Current surgery最新文献

{"title":"Tough love.","authors":"Foust","doi":"10.1215/9781478002079-026","DOIUrl":"https://doi.org/10.1215/9781478002079-026","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"57 5 1","pages":"393"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49308617","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}

{"title":"Electrosurgery","authors":"Christopher M. Jones MD , Ketsia B. Pierre MD , Ian B. Nicoud BS , Steven C. Stain MD , Willie V. Melvin III MD","doi":"10.1016/j.cursur.2006.06.017","DOIUrl":"10.1016/j.cursur.2006.06.017","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 458-463"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405260","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}

{"title":"Patterns and Predictions of Resident Misbehavior—A 10-Year Retrospective Look","authors":"Andrew S. Resnick MD,&nbsp;James L. Mullen MD,&nbsp;Larry R. Kaiser MD,&nbsp;Jon B. Morris MD","doi":"10.1016/j.cursur.2006.05.004","DOIUrl":"10.1016/j.cursur.2006.05.004","url":null,"abstract":"<div><h3>Background</h3><p>Surgical educators are charged with ensuring that their trainees conduct themselves in a professional manner. The authors retrospectively reviewed a 10-year experience of incident reports on surgical housestaff to determine patterns and predictors of behavior.</p></div><div><h3>Methods</h3><p>A retrospective review of all letters, e-mails, and incident reports was conducted for general surgery residents from 1995 to 2005. Descriptive variables were selected for binary categorization (not mutually exclusive): poor professional conduct, protocol violation, administrative deficiency, verbal mistreatment, physical boundary issues, mistreatment of superiors, and deficient medical student interaction. Resident status was defined as current, graduate, and attrition.</p></div><div><h3>Results</h3><p>Of 110 residents {90 [82%] categorical, 23 [21%] undesignated preliminary (3 overlapped both groups); 87 [79%] male, 23 [21%] female} who trained at the University of Pennsylvania during this period, 66 complaints were generated about 29 individuals. Overall, 50 of the 66 complaints (76%) were directed toward men and the remaining 16 (24%) toward women; 24% of all men and 35% of all women received 1 or more complaints. A total of 76% of complaints concerned categorical residents and 24% undesignated preliminary residents. And 26% of all categorical residents and 26% of all preliminary residents received at least 1 complaint. The most common complaints concerned professional conduct (83%), protocol violation (33%), verbal mistreatment (23%), deficiencies of administrative duties (8%), violations of physical boundaries (5%), deficient medical student interaction (5%), and mistreatment of attendings by residents (3%). Recipients of verbal mistreatment included staff nurses (27%), radiology technicians (13%), medical students (13%), environmental services employees (7%), security guards (7%), patients (7%), surgery attendings (7%), anesthesia attendings (7%), internal medicine chief residents (7%), and pharmacists (7%). A total of 31% of the complaints were regarding residents who involuntarily departed and 7% regarding residents who left voluntarily before completion. The mean PGY level at first complaint was 2.2 years. Of the 29 residents receiving complaints, 16 had recurrent offenses (range 2 to 7 total complaints, positive predictive value [PPV] 53%).</p></div><div><h3>Conclusion</h3><p>Resident misbehavior manifests early and recurs often. Furthermore, it is frequently directed toward perceived subordinates. Nondesignated preliminary status, premature departure from the program, and the eventual selection of specific subspecialty fellowships seems to increase the risk for resident misbehavior. Identified residents require close surveillance and remediation.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 418-425"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.05.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405251","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}

{"title":"Stimulating Resident Research in a General Surgery Residency Community Program","authors":"Joann Lohr MD ,&nbsp;J. Michael Smith MD ,&nbsp;Richard Welling MD ,&nbsp;Amy Engel MA ,&nbsp;Kim Hasselfeld BS ,&nbsp;Joy Rusche","doi":"10.1016/j.cursur.2006.04.011","DOIUrl":"10.1016/j.cursur.2006.04.011","url":null,"abstract":"<div><h3>Objective</h3><p>Resident research teams were established at this community hospital in the 1997 academic year. Research productivity, including publications and presentations in the years before establishing research teams and the 8 years subsequent to establishment of research teams with faculty mentors, was reviewed.</p></div><div><h3>Methods</h3><p>Each team is supported by a research specialist who provides assistance with project design, data evaluation, statistical analysis, manuscript editing, and preparation of research presentations. Every resident is assigned to a research team that meets monthly. The teams consist of a 4th- or 5th-year resident, 2nd- or 3rd-year resident, surgical intern, research team mentor, and research specialist. The resident is required to be an active contributing co-investigator on 1 team project per year, contributing to the development and performance of the study, participating in writing the manuscript, and must be able to defend the study. By the end of the third year, the resident is required to complete 1 individual project that is submitted to the postgraduate competition for residents. In addition, a completed manuscript must be ready to submit to a peer-reviewed journal. Promotion can be denied if the appropriate time has not been devoted to research. Minimum completion requirements include a case report and a presentation at a national or regional meeting. The research registry was reviewed for all presentations and publications given by the surgical residents during the 8 years before the teams were established and the 8 years after the teams were formed.</p></div><div><h3>Results</h3><p>In the 8 years before the establishment of research teams, 60 papers were published. After the establishment of research teams, 77 papers were published. During the 8 years before research teams were being established, 69 presentations were given. During the subsequent 8 years with the use of mentoring and research teams, 92 presentations were given. The research teams resulted in a 33% increase in presentations and a 13% increase in publications.</p></div><div><h3>Conclusions</h3><p>Establishment of research teams and mentoring can help stimulate research interest and activity. Continuity on research teams throughout the 5-year residency is also crucial for the progression and development, duration, and completion of projects. Continuity of the mentor and research specialists also helps facilitate productivity and completion of the task. This method has been highly successful in improving the research presentations and publications in a community-based hospital residency.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 426-434"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405252","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}

{"title":"The 80-Hour Resident Workweek Does Not Adversely Affect Patient Outcomes or Resident Education","authors":"Christian de Virgilio MD ,&nbsp;Arezou Yaghoubian BS ,&nbsp;Roger J. Lewis MD ,&nbsp;Bruce E. Stabile MD ,&nbsp;Brant A. Putnam MD","doi":"10.1016/j.cursur.2006.03.006","DOIUrl":"10.1016/j.cursur.2006.03.006","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine whether the 80-hour resident workweek adversely affects patient outcomes or resident education.</p></div><div><h3>Methods</h3><p>To assess patient outcomes, the authors reviewed trauma patient morbidity and mortality at the second busiest level I trauma center in Los Angeles County before (July 1998-June 2003, Period 1) and after (July 2003-June 2005, Period 2) implementation of the duty hour limitation via a retrospective review of a prospective database. All patients were operated and managed by residents under faculty supervision. Patient characteristics included the injury severity score (ISS), mechanism of injury, complications, and death. To assess resident education, the authors compared ABSITE percentile scores, first-time pass rates on the American Board of Surgery Qualifying and Certifying Examinations, and total and chief resident operative case volumes. In addition, they estimated institutional costs incurred to comply with the new duty hour rules.</p></div><div><h3>Results</h3><p><em>Patient outcomes</em>. Over the entire 7-year study period, 11,518 trauma patients were transported to Harbor-UCLA Medical Center. Compared with Period 1, Period 2 experienced an increase in average yearly patient volume from 1510 to 1981 (p 0.01). The average ISS also increased, from 7.9 to 9.6 (p &lt; 0.0001), as did the proportion of penetrating trauma from 14.8% to 17.6% (p &lt; 0.0001). Morbidity and mortality rates remained unchanged. <em>Resident education</em>. Mean ABSITE scores and first-time Qualifying and Certifying Exam pass rates were unchanged. Mean resident total major case volumes increased significantly in Period 2 from 831 to 1156 (p &lt; 0.0001), whereas chief resident year case volumes were unchanged. The estimated cost incurred by this institution to conform to the new work hour standards was approximately $359,000 per year.</p></div><div><h3>Conclusions</h3><p>Despite concerns that the 80-hour workweek might threaten patient care and resident education, the morbidity and mortality rates at a busy level I trauma center remained unchanged. The quality of surgical resident education, as measured by operative volumes, ABSITE scores, and written and oral board examination pass rates were likewise unchanged. The reorganization of the authors’ general surgery residency program to comply with the duty hour restrictions was achieved within reasonable cost.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 435-439"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.03.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405253","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}

{"title":"When Should We Order a CT Scan and When Should We Rely on the Results to Diagnose an Acute Appendicitis?","authors":"Adil Ceydeli MD ,&nbsp;Simon Lavotshkin ,&nbsp;Jack Yu MD ,&nbsp;Leslie Wise MD","doi":"10.1016/j.cursur.2006.06.008","DOIUrl":"10.1016/j.cursur.2006.06.008","url":null,"abstract":"<div><h3>Objective</h3><p>The objective of this study was to retrospectively analyze the last 100 consecutive emergency appendectomies performed in the authors’ institution, which is a community-based teaching hospital, and look at the accuracy of the CT scan in the diagnosis of acute appendicitis.</p></div><div><h3>Design</h3><p>Retrospective clinical study.</p></div><div><h3>Setting</h3><p>A 600-bed community-based teaching hospital.</p></div><div><h3>Methods</h3><p>The last 100 consecutive emergency appendectomies, which were performed at New York Methodist Hospital in 2004, were retrospectively analyzed. The collected data included the demographics of the patients, relevant history, physical examination, laboratory and radiological tests, and pathology results.</p><p>The statistical analyses were performed using the JMP version 3.2 software (SAS Institute Inc., Cary, North Carolina). An alpha value of 0.05 was used in all statistical analyses, and p values were considered as being statistically significant at or below the alpha value of 0.05.</p></div><div><h3>Results</h3><p>There was no statistically significant correlation between the acute appendicitis and some of the typical presenting symptoms and signs of acute appendicitis (rebound tenderness, low-grade fever, elevated white blood cell count, and anorexia).</p><p>The sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan in this retrospective analysis were 96%, 75%, 98.5%, and 50%, respectively, with an overall efficiency of 95%. However, the sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan increased after reevaluation of the false-positive, false-negative, and inconclusive CT results by an experienced radiologist in a blind fashion (97%, 100%, 100%, and 71%, respectively). The correlation between the CT scan and the pathology result was statistically significant when the CT result was positive or negative (p = 0.0001).</p></div><div><h3>Conclusion</h3><p>The CT scan is indicated when the clinical presentation is equivocal, and it will be helpful if the result is positive or interpreted as negative only by an experienced radiology attending.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 464-468"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405258","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}

{"title":"Deck of Cards","authors":"Riley Bove MS IV","doi":"10.1016/j.cursur.2006.07.004","DOIUrl":"https://doi.org/10.1016/j.cursur.2006.07.004","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Page 482"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137225977","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}

{"title":"Forty Years in the Saddle: Lessons Learned as Program Director in One Program for Forty Years","authors":"Allen Silbergleit MD","doi":"10.1016/j.cursur.2006.05.008","DOIUrl":"10.1016/j.cursur.2006.05.008","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 373-384"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.05.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405827","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}

{"title":"A PGY1 Curriculum—Meeting a Need for Changing Times","authors":"John A. Weigelt MD,&nbsp;Deborah E. Simpson PhD,&nbsp;Rebecca C. Anderson PhD,&nbsp;Karen J. Brasel MD,&nbsp;Philip N. Redlich MD","doi":"10.1016/j.cursur.2006.06.004","DOIUrl":"10.1016/j.cursur.2006.06.004","url":null,"abstract":"<div><p>A systematic process is described that produced a PGY1 curriculum for the surgical residents at Medical College of Wisconsin. The process involved faculty and residents. Topics were selected based on the six general competencies. Objectives were developed for all topics. The curriculum was delivered to the residents while they were off clinical duty. This Protected Block Curriculum approach was chosen to facilitate the learning structure of the curriculum. Feedback was positive, learning objectives appeared to be achieved and the plan is to continue to develop the PGY1 curriculum in the same format.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 410-417"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405832","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}

{"title":"The Legacy of Sir Henry Souttar: Pioneer of the First Mitral Valvulotomy","authors":"George M. Comas MD,&nbsp;Warren D. Widmann MD,&nbsp;Mark A. Hardy MD","doi":"10.1016/j.cursur.2006.07.001","DOIUrl":"10.1016/j.cursur.2006.07.001","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 476-481"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26346708","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}