Current surgery最新文献_第6页

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.02.003

Natalie Weger DO

引用次数: 0

Senior Medical Student “Boot Camp”: Can Result in Increased Self-Confidence Before Starting Surgery Internships 高年级医学生“新兵训练营”:在开始外科实习之前可以增加自信

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.03.004

Robert M. Esterl Jr MD , David L. Henzi EdD , Stephen M. Cohn MD

{"title":"Senior Medical Student “Boot Camp”: Can Result in Increased Self-Confidence Before Starting Surgery Internships","authors":"Robert M. Esterl Jr MD , David L. Henzi EdD , Stephen M. Cohn MD","doi":"10.1016/j.cursur.2006.03.004","DOIUrl":"10.1016/j.cursur.2006.03.004","url":null,"abstract":"<div><h3>Objective</h3><p>Surgical residents often begin the internship without prerequisite skills necessary for appropriate patient care. The purpose of this study was to develop a surgical internship readiness elective or senior medical student (SMS) “Boot Camp” for fourth-year medical students to prepare them for the rigors of surgery internship.</p></div><div><h3>Design</h3><p>Sixteen fourth-year medical students completed a series of clinical and didactic sessions over a 4-week elective. Students evaluated the effectiveness of the elective with a pre- and post-survey that focused on confidence levels in 4 areas: anatomic dissection, administrative skills, technical skills, and patient management. Students also participated in a focus group session that identified strengths and weaknesses of the elective. Students were also assessed on performance by anesthesiology faculty in the mock patient code and by nursing faculty in mock nursing page sessions.</p></div><div><h3>Results</h3><p>Upon completion of the elective, students rated themselves as more confident in all 57 categories on the survey. During the focus group session, students identified several strengths of the elective and offered recommendations for improvements in the elective.</p></div><div><h3>Conclusion</h3><p>The SMS “Boot Camp” gave fourth-year medical students confidence and an opportunity to develop necessary prerequisite skills to begin the surgery internship.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 264-268"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145638","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}

引用次数: 137

Myths and Realities of the 80-Hour Work Week 《每周80小时工作制的神话与现实

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.04.004

Paul J. Schenarts MD , Kimberly D. Anderson Schenarts PhD , Michael F. Rotondo MD

{"title":"Myths and Realities of the 80-Hour Work Week","authors":"Paul J. Schenarts MD , Kimberly D. Anderson Schenarts PhD , Michael F. Rotondo MD","doi":"10.1016/j.cursur.2006.04.004","DOIUrl":"10.1016/j.cursur.2006.04.004","url":null,"abstract":"<div><h3>Background</h3><p>Myths are so ingrained into cultural traditions that emotion frequently overshadows a rational evaluation of the facts. The reduction in resident work hours has resulted in the formation of several myths. The purpose of this review is to examine the published data on resident work hours to separate out myth from reality.</p></div><div><h3>Methods</h3><p>An electronic database was searched for publications related to resident training, work-hours, continuity of care, sleep deprivation, quality of life, patient safety, clinical/operative experience, faculty work hours, and surgical education.</p></div><div><h3>Results</h3><p>Sleep deprivation has been shown to be harmful, and residents played a role in advocating for work-hour limits. Surgical residents have seen a less dramatic improvement in quality of life compared with other disciplines. Work-hour reductions have decreased participation in clinic but have not resulted in a significant decline in clinical or operative exposure. Limiting resident work hours will unlikely result in a decrease health-care cost. Reduction in resident work hours has not resulted in an improvement or deterioration in patient outcome. Reduction of work hours has not increased faculty work hours nor made surgery a more attractive career choice.</p></div><div><h3>Conclusions</h3><p>Despite strongly held opinions, resident work-hour reduction has resulted in little significant change in lifestyle, clinical exposure, patient well-being, faculty work hours, or medical student recruitment.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 269-274"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145639","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}

引用次数: 40

Blunt Traumatic Pericardial Rupture Presenting With Cardiac Herniation 钝性外伤性心包破裂伴心脏疝

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.04.008

Kullada O. Pichakron MD, Jon Perlstein MD

引用次数: 9

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.02.004

Dan Baillie MD

引用次数: 0

Choledochal Cyst Cholangiocarcinoma Arising from Adenoma: Case Report and a Review of the Literature 胆总管囊肿胆管癌起源于腺瘤:1例报告及文献复习

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.04.010

Jan Franko MD, Michael L. Nussbaum MD, Jon B. Morris MD

引用次数: 24

Mastering Reimbursement: Basics of the Surgical Package 掌握报销:手术包的基础

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.02.002

Karen R. Borman MD

引用次数: 1

The Clinical and Laboratory Response to Recombinant Factor VIIa in Trauma and Surgical Patients with Acquired Coagulopathy 创伤和外科获得性凝血病患者对重组因子VIIa的临床和实验室反应

Current surgery Pub Date : 2006-07-01 DOI: 10.1016/j.cursur.2006.03.007

Neil R. McMullin MD, David S. Kauvar MD, Heather M. Currier MD, Toney W. Baskin MD, Anthony E. Pusateri PhD, John B. Holcomb MD

{"title":"The Clinical and Laboratory Response to Recombinant Factor VIIa in Trauma and Surgical Patients with Acquired Coagulopathy","authors":"Neil R. McMullin MD, David S. Kauvar MD, Heather M. Currier MD, Toney W. Baskin MD, Anthony E. Pusateri PhD, John B. Holcomb MD","doi":"10.1016/j.cursur.2006.03.007","DOIUrl":"10.1016/j.cursur.2006.03.007","url":null,"abstract":"<div><h3>Objective</h3><p>In bleeding patients who are coagulopathic, the clinical response to administration of recombinant factor VIIa (rFVIIa) relates to the changes in prothrombin time (PT).</p></div><div><h3>Design</h3><p>Retrospective review of all surgical and trauma patients who were coagulopathic and received factor VIIa at the authors’ institution over the past 27 months.</p></div><div><h3>Setting</h3><p>Academic tertiary referral facility and level I trauma center.</p></div><div><h3>Participants</h3><p>Eighteen patients met inclusion criteria, 10 trauma and 8 surgical. Mean age 50 years (range, 17-84).</p></div><div><h3>Results</h3><p>Overall mortality was 39%. All but 1 patient (17/18) had resolution of coagulopathic bleeding with rFVIIa, and all clinical responders (n = 17) (defined as clinical cessation of bleeding within 24 hours determined by either attending surgeon or chief resident progress note) had a decrease in PT to normal range. In contrast, the single clinical nonresponder had an insignificant PT decrease (19 to 18 seconds). Prothrombin time decreased from 20 ± 4 seconds to 12 ± 2 seconds, p < 0.05 (n = 17). International Normalized Ratio (INR) decreased from 1.59 to 0.86, p < 0.05 (n = 17). Fibrinogen before administration was 299.73 (range, 105-564) (n = 15). pH before administration was 7.25 (±0.18) (n = 10). Patient temperature was 98.64 (±2.06). Effect in partial thromboplastin time (PTT) was inconsistent (50 ± 49 seconds to 34 ± 6 seconds, p > 0.05). Transfusion requirements for red blood cells (14 to 3 units) and plasma (12 to 3 units) were significantly reduced after rFVIIa. There were no significant differences in percentage PT decrease between dose ≥100 mcg/kg vs <100 mcg/kg, surgical vs trauma patients, survivors vs nonsurvivors, and those with pretreatment platelet count ≥100 K vs <100 K.</p></div><div><h3>Conclusions</h3><p>The administration of rFVIIa caused a decrease in the PT in nearly all patients. There were an insufficient number of patients to support the use of PT as a clinical predictor of response; however, the data are suggestive of such utility. If the PT does not correct, then it is likely that there is a deficiency of other factors of the coagulation cascade.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 246-251"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.03.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26147411","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}

引用次数: 26

Acute Lung Injury: An Indicator of Serious Systemic Illness 急性肺损伤:严重全身性疾病的一个指标

Current surgery Pub Date : 2006-05-01 DOI: 10.1016/j.cursur.2005.06.005

John P. Kepros MD, Jeff M. Gauvin MD, Donald N. Reed Jr. MD, Janet Osuch MD

{"title":"Acute Lung Injury: An Indicator of Serious Systemic Illness","authors":"John P. Kepros MD, Jeff M. Gauvin MD, Donald N. Reed Jr. MD, Janet Osuch MD","doi":"10.1016/j.cursur.2005.06.005","DOIUrl":"10.1016/j.cursur.2005.06.005","url":null,"abstract":"<div><p>The history of the acute respiratory distress syndrome (ARDS) parallels that of critical care. Descriptive and colorful names for the condition such as “shock lung,” “post perfusion lung,” and “traumatic wet lung” clearly communicate the reality that the pulmonary tissue is involved in a pathologic process. It is not difficult to speculate that the focus on the lung originated from the dramatic chest radiographs and gas exchange abnormalities frequently observed in association with the syndrome. However, a named condition does not necessarily dictate the therapeutic approach to it, and a review of some pertinent studies suggests the condition is in fact systemic in nature. Concurrent with this recognition, the need for markers of severity of illness has become more important. Rather than a process needing primarily pulmonary approaches to management, it now seems that ARDS is the result of systemic events with noticeable pulmonary manifestations, which may suffice as a clinical marker for severity of systemic inflammation. Because the pathophysiology has been described elsewhere,<span><sup>1</sup></span> this article will focus on the clinical trials that are shaping our perception and management of the syndrome.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 197-201"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.06.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073362","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}

引用次数: 0

Lymphoscintigraphy Does Not Enhance Sentinel Node Identification or Alter Management of Patients With Early Breast Cancer 淋巴显像不能增强前哨淋巴结的识别或改变早期乳腺癌患者的治疗

Current surgery Pub Date : 2006-05-01 DOI: 10.1016/j.cursur.2006.02.008

Angela Shoher MD , Amna Diwan MD , Bin S. Teh MD , Hsin H. Lu MD , Ron Fisher MD , Anthony Lucci Jr. MD

{"title":"Lymphoscintigraphy Does Not Enhance Sentinel Node Identification or Alter Management of Patients With Early Breast Cancer","authors":"Angela Shoher MD , Amna Diwan MD , Bin S. Teh MD , Hsin H. Lu MD , Ron Fisher MD , Anthony Lucci Jr. MD","doi":"10.1016/j.cursur.2006.02.008","DOIUrl":"10.1016/j.cursur.2006.02.008","url":null,"abstract":"<div><h3>Summary</h3><p>Lymphoscintigraphy (LS) is often performed before sentinel lymph node dissection (SLND) for breast cancer. The purpose of this study was to determine whether routine LS enhances rate of identification of sentinel nodes (SN), and if findings on LS alter either the SLND procedure or the subsequent patient management.</p></div><div><h3>Methods</h3><p>LS using technetium-99m sulfur colloid (99<sup>m</sup>Tc) was performed in 136 consecutive patients undergoing SLND for invasive breast cancer. Three equal aliquots of 99<sup>m</sup>Tc were injected peritumorally, and LS images were obtained at 60 to 120 min after 99<sup>m</sup>Tc injection. Data were collected on the success of LS to visualize SN. Information regarding body mass index (BMI), biopsy type (core vs excisional), tumor location (medial vs lateral), and SN positivity were recorded and comparison was made with success of operative SN identification. In all SLND cases, 1% lymphazurin blue dye was used in addition to the 99<sup>m</sup>Tc.</p></div><div><h3>Results</h3><p>LS failed to identify an SN in 9 of 136 cases (6.6%). Failed mappings did not correlate with biopsy type, tumor location, or SN positivity. There was a positive correlation between increased BMI and failed LS (p = <0.001). Failed LS did not predict operative SLND failure, as an SN was identified in 100% of cases (136/136), including the 9 with a failed LS. In 67% (6/9) of the failed LS, the SN was both hot and blue at operation. Internal mammary (IM) drainage was observed in 4% (6/136) of LS. Positive SN were found in 26% (35/136) of patients. Findings on LS did not affect adjuvant treatment decisions in any patient.</p></div><div><h3>Conclusions</h3><p>There was a correlation between failed LS and BMI, but no correlation with biopsy type or tumor location. Drainage to extraaxillary sites was rare. LS findings did not enhance success of intraoperative identification of SN or alter the postoperative management of patients with early stage breast cancer.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 207-212"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.02.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073365","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}

引用次数: 21