A. Altaf, L. Attar, H. Marzouki, A. Maghrabi, H. Tashkandi, Wisam H. Jamal, M. Aljiffry
Introduction: Career satisfaction is vital to attain the superlative quality of work; dissatisfaction can consequently impact physicians' performance. This study was conducted to ascertain the level of physicians' satisfaction at work as well as identifying influencing factors. Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Participants were clinicians serving in different specialties for 2 years or more after finishing their training. Job satisfaction was assessed through a self-administered questionnaire. Response to each question to each question was devised using 5-point Likert scale on a wide range of demographics, job characteristics, and five main domains of job satisfaction. Data analysis was executed using SPSS package (v. 24). Results: A total of 159 clinicians participated in our study. Majority of the participants were Saudi (145, 91.2%), with 113 male (71%). Age ranged between 30 and 40 years. 140 were married (88%). In general, more than one-third of the physicians were dissatisfied with their overall job condition 60 (38.0%). The most important prognosticators of career satisfaction were found to be age, years of experience, and type of practice (public vs. private or both). When a multivariate analysis, regression model was applied, “clinicians satisfaction with workload” and “time and energy spent on administrative tasks” were found to have a negative effect on job satisfaction. Conclusion: More than one-third of the clinicians were generally dissatisfied with their overall job condition. Goals should be directed to improve the elements that adversely affect career satisfaction. Necessary interventions are indicated to improve clinicians' performance in clinical practice, maximize the quality of care, and maintain stable workforce.
{"title":"Predictors of career satisfaction among physicians: Observations from a tertiary care center","authors":"A. Altaf, L. Attar, H. Marzouki, A. Maghrabi, H. Tashkandi, Wisam H. Jamal, M. Aljiffry","doi":"10.4103/ssj.ssj_24_19","DOIUrl":"https://doi.org/10.4103/ssj.ssj_24_19","url":null,"abstract":"Introduction: Career satisfaction is vital to attain the superlative quality of work; dissatisfaction can consequently impact physicians' performance. This study was conducted to ascertain the level of physicians' satisfaction at work as well as identifying influencing factors. Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Participants were clinicians serving in different specialties for 2 years or more after finishing their training. Job satisfaction was assessed through a self-administered questionnaire. Response to each question to each question was devised using 5-point Likert scale on a wide range of demographics, job characteristics, and five main domains of job satisfaction. Data analysis was executed using SPSS package (v. 24). Results: A total of 159 clinicians participated in our study. Majority of the participants were Saudi (145, 91.2%), with 113 male (71%). Age ranged between 30 and 40 years. 140 were married (88%). In general, more than one-third of the physicians were dissatisfied with their overall job condition 60 (38.0%). The most important prognosticators of career satisfaction were found to be age, years of experience, and type of practice (public vs. private or both). When a multivariate analysis, regression model was applied, “clinicians satisfaction with workload” and “time and energy spent on administrative tasks” were found to have a negative effect on job satisfaction. Conclusion: More than one-third of the clinicians were generally dissatisfied with their overall job condition. Goals should be directed to improve the elements that adversely affect career satisfaction. Necessary interventions are indicated to improve clinicians' performance in clinical practice, maximize the quality of care, and maintain stable workforce.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114680032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Rabie, A. Hummadi, Mohammad Bazeed, I. El Hakeem, A. Al Qahtani, H. Haroon, Abbas Al Zain
Background: Despite its rarity, gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Several guidelines are currently present where, among other recommendations, mutational analysis and referral to specialized centers have been mentioned. However, this might be difficult to apply at times. Aim: The aim of the study is to explore our experience in the management of GIST. Patients and Methods: Histopathologically-proven GISTs, encountered in our hospital in the period from June 2012 to November 2018, were included in the study. Results: We identified 14 patients, 8 males and 6 females, with a mean age of 58.6 years. Thirteen patients were sporadic GIST, while one was syndromic (associated with neurofibromatosis, multifocal, and arose from the small gut). Twelve patients presented in an emergency situation, while two presented in an elective setting. Thirteen cases were primary localized GISTs and one was metastatic. The organs involved were the stomach in five cases, ileum in four cases, jejunum in two cases, duodenum in two cases, and rectum in one case. In 13 cases, the patient's complaint led to the diagnosis, while in one case, it was discovered incidentally on investigations for another illness. The main clinical features were abdominal pain in five cases, melena and anemia in four cases, hematemesis and melena in one case, rectal bleeding in one case, abdominal pain and mass in one case, intestinal obstruction in one case, and urinary retention and constipation in one case. The mean diameter of the cyst on computed tomography was 8.7 cm. An endoscopic biopsy was performed in six occasions and missed the diagnosis in four of them, whereas percutaneous biopsy was performed in five occasions and was suggestive in two cases and diagnostic in the remaining three. According to a combination of stage, (primary, metastatic, or recurrent) size, risk stratification, mode of presentation, performance status, and comorbidities, treatment was planned. Five patients received surgery only, three patients received surgery followed by imatinib, one patient left to be treated elsewhere, and three patients received surgery to be followed by imatinib but did not show up, one patient received imatinib only, and one patient is still under evaluation. The mean duration of follow-up was 65.7 months, where the disease showed no recurrence in four cases, metastasized to the liver in two cases, and death occurred in two cases, while five cases were lost to follow-up. In this series, no mutational analysis was performed as imatinib was the only drug used, and no referral to specialized centers was done. Conclusion: Surgical resection and kit inhibitors, either alone or in sequence, are the main pillars of treatment of GIST. Risk stratification, in addition to the mode of presentation, the presence or absence of metastasis and comorbidities, dictates which plan to follow. Except for mutational analysis, and referra
{"title":"Gastrointestinal stromal tumors: Do we follow the current guidelines? A self-critique","authors":"M. Rabie, A. Hummadi, Mohammad Bazeed, I. El Hakeem, A. Al Qahtani, H. Haroon, Abbas Al Zain","doi":"10.4103/ssj.ssj_7_19","DOIUrl":"https://doi.org/10.4103/ssj.ssj_7_19","url":null,"abstract":"Background: Despite its rarity, gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Several guidelines are currently present where, among other recommendations, mutational analysis and referral to specialized centers have been mentioned. However, this might be difficult to apply at times. Aim: The aim of the study is to explore our experience in the management of GIST. Patients and Methods: Histopathologically-proven GISTs, encountered in our hospital in the period from June 2012 to November 2018, were included in the study. Results: We identified 14 patients, 8 males and 6 females, with a mean age of 58.6 years. Thirteen patients were sporadic GIST, while one was syndromic (associated with neurofibromatosis, multifocal, and arose from the small gut). Twelve patients presented in an emergency situation, while two presented in an elective setting. Thirteen cases were primary localized GISTs and one was metastatic. The organs involved were the stomach in five cases, ileum in four cases, jejunum in two cases, duodenum in two cases, and rectum in one case. In 13 cases, the patient's complaint led to the diagnosis, while in one case, it was discovered incidentally on investigations for another illness. The main clinical features were abdominal pain in five cases, melena and anemia in four cases, hematemesis and melena in one case, rectal bleeding in one case, abdominal pain and mass in one case, intestinal obstruction in one case, and urinary retention and constipation in one case. The mean diameter of the cyst on computed tomography was 8.7 cm. An endoscopic biopsy was performed in six occasions and missed the diagnosis in four of them, whereas percutaneous biopsy was performed in five occasions and was suggestive in two cases and diagnostic in the remaining three. According to a combination of stage, (primary, metastatic, or recurrent) size, risk stratification, mode of presentation, performance status, and comorbidities, treatment was planned. Five patients received surgery only, three patients received surgery followed by imatinib, one patient left to be treated elsewhere, and three patients received surgery to be followed by imatinib but did not show up, one patient received imatinib only, and one patient is still under evaluation. The mean duration of follow-up was 65.7 months, where the disease showed no recurrence in four cases, metastasized to the liver in two cases, and death occurred in two cases, while five cases were lost to follow-up. In this series, no mutational analysis was performed as imatinib was the only drug used, and no referral to specialized centers was done. Conclusion: Surgical resection and kit inhibitors, either alone or in sequence, are the main pillars of treatment of GIST. Risk stratification, in addition to the mode of presentation, the presence or absence of metastasis and comorbidities, dictates which plan to follow. Except for mutational analysis, and referra","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127380829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Retroperitoneal sarcomas (RPSs) are large in size and often involve adjacent organs or vital structures. Completeness of resection is critical for long-term survival; however, this often involves extensive surgeries. This study aimed to identify predictors of early severe postoperative complications after RPS surgery. Methodology: In patients who underwent surgery for RPS, intraoperative variables and patient characteristics were assessed to determine predictors for severe postoperative complications. Results: Two hundred and thirty-three patients were included. In comparison to patients who had no comorbidity, those with one or more comorbidities were more likely to have postoperative complications (odds ratio [OR]: 2.38; confidence interval [CI]: 1.03–5.48). Patients who avoided admission to the intensive care unit (ICU) within 24 h of surgery had less complications postoperatively (OR: 0.08; CI: 0.02–0.30). Multiple organ resection during surgery and patients' age had no impact on the occurrence of severe complications. Conclusion: This study showed that a high patient comorbidity index, male gender, and early admission to the ICU were independently associated with an increased risk of postoperative severe complications. However, the age of the patient and degree of surgical resection had no impact on this occurrence. These findings suggest that age and extent of resection should not be used as a sole determinant of patient's eligibility for curative surgery.
{"title":"Predictors of postoperative complications in retroperitoneal sarcoma surgery","authors":"M. Nassif","doi":"10.4103/ssj.ssj_28_19","DOIUrl":"https://doi.org/10.4103/ssj.ssj_28_19","url":null,"abstract":"Introduction: Retroperitoneal sarcomas (RPSs) are large in size and often involve adjacent organs or vital structures. Completeness of resection is critical for long-term survival; however, this often involves extensive surgeries. This study aimed to identify predictors of early severe postoperative complications after RPS surgery. Methodology: In patients who underwent surgery for RPS, intraoperative variables and patient characteristics were assessed to determine predictors for severe postoperative complications. Results: Two hundred and thirty-three patients were included. In comparison to patients who had no comorbidity, those with one or more comorbidities were more likely to have postoperative complications (odds ratio [OR]: 2.38; confidence interval [CI]: 1.03–5.48). Patients who avoided admission to the intensive care unit (ICU) within 24 h of surgery had less complications postoperatively (OR: 0.08; CI: 0.02–0.30). Multiple organ resection during surgery and patients' age had no impact on the occurrence of severe complications. Conclusion: This study showed that a high patient comorbidity index, male gender, and early admission to the ICU were independently associated with an increased risk of postoperative severe complications. However, the age of the patient and degree of surgical resection had no impact on this occurrence. These findings suggest that age and extent of resection should not be used as a sole determinant of patient's eligibility for curative surgery.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121807341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rajendran Ramaswamy, S. Hegab, R. Baz, Saif Galib, Ghazi Mukattash
Background: Lower complication rates are observed if urethral plate (UP) is preserved and utilized for reparative surgery of hypospadias. Aim: This study aims to analyze our results of hypospadias repair by UP preservation, and using vascular dartos flap as interposition flap. Materials and Methods: prospective, cohort study of operated cases of hypospadias over 4.5 years' period. Data including age, diagnosis, preoperative testosterone administration, operation, postoperative complications, and assessment of outcome using hypospadias objective scoring evaluation (HOSE) system were collected. We preserved UP as far as possible, for urethral tube construction. We applied meatal advancement and glanuloplasty incorporated (MAGPI) for glanular/coronal hypospadias and tubularized incised plate urethroplasty (TIPU) (Snodgrass) for most other cases. Single dorsal vascular dartos-flap was transposed ventrally as interposition flap in TIPU. Single transurethral catheter 6F/8F size was employed as urethral stent as well as for bladder drainage. At the first review at 2 weeks after getting discharged, all patients underwent urethral calibration and first HOSE-score assessment. Maximum HOSE-score was 16 points and minimum 5. Results: A total of 111 patients with mean (range) age of 34.69 m (11 m– 123 m) were studied. TIPU (n = 49), MAGPI (n = 44), and others (n = 18) were the operations. There were 10 permanent complications; 9 following TIPU (7 (14.3%) single urethrocutaneous fistula (UCF), 1 torsion penis, 1 glans-dehiscence), and 1 following MAGPI (glans-dehiscence). Mean follow-up period was 15 m (range = 3–36 m). HOSE score ≥14 was achieved in 106 (95.5%) cases. Conclusion: The excellent result of MAGPI in our series is due to strict case selection and technical precision. UCF rate of 14.3% in TIPU can be due to the unselected nature of our cases which included small glans diameter and unfavorable UP characteristics.
{"title":"Results of urethral plate preservation and use of vascular dartos flap in hypospadias repair","authors":"Rajendran Ramaswamy, S. Hegab, R. Baz, Saif Galib, Ghazi Mukattash","doi":"10.4103/ssj.ssj_23_18","DOIUrl":"https://doi.org/10.4103/ssj.ssj_23_18","url":null,"abstract":"Background: Lower complication rates are observed if urethral plate (UP) is preserved and utilized for reparative surgery of hypospadias. Aim: This study aims to analyze our results of hypospadias repair by UP preservation, and using vascular dartos flap as interposition flap. Materials and Methods: prospective, cohort study of operated cases of hypospadias over 4.5 years' period. Data including age, diagnosis, preoperative testosterone administration, operation, postoperative complications, and assessment of outcome using hypospadias objective scoring evaluation (HOSE) system were collected. We preserved UP as far as possible, for urethral tube construction. We applied meatal advancement and glanuloplasty incorporated (MAGPI) for glanular/coronal hypospadias and tubularized incised plate urethroplasty (TIPU) (Snodgrass) for most other cases. Single dorsal vascular dartos-flap was transposed ventrally as interposition flap in TIPU. Single transurethral catheter 6F/8F size was employed as urethral stent as well as for bladder drainage. At the first review at 2 weeks after getting discharged, all patients underwent urethral calibration and first HOSE-score assessment. Maximum HOSE-score was 16 points and minimum 5. Results: A total of 111 patients with mean (range) age of 34.69 m (11 m– 123 m) were studied. TIPU (n = 49), MAGPI (n = 44), and others (n = 18) were the operations. There were 10 permanent complications; 9 following TIPU (7 (14.3%) single urethrocutaneous fistula (UCF), 1 torsion penis, 1 glans-dehiscence), and 1 following MAGPI (glans-dehiscence). Mean follow-up period was 15 m (range = 3–36 m). HOSE score ≥14 was achieved in 106 (95.5%) cases. Conclusion: The excellent result of MAGPI in our series is due to strict case selection and technical precision. UCF rate of 14.3% in TIPU can be due to the unselected nature of our cases which included small glans diameter and unfavorable UP characteristics.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114516941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We think that the small sample size of the study by Kalyanwat et al.[1] could not give an appropriate conclusion, and the authors should include this as a limitation for their study. Moreover, the authors did not consider the data reported in the most recent meta-analyses. To support their findings, they considered only a meta‐analysis published in 2015 by Su’a et al.[3] who found a limited clinical significance of chewing gum.
{"title":"Chewing gum and postoperative ileus: How to solve a multifactorial problem?","authors":"Y. Kamal","doi":"10.4103/ssj.ssj_53_18","DOIUrl":"https://doi.org/10.4103/ssj.ssj_53_18","url":null,"abstract":"We think that the small sample size of the study by Kalyanwat et al.[1] could not give an appropriate conclusion, and the authors should include this as a limitation for their study. Moreover, the authors did not consider the data reported in the most recent meta-analyses. To support their findings, they considered only a meta‐analysis published in 2015 by Su’a et al.[3] who found a limited clinical significance of chewing gum.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124111032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Al-Jiffry, Mohamed Al Saeed, Majed Al-Mourgi, A. Younes, Samir Badr, T. Abdel-Rahman, Ayman Attalla, Abdullah Al-Sawat, Mohamed Hatem, M. EL-mETEINI, Ali Al-Jiffry
Background and Aim of the Work: Combination of partial hepatectomy with complete excision of the caudate lobe was found to improve the outcome of resectable Klatskin tumors. In this prospective multicenter study, the outcome of these combined resections would be evaluated. Patients and Methods: This prospective study enrolled 72 patients with resectable Klatskin tumors. The study was conducted in Taif tertiary hospital and Ain Shams University Hospitals from January 2008 to December 2014. All patients underwent partial hepatectomy with complete excision of the caudate lobe after preoperative biliary drainage. The primary outcome was the resection margin (positive or negative), postoperative complications, and patient survival. Other outcomes included; the mean operative time, mean amount of blood loss, and prognostic factors correlated with survival. Results: The number of patients underwent combined resection were 72 patients, 49 males and 23 females with mean age of 58.3 ± 14.2 years. Mean operative time was 243 ± 57 min and the mean blood loss was 896 ± 211 ml. The recorded postoperative complications included; bile leak in 16.7%, wound infection in 15.3%, pleural effusion in 12.5%, liver failure in 4.2%, and liver abscess in 4.2%. Recorded hospital mortality was 5.6%. The resection margin was negative (R0) in 51/72 patients (70.8%). The overall mean survival during the follow-up was 48 ± 10.2 months. The estimated overall 5-year survival rate was 37.5% increased to 50.1% in R0 patients, and it was 4.8% when the margin was positive. There was a significant positive correlation between the patient survival and the negativity of the resection margin, and a negative significant correlation with the pretreatment level of carcinoembryonic antigen. Age, gender, Bismuth classification, and pretreatment level of carbohydrate antigen 19.9 had insignificant correlation with the survival. Conclusion: The excision of the caudate lobe with extended hepatic resection by the experienced hepatobiliary surgeon in properly selected patients survival has been proved to be safe and effective.
{"title":"Outcome of combined complete excision of the caudate lobe with partial hepatectomy for treatment of resectable Klatskin tumors","authors":"B. Al-Jiffry, Mohamed Al Saeed, Majed Al-Mourgi, A. Younes, Samir Badr, T. Abdel-Rahman, Ayman Attalla, Abdullah Al-Sawat, Mohamed Hatem, M. EL-mETEINI, Ali Al-Jiffry","doi":"10.4103/ssj.ssj_51_18","DOIUrl":"https://doi.org/10.4103/ssj.ssj_51_18","url":null,"abstract":"Background and Aim of the Work: Combination of partial hepatectomy with complete excision of the caudate lobe was found to improve the outcome of resectable Klatskin tumors. In this prospective multicenter study, the outcome of these combined resections would be evaluated. Patients and Methods: This prospective study enrolled 72 patients with resectable Klatskin tumors. The study was conducted in Taif tertiary hospital and Ain Shams University Hospitals from January 2008 to December 2014. All patients underwent partial hepatectomy with complete excision of the caudate lobe after preoperative biliary drainage. The primary outcome was the resection margin (positive or negative), postoperative complications, and patient survival. Other outcomes included; the mean operative time, mean amount of blood loss, and prognostic factors correlated with survival. Results: The number of patients underwent combined resection were 72 patients, 49 males and 23 females with mean age of 58.3 ± 14.2 years. Mean operative time was 243 ± 57 min and the mean blood loss was 896 ± 211 ml. The recorded postoperative complications included; bile leak in 16.7%, wound infection in 15.3%, pleural effusion in 12.5%, liver failure in 4.2%, and liver abscess in 4.2%. Recorded hospital mortality was 5.6%. The resection margin was negative (R0) in 51/72 patients (70.8%). The overall mean survival during the follow-up was 48 ± 10.2 months. The estimated overall 5-year survival rate was 37.5% increased to 50.1% in R0 patients, and it was 4.8% when the margin was positive. There was a significant positive correlation between the patient survival and the negativity of the resection margin, and a negative significant correlation with the pretreatment level of carcinoembryonic antigen. Age, gender, Bismuth classification, and pretreatment level of carbohydrate antigen 19.9 had insignificant correlation with the survival. Conclusion: The excision of the caudate lobe with extended hepatic resection by the experienced hepatobiliary surgeon in properly selected patients survival has been proved to be safe and effective.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124961421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In recent years, the flipped classroom (FC) method of teaching has received much attention in health sciences education. The concept of FC has been present in medical education since the 1990s with the introduction of team-based learning. Flipping the classroom is the practice of providing learners with study materials, traditionally covered in lectures, to be learned before class while the teacher becomes the facilitator of classroom discussion. The successful flipped class requires well-planned learning design, interesting study materials, effective plan for formative assessment, to identify gaps in learning, and suitable innovative teaching tools to close the gaps. Although it has been introduced few years back, this concept is new in our institute and we studied this as a pilot project for surgery students. Flipped classroom teaching method elaborated to the students ,before starting this new teaching learning method. Objective: The objective of the study is to assess the effectiveness of FC teaching in surgery for undergraduate students. Collation of students perception of this new TE-Learning compared to traditional teaching methods. Methodology: One hundred students of final-year MBBS were included in this study for the surgery subject. Randomly chosen by computer, they were divided into two groups (n = 50). One group followed FC and the other group followed traditional teaching method handled by two different faculties. This study is undertaken to find the effectiveness of FC. Five module were prepared on the topic Groin Hernia “ for this “flipped group” learning. Students in flip group were provided with study materials, videos, and before classroom discussion, while the other group followed didactic lecture. Effectiveness of this new method was assessed by pretest, posttest at the end of the topic, and feedback on perception of flipped class obtained by a questionnaire. Results: FL group students felt that learning surgery is more interesting and brings in motivation and better understanding of the topic taught. Videos and surgical anatomy were found easy to understand. Eighty-two percent used lecture notes, 62% found PPT easy to follow, while 78% found animation more interesting. In posttest also, flipped group performed better than didactic lecture method. Success depends on the topic chosen, especially in surgery. Conclusion: Flipped class not only brings motivation but also improves their understanding of the course materials and enhanced their communication skill and clinical thinking. Students in the Flipped Class, showed a preference for this method of teaching and found this more interesting.
{"title":"Flipped classroom as an effective educational tool in teaching surgery for undergraduate students","authors":"Ramula M. Durai, M. Mohanraj","doi":"10.4103/ssj.ssj_54_18","DOIUrl":"https://doi.org/10.4103/ssj.ssj_54_18","url":null,"abstract":"Background: In recent years, the flipped classroom (FC) method of teaching has received much attention in health sciences education. The concept of FC has been present in medical education since the 1990s with the introduction of team-based learning. Flipping the classroom is the practice of providing learners with study materials, traditionally covered in lectures, to be learned before class while the teacher becomes the facilitator of classroom discussion. The successful flipped class requires well-planned learning design, interesting study materials, effective plan for formative assessment, to identify gaps in learning, and suitable innovative teaching tools to close the gaps. Although it has been introduced few years back, this concept is new in our institute and we studied this as a pilot project for surgery students. Flipped classroom teaching method elaborated to the students ,before starting this new teaching learning method. Objective: The objective of the study is to assess the effectiveness of FC teaching in surgery for undergraduate students. Collation of students perception of this new TE-Learning compared to traditional teaching methods. Methodology: One hundred students of final-year MBBS were included in this study for the surgery subject. Randomly chosen by computer, they were divided into two groups (n = 50). One group followed FC and the other group followed traditional teaching method handled by two different faculties. This study is undertaken to find the effectiveness of FC. Five module were prepared on the topic Groin Hernia “ for this “flipped group” learning. Students in flip group were provided with study materials, videos, and before classroom discussion, while the other group followed didactic lecture. Effectiveness of this new method was assessed by pretest, posttest at the end of the topic, and feedback on perception of flipped class obtained by a questionnaire. Results: FL group students felt that learning surgery is more interesting and brings in motivation and better understanding of the topic taught. Videos and surgical anatomy were found easy to understand. Eighty-two percent used lecture notes, 62% found PPT easy to follow, while 78% found animation more interesting. In posttest also, flipped group performed better than didactic lecture method. Success depends on the topic chosen, especially in surgery. Conclusion: Flipped class not only brings motivation but also improves their understanding of the course materials and enhanced their communication skill and clinical thinking. Students in the Flipped Class, showed a preference for this method of teaching and found this more interesting.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"42 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132227432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Repair of hernia is one of the most common general surgery operations. Strangulation of the hernia contents requiring bowel resection is one of the serious complications of hernias. The aim of the present study is to evaluate the risk factors of bowel resection in patients undergoing emergency surgical repair of hernia. Methods: A retrospective study reviewed the medical records of all patients who underwent emergency surgery for hernia from January 2014 to December 2017 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients were stratified into two groups: bowel resection was required (Group 1) or not (Group 2). Extracted patients' data for each group included four different fields: (1) personal data and patients' characteristics, (2) preoperative assessment, (3) intraoperative assessment, and (4) postoperative length of hospitalization and complications. The data were analyzed to determine the risk factors for bowel resection. Results: A total of 83 patients underwent emergency surgery hernia repair during the study. A univariate multiple logistic regression model identified three variables that were independent risk factors for bowel resection: duration of symptoms >24 h (odds ratio = 6.093), previous abdominal surgery (odds ratio = 4.531), and high American Society of Anesthesiologists (ASA) classification score (odds ratio = 8.273). Conclusion: Risk factors for bowel resection in emergency hernia repair include high ASA score, previous abdominal surgery, and prolonged the duration of symptoms. Further prospective studies are recommended to confirm the findings of this study.
{"title":"Risk of bowel resection in patients with hernia","authors":"A. Altaf, Wafaa Algethmi","doi":"10.4103/ssj.ssj_44_18","DOIUrl":"https://doi.org/10.4103/ssj.ssj_44_18","url":null,"abstract":"Introduction: Repair of hernia is one of the most common general surgery operations. Strangulation of the hernia contents requiring bowel resection is one of the serious complications of hernias. The aim of the present study is to evaluate the risk factors of bowel resection in patients undergoing emergency surgical repair of hernia. Methods: A retrospective study reviewed the medical records of all patients who underwent emergency surgery for hernia from January 2014 to December 2017 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients were stratified into two groups: bowel resection was required (Group 1) or not (Group 2). Extracted patients' data for each group included four different fields: (1) personal data and patients' characteristics, (2) preoperative assessment, (3) intraoperative assessment, and (4) postoperative length of hospitalization and complications. The data were analyzed to determine the risk factors for bowel resection. Results: A total of 83 patients underwent emergency surgery hernia repair during the study. A univariate multiple logistic regression model identified three variables that were independent risk factors for bowel resection: duration of symptoms >24 h (odds ratio = 6.093), previous abdominal surgery (odds ratio = 4.531), and high American Society of Anesthesiologists (ASA) classification score (odds ratio = 8.273). Conclusion: Risk factors for bowel resection in emergency hernia repair include high ASA score, previous abdominal surgery, and prolonged the duration of symptoms. Further prospective studies are recommended to confirm the findings of this study.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"23 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123426425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Rabie, K. Elshaar, M. A. Al Skaini, H. Ageely, A. Zaid, I. El Hakeem, Saad Al Qahtani
Background: Surgery was the only known curative treatment for hydatid disease. Currently, this is being changed. Aims: The aim of this study was to explore the evolution of our management policy for hydatid disease. Patients and Methods: We retrieved records of patients with hydatid disease, treated in our unit in the period from January 1998 to February 2012. Results: Twenty-seven patients were identified. For comparison and driven by the appearance of nonsurgical means in the series, patients were divided into two groups: the first group included the first 12 patients and the second group included the last 15 patients. In the first group, all patients received surgery and only two (16.7%) received postoperative albendazole therapy. In the second group, only four patients (26.7%) received surgery with perioperative pharmacotherapy, eight patients (53.3%) received pharmacotherapy alone, and three patients (20%) received puncture-aspiration-injection-reaspiration (PAIR) with periprocedural pharmacotherapy. In those who received surgery with adjuvant pharmacotherapy, one patient died and the cyst disappeared in the remaining three. In those who received PAIR, the cyst disappeared in one case and regressed in the other two. In those who received pharmacotherapy alone, two patients showed disappearance of the cyst, one showed partial response, and five are under follow-up. Conclusions: Surgery is no longer the first-line treatment for hydatid disease. It should be reserved for complicated cases and those presenting as an emergency. When applied, surgery should be backed by pharmacotherapy which has a pivotal role, both as a sole agent and as an adjunctive to therapy.
{"title":"Current trends in the management of hydatid disease: Surgeons' perspective","authors":"M. Rabie, K. Elshaar, M. A. Al Skaini, H. Ageely, A. Zaid, I. El Hakeem, Saad Al Qahtani","doi":"10.4103/ssj.ssj_50_18","DOIUrl":"https://doi.org/10.4103/ssj.ssj_50_18","url":null,"abstract":"Background: Surgery was the only known curative treatment for hydatid disease. Currently, this is being changed. Aims: The aim of this study was to explore the evolution of our management policy for hydatid disease. Patients and Methods: We retrieved records of patients with hydatid disease, treated in our unit in the period from January 1998 to February 2012. Results: Twenty-seven patients were identified. For comparison and driven by the appearance of nonsurgical means in the series, patients were divided into two groups: the first group included the first 12 patients and the second group included the last 15 patients. In the first group, all patients received surgery and only two (16.7%) received postoperative albendazole therapy. In the second group, only four patients (26.7%) received surgery with perioperative pharmacotherapy, eight patients (53.3%) received pharmacotherapy alone, and three patients (20%) received puncture-aspiration-injection-reaspiration (PAIR) with periprocedural pharmacotherapy. In those who received surgery with adjuvant pharmacotherapy, one patient died and the cyst disappeared in the remaining three. In those who received PAIR, the cyst disappeared in one case and regressed in the other two. In those who received pharmacotherapy alone, two patients showed disappearance of the cyst, one showed partial response, and five are under follow-up. Conclusions: Surgery is no longer the first-line treatment for hydatid disease. It should be reserved for complicated cases and those presenting as an emergency. When applied, surgery should be backed by pharmacotherapy which has a pivotal role, both as a sole agent and as an adjunctive to therapy.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132352844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The presence of thyroid tissue in the mediastinum after total thyroidectomy is commonly known as “forgotten goiter,” which is considered as an extremely rare condition with controversy regarding the etiological causes. We report a 57-year-old female who has had a total thyroidectomy. Postoperatively, she underwent a computed tomography scan which revealed a retrosternal goiter. A reexploration was performed utilizing the previous collar incision. The mass was totally below the thoracic inlet separated from the central neck compartment. Forgotten goiter, though a rare pathology, can be prevented by meticulous preoperative imaging and can be managed during the first operation; however, surgical treatment for forgotten goiter, when performed in specialized centers, can be achieved through cervical approach and is associated with low morbidity.
{"title":"Forgotten retrosternal goiter","authors":"A. Ismail, Mohammed Alfehaid, Hussam M Binyousef","doi":"10.4103/ssj.ssj_39_18","DOIUrl":"https://doi.org/10.4103/ssj.ssj_39_18","url":null,"abstract":"The presence of thyroid tissue in the mediastinum after total thyroidectomy is commonly known as “forgotten goiter,” which is considered as an extremely rare condition with controversy regarding the etiological causes. We report a 57-year-old female who has had a total thyroidectomy. Postoperatively, she underwent a computed tomography scan which revealed a retrosternal goiter. A reexploration was performed utilizing the previous collar incision. The mass was totally below the thoracic inlet separated from the central neck compartment. Forgotten goiter, though a rare pathology, can be prevented by meticulous preoperative imaging and can be managed during the first operation; however, surgical treatment for forgotten goiter, when performed in specialized centers, can be achieved through cervical approach and is associated with low morbidity.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115866382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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