Studies in health technology and informatics, 2005
This study describes a comparison between an animal model and a haptic enabled, needle based, gra... more This study describes a comparison between an animal model and a haptic enabled, needle based, graphical user interface simulator (SimPL), for teaching Diagnostic Peritoneal Lavage (DPL). Forty novice medical students were divided into two groups and then trained to perform a DPL on either a pig or the SimPL. All subjects completed a pre and post test of basic knowledge and were tested by performing a DPL on a TraumaMan mannequin and evaluated by two trauma surgeons blinded to group. The results showed significant improvement over baseline knowledge in both groups but more so in the SimPL group. The simulator group performed better on site selection (p<0.001) and technique (p<0.002) than those who trained on a pig. The finding that a simulator is superior to an animal model for teaching an important skill to medical students has profound implications on future training and deserves further study.
Résumé/Abstract The Sequential Compression Device (SCD) is frequently the sole measure used to pr... more Résumé/Abstract The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD ...
Chemical warfare agents (CWAs) are potential threats to both military personnel and civilians. Th... more Chemical warfare agents (CWAs) are potential threats to both military personnel and civilians. The potential of associated traumatic injuries requiring surgical treatment is significant, especially in a battlefield scenario. An existing traumatic wound may be ...
The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venou... more The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD prophylaxis among nonambulatory trauma patients at risk for DVT. We conducted a prospective observational study at two Level I university-affiliated trauma centers. Nonambulatory trauma patients were observed during their early postadmission period in a non-critical care setting. Six observations were made as to proper SCD applications during a 24-hour period (two times in the morning shift, two in the evening shift, and two overnight). "Full compliance" was defined as SCD on and functioning properly in all six observations. In a total of 1343 observations in 227 patients only 42 patients (19%) were fully compliant. The devices were on and functioning in 712 (53%) observations. Among the 185 patients who were not fully compliant DVT ri...
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, Mar 2, 1998
Background and Objectives: Reported complications of retained gallstones following laparoscopic c... more Background and Objectives: Reported complications of retained gallstones following laparoscopic cholecystectomy (LC) are increasing. This study was undertaken to evaluate the effects of retained gallstones following LC in a prairie dog model. Methods: Twenty-seven prairie dogs with diet-induced gallstones were divided into three groups of nine. Group I (control) had LC with removal of stones. Group II had LC followed by return of native stones intra-abdominally. Group III had LC followed by return of infected stones (stones dipped in Escherichia coli) intra-abdominally. Animals were euthanized at two months and the character and extent of intra-abdominal adhesions were scored. Results: Adhesions were present in 56% of animals in Group I, 89% in Group II, and 100% in Group III. The character and extent of adhesions in groups II & III were significantly greater than the control group (p < 0.03). Group III exhibited the highest degree of adhesions when compared to control (p < 0.007). Histopathology revealed evidence of micro-abscess formation, foreign body giant cell reaction, and fat necrosis adjacent to retained stones. Conclusion: Retained intra-abdominal gallstones, especially if infected, are associated with increased adhesions and inflammatory response in this LC model. Further investigation into the long-term consequences of this entity is warranted.
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, Mar 2, 1998
Background and Objectives: Reported complications of retained gallstones following laparoscopic c... more Background and Objectives: Reported complications of retained gallstones following laparoscopic cholecystectomy (LC) are increasing. This study was undertaken to evaluate the effects of retained gallstones following LC in a prairie dog model. Methods: Twenty-seven prairie dogs with diet-induced gallstones were divided into three groups of nine. Group I (control) had LC with removal of stones. Group II had LC followed by return of native stones intra-abdominally. Group III had LC followed by return of infected stones (stones dipped in Escherichia coli) intra-abdominally. Animals were euthanized at two months and the character and extent of intra-abdominal adhesions were scored. Results: Adhesions were present in 56% of animals in Group I, 89% in Group II, and 100% in Group III. The character and extent of adhesions in groups II & III were significantly greater than the control group (p < 0.03). Group III exhibited the highest degree of adhesions when compared to control (p < 0.007). Histopathology revealed evidence of micro-abscess formation, foreign body giant cell reaction, and fat necrosis adjacent to retained stones. Conclusion: Retained intra-abdominal gallstones, especially if infected, are associated with increased adhesions and inflammatory response in this LC model. Further investigation into the long-term consequences of this entity is warranted.
The Journal of Trauma: Injury, Infection, and Critical Care, 2002
Background: Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only r... more Background: Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only recently has technology advanced to allow application to the complex field of trauma resuscitation. The purpose of our study was to validate an advanced HPS as an evaluation tool of trauma team resuscitation skills.
Previous studies have suggested that patients transported by emergency medical services (EMS) fol... more Previous studies have suggested that patients transported by emergency medical services (EMS) following major trauma had a longer injury-to-treatment interval and a higher mortality rate than their non-EMS-transported counterparts. There is little actual benefit of thoracolumbar immobilization for patients with torso gunshot wounds (GSW). Retrospective analysis of prospectively gathered data from the Maryland Institute for Emergency Medical Service Systems State Trauma Registry from July 1, 1995, through June 30, 1998. All designated trauma centers in Maryland. All patients with torso GSW. (1) A patient was considered to have benefited from immobilization if he or she had less than complete neurologic deficits in the presence of an unstable vertebral column, as shown by the need for operative stabilization of the vertebral column; (2) mortality. There were 1000 patients with torso GSW. Among them, 141 patients (14.1%) had vertebral column and/or spinal cord injuries. Two patients (0.2%) (95% confidence interval, -0.077% to 0.48%) required operative vertebral column stabilization, while 6 others required other spinal operations for decompression and/or foreign body removal. The presence of vertebral column injury was actually associated with lower mortality (7.1% vs 14.8%, P&lt;.02). This study suggests that thoracolumbar immobilization is almost never beneficial in patients with torso GSW, and that a higher mortality rate existed among those GSW patients without vertebral column injury vs those with such injuries. The role of formal thoracolumbar immobilization for patients with torso GSW should be reexamined.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Background and Objectives: Reported complications of retained gallstones following laparoscopic c... more Background and Objectives: Reported complications of retained gallstones following laparoscopic cholecystectomy (LC) are increasing. This study was undertaken to evaluate the effects of retained gallstones following LC in a prairie dog model.
Studies in health technology and informatics, 2005
This study describes a comparison between an animal model and a haptic enabled, needle based, gra... more This study describes a comparison between an animal model and a haptic enabled, needle based, graphical user interface simulator (SimPL), for teaching Diagnostic Peritoneal Lavage (DPL). Forty novice medical students were divided into two groups and then trained to perform a DPL on either a pig or the SimPL. All subjects completed a pre and post test of basic knowledge and were tested by performing a DPL on a TraumaMan mannequin and evaluated by two trauma surgeons blinded to group. The results showed significant improvement over baseline knowledge in both groups but more so in the SimPL group. The simulator group performed better on site selection (p<0.001) and technique (p<0.002) than those who trained on a pig. The finding that a simulator is superior to an animal model for teaching an important skill to medical students has profound implications on future training and deserves further study.
Résumé/Abstract The Sequential Compression Device (SCD) is frequently the sole measure used to pr... more Résumé/Abstract The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD ...
Chemical warfare agents (CWAs) are potential threats to both military personnel and civilians. Th... more Chemical warfare agents (CWAs) are potential threats to both military personnel and civilians. The potential of associated traumatic injuries requiring surgical treatment is significant, especially in a battlefield scenario. An existing traumatic wound may be ...
The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venou... more The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD prophylaxis among nonambulatory trauma patients at risk for DVT. We conducted a prospective observational study at two Level I university-affiliated trauma centers. Nonambulatory trauma patients were observed during their early postadmission period in a non-critical care setting. Six observations were made as to proper SCD applications during a 24-hour period (two times in the morning shift, two in the evening shift, and two overnight). "Full compliance" was defined as SCD on and functioning properly in all six observations. In a total of 1343 observations in 227 patients only 42 patients (19%) were fully compliant. The devices were on and functioning in 712 (53%) observations. Among the 185 patients who were not fully compliant DVT ri...
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, Mar 2, 1998
Background and Objectives: Reported complications of retained gallstones following laparoscopic c... more Background and Objectives: Reported complications of retained gallstones following laparoscopic cholecystectomy (LC) are increasing. This study was undertaken to evaluate the effects of retained gallstones following LC in a prairie dog model. Methods: Twenty-seven prairie dogs with diet-induced gallstones were divided into three groups of nine. Group I (control) had LC with removal of stones. Group II had LC followed by return of native stones intra-abdominally. Group III had LC followed by return of infected stones (stones dipped in Escherichia coli) intra-abdominally. Animals were euthanized at two months and the character and extent of intra-abdominal adhesions were scored. Results: Adhesions were present in 56% of animals in Group I, 89% in Group II, and 100% in Group III. The character and extent of adhesions in groups II & III were significantly greater than the control group (p < 0.03). Group III exhibited the highest degree of adhesions when compared to control (p < 0.007). Histopathology revealed evidence of micro-abscess formation, foreign body giant cell reaction, and fat necrosis adjacent to retained stones. Conclusion: Retained intra-abdominal gallstones, especially if infected, are associated with increased adhesions and inflammatory response in this LC model. Further investigation into the long-term consequences of this entity is warranted.
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, Mar 2, 1998
Background and Objectives: Reported complications of retained gallstones following laparoscopic c... more Background and Objectives: Reported complications of retained gallstones following laparoscopic cholecystectomy (LC) are increasing. This study was undertaken to evaluate the effects of retained gallstones following LC in a prairie dog model. Methods: Twenty-seven prairie dogs with diet-induced gallstones were divided into three groups of nine. Group I (control) had LC with removal of stones. Group II had LC followed by return of native stones intra-abdominally. Group III had LC followed by return of infected stones (stones dipped in Escherichia coli) intra-abdominally. Animals were euthanized at two months and the character and extent of intra-abdominal adhesions were scored. Results: Adhesions were present in 56% of animals in Group I, 89% in Group II, and 100% in Group III. The character and extent of adhesions in groups II & III were significantly greater than the control group (p < 0.03). Group III exhibited the highest degree of adhesions when compared to control (p < 0.007). Histopathology revealed evidence of micro-abscess formation, foreign body giant cell reaction, and fat necrosis adjacent to retained stones. Conclusion: Retained intra-abdominal gallstones, especially if infected, are associated with increased adhesions and inflammatory response in this LC model. Further investigation into the long-term consequences of this entity is warranted.
The Journal of Trauma: Injury, Infection, and Critical Care, 2002
Background: Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only r... more Background: Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only recently has technology advanced to allow application to the complex field of trauma resuscitation. The purpose of our study was to validate an advanced HPS as an evaluation tool of trauma team resuscitation skills.
Previous studies have suggested that patients transported by emergency medical services (EMS) fol... more Previous studies have suggested that patients transported by emergency medical services (EMS) following major trauma had a longer injury-to-treatment interval and a higher mortality rate than their non-EMS-transported counterparts. There is little actual benefit of thoracolumbar immobilization for patients with torso gunshot wounds (GSW). Retrospective analysis of prospectively gathered data from the Maryland Institute for Emergency Medical Service Systems State Trauma Registry from July 1, 1995, through June 30, 1998. All designated trauma centers in Maryland. All patients with torso GSW. (1) A patient was considered to have benefited from immobilization if he or she had less than complete neurologic deficits in the presence of an unstable vertebral column, as shown by the need for operative stabilization of the vertebral column; (2) mortality. There were 1000 patients with torso GSW. Among them, 141 patients (14.1%) had vertebral column and/or spinal cord injuries. Two patients (0.2%) (95% confidence interval, -0.077% to 0.48%) required operative vertebral column stabilization, while 6 others required other spinal operations for decompression and/or foreign body removal. The presence of vertebral column injury was actually associated with lower mortality (7.1% vs 14.8%, P&lt;.02). This study suggests that thoracolumbar immobilization is almost never beneficial in patients with torso GSW, and that a higher mortality rate existed among those GSW patients without vertebral column injury vs those with such injuries. The role of formal thoracolumbar immobilization for patients with torso GSW should be reexamined.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Background and Objectives: Reported complications of retained gallstones following laparoscopic c... more Background and Objectives: Reported complications of retained gallstones following laparoscopic cholecystectomy (LC) are increasing. This study was undertaken to evaluate the effects of retained gallstones following LC in a prairie dog model.
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Papers by James Bonar