Current surgery最新文献

{"title":"Solid-Pseudopapillary Tumors of the Pancreas: Case Report and Literature Review","authors":"Wesley P. Francis MD,&nbsp;Etai Goldenberg BS,&nbsp;N. Volkan Adsay MD,&nbsp;Christopher P. Steffes MD,&nbsp;John D. Webber MD","doi":"10.1016/j.cursur.2006.06.010","DOIUrl":"10.1016/j.cursur.2006.06.010","url":null,"abstract":"<div><p>Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms of low malignant potential that mostly affect young women. These tumors are of unclear pathogenesis, are slow growing, and can become considerably large before causing symptoms. Complete resection is curative in most cases. This is the case of a 39-year-old African-American woman undergoing evaluation for Roux-en-Y gastric bypass, who was found to have a pancreatic mass. Image-guided biopsy revealed SPT. The patient underwent complete excision of the tumor and had an open Roux-en-Y gastric bypass performed concurrently. The patient had an uneventful postoperative course. A review of the literature is presented.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 469-472"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26346707","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":"General Surgery Morning Report: A Competency-Based Conference that Enhances Patient Care and Resident Education","authors":"Brendon M. Stiles MD,&nbsp;T. Brett Reece MD,&nbsp;Traci L. Hedrick MD,&nbsp;Robert A. Garwood MD,&nbsp;Michael G. Hughes MD,&nbsp;Joseph J. Dubose MD,&nbsp;Reid B. Adams MD,&nbsp;Bruce D. Schirmer MD,&nbsp;Hilary A. Sanfey MD,&nbsp;Robert G. Sawyer MD","doi":"10.1016/j.cursur.2006.06.005","DOIUrl":"10.1016/j.cursur.2006.06.005","url":null,"abstract":"<div><h3>Purpose</h3><p>After adopting a night float system, the residency program at the University of Virginia Health System Department of Surgery initiated a daily morning report (MR). The conference was originated to sign out new admissions and consults from the previous day to the services that would assume care. Although initially oriented toward transfer of patient information, MR is also hypothesized to serve as a competency-based resident education tool.</p></div><div><h3>Methods</h3><p>An anonymous survey was distributed to on-service residents (n = 25). Questions were asked on a 5-point Likert scale. Respondents also ranked the weekly conferences, including MR, in terms of educational benefit derived.</p></div><div><h3>Results</h3><p>Most residents agreed that MR is an efficient method to sign-out patient care [84% stongly agree (SA) or agree (A)] and that it provides an excellent educational experience (88% SA or A). They agreed that it is presented in an evidence-based format (88% SA or A). Regarding the core competencies, residents all asserted that MR addresses “patient care” (100% SA or A) and “medical knowledge” (100% SA or A). Most agreed that it addresses “professionalism” (60% SA or A), “interpersonal skills and communication” (76% SA or A), and “practice-based learning and improvement” (92% SA or A). The 4 most important components identified with respect to continuing to improve both patient care and resident education were the presence of the on-call attending, a review of relevant radiology, provision of follow-up on select cases, and critical review of the literature. On average, MR was seen as the most educational conference, with 52% of residents ranking it first.</p></div><div><h3>Conclusions</h3><p>Although MR is ubiquitous in most primary care residency programs, such a conference has not typically been held on surgical services. The MR was developed at the University of Virginia Health System Department of Surgery as a necessity for patient sign-out. As this conference has continued to evolve, it has become an excellent tool for resident education. It now serves the purpose of enhancing patient care and medical education and of providing evidence of learning and assessment of the general competencies. The MR provides an example for program directors of how to tailor existing resident work sessions or conferences to meet Accreditation Council for Graduate Medical Education (ACGME) competency requirements.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 385-390"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405831","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":"Missed Opportunities: A Descriptive Assessment of Teaching and Attitudes Regarding Communication Skills in a Surgical Residency","authors":"Olivia A. Hutul BS ,&nbsp;Robert O. Carpenter MD ,&nbsp;John L. Tarpley MD ,&nbsp;Kimberly D. Lomis MD","doi":"10.1016/j.cursur.2006.06.016","DOIUrl":"10.1016/j.cursur.2006.06.016","url":null,"abstract":"<div><h3>Background</h3><p>The Accreditation Council for Graduate Medical Education (ACGME) requires that “residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates.” The authors sought to assess current methods of teaching and attitudes regarding communication skills in their surgical residency.</p></div><div><h3>Methods</h3><p>After obtaining Institutional Review Board (IRB) exemption, voluntary anonymous surveys were completed by a sample of convenience at the Vanderbilt University Medical Center: surgical residents at Grand Rounds and attending surgeons in a faculty meeting. Data were evaluated from 49 respondents (33 of 75 total surgical residents, 16 representative attending surgeons).</p></div><div><h3>Results</h3><p>One hundred percent of respondents rated the importance of communication to the successful care of patients as “4” or “5” of 5. Direct attending observation of residents communicating with patients/families was confirmed by residents and faculty.</p><p>Residents reported varying levels of comfort with different types of conversations. Residents were “comfortable” or “very comfortable” as follows: obtaining informed consent, 91%; reporting operative findings, 64%; delivering bad news, 61%; conducting a family conference, 40%; discussing do not resuscitate (DNR) orders, 36%; and discussing transition to comfort care, 24%.</p><p>Resident receptiveness to communication skills education varied with proposed venues: 84% favored teaching in the course of routine clinical care, 52% via online resources, and 46% in workshops.</p><p>Residents were asked how frequently they received feedback specific to their communication skills during the past 6 months: Most residents reported 0 (39%) or 1 (21%) feedback episode. Only 30% of resident respondents reported receiving feedback that they perceived helpful.</p><p>Attending surgeons reported that they did provide residents feedback specific to their communication skills. When asked to estimate the number of feedback episodes in the last 6 months, 16 faculty members reported a total of 67 feedback episodes, whereas 33 residents reported a total of only 24 episodes.</p><p>Most faculty members rated their comfort with providing feedback specific to communication skills as “very comfortable” (56%) or “comfortable” (19%). “Time constraints” was the most frequently cited barrier to teaching communication skills.</p></div><div><h3>Conclusions</h3><p>Communication skills are valued as integral to patient care by both residents and faculty in this study. Residents are most receptive to teaching of communication skills in the clinical setting. Faculty members report they are providing feedback to residents. Although residents report direct observation by faculty, currently only a minority (30%) are receiving feedback regarding communication that they consider","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Pages 401-409"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26405833","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":"“What’s So Special about an 80-Hour Work Week?”","authors":"Richard M. Bell MD","doi":"10.1016/j.cursur.2006.05.007","DOIUrl":"https://doi.org/10.1016/j.cursur.2006.05.007","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 6","pages":"Page 440"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.05.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137226525","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":"Lipomatous Disorder of the Peri-Trochanteric Soft Tissue: Case Report and Review","authors":"Parviz Goshtasby MD ,&nbsp;Glen Brooks MD ,&nbsp;L. Peter Fielding MD","doi":"10.1016/j.cursur.2006.03.005","DOIUrl":"10.1016/j.cursur.2006.03.005","url":null,"abstract":"<div><p>Disorders of fatty tissue metabolism and body contour are frequently described in the literature. Several different syndromes have been ascribed to recurring characteristics of fatty deposition with similar underlying etiologies. These syndromes can generally be classified into the lipomatoses (abnormal accumulations of fat) and the lipodystrophies (abnormal fat atrophy). The authors describe a case of isolated symmetrical lipomatosis of the soft tissue overlying the trochanters that developed a recurrence after treatment with liposuction. They have attempted to match this patient’s disorder into 1 of several reported syndromes, with benign symmetric lipomatosis and acquired partial lipodystrophy at the top of the differential diagnosis. However, some characteristics of this patient may warrant a separate categorization for her condition. In this case report, the current literature on disorders of fatty tissue metabolism is reviewed and a discussion of relevant factors and issues surrounding their clinical significance and management is provided.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 338-344"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26251960","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":"Littoral Cell Angioma: A Case Report and Review","authors":"Rhonda L. Harmon MD,&nbsp;Carlos A. Cerruto MD,&nbsp;Adam Scheckner MD","doi":"10.1016/j.cursur.2006.06.011","DOIUrl":"10.1016/j.cursur.2006.06.011","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 345-350"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26251961","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":"","authors":"Joseph C.L. Merola MD (Chairman)","doi":"10.1016/j.cursur.2006.02.006","DOIUrl":"https://doi.org/10.1016/j.cursur.2006.02.006","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 304-305"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.02.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137409779","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":"Bowel Perforation from Bevacizumab for the Treatment of Metastatic Colon Cancer: Incidence, Etiology, and Management","authors":"John H. Heinzerling BA ,&nbsp;Sergio Huerta MD","doi":"10.1016/j.cursur.2006.06.002","DOIUrl":"10.1016/j.cursur.2006.06.002","url":null,"abstract":"<div><p>Avastin (Bevacizumab) is a recently developed monoclonal antibody against vascular endothelial growth factor (VEGF) receptor that increases survival in patients with metastatic colorectal cancer. Bowel perforation is a known risk factor of unknown etiology associated with the use of Avastin. In this report, the incidence, risk factors, typical presentation, and management of patients with this complication is described.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 334-337"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26251959","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":"Preparing for the In-Training Service Examination","authors":"James A. Chambers MD","doi":"10.1016/j.cursur.2006.04.006","DOIUrl":"10.1016/j.cursur.2006.04.006","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 354-355"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26251966","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":"Preparing for the In-Service Examination","authors":"Paul S. Vietzen MD","doi":"10.1016/j.cursur.2006.04.005","DOIUrl":"10.1016/j.cursur.2006.04.005","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 355-356"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26251964","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}