Current surgery最新文献_第8页

Current surgery Pub Date : 2006-05-01 DOI: 10.1016/j.cursur.2005.12.014

Wade Kang MD

引用次数: 0

Supervision 监督

Current surgery Pub Date : 2006-05-01 DOI: 10.1016/j.cursur.2005.12.005

John A. Weigelt MD (Editor-in-Chief, Current Surgery)

引用次数: 0

Bifid Vermiform Appendix: A Case Report 双虫形附录:1例报告

Current surgery Pub Date : 2006-05-01 DOI: 10.1016/j.cursur.2006.02.001

Ewen A. Griffiths, Jayaraman Jagadeesan, Tarannum Fasih, Mark Mercer-Jones

{"title":"Bifid Vermiform Appendix: A Case Report","authors":"Ewen A. Griffiths, Jayaraman Jagadeesan, Tarannum Fasih, Mark Mercer-Jones","doi":"10.1016/j.cursur.2006.02.001","DOIUrl":"10.1016/j.cursur.2006.02.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Appendiceal anomalies are extremely rare: they have a reported incidence of between 0.004% and 0.009% of appendectomy specimens. The authors report a case of a patient who was found to have 2 appendices at emergency laparotomy, review the classification system used, and discuss the potential clinical pitfalls of similar cases.</p></div><div><h3>Case Report</h3><p>A 23-year-old man was admitted as an emergency with abdominal pain and vomiting. The operative finding was of a bifid appendix. One appendix was grossly gangrenous and lacked a mesoappendix, whereas the other had a mesoappendix and appeared macroscopically normal. The appendices shared a common base that arose from the cecum in the typical anatomical position. No other intra-abdominal malformations were present at inspection during laparotomy. Histology confirmed features of gangrenous appendicitis. His postoperative recovery was uneventful, and he was discharged after 4 days.</p></div><div><h3>Conclusion</h3><p>Although rare, it is important for several reasons that surgeons are aware of the potential anatomical anomalies and malpositions of the vermiform appendix: first, a missed second appendix may result in serious clinical and medico-legal consequences; second, a double appendix can be confused with other intra-abdominal conditions; and finally, they can be associated with other congenital abnormalities.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 176-178"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073483","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: 24

Surgical Management of a Hemodialysis Catheter-Induced Right Atrial Thrombus 血液透析导管诱发的右心房血栓的外科治疗

Current surgery Pub Date : 2006-05-01 DOI: 10.1016/j.cursur.2005.08.011

Peter F. Lalor MD , Francis Sutter DO

引用次数: 10

Surgeons’ Attitudes About Communicating With Patients and Their Families 外科医生对与患者及家属沟通的态度

Current surgery Pub Date : 2006-05-01 DOI: 10.1016/j.cursur.2005.08.007

Michael J. Sise MD , C. Beth Sise MSN , Daniel I. Sack BA , Maurine Goerhing MSN

{"title":"Surgeons’ Attitudes About Communicating With Patients and Their Families","authors":"Michael J. Sise MD , C. Beth Sise MSN , Daniel I. Sack BA , Maurine Goerhing MSN","doi":"10.1016/j.cursur.2005.08.007","DOIUrl":"10.1016/j.cursur.2005.08.007","url":null,"abstract":"<div><h3>Context</h3><p>Surgeons face difficult communication challenges with patients and their families. There is a need for improved education in communication skills, especially in giving bad news. Understanding surgeons’ attitudes is the first step in designing effective education programs.</p></div><div><h3>Objective</h3><p>To determine surgeons’ self-assessment of competence, rating of importance, and perceived need for training in communication skills relevant to patient care.</p></div><div><h3>Design</h3><p>Anonymous self-report mail survey of demographic information and attitudes toward 12 patient care-related communication skills.</p></div><div><h3>Setting</h3><p>San Diego County, California, a geographically distinct area of close to 3 million inhabitants receiving health care from over 6000 physicians.</p></div><div><h3>Participants</h3><p>A total of 351 (43.4%) respondents from the 833 surgical specialists in the San Diego County Medical Society list of member and nonmember physicians.</p></div><div><h3>Main outcome measures</h3><p>Measurement of surgeons’ attitudes toward self-perceived competence, importance, need for training in the communication skills, and the influence of age, duration of practice, and surgical-specialty on attitudes.</p></div><div><h3>Results</h3><p>Most respondents rated their competence high except in 3 skills relating to a patient’s death. They found all skills important and indicated a need for training in them. Younger surgeons rated their competence and the importance significantly lower in the 3 skills relating to a patient’s death (p < 0.05). Critical care surgical specialists rated their competence and the importance higher in skills relating to breaking bad news and a patient’s death than did the non-critical care group (p < 0.05). Older surgeons and critical care specialists also indicated a higher level of support for training in these skills.</p></div><div><h3>Conclusion</h3><p>These results suggest that surgical specialists rate themselves as competent in effective communication, believe in its importance, and agree with the need for training. An organized approach to training in interaction skills, especially in giving bad news, is warranted.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 213-218"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.08.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073363","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: 37

Do General Surgery Applicants Really Want to be General Surgeons? 普通外科申请者真的想成为普通外科医生吗?

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.12.003

Dorothy A. Andriole MD, Donna B. Jeffe PhD, Mary Klingensmith MD

{"title":"Do General Surgery Applicants Really Want to be General Surgeons?","authors":"Dorothy A. Andriole MD, Donna B. Jeffe PhD, Mary Klingensmith MD","doi":"10.1016/j.cursur.2005.12.003","DOIUrl":"10.1016/j.cursur.2005.12.003","url":null,"abstract":"<div><h3>Objective</h3><p>The authors sought to compare categorical general surgery applicants with applicants in other specialties regarding their final specialty-choice ranking for residency positions.</p></div><div><h3>Method</h3><p>The authors analyzed the 2004-match year applicant-pool data from the Electronic Residency Application Service and Common Application Service as well as rank-list data from the National Resident Matching Program (NRMP), the Urology Match Program, and the San Francisco Matching Program for 20 different specialties. Two-tailed chi-square tests measured differences between the proportions of applicants who ultimately ranked programs in categorical general surgery and each of 19 other specialties and between the proportions of U.S. students who ranked categorical general surgery and each of 19 other specialties as a non-preferred choice. A Bonferroni-adjusted alpha was set at 0.0013 to reduce the likelihood of a type I error.</p></div><div><h3>Results</h3><p>The proportion of applicants ranking each specialty ranged from 42% (786/1859) in pathology to 91% (282/31l) in neurological surgery. The proportion of categorical general surgery applicants ranking categorical general surgery programs was 51% (2004/3900), which was significantly lower than the proportions ranking 12 of 19 other specialties (each p < 0.001). Of the 2004 categorical general surgery applicants ranking categorical general surgery programs, 278 (278/2004, 14%) ranked categorical general surgery as a non-preferred specialty. Among 1230 U.S. students ranking categorical general surgery programs, 144 (12%) did so as a non-preferred specialty—a proportion significantly higher compared with U.S. students ranking 15 of 19 other specialties as non-preferred (each p < 0.001).</p></div><div><h3>Conclusions</h3><p>In 2004, the categorical general surgery applicant pool was relatively uncommitted to the specialty of general surgery. The number of applicants ranking categorical general surgery as a non-preferred specialty was likely even higher than these data indicate, as unmatched applicants in non-NRMP matches who then ranked categorical general surgery programs in the NRMP were tabulated by the NRMP as having ranked categorical general surgery as their preferred specialty.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 2","pages":"Pages 145-150"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.12.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25891595","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: 8

How Do Surgical Residents and Non-Physician Practitioners Play Together in the Sandbox? 外科住院医生和非内科医生如何在沙盒中一起玩?

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.12.009

Andrew S. Resnick MD, Barbara A. Todd CRNP, James L. Mullen MD, Jon B. Morris MD

{"title":"How Do Surgical Residents and Non-Physician Practitioners Play Together in the Sandbox?","authors":"Andrew S. Resnick MD, Barbara A. Todd CRNP, James L. Mullen MD, Jon B. Morris MD","doi":"10.1016/j.cursur.2005.12.009","DOIUrl":"10.1016/j.cursur.2005.12.009","url":null,"abstract":"<div><h3>Introduction</h3><p>The reduction of resident work hours due to the 80-hour workweek has created pressure on academic health-care systems to find “replacement residents.” At the authors’ institution, a group of nurse practitioners (NPs) and physician assistants (PAs), collectively referred to as non-physician practitioners (NPPs), were hired as these reinforcements, such that the number of NPPs (56) was almost twice the number of clinical categorical surgery residents (37). An experienced leader with national credibility was hired to run the NPP program. On each service, the call system was changed to a night float system, whereby residents were pulled from traditional resident teams to serve as nighttime residents during the week. A total of 1-3 NPPs were hired for each team, but whether NPPs worked for the team as a whole, or were assigned to individual attendings, was left to the discretion of the division chiefs. One year after the start of this program, the authors wanted to study the effects it has had on both surgery resident education and NPP job satisfaction.</p></div><div><h3>Methods</h3><p>An electronic, anonymous survey was conducted during a monthly surgery resident meeting, and out of 72 categorical and preliminary surgery residents, 50% submitted answers to 12 questions. A similar electronic survey was administered to all 56 NPPs, with 45% responding.</p></div><div><h3>Results</h3><p>Overall, 63% of residents believed that lines of communication between surgery team members were clear, and 58% of residents and 71% of NPPs believed that attendings, residents, and NPPs worked together effectively. A total of 91% of residents believed that the addition of NPPs to the teams was positive overall, and 80% of NPPs were satisfied with their positions. Overall, 60% of residents and 50% of NPPs felt that educational goals were being met.</p></div><div><h3>Discussion</h3><p>Implementation of the 80-hour workweek and introduction of NPs and PAs onto the inpatient surgical services has altered resident education at the authors’ institution. Although overall most residents view the addition of NPPs to the clinical services as positive, there are concerns about the program. Although hired to fill the void left by decreasing labor hours of residents, NPPs do not necessarily have the same goals as surgery residents and there is confusion about how NPPs fit into the hierarchy of the traditional surgical team.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 2","pages":"Pages 155-164"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.12.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25891598","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

Agenesis of the Gallbladder 胆囊发育不全

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.04.018

Hamed Kabiri MD, Orville H. Domingo MD, Chris D. Tzarnas MD

引用次数: 17

Cervical Spine Evaluation in the Community Hospital 社区医院的颈椎评估

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.07.002

Lori L. Fraser MD, Thomas J. Veverka MD, Mark S. Adams MD

引用次数: 1

Mastering Reimbursement: Basic CPT Code Selection 掌握报销:基本CPT代码选择

Current surgery Pub Date : 2006-03-01 DOI: 10.1016/j.cursur.2005.12.015

Karen R. Borman MD

引用次数: 1