Carolinas Medical Center | Hope W.W.,New Hannover Regional Medical Center | Scott D.J.,University of Texas Southwestern Medical Center
Surgical Endoscopy and Other Interventional Techniques | Year: 2011

Background: The value of robotic assistance for intracorporeal suturing is not well defined. We compared robotic suturing with laparoscopic suturing on the FLS model with a large cohort of surgeons. Methods: Attendees (n = 117) at the SAGES 2006 Learning Center robotic station placed intracorporeal sutures on the FLS box-trainer model using conventional laparoscopic instruments and the da Vinci® robot. Participant performance was recorded using a validated objective scoring system, and a questionnaire regarding demographics, task workload, and suturing modality preference was completed. Construct validity for both tasks was assessed by comparing the performance scores of subjects with various levels of experience. A validated questionnaire was used for workload measurement. Results: Of the participants, 84% had prior laparoscopic and 10% prior robotic suturing experience. Within the allotted time, 83% of participants completed the suturing task laparoscopically and 72% with the robot. Construct validity was demonstrated for both simulated tasks according to the participants' advanced laparoscopic experience, laparoscopic suturing experience, and self-reported laparoscopic suturing ability (p < 0.001 for all) and according to prior robotic experience, robotic suturing experience, and self-reported robotic suturing ability (p < 0.001 for all), respectively. While participants achieved higher suturing scores with standard laparoscopy compared with the robot (84 ± 75 vs. 56 ± 63, respectively; p < 0.001), they found the laparoscopic task more physically demanding (NASA score 13 ± 5 vs. 10 ± 5, respectively; p < 0.001) and favored the robot as their method of choice for intracorporeal suturing (62 vs. 38%, respectively; p < 0.01). Conclusions: Construct validity was demonstrated for robotic suturing on the FLS model. Suturing scores were higher using standard laparoscopy likely as a result of the participants' greater experience with laparoscopic suturing versus robotic suturing. Robotic assistance decreases the physical demand of intracorporeal suturing compared with conventional laparoscopy and, in this study, was the preferred suturing method by most surgeons. Curricula for robotic suturing training need to be developed. © 2010 Springer Science+Business Media, LLC.

Kotlyarevska K.,New Hannover Regional Medical Center | Wolfgram P.,University of Wisconsin - Madison | Lee J.M.,University of Michigan
Journal of Adolescent Health | Year: 2011

Purpose: To determine whether waist circumference (WC) is a better predictor of insulin resistance (IR) than body mass index (BMI) in U.S. adolescents aged 1218 years. Methods: Using data from the National Health and Nutrition Examination Survey 19992002, we evaluated an ethnicaly diverse sample of 1,571 adolescents with regard to BMI, WC, and fasting glucose and insulin levels. Children were classified as having IR if they had a homeostasis model assessment of insulin resistance (insulin [U/mL] × glucose [mmol/L]/22.5) of greater than 4.39. We created receiver operating characteristic curves predicting IR across various thresholds of WC and BMI, and area under the curve was compared. Results: The prevalence rate of IR in the study population was 11.8%. Measures of test performance (sensitivity and specificity) for predicting IR were similar for abnormal BMI and WC thresholds; that is, thresholds of BMI 85th% and WC 75th% and thresholds of BMI 95th% and WC 90th% were quite similar. There were no significant differences in area under the curve for WC versus BMI (.85; 95% CI,.83.88; p =.84) either for the overall population or for specific racial groups. Conclusions: WC does not seem to provide a distinct advantage over BMI for identifying adolescents with IR. © 2011 Society for Adolescent Health and Medicine. All rights reserved.

Joyner K.,New Hannover Regional Medical Center
Bariatric Nursing and Surgical Patient Care | Year: 2012

Purpose: To enhance the vitamin and mineral supplementation knowledge base of all bariatric surgery care providers. Significance: Bariatric surgery patients require ongoing nutritional counseling during their weight loss surgery experience. It is not the sole responsibility of the dietician. A multidisciplinary approach is paramount. This article will discuss the common bariatric procedures performed in the U.S. and their respective vitamin and mineral deficiencies based on the surgical physiology. In addition, basic vitamin and mineral charts are provided that list basic information (why, what, when, and how) all bariatric care providers must be familiar in order to assure optimal preoperative and postoperative care. © Mary Ann Liebert, Inc.

Garvey J.L.,Carolinas Medical Center | Monk L.,Duke University | Granger C.B.,Duke University | Studnek J.R.,Carolinas Medical Center | And 3 more authors.
Circulation | Year: 2012

Background - For patients with an acute ST-segment elevation myocardial infarction, cardiac catheterization laboratory (CCL) activation by emergency medical technicians or emergency physicians has been shown to substantially reduce treatment times. One drawback to this approach involves overtriage, whereby CCL staffs are activated for patients who ultimately do not require emergent coronary angiography or for patients who undergo angiography but are not found to have coronary artery occlusion. Methods and Results - We examined CCL activation at 14 primary angioplasty hospitals to determine the course of management, including the rate of inappropriate activation. Among 3973 activations (29% by emergency medical technicians, 71% by emergency physicians) between December 2008 and December 2009, appropriate CCL activations occurred for 3377 patients (85%), with 2598 patients (76.9% of appropriate activations) receiving primary percutaneous coronary intervention. Reasons for inappropriate activations (596 patients; 15%) included ECG reinterpretations (427 patients; 72%) or the fact that the patient was not a CCL candidate (169 patients; 28%). The rate of cancellation because of reinterpretation of emergency medical technicians' ECG (6% of all activations) was more common than for cancellation because of reinterpretation of emergency physicians' ECG (4.6%). Conclusions - This represents the first report of the rates of CCL cancellation for ST-segment elevation myocardial infarction system activation by emergency medical technicians and emergency physicians in a large group of hospitals organized within a statewide program. The high rate of coronary intervention and relatively low rate of inappropriate activation suggest that systematic CCL activation by emergency personnel on a broad scale is feasible and accurate, and these rates set a benchmark for ST-segment elevation myocardial infarction systems. © 2011 American Heart Association, Inc.

Hildebrand J.R.,New Hannover Regional Medical Center | Sastry S.,South East Area Health Education Center
Journal of Oncology Practice | Year: 2013

Purpose: Patients who continue to smoke after the diagnosis of bronchogenic carcinoma (BC) experience increased rates of morbidity and mortality. Evidence suggests that smokers are more likely to quit if they are counseled by their physicians. However, there may be a prevailing belief among physicians that treating tobacco dependence is futile in this population. The purpose of this study was to investigate whether physicians addressed smoking cessation with patients who were diagnosed with BC. Methods: A retrospective medical record review of patients who were diagnosed with BC between 2008 and 2010 was conducted at a community medical center using the hospital cancer registry. Demographic information including age, race, sex, stage, and smoking status at the time of diagnosis was collected. Evidence of tobacco cessation counseling was sought through billing codes, physician notes, and orders surrounding the time of diagnosis. Results: A total of 948 patients were diagnosed with lung cancer between 2008 and 2010; 438 were current smokers at diagnosis, and only 36% were counseled on smoking cessation. On average, each patient encountered three different physicians in both the inpatient and outpatient settings. Of note, patients with stage I disease were 1.7× more likely to be counseled than those with stage IV disease (P = .017). Conclusion: Despite evidence that smoking cessation is beneficial even after the diagnosis of BC, physicians are not counseling their patients sufficiently. With the implementation of quality improvement programs, we expect smoking cessation counseling for patients with BC will improve. Copyright © 2013 by American Society of Clinical Oncology.

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