Principles of Rodent Surgery for the New Surgeon

For both scientific and animal welfare reasons, training in basic surgical concepts and techniques should be undertaken before ever seeking to perform surgery on a rodent. Students, post-doctoral scholars, and others interested in performing surgery on rodents as part of a research protocol may not have had formal surgical training as part of their required coursework. Surgery itself is a technical skill, and one that will improve with practice. The principles of aseptic technique, however, often remain unexplained or untaught. For most new surgeons, this vital information is presented in piecemeal fashion or learned on the job, neither of which is ideal. It may also make learning how to perform a particular surgery difficult, as the new surgeon is learning both a surgical technique and the principles of asepsis at the same time. This article summarizes and makes recommendations for basic surgical skills and techniques necessary for successful rodent surgery. This article is designed to supplement hands-on training by the user''s institution.     

An introduction to the practical and ethical perspectives on the need to advance and standardize the intracoelomic surgical implantation of electronic tags in fish

The intracoelomic surgical implantation of electronic tags (including radio and acoustic telemetry transmitters, passive integrated transponders and archival biologgers) is frequently used for conducting studies on fish. Electronic tagging studies provide information on the spatial ecology, behavior and survival of fish in marine and freshwater systems. However, any surgical procedure, particularly one where a laparotomy is performed and the coelomic cavity is opened, has the potential to alter the survival, behavior or condition of the animal which can impair welfare and introduce bias. Given that management, regulatory and conservation decisions are based on the assumption that fish implanted with electronic tags have similar fates and behavior relative to untagged conspecifics, it is critical to ensure that best surgical practices are being used. Also, the current lack of standardized surgical procedures and reporting of specific methodological details precludes cross-study and cross-year analyses which would further progress the field of fisheries science. This compilation of papers seeks to identify the best practices for the entire intracoelomic tagging procedure including pre- and post-operative care, anesthesia, wound closure, and use of antibiotics. Although there is a particular focus on salmonid smolts given the large body of literature available on that group, other life-stages and species of fish are discussed where there is sufficient knowledge. Additional papers explore the role of the veterinarian in fish surgeries, the need for minimal standards in the training of fish surgeons, providing a call for more complete and transparent procedures, and identifying trends in procedures and research needs. Collectively, this body of knowledge should help to improve data quality (including comparability and repeatability), enhance management and conservation strategies, and maintain the welfare status of tagged fish.     

Residency training in plastic surgery: a survey of educational goals

With the advent of integrative plastic surgical training programs, requirements for earlier specialization decisions, and an increasing subspecialization within the practice of plastic surgery, the educational goals of residency training may have changed. The duration and extent of training required are also currently being questioned. This study was performed to better understand the necessary roles of plastic surgery residencies and to determine how these demands might optimally be met. Of 151 practicing plastic surgeons in the Ontario, Canada, region, 81 (53.6 percent) responded to a survey. General agreement was that 2 years was an optimal length of time for core surgical training, which should then be followed by at least 3 years of plastic surgical training. Opinions on the ideal length of time training in specific medical and surgical disciplines are discussed. Overall, respondents thought that two thirds of training should occur in tertiary care centers, with the remaining time spent at smaller community centers and private clinics. Nearly half of respondents thought that research training should be a mandatory part of the residency, although the amount of protected time for this activity varied substantially. Most thought that unrestricted elective time should also be available. Academic plastic surgeons rated the importance of research training (p < 0.01), critical appraisal skills (p < 0.05), and teaching skills (p < 0.05) as significantly more important than did their nonacademic colleagues. The authors present results from the Ontario region and a template for determining optimal characteristics for training programs. Further investigation may be of timely importance during a foreseeable future transition from traditional to integrative plastic surgery residency training.     

The veterinarian’s role in surgical implantation of electronic tags in fish

The current role of veterinarians participating in the intracoelomic surgical implantation of electronic tags in fisheries research projects with researchers is limited, but could be expanded. Veterinary training is broadly applicable to conducting surgeries on any species, and there are increasing numbers of veterinarians with fish-specific experience. A few of the roles veterinarians can play include advising on surgical instrument selection and acquisition, interfacing with Institutional Animal Care and Use Committees, devising strategies for anesthesia, providing direction on disinfection and sterilization, complying with regulatory requirements, providing individualized surgery instruction, and occasionally performing field surgeries. Veterinarians and fish researchers bring different strengths and deficits to bear in a fish surgery project, and it is helpful to recognize these for successful collaborations. Engaging veterinary consultation for electronic tag implantation surgeries in fish can be a mutually beneficial experience for the researcher and the veterinarian, with dividends in data quality and welfare of the research subjects.     

Positioning Accuracy in Otosurgery Measured with Optical Tracking

Objectives

To assess positioning accuracy in otosurgery and to test the impact of the two-handed instrument holding technique and the instrument support technique on surgical precision. To test an otologic training model with optical tracking.

Study Design

In total, 14 ENT surgeons in the same department with different levels of surgical experience performed static and dynamic tasks with otologic microinstruments under simulated otosurgical conditions.

Methods

Tip motion of the microinstrument was registered in three dimensions by optical tracking during 10 different tasks simulating surgical steps such as prosthesis crimping and dissection of the middle ear using formalin-fixed temporal bone. Instrument marker trajectories were compared within groups of experienced and less experienced surgeons performing uncompensated or compensated exercises.

Results

Experienced surgeons have significantly better positioning accuracy than novice ear surgeons in terms of mean displacement values of marker trajectories. The instrument support and the two-handed instrument holding techniques significantly reduce surgeons’ tremor. The laboratory set-up presented in this study provides precise feedback for otosurgeons about their surgical skills and proved to be a useful device for otosurgical training.

Conclusions

Simple tremor compensation techniques may offer trainees the potential to improve their positioning accuracy to the level of more experienced surgeons. Training in an experimental otologic environment with optical tracking may aid acquisition of technical skills in middle ear surgery and potentially shorten the learning curve. Thus, simulated exercises of surgical steps should be integrated into the training of otosurgeons.     

Antibiotic use during the intracoelomic implantation of electronic tags into fish

The use of antibiotics, in particular, the use of a single dose of antibiotics during electronic tag implantation is of unproven value, and carries with it the potential for the development of antibiotic resistance in bacteria and the alteration of the immune response of the fish. Antibiotic use during electronic tag implantation must conform to relevant drug laws and regulations in the country where work is being done, including the requirements for withdrawal times before human consumption is a possibility. Currently, the choice of antibiotics (most often tetracycline or oxytetracycline) and the use of a single dose of the drug are decisions made without knowledge of the basic need for antibiotic usage and of the bacteria involved in infections that occur following electronic tag implantation. Correct perioperative use of an antibiotic is to apply the drug to the animal before surgery begins, to assure serum and tissue levels of the drug are adequate before the incision is made. However, the most common perioperative application of antibiotics during implantation of an electronic tag is to delay the administration of the drug, injecting it into the coelom after the electronic tag is inserted, just prior to closure of the incision. There is little empirical evidence that the present application of antibiotics in fish being implanted with electronic tags is of value. Improvements should first be made to surgical techniques, especially the use of aseptic techniques and sterilized instruments and electronic tags, before resorting to antibiotics.     

构建医学检验专业技能培训体系的规划与设计思路

依据医学检验发展的现状与前景及我校医学检验教育改革现状,构建专业技能培训体系及评价标准,改变单学科自成体系的培养模式,克服了实践教学的盲目性。有效地利用有限的时间培养学生的操作能力、创新能力及市场适应能力,提高学生的综合素质,并通过医学检验专业技能培训体系的应用,能使学校教学更有效地与市场接轨,为医学检验市场提供高素质的有创造性的专业技术人才。     

Evaluation of water entry into the coelom and different levels of aseptic technique during surgical implantation of electronic tags in freshwater fish

We reviewed the literature in an attempt to determine the importance of aseptic technique when implanting electronic tags in fish. Given that there was negligible information on this topic we embarked on a study where bluegill (Lepomis macrochirus) were used as a model to investigate the effects of different aseptic surgical techniques for the intracoelomic implantation of electronic tags in fish. First we tested the effects of water entry into the incision using five treatments: lake, distilled and saline water introduced into the incision, water-free controls, and non-surgery controls. For fish in the water treatments, 1 mL of the sample was introduced into their coelom prior to incision closure. Fish were held for 10 days to monitor survival and at the end of the study, the survivors were blood sampled and euthanized to evaluate condition and health using the health assessment index. In a second experiment, four aseptic treatments were used: non-sterile, field-based, high-grade sterility, and non-surgery controls and fish were monitored as in the first experiment. For both experiments, no differences in physiological status, health or mortality were noted among treatment groups. However, in the aseptic techniques experiment, surgical times were approximately twice as long for fish in the sterile treatment as compared to other groups and the costs of surgical supplies was greater than that of the less-sterile treatments. Although we failed to document any benefit of keeping water out of the incision or using aseptic technique for bluegill, in other situations and for other species, such approaches may be important. As such, we encourage fish surgeons practicing intracoelomic implants to attempt to prevent water entry into the coelom. We also encourage, at least some level of infection control (e.g., non-sterile gloves, clean tags and surgical tools) consistent with good veterinary practices to maintain the welfare status of tagged fish and ensure that the data from tagged fish representative of untagged conspecifics. However, the most prudent and ethical approach would be to work with veterinarians to incorporate formal sterilization procedures, equipment (e.g., sterile gloves) and aseptic technique into field surgical techniques.     

Development and training of coordination skills in 11- to 19-year-old soccer players

The purpose of the study was to determine the specificity of the development and training of coordination skills (CSs) in 11- to 19-year-old soccer players (n = 600). Tests for soccer players’ CSs and technical skills and one- and two-year training experiments on targeted development of CSs were used. It was found that the period from 11 to 13 years of age was the most favorable for the development of CSs in soccer players, and the period from 14 to 16 years of age was the next most favorable. The use of special coordination training aimed at development of individual CSs led to a greater improvement, with the CS and technical skill parameters of athletes from the experimental groups being significantly higher (by 2.5–38.3 and 3.6–12.2%, respectively) than those of athletes from the control groups developing CSs by the traditional method using dexterity exercises.     

Organisation of vascular surgical services: evolution or revolution?

The trend towards subspecialisation in hospital services is likely to lead to the development of vascular surgery as a separate specialty. If vascular surgery is to emerge as a high quality service then vascular emergencies--a substantial component of the workload--should be dealt with by surgeons with adequate training, and all patients should have equal access to the service. A specialist vascular surgical unit would have to be large enough to make efficient use of other services that it needs, such as radiology, and so may require the amalgamation of smaller health district units. Because of the differing local degrees of subspecialisation, national or regional strategies for vascular surgery must be developed.     

专科层次临床医学专业课程建设效果调查分析

目的:了解临床医学专业课程建设情况,总结专科层次临床医学专业教育教学的主要成绩,查找专业建设存在的问题,为专科层次临床医学专业教育教学改革提出改进意见。方法:对我校2013届(应届生)306名、2011届和2012届(往届生)333名专科层次临床医学专业毕业生进行问卷调查,主要调查内容包括:课程内容、课程资源和课程评价。结果:专科层次临床医学专业毕业生认为本专业核心课程知识和技能模块设计合理,且应届毕业生认可度高于往届毕业生;对专业类纸质图书、纸质期刊等课程资源满意度高,认为专业类精品课程、教学视频等课程资源需要进一步改善;毕业生对专业知识考评认可度较高,应届生认可度优于往届生。结论:专科层次临床医学专业课程建设效果较好,特别是课程内容安排和课程评价合理,但在专业技能训练和课程资源建设方面需重点加强。     

Determining undergraduate curriculum content in plastic surgery

The purpose of this study was to determine the cognitive knowledge and clinical skills related to plastic surgery that are essential for inclusion in an undergraduate curriculum. A questionnaire was distributed to surgical clerkship directors, plastic surgeons, and 1980 graduates of four medical schools. Respondents were asked to rate (0-3) the importance of 74 knowledge items and 28 clinical skills in relation to the knowledge/proficiency necessary for students to achieve prior to graduating from medical school (0 = unnecessary, 3 = indepth knowledge/proficiency important). Results of the questionnaire enabled the determination of mean response scores and the hierarchical ranking of questionnaire items. There was a high degree of correlation between the rankings of the three groups of respondents indicating agreement on knowledge and clinical skills in plastic surgery that are essential, as well as those nonessential, for the competent practice of medicine.     

Surgical care in the village

The care of people suffering from surgical disease or injury is unique in requiring, even at its simplest level, a certain degree of psychomotor skill and technological support. This cannot be achieved and maintained in isolation with any consistency. Villages must therefore be interdependent and related to supervision from the district hospital. The responsibility for village care rests with the district physician. He must be adequately trained for this purpose and provided with the simple facilities that are required. He extends his reach into the villages through the auxiliary health workers, who must be taught the skills necessary for simple surgical procedures and be trained to stabilize those patients that they cannot treat for transport to the district hospital. Although the skills and facilities required must be determined locally, there is a need to define the broad principles of training and to develop simple and adequate technology at village and district levels.     

Training in molecular cytopathology testing

Training in molecular cytopathology testing is essential in developing and maintaining skills in modern molecular technologies as they are introduced to a universal health care system such as extant in the UK and elsewhere. We review the system in place in Northern Ireland (NI) for molecular testing of solid tumours, as an example to train staff of all grades, including pathologists, clinical scientists, biomedical scientists and equivalent technical grades. We describe training of pathologists as part of the NI Deanery medical curriculum, the NI training programme for scientists and laboratory rotation for Biomedical Scientists. Collectively, the aims of our training are two‐fold: to provide a means by which individuals may extend their experience and skills; and to provide and maintain a skilled workforce for service delivery. Through training and competency, we introduce new technologies and tests in response to personalised medicine therapies with a competent workforce. We advocate modifying programmes to suit individual needs for skill development, with formalised courses in pre‐analytical, analytical and postanalytical demands of modern molecular pathology. This is of particular relevance for cytopathology in small samples such those from formalin‐fixed paraffin‐embedded cell blocks. We finally introduce how university courses can augment training and develop a skilled workforce to benefit the delivery of services to our patients.     

A review of tricaine methanesulfonate for anesthesia of fish

Tricaine methanesulfonate (TMS) is an anesthetic that is approved for provisional use in some jurisdictions such as the United States, Canada, and the United Kingdom (UK). Many hatcheries and research studies use TMS to immobilize fish for marking or transport and to suppress sensory systems during invasive procedures. Improper TMS use can decrease fish viability, distort physiological data, or result in mortalities. Because animals may be anesthetized by junior staff or students who may have little experience in fish anesthesia, training in the proper use of TMS may decrease variability in recovery, experimental results and increase fish survival. This document acts as a primer on the use of TMS for anesthetizing juvenile salmonids, with an emphasis on its use in surgical applications. Within, we briefly describe many aspects of TMS including the legal uses for TMS, and what is currently known about the proper storage and preparation of the anesthetic. We outline methods and precautions for administration and changes in fish behavior during progressively deeper anesthesia and discuss the physiological effects of TMS and its potential for compromising fish health. Despite the challenges of working with TMS, it is currently one of the few legal options available in the USA and in other countries until other anesthetics are approved and is an important tool for the intracoelomic implantation of electronic tags in fish.     

构建融合医学人文教育的新型医学遗传学教学模式

医学遗传学是广泛涉及基础与临床学科的综合性课程,对于医学生是至关重要的必修课程。现代医学已由传统的生物-医学模式向生物-心理-社会医学模式转化,医学诊疗模式从最初的以"疾病为中心"到"以病人为中心"的方式转变,医生不仅精通医术,更要理解患者的心理,与其进行良好的沟通,因此现代医学成为了一门具有自然科学、人文社会科学双重属性的综合性科学体系。长期以来,我国医学院校的教学仍然是生物医学知识和技能占据主导地位,人文课程不受重视。因此,必须加强医学人文知识的学习和技能培训,只有这样才能在未来的医疗工作中掌握良好的医患沟通技巧,建立和谐的医患关系,对处理好日渐增多的医疗纠纷、维护医患双方的共同利益具有重要意义。     

Physiological responses of Pacific halibut, <Emphasis Type="Italic">Hippoglossus stenolepis</Emphasis>, to intracoelomic implantation of electronic archival tags,with a review of tag implantation techniques employed in flatfishes

Management of Pacific halibut (Hippoglossus stenolepis), a long-lived flatfish, is complicated by possible ontogenic and sex-specific variation in migration. Archival tags promise the ability to help uncover long-term movement patterns at the individual level, if the tags can be retained and recovered from healthy fish. We examined fifteen individuals (69–90 cm fork length) for long-term physiological response to intracoelomic implantation of three types of archival tags: fully internal, internal with right angle protruding light stalk, and internal with straight protruding light stalk. Tags represented 0.05–0.16% of initial fish weights. Fish were reared at 10.8 ± 1.1°C for 59 weeks post-surgery. One fish died after 39 weeks from thermal stress unrelated to the surgical procedure. Temporal variation in behavior of tagged fish was indistinguishable from that of controls (n = 15 tagged, 5 controls). Treatment and control-group fish grew at similar rates. No tag expulsion or physiological response was evident in the individual that died at 39 weeks, but nine of eleven individuals dissected at the end of 59 weeks had developed internal responses. These responses ranged from deposition of fibrous protein and/or calcitic material on tag surfaces to partial or full tag encapsulation in either the visceral peritoneal layer (fully-internal tags) or the intestinal mesenteries (stalk-bearing tags). The responses were within the range reported for other pleuronectids implanted with tags of similar configuration and may have implications for design and interpretation of long-term tagging studies. Encapsulation may reduce the probability of tag recoveries even in the absence of tag expulsion, especially in species eviscerated at sea.     

Effects of suture material on incision healing, growth and survival of juvenile largemouth bass implanted with miniature radio transmitters: case study of a novice and experienced fish surgeon

Juvenile largemouth bass Micropterus salmoides , intraperitoneally implanted with microradio transmitters exhibited short-term (5 days) inflammation around the incision and suture insertion points for both non-absorbable braided silk and non-absorbable polypropylene monofilament, but in the longer term (20 days) almost all sutures were shed and the incisions were completely healed. Cumulative mortality was higher for fish with braided silk sutures, however, post-mortem analysis revealed that violations to the gastro-intestinal tract from the surgical procedure were the usual cause of the mortality. Mortality was generally low in control fish. The two surgeons who performed the implantations differed substantially in experience. Despite receiving basic training, the novice surgeon took longer to complete the surgeries, had reduced suture precision and experienced more fish mortality relative to the experienced surgeon. For both surgeons, it took longer to complete suturing with polypropylene than with braided silk. During the surgery day, the experienced surgeon exhibited consistently rapid surgery times, whereas the novice surgeon exhibited significantly improved speed as the number of surgeries completed increased. This study suggests that microtransmitters can be successfully implanted in juvenile largemouth bass but some mortality can be expected. This mortality seems to be independent of suture material, but dependent upon the experience of the surgeon.     

Current Trainee and Workforce Patterns for Thyroid and Parathyroid Surgery in the United States

ObjectiveThyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to direct research, education, and quality improvement interventions.MethodsWe tabulated case numbers for privately insured patients undergoing thyroid and parathyroid surgery in Marketscan: 2010–2016 and trainee case logs for residents and fellows in general surgery and otolaryngology. Summary statistics and tests for trends and differences were calculated.ResultsMarketscan data captured 114 500 thyroid surgeries. The proportion performed by each specialty was not significantly different. Otolaryngologists performed 58 098 and general surgeons performed 56 402. Otolaryngologists more commonly performed hemithyroidectomy (n = 25 148, 43.29% of all thyroid surgeries performed by otolaryngologists) compared to general surgeons (n = 20 353, 36.09% of all thyroid surgeries performed by general surgeons). Marketscan data captured 21 062 parathyroid surgeries: 6582 (31.25%) were performed by otolaryngologists, and 14 480 (68.75%) were performed by general surgeons. The case numbers of otolaryngology and general surgery trainees completing residency and fellowship varied 6- to 9-fold across different sites. The wide variation may reflect both the level of exposure a particular training program offers and trainee level of interest.ConclusionThyroid surgical care is equally provided by general surgeons and otolaryngologists. Both specialties contribute significantly to parathyroid surgical care. Both specialties should provide input into and be targets of research, quality, and education interventions.     

分子实验技能课程教学模式初探

目的:探索适合临床研究生的分子实验技能课教学模式,提高研究生科研思维能力和实验技能。方法:根据临床研究生的特点,以学生为主体,注重学生科研思维的培养,运用多样化的教学手段,对研究生临床分子实验技能课程的教学方法进行探索。结果:通过实验技能课的学习与培训,临床研究生科研思维能力得到很大的提升,对医学实验研究兴趣增加,取得了很好的教学效果。结论:多元化教学模式比较适合临床研究生实验技能课的教学。