Browsing by Author "Rebolledo R."
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- ItemEarly and late morbidity and mortality of aortic valve replacement with mechanical or biological prostheses during the last decade: The gold standardMorbimortalidad precoz y alejada del reemplazo valvular aórtico con prótesis mecánica y biológica durante la última década: El estándar de oro(2009) Becker P.; Ramírez A.; Cifuentes I.; Rebolledo R.; Zalaquett R.; Morán S.; Arretz C.; Godoy I.; Irarrázaval M.J.Background: There is a growing interest in alternative techniques for aortic valve replacement (AVR). Therefore it is important to have updated results of conventional AVR as a valid comparative standard. Aim: To evaluate both perioperative and late morbidity and mortality in patients undergoing conventional AVR, with either mechanical (RVAm) or biological (RVAb) prostheses. Patients and methods: Retrospective review of medical records and operative protocols of patients undergoing AVR between January 1995 and December 2005. Patients with previous cardiac surgery, aortic balloonplasty or simultaneous cardiovascular procedures were excluded. Results: During the study period, 788 patients underwent AVR and 317 met the inclusion criteria. Of the latter, 175 patients aged 13 to 83 years (63% males) were subjected to AVRm and 142 patients aged 49 to 87 years (64% males), were subjected to AVRb. Five (1.6%) patients died during the perioperative period (one AVRm and four AVRb). All were older than 65 years. Perioperative complications were recorded in 29 and 25% of patients in AVRm and AVRb groups, respectively (NS). During a median follow-up of six years, complications were recorded in 12 and 4% of patients in AVRm and AVRb groups, respectively (p <0.05). The actuarial survival for AVRm group at 1, 5 and 10 years, was 96, 92 and 87%, respectively. The figures for AVRb group were 95, 86 and 83%, respectively (NS). The 10 year reintervention free survival was 97% for the AVRm group and 84% for the AVRb (p <0.05). Conclusions: Perioperative mortality and rates of complications of AVR in this series of patients are low, which compares favorably with other series.
- ItemValidity Argument for a Simulation-Based Objective Structured Clinical Examination Scenario for Evaluation of Surgical Skills in Trauma(Academic Press Inc., 2021) Ortiz C.; Belmar F.; Vela J.; Contreras C.; Inzunza M.; Varas J.; Jarufe N.; Achurra P.; Ramos J.P.; Zinco A.; Rebolledo R.; Alseidi A.© 2021 Elsevier Inc.Background: Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have diminished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models. Objective: The aim of this study was to evaluate under a contemporary validity framework, an objective structured clinical evaluation (OSCE) scenario for the assessment of basic and advanced surgical skills in trauma and emergency surgery. Methods: An OSCE-type simulation assessment program was developed incorporating six stations representing basic and advanced surgical skills that are essential in trauma surgery. Each station was designed using ex-vivo animal tissue. The stations included basic knots and sutures, bowel resection and anastomosis, vascular end-to-end anastomosis, lung injury repair, cardiac injury repair, and laparoscopic suturing. Eight postgraduate year 2 (PY-2), eight recently graduated surgeons (RGS), and 3 experts were recruited, and their performance was blindly assessed by experts using the validated general rating scale OSATS (Objective Structured Assessment of Technical Skills) as well as the time taken to complete the procedure. Results: Significant differences were identified among groups. The average OSATS score was 82 for the PY2 group, 113 for the RGS group, and 147 for the experts (P < 0.01). The average procedural time to complete all the stations was 98 minutes for the PY2 group, 68 minutes for the RGS group, and 35 minutes for the expert surgeons (P < 0.01). Conclusion: An OSCE scenario designed using ex-vivo tissue met 4 out of 5 criteria of the Messick validity framework: content, relation to other variables, response process and consequences of the test. The results show it is a valid strategy for the evaluation of practical skills in trauma surgery.