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Ibrahim E.F.,Wexham Park Hospital | Richardson M.D.,Epworth Hospital | Nestel D.,Monash University
Medical Education | Year: 2015

Context: Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery.Objectives: This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training.Methods: Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis.Results: Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure.Conclusions: Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. © 2015 John Wiley & Sons Ltd. Source


Iyer S.,Wexham Park Hospital
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Extensor indicis (EI) transfer is the commonest tendon transfer to restore thumb extension after loss of extensor pollicis longus (EPL) function. Rarely are there clinical situations when EI is not available as a donor motor and alternative techniques have to be employed. I report a successful reconstruction of thumb extension using Extensor digiti minimi (EDM) in an adult male patient in whom EI and Abductor pollicis longus (APL) were not available as donor motors. A literature review reveals that this is the first report of such a transfer in an adult; only one previous EDM transfer has been reported for thumb extension on a child in 2011. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Source


Guo S.,Wexham Park Hospital
Trauma Monthly | Year: 2012

Traumatic rupture of the distal biceps tendon is rare. Conservative treatment can result in reduced flexion and supination power with reduced function. This case report emphasizes the need for prompt surgical treatment and describes the possible complications of delayed surgical intervention. Copyright © 2012, Kowsar Corp. Source


Evgeniou E.,Wexham Park Hospital
Journal of Surgical Education | Year: 2012

Introduction: The advances in Internet and computer technology offer many solutions that can enhance surgical education and increase the effectiveness of surgical teaching. E-learning plays an important role in surgical education today, with many e-learning projects already available on the Internet. Educational Theory: E-learning is based on a mixture of educational theories that derive from behaviorist, cognitivist, and constructivist educational theoretical frameworks. Can Educational Theory Improve E-learning? Conventional educational theory can be applied to improve the quality and effectiveness of e-learning. The theory of "threshold concepts" and educational theories on reflection, motivation, and communities of practice can be applied when designing e-learning material. E-learning in Surgical Education: E-learning has many advantages but also has weaknesses. Studies have shown that e-learning is an effective teaching method that offers high levels of learner satisfaction. Instead of trying to compare e-learning with traditional methods of teaching, it is better to integrate in e-learning elements of traditional teaching that have been proven to be effective. Conclusions: E-learning can play an important role in surgical education as a blended approach, combined with more traditional methods of teaching, which offer better face-to-interaction with patients and colleagues in different circumstances and hands on practice of practical skills. National provision of e-learning can make evaluation easier. The correct utilization of Internet and computer resources combined with the application of valid conventional educational theory to design e-learning relevant to the various levels of surgical training can be effective in the training of future surgeons. © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. Source


Okonko D.O.,Imperial College London | Mandal A.K.J.,Wexham Park Hospital | Missouris C.G.,Wexham Park Hospital | Poole-Wilson P.A.,Imperial College London
Journal of the American College of Cardiology | Year: 2011

Objectives: The aim of this study was to comprehensively delineate iron metabolism and its implications in patients with chronic heart failure (CHF). Background: Iron deficiency is an emerging therapeutic target in CHF. Methods: Iron and clinical indexes were quantified in 157 patients with CHF. Results: Several observations were made. First, iron homeostasis was deranged in anemic and nonanemic subjects and characterized by diminished circulating (transferrin saturation) and functional (mean cell hemoglobin concentration) iron status in the face of seemingly adequate stores (ferritin). Second, while iron overload and elevated iron stores were rare (1%), iron deficiency (transferrin saturation <20%) was evident in 43% of patients. Third, disordered iron homeostasis related closely to worsening inflammation and disease severity and strongly predicted lower hemoglobin levels independently of age, sex, erythrocyte sedimentation rate, New York Heart Association (NYHA) functional class, and creatinine. Fourth, the etiologies of anemia varied with disease severity, with an iron-deficient substrate (anemia of chronic disease and/or iron-deficiency anemia) evident in 16%, 72%, and 100% of anemic NYHA functional class I or II, III, and IV patients, respectively. Although anemia of chronic disease was more prevalent than iron-deficiency anemia, both conditions coexisted in 17% of subjects. Fifth, iron deficiency was associated with lower peak oxygen consumption and higher ratios of ventilation to carbon dioxide production and identified those at enhanced risk for death (hazard ratio: 3.38; 95% confidence interval: 1.48 to 7.72; p = 0.004) independently of hemoglobin. Nonanemic iron-deficient patients had a 2-fold greater risk for death than anemic iron-replete subjects. Conclusions: Disordered iron homeostasis in patients with CHF relates to impaired exercise capacity and survival and appears prognostically more ominous than anemia. © 2011 American College of Cardiology Foundation. Source

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