Duke Sports Medicine Specialists Jocelyn Wittstein, MD, Janna Fonseca, ATC, and Michael Messer ,PT, present on Soccer Injury Prevention including Concussion Management and the 11+ program that significantly reduces ACL tear rates in soccer.

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LASIK, or "laser-assisted in situ keratomileusis," is the most commonly performed laser eye surgery to treat myopia, hyperopia and astigmatism. The goal of the treatment is to reshape the cornea to correct the refractive error of the eye.
The cornea is the transparent dome-shaped structure in front of the eye. The cornea refracts light and accounts for about two-thirds of the eye's total optical power. Altering the curvature of the cornea changes the way light rays enter the eye. As a result, the light rays can be focused properly onto the retina for clearer vision.
For nearsighted people, the laser is used to flatten the cornea. For farsighted people, the cornea is made steeper. For patients with astigmatism, the laser is used to smooth the irregularly-shaped cornea into a more regular shape.
The outer layer of the cornea - the epithelium – is capable of replacing itself within a few days after being damaged or removed. The deeper layer of the cornea – the stroma, on the contrary, is a permanent corneal tissue with very limited regenerative capacity. The stroma, if reshaped by a laser, will remain that way permanently.
In this procedure, a thin, circular "FLAP" is created in the surface of the cornea to gain access to the permanent corneal tissue. This can be done with a mechanical cutting tool called a microkeratome, OR, for a blade-free experience, by a femtosecond laser. An excimer laser is then used to remove some corneal tissue to reshape the cornea. Excimer laser uses cool ultraviolet light beams to vaporize microscopic amounts of tissue in a precise manner to accurately reshape the cornea. The excimer laser is computer-controlled and is programmed based on the patient’s refractive error. The flap is then laid back in place and is allowed to heal.
LASIK eye surgery is mostly painless and can be completed within minutes. Improved vision can usually be seen overnight.

PRK, or photorefractive keratectomy, was the first type of laser eye surgery for vision correction and is the predecessor to the popular LASIK procedure. In PRK, NO flap is created. Rather, the epithelial cells on the eye surface are simply removed. An excimer laser is then used to reshape the cornea just like it does in LASIK.
The vision correction outcomes of PRK surgery are comparable to those of LASIK, but the recovery period is longer. This is because the epithelium is completely removed in PRK and it takes a few days to regenerate. PRK patients also have more discomfort and haziness of vision in the first few days after the surgery. Improved vision also takes longer to achieve.
PRK does, however, offer certain advantages. Because PRK does not involve creation of a flap, which contains both epithelial and deeper stromal tissue, the entire thickness of the stroma is available for treatment. The treatment range is therefore higher. This is particularly useful for patients with high levels of myopia or for those whose cornea is too thin for LASIK. PRK is also free of flap-related complication risks.

Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Standard
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017

AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.

Laparoscopic surgery is now commonly used as a type of minimally invasive surgery, but what is it and why is it used?

Interested in learning more about minimally invasive techniques, or having surgery planned? Visit https://www.topdoctors.co.uk/doctor/charles-imber

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Tracheostomy Suctioning- Nursing Skills

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Tracheostomy Suctioning- Nursing Skills:

In this video we’re going to talk about suctioning a tracheostomy. You may need to do this before you do trach care or just because the patient requires suctioning. Make sure that you assess the patient before you start so that you know what their one sounds are, and what their oxygen saturation is. We love you guys! Go out and be your best selves today! And, as always, happy nursing!

Bookmarks:
0.05 Introduction to trach suctioning
0:21 Suction setup
0:42 Opening suction kit
1:55 Sterile water
2:13 Starting trach suctioning
2:00 Catheter insertion
3:00 Catheter pass #2
3:26 Listen to lungs
3:31 Outro

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Examination of a patient with post-enucleation socket syndrome.

Eye tests are important for the detection of many common eye infections and diseases. Eyes are also an important indicator to detect chronic systemic diseases like Hypertension and Diabetes.  Must after maxillofacial trauma to rule out any near and late complications emerging for the eyes. 2. There are two perspectives for examining the eyes : 1. Ophthalmic Perspective – because eyes are prone to many infections, diseases and conditions. 2. Maxillofacial Perspective – because the eyes and the orbit forms an integral component of facial and mid-facial fractures and trauma.

A video showing Two port laparoscopic Cholecystectomy

Appendicitis is one of the most common surgical problems. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient’s internal organs on a television monitor. In some cases, one of the small openings may be lengthened to complete the procedure.

aricose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins of your lower body. For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Examination of the hip

A very bad lasik eye surgery duringwhich the surgeon messed everything

A video showing the PRK laser eye surgery

Closing the abdomen after laparotomy

This video demonstrates how to treat venereal warts or condyloma using a cryosurgery technique.

basic subcutaneous (SQ) injection techniques

Endometrial Polyp is removed using a IUR (Smith@Nephew)by B.C. Schoot Gynaecologist dept OB/GYN Catharina Hospital Eindhoven The Netherlands

Removal of the womb by keyhole surgery. The womb is detached from its pelvic attachments and removed through the birth canal. The birth canal is then stitched closed.

Laparoscopic Colon Resection video

Open rhinoplasty without oseotomies. Basic steps for rasping of dorsal hump and cephalic trim with septoplasty and tip strut.