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Sample records for surgeon general executive

  1. Surgeon General's Family Health History Initiative

    Science.gov (United States)

    ... Source Code The Surgeon General's Family Health History Initiative To help focus attention on the importance of ... health campaign, called the Surgeon General's Family History Initiative, to encourage all American families to learn more ...

  2. Meeting Increasing Demands for Rural General Surgeons.

    Science.gov (United States)

    Mccarthy, Mary C; Bowers, Howard E; Campbell, Damon M; Parikh, Priti P; Woods, Randy J

    2015-12-01

    Dynamic assessment of the effective surgical workforce recommends 27,300 general surgeons in 2030; 2,525 more than are presently being trained. Rural shortages are already critical and there has been insufficient preparation for this need. A literature review of the factors influencing the choice of rural practice was performed. A systematic search was conducted of PubMed and the Web of Science to identify applicable studies in rural practice, surgical training, and rural general surgery. These articles were reviewed to identify the pertinent reports. The articles chosen for review are directed to four main objectives: 1) description of the challenges of rural practice, 2) factors associated with the choice of rural practice, 3) interventions to increase interest and preparation for rural practice, and 4) present successful rural surgical practice models. There is limited research on the factors influencing surgeons in the selection of rural surgery. The family practice literature suggests that physicians are primed for rural living through early experience, with reinforcement during medical school and residency, and retained through community involvement, and personal and professional satisfaction. However, more research into the factors drawing surgeons specifically to rural surgery, and keeping them in the community, is needed.

  3. The Core Competencies for General Orthopaedic Surgeons.

    Science.gov (United States)

    Kellam, James F; Archibald, Douglas; Barber, James W; Christian, Eugene P; D'Ascoli, Richard J; Haynes, Richard J; Hecht, Suzanne S; Hurwitz, Shepard R; Kellam, James F; McLaren, Alexander C; Peabody, Terrance D; Southworth, Stephen R; Strauss, Robert W; Wadey, Veronica M R

    2017-01-18

    With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. These

  4. Perspectives of South African general surgeons regarding their ...

    African Journals Online (AJOL)

    Objectives. To canvass the perceptions of SA general surgeons regarding certain aspects of their training. Methods. An electronic postal survey was conducted. All general surgeons on the Association of Surgeons of South Africa database were requested to complete a structured questionnaire. Four Likert scale items were ...

  5. Specialization and the Current Practices of General Surgeons

    Science.gov (United States)

    Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

    2014-01-01

    Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

  6. Where are general surgeons located in South Africa? | Dell | South ...

    African Journals Online (AJOL)

    South African Journal of Surgery ... Methods: A descriptive analysis of the general surgical workforce in South Africa was performed. The total number of specialist and non-specialist general surgeons working in the public sector in South Africa was documented between the periods from the 1 October 2014 until 31 ...

  7. An audit of nephrectomy by general surgeons | Mungadi | Nigerian ...

    African Journals Online (AJOL)

    ... nephrectomy for non functioning hydronephrotic kidneys. The outcome in the treatment of the congenital renal anomalies, malignant and trauma to the kidney was not satisfactory suggesting the trained urologist will be better equipped to sort things out. Keywords: audit, nephrectomy, general surgeons. Nigerian Journal of ...

  8. Perspectives of South African general surgeons regarding their ...

    African Journals Online (AJOL)

    Perspectives of South African general surgeons regarding their postgraduate training. MD Smith. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  9. Practice patterns and career satisfaction of Canadian female general surgeons.

    Science.gov (United States)

    Hebbard, Pamela C; Wirtzfeld, Debrah A

    2009-06-01

    We wanted to study how female general surgeons in Canada manage lifestyle and career demands. All female Canadian general surgeons registered with the Royal College of Physicians and Surgeons of Canada were asked to complete a survey evaluating their practice patterns, personal lives, and levels of satisfaction related to these factors. Eighty-five surveys (66%) were returned. Most respondents work in full-time clinical practices. While it was rare to find women in part-time or shared practices, 35% of women reported interest in these alternative models. Respondents described the necessary factors for a transition into alternative models. Job satisfaction was high (3.8 out of 5), with personal and parenting satisfaction being less highly rated (3.3 and 3.2, respectively). Canadian female general surgeons have active and satisfying careers, although many would like to work in alternative practice models that better conform to their lifestyle demands. This pressure will have a significant impact on the future surgical workforce.

  10. Thomas James Walker (1835-1916): Surgeon and general practitioner.

    Science.gov (United States)

    Thomas, Martyn

    2018-02-01

    Thomas James Walker was a surgeon and general practitioner who worked in the city of Peterborough at a time when there were changes and innovations in the practice of medicine. After training in medicine and surgery at Edinburgh University, he qualified in London in 1857. He was a pioneer of laryngoscopy. He played an important role in introducing antiseptic surgery to the Peterborough Infirmary and was instrumental in the development of the operating theatre which opened in 1894. He was a philanthropist and collector of Roman and Saxon artefacts. In 1915, he was recognized as an outstanding member of the Peterborough community when he was offered the Freedom of the City.

  11. 29 CFR 541.100 - General rule for executive employees.

    Science.gov (United States)

    2010-07-01

    ... REGULATIONS DEFINING AND DELIMITING THE EXEMPTIONS FOR EXECUTIVE, ADMINISTRATIVE, PROFESSIONAL, COMPUTER AND OUTSIDE SALES EMPLOYEES Executive Employees § 541.100 General rule for executive employees. (a) The term...

  12. Preventing infection in general surgery: improvements through education of surgeons by surgeons.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-08-01

    Surgical patients are at particular risk of healthcare-associated infection (HCAI) due to the presence of a surgical site leading to surgical site infection (SSI), and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice; this was used to inform the development of a targeted educational initiative by surgeons specifically for surgical trainees. Parameters assessed during the initial audit and a further audit after the educational initiative were related to intra- and postoperative aspects of the prevention of SSIs, as well as care of peripheral venous catheters (PVCs) in surgical patients. The proportion of prophylactic antibiotics administered prior to incision across 360 operations increased from 30.0% to 59.1% (P<0.001). Surgical site dressings were observed in 234 patients, and a significant decrease was found in the percentage of dressings that were tampered with during the initial 48h after surgery (16.5% vs 6.2%, P=0.030). In total, 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVCs in situ (37.9% vs 24.4%, P<0.001), PVCs in situ for >72h (10.6% vs 3.1%, P<0.001) and PVCs covered with clean and intact dressings (87.3% vs 97.6%, P<0.001). Significant improvements in surgical practice were established for the prevention of SSI and CRBSI through a focused educational programme developed by and for surgeons. Potentially, other specific measures may also be warranted to achieve further improvements in infection prevention in surgical practice.

  13. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education.

    Science.gov (United States)

    Engels, Paul T; de Gara, Chris

    2010-06-30

    Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  14. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

    Directory of Open Access Journals (Sweden)

    de Gara Chris

    2010-06-01

    Full Text Available Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  15. Emergent management of postpartum hemorrhage for the general and acute care surgeon

    Directory of Open Access Journals (Sweden)

    Blankenship Charles L

    2009-11-01

    Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

  16. My Family Health Portrait, A tool from the Surgeon General | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. My Family Health Portrait, A tool from the Surgeon General ... use Why is it important to know my family medical history? Your family medical history is a ...

  17. 76 FR 73644 - Announcement of Requirements and Registration for the United States Surgeon General's Healthy...

    Science.gov (United States)

    2011-11-29

    ..., excessive alcohol use) and these chronic illnesses have been well established. The Surgeon General's Vision... computer, a mobile device (e.g., mobile phone, portable sensor, etc.), console, or any platform broadly...

  18. Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon.

    Science.gov (United States)

    Fernández, Luis G

    2016-09-01

    Traditionally, the surgical approach to managing abdominal injuries was to assess the extent of trauma, repair any damage and close the abdomen in one definitive procedure rather than leave the abdomen open. With advances in medicine, damage control surgery using temporary abdominal closure methods is being used to manage the open abdomen (OA) when closure is not possible. Although OA management is often observed in traumatic injuries, the extension of damage control surgery concepts, in conjunction with OA, for the management of the septic patient requires that the general surgeon who is faced with these challenges has a comprehensive knowledge of this complex subject. The purpose of this article is to provide guidance to the acute care and general surgeon on the use of OA negative pressure therapy (OA-NPT; ABTHERA™ Open Abdomen Negative Pressure Therapy System, KCI, an ACELITY Company, San Antonio, TX) for OA management. A literature review of published evidence, clinical recommendations on managing the OA and a case study demonstrating OA management using OA-NPT have been included. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  19. Diffusion of laparoscopic cholecystectomy among general surgeons in the United States.

    Science.gov (United States)

    Escarce, J J; Bloom, B S; Hillman, A L; Shea, J A; Schwartz, J S

    1995-03-01

    Introduced in 1989, laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic gallstones. This study describes the diffusion of laparoscopic cholecystectomy among general surgeons; assesses the importance of various reasons for surgeons adopting the procedure; and examine the influence of surgeon, practice, and health care market characteristics on the timing of adoption. The data were obtained from a survey of a national sample of surgeons. Most surgeons (81%) adopted laparoscopic cholecystectomy by early 1992. More than three fourths of adopters identified the desire to keep up with the state-of-the-art and improved patient outcomes as very or extremely important reasons for adoption. Results of proportional hazards regression analysis indicate that individual surgeons' adoption behavior generally was consistent with expected utility maximization in an uncertain new technological environment. Of particular interest, fee-for-service payment and more competitive practice settings and markets were associated with earlier adoption. These findings suggest that the "technological imperative" and surgeons' perception of the relative clinical and financial advantages of laparoscopic cholecystectomy were important reasons for the rapid diffusion of laparoscopic cholecystectomy. Policies that accelerate current trends toward payment of physicians based on salary or capitation and promote the growth of multispecialty group practice could slow the diffusion of new physician-based product innovations in health care.

  20. Perspectives of South African general surgeons regarding their ...

    African Journals Online (AJOL)

    2014-08-03

    Aug 3, 2014 ... in the service platform, most commonly in the public sector. De. Beer et al. ... general surgery in the different departments is not uniform, the use of extended ... uniform, the role of the private sector is not uniform, and lastly the.

  1. Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

    International Nuclear Information System (INIS)

    Najafi, Massoome; Ebrahimi, Mandana; Kaviani, Ahmad; Hashemi, Esmat; Montazeri, Ali

    2005-01-01

    There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance)

  2. Comparison of Appendectomy Outcomes Between Senior General Surgeons and General Surgery Residents.

    Science.gov (United States)

    Siam, Baha; Al-Kurd, Abbas; Simanovsky, Natalia; Awesat, Haitham; Cohn, Yahav; Helou, Brigitte; Eid, Ahmed; Mazeh, Haggi

    2017-07-01

    In some centers, the presence of a senior general surgeon (SGS) is obligatory in every procedure, including appendectomy, while in others it is not. There is a relative paucity in the literature of reports comparing the outcomes of appendectomies performed by unsupervised general surgery residents (GSRs) with those performed in the presence of an SGS. To compare the outcomes of appendectomies performed by SGSs with those performed by GSRs. A retrospective analysis was performed of all patients 16 years or older operated on for assumed acute appendicitis between January 1, 2008, and December 31, 2015. The cohort study compared appendectomies performed by SGSs and GSRs in the general surgical department of a teaching hospital. The primary outcome measured was the postoperative early and late complication rates. Secondary outcomes included time from emergency department to operating room, length of surgery, surgical technique (open or laparoscopic), use of laparoscopic staplers, and overall duration of postoperative antibiotic treatment. Among 1649 appendectomy procedures (mean [SD] patient age, 33.7 [13.3] years; 612 female [37.1%]), 1101 were performed by SGSs and 548 by GSRs. Analysis demonstrated no significant difference between the SGS group and the GSR group in overall postoperative early and late complication rates, the use of imaging techniques, time from emergency department to operating room, percentage of complicated appendicitis, postoperative length of hospital stay, and overall duration of postoperative antibiotic treatment. However, length of surgery was significantly shorter in the SGS group than in the GSR group (mean [SD], 39.9 [20.9] vs 48.6 [20.2] minutes; P < .001). This study demonstrates that unsupervised surgical residents may safely perform appendectomies, with no difference in postoperative early and late complication rates compared with those performed in the presence of an SGS.

  3. Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

    Science.gov (United States)

    Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

    2003-12-01

    Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

  4. Complications of bariatric surgery--What the general surgeon needs to know.

    Science.gov (United States)

    Healy, Paul; Clarke, Christopher; Reynolds, Ian; Arumugasamy, Mayilone; McNamara, Deborah

    2016-04-01

    Obesity is an important cause of physical and psychosocial morbidity and it places a significant burden on health system costs and resources. Worldwide an estimated 200 million people over 20 years are obese and in the U.K. the Department of Health report that 61.3% of people in the U.K. are either overweight or obese. Surgery for obesity (bariatric surgery) is being performed with increasing frequency in specialist centres both in the U.K. and Ireland and abroad due to the phenomenon of health tourism. Its role and success in treating medical conditions such as diabetes mellitus and hypertension in obese patients will likely lead to an even greater number of bariatric surgery procedures being performed. Patients with early postoperative complications may be managed in specialist centres but patients with later complications, occurring months or years after surgery, may present to local surgical units for assessment and management. This review will highlight the late complications of the 3 most commonly performed bariatric surgery procedures that the emergency general surgeon may encounter. It will also highlight the complications that require urgent intervention by the emergency general surgeon and those that can be safely referred to a bariatric surgeon for further management after initial assessment and investigations. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  5. 77 FR 12845 - Announcement of Requirements and Registration for Surgeon General's (SG) Youth Video Contest

    Science.gov (United States)

    2012-03-02

    ... of the Contest and their immediate family (spouse, parents and step-parents, siblings and step-siblings, and children and step- children) and household members (people who share the same residence at... conjunction with the launch of the new SG Report, the Surgeon General will be releasing a Consumer Piece in...

  6. TV Violence and the Child; The Evolution and Fate of the Surgeon General's Report.

    Science.gov (United States)

    Cater, Douglass; Strickland, Stephen

    The U.S. Surgeon General's report on the effects of televised violence on children is discussed--how the report began, how it was compiled, and the results. The book concludes that broadcast media influence kept the most respected social scientist investigators of the subject off the Committee, and that the final results were distorted in the…

  7. Drunk Driving. Surgeon General's Workshop. Proceedings (Washington, D.C., December 14-16, 1988).

    Science.gov (United States)

    Janus Associates.

    This volume presents solutions, recommendations, and strategies in eleven interrelated areas considered at the Surgeon General's Workshop on Drunk Driving held in Washington, D.C. in December of 1988. Lists of the members of the Workshop Planning Committee and members of the federal advisory group on follow-up activities for the workshop are…

  8. Canadian Hepatitis C Look-Back Investigation to Detect Transmission from an Infected General Surgeon

    Directory of Open Access Journals (Sweden)

    Meenakshi Dawar

    2010-01-01

    Full Text Available BACKGROUND: In February 2007, a general surgeon in Charlottetown, Prince Edward Island, tested positive for hepatitis C virus (HCV. The surgeon’s infection onset date could not be determined; however, episodic hepatic enzyme elevations were first detected in November 2004 and again in February 2007. HCV transmission during surgery, alhough rare, has been documented. A phased look-back HCV screening program was conducted to detect HCV transmission from this surgeon to patients who underwent the highest-risk procedures in the three years before his positive test.

  9. Loch ness, special operations executive and the first surgeon in paradise: Robert Kenneth Wilson (26.1.1899-6.6.1969).

    Science.gov (United States)

    Watters, David A K

    2007-12-01

    Lieutenant Colonel Robert Kenneth Wilson (1899-1969) was a surgeon who fought in both world wars and joined the Special Operations Executive parachuting behind enemy lines into Holland, France and Borneo, the last mission being with Australian forces (Semut II). He was an expert on firearms and gave opinion on ballistics at the Old Bailey during the 1930s. He also wrote a definitive text on automatic pistols with editions published in 1943 and 1975. He was an Edinburgh Fellow (1926), who had a practice in general surgery and gynaecology in Queen Anne Street during the 1930s. He took the famous 1934 'surgeon's photo' of the Loch Ness monster that was not admitted to be a hoax until 1994. After World War II, he became the first surgical specialist to work in the public service of the then Territory of Papua and New Guinea (1950-1956), where he wrote several papers on surgical topics. He married Gwen (1924), the daughter of Henrietta Gulliver, an Australian painter. They had two sons, Richard and Phillip. After practice he retired to Melbourne where he died of carcinoma oesophagus.

  10. A multitasking general executive for compound continuous tasks.

    Science.gov (United States)

    Salvucci, Dario D

    2005-05-06

    As cognitive architectures move to account for increasingly complex real-world tasks, one of the most pressing challenges involves understanding and modeling human multitasking. Although a number of existing models now perform multitasking in real-world scenarios, these models typically employ customized executives that schedule tasks for the particular domain but do not generalize easily to other domains. This article outlines a general executive for the Adaptive Control of Thought-Rational (ACT-R) cognitive architecture that, given independent models of individual tasks, schedules and interleaves the models' behavior into integrated multitasking behavior. To demonstrate the power of the proposed approach, the article describes an application to the domain of driving, showing how the general executive can interleave component subtasks of the driving task (namely, control and monitoring) and interleave driving with in-vehicle secondary tasks (radio tuning and phone dialing). 2005 Lawrence Erlbaum Associates, Inc.

  11. The Approach of General Surgeons to Oncoplastic and Reconstructive Breast Surgery in Turkey: A Survey of Practice Patterns

    Directory of Open Access Journals (Sweden)

    Mustafa Emiroğlu

    2014-12-01

    Full Text Available Background: Oncoplastic Breast Surgery (OBS, which is a combination of oncological procedures and plastic surgery techniques, has recently gained widespread use. Aims: To assess the experiences, practice patterns and preferred approaches to Oncoplastic and Reconstructive Breast Surgery (ORBS undertaken by general surgeons specializing in breast surgery in Turkey. Study Design: Cross-sectional study. Methods: Between December 2013 and February 2014, an eleven-question survey was distributed among 208 general surgeons specializing in breast surgery. The questions focused on the attitudes of general surgeons toward performing oncoplastic breast surgery (OBS, the role of the general surgeon in OBS and their training for it as well as their approaches to evaluating cosmetic outcomes in Breast Conserving Surgery (BCS and informing patients about ORBS preoperatively. Results: Responses from all 208 surgeons indicated that 79.8% evaluated the cosmetic outcomes of BCS, while 94.2% informed their patients preoperatively about ORBS. 52.5% performed BCS (31.3% themselves, 21.1% together with a plastic surgeon. 53.8% emphasized that general surgeons should carry out OBS themselves. 36.1% of respondents suggested that OBS training should be included within mainstream surgical training, whereas 27.4% believed this training should be conducted by specialised centres. Conclusion: Although OBS procedure rates are low in Turkey, it is encouraging to see general surgeons practicing ORBS themselves. The survey demonstrates that our general surgeons aspire to learn and utilize OBS techniques.

  12. From Surgeon General's bookshelf to National Library of Medicine: a brief history.

    Science.gov (United States)

    Blake, J B

    1986-10-01

    The National Library of Medicine originated as a few books in the office of the army's surgeon general, Joseph Lovell, between 1818 and 1836. It became the nation's largest medical library after the Civil War under the direction of John Shaw Billings and began publishing the Index-Catalogue of the Library of the Surgeon General's Office and preparing the Index Medicus. After Billings retired in 1895, the library marked time as army medical officers were rotated through as directors until modernization began under Harold Wellington Jones during World War II. during the directorship of Frank B. Rogers (1949-1963), who introduced MEDLARS, guided the move to a new building in Bethesda, and revitalized other operations, the institution received statutory authority as the National Library of Medicine within the Public Health Service (1956). By 1965, which was marked by the passage of the Medical Library Assistance Act, the library had again regained a position of world leadership.

  13. The authoritative metaphor and social change: Surgeon General C. Everett Koop's Direct Mailer, "Understanding AIDS".

    Science.gov (United States)

    Jensen, Robin E; King, Abigail Selzer

    2013-01-01

    In 1988, Surgeon General C. Everett Koop published "Understanding AIDS," the nation's first and only direct mailing sent to every private home in the country. His appeals therein were driven by what we label authoritative metaphors. Communicated by and/or attributed to persons of authority, authoritative metaphors capitalize on the symbolic force of sanctioned power by appealing to the ethos of office. In "Understanding AIDS," we find that Koop drew from his positions as a surgeon and a general, respectively, to equate AIDS with an unprecedented plague and an unprecedented war. He created new authoritative metaphors out of the vestiges of familiar metaphors related to disease and public health and thereby portrayed AIDS as a recognizable but decisively unique dilemma requiring distinct preventative behaviors.

  14. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

    OpenAIRE

    de Gara Chris; Engels Paul T

    2010-01-01

    Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which ...

  15. A model for a career in a specialty of general surgery: One surgeon's opinion.

    Science.gov (United States)

    Ko, Bona; McHenry, Christopher R

    2018-01-01

    The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons. Case logs collected from 1991-2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME "Major Case Categories" and there frequencies were determined. 10,324 operations were performed on 8209 patients. 412.9 ± 84.9 operations were performed yearly including 279.3 ± 42.7 general and 133.7 ± 65.5 endocrine operations. A high-volume endocrine surgery practice and a rank of tenured professor were achieved by years 11 and 13, respectively. At year 25, the frequency of endocrine operations exceeded general surgery operations. Maintaining a foundation in broad-based general surgery with a specialty focus is a sustainable career model. Residents and fellows can use the model to help plan their careers with realistic expectations. Copyright © 2017. Published by Elsevier Inc.

  16. Implantation of peritoneal catheters by laparotomy: nephrologists obtained similar results to general surgeons

    Directory of Open Access Journals (Sweden)

    Restrepo CA

    2014-10-01

    Full Text Available Cesar A Restrepo, Carlos Alberto Buitrago, Cielo Holguin Division of Nephrology, Department of Health Sciences, Caldas University, Caldas, ColombiaPurpose: To analyze the complications and costs of minilaparotomies performed by a nephrologist (group A compared with conventional laparotomies performed by a surgeon (group B for peritoneal catheter implantation.Setting: Two university hospitals (Santa Sofia and Caldas in Manizales, Caldas, Colombia.Methods: The study included stage 5 chronic kidney disease patients, with indication of renal replacement therapy, who were candidates for peritoneal dialysis and gave informed consent for a peritoneal catheter implant. Minilaparotomies were performed by a nephrologist in a minor surgery room under local anesthesia. Conventional laparotomies were performed by a surgeon in an operating room under general anesthesia.Results: Two nephrologists inserted 157 peritoneal catheters, and seven general surgeons inserted 185 peritoneal catheters. The groups had similar characteristics: the mean age was 55 years, 49.5% were men, and the primary diagnoses were diabetic nephropathy, hypertensive nephropathy, and unknown etiology. The implant was successful for 98.09% of group A and 99.46% of group B. There was no procedure-related mortality. The most frequent complications in the first 30 days postsurgery in group A versus group B, respectively, were: peritonitis (6.37% versus 3.78%, exit-site infection (3.82% versus 2.16%, tunnel infection (0% versus 0.54%, catheter entrapment by omentum (1.27% versus 3.24%, peritoneal effluent spillover (1.91% versus 2.16%, draining failure (4.46% versus 6.49%, hematoma (0% versus 1.08%, catheter migration with kinking (3.18% versus 2.70%, hemoperitoneum (1.27% versus 0%, and hollow viscera accidental puncture (1.91% versus 0.54%. There were no statistically significant differences in the number of complications between groups. In 2013, the cost of a surgeon-implanted peritoneal

  17. Simty: generalized SIMT execution on RISC-V

    OpenAIRE

    Collange , Sylvain

    2017-01-01

    International audience; We present Simty, a massively multi-threaded RISC-V processor core that acts as a proof of concept for dynamic inter-thread vector-ization at the micro-architecture level. Simty runs groups of scalar threads executing SPMD code in lockstep, and assembles SIMD instructions dynamically across threads. Unlike existing SIMD or SIMT processors like GPUs or vector processors, Simty vector-izes scalar general-purpose binaries. It does not involve any instruction set extension...

  18. Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: The need for pediatric surgery specialists.

    Science.gov (United States)

    Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung

    2017-11-01

    This study compared the outcomes of infants who underwent surgery in neonatal intensive care units by pediatric surgeons and by general surgeons. This was a retrospective study of infants who underwent surgery in neonatal intensive care units between 2010 and 2014. A total of 227 patients were included. Of these patients, 116 were operated on by pediatric surgeons (PS) and 111 were operated on by general surgeons (GS). The outcome measures were the overall rate of operative complications, unplanned reoperation, mortality rate, length of stay, operative time, and number of total number of operative procedures. The overall operative complication rate was higher in the GS group compared with the PS group (18.7% vs. 7.0%, p=0.0091). The rate of unplanned reoperations was also higher in the GS group (10.8% vs. 3.5%, p=0.0331). The median operation time (90min vs. 75min, p=0.0474) and median length of stay (24days vs. 18days, p=0.0075) were significantly longer in the GS group. The adjusted odd ratios of postoperative complications for GS were 2.9 times higher than that of PS (OR 2.90, p=0.0352). The operative quality and patient outcomes of the PS group were superior to those of the GS group. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. General Adjustment Influence Factor of Malaysian Construction Expatriates Executives Abroad

    Directory of Open Access Journals (Sweden)

    Zainol Halmi

    2016-01-01

    Full Text Available The success of Malaysian construction companies creates an opportunity to explore abroad. Past studies have shown that the difficulty of expatriates in adjusting to a new environment is the main aspect that leads to failure of assignments. The success in implementing an overseas assignment does not solely depend on an expatriate’s technical expertise. The adjustment issues such as the interaction with the host nationals, and adaptability to the host country’s culture also exert influence on the assignment. The research was conducted to identify the influence of executive expatriate general adjustment on assignment in host countries. The objective of the study was to identify adjustment influence factors relating to general adjustment abroad. Questionnaires were sent to Malaysian expatriate executives. Sixty four Malaysian expatriate executives from Malaysian construction companies overseas were involved in this study. The findings show interaction, social and living environment influences their adjustment during expatriation. Pre-departure training preparation aspects for expatriates is a good step before their departure to host countries.

  20. Does general surgery residency prepare surgeons for community practice in British Columbia?

    Science.gov (United States)

    Hwang, Hamish

    2009-01-01

    Background Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. Methods During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. Results I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. Conclusion On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and “other,” which comprised mostly hand surgery. PMID:19503663

  1. Live transference of surgical subspecialty skills using telerobotic proctoring to remote general surgeons.

    Science.gov (United States)

    Ereso, Alexander Q; Garcia, Pablo; Tseng, Elaine; Gauger, Grant; Kim, Hubert; Dua, Monica M; Victorino, Gregory P; Guy, T Sloane

    2010-09-01

    Certain clinical environments, including military field hospitals or rural medical centers, lack readily available surgical subspecialists. We hypothesized that telementoring by a surgical subspecialist using a robotic platform is feasible and can convey subspecialty knowledge and skill to a remotely located general surgeon. Eight general surgery residents evaluated the effect of remote surgical telementoring by performing 3 operative procedures, first unproctored and then again when teleproctored by a surgical subspecialist. The clinical scenarios consisted of a penetrating right ventricular injury requiring suture repair, an open tibial fracture requiring external fixation, and a traumatic subdural hematoma requiring craniectomy. A robotic platform consisting of a pan-and-tilt camera with laser pointer attached to an overhead surgical light with integrated audio allowed surgical subspecialists the ability to remotely teleproctor residents. Performance was evaluated using an Operative Performance Scale. Satisfaction surveys were given after performing the scenario unproctored and again after proctoring. Overall mean performance scores were superior in all scenarios when residents were proctored than when they were not (4.30 +/- 0.25 versus 2.43 +/- 0.20; p knowledge of anatomy, were all superior when residents were proctored (p < 0.001). Satisfaction surveys showed greater satisfaction and comfort among residents when proctored. Proctored residents believed the robotic platform facilitated learning and would be feasible if used clinically. This study supports the use of surgical teleproctoring in guiding remote general surgeons by a surgical subspecialist in the care of a wounded patient in need of an emergency subspecialty operation. Copyright 2010. Published by Elsevier Inc.

  2. Career satisfaction among general surgeons in Canada: a qualitative study of enablers and barriers to improve recruitment and retention in general surgery.

    Science.gov (United States)

    Ahmed, Najma; Conn, Lesley Gotlib; Chiu, Mary; Korabi, Bochra; Qureshi, Adnan; Nathens, Avery B; Kitto, Simon

    2012-11-01

    To understand what influences career satisfaction among general surgeons in urban and rural areas in Canada in order to improve recruitment and retention in general surgery. Semistructured interviews were conducted with 32 general surgeons in 2010 who were members of the Canadian Association of General Surgeons and who currently practice in either an urban or rural area. Interviews explored factors contributing to career satisfaction, as well as suggestions for preventive, screening, or management strategies to support general surgery practice. Findings revealed that both urban and rural general surgeons experienced the most satisfaction from their ability to resolve patient problems quickly and effectively, enhancing their sense of the meaningfulness of their clinical practice. The supportive relationships with colleagues, trainees, and patients was also cited as a key source of career satisfaction. Conversely, insufficient access to resources and a perceived disconnect between hospital administration and clinical practice priorities were raised as key "systems-level" problems. As a result, many participants felt alienated from their work by these systems-level barriers that were perceived to hinder the provision of high-quality patient care. Career satisfaction among both urban and rural general surgeons was influenced positively by the social aspects of their work, such as patient and colleague relationships, as well as a perception of an increasing amount of control and autonomy over their professional commitments. The modern general surgeon values a balance between professional obligations and personal time that may be difficult to achieve given the current system constraints.

  3. External validation of the Society of Thoracic Surgeons General Thoracic Surgery Database.

    Science.gov (United States)

    Magee, Mitchell J; Wright, Cameron D; McDonald, Donna; Fernandez, Felix G; Kozower, Benjamin D

    2013-11-01

    The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) reports outstanding results for lung and esophageal cancer resection. However, a major weakness of the GTSD has been the lack of validation of this voluntary registry. The purpose of this study was to perform an external, independent audit to assess the accuracy of the data collection process and the quality of the database. An independent firm was contracted to audit 5% of sites randomly selected from the GTDB in 2011. Audits were performed remotely to maximize the number of audits performed and reduce cost. Auditors compared lobectomy cases submitted to the GTSD with the hospital operative logs to evaluate completeness of the data. In addition, 20 lobectomy records from each site were audited in detail. Agreement rates were calculated for 32 individual data elements, 7 data categories pertaining to patient status or care delivery, and an overall agreement rate for each site. Six process variables were also evaluated to assess best practice for data collection and submission. Ten sites were audited from the 222 participants. Comparison of the 559 submitted lobectomy cases with operative logs from each site identified 28 omissions, a 94.6% agreement rate (discrepancies/site range, 2 to 27). Importantly, cases not submitted had no mortality or major morbidity, indicating a lack of purposeful omission. The aggregate agreement rates for all categories were greater than 90%. The overall data accuracy was 94.9%. External audits of the GTSD validate the accuracy and completeness of the data. Careful examination of unreported cases demonstrated no purposeful omission or gaming. Although these preliminary results are quite good, it is imperative that the audit process is refined and continues to expand along with the GTSD to insure reliability of the database. The audit results are currently being incorporated into educational and quality improvement processes to add further value. Copyright

  4. Executive Summary of the American College of Surgeons/Surgical Infection Society Surgical Site Infection Guidelines-2016 Update.

    Science.gov (United States)

    Ban, Kristen A; Minei, Joseph P; Laronga, Christine; Harbrecht, Brian G; Jensen, Eric H; Fry, Donald E; Itani, Kamal M F; Dellinger, E Patchen; Ko, Clifford Y; Duane, Therese M

    Guidelines regarding the prevention, detection, and management of surgical site infections (SSIs) have been published previously by a variety of organizations. The American College of Surgeons (ACS)/Surgical Infection Society (SIS) Surgical Site Infection (SSI) Guidelines 2016 Update is intended to update these guidelines based on the current literature and to provide a concise summary of relevant topics.

  5. Reliable assessment of general surgeons' non-technical skills based on video-recordings of patient simulated scenarios.

    Science.gov (United States)

    Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter; Konge, Lars; Rosenberg, Jacob; Oestergaard, Doris

    2013-11-01

    Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training. A 1-day course was conducted for 15 general surgeons in which they rated surgeons' nontechnical skills in 9 video recordings of scenarios simulating real intraoperative situations. Data were gathered from 2 sessions separated by a 4-hour training session. Interrater reliability was high for both pretraining ratings (Cronbach's α = .97) and posttraining ratings (Cronbach's α = .98). There was no statistically significant development in assessment skills. The D study showed that 2 untrained raters or 1 trained rater was needed to obtain generalizability coefficients >.80. The high pretraining interrater reliability indicates that videos were easy to rate and Non-Technical Skills for Surgeons dk easy to use. This implies that Non-Technical Skills for Surgeons dk (NOTSSdk) could be an important tool in surgical training, potentially improving safety and quality for surgical patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. 76 FR 24901 - Request for Input To Inform a Possible Surgeon General Action on Prescription Drug Abuse in Youth

    Science.gov (United States)

    2011-05-03

    ... self- harm (suicide attempts). Approach: ONDCP highlighted prescription drug abuse in its 2010 National... a Possible Surgeon General Action on Prescription Drug Abuse in Youth AGENCY: National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services (HHS). ACTION...

  7. The Social Effects of Advertising as Perceived by Advertising Executives, Businessmen, and the General Public.

    Science.gov (United States)

    Surlin, Stuart H.

    This study attempts to compare the perceptions and self-reported behavior of high, middle, and low authoritarian advertising executives, business executives, and members of the general public concerning the social effects of advertising. For the advertising sample, a total of 393 men and women were selected according to their executive positions…

  8. Protecting and improving health through the radiological sciences. A report to the Surgeon General

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1966-04-01

    This is the third in a series of reports prepared by the-National Advisory Committee on Radiation for the Surgeon General of the Public Health Service. The first two were directed to the broad responsibilities of the Service in the field of radiation control and to problems concerned with the protection of the public against undue radiation exposure from contamination of the environment with radioactive materials. In this report the Committee traces the remarkable growth that has taken place in the uses of ionizing radiation in the health professions, in industry, and in other walks of life. It also notes a number of emerging problems which not only are of importance from the point of view of radiation protection, but also, if not alleviated, threaten the quality of medical care in the United States and the translation of the advances of atomic research into needed benefits for the people. These problems include (a) serious weaknesses in academic departments of radiology which have restricted efforts to provide adequate instruction of medical and post-doctoral students in the clinical applications of ionizing radiation, including radiation protection; and (b) an increasingly severe shortage of manpower in all branches of the radiological sciences. The magnitude and complexity of these problems are sufficiently great that a concerted effort is needed by the Public Health Service to correct them. The alleviation of the problems just cited is but a part of a more comprehensive series of responsibilities faced by the Service in the radiological sciences. The Service must play an important role in the prevention of undue exposure of the population from medical, occupational, and environmental sources of ionizing radiation; at the same time, it must actively support the development and application of radiological methods in the diagnosis and treatment of diseases. In order that the Service may effectively meet its enlarging responsibilities in the radiological sciences

  9. Protecting and improving health through the radiological sciences. A report to the Surgeon General

    International Nuclear Information System (INIS)

    1966-04-01

    This is the third in a series of reports prepared by the-National Advisory Committee on Radiation for the Surgeon General of the Public Health Service. The first two were directed to the broad responsibilities of the Service in the field of radiation control and to problems concerned with the protection of the public against undue radiation exposure from contamination of the environment with radioactive materials. In this report the Committee traces the remarkable growth that has taken place in the uses of ionizing radiation in the health professions, in industry, and in other walks of life. It also notes a number of emerging problems which not only are of importance from the point of view of radiation protection, but also, if not alleviated, threaten the quality of medical care in the United States and the translation of the advances of atomic research into needed benefits for the people. These problems include (a) serious weaknesses in academic departments of radiology which have restricted efforts to provide adequate instruction of medical and post-doctoral students in the clinical applications of ionizing radiation, including radiation protection; and (b) an increasingly severe shortage of manpower in all branches of the radiological sciences. The magnitude and complexity of these problems are sufficiently great that a concerted effort is needed by the Public Health Service to correct them. The alleviation of the problems just cited is but a part of a more comprehensive series of responsibilities faced by the Service in the radiological sciences. The Service must play an important role in the prevention of undue exposure of the population from medical, occupational, and environmental sources of ionizing radiation; at the same time, it must actively support the development and application of radiological methods in the diagnosis and treatment of diseases. In order that the Service may effectively meet its enlarging responsibilities in the radiological sciences

  10. A critique of the US Surgeon General?s conclusions regarding e-cigarette use among youth and young adults in the United States of America

    OpenAIRE

    Polosa, Riccardo; Russell, Christopher; Nitzkin, Joel; Farsalinos, Konstantinos E.

    2017-01-01

    Background In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America. Methods Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions. Results Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is ...

  11. Emergent Management of Postpartum Hemorrhage for the General and Acute Care Surgeon

    Science.gov (United States)

    2009-01-01

    preeclampsia . If the patient has contraindications to methylergonovine or if the hemorrhage is still non- responsive, 250 μg of 15-methylprostagandin F2α may...practiced surgical strategies in combination with a basic knowledge PPH specific etiologies , physiology and inter- ventions permits surgeons to efficiently

  12. NCI Statement on the U.S. Surgeon General's "Call to Action to Prevent Skin Cancer"

    Science.gov (United States)

    As the Federal Government's principal agency for cancer research and training, the National Cancer Institute (NCI) endorses the U.S. Surgeon General’s “Call to Action to Prevent Skin Cancer,” which provides a comprehensive evaluation of the current state of skin cancer prevention efforts in the United States and recommends actions for improvement in the future.

  13. A Multitasking General Executive for Compound Continuous Tasks

    Science.gov (United States)

    Salvucci, Dario D.

    2005-01-01

    As cognitive architectures move to account for increasingly complex real-world tasks, one of the most pressing challenges involves understanding and modeling human multitasking. Although a number of existing models now perform multitasking in real-world scenarios, these models typically employ customized executives that schedule tasks for the…

  14. Comparison of minimally invasive surgical skills of neurosurgeons versus general surgeons: is there a difference in the first exposure to a virtual reality simulator?

    Science.gov (United States)

    Hassan, I; Bin Dayne, K; Kappus, C; Gerdes, B; Rothmund, M; Hellwig, D

    2007-04-01

    The increasing use of minimally invasive surgery, which has a longer learning curve compared to open surgery lets the necessity to develop training programs to improve endoscopic skills of trainees become ever clearer. The aim of this study was to compare the endoscopic skills of neurosurgeons versus general surgeons at first exposure to a virtual reality simulator. 72 general surgeons who visited the 122nd Conference of the German Surgeons Society (DGCH in Munich 2005) and 35 neuroendoscopic surgeons, who visited the Third World Conference of the International Study Group of Neuroendoscopy (ISGNE in Marburg 2005) participated in this study. Each participant performed the basic module "clip application" on the virtual reality simulator (LapSim). All participants were given the same pretest instructions. Time to complete the task, error score and economy of motion were recorded. The general surgeons performed the clip application faster, but with more errors than neuroendoscopic surgeons. However, the difference of both parameters was not significant. Both surgeon groups have a similar score for economy of motion. Although neuroendoscopic surgeons were exposed to a foreign procedure and unfamiliar equipment, they were able to perform virtual endoscopy with similar accuracy as general surgeons, who are adapted to these endoscopic instruments and procedures and do these daily.

  15. General Public Space Travel and Tourism. Volume 1; Executive Summary

    Science.gov (United States)

    ONeil, Daniel (Compiler); Bekey, Ivan; Mankins, John; Rogers, Thomas F.; Stallmer, Eric W.

    1998-01-01

    Travel and tourism is one of the world's largest businesses. Its gross revenues exceed $400 billion per year in the U.S. alone, and it is our second largest employer. U.S. private sector business revenues in the space information area now approximate $10 billion per year, and are increasing rapidly. Not so in the human spaceflight area. After spending $100s of billions (1998 dollars) in public funds thereon, and continuing to spend over $5 billion per year, the government is still the only customer for human spaceflight goods and services. Serious and detailed consideration was first given to the possibility of space being opened up to trips by the general public three decades ago, and some initial attempts to do so were made a dozen years ago. But the difficulties were great and the Challenger disaster put an end to them. In recent years professional space tourism studies have been conducted in the United Kingdom, Germany and, especially, Japan. In the U.S., technological progress has been pronounced; we have had nearly a decade's experience in seeing our astronauts travel to-from low Earth orbit (LEO) safely, and we expect to commence assembly of a LEO space station housing a half-dozen people this year. Too, NASA and our space industry now have new and promising space transportation development programs underway, especially the X-33 and X-34 programs, and some related, further generation, basic technology development programs. And five private companies are also working on the design of new surface - LEO vehicles. The first professional space tourism market studies have been conducted in several countries in the past few years, especially in Japan and here. The U.S. study makes it clear that, conceptually, tens of millions of us would like to take a trip to space if we could do so with reasonable safety, comfort and reliability, and at an acceptable price. Initial businesses will address the desires of those willing to pay a greater price and accept a greater

  16. Site investigations. Investigation methods and general execution programme

    International Nuclear Information System (INIS)

    2001-01-01

    SKB plans to commence site investigations in 2002. The present report is a broadening of the general programme and describes the execution of the investigations in so-called discipline-specific programmes for the disciplines geology, rock mechanics, thermal properties, hydrogeology, hydro geochemistry, transport properties of the rock and surface ecosystems. It also describes various technical aspects of drilling, which comprises a significant portion of the investigations. Based on this possible programme, site-specific programmes will then be prepared and adapted to the site-specific questions and conditions on the specific candidate area. The main product of the investigations is a site description. This document presents an integrated description of the site (geosphere and biosphere) and its regional environs with respect to current state and naturally ongoing processes. Provided that the initial site investigation shows that the site is still favourable, complete investigations are commenced. Primary investigation data are stored in SKB's database SICADA. The database's primary data mainly represent parameter values for single measurement points or limited measurement objects. Primary data are subjected to both discipline-specific and integrated analysis and interpretation in order to be able to subdivide the site into suitable geometric units and to assign discipline-specific properties to these geometric units. In this way a three-dimensional, primarily geo scientific, site-descriptive model of rock and ground is built. The site-descriptive model is represented with the aid of both geographic information systems (GIS) and above all SKB's CAD-based computer tool, Rock Visualization System (RVS). RVS is also used as an active instrument in the interpretation of information, especially to be able to judge the relative locations of different deformation zones. When the site has been selected, the investigations are focused on characterizing conditions at depth

  17. Site investigations. Investigation methods and general execution programme

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-01-01

    SKB plans to commence site investigations in 2002. The present report is a broadening of the general programme and describes the execution of the investigations in so-called discipline-specific programmes for the disciplines geology, rock mechanics, thermal properties, hydrogeology, hydro geochemistry, transport properties of the rock and surface ecosystems. It also describes various technical aspects of drilling, which comprises a significant portion of the investigations. Based on this possible programme, site-specific programmes will then be prepared and adapted to the site-specific questions and conditions on the specific candidate area. The main product of the investigations is a site description. This document presents an integrated description of the site (geosphere and biosphere) and its regional environs with respect to current state and naturally ongoing processes. Provided that the initial site investigation shows that the site is still favourable, complete investigations are commenced. Primary investigation data are stored in SKB's database SICADA. The database's primary data mainly represent parameter values for single measurement points or limited measurement objects. Primary data are subjected to both discipline-specific and integrated analysis and interpretation in order to be able to subdivide the site into suitable geometric units and to assign discipline-specific properties to these geometric units. In this way a three-dimensional, primarily geo scientific, site-descriptive model of rock and ground is built. The site-descriptive model is represented with the aid of both geographic information systems (GIS) and above all SKB's CAD-based computer tool, Rock Visualization System (RVS). RVS is also used as an active instrument in the interpretation of information, especially to be able to judge the relative locations of different deformation zones. When the site has been selected, the investigations are focused on characterizing

  18. Umbilical endometriosis mimicking as papilloma to general surgeons: A case report

    Directory of Open Access Journals (Sweden)

    A Singh

    2012-05-01

    Full Text Available IntroductionCutaneous or umbilical endometriosis is a rare entity that isoften overlooked because of chronic abdominal pain. Wepresent a case of umbilical hernia that presented to thegeneral surgeons due to chronic abdominal pain and nodulein the umbilicus, which was clinically diagnosed as umbilicalpapilloma.Case presentationA 48-year old multiparous Caucasian woman presented withpainful nodule in the umbilicus for two and half years. Thenodule was excised and the histopathological diagnosis wasumbilicus endometriosis.ConclusionUmbilical endometriosis is a very rare disease but should beconsidered as a differential diagnosis in women presentingwith umbilical swelling.

  19. Accounting for graduate medical education production of primary care physicians and general surgeons: timing of measurement matters.

    Science.gov (United States)

    Petterson, Stephen; Burke, Matthew; Phillips, Robert; Teevan, Bridget

    2011-05-01

    Legislation proposed in 2009 to expand GME set institutional primary care and general surgery production eligibility thresholds at 25% at entry into training. The authors measured institutions' production of primary care physicians and general surgeons on completion of first residency versus two to four years after graduation to inform debate and explore residency expansion and physician workforce implications. Production of primary care physicians and general surgeons was assessed by retrospective analysis of the 2009 American Medical Association Masterfile, which includes physicians' training institution, residency specialty, and year of completion for up to six training experiences. The authors measured production rates for each institution based on physicians completing their first residency during 2005-2007 in family or internal medicine, pediatrics, or general surgery. They then reassessed rates to account for those who completed additional training. They compared these rates with proposed expansion eligibility thresholds and current workforce needs. Of 116,004 physicians completing their first residency, 54,245 (46.8%) were in primary care and general surgery. Of 683 training institutions, 586 met the 25% threshold for expansion eligibility. At two to four years out, only 29,963 physicians (25.8%) remained in primary care or general surgery, and 135 institutions lost eligibility. A 35% threshold eliminated 314 institutions collectively training 93,774 residents (80.8%). Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. Copyright © by the Association of American medical Colleges.

  20. Virtual reality technology and surgical training--a survey of general surgeons in Ireland.

    Science.gov (United States)

    Early, S A; Roche-Nagle, G

    2006-01-01

    Virtual Reality Technology (VRT) is a validated method of training in industry but only recently has found a place in the postgraduate surgical curriculum. We surveyed 143 Irish consultant surgeons to ascertain their opinions on this topical issue. The survey consisted of 22 questions to which the consultants were asked to respond by choosing from a 5-point Likert scale. Sixty-five per cent responded. A majority of 72% had seen VRT but only 47% had 'hands on' experience. Forty-six per cent believed that they were poorly informed regarding available technologies. As consultants became more informed about VRT significant differences were seen with regard to attitudes regarding the role of VR in skills in surgical training (p<0.05) and in the ability to define teaching objectives (p<0.005). Our survey suggests that the underuse of the current offerings is not due to a perceived lack of interest on the part of the surgical trainers. Suppliers of these programmes have a responsibility to adequately educate and collaborate with all parties involved to improve overall benefit from these simulators.

  1. Selected text of Atomic Energy Act, Executive Orders and other laws of general interest to safeguards and security executives

    International Nuclear Information System (INIS)

    Cadwell, J.J.; Ruger, C.J.

    1995-12-01

    This document is one of a three report set, BNL 52201 contains detailed information for use by executives. BNL 52202 is titled, U.S. Statutes of General Interest to Safeguards and Security Officers, and contains less detail than BNL 52201. It is intended for use by officers. BNL 52203 is titled, U.S.Statutes for Enforcement by Security Inspectors, and only contains statutes to be applied by uniformed security inspectors. These are a newly updated version of a set of documents of similar titles published in September 1988, which were an updated version of an original set of documents published in November 1983

  2. Software design of a general purpose data acquisition and control executive

    International Nuclear Information System (INIS)

    Labiak, W.G.; Minor, E.G.

    1981-01-01

    The software design of an executive which performs general purpose data acquisition, monitoring, and control is presented. The executive runs on a memory-based mini or micro-computer and communicates with a disk-based computer where data analysis and display are done. The executive design stresses reliability and versatility, and has yielded software which can provide control and monitoring for widely different hardware systems. Applications of this software on two major fusion energy experiments at Lawrence Livermore National Laboratory will be described

  3. Reliable assessment of general surgeons' non-technical skills based on video-recordings of patient simulated scenarios

    DEFF Research Database (Denmark)

    Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter

    2013-01-01

    Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training.......Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training....

  4. Pension benefits of executive directors : A comparative study of general retailers between 2006-2010

    OpenAIRE

    Condric, Tomislav; Tomic, Katarina

    2012-01-01

    Several recent corporate governance scandals relate to non-disclosure or high amounts of pension benefits given to executive directors. The lack of disclosure and transparency has gained pensions benefits greater attention as a significant part of the total remuneration received by executive directors. Due to the associated problems there is a greater need for better disclosure and in turn heightened transparency towards shareholders.   This qualitative case study focuses on general retailers...

  5. An integrative architecture for general intelligence and executive function revealed by lesion mapping

    Science.gov (United States)

    Colom, Roberto; Solomon, Jeffrey; Krueger, Frank; Forbes, Chad; Grafman, Jordan

    2012-01-01

    Although cognitive neuroscience has made remarkable progress in understanding the involvement of the prefrontal cortex in executive control, the broader functional networks that support high-level cognition and give rise to general intelligence remain to be well characterized. Here, we investigated the neural substrates of the general factor of intelligence (g) and executive function in 182 patients with focal brain damage using voxel-based lesion–symptom mapping. The Wechsler Adult Intelligence Scale and Delis–Kaplan Executive Function System were used to derive measures of g and executive function, respectively. Impaired performance on these measures was associated with damage to a distributed network of left lateralized brain areas, including regions of frontal and parietal cortex and white matter association tracts, which bind these areas into a coordinated system. The observed findings support an integrative framework for understanding the architecture of general intelligence and executive function, supporting their reliance upon a shared fronto-parietal network for the integration and control of cognitive representations and making specific recommendations for the application of the Wechsler Adult Intelligence Scale and Delis–Kaplan Executive Function System to the study of high-level cognition in health and disease. PMID:22396393

  6. Executive summary and general conclusions of the rock sealing project

    International Nuclear Information System (INIS)

    Pusch, R.

    1992-06-01

    The Stripa Rock Sealing Project logically followed the two first Stripa research phases dealing with canister-embedment and plugging of excavations in repositories. The major activities in the third phase were: * Literature review and interviews for setting the state of art of rock fracture sealing. * Pilot field and lab testing applying a new effective 'dynamic' grouting technique. * Development of a general grout flow theory. * Investigation of physical properties and longevity of major candidate grouts. * Performance of 4 large-scale tests. The literature study showed that longevity aspects limited the number of potentially useful grout materials to smectitic clay and cement. The pilot testing showed that fine-grained grouts can be effectively injected in relatively fine fractures. The theoretical work led to a general grout flow theory valid both for grouting at a constant, static pressure with non-Newtonian material properties, and for 'dynamic' injection with superimposed oscillations, yielding Newtonian material behavior. The investigation of physical properties of candidate grouts with respect to hydraulic conductivity, shear strength, sensitivity to mechanical strain, as well as to chemical stability, showed that effective sealing is offered, and that any rock can have its bulk conductivity reduced to about 10 -10 m/s. The field tests comprised investigation of excavation-induced disturbance and attempts to seal disturbed rock, and in separate tests, grouting of deposition holes and a natural fine-fracture zone. Considerable disturbance of nearfield rock by blasting and stress changes, yielding an increase in axial hydraulic conductivity by 3 and 1 order of magnitude, respectively, was documented but various factors, primarily debris in the fractures, made grouting of blasted rock ineffective. Narrow fractures in deposition holes and in a natural fracture zone were sealed rather effectively. (au)

  7. Are general surgeons able to accurately self-assess their level of technical skills?

    Science.gov (United States)

    Rizan, C; Ansell, J; Tilston, T W; Warren, N; Torkington, J

    2015-11-01

    Self-assessment is a way of improving technical capabilities without the need for trainer feedback. It can identify areas for improvement and promote professional medical development. The aim of this review was to identify whether self-assessment is an accurate form of technical skills appraisal in general surgery. The PubMed, MEDLINE(®), Embase(™) and Cochrane databases were searched for studies assessing the reliability of self-assessment of technical skills in general surgery. For each study, we recorded the skills assessed and the evaluation methods used. Common endpoints between studies were compared to provide recommendations based on the levels of evidence. Twelve studies met the inclusion criteria from 22,292 initial papers. There was no level 1 evidence published. All papers compared the correlation between self-appraisal versus an expert score but differed in the technical skills assessment and the evaluation tools used. The accuracy of self-assessment improved with increasing experience (level 2 recommendation), age (level 3 recommendation) and the use of video playback (level 3 recommendation). Accuracy was reduced by stressful learning environments (level 2 recommendation), lack of familiarity with assessment tools (level 3 recommendation) and in advanced surgical procedures (level 3 recommendation). Evidence exists to support the reliability of self-assessment of technical skills in general surgery. Several variables have been shown to affect the accuracy of self-assessment of technical skills. Future work should focus on evaluating the reliability of self-assessment during live operating procedures.

  8. Dealing with sickness certification – a survey of problems and strategies among general practitioners and orthopaedic surgeons

    Directory of Open Access Journals (Sweden)

    Nilsson Gunnar

    2007-10-01

    Full Text Available Abstract Background In order to get sickness benefit a sick-listed person need a medical certificate issued by a physician; in Sweden after one week of self-certification. Physicians experience sick-listing tasks as problematic and conflicts may arise when patients regard themselves unable to work due to complaints that are hard to objectively verify for the physician. Most GPs and orthopaedic surgeons (OS deal regularly with sick-listing issues in their daily practice. The aim of this study was to explore perceived problems and coping strategies related to tasks of sickness certification among general practitioners (GP and orthopaedic surgeons (OS. Methods A cross-sectional study about sickness certification in two Swedish counties, with 673 participating GPs and 149 OSs, who answered a comprehensive questionnaire. Frequencies together with crude and adjusted (gender and working years Odds ratios were calculated. Results A majority of the GPs and OSs experienced problems in sickness certification every week. To assess the patient's work ability, to handle situations when they and the patient had different opinions about the need for sickness absence, and to issue prolongation certificates when the previous was issued by another physician were reported as problematic by a majority in both groups. Both GPs and OSs prolonged sickness certifications due to waiting times in health care or at Social Insurance Office (SIO. To handle experienced problems they used different strategies; OSs issued sickness certificates without personal appointment more often than the GPs, who on the other hand reported having contact with SIO more often than the OSs. A higher rate of GPs experienced support from management and had a common strategy for handling sickness certification at the clinic than the OSs. Conclusion Most GPs and OSs handled sickness certification weekly and reported a variety of problems in relation to this task, generally GPs to a higher extent

  9. Implementation of an electronic surgical referral service. Collaboration, consensus and cost of the surgeongeneral practitioner Delphi approach

    Directory of Open Access Journals (Sweden)

    Augestad KM

    2014-09-01

    Full Text Available Knut Magne Augestad,1–3 Arthur Revhaug,1,3 Roar Johnsen,4 Stein-Olav Skrøvseth,2 Rolv-Ole Lindsetmo1,3 1Department of Gastrointestinal Surgery, 2Department of Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway; 3Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 4Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Background: Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines. Methods: Prospective observational survey of implementation of electronic medical record (EMR-supported guidelines for surgical treatment. Results: One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs' EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £ to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401–670 and 37 (range 29–49 referred patients, respectively, were needed to provide a cost-effective service. Conclusion: A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to

  10. Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists.

    Science.gov (United States)

    Blikkendaal, Mathijs D; Twijnstra, Andries R H; Stiggelbout, Anne M; Beerlage, Harrie P; Bemelman, Willem A; Jansen, Frank Willem

    2013-12-01

    In laparoscopic surgery, conversion to laparotomy is associated with worse clinical outcomes, especially if the conversion is due to a complication. Although apparently important, no commonly used definition of conversion exists. The aim of this study was to achieve multidisciplinary consensus on a uniform definition of conversion. On the basis of definitions currently used in the literature, a web-based Delphi consensus study was conducted among members of all four Dutch endoscopic societies. The rate of agreement (RoA) was calculated; a RoA of >70% suggested consensus. The survey was completed by 268 respondents in the first Delphi round (response rate, 45.6%); 43% were general surgeons, 49% gynecologists, and 8% urologists. Average ± standard deviation laparoscopic experience was 12.5 ± 7.2 years. On the basis of the results of round 1, a consensus definition was compiled. Conversion to laparotomy is an intraoperative switch from a laparoscopic to an open abdominal approach that meets the criteria of one of the two subtypes: strategic conversion, a standard laparotomy that is made directly after the assessment of the feasibility of completing the procedure laparoscopically and because of anticipated operative difficulty or logistic considerations; and reactive conversion, the need for a laparotomy because of a complication or (extension of an incision) because of (anticipated) operative difficulty after a considerable amount of dissection (i.e., >15 min in time). A laparotomy after a diagnostic laparoscopy (i.e., to assess the curability of the disease) should not be considered a conversion. In the second Delphi round, a RoA of 90% was achieved with this definition. After two Delphi rounds, consensus on a uniform multidisciplinary definition of conversion was achieved within a representative group of general surgeons, gynecologists, and urologists. An unambiguous interpretation will result in a more reliable clinical registration of conversion and scientific

  11. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery.

    Science.gov (United States)

    Szold, Amir; Bergamaschi, Roberto; Broeders, Ivo; Dankelman, Jenny; Forgione, Antonello; Langø, Thomas; Melzer, Andreas; Mintz, Yoav; Morales-Conde, Salvador; Rhodes, Michael; Satava, Richard; Tang, Chung-Ngai; Vilallonga, Ramon

    2015-02-01

    Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when

  12. An Executive Appraisal of Courses which Best Prepare One for General Management.

    Science.gov (United States)

    Hildebrandt, H. W.; And Others

    1982-01-01

    Summarizes 1980-81 data from 1,158 newly promoted executives who rated business administration courses that best prepare a young person for a general management career. Business communication--oral and written--was the course selected as "very important" more often than any of 13 courses. (PD)

  13. Discrete-Event Execution Alternatives on General Purpose Graphical Processing Units

    International Nuclear Information System (INIS)

    Perumalla, Kalyan S.

    2006-01-01

    Graphics cards, traditionally designed as accelerators for computer graphics, have evolved to support more general-purpose computation. General Purpose Graphical Processing Units (GPGPUs) are now being used as highly efficient, cost-effective platforms for executing certain simulation applications. While most of these applications belong to the category of time-stepped simulations, little is known about the applicability of GPGPUs to discrete event simulation (DES). Here, we identify some of the issues and challenges that the GPGPU stream-based interface raises for DES, and present some possible approaches to moving DES to GPGPUs. Initial performance results on simulation of a diffusion process show that DES-style execution on GPGPU runs faster than DES on CPU and also significantly faster than time-stepped simulations on either CPU or GPGPU.

  14. A critique of the US Surgeon General's conclusions regarding e-cigarette use among youth and young adults in the United States of America.

    Science.gov (United States)

    Polosa, Riccardo; Russell, Christopher; Nitzkin, Joel; Farsalinos, Konstantinos E

    2017-09-06

    In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America. Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions. Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is either infrequent or experimental, and negligible among never-smoking youth. The majority of the very small proportion of US youth who use e-cigarettes on a regular basis, consume nicotine-free products. The sharpest declines in US youth smoking rates have occurred as e-cigarettes have become increasingly available. Most of the evidence presented in the Surgeon General's discussion of nicotine harm is not applicable to e-cigarette use, because it relies almost exclusively on exposure to nicotine in the cigarette smoke and not to nicotine present in e-cigarette aerosol emissions. Moreover, the referenced literature describes effects in adults, not youth, and in animal models that have little relevance to real-world e-cigarette use by youth. The Surgeon General's report is an excellent reference document for the adverse outcomes due to nicotine in combination with several other toxicants present in tobacco smoke, but fails to address the risks of nicotine decoupled from tobacco smoke constituents. The report exaggerates the toxicity of propylene glycol (PG) and vegetable glycerin (VG) by focusing on experimental conditions that do not reflect use in the real-world and provides little discussion of emerging evidence that e-cigarettes may significantly reduce harm to smokers who have completely switched. The U.S. Surgeon General's claim that e-cigarette use among U.S. youth and young adults is an emerging public health concern does not appear to be supported by the best available evidence on the health risks

  15. Executive functioning and general cognitive ability in pregnant women and matched controls.

    Science.gov (United States)

    Onyper, Serge V; Searleman, Alan; Thacher, Pamela V; Maine, Emily E; Johnson, Alicia G

    2010-11-01

    The current study compared the performances of pregnant women with education- and age-matched controls on a variety of measures that assessed perceptual speed, short-term and working memory capacity, subjective memory complaints, sleep quality, level of fatigue, executive functioning, episodic and prospective memory, and crystallized and fluid intelligence. A primary purpose was to test the hypothesis of Henry and Rendell (2007) that pregnancy-related declines in cognitive functioning would be especially evident in tasks that place a high demand on executive processes. We also investigated a parallel hypothesis: that the pregnant women would experience a broad-based reduction in cognitive capability. Very limited support was found for the executive functioning hypothesis. Pregnant women scored lower only on the measure of verbal fluency (Controlled Oral Word Association Test, COWAT) but not on the Wisconsin Card Sorting Task or on any working memory measures. Furthermore, group differences in COWAT performance disappeared after controlling for verbal IQ (Shipley vocabulary). In addition, there was no support for the general decline hypothesis. We conclude that pregnancy-associated differences in performance observed in the current study were relatively mild and rarely reached either clinical or practical significance.

  16. CHAracteristics of research studies that iNfluence practice: a GEneral survey of Canadian orthopaedic Surgeons (CHANGES): a pilot survey.

    Science.gov (United States)

    de Sa, Darren; Thornley, Patrick; Evaniew, Nathan; Madden, Kim; Bhandari, Mohit; Ghert, Michelle

    2015-01-01

    Evidence Based Medicine (EBM) is increasingly being applied to inform clinical decision-making in orthopaedic surgery. Despite the promotion of EBM in Orthopaedic Surgery, the adoption of results from high quality clinical research seems highly unpredictable and does not appear to be driven strictly by randomized trial data. The objective of this study was to pilot a survey to determine if we could identify surgeon opinions on the characteristics of research studies that are perceived as being most likely to influence clinical decision-making among orthopaedic surgeons in Canada. A 28-question electronic survey was distributed to active members of the Canadian Orthopaedic Association (COA) over a period of 11 weeks. The questionnaire sought to analyze the influence of both extrinsic and intrinsic characteristics of research studies and their potential to influence practice patterns. Extrinsic factors included the perceived journal quality and investigator profiles, economic impact, peer/patient/industry influence and individual surgeon residency/fellowship training experiences. Intrinsic factors included study design, sample size, and outcomes reported. Descriptive statistics are provided. Of the 109 members of the COA who opened the survey, 95 (87%) completed the survey in its entirety. The overall response rate was 11% (95/841). Surgeons achieved consensus on the influence of three key designs on their practices: 1) randomized controlled trials 94 (99%), 2) meta-analysis 83 (87%), and 3) systematic reviews 81 (85%). Sixty-seven percent of surgeons agreed that studies with sample sizes of 101-500 or more were more likely to influence clinical practice than smaller studies (n = design influencing adoption included 1) reputation of the investigators (99%) and 2) perceived quality of the journal (75%). Although study design and sample size (i.e. minimum of 100 patients) have some influence on clinical decision making, surgeon respondents are equally influenced

  17. General versus executive cognitive ability in pupils with ADHD and with milder attention problems

    Directory of Open Access Journals (Sweden)

    Ek U

    2013-01-01

    Full Text Available Ulla Ek,1 Joakim Westerlund,2 Elisabeth Fernell31Department of Special Education, 2Department of Psychology, Stockholm University, Stockholm, 3Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg and the Research and Development Centre, Skaraborg Hospital Skövde, SwedenBackground: The aim of this study was to analyze two main types of cognitive domains in school children with different types and severities of attention-related problems. The cognitive domains examined were general cognitive ability and executive abilities.Methods: Three different clinical samples of pupils with school problems were analyzed to assess their cognitive Wechsler Intelligence Scale for Children profiles. In particular, the general cognitive ability index and the executive markers (ie, verbal memory index and processing speed index were of interest. Of the total sample (n = 198, two main groups were contrasted; one met the full criteria for attention deficit hyperactivity disorder (ADHD/subthreshold ADHD, and one was comprised of those with milder attention problems, insufficient to meet the criteria for ADHD/subthreshold ADHD.Results: It could be demonstrated that both groups had a significantly higher score on the general cognitive ability index than on measures of working memory and processing speed. This difference was more pronounced for boys.Conclusion: These types of cognitive differences need to be considered in children with different kinds of learning, behavior, and attention problems; this is also true for children presenting with an average general intelligence quotient and with milder attention problems. Current educational expectations are demanding for children with mild difficulties, and such cognitive information will add to the understanding of the child's learning problems, hopefully leading to a better adapted education than that conventionally available.Keywords: working memory, processing speed, children, learning and

  18. Stress in surgeons.

    Science.gov (United States)

    Green, A; Duthie, H L; Young, H L; Peters, T J

    1990-10-01

    A sample of 1000 members of the Association of Surgeons of Great Britain and Ireland was circulated with a postal questionnaire relating to their occupational stressors, their type A coronary-prone behaviour and their mental health. Six hundred and seventy-two (67 per cent) useable forms were returned anonymously. The major individual stressors were: (1) the interference of the job with personal life, (2) general administration, and (3) the number of patients in clinics. Type A behaviour was similar to that of other professional groups. Surgeons showed mean scores significantly higher than the general population on two subscales of the mental health index (free-floating anxiety and hysterical anxiety). The findings for the few female surgeons (2 per cent) were similar to those in men but they did not exhibit raised free-floating anxiety levels.

  19. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Adults With Vestibular Schwannomas: Executive Summary.

    Science.gov (United States)

    Olson, Jeffrey J; Kalkanis, Steven N; Ryken, Timothy C

    2018-02-01

    Vestibular schwannomas (VS) are uncommon lesions that are a substantial challenge to the neurosurgeons, otologists, and radiation oncologists who undertake their clinical management. A starting point to improving the current knowledge is to define the benchmarks of the current research studying VS management using evidence-based techniques in order to allow meaningful points of departure for future scientific and clinical research. To establish the best evidence-based management of VS, including initial otologic evaluation, imaging diagnosis, use of surgical techniques, assessment of tumor pathology, and the administration of radiation therapy. Multidisciplinary writing groups were identified to design questions, literature searches, and collection and classification of relevant findings. This information was then translated to recommendations based on the strength of the available literature. This guideline series yielded some level 2 recommendations and a greater number of level 3 recommendations directed at the management of VS. Importantly, in some cases, a number of well-designed questions and subsequent searches did not yield information that allowed creation of a meaningful and justifiable recommendation. This series of guidelines was constructed to assess the most current and clinically relevant evidence for the management of VS. They set a benchmark regarding the current evidence base for this type of tumor while also highlighting important key areas for future basic and clinical research, particularly on those topics for which no recommendations could be formulated.  The full guidelines can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma. Copyright © 2017 by the Congress of Neurological Surgeons

  20. 21 CFR 878.4460 - Surgeon's glove.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgeon's glove. 878.4460 Section 878.4460 Food... DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4460 Surgeon's glove. (a) Identification. A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by...

  1. Executive Function and Mathematics Achievement: Are Effects Construct- and Time-General or Specific?

    Science.gov (United States)

    Duncan, Robert; Nguyen, Tutrang; Miao, Alicia; McClelland, Megan; Bailey, Drew

    2016-01-01

    Executive function (EF) is considered a set of interrelated cognitive processes, including inhibitory control, working memory, and attentional shifting, that are connected to the development of the prefrontal cortex and contribute to children's problem solving skills and self regulatory behavior (Best & Miller, 2010; Garon, Bryson, &…

  2. Disparities in the Utilization of Laparoscopic Surgery for Colon Cancer in Rural Nebraska: A Call for Placement and Training of Rural General Surgeons.

    Science.gov (United States)

    Gruber, Kelli; Soliman, Amr S; Schmid, Kendra; Rettig, Bryan; Ryan, June; Watanabe-Galloway, Shinobu

    2015-01-01

    Advances in medical technology are changing surgical standards for colon cancer treatment. The laparoscopic colectomy is equivalent to the standard open colectomy while providing additional benefits. It is currently unknown what factors influence utilization of laparoscopic surgery in rural areas and if treatment disparities exist. The objectives of this study were to examine demographic and clinical characteristics associated with receiving laparoscopic colectomy and to examine the differences between rural and urban patients who received either procedure. This study utilized a linked data set of Nebraska Cancer Registry and hospital discharge data on colon cancer patients diagnosed and treated in the entire state of Nebraska from 2008 to 2011 (N = 1,062). Multiple logistic regression analysis was performed to identify predictors of receiving the laparoscopic treatment. Rural colon cancer patients were 40% less likely to receive laparoscopic colectomy compared to urban patients. Independent predictors of receiving laparoscopic colectomy were younger age (colon cancer and important disparities exist for rural cancer patients in accessing the specialized treatment. As cancer treatment becomes more specialized, the importance of training and placement of general surgeons in rural communities must be a priority for health care planning and professional training institutions. © 2015 National Rural Health Association.

  3. Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register.

    Science.gov (United States)

    Hickey, Graeme L; Grant, Stuart W; Freemantle, Nick; Cunningham, David; Munsch, Christopher M; Livesey, Steven A; Roxburgh, James; Buchan, Iain; Bridgewater, Ben

    2014-09-01

    To explore the relationship between in-hospital mortality following adult cardiac surgery and the time since primary clinical qualification for the responsible consultant cardiac surgeon (a proxy for experience). Retrospective analysis of prospectively collected national registry data over a 10-year period using mixed-effects multiple logistic regression modelling. Surgeon experience was defined as the time between the date of surgery and award of primary clinical qualification. UK National Health Service hospitals performing cardiac surgery between January 2003 and December 2012. All patients undergoing coronary artery bypass grafts and/or valve surgery under the care of a consultant cardiac surgeon. All-cause in-hospital mortality. A total of 292,973 operations performed by 273 consultant surgeons (with lengths of service from 11.2 to 42.0 years) were included. Crude mortality increased approximately linearly until 33 years service, before decreasing. After adjusting for case-mix and year of surgery, there remained a statistically significant (p=0.002) association between length of service and in-hospital mortality (odds ratio 1.013; 95% CI 1.005-1.021 for each year of 'experience'). Consultant cardiac surgeons take on increasingly complex surgery as they gain experience. With this progression, the incidence of adverse outcomes is expected to increase, as is demonstrated in this study. After adjusting for case-mix using the EuroSCORE, we observed an increased risk of mortality in patients operated on by longer serving surgeons. This finding may reflect under-adjustment for risk, unmeasured confounding or a real association. Further research into outcomes over the time course of surgeon's careers is required. © The Royal Society of Medicine.

  4. An examination of the advances in science and technology of prevention of tooth decay in young children since the Surgeon General's Report on Oral Health.

    Science.gov (United States)

    Milgrom, Peter; Zero, Domenick T; Tanzer, Jason M

    2009-01-01

    This paper addresses a number of areas related to how effectively science and technology have met Healthy People 2010 goals for tooth decay prevention. In every area mentioned, it appears that science and technology are falling short of these goals. Earlier assessments identified water fluoridation as one of the greatest public health accomplishments of the last century. Yet, failure to complete needed clinical and translational research has shortchanged the caries prevention agenda at a critical juncture. Science has firmly established the transmissible nature of tooth decay. However, there is evidence that tooth decay in young children is increasing, although progress has been made in other age groups. Studies of risk assessment have not been translated into improved practice. Antiseptics, chlorhexidine varnish, and polyvinylpyrrolidone iodine (PVI-I) may have value, but definitive trials are needed. Fluorides remain the most effective agents, but are not widely disseminated to the most needy. Fluoride varnish provides a relatively effective topical preventive for very young children, yet definitive trials have not been conducted. Silver diamine fluoride also has potential but requires study in the United States. Data support effectiveness and safety of xylitol, but adoption is not widespread. Dental sealants remain a mainstay of public policy, yet after decades of research, widespread use has not occurred. We conclude that research has established the public health burden of tooth decay, but insufficient research addresses the problems identified in the report Oral Health in America: A Report of the Surgeon General. Transfer of technology from studies to implementation is needed to prevent tooth decay among children. This should involve translational research and implementation of scientific and technological advances into practice.

  5. 8 May 2014 - W. Watson-Wright, Assistant Director General and Executive Secretary UNESCO Intergovernmental Oceanographic Commission Assistant Director-General for the Natural Sciences Sector ad interim visiting the CMS cavern with CMS Collaboration Deputy Spkokesperson K. Borras. Adviser to the Director-General, in charge of Relations with International Organisations M. Bona present throughout.

    CERN Multimedia

    Brice, Maximilien

    2014-01-01

    Ms Wendy Watson-Wright Assistant Director General and Executive Secretary UNESCO Intergovernmental Oceanographic Commission Assistant Director-General for the Natural Sciences Sector ad interim UNESCO

  6. [The surgeon and deontology].

    Science.gov (United States)

    Sucila, Antanas

    2002-01-01

    The aim of study is to recall surgeons deontological principles and errors. The article demonstrates some specific deontological errors, performed by surgeon on patients and his colleagues; points out painful sequela of these errors as well. CONCLUSION. The surgeon should take in account deontological principles rigorously in routine daily practice.

  7. 76 FR 37404 - Identification of Nine Entities Pursuant to Executive Order 13566 and Amendment of General...

    Science.gov (United States)

    2011-06-27

    ... Africa Commercial Bank from the authorization set forth therein. DATES: The identification by the... Africa Commercial Bank from General License No. 1A, are effective June 21, 2011. FOR FURTHER INFORMATION... Bank, North Africa International Bank, and North Africa Commercial Bank from its scope. Also on June 21...

  8. 31 March 2016 - Qatar Foundation Research and Development Executive Vice President H. Al-Ibrahim signing a Cooperation Agreement with CERN Director-General F. Gianotti.

    CERN Multimedia

    Brice, Maximilien

    2016-01-01

    Dr Hamad Al-Ibrahim Executive Vice President, Qatar Foundation Research and Development. Were present: CERN International Relations Unit, Adviser for Qatar P. Fassnacht; CERN Director for Research and Computing E. Elsen; Texas A&M Professor of Physics A. Safonov ; CERN Director for International Relations C. Warakaulle; Professor of Physics, Qatar University I.Al-Qaradawi; Executive Vice President H. Al-Ibrahim; CERN Director-General F. Gianotti; Ambassador Faisal Bin Abdulla Al-Henzab to the UNOG; Director of Research Computing, Texas A&M, Qatar O. Bouhali; Vice Dean, Texas A&M, Qatar E. Massad; Executive Director, Research Coordination & Special Initiatives, Qatar Foundation R&D D. Khoury.

  9. Impaired theory of mind in Chinese children and adolescents with idiopathic generalized epilepsy: Association with behavioral manifestations of executive dysfunction.

    Science.gov (United States)

    Zhang, Ting; Chen, Lingyan; Wang, Yu; Zhang, Mengmeng; Wang, Lanlan; Xu, Xiangjun; Xiao, Gairong; Chen, Jing; Shen, Yeru; Zhou, Nong

    2018-02-01

    Epilepsy is a common neurological disorder with a core feature of cognitive impairments. Previous studies showed that patients with focal epilepsy have deficits in both theory of mind (ToM) and executive function (EF). However, there are few studies of ToM in patients with idiopathic generalized epilepsy (IGE), especially in populations with pediatric epilepsy. The aim of this study was to examine the characteristics of ToM and EF, including some of their subcomponents, and explore the relationship between them in Chinese children with IGE. We recruited 54 children and adolescents with IGE as the experimental subjects and 37 typically developing children and adolescents as control subjects. Both groups completed ToM tests, namely, second-order false belief tasks (FBTs) and faux pas tasks (FPTs). Their caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) at the same time. Children and adolescents with IGE displayed worse performance on some of the FBTs and FPTs than healthy controls (pchildren with newly diagnosed epilepsy displayed significant deficits in FBT, FPT, and distinct subscales of EF. Our results revealed significant impairments in ToM and EF in children and adolescents with IGE compared with healthy controls. We found significant correlations between ToM and two subcomponents of EF (inhibition and working memory) in children with IGE. Additionally, the duration of seizures affected ToM in patients but was a less powerful predictor than the two subcomponents of EF. Even for children with new-onset seizures and without medication, the deficits in ToM and some distinct subscales of EF were apparent. This result has clinical implications for both nonpharmaceutical therapies and cognitive rehabilitation. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. The general practitioner and the surgeon: stereotypes and medical specialties O clínico e o cirurgião: esteriótipos e especialidades médicas

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    2004-02-01

    Full Text Available OBJECTIVE: To investigate and characterize the professional stereotypes associated with general medicine and surgery among Brazilian medical residents. METHODS: A randomized sample of residents of the General Medicine and Surgery Residence Programs were interviewed and their perceptions and views of general and surgical doctors were compared. RESULTS: The general practitioner was characterized by the residents in general to be principally a sensitive and concerned doctor with a close relationship with the patient; (45%; calm, tranquil, and balanced (27%; with intellectual skills (25%; meticulous and attentive to details (23%; slow to resolve problems and make decisions (22%; and working more with probabilities and hypotheses (20%. The surgeon was considered to be practical and objective (40%; quickly resolving problems (35%; technical with manual skills (23%; omnipotent, arrogant, and domineering (23%; anxious, stressed, nervous, and temperamental (23%; and more decided, secure, and courageous (20%. Only the residents of general medicine attributed the surgeon with less knowledge of medicine and only the surgeons attributed gender characteristics to their own specialty. CONCLUSION: There was considerable similarity in the description of a typical general practitioner and surgeon among the residents in general, regardless of the specialty they had chosen. It was interesting to observe that these stereotypes persist despite the transformations in the history of medicine, i.e. the first physicians (especially regarding the valorization of knowledge and the first surgeons, so-called "barber surgeons" in Brazil (associated with less knowledge and the performance of high-risk procedures.OBJETIVOS: Investigar e caracterizar entre residentes brasileiros os estereótipos profissionais associados ao médico clínico e ao cirurgião. METODOLOGIA: uma amostra randomizada de residentes dos programas de Clínica Médica e Cirurgia foi entrevistada e suas

  11. Neuropsychological correlates of remission in chronic schizophrenia subjects: The role of general and task-specific executive processes

    Directory of Open Access Journals (Sweden)

    Thais Rabanea-Souza

    2016-03-01

    Conclusion: The present findings suggest that executive function deficits are present in chronic schizophrenic patients. In addition, specific executive processes might be associated to symptom remission. Future studies examining prospectively first-episode, drug naive patients diagnosed with schizophrenia may be especially elucidative.

  12. Executive functions cannot be distinguished from general intelligence: Two variations on a single theme within a symphony of latent variance

    Directory of Open Access Journals (Sweden)

    Donald R Royall

    2014-10-01

    Full Text Available The empirical foundation of executive control function (ECF remains controversial. We have employed structural equation models (SEM to explicitly distinguish domain-specific variance in ECF performance from memory (MEM and shared cognitive performance variance, i.e., Spearman’s g. ECF does not survive adjustment for both MEM and g in a well fitting model of data obtained from non-demented older persons (N = 193. Instead, the variance in putative ECF measures is attributable only to g, and related to functional status only through a fraction of that construct (i.e., dECF. dECF is a homolog of the latent variable δ, which we have previously associated specifically with the Default Mode Network (DMN. These findings undermine the validity of ECF and its putative association with the frontal lobe. ECF may have no existence independent of general intelligence, and no functionally salient association with the frontal lobe outside of that structure’s contribution to the DMN.

  13. The Surgeon and Advocacy

    African Journals Online (AJOL)

    and how the hospital administration handles and resolves ... regard to having systems that improve patient care. Surgeons have been ... implementation of the Surgical safety checklist (9). ... aviation industry, has helped to streamline patient.

  14. Civil Surgeon Info

    Data.gov (United States)

    Department of Homeland Security — USCIS designates certain doctors (also known as civil surgeons) to perform the medical exam required for most Green Card applicants. This data set represents the...

  15. Society of Thoracic Surgeons

    Science.gov (United States)

    ... Apply for Membership Membership Directory Pay Your Dues Industry Mailing List License & eBlast Communications Programs Advertise on ... Hotel Discount Copyright © 2017 The Society of Thoracic Surgeons. ...

  16. Society of Laparoendoscopic Surgeons

    Science.gov (United States)

    ... the Minimally Invasive Surgery and Therapy World. Nezhat’s History of Endoscopy In 2005 pioneering surgeon Dr. Camran Nezhat was awarded a fellowship by The American College of Obstetrics and Gynecology to research and write this important ...

  17. Surgeons' vision rewarded.

    Science.gov (United States)

    Baillie, Jonathan

    2010-08-01

    Surgeons and clinical staff, theatre circulation and scrub personnel, and anaesthetists, as well as the estates and facilities team at Kent's Maidstone Hospital, have worked with specialist supplier of integrated audio, video, and instrumentation systems for the operating room, Olympus Medical, to develop what is claimed is among the UK's most advanced operating theatres yet built for laparoscopic and endoscopic surgery. HEJ editor Jonathan Baillie discussed the project with Amir Nisar, the surgeon who championed efforts to get the facility built, and Olympus Medical national sales manager, systems integration, James Watts.

  18. Standardized Training to Improve Readiness of the Medical Reserve Corps: A Department of Health and Human Services Program under the Direction of the Office of the Surgeon General

    National Research Council Canada - National Science Library

    Cox, Cynthia A

    2006-01-01

    .... According to recent studies and surveys, disaster operations are an unfamiliar role for most MRC volunteers and the public health workforce in general, and few volunteers receive this important preparedness training...

  19. Surgeon Participation in Early Accountable Care Organizations.

    Science.gov (United States)

    Resnick, Matthew J; Graves, Amy J; Buntin, Melinda B; Richards, Michael R; Penson, David F

    2018-03-01

    We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation. Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs. Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015. We fit multivariable logistic regression models to characterize key drivers of ACO participation, and more specifically, the interaction between ACO affiliation and organizational structure. Of 125,425 US surgeons, 27,956 (22.3%) participated in at least 1 ACO program in 2015. We observed heterogeneity in participation by subspecialty, with trauma and transplant reporting the highest rate of ACO enrollment (36% for both) and plastic surgeons reporting the lowest (12.9%) followed by ophthalmology (16.0%) and hand (18.6%). Surgeons in group practices and integrated systems were more likely to participate relative to those practicing independently (aOR 1.57, 95% CI 1.50, 1.64; aOR 4.87, 95% CI 4.68, 5.07, respectively). We observed a statistically significant interaction (P organization. Model-derived predicted probabilities revealed that, within each specialty, surgeons in integrated health systems had the highest predicted probabilities of ACO and those practicing independently generally had the lowest. We observed considerable variation in ACO enrollment among US surgeons, mediated at least in part by differences in practice organization. These data underscore the need for development of frameworks to characterize the strategic advantages and disadvantages associated with APM participation.

  20. Business knowledge in surgeons.

    Science.gov (United States)

    Satiani, Bhagwan

    2004-07-01

    Surgeons and residents in training receive little, if any, formal education in the economic side of clinical practice during medical school or residency. As medical professionals face shrinking reimbursement, loss of control over health care decisions, and limited resources, surgical specialties must reevaluate the need to teach their members business survival skills. Before designing business related-teaching modules, educators must know the exact gaps in knowledge that exist among surgeons. This article reports a survey of 133 surgeons in the Midwest who were asked to rate their knowledge base in 11 business topics relevant to the practice of medicine. The survey showed that the average surgeon perceives himself or herself to be poorly equipped to understand basic financial accounting principles, financial markets, economics of health care, tools for evaluating purchases, marketing, budgets, antitrust and fraud and abuse regulations, and risk and return on investments. Armed with this data, teaching faculty, health care systems, and medical specialty societies should design business education seminars to better position surgical specialists and trainees to communicate with insurers, hospital administrators, health care organizations, and their own personal financial advisors.

  1. Surgeon-performed ultrasonography

    DEFF Research Database (Denmark)

    Todsen, Tobias

    2017-01-01

    Surgeons are increasingly using ultrasonography (US) in their clinical management of patients. However, US is a very user-dependent imaging modality and proper skills of the US operator are needed to ensure quality in patient care. This thesis explores the validity evidence for assessment...

  2. The puzzle box as a simple and efficient behavioral test for exploring impairments of general cognition and executive functions in mouse models of schizophrenia.

    Science.gov (United States)

    Ben Abdallah, Nada M-B; Fuss, Johannes; Trusel, Massimo; Galsworthy, Michael J; Bobsin, Kristin; Colacicco, Giovanni; Deacon, Robert M J; Riva, Marco A; Kellendonk, Christoph; Sprengel, Rolf; Lipp, Hans-Peter; Gass, Peter

    2011-01-01

    Deficits in executive functions are key features of schizophrenia. Rodent behavioral paradigms used so far to find animal correlates of such deficits require extensive effort and time. The puzzle box is a problem-solving test in which mice are required to complete escape tasks of increasing difficulty within a limited amount of time. Previous data have indicated that it is a quick but highly reliable test of higher-order cognitive functioning. We evaluated the use of the puzzle box to explore executive functioning in five different mouse models of schizophrenia: mice with prefrontal cortex and hippocampus lesions, mice treated sub-chronically with the NMDA-receptor antagonist MK-801, mice constitutively lacking the GluA1 subunit of AMPA-receptors, and mice over-expressing dopamine D2 receptors in the striatum. All mice displayed altered executive functions in the puzzle box, although the nature and extent of the deficits varied between the different models. Deficits were strongest in hippocampus-lesioned and GluA1 knockout mice, while more subtle deficits but specific to problem solving were found in the medial prefrontal-lesioned mice, MK-801-treated mice, and in mice with striatal overexpression of D2 receptors. Data from this study demonstrate the utility of the puzzle box as an effective screening tool for executive functions in general and for schizophrenia mouse models in particular. Published by Elsevier Inc.

  3. Executive summary

    International Nuclear Information System (INIS)

    1981-02-01

    This paper is an 'executive summary' of work undertaken to review proposals for transport, handling and emplacement of high level radioactive wastes in an underground repository, appropriate to the U.K. context, with particular reference to: waste block size and configuration; self-shielded or partially-shielded block; stages of disposal; transportation within the repository; emplacement in vertical holes or horizontal tunnels; repository access by adit, incline or shaft; and costs. The paper contains a section on general conclusions and recommendations. (U.K.)

  4. Tabled Execution in Scheme

    Energy Technology Data Exchange (ETDEWEB)

    Willcock, J J; Lumsdaine, A; Quinlan, D J

    2008-08-19

    Tabled execution is a generalization of memorization developed by the logic programming community. It not only saves results from tabled predicates, but also stores the set of currently active calls to them; tabled execution can thus provide meaningful semantics for programs that seemingly contain infinite recursions with the same arguments. In logic programming, tabled execution is used for many purposes, both for improving the efficiency of programs, and making tasks simpler and more direct to express than with normal logic programs. However, tabled execution is only infrequently applied in mainstream functional languages such as Scheme. We demonstrate an elegant implementation of tabled execution in Scheme, using a mix of continuation-passing style and mutable data. We also show the use of tabled execution in Scheme for a problem in formal language and automata theory, demonstrating that tabled execution can be a valuable tool for Scheme users.

  5. Canadian cardiac surgeons' perspectives on biomedical innovation.

    Science.gov (United States)

    Snyman, Gretchen; Tucker, Joseph E L; Cimini, Massimo; Narine, Kishan; Fedak, Paul W M

    2012-01-01

    Barriers to successful innovation can be identified and potentially addressed by exploring the perspectives of key stakeholders in the innovation process. Cardiac surgeons in Canada were surveyed for personal perspectives on biomedical innovation. Quantitative data was obtained by questionnaire and qualitative data via interviews with selected survey participants. Surgeons were asked to self-identify into 1 of 3 categories: "innovator," "early adopter," or "late adopter," and data were compared between groups. Most surgeons viewed innovation favourably and this effect was consistent irrespective of perceived level of innovativeness. Key barriers to the innovation pathway were identified: (1) support from colleagues and institutions; (2) Canada's health system; (3) sufficient investment capital; and (4) the culture of innovation within the local environment. Knowledge of the innovation process was perceived differently based on self-reported innovativeness. The majority of surgeons did not perceive themselves as having the necessary knowledge and skills to effectively translate innovative ideas to clinical practice. In general, responses indicate support for implementation of leadership and training programs focusing on the innovation process in an effort to prepare surgeons and enhance their ability to successfully innovate and translate new therapies. The perspectives of cardiac surgeons provide an intriguing portal into the challenges and opportunities for healthcare innovation in Canada. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  6. Assessment, surgeon, and society.

    Science.gov (United States)

    Norcini, John; Talati, Jamsheer

    2009-08-01

    An increasing public demand to monitor and assure the quality of care provided by physicians and surgeons has been accompanied by a deepening appreciation within the profession of the demands of self-regulation and the need for accountability. To respond to these developments, the public and the profession have turned increasingly to assessment, both to establish initial competence and to ensure that it is maintained throughout a career. Fortunately, this comes at a time when there have been significant advances in the breadth and quality of the assessment tools available. This article provides an overview of the drivers of change in assessment which includes the educational outcomes movement, the development of technology, and advances in assessment. It then outlines the factors that are important in selecting assessment devices as well as a system for classifying the methods that are available. Finally, the drivers of change have spawned a number of trends in the assessment of competence as a surgeon. Three of them are of particular note, simulation, workplace-based assessment, and the assessment of new competences, and each is reviewed with a focus on its potential.

  7. Execution and executability

    Science.gov (United States)

    Bradford, Robert W.; Harrison, Denise

    2015-09-01

    "We have a new strategy to grow our organization." Developing the plan is just the start. Implementing it in the organization is the real challenge. Many organizations don't fail due to lack of strategy; they struggle because it isn't effectively implemented. After working with hundreds of companies on strategy development, Denise and Robert have distilled the critical areas where organizations need to focus in order to enhance profitability through superior execution. If these questions are important to your organization, you'll find useful answers in the following articles: Do you find yourself overwhelmed by too many competing priorities? How do you limit how many strategic initiatives/projects your organization is working on at one time? How do you balance your resource requirements (time and money) with the availability of these resources? How do you balance your strategic initiative requirements with the day-to-day requirements of your organization?

  8. Decreased heart rate variability in surgeons during night shifts

    DEFF Research Database (Denmark)

    Amirian, Ilda; Toftegård Andersen, Lærke; Rosenberg, Jacob

    2014-01-01

    BACKGROUND: Heart rate variability (HRV) has been used as a measure of stress and mental strain in surgeons. Low HRV has been associated with death and increased risk of cardiac events in the general population. The aim of this study was to clarify the effect of a 17-hour night shift on surgeons'...

  9. English law for the surgeon II: clinical negligence.

    Science.gov (United States)

    Jerjes, Waseem; Mahil, Jaspal; Upile, Tahwinder

    2011-12-21

    Traditionally, in the United Kingdom and Europe, the surgeon was generally not troubled by litigation from patients presenting as elective as well as emergency cases, but this aspect of custom has changed. Litigation by patients now significantly affects surgical practice and vicarious liability often affects hospitals. We discuss some fundamental legal definitions, a must to know for a surgeon, and highlight some interesting cases.

  10. Orthognathic surgery: general considerations.

    Science.gov (United States)

    Khechoyan, David Y

    2013-08-01

    a patient's appearance and occlusal function can be improved significantly, impacting the patient's sense of self and well-being. Successful outcomes in modern orthognathic surgery rely on close collaboration between the surgeon and the orthodontist across all stages of treatment, from preoperative planning to finalization of occlusion. Virtual computer planning promotes a more accurate analysis of dentofacial deformity and preoperative planning. It is also an invaluable aid in providing comprehensive patient education. In this article, the author describes the general surgical principles that underlie orthognathic surgery, highlighting the sequence of treatment, preoperative analysis of dentofacial deformity, surgical execution of the treatment plan, and possible complications.

  11. Choosing a Surgeon: An Exploratory Study of Factors Influencing Selection of a Gender Affirmation Surgeon.

    Science.gov (United States)

    Ettner, Randi; Ettner, Frederic; White, Tonya

    2016-01-01

    Purpose: Selecting a healthcare provider is often a complicated process. Many factors appear to govern the decision as to how to select the provider in the patient-provider relationship. While the possibility of changing primary care physicians or specialists exists, decisions regarding surgeons are immutable once surgery has been performed. This study is an attempt to assess the importance attached to various factors involved in selecting a surgeon to perform gender affirmation surgery (GAS). It was hypothesized that owing to the intimate nature of the surgery, the expense typically involved, the emotional meaning attached to the surgery, and other variables, decisions regarding choice of surgeon for this procedure would involve factors other than those that inform more typical healthcare provider selection or surgeon selection for other plastic/reconstructive procedures. Methods: Questionnaires were distributed to individuals who had undergone GAS and individuals who had undergone elective plastic surgery to assess decision-making. Results: The results generally confirm previous findings regarding how patients select providers. Conclusion: Choosing a surgeon to perform gender-affirming surgery is a challenging process, but patients are quite rational in their decision-making. Unlike prior studies, we did not find a preference for gender-concordant surgeons, even though the surgery involves the genital area. Providing strategies and resources for surgical selection can improve patient satisfaction.

  12. [What Do Young Surgeons Want? Modern Requirements for Senior Surgeons].

    Science.gov (United States)

    Roeth, Anjali A; Mille, Markus

    2018-02-01

    Due to the shortage of surgical specialists, the question arises as to what surgical residents want and how the fascination of general and visceral surgery may be highlighted. The surgical working group "Young Surgeons" (CAJC) of the German Society for General and Visceral Surgery (DGAV) has organised and subdivided the aspects of an attractive surgical workplace and provides solutions. On the one hand, there is the structured and transparent residency which includes a defined curriculum, assistance of sub-steps during surgery, residency dialogues held on a regular basis, logbooks, the possibility of training and simulation in the clinic as well as permission to participate in further education and training. This has to go hand in hand with a "livable surgery" that is characterised by the compatibility of family and work, better planning of the routine in the clinic, a positive feedback culture, work-life balance, new work (time) models and more time for teaching and research. For many of these aspects, the head of surgery has to be the central role model to initiate structural changes in the clinic, especially as many of these key points may be easily implemented. In this way, the attraction of surgery can be rapidly enhanced and a "livable surgery" may be lived. Georg Thieme Verlag KG Stuttgart · New York.

  13. Surgeon-performed ultrasonography.

    Science.gov (United States)

    Todsen, Tobias

    2017-11-01

    Surgeons are increasingly using ultrasonography (US) in their clinical management of patients. However, US is a very user-dependent imaging modality and proper skills of the US operator are needed to ensure quality in patient care. This thesis explores the validity evidence for assessment of competence in abdominal and head & neck ultrasonography using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. With the use of Messick's unitary framework of validity, five sources of validity evidence were explored: test content, response processes, inter-nal structure, relations to other variables, and consequences. Research paper I examined validity evidence for the use of the OSAUS scale to assess physicians' abdominal point-of-care US competence in an experimental setting using patient cases with and without pathological conditions. The RESULTS provided validity evidence of the internal structure of the OSAUS scale and a deci-sion study predicted that four cases and two raters or five cases and one rater could ensure sufficient reliability in future test setups. The relation to other variables was supported by a signifi-cant difference in scores between US experience levels, and by a strong correlation between the OSAUS score and diagnostic accuracy. Research paper II explored the transfer of learning from formal point-of-care US training to performance on patients in a randomized controlled study. The RESULTS supported validity evi-dence regarding OSAUS scores' relation to other variables by demonstrating a significant discrimination in the progress of training-a more refined validity evidence than the relation to difference experience levels. The RESULTS showed that physicians could transfer the skills learned on an ultrasonography course to improved US performance and diagnostic accuracy on patients. However, the RESULTS also indicated that following an initial course, additional training is needed for physicians to achieve competence in US

  14. Solving the surgeon ergonomic crisis with surgical exosuit.

    Science.gov (United States)

    Liu, Shanglei; Hemming, Daniel; Luo, Ran B; Reynolds, Jessica; Delong, Jonathan C; Sandler, Bryan J; Jacobsen, Garth R; Horgan, Santiago

    2018-01-01

    The widespread adoption of laparoscopic surgery has put new physical demands on the surgeon leading to increased musculoskeletal disorders and injuries. Shoulder, back, and neck pains are among the most common complaints experienced by laparoscopic surgeons. Here, we evaluate the feasibility and efficacy of a non-intrusive progressive arm support exosuit worn by surgeons under the sterile gown to reduce pain and fatigue during surgery. This is a prospective randomized crossover study approved by the Internal Review Board (IRB). The study involves three phases of testing. In each phase, general surgery residents or attendings were randomized to wearing the surgical exosuit at the beginning or at the crossover point. The first phase tests for surgeon manual dexterity wearing the device using the Minnesota Dexterity test, the Purdue Pegboard test, and the Fundamentals of Laparoscopic Surgery (FLS) modules. The second phase tests the effect of the device on shoulder pain and fatigue while operating the laparoscopic camera. The third phase rates surgeon experience in the operating room between case-matched operating days. Twenty subjects were recruited for this study. Surgeons had the similar dexterity scores and FLS times whether or not they wore the exosuit (p value ranges 0.15-0.84). All exosuit surgeons completed 15 min of holding laparoscopic camera compared to three non-exosuit surgeons (p Exosuit surgeons experienced significantly less fatigue at all time periods and arm pain (3.11 vs 5.88, p = 0.019) at 10 min. Surgeons wearing the exosuit during an operation experienced significant decrease in shoulder pain and 85% of surgeons reported some form of pain reduction at the end of the operative day. The progressive arm support exosuit can be a minimally intrusive device that laparoscopic surgeons wear to reduce pain and fatigue of surgery without significantly interfering with operative skills or manual dexterity.

  15. Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout.

    Science.gov (United States)

    van Wulfften Palthe, Olivier D R; Neuhaus, Valentin; Janssen, Stein J; Guitton, Thierry G; Ring, David

    2016-08-01

    Burnout is common in professions such as medicine in which employees have frequent and often stressful interpersonal interactions where empathy and emotional control are important. Burnout can lead to decreased effectiveness at work, negative health outcomes, and less job satisfaction. A relationship between burnout and job satisfaction is established for several types of physicians but is less studied among surgeons who treat musculoskeletal conditions. We asked: (1) For surgeons treating musculoskeletal conditions, what risk factors are associated with worse job dissatisfaction? (2) What risk factors are associated with burnout symptoms? Two hundred ten (52% of all active members of the Science of Variation Group [SOVG]) surgeons who treat musculoskeletal conditions (94% orthopaedic surgeons and 6% trauma surgeons; in Europe, general trauma surgeons do most of the fracture surgery) completed the Global Job Satisfaction instrument, Shirom-Malamed Burnout Measure, and provided practice and surgeon characteristics. Most surgeons were male (193 surgeons, 92%) and most were academically employed (186 surgeons, 89%). Factors independently associated with job satisfaction and burnout were identified with multivariable analysis. Greater symptoms of burnout (β, -7.13; standard error [SE], 0.75; 95% CI, -8.60 to -5.66; p job satisfaction. Having children (β, -0.45; SE, 0.0.21; 95% CI, -0.85 to -0.043; p = 0.030; adjusted R(2), 0.046) was the only factor independently associated with fewer symptoms of burnout. Among an active research group of largely academic surgeons treating musculoskeletal conditions, most are satisfied with their job. Efforts to limit burnout and job satisfaction by optimizing engagement in and deriving meaning from the work are effective in other settings and merit attention among surgeons. Level II, prognostic study.

  16. The surgeon and casemix.

    Science.gov (United States)

    Hart, J A; Wallace, D

    1998-10-19

    Casemix funding has markedly increased surgeons' awareness of the economies of the activities they undertake. Surgery has become a major focus at all large public hospitals, because of its high earning potential, and this pressure to maximise funding could influence surgical practice. Casemix funding's emphasis on length of hospital stay has encouraged forward planning for earlier discharge after surgical procedures. Patients are now assessed in pre-admission clinics, educated about their condition and their hospital stay, and a plan formulated for their discharge and rehabilitation. Funding for major surgical procedures of long duration in patients with complex conditions should reflect the higher level of resource utilisation. Tertiary referral centres, because of their commitment to training and research and their more severely ill patient population, are less cost-effective and require funding to ensure their viability. The improved information that casemix generates should be used to evaluate outcomes and improve patient care; efficiency must not take precedence over quality of care and compassion.

  17. Impact of Different Surgeons on Dental Implant Failure.

    Science.gov (United States)

    Chrcanovic, Bruno Ramos; Kisch, Jenö; Albrektsson, Tomas; Wennerberg, Ann

    To assess the influence of several factors on the prevalence of dental implant failure, with special consideration of the placement of implants by different dental surgeons. This retrospective study is based on 2,670 patients who received 10,096 implants at one specialist clinic. Only the data of patients and implants treated by surgeons who had inserted a minimum of 200 implants at the clinic were included. Kaplan-Meier curves were stratified with respect to the individual surgeon. A generalized estimating equation (GEE) method was used to account for the fact that repeated observations (several implants) were placed in a single patient. The factors bone quantity, bone quality, implant location, implant surface, and implant system were analyzed with descriptive statistics separately for each individual surgeon. A total of 10 surgeons were eligible. The differences between the survival curves of each individual were statistically significant. The multivariate GEE model showed the following variables to be statistically significant: surgeon, bruxism, intake of antidepressants, location, implant length, and implant system. The surgeon with the highest absolute number of failures was also the one who inserted the most implants in sites of poor bone and used turned implants in most cases, whereas the surgeon with the lowest absolute number of failures used mainly modern implants. Separate survival analyses of turned and modern implants stratified for the individual surgeon showed statistically significant differences in cumulative survival. Different levels of failure incidence could be observed between the surgeons, occasionally reaching significant levels. Although a direct causal relationship could not be ascertained, the results of the present study suggest that the surgeons' technique, skills, and/or judgment may negatively influence implant survival rates.

  18. Implant vendors and hospitals: competing influences over product choice by orthopedic surgeons.

    Science.gov (United States)

    Burns, Lawton R; Housman, Michael G; Booth, Robert E; Koenig, Aaron

    2009-01-01

    Vendors of hip and knee implants court orthopedic surgeons to adopt their products. Hospitals, which have to pay for these products, now court the same surgeons to help reduce the number of vendors and contain implant costs. This study measures the surgeon's perceived alignment of interests with both vendors and hospitals and gauges surgeons' exposure and receptivity to hospital cost-containment efforts. We surveyed all practicing orthopedists performing 12 or more implant procedures annually in Pennsylvania. The survey identified the surgeon's preferred vendor, tenure with that vendor, use of the vendor during residency training, receipt of financial payments from the vendor, alignment of interests with both vendor and hospital stakeholders, and exposure and receptivity to hospital cost-containment efforts. Surgeons have long-standing relationships with implant vendors, but only a small proportion receive financial payments. Surgeons align most closely with the vendor's sales representative and least closely with the hospital's purchasing manager. Paradoxically, surgeons support hospital efforts to limit the number of vendors but report that their own choice of vendor is not constrained. The major drivers of surgeons' alignment and stance toward cost containment are their tenure with and receipt of financial payments from the vendor. Hospitals face a competitive disadvantage in capturing the attention of orthopedists, compared with implant vendors. The vendors' advantage stems from historical, financial, and service benefits offered to surgeons. Hospital executives now seek to offer comparable benefits to surgeons.

  19. Thomas Vicary, barber-surgeon.

    Science.gov (United States)

    Thomas, Duncan P

    2006-05-01

    An Act of Parliament in 1540 uniting the barbers and surgeons to form the Barber-Surgeons' Company represented an important foundation stone towards better surgery in England. Thomas Vicary, who played a pivotal role in promoting this union, was a leading surgeon in London in the middle of the 16th century. While Vicary made no direct contribution to surgical knowledge, he should be remembered primarily as one who contributed much towards the early organization and teaching of surgery and to the consequent benefits that flowed from this improvement.

  20. Executive Dysfunction

    Science.gov (United States)

    Rabinovici, Gil D.; Stephens, Melanie L.; Possin, Katherine L.

    2015-01-01

    Purpose of Review: Executive functions represent a constellation of cognitive abilities that drive goal-oriented behavior and are critical to the ability to adapt to an ever-changing world. This article provides a clinically oriented approach to classifying, localizing, diagnosing, and treating disorders of executive function, which are pervasive in clinical practice. Recent Findings: Executive functions can be split into four distinct components: working memory, inhibition, set shifting, and fluency. These components may be differentially affected in individual patients and act together to guide higher-order cognitive constructs such as planning and organization. Specific bedside and neuropsychological tests can be applied to evaluate components of executive function. While dysexecutive syndromes were first described in patients with frontal lesions, intact executive functioning relies on distributed neural networks that include not only the prefrontal cortex, but also the parietal cortex, basal ganglia, thalamus, and cerebellum. Executive dysfunction arises from injury to any of these regions, their white matter connections, or neurotransmitter systems. Dysexecutive symptoms therefore occur in most neurodegenerative diseases and in many other neurologic, psychiatric, and systemic illnesses. Management approaches are patient specific and should focus on treatment of the underlying cause in parallel with maximizing patient function and safety via occupational therapy and rehabilitation. Summary: Executive dysfunction is extremely common in patients with neurologic disorders. Diagnosis and treatment hinge on familiarity with the clinical components and neuroanatomic correlates of these complex, high-order cognitive processes. PMID:26039846

  1. What Is a Pediatric Heart Surgeon?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Heart Surgeon? Page Content Article Body If your ... require heart surgery. What Kind of Training Do Pediatric Heart Surgeons Have? Pediatric heart surgeons are medical ...

  2. What Is a Foot and Ankle Surgeon?

    Science.gov (United States)

    ... A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle surgeons are the surgical ... every age. What education has a foot and ankle surgeon received? After completing undergraduate education, the foot ...

  3. JEDI - an executive dashboard and decision support system for lean global military medical resource and logistics management.

    Science.gov (United States)

    Sloane, Elliot B; Rosow, Eric; Adam, Joe; Shine, Dave

    2006-01-01

    Each individual U.S. Air Force, Army, and Navy Surgeon General has integrated oversight of global medical supplies and resources using the Joint Medical Asset Repository (JMAR). A Business Intelligence system called the JMAR Executive Dashboard Initiative (JEDI) was developed over a three-year period to add real-time interactive data-mining tools and executive dashboards. Medical resources can now be efficiently reallocated to military, veteran, family, or civilian purposes and inventories can be maintained at lean levels with peaks managed by interactive dashboards that reduce workload and errors.

  4. Smartphones and the plastic surgeon.

    Science.gov (United States)

    Al-Hadithy, Nada; Ghosh, Sudip

    2013-06-01

    Surgical trainees are facing limited training opportunities since the introduction of the European Working Time Directive. Smartphone sales are increasing and have usurped computer sales for the first time. In this context, smartphones are an important portable reference and educational tool, already in the possession of the majority of surgeons in training. Technology in the palm of our hands has led to a revolution of accessible information for the plastic surgery trainee and surgeon. This article reviews the uses of smartphones and applications for plastic surgeons in education, telemedicine and global health. A comprehensive guide to existing and upcoming learning materials and clinical tools for the plastic surgeon is included. E-books, podcasts, educational videos, guidelines, work-based assessment tools and online logbooks are presented. In the limited resource setting of modern clinical practice, savvy plastic surgeons can select technological tools to democratise access to education and best clinical care. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. A general psychopathology factor (P factor) in children: Structural model analysis and external validation through familial risk and child global executive function.

    Science.gov (United States)

    Martel, Michelle M; Pan, Pedro M; Hoffmann, Maurício S; Gadelha, Ary; do Rosário, Maria C; Mari, Jair J; Manfro, Gisele G; Miguel, Eurípedes C; Paus, Tomás; Bressan, Rodrigo A; Rohde, Luis A; Salum, Giovanni A

    2017-01-01

    High rates of comorbidities and poor validity of disorder diagnostic criteria for mental disorders hamper advances in mental health research. Recent work has suggested the utility of continuous cross-cutting dimensions, including general psychopathology and specific factors of externalizing and internalizing (e.g., distress and fear) syndromes. The current study evaluated the reliability of competing structural models of psychopathology and examined external validity of the best fitting model on the basis of family risk and child global executive function (EF). A community sample of 8,012 families from Brazil with children ages 6-12 years completed structured interviews about the child and parental psychiatric syndromes, and a subsample of 2,395 children completed tasks assessing EF (i.e., working memory, inhibitory control, and time processing). Confirmatory factor analyses tested a series of structural models of psychopathology in both parents and children. The model with a general psychopathology factor ("P factor") with 3 specific factors (fear, distress, and externalizing) exhibited the best fit. The general P factor accounted for most of the variance in all models, with little residual variance explained by each of the 3 specific factors. In addition, associations between child and parental factors were mainly significant for the P factors and nonsignificant for the specific factors from the respective models. Likewise, the child P factor-but not the specific factors-was significantly associated with global child EF. Overall, our results provide support for a latent overarching P factor characterizing child psychopathology, supported by familial associations and child EF. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  6. Occupational Stress and Burnout among Surgeons in Fiji.

    Science.gov (United States)

    Patel, Rajeev; Huggard, Peter; van Toledo, Annik

    2017-01-01

    This study examined the levels of occupational stress and burnout among surgeons in Fiji. A document set comprising a cover letter; a consent form; a sociodemographic and supplementary information questionnaire; the Maslach Burnout Inventory (MBI); the 12-item General Health Questionnaire (GHQ-12); the Alcohol Use Disorders Identification Test (AUDIT); and the Professional Quality of Life (ProQOL) questionnaires were provided to surgeons from three public divisional hospitals in Fiji. Thirty-six of 43 (83.7%) invited surgeons participated in the study. According to their MBI scores, surgeons suffered from low (10, 27.8%), moderate (23, 63.9%), and high (3, 8.3%) levels of burnout. Comparatively, 23 (63.9%) demonstrated moderate burnout according to their ProQOL scores. Substantial psychiatric morbidity was observed in 16 (44.0%) surgeons per their GHQ-12 scores. Consumption of alcohol was noted in 29 (80.6%) surgeons, and 12 (33.4%) had AUDIT scores characterizing their alcohol use in excess of low-risk guidelines or as harmful or hazardous drinking. Surgeons of Fijian nationality showed higher MBI emotional exhaustion and depersonalization scores compared with surgeons of other nationalities. Surgeons with an awareness of the availability of counseling services at their hospitals showed low AUDIT and ProQOL burnout scores. Smokers, alcohol drinkers, and kava drinkers showed higher AUDIT scores. This study highlights a level of occupational stress and burnout among surgeons in Fiji and a lack of awareness of their mental and physical well-being. The authors recommend that occupational stress and burnout intervention strategies be put in place in hospitals in Fiji.

  7. The Forgotten Shrines: General Masaharu Homma – General Tomoyuki Yamashita Execution Shrines Depicting History, Significance, and Deterioration as a Study for Heritage and Cultural Tourism Attraction Management and Development in Los Baños, Laguna

    Directory of Open Access Journals (Sweden)

    Mercado Jame Monren T.

    2014-01-01

    Full Text Available Shrines and monuments represent honourable respect for a person or a significant scenario that affects the cultural and heritage value of a community or a nation. These are also considered as a potential tourism resource of a community that could be used as a unique attraction for impending tourists. This paper identified and analyzed the practices of the community of Los Baños, Laguna, Philippines for the conservation and development of General Masaharu Homma - General Tomoyuki Yamashita Execution Shrines. The objectives of the study are: to identify the significances of the shrines and used it as a tourism development resource; to assess the practices of the authority on conservation and preservation; and to furnish recommendation that they could use for implementing or revising their plans and programs. It was recognized by the researcher that the sites were already deteriorated and mismanagement was already a problem. These things happened due to lack of financial capabilities and poor knowledge on conservation and preservation. As a general recommendation, the researcher suggested to create an organization attached to the local government unit of Los Baños that will supervise and develop heritage and cultural sites of the municipality.

  8. An online review of plastic surgeons in southern California.

    Science.gov (United States)

    Lewis, Priya; Kobayashi, Emily; Gupta, Subhas

    2015-05-01

    It has become commonplace for patients to access online reviews of physicians when making choices about health care, just as any consumer would in today's computer-dependent world. Previous studies have shown that online reviews of physicians are generally positive. However, 1 negative review has the potential to adversely affect business and reputations. To characterize the online presence of plastic surgeons in Southern California as portrayed by physician rating websites (PRWs). An extensive online database of board-certified plastic surgeons was used to generate a list of surgeons within a 50-mile radius of Pomona, CA. Ratings from the PRWs HealthGrades.com, Vitals.com, and UCompareHealthcare.com were cataloged by number of reviews and ratings. Two hundred sixty-three surgeons were evaluated with the most-represented cities being Beverly Hills (N=47), Los Angeles (N=31), and Newport Beach (N=27). Ninety-seven percent of the surgeons were rated on at least 1 of the 3 PRWs chosen. In general, surgeons were rated highly, with a mean rating of 85%, SD, 14% (Ponline ratings ranged from 0 to 222 per surgeon. The median number of total reviews was 25 and the mean rating for those surgeons above and below the median were equivocal, at 86% and 85%, respectively (P=0.284). In this study, we found that plastic surgeons in Southern California have an online presence that can be influenced by their patients; they should be aware of this and conscious of their online reputations. Overall, the ratings were high, regardless of the number of reviews.

  9. Discrepancies in the female pelvic medicine and reconstructive surgeon workforce.

    Science.gov (United States)

    Muffly, Tyler M; Weterings, Robbie; Barber, Mathew D; Steinberg, Adam C

    2015-01-01

    It is unclear whether the current distribution of surgeons practicing female pelvic medicine and reconstructive surgery in the United States is adequate to meet the needs of a growing and aging population. We assessed the geographic distribution of female pelvic surgeons as represented by members of the American Urogynecologic Society (AUGS) throughout the United States at the county, state, and American Congress of Obstetricians and Gynecologists district levels. County-level data from the AUGS, American Congress of Obstetricians and Gynecologists, and the United States Census were analyzed in this observational study. State and national patterns of female pelvic surgeon density were mapped graphically using ArcGIS software and 2010 US Census demographic data. In 2013, the 1058 AUGS practicing physicians represented 0.13% of the total physician workforce. There were 6.7 AUGS members available for every 1 million women and 20 AUGS members for every 1 million postreproductive-aged women in the United States. The density of female pelvic surgeons was highest in metropolitan areas. Overall, 88% of the counties in the United States lacked female pelvic surgeons. Nationwide, there was a mean of 1 AUGS member for every 31 practicing general obstetrician-gynecologists. These findings have implications for training, recruiting, and retaining female pelvic surgeons. The uneven distribution of female pelvic surgeons throughout the United States is likely to worsen as graduating female pelvic medicine and reconstructive surgery fellows continue to cluster in urban areas.

  10. The lesser spotted pregnant surgeon.

    Science.gov (United States)

    Hamilton, L C

    2017-10-19

    With more women entering surgical training, it will become more commonplace to encounter pregnant surgeons. This paper discusses the evidence for work-related risk factors as well as outlining the rights of a pregnant doctor. There are, in fact, very few real risks to pregnancy encountered as a surgeon, with the main risks involving standing or sitting for long periods and fatigue, which can be managed with support from the department. It is important for women in surgery to know that it is possible to continue their training while pregnant so they do not feel pressured into changing to a less demanding specialty or even leaving medicine entirely. It is also important for other professionals to understand the risks and choices faced by pregnant surgeons so that they can better support them in the workplace.

  11. Executive functions in synesthesia

    NARCIS (Netherlands)

    Rouw, Romke; van Driel, Joram; Knip, Koen; Richard Ridderinkhof, K.

    2013-01-01

    In grapheme-color synesthesia, a number or letter can evoke two different and possibly conflicting (real and synesthetic) color sensations at the same time. In this study, we investigate the relationship between synesthesia and executive control functions. First, no general skill differences were

  12. Executive summary

    NARCIS (Netherlands)

    van Nimwegen, N.; van Nimwegen, N.; van der Erf, R.

    2009-01-01

    The Demography Monitor 2008 gives a concise overview of current demographic trends and related developments in education, the labour market and retirement for the European Union and some other countries. This executive summary highlights the major findings of the Demography Monitor 2008 and further

  13. Kant and the cosmetic surgeon.

    Science.gov (United States)

    Carey, J S

    1989-07-01

    Philosophers know that modern philosophy owes a great debt to the intellectual contributions of the 18th century philosopher Immanuel Kant. This essay attempts to show how cosmetic surgeons, and all surgeons at that, could learn much from his work. Not only did Kant write about the structure of human reasoning and how it relates to appearances but he also wrote about the nature of duties and other obligations. His work has strongly influenced medical ethics. In a more particular way, Kant wrote the most important work on aesthetics. His theory still influences how philosophers understand the meaning of the beautiful and how it pertains to the human figure. This essay presents an exercise in trying to apply Kantian philosophy to aesthetic plastic surgery. Its intention is to show cosmetic surgeons some of the implicit and explicit philosophical principles and potential arguments undergirding their potential surgical evaluations. It is meant to challenge the surgeon to reconsider how decisions are made using philosophical reasoning instead of some of the more usual justifications based on psychology or sociology.

  14. Digital Footprint of Neurological Surgeons.

    Science.gov (United States)

    Kim, Christopher; Gupta, Raghav; Shah, Aakash; Madill, Evan; Prabhu, Arpan V; Agarwal, Nitin

    2018-05-01

    Patients are increasingly turning to online resources to inquire about individual physicians and to gather health information. However, little research exists studying the online presence of neurosurgeons across the country. This study aimed to characterize these online profiles and assess the scope of neurosurgeons' digital identities. Medicare-participating neurologic surgeons from the United States and Puerto Rico were identified using the Centers for Medicare and Medicaid Services (CMS) Physician Comparable Downloadable File. Each physician was characterized by his or her medical education, graduation year, city of practice, gender, and affiliation with an academic institution. Using a Google-based custom search tool, the top 10 search results for each physician were extracted and categorized as 1 of the following: 1) physician, hospital, or healthcare system controlled, 2) third-party or government controlled, 3) social media-based, 4) primary journal article, or 5) other. Among the physicians within the CMS database, 4751 self-identified as being neurosurgeons, yielding a total of 45,875 uniform resource locator search results pertinent to these physicians. Of the 4751 neurosurgeons, 2317 (48.8%) and 2434 (51.2%) were classified as academic and nonacademic neurosurgeons, respectively. At least 1 search result was obtained for every physician. Hospital, healthcare system, or physician-controlled websites (18,206; 39.7%) and third-party websites (17,122; 37.3%) were the 2 most commonly observed domain types. Websites belonging to social media platforms accounted for 4843 (10.6%) search results, and websites belonging to peer-reviewed academic journals accounted for 1888 (4.1%) search results. The frequency with which a third-party domain appeared as the first search result was higher for nonacademic neurosurgeons than for academic neurosurgeons. In general, neurosurgeons lacked a controllable online presence within their first page of Google Search results

  15. 75 FR 62501 - Senior Executive Service Performance Review Board: Update

    Science.gov (United States)

    2010-10-12

    ... AGENCY FOR INTERNATIONAL DEVELOPMENT Senior Executive Service Performance Review Board: Update... Development, Office of Inspector General's Senior Executive Service Performance Review Board. DATES: September... reference-- USAID OIG Senior Executive Service (SES) Performance Review Board). SUPPLEMENTARY INFORMATION: 5...

  16. Women surgeons in the new millennium.

    Science.gov (United States)

    Troppmann, Kathrin M; Palis, Bryan E; Goodnight, James E; Ho, Hung S; Troppmann, Christoph

    2009-07-01

    Women are increasingly entering the surgical profession. To assess professional and personal/family life situations, perceptions, and challenges for women vs men surgeons. National survey of American Board of Surgery-certified surgeons. A questionnaire was mailed to all women and men surgeons who were board certified in 1988, 1992, 1996, 2000, or 2004. Of 3507 surgeons, 895 (25.5%) responded. Among these, 178 (20.3%) were women and 698 (79.7%) were men. Most women and men surgeons would choose their profession again (women, 82.5%; men, 77.5%; P = .15). On multivariate analysis, men surgeons (odds ratio [OR], 2.5) and surgeons of a younger generation (certified in 2000 or 2004; OR, 1.3) were less likely to favor part-time work opportunities for surgeons. Most of the surgeons were married (75.6% of women vs 91.7% of men, P women surgeons (OR, 5.0) and surgeons of a younger generation (OR, 1.9) were less likely to have children. More women than men surgeons had their first child later in life, while already in surgical practice (62.4% vs 32.0%, P women surgeons vs 79.4% of men surgeons (P women surgeons than men surgeons thought that maternity leave was important (67.8% vs 30.8%, P work (86.5% vs 69.7%, P Women considering a surgical career should be aware that most women surgeons would choose their profession again. Strategies to maximize recruitment and retention of women surgeons should include serious consideration of alternative work schedules and optimization of maternity leave and child care opportunities.

  17. The Glass Houses of Attending Surgeons: An Assessment of Unprofessional Behavior on Facebook Among Practicing Surgeons.

    Science.gov (United States)

    Langenfeld, Sean J; Sudbeck, Craig; Luers, Thomas; Adamson, Peter; Cook, Gates; Schenarts, Paul J

    2015-01-01

    Our recent publication demonstrated that unprofessional behavior on Facebook is common among surgical residents. In the formulation of standards and curricula to address this issue, it is important that surgical faculty lead by example. Our current study refocuses on the Facebook profiles of faculty surgeons involved in the education of general surgery residents. The American College of Surgeons (ACS) web site was used to identify general surgery residencies located in the Midwest. Departmental web sites were then searched to identify teaching faculty for the general surgery residency. Facebook was then searched to determine which faculty had profiles available for viewing by the general public. Profiles were then placed in 1 of the 3 following categories: professional, potentially unprofessional, or clearly unprofessional. A chi-square test was used to determine significance. In all, 57 residency programs were identified on the ACS web site, 100% of which provided an institutional web site listing the surgical faculty. A total of 758 general surgery faculty were identified (133 women and 625 men), of which 195 (25.7%) had identifiable Facebook accounts. In all, 165 faculty (84.6%) had no unprofessional content, 20 (10.3%) had potentially unprofessional content, and 10 (5.1%) had clearly unprofessional content. Inter-rater reliability was good (88.9% agreement, κ = 0.784). Clearly unprofessional behavior was found only in male surgeons. For male surgeons, clearly unprofessional behavior was more common among those in practice for less than 5 years (p = 0.031). Alcohol and politics were the most commonly found variables in the potentially unprofessional group. Inappropriate language and sexually suggestive material were the most commonly found variables in the clearly unprofessional group. Unprofessional behavior on Facebook is less common among surgical faculty compared with surgical residents. However, the rates remain unacceptably high, especially among men and

  18. Educating Executive Function

    Science.gov (United States)

    Blair, Clancy

    2016-01-01

    Executive functions are thinking skills that assist with reasoning, planning, problem solving, and managing one’s life. The brain areas that underlie these skills are interconnected with and influenced by activity in many different brain areas, some of which are associated with emotion and stress. One consequence of the stress-specific connections is that executive functions, which help us to organize our thinking, tend to be disrupted when stimulation is too high and we are stressed out, or too low when we are bored and lethargic. Given their central role in reasoning and also in managing stress and emotion, scientists have conducted studies, primarily with adults, to determine whether executive functions can be improved by training. By and large, results have shown that they can be, in part through computer-based videogame-like activities. Evidence of wider, more general benefits from such computer-based training, however, is mixed. Accordingly, scientists have reasoned that training will have wider benefits if it is implemented early, with very young children as the neural circuitry of executive functions is developing, and that it will be most effective if embedded in children’s everyday activities. Evidence produced by this research, however, is also mixed. In sum, much remains to be learned about executive function training. Without question, however, continued research on this important topic will yield valuable information about cognitive development. PMID:27906522

  19. Social media and the surgeon.

    Science.gov (United States)

    Margolin, David A

    2013-03-01

    As the Internet has matured, social media has developed and become a part of our everyday life. Whether it is Facebook, YouTube, or LinkedIn, we now communicate with each other and the world in a very different manner. As physicians, and specifically colon and rectal surgeons, it is important that we understand this new technology, learn its limitations, and utilize it to foster growth of our practice, trade, and potentially result in better patient care.

  20. Musculoskeletal Pain in Gynecologic Surgeons

    Science.gov (United States)

    Adams, Sonia R.; Hacker, Michele R.; McKinney, Jessica L.; Elkadry, Eman A.; Rosenblatt, Peter L.

    2013-01-01

    Objective To describe the prevalence of musculoskeletal pain and symptoms in gynecologic surgeons. Design Prospective cross-sectional survey study (Canadian Task Force classification II-2). Setting Virtual. All study participants were contacted and participated via electronic means. Participants Gynecologic surgeons. Interventions An anonymous, web-based survey was distributed to gynecologic surgeons via electronic newsletters and direct E-mail. Measurements and Main Results There were 495 respondents with complete data. When respondents were queried about their musculoskeletal symptoms in the past 12 months, they reported a high prevalence of lower back (75.6%) and neck (72.9%) pain and a slightly lower prevalence of shoulder (66.6%), upper back (61.6%), and wrist/hand (60.9%) pain. Many respondents believed that performing surgery caused or worsened the pain, ranging from 76.3% to 82.7% in these five anatomic regions. Women are at an approximately twofold risk of pain, with adjusted odds ratios (OR) of 1.88 (95% confidence interval [CI], 1.1–3.2; p 5 .02) in the lower back region, OR 2.6 (95% CI, 1.4–4.8; p 5 .002) in the upper back, and OR 2.9 (95% CI, 1.8–4.6; p 5 .001) in the wrist/hand region. Conclusion Musculoskeletal symptoms are highly prevalent among gynecologic surgeons. Female sex is associated with approximately twofold risk of reported pain in commonly assessed anatomic regions. Journal of Minimally Invasive Gynecology (2013) 20, 656-660 PMID:23796512

  1. Hand dominance in orthopaedic surgeons.

    LENUS (Irish Health Repository)

    Lui, Darren F

    2012-08-01

    Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.

  2. Surgeons' motivation for choice of workplace.

    Science.gov (United States)

    Kähler, Lena; Kristiansen, Maria; Rudkjøbing, Andreas; Strandberg-Larsen, Martin

    2012-09-01

    To ensure qualified health care professionals at public hospitals in the future, it is important to understand which factors attract health care professionals to certain positions. The aim of this study was to explore motives for choosing employment at either public or private hospitals in a group of Danish surgeons, as well as to examine if organizational characteristics had an effect on motivation. Eight qualitative interviews were conducted with surgeons from both public and private hospitals sampled using the snowball method. The interviews were based on a semi-structured interview guide and analyzed by means of phenomenological theory. Motivational factors such as personal influence on the job, the opportunity to provide the best possible patient care, challenging work tasks colleagues, and ideological reasons were emphasized by the surgeons as important reasons for their choice of employment. Motivational factors appeared to be strongly connected to the structure of the organization; especially the size of the organization was perceived to be essential. It is worth noting that salary, in contrast to the general belief, was considered a secondary benefit rather than a primary motivational factor for employment. The study revealed that motivational factors are multidimensional and rooted in organizational structure; i.e. organizational size rather than whether the organization is public or private is crucial. There is a need for further research on the topic, but it seems clear that future health care planning may benefit from taking into account the implications that large organizational structures have for the staff working within these organizations. not relevant. not relevant.

  3. [Improving the surgeon's image: introduction].

    Science.gov (United States)

    Tajima, Tomoo

    2004-05-01

    The number of medical students who aspire to become surgeons has been decreasing in recent years. With a vicious spiral in the decreasing number and the growing deterioration of surgeons' working conditions, there is fear of deterioration of surgical care and subsequent disintegration of overall health care in Japan. The purpose of this issue is to devise a strategy for improving surgeons' image and their working conditions to attract future medical students. However, we cannot expect a quick cure for the problem of the decreasing number of applicants for surgery since this issue is deeply related to many fundamental problems in the health care system in Japan. The challenge for surgical educators in coming years will be to solve the problem of chronic sleep deprivation and overwork of surgery residents and to develop an efficient program to meet the critical educational needs of surgical residents. To solve this problem it is necessary to ensure well-motivated surgical residents and to develop an integrated research program. No discussion of these issues would be complete without attention to the allocation of scarce medical resources, especially in relation to financial incentives for young surgeons. The authors, who are conscientious representatives of this society, would like to highlight these critical problems and issues that are particularly relevant to our modern surgical practice, and it is our sincere hope that all members of this society fully recognize these critical issues in the Japanese health care system to take leadership in improving the system. With the demonstration of withholding unnecessary medical conducts we may be able to initiate a renewal of the system and eventually to fulfill our dreams of Japan becoming a nation that can attract many patients from all over the world. Furthermore, verification of discipline with quality control and effective surgical treatment is needed to avoid criticism by other disciplines for being a self

  4. The Nonwhite Woman Surgeon: A Rare Species.

    Science.gov (United States)

    Frohman, Heather A; Nguyen, Thu-Hoai C; Co, Franka; Rosemurgy, Alexander S; Ross, Sharona B

    2015-01-01

    As of 2012, 39% of medical student graduates were nonwhite, yet very few nonwhite women graduates chose to become surgeons. To better understand issues regarding nonwhite women in surgery, an online survey was sent to surgeons across the United States. Results are based on self-reported data. Mean data are reported. A total of 194 surgeons (42% women) completed the survey; only 12% of responders were nonwhite. Overall, 56% of nonwhite women felt they earned less than what men surgeons earn for equal work. Nonwhite women surgeons earned less than what men surgeons ($224,000 vs. 351,000, p women surgeons ($285,000, p = 0.02) earned. Overall, 96% of nonwhite surgeons believed that racial discrimination currently exists among surgeons. The few nonwhite women surgeons in the United States recognize that they are paid significantly less than what other surgeons are paid. Inequitable remuneration and a discriminatory work environment encountered by nonwhite women surgeons must be addressed. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  5. Using Texting for Clinical Communication in Surgery: A Survey of Academic Staff Surgeons.

    Science.gov (United States)

    Firdouse, Mohammed; Devon, Karen; Kayssi, Ahmed; Goldfarb, Jeremy; Rossos, Peter; Cil, Tulin D

    2018-03-01

    Text messaging has become ubiquitous and is being increasingly used within the health care system. The purpose of this study was to understand texting practices for clinical communication among staff surgeons at a large academic institution. Staff surgeons in 4 subspecialties (vascular, plastics, urology, and general surgery) were surveyed electronically. A total of 62 surgeons from general surgery (n = 33), vascular surgery (n = 6), plastic surgery (n = 13), and urology (n = 10) completed the study (response rate 30%). When conveying urgent patient-related information, staff surgeons preferred directly calling other staff surgeons (61.5%) and trainees (58.8%). When discussing routine patient information, staff surgeons used email to reach other staff surgeons (54.9%) but preferred texting (62.7%) for trainees. The majority of participants used texting because it is fast (65.4%), convenient (69.2%) and allows transmitting information to multiple recipients simultaneously (63.5%). Most felt that texting enhances patient care (71.5%); however, only half believed that it enhanced trainees' educational experiences. The majority believed that texting identifiable patient information breaches patient confidentiality. Our data showed high adoption of text messaging for clinical communication among surgeons, particularly with trainees. The majority of surgeons acknowledge security concerns inherent in texting for patient care. Existing mobile communication platforms fail to meet the needs of academic surgeons. Further research should include guidelines related to texting in clinical practice, educational implications of texting, and technologies to better meet the needs of clinicians working in an academic surgical settings.

  6. Emergency surgeon-performed hepatobiliary ultrasonography.

    LENUS (Irish Health Repository)

    Kell, M R

    2012-02-03

    BACKGROUND: Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined. METHODS: A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2-5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2-5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses. RESULTS: Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94.3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95.2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96.2 per cent of patients. Time to scan was significantly shorter following SUS (3.1 versus 12.0 h, P < 0.05). CONCLUSION: SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.

  7. Executive summary

    International Nuclear Information System (INIS)

    2002-01-01

    On 18 May 2001, the Finnish Parliament ratified the Decision in Principle on the final disposal facility for spent nuclear fuel at Olkiluoto, within the municipality of Eurajoki. The Municipality Council and the government has made positive decisions earlier, at the end of 2000, and in compliance with the Nuclear Energy Act, Parliament's ratification was then required. The decision is valid for the spent fuel generated by the existing Finnish nuclear power plants and means that the construction of the final disposal facility is considered to be in line with the overall good of society. Earlier steps included, amongst others, the approval of the technical project by the Safety Authority. Future steps include construction of an underground rock characterisation facility, ONKALO (2003-2004), and application for separate construction and operating licences for the final disposal facility (from about 2010). How did this political and societal decision come about? The FSC Workshop provided the opportunity to present the history leading up to the Decision in Principle (DiP), and to examine future perspectives with an emphasis on stakeholder involvement. This Executive Summary gives an overview of the presentations and discussions that took place at the workshop. It presents, for the most part, a factual account of the individual presentations and of the discussions that took place. It relies importantly on the notes that were taken at the meeting. Most materials are elaborated upon in a fuller way in the texts that the various speakers and session moderators contributed for these proceedings. The structure of the Executive Summary follows the structure of the workshop itself. Complementary to this Summary and also provided with this document, is a NEA Secretariat's perspective aiming to place the results of all discussions, feedback and site visit into an international perspective. (authors)

  8. Veterinary surgeons' attitudes towards physician-assisted suicide: an empirical study of Swedish experts on euthanasia.

    Science.gov (United States)

    Lerner, Henrik; Lindblad, Anna; Algers, Bo; Lynöe, Niels

    2011-05-01

    To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. A questionnaire about attitudes towards PAS, including prioritization of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS.

  9. Contemporary use of social media by consultant colorectal surgeons.

    Science.gov (United States)

    McDonald, J J; Bisset, C; Coleman, M G; Speake, D; Brady, R R W

    2015-02-01

    There is evidence of significant growth in the engagement of UK health-care professionals with 'open' social media platforms, such as Twitter and LinkedIn. Social media communication provides many opportunities and benefits for medical education and interaction with patients and colleagues. This study was undertaken to evaluate the uptake of public social media membership and the characteristics of use of such media channels amongst contemporary UK consultant colorectal surgeons. Colorectal surgeons were identified from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) national registry of colorectal mortality outcomes and were cross-referenced with the General Medical Council (GMC) register. Individuals were identified by manual searching on a number of social media platforms. Matching accounts were then examined to confirm ownership and to evaluate key markers of use. Six-hundred and eighteen individual consultant colorectal surgeons from 142 health authorities were studied (79.5% were ACPGBI members and 90.8% were male). Two-hundred and twenty-nine (37.1%) had LinkedIn profiles (37.7% male surgeons, 29.8% female surgeons; P = 0.2530). LinkedIn membership was significantly higher in ACPGBI members (P social media than reported studies from other health-care professional groups. Further education and appropriate guidance on usage may encourage uptake and confidence, particularly in younger consultants. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  10. Burnout syndrome in oral and maxillofacial surgeons: a critical analysis.

    Science.gov (United States)

    Porto, G G; Carneiro, S C; Vasconcelos, B C; Nascimento, M M; Leal, J L F

    2014-07-01

    The aim of this study was to determine the prevalence of burnout syndrome among Brazilian oral and maxillofacial surgeons and its relationship with socio-demographic, clinical, and habit variables. The sample of this study comprised 116 surgeons. The syndrome was quantified using the Maslach Burnout Inventory (General Survey), which defines burnout as the triad of high emotional exhaustion, high depersonalization, and low personal accomplishment. The criteria of Grunfeld et al. were used to evaluate the presence of the syndrome (17.2%). No significant differences between the surgeons diagnosed with and without the syndrome were observed according to age (P=0.804), sex (P=0.197), marital status (P=0.238), number of children (P=0.336), years of professional experience (P=0.102), patients attended per day (P=0.735), hours worked per week (P=0.350), use of alcohol (P=0.148), sports practice (P=0.243), hobbies (P=0.161), or vacation period per year (P=0.215). Significant differences occurred in the variables sex in the emotional exhaustion subscale (P=0.002) and use or not of alcohol in the personal accomplishment subscale (P=0.035). Burnout syndrome among Brazilian surgeons is average, showing a low personal accomplishment. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Surgeons in Difficulty: An Exploration of Differences in Assistance-Seeking Behaviors between Male and Female Surgeons.

    Science.gov (United States)

    Sanfey, Hilary; Fromson, John; Mellinger, John; Rakinic, Jan; Williams, Michael; Williams, Betsy

    2015-08-01

    Physician burnout is associated with diminished ability to practice with requisite skill and safety. Physicians are often reluctant to seek help for an impaired colleague or for impairment that affects their own ability to practice. To better support surgeons in difficulty, we explored sex differences in assistance-seeking behaviors under stress. Surgeons in 3 national societies completed an IRB-approved anonymous multiple-choice and free-text response survey. Responses were explored with the general linear model using item-specific continuous and categorical methods. Two hundred and twelve surgeons (n = 79 [37.3%] male, n = 133 [63%] female) responded. Although men and women worked similar hours (p > 0.05), women worked more clinical (p work-life balance, as identified by aggregate variables related to emotional/decisional partnership, non-work-related chore support, and personal fulfillment (F = 15.29; df 3/16; p < 0.01), but change jobs less frequently (F = 4.23; df 1/201; p < 0.05). Males are more likely to seek help from colleagues (chi-square 107.5; p < 0.01) or friends (chi-square 123.8; p < 0.01) and women are more likely to seek support from professional counselors (chi-square 146.8; p < 0.01). Almost one-third of surgeons would ignore behaviors that adversely impact well being and could result in potential personal or patient safety. The differences between the assistance-seeking and reporting behaviors of male and female surgeons in distress could have implications for identification and treatment of this population. These findings can be used to develop educational activities to teach surgeons how to effectively handle these challenging situations. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Educating executive function.

    Science.gov (United States)

    Blair, Clancy

    2017-01-01

    Executive functions are thinking skills that assist with reasoning, planning, problem solving, and managing one's life. The brain areas that underlie these skills are interconnected with and influenced by activity in many different brain areas, some of which are associated with emotion and stress. One consequence of the stress-specific connections is that executive functions, which help us to organize our thinking, tend to be disrupted when stimulation is too high and we are stressed out, or too low when we are bored and lethargic. Given their central role in reasoning and also in managing stress and emotion, scientists have conducted studies, primarily with adults, to determine whether executive functions can be improved by training. By and large, results have shown that they can be, in part through computer-based videogame-like activities. Evidence of wider, more general benefits from such computer-based training, however, is mixed. Accordingly, scientists have reasoned that training will have wider benefits if it is implemented early, with very young children as the neural circuitry of executive functions is developing, and that it will be most effective if embedded in children's everyday activities. Evidence produced by this research, however, is also mixed. In sum, much remains to be learned about executive function training. Without question, however, continued research on this important topic will yield valuable information about cognitive development. WIREs Cogn Sci 2017, 8:e1403. doi: 10.1002/wcs.1403 For further resources related to this article, please visit the WIREs website. © 2016 Wiley Periodicals, Inc.

  13. [Women pioneers: first female cardiothoracic surgeons in the USA and in Israel].

    Science.gov (United States)

    Fertouk, Michal; Bekerman, Ziv; Kremer, Ran; Adler, Zvi; Bolotin, Gil

    2014-08-01

    At the beginning of the 1960's, three female doctors managed to break the glass ceiling and become the first female cardiothoracic surgeons in the USA. Since then, the number of certified female cardiothoracic surgeons has steadily increased. Nevertheless, females stilt only account for a minority of cardiothoracic surgeons in the USA. In Israel, three women have become specialists in cardiothoracic surgery over the last two decades, aLthough these surgeons are working as general thoracic surgery consultants, without any representative females in cardiac surgery.

  14. Economic impact of a head and neck oncologic surgeon: the case mix index.

    Science.gov (United States)

    Jalisi, Scharukh; Sanan, Akshay; Mcdonough, Katie; Hussein, Khalil; Platt, Michael; Truong, Minh Tam; Couch, Marion; Burkey, Brian B

    2014-10-01

    Head and neck oncologic surgery is a time-consuming specialty that requires extensive resources and manpower. Case mix index (CMI) is used in evaluating the complexity and economic impact of surgeons. Head and neck oncologic surgeons generate significant revenue for hospitals, yet compensation is relatively low. Retrospective review of a tertiary hospital's case mix data for 605 otolaryngology admissions from 2009 to 2011 was performed. CMI comparison for head and neck oncologic surgeons versus general otolaryngology was performed. In an otolaryngology department of 9 surgeons; there was a significant difference (p 1) favoring head and neck oncologic surgeons. Head and neck oncologic surgeons increase the CMI for hospitals and ultimately influence the hospital's reimbursement. There is a need for increased collaboration between hospitals and departments in fostering and furthering their head and neck surgical oncology programs by taking CMI into consideration. © 2013 Wiley Periodicals, Inc.

  15. Surgeon-Based 3D Printing for Microvascular Bone Flaps.

    Science.gov (United States)

    Taylor, Erin M; Iorio, Matthew L

    2017-07-01

    Background  Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer. Methods  Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models. Results  Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle. Conclusions  Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer. Level of Evidence  Level IV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  16. Do Orthopaedic Surgeons Acknowledge Uncertainty?

    Science.gov (United States)

    Teunis, Teun; Janssen, Stein; Guitton, Thierry G; Ring, David; Parisien, Robert

    2016-06-01

    Much of the decision-making in orthopaedics rests on uncertain evidence. Uncertainty is therefore part of our normal daily practice, and yet physician uncertainty regarding treatment could diminish patients' health. It is not known if physician uncertainty is a function of the evidence alone or if other factors are involved. With added experience, uncertainty could be expected to diminish, but perhaps more influential are things like physician confidence, belief in the veracity of what is published, and even one's religious beliefs. In addition, it is plausible that the kind of practice a physician works in can affect the experience of uncertainty. Practicing physicians may not be immediately aware of these effects on how uncertainty is experienced in their clinical decision-making. We asked: (1) Does uncertainty and overconfidence bias decrease with years of practice? (2) What sociodemographic factors are independently associated with less recognition of uncertainty, in particular belief in God or other deity or deities, and how is atheism associated with recognition of uncertainty? (3) Do confidence bias (confidence that one's skill is greater than it actually is), degree of trust in the orthopaedic evidence, and degree of statistical sophistication correlate independently with recognition of uncertainty? We created a survey to establish an overall recognition of uncertainty score (four questions), trust in the orthopaedic evidence base (four questions), confidence bias (three questions), and statistical understanding (six questions). Seven hundred six members of the Science of Variation Group, a collaboration that aims to study variation in the definition and treatment of human illness, were approached to complete our survey. This group represents mainly orthopaedic surgeons specializing in trauma or hand and wrist surgery, practicing in Europe and North America, of whom the majority is involved in teaching. Approximately half of the group has more than 10 years

  17. 8 CFR 1003.0 - Executive Office for Immigration Review.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Executive Office for Immigration Review. 1003.0 Section 1003.0 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE GENERAL PROVISIONS EXECUTIVE OFFICE FOR IMMIGRATION REVIEW § 1003.0 Executive Office for...

  18. 8 CFR 3.0 - Executive Office for Immigration Review

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Executive Office for Immigration Review 3.0 Section 3.0 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY GENERAL PROVISIONS EXECUTIVE OFFICE FOR IMMIGRATION REVIEW § 3.0 Executive Office for Immigration Review Regulations of the Executive Office for...

  19. 工作记忆、中央执行功能与流体智力的关系分析%Study on the relationship of working memory, central executive function and general fluid intelligence

    Institute of Scientific and Technical Information of China (English)

    葛振林; 党瑾璇; 李静; 高晓彩; 张富昌

    2013-01-01

    The study aims at explore the relationship among the working memory capacity,the components of central executive function and general fluid intelligence.Main conclusions are as follows:(1) the separability of the central executive function in working memory is conformed by the present results; (2) the WMC is strongly related to Raven liquid test(r=0.208 **) ;(3) compared to the switching and inhibition capacity in central executive function,updating can predict and explain general fluid intelligence better.%探讨工作记忆、中央执行功能子成分与流体智力的关系.以秦巴山区18~40岁健康成人为研究对象,通过对中央执行功能子成分、工作记忆广度以及流体智力的测量,分析了各变量之间的关系,并进一步探讨了中央执行功能各子成分的可分离性.得到(1)工作记忆中的中央执行功能具有可分离性;(2)工作记忆广度与瑞文测验成绩之间的显著相关是刷新功能的作用;(3)相对于抑制功能和转换功能,刷新功能对流体智力具有更强的预测效应和解释力.

  20. Burnout and career satisfaction among American surgeons.

    Science.gov (United States)

    Shanafelt, Tait D; Balch, Charles M; Bechamps, Gerald J; Russell, Thomas; Dyrbye, Lotte; Satele, Daniel; Collicott, Paul; Novotny, Paul J; Sloan, Jeff; Freischlag, Julie A

    2009-09-01

    To determine the incidence of burnout among American surgeons and evaluate personal and professional characteristics associated with surgeon burnout. : Burnout is a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work. A limited amount of information exists about the relationship between specific demographic and practice characteristics with burnout among American surgeons. Members of the American College of Surgeons (ACS) were sent an anonymous, cross-sectional survey in June 2008. The survey evaluated demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL). Burnout and QOL were measured using validated instruments. Of the approximately 24,922 surgeons sampled, 7905 (32%) returned surveys. Responders had been in practice 18 years, worked 60 hours per week, and were on call 2 nights/wk (median values). Overall, 40% of responding surgeons were burned out, 30% screened positive for symptoms of depression, and 28% had a mental QOL score >1/2 standard deviation below the population norm. Factors independently associated with burnout included younger age, having children, area of specialization, number of nights on call per week, hours worked per week, and having compensation determined entirely based on billing. Only 36% of surgeons felt their work schedule left enough time for personal/family life and only 51% would recommend their children pursue a career as a physician/surgeon. Burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice. Additional research is needed to identify individual, organizational, and societal interventions that preserve and promote the mental health of American surgeons.

  1. Can Surgeon Demographic Factors Predict Postoperative Complication Rates After Elective Spinal Fusion?

    Science.gov (United States)

    Chun, Danielle S; Cook, Ralph W; Weiner, Joseph A; Schallmo, Michael S; Barth, Kathryn A; Singh, Sameer K; Freshman, Ryan D; Patel, Alpesh A; Hsu, Wellington K

    2018-03-01

    Retrospective cohort. Determine whether surgeon demographic factors influence postoperative complication rates after elective spine fusion procedures. Surgeon demographic factors have been shown to impact decision making in the management of degenerative disease of the lumbar spine. Complication rates are frequently reported outcome measurements used to evaluate surgical treatments, quality-of-care, and determine health care reimbursements. However, there are few studies investigating the association between surgeon demographic factors and complication outcomes after elective spine fusions. A database of US spine surgeons with corresponding postoperative complications data after elective spine fusions was compiled utilizing public data provided by the Centers for Medicare and Medicaid Services (2011-2013) and ProPublica Surgeon Scorecard (2009-2013). Demographic data for each surgeon was collected and consisted of: surgical specialty (orthopedic vs. neurosurgery), years in practice, practice setting (private vs. academic), type of medical degree (MD vs. DO), medical school location (United States vs. foreign), sex, and geographic region of practice. General linear mixed models using a Beta distribution with a logit link and pairwise comparison with post hoc Tukey-Kramer were used to assess the relationship between surgeon demographics and complication rates. 2110 US-practicing spine surgeons who performed spine fusions on 125,787 Medicare patients from 2011 to 2013 met inclusion criteria for this study. None of the surgeon demographic factors analyzed were found to significantly affect overall complication rates in lumbar (posterior approach) or cervical spine fusion. Publicly available complication rates for individual spine surgeons are being utilized by hospital systems and patients to assess aptitude and gauge expectations. The increasing demand for transparency will likely lead to emphasis of these statistics to improve outcomes. We conclude that none of the

  2. A leadership development program for surgeons: First-year participant evaluation.

    Science.gov (United States)

    Pradarelli, Jason C; Jaffe, Gregory A; Lemak, Christy Harris; Mulholland, Michael W; Dimick, Justin B

    2016-08-01

    In a dynamic health care system, strong leadership has never been more important for surgeons. Little is known about how to design and conduct effectively a leadership program specifically for surgeons. We sought to evaluate critically a Leadership Development Program for practicing surgeons by exploring how the program's strengths and weaknesses affected the surgeons' development as physician-leaders. At a large academic institution, we conducted semistructured interviews with 21 surgical faculty members who applied voluntarily, were selected, and completed a newly created Leadership Development Program in December 2012. Interview transcripts underwent qualitative descriptive analysis with thematic coding based on grounded theory. Themes were extracted regarding surgeons' evaluations of the program on their development as physician-leaders. After completing the program, surgeons reported personal improvements in the following 4 areas: self-empowerment to lead, self-awareness, team-building skills, and knowledge in business and leadership. Surgeons felt "more confident about stepping up as a leader" and more aware of "how others view me and my interactions." They described a stronger grasp on "giving feedback" as well as a better understanding of "business/organizational issues." Overall, surgeon-participants reported positive impacts of the program on their day-to-day work activities and general career perspective as well as on their long-term career development plans. Surgeons also recommended areas where the program could potentially be improved. These interviews detailed self-reported improvements in leadership knowledge and capabilities for practicing surgeons who completed a Leadership Development Program. A curriculum designed specifically for surgeons may enable future programs to equip surgeons better for important leadership roles in a complex health care environment. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Breast imaging: a surgeon's prospective

    International Nuclear Information System (INIS)

    Wallace, Anne M.; Comstock, Christopher; Hoh, Carl K.; Vera, David R.

    2005-01-01

    Mammography, ultrasound, magnetic resonance imaging, positron emission tomography, gamma camera and intraoperative gamma detection, and computed tomography are employed in the diagnosis and treatment of breast cancer. This paper summarizes the role of each modality from the perspective of the physician responsible for management of the patient's care. An understanding of an imaging modality's current role can provide insights into the design of new applications and diagnostic agents. Moreover, knowledge of the mechanism by which each modality provides clinical information can guide the design of new imaging methods that complement and add certainty to the patient's management. The reader should note the lack of molecular information provided by the current imaging methods. The perspective concludes with a request for an imaging technique that can measure the biologic aggressiveness of a woman's cancer. The surgeon notes that basing the formation of an image on a molecular process would be compatible with current medical practice, which utilizes molecular concepts to base medical decisions. In addition, molecular imaging will enable rapid translation between basic science and medical practice

  4. Working night shifts affects surgeons' biological rhythm

    DEFF Research Database (Denmark)

    Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob

    2015-01-01

    BACKGROUND: Chronic sleep deprivation combined with work during the night is known to affect performance and compromise residents' own safety. The aim of this study was to examine markers of circadian rhythm and the sleep-wake cycle in surgeons working night shifts. METHODS: Surgeons were monitor...

  5. The Future Medical Science and Colorectal Surgeons.

    Science.gov (United States)

    Kim, Young Jin

    2017-12-01

    Future medical technology breakthroughs will build from the incredible progress made in computers, biotechnology, and nanotechnology and from the information learned from the human genome. With such technology and information, computer-aided diagnoses, organ replacement, gene therapy, personalized drugs, and even age reversal will become possible. True 3-dimensional system technology will enable surgeons to envision key clinical features and will help them in planning complex surgery. Surgeons will enter surgical instructions in a virtual space from a remote medical center, order a medical robot to perform the operation, and review the operation in real time on a monitor. Surgeons will be better than artificial intelligence or automated robots when surgeons (or we) love patients and ask questions for a better future. The purpose of this paper is looking at the future medical science and the changes of colorectal surgeons.

  6. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad

    2014-01-01

    BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... and distributed electronically via e-mail to a total of 1253 members of The Danish Society of Surgeons and The Danish Society of Young Surgeons. RESULTS: In total, 352 (approximately 30%) surgeons completed the questionnaire, 54.4% were over 50 years of age, and 76.6% were men. When choosing surgery, the most...

  7. Being a surgeon--the myth and the reality: a meta-synthesis of surgeons' perspectives about factors affecting their practice and well-being.

    Science.gov (United States)

    Orri, Massimiliano; Farges, Olivier; Clavien, Pierre-Alain; Barkun, Jeffrey; Revah-Lévy, Anne

    2014-11-01

    Synthesize the findings from individual qualitative studies about surgeons' account of their practice. Social and contextual factors of practice influence doctors' well-being and therapeutic relationships. Little is known about surgery, but it is generally assumed that surgeons are not affected by them. We searched international publications (2000-2012) to identify relevant qualitative research exploring how surgeons talk about their practice. Meta-ethnography (a systematic analysis of qualitative literature that compensates for the potential lack of generalizability of the primary studies and provides new insight by their conjoint interpretation) was used to identify key themes and synthesize them. We identified 51 articles (>1000 surgeons) from different specialties and countries. Two main themes emerged. (i) The patient-surgeon relationship, described surgeons' characterizations of their relationships with patients. We identified factors influencing surgical decision making, communication, and personal involvement in the process of care; these were surgeon-related, patient-related, and contextual. (ii) Group relations and culture described perceived issues related to surgical culture (image and education, teamwork, rules, and guidelines); it highlighted the influence of a social dimension on surgical practice. In both themes, we uncovered an emotional dimension of surgeons' practice. Surgeons' emphasis on technical aspects, individuality, and performance seems to impede a modern patient-centered approach to care and to act as a barrier to well-being. Our findings suggest that taking into account the relational and emotional dimensions of surgical practice (both with patients and within the institution) might improve surgical innovation, surgeons' well-being, and the attractiveness of this specialty.

  8. Paediatric Abdominal Surgical Emergencies in a General Surgical ...

    African Journals Online (AJOL)

    ... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

  9. Executive summary

    International Nuclear Information System (INIS)

    2014-01-01

    The workshop included an opening session, six sessions with participant presentations followed by short discussion, and two facilitated discussion sessions. The contributions presented were devoted to new methodological developments, projects with external hazards analysis activities, interesting aspects of external hazards analysis and expected challenges for future analyses. The contributions presented and the discussions organized during the workshop provided valuable input for strengthening the role of WGRISK in supporting the development and application of probabilistic safety assessment and risk-oriented decision making methods in the area of external hazards. The workshop supported the key general objectives of collecting and exchanging information from OECD member states on the methods and approaches used in probabilistic safety assessment in this area. The focus of the workshop was on external events PSA for nuclear power plants, including all modes of operation. The workshop scope was generally limited to external, natural hazards, including those hazards where the distinction between natural and man-made hazards is not sharp (e.g., external floods caused by dam failures). The participation was open to experts from regulatory authorities and their technical support organizations, research organizations, utilities, nuclear power plant (NPP) designers and vendors, industry associations and observers from OECD NEA member countries. The Background, Objectives, Organization, and Topics of the Workshop are presented in chapter 1. The WGRISK activities preceding the workshop and leading to the decision to organize it are described in Chapter 2. The detailed information about the presentations, discussions, and results of the workshop is presented in Chapter 3. Detailed information about the conclusions made during the workshop is presented in Chapter 4. The list of participants, the workshop agenda and the papers/presentations are attached in the appendixes

  10. Body dysmorphia, self-mutilation and the reconstructive surgeon.

    Science.gov (United States)

    Chan, James Kwok-Kwan; Jones, Sophie M; Heywood, Anthony J

    2011-01-01

    Body dysmorphic disorder (BDD) is a disabling preoccupation with a slight or an imagined defect in appearance. It is recognised in some patients who present to the plastic surgeon requesting multiple cosmetic procedures. Very rarely, BDD patients may wish for amputation of a healthy limb and may even mutilate themselves deliberately in order to necessitate amputation. These patients pose a diagnostic challenge as BDD is uncommon and they are often uncooperative whilst appearing mentally sound. Furthermore, they raise difficult ethical and legal issues for the surgeon. Although there is some guidance for the management of BDD patients seeking elective amputation, there is currently none for the management of those who present in the emergency setting. Illustrated by the case of a man who, having failed to find a complicit surgeon, attempted self-amputation of the hand, we review the relevant ethical, legal and management issues with advice by the British Medical Association and General Medical Council. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Leadership theory: implications for developing dental surgeons in primary care?

    Science.gov (United States)

    Willcocks, S

    2011-02-12

    The development of leadership in healthcare has been seen as important in recent years, particularly at the clinical level. There have been various specific initiatives focusing on the development of leadership for doctors, nurses and other health care professions: for example, a leadership competency framework for doctors, the LEO programme and the RCN clinical leadership programme for nurses. The NHS has set up a Leadership Council to coordinate further developments. However, there has not been the same focus in dentistry, although the recent review of NHS dental services (Steele review) has proposed a need for leadership initiatives in NHS dentistry as a medium-term action. Central to this will be a need to focus on the leadership role for dental surgeons. Leadership is all the more important in dentistry, given the change of government and the policy of retrenchment, major public sector reform, the emergence of new organisations such as new commissioning consortia, possible changes to the dental contract, new ways of working, and changes to the profession such as the requirements for the revalidation of dental surgeons. The question is: which leadership theory or approach is best for dental surgeons working in primary care? This paper builds on earlier work exploring this question in relation to doctors generally, and GPs, in particular, and planned work on nurses. It will seek to address this question in relation to dental surgeons working in primary care.

  12. Surgeon and nonsurgeon personalities at different career points.

    Science.gov (United States)

    Drosdeck, Joseph M; Osayi, Sylvester N; Peterson, Laura A; Yu, Lianbo; Ellison, Edwin Christopher; Muscarella, Peter

    2015-06-01

    Previous studies have demonstrated correlations between personality traits and job performance and satisfaction. Evidence suggests that personality differences exist between surgeons and nonsurgeons, some of which may develop during medical training. Understanding these personality differences may help optimize job performance and satisfaction among surgical trainees and be used to identify individuals at risk of burnout. This study aims to identify personality traits of surgeons and nonsurgeons at different career points. We used The Big Five Inventory, a 44-item measure of the five factor model. Personality data and demographics were collected from responses to an electronic survey sent to all faculty and house staff in the Departments of Surgery, Medicine, and Family Medicine at The Ohio State University College of Medicine. Data were analyzed to identify differences in personality traits between surgical and nonsurgical specialties according to level of training and to compare surgeons to the general population. One hundred ninety-two house staff and faculty in surgery and medicine completed the survey. Surgeons scored significantly higher on conscientiousness and extraversion but lower on agreeableness compared to nonsurgeons (all P personality differences between surgical and nonsurgical specialties. The use of personality testing may be a useful adjunct in the residency selection process for applicants deciding between surgical and nonsurgical specialties. It may also facilitate early intervention for individuals at high risk for burnout and job dissatisfaction. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Executive Summary

    International Nuclear Information System (INIS)

    2013-01-01

    This report documents the proceedings of the Workshop on 'Safety Assessment of Fuel Cycle Facilities - Regulatory Approaches and Industry Perspectives' held in Toronto, Canada, on 27-29 September 2011. The workshop was organised by the Committee for the Safety on Nuclear Installations (CSNI) of the OECD/Nuclear Energy Agency (NEA) and hosted by the Canadian Nuclear Safety Commission (CNSC). More than 60 specialists representing 11 countries and international organisations attended the workshop. A total of 31 papers were presented and discussed in open forum. In addition, an opportunity was taken to consider the impacts of the events at Fukushima on Fuel Cycle Facilities (FCFs) in general. Nuclear fuel is produced, processed, and stored mainly in industrial-scale facilities. Uranium ores are processed and refined to produce a pure uranium salt stream, Uranium is converted and enriched, nuclear fuel is fabricated (U fuel and U/Pu fuel for the close cycle option); and spent fuel is stored and in some countries also reprocessed (close cycle option). Facilities dedicated to the research and development of new fuel or new processes are also considered as Fuel Cycle Facilities. The safety assessment of nuclear facilities has often been led by the methodology and techniques initially developed for Nuclear Power Plants (NPPs). As FCFs cover a wide diversity of installations, the various approaches of national regulators, and their technical support organizations (TSO), for the Safety Assessment of Fuel Cycle Facilities are also diverse as are the approaches by their industries in providing safety justifications for their facilities. The objective of this workshop was to review the various approaches of national regulators, and their technical support organizations, in the Safety Assessment of Fuel Cycle Facilities and the experience of their industry in providing safety justification for their facilities. It addressed the present situation in various NEA member

  14. Burnout syndrome in dental surgeons from Lima Metropolitan hospitals

    OpenAIRE

    Robles Velásquez, Ronald; Cáceres Gutiérrez, Lita

    2014-01-01

    This research was carried out in a probabilistic randomized sample of 117 dental surgeons who work in hospitals from the Armed Forces, Social Security and the Ministry of Health (MINSA) from Lima and El Callao, during the months of March and April 2008. Its objective was to determine the levels of the Burnout Syndrome in this population and its association with some socio-demographic, labor and general health variables. The Maslash Burnout Inventory questionnaire, as well as a personal data s...

  15. Projecting surgeon supply using a dynamic model.

    Science.gov (United States)

    Fraher, Erin P; Knapton, Andy; Sheldon, George F; Meyer, Anthony; Ricketts, Thomas C

    2013-05-01

    To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028. The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services. Accurate forecasts of surgical service capacity are crucial to inform the federal government, training institutions, professional associations, and others charged with improving access to health care. The study uses a dynamic stock and flow model that simulates future changes in numbers and specialty type by factoring in changes in surgeon demographics and policy factors. : Forecasts show that overall surgeon supply will decrease 18% during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines. The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas.

  16. Retention of Mohs surgeons in academic dermatology.

    Science.gov (United States)

    Zhang, Shali; Mina, Mary Alice; Brown, Marc D; Zwald, Fiona O

    2015-08-01

    Retention of academic Mohs surgeons is important for the growth of this specialty and teaching of residents and students. To examine factors that influence retention of Mohs surgeons in academics and to better understand reasons for their departure. A survey was electronically distributed to academic Mohs surgeons in the American College of Mohs Surgery, asking them to rate the importance of several variables on their decision to remain in academia. Private practice Mohs surgeons who had left academics were also surveyed. Two hundred thirty-six dermatologic surgeons completed the survey. Twenty-nine percent work full time in academics, and approximately 7% work part time. The top reasons for practicing in the academic setting are intellectual stimulation, teaching opportunities, and collaboration with other university physicians and researchers. Seventy-one percent of respondents reported they would stay in academics, 7% indicated they would not, and 22% were unsure. Unfair compensation, inadequate support staff, poor leadership, increased bureaucracy, and decreased autonomy were top reasons that may compel a Mohs surgeon to leave. Opportunities for intellectual stimulation, collaboration, and teaching remain the main draw for academic Mohs surgeons. A supportive environment, strong leadership, and establishing fair compensation are imperative in ensuring their stay.

  17. Do Surgeons React?: A Retrospective Analysis of Surgeons' Response to Harassment of a Colleague During Simulated Operating Theatre Scenarios.

    Science.gov (United States)

    Gostlow, Hannah; Vega, Camila Vega; Marlow, Nicholas; Babidge, Wendy; Maddern, Guy

    2017-07-24

    To assess and report on surgeons' ability to identify and manage incidences of harassment. The Royal Australasian College of Surgeons is committed to driving out discrimination, bullying, harassment, and sexual harassment from surgical training and practice, through changing the culture of the workplace. To eradicate these behaviors, it is first critical to understand how the current workforce responds to these actions. A retrospective analysis of video data of an operating theatre simulation was conducted to identify how surgeons, from a range of experience levels, react to instances of harassment. Thematic analysis was used to categorize types of harassment and participant response characteristics. The frequency of these responses was assessed and reported. The type of participant response depended on the nature of harassment being perpetuated and the seniority of the participant. In the 50 instances of scripted harassment, active responses were enacted 52% of the time, acknowledgment responses 16%, and no response enacted in 30%. One senior surgeon also perpetuated the harassment (2%). Trainees were more likely to respond actively compared with consultants. It is apparent that trainees are more aware of instances of harassment, and were more likely to intervene during the simulated scenario. However, a large proportion of harassment was unchallenged. The hierarchical nature of surgical education and the surgical workforce in general needs to enable a culture in which the responsibility to intervene is allowed and respected. Simulation-based education programs could be developed to train in the recognition and intervention of discrimination, bullying, harassment and sexual harassment.

  18. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy?

    Science.gov (United States)

    Stefanidis, Dimitrios; Chintalapudi, Nikita; Anderson-Montoya, Brittany; Oommen, Bindhu; Tobben, Daniel; Pimentel, Manuel

    2017-01-01

    The reported incidence (0.16-1.5 %) of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is higher than during open cholecystectomy and has not decreased over time despite increasing experience with the procedure. The "critical view of safety" (CVS) technique may help to prevent BDI when certain criteria are met prior to division of any structures. This study aimed to evaluate the adherence of practicing surgeons to the CVS criteria during LC and the impact of a training intervention on CVS identification. LC procedures of general surgeons were video-recorded. De-identified recordings were reviewed by a blinded observer and rated on a 6-point scale using the previously published CVS criteria. A coaching program was conducted, and participating surgeons were re-assessed in the same manner. The observer assessed ten LC videos, each involving a different surgeon. The CVS was adequately achieved by two surgeons (20 %). The remaining eight surgeons (80 %) did not obtain adequate CVS prior to division of any structures, despite two surgeons dictating that they did; the mean score of this group was 1.75. After training, five participating surgeons (50 %) scored > 4, and the mean increased from 1.75 (baseline) to 3.75 (p < 0.05). The CVS criteria were not routinely used by the majority of participating surgeons. Further, one-fourth of those who claimed to obtain the CVS did so inadequately. All surgeons who participated in training showed improvement during their post-assessment. Our findings suggest that education of practicing surgeons in the application of the CVS during LC can result in increased implementation and quality of the CVS. Pending studies with larger samples, our findings may partly explain the sustained BDI incidence despite increased experience with LC. Our study also supports the value of direct observation of surgical practices and subsequent training for quality improvement.

  19. Lifelong Learning for the Hand Surgeon.

    Science.gov (United States)

    Adkinson, Joshua M; Chung, Kevin C

    2015-09-01

    Hand surgeons are faced with the impossible task of mastering a rapidly expanding pool of knowledge and surgical techniques. Dedication to lifelong learning is, therefore, an essential component of delivering the best, most up-to-date care for patients. Board certification, participation in continuing medical education and maintenance of certification activities, and attendance at national meetings are essential mechanisms by which hand surgeons may foster the acquisition of essential knowledge and clinical skills, This article highlights the history, current status, and emerging needs in continuing medical education for the hand surgeon. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Executive Summary

    International Nuclear Information System (INIS)

    2014-01-01

    and JNES), Sweden (Studsvik Nuclear AB) and USA (SNL), independent experts acting on behalf of the safety regulatory body of Germany (BAM and TUV), operators from France (AREVA) and Germany (GNS), and of the IAEA. The papers discussed the impact of extending storage periods, operational and licensing experiences in storage facilities, results of experiments, and identified necessary R and D to confirm safety of fuel and cask during the long-term storage. For each session, a summary of each paper is given. This part of the proceedings ends with the General Conclusions and Recommendations derived from the workshop

  1. Richard von Volkmann: surgeon and Renaissance man.

    Science.gov (United States)

    Willy, Christian; Schneider, Peter; Engelhardt, Michael; Hargens, Alan R; Mubarak, Scott J

    2008-02-01

    Richard von Volkmann (1830-1889), one of the most important surgeons of the 19(th) century, is regarded as one of the fathers of orthopaedic surgery. He was a contemporary of Langenbeck, Esmarch, Lister, Billroth, Kocher, and Trendelenburg. He was head of the Department of Surgery at the University of Halle, Germany (1867-1889). His popularity attracted doctors and patients from all over the world. He was the lead physician for the German military during two wars. From this experience, he compared the mortality of civilian and war injuries and investigated the general poor hygienic conditions in civilian hospitals. This led him to introduce the "antiseptic technique" to Germany that was developed by Lister. His powers of observation and creativity led him to findings and achievements that to this day bear his name: Volkmann's contracture and the Hueter-Volkmann law. Additionally, he was a gifted writer; he published not only scientific literature but also books of children's fairy tales and poems under the pen name of Richard Leander, assuring him a permanent place in the world of literature as well as orthopaedics.

  2. Executive summary

    International Nuclear Information System (INIS)

    2015-01-01

    routes to fabricate materials and components for innovative nuclear systems. The 'ions vs. neutron irradiation' topic focused on specific irradiation comparisons including mechanical properties and microstructural effects caused by ion or neutron irradiation. Comparative irradiation studies on a common material were also welcome. Fuel-cladding interaction was not covered in this edition of the workshop. The workshop received 74 abstracts, and was scheduled with 5 invited talks, 27 oral presentations and 2 poster sessions (42 posters) from 75 registered participants. However, it was necessary to reorganise the programme at extremely short notice to take into account the effects of the unexpected US government shutdown and the constraints this imposed on the workshop. In total, 38 participants from 12 countries and 2 international organisations attended, and the final number of presentations amounted to 51 (22 oral presentations and 29 posters). The re-scheduled workshop opened with the welcome address by S. Cornet on behalf of the OECD Nuclear Energy Agency followed by technical sessions: Session I: Overview on programmes and metal alloys. Session II: Metal alloys. Session III: Novel pathways. Session IV: Ceramic composites, ions vs. neutrons and general

  3. Career and lifestyle satisfaction among surgeons: what really matters? The National Lifestyles in Surgery Today Survey.

    Science.gov (United States)

    Troppmann, Kathrin M; Palis, Bryan E; Goodnight, James E; Ho, Hung S; Troppmann, Christoph

    2009-08-01

    Optimizing recruitment of the next surgical generation is paramount. Unfortunately, many nonsurgeons perceive surgeons' lifestyle as undesirable. It is unknown, however, whether the surgeons-important opinion makers about their profession-are indeed dissatisfied. We analyzed responses to a survey mailed to all surgeons who were certified by the American Board of Surgery in 1988, 1992, 1996, 2000, and 2004. We performed multivariate analyses to study career dissatisfaction and inability to achieve work-life balance, while adjusting for practice characteristics, demographics, and satisfaction with reimbursement. A total of 895 (25.5%) surgeons responded: mean age was 46 years; 80% were men; 88% were married; 86% had children; 45% were general surgeons; 72% were in urban practice; and 83% were in nonuniversity practice. Surgeons worked 64 hours per week; ideally, they would prefer to work 50 hours per week (median). Fifteen percent were dissatisfied with their careers. On multivariate analysis, significant (p work-life balance. On multivariate analysis, dissatisfaction with reimbursement (OR 3.0) was a significant risk factor. Respondents' lives could be improved by "limiting emergency call" (77%), "diminishing litigation" (92%), and "improving reimbursement" (94%). Most surgeons are satisfied with their careers. Areas in need of improvement, particularly for nonuniversity surgeons, include reimbursement, work hours, and litigation. Strong local and national advocacy may not only improve career satisfaction, but could also render the profession more attractive for those contemplating a surgical career.

  4. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  5. GENERAL SURGERY

    African Journals Online (AJOL)

    could cripple the global economy. Greater attention ... Africa and 5.7 general surgeons per 100 000 in the US.12 One of the key ... 100 000 insured population working in the private sector, which is comparable with the United States (US).

  6. Surgeon-patient communication during awake procedures.

    Science.gov (United States)

    Smith, Claire S; Guyton, Kristina; Pariser, Joseph J; Siegler, Mark; Schindler, Nancy; Langerman, Alexander

    2017-06-01

    Surgeons are increasingly performing procedures on awake patients. Communication during such procedures is complex and underexplored in the literature. Surgeons were recruited from the faculty of 2 hospitals to participate in an interview regarding their approaches to communication during awake procedures. Three researchers used the constant comparative method to transcribe, code, and review interviews until saturation was reached. Twenty-three surgeons described the advantages and disadvantages of awake procedures, their communication with the awake patient, their interactions with staff and with trainees, the environment of awake procedures, and how communication in this context is taught and learned. Surgeons recognized communication during awake procedures as important and reported varied strategies for ensuring patient comfort in this context. However, they also acknowledged challenges with multiparty communication during awake procedures, especially in balancing commitments to teaching with their duty to comfort the patient. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. The Internet and the paediatric surgeon.

    Science.gov (United States)

    Srinivas, M; Inumpudi, A; Mitra, D K

    1998-12-01

    The Internet, which has truly united the world, is an extensive network of inter-linked computers storing immense bytes of information that can be accessed by anyone, transcending all barriers. The paediatric surgery Internet consists of exponentially growing material that deals with information specifically for paediatric surgeons and patients of the paediatric age group. We reviewed the methods available to take advantage of this network to enable busy paediatric surgeons to accrue the benefits easily and efficiently rather than be lost in the information ocean by surfing individually. By getting connected to the Internet, the paediatric surgeon gains enormous information that can be useful for patient care. The Internet has revolutionised scientific publications by virtue of its fast and accurate transmission of manuscripts. Paediatric surgeons can send manuscripts by this channel and also access journals, obviating the inherent lag period of communication by post.

  8. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech (Katrine Tholstrup Pedersen), Katrine Tholstrup

    in surgeons performing MIS is high and derives mainly from static postures. Positioning of monitor, adjustment of table height and instrument design also contribute substantially. Robotic assisted laparoscopy seems less physically demanding for the surgeon compared with conventional laparoscopy. However, some...... put the patients at a higher risk of complications, and on the longer term there is an increasing risk for the surgeon to develop chronic musculoskeletal pain that will disable him/her to perform his/her job. Therefore, surgeons’ musculoskeletal health is of vital importance and must be considered...... alongside patient safety. The present literature study supports the need for a randomized controlled trial evaluating the effect of an individually designed training program for surgeons performing MIS....

  9. Income, productivity, and satisfaction of breast surgeons.

    Science.gov (United States)

    Bendorf, David C; Helmer, Stephen D; Osland, Jacqueline S; Tenofsky, Patty L

    2010-03-01

    The purpose of this study was to assess how the practice patterns of breast surgeons affect their income and job satisfaction. A 19-question survey regarding practice patterns and income and job satisfaction was mailed to all active US members of the American Society of Breast Surgeons. There were 772 responses. An increasing percentage of breast care was associated with lower incomes (P=.0001) and similar income satisfaction (P=.4517) but higher job satisfaction (P=.0001). The increasing proportion of breast care was also associated with fewer hours worked per week (P=.0001). Although incomes were lower in surgeons with a higher proportion of their practice in breast care, income satisfaction was not affected. Although cause and effect relationships between income and breast surgery are difficult to establish, several trends do emerge. Most significantly, we found that dedicated breast surgeons have higher job satisfaction ratings and similar income satisfaction despite lower incomes. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  10. International programme on the health effects of the Chernobyl accident. Report by the Director-General. Executive Board 95. session, provisional agenda item 12

    International Nuclear Information System (INIS)

    1994-10-01

    The International Programme on the Health Effects of the Chernobyl Accident (IPHECA) have been initiated in mid-1991 following its endorsement by the Forty-fourth World Health Assembly in resolution WHA44.36. This report by the Director General outlines the progress made in the implementation of the Programme, and summarises the scientific information obtained to date on the health effects and planned future activities. The major projects under the programme include Thyroid project, Hematology project, Dosimetry and Communication Support Services, Brain Damage in utero project and Epidemiological Registry project

  11. Psychosocial working conditions and work-related stressors among UK veterinary surgeons.

    Science.gov (United States)

    Bartram, David J; Yadegarfar, Ghasem; Baldwin, David S

    2009-08-01

    Anecdotally, veterinary surgeons report high levels of work-related stress. To investigate psychosocial working conditions, self-reported causes of work-related stress and satisfaction among a representative sample of vets practising in the UK. A cross-sectional study using a questionnaire mailed to a stratified random sample of 3200 vets. The Health & Safety Executive Management Standards Indicator Tool and a series of bespoke questions were embedded in a 120 item questionnaire, which also assessed anxiety and depressive symptoms, alcohol consumption, suicidal ideation, positive mental well-being and work-home interaction. A total of 1796 useable questionnaires were returned (response rate 56%). Number of hours worked and making professional mistakes were the main reported contributors to stress. Good clinical outcomes and relationships with colleagues were the greatest sources of satisfaction. Anxiety and depressive symptoms are associated with less favourable working conditions. Compared to the general population, the sample reported higher risk of work-related stress for demands and managerial support but lower risk for relationships and change. The results could be used to inform the development of targeted interventions.

  12. Executable Architecture Research at Old Dominion University

    Science.gov (United States)

    Tolk, Andreas; Shuman, Edwin A.; Garcia, Johnny J.

    2011-01-01

    Executable Architectures allow the evaluation of system architectures not only regarding their static, but also their dynamic behavior. However, the systems engineering community do not agree on a common formal specification of executable architectures. To close this gap and identify necessary elements of an executable architecture, a modeling language, and a modeling formalism is topic of ongoing PhD research. In addition, systems are generally defined and applied in an operational context to provide capabilities and enable missions. To maximize the benefits of executable architectures, a second PhD effort introduces the idea of creating an executable context in addition to the executable architecture. The results move the validation of architectures from the current information domain into the knowledge domain and improve the reliability of such validation efforts. The paper presents research and results of both doctoral research efforts and puts them into a common context of state-of-the-art of systems engineering methods supporting more agility.

  13. Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume.

    Science.gov (United States)

    Saraidaridis, Julia T; Hashimoto, Daniel A; Chang, David C; Bordeianou, Liliana G; Kunitake, Hiroko

    2018-03-01

    General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume. The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models. Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44-0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68-0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78-0.95, p accounting for hospital and surgeon volume.

  14. The Plastic Surgeon at Work and Play: Surgeon Health, Practice Stress, and Work-Home Balance.

    Science.gov (United States)

    Bentz, Michael L

    2016-10-01

    Plastic surgeon wellness encompasses physical and mental health, considered in the context of practice stress. In addition, the challenges of work-home balance can lead to substantial negative impact on the surgeon, family, staff, and patients. The data-driven impact of each of these three components with personal vignettes, both individually and collectively, is presented by Michael Bentz, MD as the 2016 presidential address of American Association of Plastic Surgeons.

  15. Education of the rural surgeon: experience from Tennessee.

    Science.gov (United States)

    Giles, W Heath; Arnold, Joshua D; Layman, Thomas S; Sumida, Michael P; Brown, Preston W; Burns, R Phillip; Cofer, Joseph B

    2009-12-01

    The rural surgery rotation that is contained within the general surgery residency program at The University of Tennessee College of Medicine-Chattanooga is described in this article. The advantages of this experience, including the extensive endoscopy experience and the close exposure to practicing general surgeons, are also outlined. The rotation receives uniformly positive evaluations from residents at completion, and it has become the primary gastrointestinal endoscopy educational experience in this program. The description serves as a model that can be used by other programs to construct a rural surgery rotation.

  16. Surgeon General's Call to Action to Prevent Skin Cancer

    Science.gov (United States)

    ... asafe tan. Atan means you have damaged your skin. FACT: Tanning indoors is not safer than tanning in the ... both dangerous. You can get a burn from tanning indoors. Tanned skin is damaged skin. Although it is important to ...

  17. An audit of nephrectomy by general surgeons | Mungadi | Nigerian ...

    African Journals Online (AJOL)

    Nigerian Journal of Surgical Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 3 (2005) >. Log in or Register to get access to full text downloads.

  18. Venous Thromboembolic Disease Prophylaxis Among General Surgeons in Malaysia

    Directory of Open Access Journals (Sweden)

    Subhita Prasannan

    2005-04-01

    Conclusion: The high incidence of VTE-related complications indicates that the use of thromboprophylaxis is either insufficient or not matched to the level of risk. Updated guidelines on VTE prophylaxis should be used so that a standardized approach can ensure that patients receive adequate prophylaxis where indicated.

  19. Television and Violence: Implications of the Surgeon General's Research Program

    Science.gov (United States)

    Murray, John P.

    1973-01-01

    Reports studies concerning: (a) the characteristics of television program content; (b) the characteristics of the audience--Who watches what? For how long? and, (c) the potential impact of televised violence on the attitudes, values, and behavior of the viewer. (Author/JM)

  20. Young transplant surgeons and NIH funding.

    Science.gov (United States)

    Englesbe, M J; Sung, R S; Segev, D L

    2011-02-01

    Transplant surgeons have historically been instrumental in advancing the science of transplantation. However, research in the current environment inevitably requires external funding, and the classic career development pathway for a junior investigator is the NIH K award. We matched transplant surgeons who completed fellowships between 1998 and 2004 with the NIH funding database, and also queried them regarding research effort and attitudes. Of 373 surgeons who completed a fellowship, only 6 (1.8%) received a K award; of these, 3 subsequently obtained R-level funding. An additional 5 individuals received an R-level grant within their first 5 years as faculty without a K award, 3 of whom had received a prior ASTS-sponsored award. Survey respondents reported extensive research experience during their training (78.8% spent median 24 months), a high proportion of graduate research degrees (36%), and a strong desire for more research time (78%). However, they reported clinical burdens and lack of mentorship as their primary perceived barriers to successful research careers. The very low rate of NIH funding for young transplant surgeons, combined with survey results that indicate their desire to participate in research, suggest institutional barriers to access that may warrant attention by the ASTS and the transplant surgery community. ©2010 The Authors Journal compilation©2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

  1. Designing a leadership development program for surgeons.

    Science.gov (United States)

    Jaffe, Gregory A; Pradarelli, Jason C; Lemak, Christy Harris; Mulholland, Michael W; Dimick, Justin B

    2016-01-01

    Although numerous leadership development programs (LDPs) exist in health care, no programs have been specifically designed to meet the needs of surgeons. This study aimed to elicit practicing surgeons' motivations and desired goals for leadership training to design an evidence-based LDP in surgery. At a large academic health center, we conducted semistructured interviews with 24 surgical faculty members who voluntarily applied and were selected for participation in a newly created LDP. Transcriptions of the interviews were analyzed using analyst triangulation and thematic coding to extract major themes regarding surgeons' motivations and perceived needs for leadership knowledge and skills. Themes from interview responses were then used to design the program curriculum specifically to meet the leadership needs of surgical faculty. Three major themes emerged regarding surgeons' motivations for seeking leadership training: (1) Recognizing key gaps in their formal preparation for leadership roles; (2) Exhibiting an appetite for personal self-improvement; and (3) Seeking leadership guidance for career advancement. Participants' interviews revealed four specific domains of knowledge and skills that they indicated as desired takeaways from a LDP: (1) leadership and communication; (2) team building; (3) business acumen/finance; and (4) greater understanding of the health care context. Interviews with surgical faculty members identified gaps in prior leadership training and demonstrated concrete motivations and specific goals for participating in a formal leadership program. A LDP that is specifically tailored to address the needs of surgical faculty may benefit surgeons at a personal and institutional level. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Management report of the executive board 2005

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    This 2005 report of the executive board of the group AREVA provides information on the following five topics: 1 - asset of financial position and performance with the human resources and the environmental report. 2 - general information on the company and share capital. 3 - the regulated agreements. 4 - information regarding executive management and supervisory bodies. 5 - annual general meeting of shareholders of may 2, 2006 and financial statements and notes. (A.L.B.)

  3. Management report of the executive board 2005

    International Nuclear Information System (INIS)

    2005-01-01

    This 2005 report of the executive board of the group AREVA provides information on the following five topics: 1 - asset of financial position and performance with the human resources and the environmental report. 2 - general information on the company and share capital. 3 - the regulated agreements. 4 - information regarding executive management and supervisory bodies. 5 - annual general meeting of shareholders of may 2, 2006 and financial statements and notes. (A.L.B.)

  4. The Surgeons' Leadership Inventory (SLI): a taxonomy and rating system for surgeons' intraoperative leadership skills.

    Science.gov (United States)

    Henrickson Parker, Sarah; Flin, Rhona; McKinley, Aileen; Yule, Steven

    2013-06-01

    Surgeons must demonstrate leadership to optimize performance and maximize patient safety in the operating room, but no behavior rating tool is available to measure leadership. Ten focus groups with members of the operating room team discussed surgeons' intraoperative leadership. Surgeons' leadership behaviors were extracted and used to finalize the Surgeons' Leadership Inventory (SLI), which was checked by surgeons (n = 6) for accuracy and face validity. The SLI was used to code video recordings (n = 5) of operations to test reliability. Eight elements of surgeons' leadership were included in the SLI: (1) maintaining standards, (2) managing resources, (3) making decisions, (4) directing, (5) training, (6) supporting others, (7) communicating, and (8) coping with pressure. Interrater reliability to code videos of surgeons' behaviors while operating using this tool was acceptable (κ = .70). The SLI is empirically grounded in focus group data and both the leadership and surgical literature. The interrater reliability of the system was acceptable. The inventory could be used for rating surgeons' leadership in the operating room for research or as a basis for postoperative feedback on performance. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. What factors influence attending surgeon decisions about resident autonomy in the operating room?

    Science.gov (United States)

    Williams, Reed G; George, Brian C; Meyerson, Shari L; Bohnen, Jordan D; Dunnington, Gary L; Schuller, Mary C; Torbeck, Laura; Mullen, John T; Auyang, Edward; Chipman, Jeffrey G; Choi, Jennifer; Choti, Michael; Endean, Eric; Foley, Eugene F; Mandell, Samuel; Meier, Andreas; Smink, Douglas S; Terhune, Kyla P; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Joseph B; Lillemoe, Keith D; Fryer, Jonathan P

    2017-12-01

    Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Surgeon preferences regarding antibiotic prophylaxis for ballistic fractures.

    Science.gov (United States)

    Marecek, Geoffrey S; Earhart, Jeffrey S; Gardner, Michael J; Davis, Jason; Merk, Bradley R

    2016-06-01

    Scant evidence exists to support antibiotic use for low velocity ballistic fractures (LVBF). We therefore sought to define current practice patterns. We hypothesized that most surgeons prescribe antibiotics for LVBF, prescribing is not driven by institutional protocols, and that decisions are based on protocols utilized for blunt trauma. A web-based questionnaire was emailed to the membership of the Orthopaedic Trauma Association (OTA). The questionnaire included demographic information and questions about LVBF treatment practices. Two hundred and twenty surgeons responded. One hundred and fifty-four (70 %) respondents worked at a Level-1 trauma center, 176 (80 %) had received fellowship education in orthopaedic trauma and 104 (47 %) treated at least 10 ballistic fractures annually. Responses were analyzed with SAS 9.3 for Windows (SAS Institute Inc, Cary, NC). One hundred eighty-six respondents (86 %) routinely provide antibiotics for LVBF. Those who did not were more apt to do so for intra-articular fractures (8/16, 50 %) and pelvic fractures with visceral injury (10/16, 63 %). Most surgeons (167, 76 %) do not believe the Gustilo-Anderson classification applies to ballistic fractures, and (20/29, 70 %) do not base their antibiotic choice on the classification system. Few institutions (58, 26 %) have protocols guiding antibiotic use for LVBF. Routine antibiotic use for LVBF is common; however, practice is not dictated by institutional protocol. Although antibiotic use generally follows current blunt trauma guidelines, surgeons do not base their treatment decisions the Gustilo-Anderson classification. Given the high rate of antibiotic use for LVBF, further study should focus on providing evidence-based treatment guidelines.

  7. Do Surgeons Treat Their Patients Like They Would Treat Themselves?

    NARCIS (Netherlands)

    Janssen, Stein J.; Teunis, Teun; Guitton, Thierry G.; Ring, David; Spoor, Andy B.; Chauhan, Aakash; Shafritz, Adam B.; Wasterlain, Amy; Terrono, Andrew L.; Neviaser, Andrew S.; Schmidt, Andrew; Nelson, Andy; Miller, Anna N.; Kristan, Anze; Apard, Thomas; Berner, Arne; Ilyas, Asif; Jubel, Axel; Jost, Bernhard; Babis, George; Watkins, Barry; Kreis, Barbara; Nolan, Betsy M.; Crist, Brett D.; Cross, Brian J.; Wills, Brian P. D.; Barreto, Camilo Jose Romero; Ekholm, Carl; Swigart, Carrie; Spath, Catherine; Zalavras, Charalampos; Cassidy, Charles; Garnavos, Christos; Moreno-Serrano, Constanza L.; Rodner, Craig; Klostermann, Cyrus; Osei, Daniel A.; Rikli, Daniel A.; Haverkamp, Daniel; Polatsch, Daniel; Drosdowech, Darren; Edelstein, David M.; Eygendaal, Denise; Verbeek, Diederik O. F.; Doornberg, Job N.; van den Bekerom, Michel P. J.; Schep, Niels; Kloen, Peter; Haverlag, Robert; Schepers, Tim

    2015-01-01

    There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. (1) Are surgeons more likely to recommend surgery when choosing for

  8. Concurrent Surgery and the Role of the Pediatric Attending Surgeon: Comparing Parents' and Surgeons' Expectations.

    Science.gov (United States)

    Choe, Jennie K; Ibarra, Christopher; Feinn, Richard S; Rodriguez-Davalos, Manuel I; Carter, Cordelia W

    2018-06-01

    The common practice of performing concurrent or overlapping operations has been intensely scrutinized by lay media and academic press to investigate its safety and cost-effectiveness. However, there is little information about its use within the pediatric population. Even less is known about parents' expectations about the surgeon's role on the day of operation and how they align with those of pediatric surgeons and surgical trainees, despite the potential for significant discrepancies in expectations to erode trust and damage the physician-family relationship. A 5-point Likert-style survey was designed to characterize expectations about the degree of involvement by pediatric attending surgeons throughout a surgical case (1 = strongly disagree, 3 = neutral, 5 = strongly agree). The survey was administered to parents of pediatric patients undergoing elective operations during a 3-month interval at a single academic institution. The survey was also administered to surgeons and surgical residents at the same institution. Multivariate multiplicity-adjusted t-tests were used to identify significant differences between responders. One hundred and ten parents and 84 pediatric surgeons and trainees completed the survey. Parents' responses to the survey ranged from 4.15 to 4.89, compared with 2.75 to 4.86 from surgeons. The differences achieved statistical significance (p children. There is a significant mismatch between parents' expectations and those of pediatric surgeons about the role of the surgeon on the day of operation, with parents consistently expecting more direct involvement by the attending surgeon. These discrepancies can have implications for both parent/patient satisfaction and medical education. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. 77 FR 51523 - Senior Executive Service Performance Review Board Membership

    Science.gov (United States)

    2012-08-24

    ... COUNCIL OF THE INSPECTORS GENERAL ON INTEGRITY AND EFFICIENCY Senior Executive Service Performance... required to establish one or more Senior Executive Service (SES) performance review boards. The purpose of these boards is to review and evaluate the initial appraisal of a senior executive's performance by the...

  10. Organ procurement from executed prisoners in China.

    Science.gov (United States)

    Sharif, A; Singh, M Fiatarone; Trey, T; Lavee, J

    2014-10-01

    Organ procurement from executed prisoners in China is internationally condemned, yet this practice continues unabated in 2014. This is despite repeated announcements from Chinese authorities that constructive measures have been undertaken to conform to accepted ethical standards. While there is unanimous agreement on the unethical nature of using organs from executed prisoners, due to its limitations on voluntary and informed consent, there is insufficient coverage of forced organ procurement from prisoners of conscience without consent. Strategies to influence positive change in China over the last few decades have failed to bring this practice to an end. While organ donation and transplantation services in China have undergone considerable structural changes in the last few years, fundamental attempts to shift practice to ethically sourced organs have floundered. In this article, we discuss the organ trade in China, reflect upon organ procurement from executed prisoners (including both capital prisoners and prisoners of conscience) and provide an overview of contradictory Chinese efforts to halt forced organ procurement from executed prisoners. Finally, we highlight current actions being taken to address this issue and offer comprehensive recommendations to bring this ethically indefensible practice to an immediate end. © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.

  11. Tutoring executives online

    DEFF Research Database (Denmark)

    Bignoux, Stephane; Sund, Kristian J.

    2018-01-01

    Studies of learning and student satisfaction in the context of online university programmes have largely neglected programmes catering specifically to business executives. Such executives have typically been away from higher education for a number of years, and have collected substantial practical...... experience in the subject matters they are taught. Their expectations in terms of both content and delivery may therefore be different from non-executive students. We explore perceptions of the quality of tutoring in the context of an online executive MBA programme through participant interviews. We find...... that in addition to some of the tutor behaviours already discussed in the literature, executive students look specifically for practical industry knowledge and experience in tutors, when judging how effective a tutor is. This has implications for both the recruitment and training of online executive MBA tutors....

  12. Tutoring Executives Online

    DEFF Research Database (Denmark)

    Bignoux, Stephane; Sund, Kristian J.

    2016-01-01

    Studies of learning and student satisfaction in the context of online university programs have largely neglected programs catering specifically to business executives. Such executives have typically been away from higher education for a number of years, and have collected substantial practical...... experience in the subject matters they are taught. Their expectations in terms of both content and delivery may therefore be different from non-executive students. We explore perceptions of the quality of tutoring in the context of an online executive MBA program through participant interviews. We find...... that in addition to some of the tutor behaviors already discussed in the literature, executive students look specifically for practical industry knowledge and experience in tutors, when judging how effective a tutor is. This has implications for both the recruitment and training of online executive MBA tutors....

  13. Social media and your practice: navigating the surgeon-patient relationship.

    Science.gov (United States)

    McLawhorn, Alexander S; De Martino, Ivan; Fehring, Keith A; Sculco, Peter K

    2016-12-01

    Utilization of social media both in the private and professional arenas has grown rapidly in the last decade. The rise of social media use within health care can be viewed as the Internet-based corollary of the patient-centered care movement, in which patient perspectives and values are central to the delivery of quality care. For orthopedic surgeons and their practices, general-purpose online social networks, such as Facebook and Twitter, are convenient platforms for marketing, providing patient education and generating referrals. Virtual health communities are used less frequently by orthopedic surgeons but provide forums for patient engagement and active surgeon-to-patient communication via blogs and ask-the-doctor platforms. This commentary reviews the current state of social media use in orthopedic practice, with particular emphasis on managing the extension of the surgeon-patient relationship online, including the unique practice risks social media poses, such as privacy concerns, potential liability, and time consumption.

  14. Designing Wearable Personal Assistants for Surgeons: An Egocentric Approach

    DEFF Research Database (Denmark)

    Jalaliniya, Shahram; Pederson, Thomas

    2015-01-01

    The design of general-purpose wearable computers demands particular care for how human perception, cognition, and action work and work together. The authors propose a human body-and-mind centric (egocentric as opposed to device-centric) design framework and present initial findings from deploying...... it in the design of a wearable personal assistant (WPA) for orthopedic surgeons. The result is a Google Glass-based prototype system aimed at facilitating touchless interaction with x-ray images, browsing of electronic patient records (EPR) when on the move, and synchronized ad hoc remote collaboration...

  15. "Back in the day"… what are surgeon bloggers saying about their careers?

    Science.gov (United States)

    Knox, Aaron D C; Reddy, Shalini; Mema, Briseida; DeMoya, Marc; Cilli-Turner, Emily; Harris, Ilene

    2014-01-01

    The projected shortage of general surgeons is owing to an increased demand for surgical services and a declining pool of practicing general surgeons. Burnout and attrition of residents from surgical residencies contribute to the latter. Attrition may be caused by the choice of a career in surgery without an understanding of the realities; subsequent recognition of the realities may cause residents to reexamine the opportunity costs of a career in the field. Because weblogs (blogs) are often used for reflection, qualitative analysis of the content of blogs authored by general surgeons may provide insight into the positive and negative realities of a surgical career. These insights may be informative to students as they consider a surgical career, may better prepare residents for the reality of what is to come, and identify targets for improving the culture of surgery and mitigating sources of career dissatisfaction. This is a qualitative analysis of entries on blogs authored by practicing general surgeons. A systematic approach was used to identify a sample of blog posts. These posts were analyzed using a constant comparative analysis method associated with constructivist grounded theory. Thirty-five posts drawn from 9 blogs were analyzed. Five main themes were identified in the reviewed blogs. Overall, 104 comments were positive in tone, 74 were neutral, and 147 were negative. There were 96 comments that focused on the rewards of being a surgeon, 88 concerning the practice environment, 57 about the educational environment, 54 about the toll of being a surgeon, and 30 pertaining to nostalgia. The most commonly identified subthemes focused on the training experience (38 comments), a surgical career providing personal fulfillment (35 comments), the impact of the culture of surgery (33 comments), and financial concerns (30 comments). A conceptual framework focused on balance was used to explain how the themes relate to each other. Themes identified are consistent with

  16. Solo-Surgeon Retroauricular Approach Endoscopic Thyroidectomy.

    Science.gov (United States)

    Lee, Doh Young; Baek, Seung-Kuk; Jung, Kwang-Yoon

    2017-01-01

    This study aimed to evaluate the feasibility and efficacy of solo-surgeon retroauricular thyroidectomy. For solo-surgery, we used an Endoeye Flex Laparo-Thoraco Videoscope (Olympus America, Inc.). A Vitom Karl Storz holding system (Karl Storz GmbH & Co.) composed of several bars connected by a ball-joint system was used for fixation of endoscope. A snake retractor and a brain-spoon retractor were used on the sternocleidomastoid. Endoscopic thyroidectomy using the solo-surgeon technique was performed in 10 patients having papillary thyroid carcinoma. The mean patient age was 36.0 ± 11.1 years, and all patients were female. There were no postoperative complications such as vocal cord paralysis and hematoma. When compared with the operating times and volume of drainage of a control group of 100 patients who underwent surgery through the conventional retroauricular approach between May 2013 and December 2015, the operating times and volume of drainage were not significantly different (P = .781 and .541, respectively). Solo-surgeon retroauricular thyroidectomy is safe and feasible when performed by a surgeon competent in endoscopic thyroidectomy.

  17. Cardiac Surgeons after Vacation: Refreshed or Rusty?

    Science.gov (United States)

    Welk, Blayne; Winick-Ng, Jennifer; McClure, Andrew; Dubois, Luc; Nagpal, Dave

    2017-10-01

    Many surgeons describe feeling a bit out of practice when they return from a vacation. There have been no studies assessing the impact of surgeon vacation on patient outcomes. We used administrative data from the province of Ontario to identify patients who underwent a coronary artery bypass grafting. Using a propensity score, we matched patients who underwent their procedure immediately after their surgeon returned from vacation of at least 7 days (n = 1,161) to patients who were not operated immediately before or after a vacation period (n = 2,138). There was no significant difference in patient mortality (odds ratio: 1.23, p = 0.52), length of operation (relative risk [RR]: 1.00 p = 0.58), or intensive care unit/ hospital stay (RR: 0.97 p = 0.66/RR: 0.98 p = 0.54, respectively). There was not a significant change in risk of death, operative length, or hospital stay after a surgeon vacation.

  18. The nature of surgeon human capital depreciation.

    Science.gov (United States)

    Hockenberry, Jason M; Helmchen, Lorens A

    2014-09-01

    To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    Directory of Open Access Journals (Sweden)

    Sheikh Asfandyar

    2012-11-01

    Full Text Available Abstract Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6% was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9% was most frequently disagreed. In the event of a medical error, majority (67.7% were ready

  20. Malpractice awareness among surgeons at a teaching hospital in Pakistan.

    Science.gov (United States)

    Sheikh, Asfandyar; Ali, Sajid; Ejaz, Sadaf; Farooqi, Marium; Ahmed, Syed Salman; Jawaid, Imran

    2012-11-06

    The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error to the patient. The most

  1. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    Science.gov (United States)

    2012-01-01

    Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error

  2. 18 December 2013 - P. Kron Chairman and Chief Executive Officer of ALSTOM signing the Guest Book with the Director-General R. Heuer and visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry. Accompanied by P. Fassnacht throughout.

    CERN Multimedia

    Jean-Claude Gadmer

    2013-01-01

    18 December 2013 - P. Kron Chairman and Chief Executive Officer of ALSTOM signing the Guest Book with the Director-General R. Heuer and visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry. Accompanied by P. Fassnacht throughout.

  3. 15 January 2010 - Vice-Chancellor & Chief Executive C. Snowden, University of Surrey, United Kingdom and Mrs Snowden visiting ALICE exhibition and experimental undeground area with Collabortion Spokesperson J. Schukraft and Beams Department Head P. Collier; Signature of the guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    15 January 2010 - Vice-Chancellor & Chief Executive C. Snowden, University of Surrey, United Kingdom and Mrs Snowden visiting ALICE exhibition and experimental undeground area with Collabortion Spokesperson J. Schukraft and Beams Department Head P. Collier; Signature of the guest book with CERN Director-General R. Heuer.

  4. Chairman of the DELL Board of Directors and Chief Executive Officer Michael S. Dell with CERN Director-General R. Heuer and in front of the ATLAS detector (centre) with ATLAS Deputy Spokesperson A. Lankford (left) and Information Technology Department Head F. Hemmer on 26th January 2010.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    Chairman of the DELL Board of Directors and Chief Executive Officer Michael S. Dell with CERN Director-General R. Heuer and in front of the ATLAS detector (centre) with ATLAS Deputy Spokesperson A. Lankford (left) and Information Technology Department Head F. Hemmer on 26th January 2010.

  5. 2 March 2012 - US Google Management Team Executive Chairman E. Schmidt visiting the LHC superconducting magnet test hall with Director for Accelerators and Technology S. Myers and Head of Technology Department F. Bordry; signing the guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice

    2012-01-01

    2 March 2012 - US Google Management Team Executive Chairman E. Schmidt visiting the LHC superconducting magnet test hall with Director for Accelerators and Technology S. Myers and Head of Technology Department F. Bordry; signing the guest book with CERN Director-General R. Heuer.

  6. 13 February 2012 - World Economic Forum Founder and Executive Chairman K. Schwab and Chairperson and Co-Founder Schwab Foundation for Social Entrepreneurship H. Schwab (Mrs)in the ATLAS experimental area at LHC Point 1 with Collaboration Former Spokesperson P. Jenni; signing the guest book with CERN Director-General R. Heuer and Head of International Relations F. Pauss.

    CERN Multimedia

    Jean-Claude Gadmer

    2012-01-01

    13 February 2012 - World Economic Forum Founder and Executive Chairman K. Schwab and Chairperson and Co-Founder Schwab Foundation for Social Entrepreneurship H. Schwab (Mrs)in the ATLAS experimental area at LHC Point 1 with Collaboration Former Spokesperson P. Jenni; signing the guest book with CERN Director-General R. Heuer and Head of International Relations F. Pauss.

  7. 23rd June 2010 - Australian Nuclear Science and Technology Organization Chief Executive Officer A. Paterson signing a Joint Statement of Intent and the guest book with CERN Director-General R. Heuer; in the ATLAS visitor centre and control room with Former Collaboration Spokesperson P. Jenni.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    23rd June 2010 - Australian Nuclear Science and Technology Organization Chief Executive Officer A. Paterson signing a Joint Statement of Intent and the guest book with CERN Director-General R. Heuer; in the ATLAS visitor centre and control room with Former Collaboration Spokesperson P. Jenni.

  8. 31 Jannuary 2012 - Pakistan COMSATS Executive Director I. E. Qureshi visiting the LHC tunnel at Point 2 with ALICE Collaboration Spokesperson P. Giubellino and International Relations Adviser R. Voss; Exchange of gifts and signature of the guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice

    2012-01-01

    31 Jannuary 2012 - Pakistan COMSATS Executive Director I. E. Qureshi visiting the LHC tunnel at Point 2 with ALICE Collaboration Spokesperson P. Giubellino and International Relations Adviser R. Voss; Exchange of gifts and signature of the guest book with CERN Director-General R. Heuer.

  9. Initial experience using a robotic-driven laparoscopic needle holder with ergonomic handle: assessment of surgeons' task performance and ergonomics.

    Science.gov (United States)

    Sánchez-Margallo, Juan A; Sánchez-Margallo, Francisco M

    2017-12-01

    The objective of this study is to assess the surgeons' performance and ergonomics during the use of a robotic-driven needle holder in laparoscopic suturing tasks. Six right-handed laparoscopic surgeons with different levels of experience took part in this study. Participants performed a set of three different intracorporeal suturing tasks organized in ten trials during a period of five weeks. Surgeons used both conventional (Conv) and robotic (Rob) laparoscopic needle holders. Precision using the surgical needle, quality of the intracorporeal suturing performance, execution time and leakage pressure for the urethrovesical anastomosis, as well as the ergonomics of the surgeon's hand posture, were analyzed during the first, fifth and last trials. No statistically significant differences in precision and quality of suturing performance were obtained between both groups of instruments. Surgeons required more time using the robotic instrument than using the conventional needle holder to perform the urethrovesical anastomosis, but execution time was significantly reduced after training ([Formula: see text] 0.05). There were no differences in leakage pressure for the anastomoses carried out by both instruments. After training, novice surgeons significantly improved the ergonomics of the wrist ([Formula: see text] 0.05) and index finger (Conv: 36.381[Formula: see text], Rob: 30.389[Formula: see text]; p = 0.024) when using the robotic instrument compared to the conventional needle holder. Results have shown that, although both instruments offer similar technical performance, the robotic-driven instrument results in better ergonomics for the surgeon's hand posture compared to the use of a conventional laparoscopic needle holder in intracorporeal suturing.

  10. Essays in Executive Compensation

    NARCIS (Netherlands)

    D. Zhang (Dan)

    2012-01-01

    textabstractThis dissertation focuses on how executive compensation is designed and its implications for corporate finance and government regulations. Chapter 2 analyzes several proposals to restrict CEO compensation and calibrates two models of executive compensation that describe how firms would

  11. Ergonomic assessment of the posture of surgeons performing endoscopic transurethral resections in urology

    Directory of Open Access Journals (Sweden)

    Sökeland Jürgen

    2009-10-01

    Full Text Available Abstract Background During transurethral endoscopic prostate and bladder operations the influence of an ergonomic redesign of the arrangement of the operation equipment - including the introduction of a video-assisted resection method ('monitor endoscopy' instead of directly viewing onto the operation area via the endoscope ('direct endoscopy' - was studied with respect to the postures of the surgeons. Methods Postures were analysed on the basis of video recordings of the surgeons performed in the operation theatre during live operations and subsequent visual posture estimation executed by an observer. In particular, head, trunk and arm positions were assigned to posture categories according to a newly developed posture classification schema. 10 urological operations with direct endoscopy and 9 with monitor endoscopy were included. Results Application of direct endoscopy coincides with distinct lateral and sagittal trunk and head inclinations, trunk torsion and strong forearm and upper arm elevations of the surgeons whereas operations with monitor endoscopy were performed with an almost upright head and trunk and hanging arms. The disadvantageous postures observed during direct endoscopy are mainly caused by the necessity to hold the endoscope continuously in close contact with the eye. Conclusion From an ergonomic point of view, application of the video-assisted resection method should be preferred in transurethral endoscopic operations in order to prevent awkward postures of the surgeons and to limit muscular strain and fatigue. Furthermore, the application of the monitor method enables the use of a chair equipped with back support and armrests and benefits the reduction of postural stress.

  12. [Memory and the executive functions].

    Science.gov (United States)

    Tirapu-Ustárroz, J; Muñoz-Céspedes, J M

    The terms 'executive functioning' or 'executive control' refer to a set of mechanisms involved in the improvement of cognitive processes to guide them towards the resolution of complex problems. Both the frontal lobes, acting as structure, and the executive processes, acting as function, work with memory contents, operating with information placed in the diencephalic structures and in the medial temporal lobe. Generally, we can state that many works find an association between frontal damage and specific memory shortages like working memory deficit, metamemory problems, source amnesia, or difficulties in the prospective memory. This paper is a critical review of the working memory concept and proposes a new term: the attentional operative system that works with memory contents. Concerning the metamemory, the frontal lobes are essential for monitoring processes in general and for 'the feeling of knowing' kind of judgements in particular. Patients suffering prefrontal damage show serious problems to remember the information source. Thus, the information is rightly remembered but the spatiotemporal context where that information was learned has been forgotten. Finally, the prospective memory deals with remembering to make something in a particular moment in the future and performing the plan previously drawn up.

  13. Can virtual reality simulators be a certification tool for bariatric surgeons?

    Science.gov (United States)

    Giannotti, Domenico; Patrizi, Gregorio; Casella, Giovanni; Di Rocco, Giorgio; Marchetti, Massimiliano; Frezzotti, Francesca; Bernieri, Maria Giulia; Vestri, Anna Rita; Redler, Adriano

    2014-01-01

    Construct validity of virtual laparoscopic simulators for basic laparoscopic skills has been proposed; however, it is not yet clear whether the simulators can identify the actual experience of surgeons in more complex procedures such as laparoscopic Roux-en-Y gastric bypass. This study tested the ability of the Lap Mentor simulator to recognize the experience in advanced laparoscopic procedures and to assess its role in the certification of bariatric surgeons. Twenty surgeons were divided into two groups according to their experience in laparoscopic and bariatric surgery. The general group included 10 general surgeons performing between 75 and 100 nonbariatric laparoscopic procedures. The bariatric group included 10 bariatric surgeons performing between 50 and 100 laparoscopic bariatric procedures. Participants were tested on the simulator in one basic task (task 1: eye-hand coordination) and in two tasks of the gastric bypass module (task 2: creation of the gastric pouch; task 3: gastrojejunal anastomosis). Comparing the groups, no significant differences were found in task 1. Analyzing the results from the gastric bypass module (bariatric vs. general), in task 2, significant differences (p < 0.05) were found in the median volume of the gastric pouch (21 vs. 48 cm(3)), in the percentage of fundus included in the pouch (8.4 vs. 29.4 %), in the complete dissection at the angle of His (10 vs. 3), and in safety parameters. In task 3, significant differences were found in the size and position of enterotomies. The Lap Mentor may be proposed as a certification tool for bariatric surgeons because it also recognizes their specific skills in the technical details of the procedure that affect long-term results. Furthermore, the possibility of analyzing the performance in detail can help define areas where the surgeon is lacking. These findings indicate a potential role of the Lap Mentor in tailoring the training to maximize improvement.

  14. Executive Compensation and Principal-Agent Theory.

    OpenAIRE

    Garen, John E

    1994-01-01

    The empirical literature on executive compensation generally fails to specify a model of executive pay on which to base hypotheses regarding its determinants. In contrast, this paper analyzes a simple principal-agent model to determine how well it explains variations in CEO incentive pay and salaries. Many findings are consistent with the basic intuition of principle-agent models that compensation is structured to trade off incentives with insurance. However, statistical significance for some...

  15. Outcomes following major emergency gastric surgery: the importance of specialist surgeons.

    Science.gov (United States)

    Khan, O A; McGlone, E R; Mercer, S J; Somers, S S; Toh, S K C

    2015-01-01

    The increasing subspecialisation of general surgeons in their elective work may result in problems for the provision of expert care for emergency cases. There is very little evidence of the impact of subspecialism on outcomes following emergency major upper gastrointestinal surgery. This prospective study investigated whether elective subspecialism of general surgeon is associated with a difference in outcome following major emergency gastric surgery. Between February 1994 and June 2010, the data from all emergency major gastric procedures (defined as patients who underwent laparotomy within 12 hours of referral to the surgical service for bleeding gastroduodenal ulcer and/or undergoing major gastric resection) was prospectively recorded. The sub-specialty interest of operating surgeon was noted and related to post-operative outcomes. Over the study period, a total of 63 major gastric procedures were performed of which 23 (37%) were performed by specialist upper gastrointestinal (UGI) consultants. Surgery performed by a specialist UGI surgeon was associated with a significantly lower surgical complication (4% vs. 28% of cases; p=0.04) and in-patient mortality rate (22% vs. 50%; p=0.03). Major emergency gastric surgery has significantly better clinical outcomes when performed by a specialist UGI surgeon. These results have important implications for provision of an emergency general surgical service. Copyright© Acta Chirurgica Belgica.

  16. Definition of colorectal anastomotic leakage: A consensus survey among Dutch and Chinese colorectal surgeons.

    Science.gov (United States)

    van Rooijen, Stefanus J; Jongen, Audrey Chm; Wu, Zhou-Qiao; Ji, Jia-Fu; Slooter, Gerrit D; Roumen, Rudi Mh; Bouvy, Nicole D

    2017-09-07

    To determine the level of consensus on the definition of colorectal anastomotic leakage (CAL) among Dutch and Chinese colorectal surgeons. Dutch and Chinese colorectal surgeons were asked to partake in an online questionnaire. Consensus in the online questionnaire was defined as > 80% agreement between respondents on various statements regarding a general definition of CAL, and regarding clinical and radiological diagnosis of the complication. Fifty-nine Dutch and 202 Chinese dedicated colorectal surgeons participated in the online survey. Consensus was found on only one of the proposed elements of a general definition of CAL in both countries: 'extravasation of contrast medium after rectal enema on a CT scan'. Another two were found relevant according to Dutch surgeons: 'necrosis of the anastomosis found during reoperation', and 'a radiological collection treated with percutaneous drainage'. No consensus was found for all other proposed elements that may be included in a general definition. There is no universally accepted definition of CAL in the Netherlands and China. Diagnosis of CAL based on clinical manifestations remains a point of discussion in both countries. Dutch surgeons are more likely to report 'subclinical' leaks as CAL, which partly explains the higher reported Dutch CAL rates.

  17. A systematic review of surgeon-patient communication: strengths and opportunities for improvement.

    Science.gov (United States)

    Levinson, Wendy; Hudak, Pamela; Tricco, Andrea C

    2013-10-01

    Effective communication is critical to patient satisfaction, outcomes of care and malpractice prevention. Surgeons need particularly effective communication skills to discuss complicated procedures and help patients make informed choices. We conducted a systematic review of the literature on surgeon-patient communication. Searches were conducted in MEDLINE, PsycINFO, and Sociological Abstract. Two reviewers screened citations and full-text articles. Quality was appraised using the Critical Appraisal Skills Program tool. Studies were categorized into content of communication, patient satisfaction, relationship of communication to malpractice, and duration of visits. 2794 citations and 74 full-text articles, 21 studies and 13 companion reports were included. Surgeons spent the majority of their time educating patients and helping them to make choices. Surgeons were generally thorough in providing details about surgical conditions and treatments. Surgeons often did not explore the emotions or concerns of patients. Potential areas of improvement included discussing some elements of informed decision making, and expressing empathy. Surgeons can enhance their communication skills, particularly in areas of relative deficiency. Studies in primary care demonstrate communication programs are effective in teaching these skills. These can be adapted to surgical training and ultimately lead to improved outcomes and satisfaction with care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  18. Conflict resolution: practical principles for surgeons.

    Science.gov (United States)

    Lee, Liz; Berger, David H; Awad, Samir S; Brandt, Mary L; Martinez, George; Brunicardi, F Charles

    2008-11-01

    Historically, surgeons have had little formal training in conflict resolution; however, there has been an increasing body of evidence that poor conflict resolution skills may have an adverse impact on patient outcomes and career advancement. Furthermore, the Accreditation Council for Graduate Medical Education has recognized the importance of conflict resolution skills in resident training by mandating the training of communication skills and professionalism. These skills have often been taught in other professions, and surgeons may need to acquaint themselves with the literature from those fields. Conflict resolution techniques such as the 7-step model or principle-based conflict resolution can be applied to conflict in the operating room, wards, and among colleagues. We propose a model for conflict resolution by using the basic tools of the history and physical exam, a process well known to all physicians.

  19. Smart apps for the smart plastic surgeon

    Directory of Open Access Journals (Sweden)

    Aniketh Venkataram

    2015-01-01

    Full Text Available Smartphones have the ability to benefit plastic surgeons in all aspects of patient care and education. With the sheer number of applications available and more being created everyday, it is easy to miss out on apps which could be of great relevance. Moreover, the range of android applications available has not been extensively discussed in the literature. To this end, we have compiled an exhaustive list of android smartphone applications, which we feel can help our day to day functioning. The apps have been extensively reviewed and neatly described along with all their potential uses. In addition, we have made an effort to highlight ′non-medical′ or efficiency apps which can improve departmental functioning. These apps have not been described in prior articles, and their functionality might not be known to all. We believe that the technology savvy plastic surgeon can make maximum use of these apps to his benefit.

  20. Professionalism and Commercialism on Cosmetic Surgeons' Websites.

    Science.gov (United States)

    Park, Sung-Yeon; Park, SangHee

    2017-07-01

    This study analyzed the homepages of 250 cosmetic surgeons' websites by focusing on the representation of cosmetic surgery providers, cosmetic surgery recipients, and cosmetic surgery practice itself. Based on a literature review, some common elements of the webpages were preidentified as the indicators of professionalism or commercialism. Subsequently, each homepage was scrutinized for their presence and salience. Overall, cosmetic surgeons' websites were high in professionalism and low in commercialism in their representation of the service providers. In depicting the recipients, the websites were moderate in both professionalism and commercialism. The representation of practice was low in professionalism and moderate in commercialism. Implications of these findings for doctors, regulators, and consumer advocates are discussed and directions for future research are proposed.

  1. Clinical decision making: how surgeons do it.

    Science.gov (United States)

    Crebbin, Wendy; Beasley, Spencer W; Watters, David A K

    2013-06-01

    Clinical decision making is a core competency of surgical practice. It involves two distinct types of mental process best considered as the ends of a continuum, ranging from intuitive and subconscious to analytical and conscious. In practice, individual decisions are usually reached by a combination of each, according to the complexity of the situation and the experience/expertise of the surgeon. An expert moves effortlessly along this continuum, according to need, able to apply learned rules or algorithms to specific presentations, choosing these as a result of either pattern recognition or analytical thinking. The expert recognizes and responds quickly to any mismatch between what is observed and what was expected, coping with gaps in information and making decisions even where critical data may be uncertain or unknown. Even for experts, the cognitive processes involved are difficult to articulate as they tend to be very complex. However, if surgeons are to assist trainees in developing their decision-making skills, the processes need to be identified and defined, and the competency needs to be measurable. This paper examines the processes of clinical decision making in three contexts: making a decision about how to manage a patient; preparing for an operative procedure; and reviewing progress during an operative procedure. The models represented here are an exploration of the complexity of the processes, designed to assist surgeons understand how expert clinical decision making occurs and to highlight the challenge of teaching these skills to surgical trainees. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

  2. Factors Associated With Financial Relationships Between Spine Surgeons and Industry: An Analysis of the Open Payments Database.

    Science.gov (United States)

    Weiner, Joseph A; Cook, Ralph W; Hashmi, Sohaib; Schallmo, Michael S; Chun, Danielle S; Barth, Kathryn A; Singh, Sameer K; Patel, Alpesh A; Hsu, Wellington K

    2017-09-15

    A retrospective review of Centers for Medicare and Medicaid Services Database. Utilizing Open Payments data, we aimed to determine the prevalence of industry payments to orthopedic and neurospine surgeons, report the magnitude of those relationships, and help outline the surgeon demographic factors associated with industry relationships. Previous Open Payments data revealed that orthopedic surgeons receive the highest value of industry payments. No study has investigated the financial relationship between spine surgeons and industry using the most recent release of Open Payments data. A database of 5898 spine surgeons in the United States was derived from the Open Payments website. Demographic data were collected, including the type of residency training, years of experience, practice setting, type of medical degree, place of training, gender, and region of practice. Multivariate generalized linear mixed models were utilized to determine the relationship between demographics and industry payments. A total of 5898 spine surgeons met inclusion criteria. About 91.6% of surgeons reported at least one financial relationship with industry. The median total value of payments was $994.07. Surgeons receiving over $1,000,000 from industry during the reporting period represented 6.6% of the database and accounted for 83.5% of the total value exchanged. Orthopedic training (P regression analysis revealed a strong inverse relationship between years of experience and number of payments from industry (r = -0.967, P Financial relationships between spine surgeons and industry are highly prevalent. Surgeon demographics have a significant association with industry-surgeon financial relationships. Our reported value of payments did not include ownership or research payments and thus likely underestimates the magnitude of these financial relationships. 3.

  3. Surgical "buy-in": the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy.

    Science.gov (United States)

    Schwarze, Margaret L; Bradley, Ciaran T; Brasel, Karen J

    2010-03-01

    There is a general consensus by intensivists and nonsurgical providers that surgeons hesitate to withdraw life-sustaining therapy on their operative patients despite a patient's or surrogate's request to do so. The objective of this study was to examine the culture and practice of surgeons to assess attitudes and concerns regarding advance directives for their patients who have high-risk surgical procedures. A qualitative investigation using one-on-one, in-person interviews with open-ended questions about the use of advance directives during perioperative planning. Consensus coding was performed using a grounded theory approach. Data accrual continued until theoretical saturation was achieved. Modeling identified themes and trends, ensuring maximal fit and faithful data representation. Surgical practices in Madison and Milwaukee, WI. Physicians involved in the performance of high-risk surgical procedures. None. We describe the concept of surgical "buy-in," a complex process by which surgeons negotiate with patients a commitment to postoperative care before undertaking high-risk surgical procedures. Surgeons describe seeking a commitment from the patient to abide by prescribed postoperative care, "This is a package deal, this is what this operation entails," or a specific number of postoperative days, "I will contract with them and say, 'look, if we are going to do this, I am going to need 30 days to get you through this operation.'" "Buy-in" is grounded in a surgeon's strong sense of responsibility for surgical outcomes and can lead to surgeon unwillingness to operate or surgeon reticence to withdraw life-sustaining therapy postoperatively. If negotiations regarding life-sustaining interventions result in treatment limitation, a surgeon may shift responsibility for unanticipated outcomes to the patient. A complicated relationship exists between the surgeon and patient that begins in the preoperative setting. It reflects a bidirectional contract that is assumed by

  4. Surgeon Reliability for the Assessment of Lumbar Spinal Stenosis on MRI: The Impact of Surgeon Experience.

    Science.gov (United States)

    Marawar, Satyajit V; Madom, Ian A; Palumbo, Mark; Tallarico, Richard A; Ordway, Nathaniel R; Metkar, Umesh; Wang, Dongliang; Green, Adam; Lavelle, William F

    2017-01-01

    Treating surgeon's visual assessment of axial MRI images to ascertain the degree of stenosis has a critical impact on surgical decision-making. The purpose of this study was to prospectively analyze the impact of surgeon experience on inter-observer and intra-observer reliability of assessing severity of spinal stenosis on MRIs by spine surgeons directly involved in surgical decision-making. Seven fellowship trained spine surgeons reviewed MRI studies of 30 symptomatic patients with lumbar stenosis and graded the stenosis in the central canal, the lateral recess and the foramen at T12-L1 to L5-S1 as none, mild, moderate or severe. No specific instructions were provided to what constituted mild, moderate, or severe stenosis. Two surgeons were "senior" (>fifteen years of practice experience); two were "intermediate" (>four years of practice experience), and three "junior" (< one year of practice experience). The concordance correlation coefficient (CCC) was calculated to assess inter-observer reliability. Seven MRI studies were duplicated and randomly re-read to evaluate inter-observer reliability. Surgeon experience was found to be a strong predictor of inter-observer reliability. Senior inter-observer reliability was significantly higher assessing central(p<0.001), foraminal p=0.005 and lateral p=0.001 than "junior" group.Senior group also showed significantly higher inter-observer reliability that intermediate group assessing foraminal stenosis (p=0.036). In intra-observer reliability the results were contrary to that found in inter-observer reliability. Inter-observer reliability of assessing stenosis on MRIs increases with surgeon experience. Lower intra-observer reliability values among the senior group, although not clearly explained, may be due to the small number of MRIs evaluated and quality of MRI images.Level of evidence: Level 3.

  5. Current trends in chaperone use by plastic and reconstructive surgeons.

    Science.gov (United States)

    Choudry, Umar; Barta, Ruth J; Kim, Nicholas

    2013-06-01

    There is a paucity of literature regarding the use of chaperones by surgeons when examining patients. Use of a chaperone not only makes the patient comfortable but also potentially protects the surgeon from perceived misconduct. This is especially true for plastic surgeons who examine sensitive areas commonly. The purpose of this study was to determine the current trends in chaperone use by plastic surgeons when examining patients. A 23-question online survey was sent to all members of the American Society of Plastic Surgeons. Data collected online were analyzed using Student t test and Pearson χ test. A P use by plastic surgeons during all examinations of patients was 30%. This rate increased up to 60% while examining sensitive areas. Male surgeons reported a higher frequency of chaperone use than female surgeons (P use compared to reconstructive surgeons (P = 0.001). Similarly, surgeons who had been in practice for more than 20 years reported a higher rate of chaperone use compared to surgeons in practice for less than 20 years (P = 0.032). Sixty-one (7.6%; 56 male and 5 female) surgeons reported being accused of inappropriate behavior by patients, of whom 49 (80%) did not have a chaperone present. There was no significant difference among male and female surgeons in rates of being accused of inappropriate behavior (7.9% vs 4.2%, P = 0.19). There was a higher rate of chaperone use by male plastic surgeons, surgeons with more than 20 years experience, and cosmetic surgeons. Despite the difference in chaperone use between the sexes, both had similar rates of being accused of inappropriate behavior during examinations by patients, and although these incidents were quite low, most had no chaperone present during those examinations.

  6. HISTORICAL NOTE JOHN HUNTER (SURGEON) John Hunter FRS ...

    African Journals Online (AJOL)

    JOHN HUNTER (SURGEON). John Hunter FRS (13 February 1728-16 October 1793) was a Scottish surgeon, one of the most distinguished scientists and surgeons of his day. He was an early advocate of careful observation and scientific method in medicine. He was the husband of Anne Hunter, a teacher, friend and ...

  7. Patient Attitudes Toward Orthopedic Surgeon Ownership of Related Ancillary Businesses.

    Science.gov (United States)

    Yi, Paul H; Cross, Michael B; Johnson, Staci R; Rasinski, Kenneth A; Nunley, Ryan M; Della Valle, Craig J

    2016-08-01

    Physician ownership of businesses related to orthopedic surgery, such as surgery centers, has been criticized as potentially leading to misuse of health care resources. The purpose of this study was to determine patients' attitudes toward surgeon ownership of orthopedic-related businesses. We surveyed 280 consecutive patients at 2 centers regarding their attitudes toward surgeon ownership of orthopedic-related businesses using an anonymous questionnaire. Three surgeon ownership scenarios were presented: (1) owning a surgery center, (2) physical therapy (PT), and (3) imaging facilities (eg, Magnetic Resonance Imaging scanner). Two hundred fourteen patients (76%) completed the questionnaire. The majority agreed that it is ethical for a surgeon to own a surgery center (73%), PT practice (77%), or imaging facility (77%). Most (>67%) indicated that their surgeon owning such a business would have no effect on the trust they have in their surgeon. Although >70% agreed that a surgeon in all 3 scenarios would make the same treatment decisions, many agreed that such surgeons might perform more surgery (47%), refer more patients to PT (61%), or order more imaging (58%). Patients favored surgeon autonomy, however, believing that surgeons should be allowed to own such businesses (78%). Eighty-five percent agreed that patients should be informed if their surgeon owns an orthopedic-related business. Although patients express concern over and desire disclosure of surgeon ownership of orthopedic-related businesses, the majority believes that it is an ethical practice and feel comfortable receiving care at such a facility. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. How surgeons make decisions when the evidence is inconclusive

    NARCIS (Netherlands)

    Hageman, Michiel G. J. S.; Guitton, Thierry G.; Ring, David; Osterman, A. Lee; Spoor, A. B.; van der Zwan, A. L.; Shrivastava, Abhay; Wahegaonkar, Abhijeet L.; Aida, E. Garcia G.; Aita, M. A.; Castillo, Alberto Pérez; Marcus, Alexander; Ladd, Amy; Terrono, Andrew L.; Gutow, Andrew P.; Schmidt, Andrew; Wang, Angela A.; Eschler, Anica; Miller, Anna N.; Wikerøy, Annette K. B.; Barquet, Antonio; Armstrong, April D.; van Vugt, Arie B.; Bedi, Asheesh; Shyam, Ashok K.; Mazzocca, Augustus D.; Jubel, Axel; Babst, Reto H.; Nolan, Betsy M.; Arciero, Bob; Bremer, Vanden; Bamberger, Brent; Peterson, Bret C.; Crist, Brett D.; Cross, Brian J.; Badman, Brian L.; Henley, C. Noel; Ekholm, Carl; Swigart, Carrie; Manke, Chad; Zalavras, Charalampos; Goldfarb, Charles A.; Cassidy, Charles; Cornell, Charles; Getz, Charles L.; Metzger, Charles; Wilson, Chris; Heiss, Christian; Perrotto, Christian J.; Wall, Christopher J.; Walsh, Christopher J.; Garnavos, Christos; Jiang, Chunyan; Lomita, Craig; Torosian, Craig M.; Rikli, Daniel A.; Whelan, Daniel B.; Wascher, Daniel C.; Hernandez, Daniel; Polatsch, Daniel; Beingessner, Daphne; Drosdowech, Darren; Tate, David E.; Hak, David; Rowland, David J.; Kalainov, David M.; Nelson, David; Weiss, David; McKee, Desirae M.; van Deurzen, D. F. G.; Endrizzi, Donald; Erol, Konul; Overbeck, Joachim P.; Baer, Wolfgang; Schwab, Eckart; Maza, Edgardo Ramos; Harvey, Edward; Rodriguez, Edward K.; Preloggler, Elisabeth; Schemitsch, Emil H.; Shin, Eon K.; Hofmeister, Eric P.; Kaplan, Thomas D.; Beeres, F. J. P.; Suarez, Fabio; Fernandes, C. H.; Cayón, Fidel Ernesto Cayón; Dolatowski, Filip Celestyn; Martin, Fischmeister; Sierra, Francisco Javier Aguilar; Lopez-Gonzalez, Francisco; Walter, Frank; Seibert, Franz Josef; Baumgaertel, Fred; Frihagen, Frede; Fuchs, P. C.; Huemer, Georg M.; Kontakis, George; Athwal, George S.; Dyer, George S. M.; Thomas, George; Kohut, Georges; Williams, Gerald; Hernandez, German Ricardo; Caro, Gladys Cecilia Zambrano; Garrigues, Grant; Merrell, Greg; DeSilva, Gregory; Della Rocca, Gregory J.; Regazzi, Gustavo; de Azevedo, Gustavo Borges Laurindo; Ruggiero, Gustavo Mantovani; Helling, H. J.; MccUtchan, Hal; Goost, Hans; Kreder, Hans J.; Hasenboehler, Paula M.; Routman, Howard D.; van der Heide, Huub; Kleinlugtenbelt, I.; McGraw, Iain; Harris, Ian; Ibrahim, Ibrahim Mohammad; Lin, Ines C.; Iossifidis, A.; Andrew, J.; Trenholm, I.; Goslings, J. Carel; Wiater, J. Michael; Choueka, Jack; Ahn, Jaimo; Kellam, James; Biert, Jan; Pomerance, Jay; Johnson, Jeff W.; Greenberg, Jeffrey A.; Yao, Jeffrey; Watson, Jeffry T.; Giuffre, Jennifer L.; Hall, Jeremy; Park, Jin-Young; Fischer, Jochen; Murachovsky, Joel; Howlett, John; McAuliffe, John; Evans, John P.; Taras, John; Braman, Jonathan; Hobby, Jonathan L.; Rosenfeld, Jonathan; Boretto, Jorge; Orbay, Jorge; Rubio, Jorge; Ortiz, Jose A.; Abboud, Joseph; Conflitti, Joseph M.; Vroemen, Joseph P. A. M.; Adams, Julie; Clarke, J. V.; Kabir, K.; Chivers, Karel; Prommersberger, Karl-Josef; Segalman, Keith; Lee, Kendrick; Eng, Kevin; Chhor, Kimberlly S.; Ponsen, K. J.; Jeray, Kyle; Marsh, L.; Poelhekke, L. M. S. J.; Mica, Ladislav; Borris, Lars C.; Halperin, Lawrence; Weiss, Lawrence; Benson, Leon; Elmans, Leon; de Mendonca, Leonardo Alves; Rocha, Leonardo; Katolik, Leonid; Lattanza, Lisa; Taitsman, Lisa; Guenter, Lob; Catalano, Louis; Buendia, Luis Antonio; Austin, Luke S.; Palmer, M. Jason; de Vries, M. R.; Bronkhorst, Maarten W. G. A.; Abdel-Ghany, Mahmoud I.; van de Sande, M. A. J.; Swiontkowski, Marc; Rizzo, Marco; Lehnhardt, Marcus; Pirpiris, Marinis; Baratz, Mark; Lazarus, Mark D.; Boyer, Martin; Richardson, Martin; Kastelec, Matej; Mormino, Matt; Budge, Matthew D.; Turina, Matthias; Wood, Megan M.; Baskies, Michael; Baumgaertner, Michael; Behrman, Michael; Hausman, Michael; Jones, Michael; LeCroy, Michael; Moskal, Michael; Nancollas, Michael; Prayson, Michael; Grafe, Michael W.; Kessler, Michael W.; van den Bekerom, Michel P. J.; Mckee, Mike; Merchant, Milind; Tyllianakis, Minos; Felipe, Naquira Escobar Luis; Chen, Neal C.; Saran, Neil; Wilson, Neil; Shortt, Nicholas L.; Schep, Niels; Rossiter, Nigel; Lasanianos, N. G.; Kanakaris, Nikolaos; Weiss, Noah D.; Harvey, Norah M.; van Eerten, P. V.; Melvanki, Parag; McCulloch, Patrick T.; Martineau, Paul A.; Appleton, Paul; Guidera, Paul; Levin, Paul; Giannoudis, Peter; Evans, Peter J.; Jebson, Peter; Kloen, Peter; Krause, Peter; Brink, Peter R. G.; Peters, J. H.; Blazar, Philip; Streubel, Philipp N.; Inna, Prashanth; Prashanth, S.; Solanki, Punita V.; Wang, Qiugen; Quell, M.; Benafield, R. Bryan; Haverlag, R.; Peters, R. W.; Varma, Rajat; Nyszkiewicz, Ralf; Costanzo, Ralph M.; de Bedout, Ramon; Ranade, Ashish S.; Smith, Raymond Malcolm; Abrams, Reid; Fricker, Renato M.; Omid, Reza; Barth, Richard; Buckley, Richard; Jenkinson, Richard; GIlbert, Richard S.; Page, Richard S.; Wallensten, Richard; Zura, Robert D.; Feibel, Robert J.; Gray, Robert R. L.; Tashijan, Robert; Wagenmakers, Robert; Pesantez, Rodrigo; van Riet, Roger; Norlin, Rolf; Pfeifer, Roman; Liem, Ronald; Kulick, Roy G.; Poolman, Rudolf W.; Shatford, Russell; Klinefelter, Ryan; Calfee, Ryan P.; Moghtaderi, Sam; Sodha, Samir; Sprujt, Sander; Kakar, Sanjeev; Kaplan, Saul; Duncan, Scott; Kluge, Sebastian; Rodriguez-Elizalde, Sebastian; Checchia, Sergio L.; Rowinski, Sergio; Dodds, Seth; Hurwit, Shep; Sprengel, K.; van der Stappen, W. A. H.; Kronlage, Steve; Belded, Steven; Morgan, Steven J.; Rhemrev, Steven J.; Hilliard, Stuart; Gosens, Taco; Sasaki, Takashi; Taleb, C.; Pritsch, Tamir; Tosounidis, Theodoros; Wyrick, Theresa; DeCoster, Thomas; Dienstknecht, Thomas; Stackhouse, Thomas G.; Hughes, Thomas; Wright, Thomas; Ly, Thuan V.; Havenhill, Timothy G.; Omara, Timothy; Siff, Todd; McLaurin, Toni M.; Wanich, Tony; Rueger, Johannes M.; Vallim, Frederico C. M.; Sabesan, Vani J.; Nikolaou, Vasileios S.; Knoll, Victoria D.; Telang, Vidyadhar; Iyer, Vishwanath M.; Jokhi, Vispi; Batson, W. Arnnold; Willems, W. Jaap; Smith, Wade R.; Belangero, William Dias; Wolkenfelt, J.; Weil, Yoram

    2013-01-01

    To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when

  9. The Executive as Integrator.

    Science.gov (United States)

    Cohn, Hans M.

    1983-01-01

    Argues that although the executive has many tasks, he or she must view internal organizational integration as a primary task, making use of organizational charts, job descriptions, statements of goals and objectives, evaluations, and feedback devices. (RH)

  10. Laparoscopy in unexplained abdominal pain: surgeon's perspective

    International Nuclear Information System (INIS)

    Abdullah, M.T.; Waqar, S.H.; Zahid, M.A.

    2016-01-01

    Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Results: Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Conclusion: Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients. (author)

  11. Three good reasons for heart surgeons to understand cardiac metabolism.

    Science.gov (United States)

    Doenst, Torsten; Bugger, Heiko; Schwarzer, Michael; Faerber, Gloria; Borger, Michael A; Mohr, Friedrich W

    2008-05-01

    It is the principal goal of cardiac surgeons to improve or reinstate contractile function with, through or after a surgical procedure on the heart. Uninterrupted contractile function of the heart is irrevocably linked to the uninterrupted supply of energy in the form of ATP. Thus, it would appear natural that clinicians interested in myocardial contractile function are interested in the way the heart generates ATP, i.e. the processes generally referred to as energy metabolism. Yet, it may appear that the relevance of energy metabolism in cardiac surgery is limited to the area of cardioplegia, which is a declining research interest. It is the goal of this review to change this trend and to illustrate the role and the therapeutic potential of metabolism and metabolic interventions for management. We present three compelling reasons why cardiac metabolism is of direct, practical interest to the cardiac surgeon and why a better understanding of energy metabolism might indeed result in improved surgical outcomes: (1) To understand cardioplegic arrest, ischemia and reperfusion, one needs a working knowledge of metabolism; (2) hyperglycemia is an underestimated and modifiable risk factor; (3) acute metabolic interventions can be effective in patients undergoing cardiac surgery.

  12. Comparison of Complications and Surgical Outcomes of Adolescent Idiopathic Scoliosis Between Junior Attending Surgeons and Senior Attending Surgeons.

    Science.gov (United States)

    Qiao, Jun; Xiao, Lingyan; Xu, Leilei; Shi, Benlong; Qian, Bangping; Zhu, Zezhang; Qiu, Yong

    2018-04-24

    To our knowledge, few studies have compared complications and surgical outcomes of adolescent idiopathic scoliosis (AIS) between junior attending surgeons and senior attending surgeons. To compare surgical strategies, complications, and outcomes of posterior corrective surgery for AIS between junior attending surgeons and senior attending surgeons. According to experience level of operation surgeons, the patients were assigned to 2 groups. Group A was the "junior surgeon" group. Group B was the "senior surgeon" group. The following parameters were compared between the 2 groups: age, sex, diagnosis, hospital of record, surgeon experience level, type of instrumentation, type of screws, estimated blood loss, duration of surgery, length of fusion, correction techniques, main curve correction, and thoracic kyphosis correction. A total of 132 patients with AIS were included in group A, whereas 207 were in group B. The translational technique was used more often in group A (P Senior surgeons used more monoaxial screws than junior surgeons (P senior group (P senior group had significant better correction rates of severe main curve (>70°) and thoracic kyphosis than the junior group (P Senior attending surgeons outperformed junior surgeons in blood loss control, thoracic kyphosis correction, and correction of severe curves. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Assessment of surgeon fatigue by surgical simulators

    Directory of Open Access Journals (Sweden)

    Tuwairqi K

    2015-04-01

    Full Text Available Khaled Tuwairqi,1 Jessica H Selter,2 Shameema Sikder3 1College of Medicine, University of Utah, Salt Lake City, UT, 2Johns Hopkins School of Medicine, 3Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA Background: The impact of fatigue on surgical performance and its implications for patient care is a growing concern. While investigators have employed a number of different tools to measure the effect of fatigue on surgical performance, the use of the surgical simulator has been increasingly implemented for this purpose. The goal of this paper is to review the published literature to achieve a better understanding of evaluation of fatigue on performance as studied with surgical simulators. Methods: A PubMed and Cochrane search was conducted using the search terms “simulator”, “surgery”, and “fatigue”. In total, 50 papers were evaluated, and 20 studies were selected after application of exclusion criteria. Articles were excluded if they did not use the simulator to assess the impact of fatigue on surgeon performance. Systematic reviews and case reports were also excluded. Results: Surgeon fatigue led to a consistent decline in cognitive function in six studies. Technical skills were evaluated in 18 studies, and a detrimental impact was reported in nine studies, while the remaining nine studies showed either no change or positive results with regard to surgical skills after experience of fatigue. Two pharmacological intervention studies reversed the detrimental impact of fatigue on cognitive function, but no change or a worsening effect was recognized for technical skills. Conclusion: Simulators are increasingly being used to evaluate the impact of fatigue on the surgeon's performance. With regard to the impact of fatigue in this regard, studies have demonstrated a consistent decline in cognitive function and mixed outcomes for technical skills. Larger studies that relate the simulator's results to real surgical

  14. What expects orthopedic surgeon from bone scan?

    International Nuclear Information System (INIS)

    Sutter, B.; Cazenave, A.

    2003-01-01

    The isotope bone scan continues to be one of the 'lost widely performed nuclear medicine investigations. Beyond the common clinical indication like detection of skeletal metastases, bone scan use is increasing in benign orthopedic conditions, and after orthopedic surgery, despite development of new investigations modalities (US, MRI). Three (or two) phase bone scintigraphy, Single Photon Emission Computer Tomography have increased its value and provided new clinical roles. This review emphasizes through some practical clinical examples how to increase diagnostic value of the method and to offer an adapted response to the orthopedic surgeon's attempts. (author)

  15. The United States Army Battalion Surgeon: Frontline Requirement or Relic of a Bygone Era?

    Science.gov (United States)

    2009-12-11

    Battalion Aid Station BN Battalion BS Battalion Surgeon CBMM Core Battalion Medical Mission DOW Died of Wounds FSO Full Spectrum Operations GMO ...General Medical Officers or GMOs . Young, motivated, and greedy for knowledge, GMOs propelled the field of military medicine forward during...peacetime through analysis, research, and innovation. Their treated populations were small and exceedingly healthy. GMOs had no mission to treat dependents

  16. Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review.

    Science.gov (United States)

    Alleblas, Chantal C J; de Man, Anne Marie; van den Haak, Lukas; Vierhout, Mark E; Jansen, Frank Willem; Nieboer, Theodoor E

    2017-12-01

    The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery. Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic surgery imposes greater ergonomic constraints on surgeons. Recent reports indicate a 73% to 88% prevalence of physical complaints among laparoscopic surgeons, which is greater than in the general working population, supporting the need to address the surgeons' physical health. To summarize the prevalence of MSDs among surgeons performing laparoscopic surgery, we performed a systematic review of studies addressing physical ergonomics as a determinant, and reporting MSD prevalence. On April 15 2016, we searched Pubmed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and PsychINFO. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. We identified 35 articles, including 7112 respondents. The weighted average prevalence of complaints was 74% [95% confidence interval (95% CI) 65-83]. We found high inconsistency across study results (I = 98.3%) and the overall response rate was low. If all nonresponders were without complaints, the prevalence would be 22% (95% CI 16-30). From the available literature, we found a 74% prevalence of physical complaints among laparoscopic surgeons. However, the low response rates and the high inconsistency across studies leave some uncertainty, suggesting an actual prevalence of between 22% and 74%. Fatigue and MSDs impact psychomotor performance; therefore, these results warrant further investigation. Continuous changes are enacted to increase patient safety and surgical care quality, and should also include efforts to improve surgeons' well-being.

  17. Nurse-surgeon object transfer: video analysis of communication and situation awareness in the operating theatre.

    Science.gov (United States)

    Korkiakangas, Terhi; Weldon, Sharon-Marie; Bezemer, Jeff; Kneebone, Roger

    2014-09-01

    One of the most central collaborative tasks during surgical operations is the passing of objects, including instruments. Little is known about how nurses and surgeons achieve this. The aim of the present study was to explore what factors affect this routine-like task, resulting in fast or slow transfer of objects. A qualitative video study, informed by an observational ethnographic approach, was conducted in a major teaching hospital in the UK. A total of 20 general surgical operations were observed. In total, approximately 68 h of video data have been reviewed. A subsample of 225 min has been analysed in detail using interactional video-analysis developed within the social sciences. Two factors affecting object transfer were observed: (1) relative instrument trolley position and (2) alignment. The scrub nurse's instrument trolley position (close to vs. further back from the surgeon) and alignment (gaze direction) impacts on the communication with the surgeon, and consequently, on the speed of object transfer. When the scrub nurse was standing close to the surgeon, and "converged" to follow the surgeon's movements, the transfer occurred more seamlessly and faster (1.0 s). The smoothness of object transfer can be improved by adjusting the scrub nurse's instrument trolley position, enabling a better monitoring of surgeon's bodily conduct and affording early orientation (awareness) to an upcoming request (changing situation). Object transfer is facilitated by the surgeon's embodied practices, which can elicit the nurse's attention to the request and, as a response, maximise a faster object transfer. A simple intervention to highlight the significance of these factors could improve communication in the operating theatre. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Surgeons' Knowledge and Practices Regarding the Role of Radiation Therapy in Breast Cancer Management

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Jessica [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Hawley, Sarah T.; Zikmund-Fisher, Brian J. [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Janz, Nancy K. [Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan (United States); Sabel, Michael S. [Department of Surgery, University of Michigan, Ann Arbor, Michigan (United States); Katz, Steven J. [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2013-12-01

    Purpose: Population-based studies suggest underuse of radiation therapy, especially after mastectomy. Because radiation oncology is a referral-based specialty, knowledge and attitudes of upstream providers, specifically surgeons, may influence patients' decisions regarding radiation, including whether it is even considered. Therefore, we sought to evaluate surgeons' knowledge of pertinent risk information, their patterns of referral, and the correlates of surgeon knowledge and referral in specific breast cancer scenarios. Methods and Materials: We surveyed a national sample of 750 surgeons, with a 67% response rate. We analyzed responses from those who had seen at least 1 breast cancer patient in the past year (n=403), using logistic regression models to identify correlates of knowledge and appropriate referral. Results: Overall, 87% of respondents were general surgeons, and 64% saw >10 breast cancer patients in the previous year. In a scenario involving a 45-year-old undergoing lumpectomy, only 45% correctly estimated the risk of locoregional recurrence without radiation therapy, but 97% would refer to radiation oncology. In a patient with 2 of 20 nodes involved after mastectomy, 30% would neither refer to radiation oncology nor provide accurate information to make radiation decisions. In a patient with 4 of 20 nodes involved after mastectomy, 9% would not refer to radiation oncology. Fewer than half knew that the Oxford meta-analysis revealed a survival benefit from radiation therapy after lumpectomy (45%) or mastectomy (32%). Only 16% passed a 7-item knowledge test; female and more-experienced surgeons were more likely to pass. Factors significantly associated with appropriate referral to radiation oncology included breast cancer volume, tumor board participation, and knowledge. Conclusions: Many surgeons have inadequate knowledge regarding the role of radiation in breast cancer management, especially after mastectomy. Targeted educational

  19. Opportunities in Total Knee Arthroplasty: Worldwide Surgeons' Perspective.

    Science.gov (United States)

    Dunbar, Michael; Newman, Jared M; Khlopas, Anton; Chughtai, Morad; Martinez, Nick; Bhowmik-Stoker, Manoshi; Mont, Michael A

    2017-07-25

    This study surveyed a group of US and international orthopaedic surgeons to prioritize areas of improvement in primary total knee arthroplasty (TKA). Specifically, we assessed surgeon responses regarding the top five areas of TKA needing improvement; which were stratified by: a) US surgeons, b) international surgeons, c) US surgeons' implant-brand-loyalty, and d) surgeons' years of experience and case volume. Four hundred and eighteen surgeons who were board-certified, in practice for at least two years, spent 60% of their time in clinical practice, and performed a minimum of 25 lower extremity joint arthroplasties per year were surveyed. They chose the top five areas (among 17) needing improvement for TKA. Results were stratified by surgeons' location (US and international), implant-brand-loyalty, years of experience, and case volume. Functional outcomes was the top identified area for improvement (US 63% and international 71%), followed by brand loyalty (Company I 68%, other brand 59%, and multi-brand/no loyalty 66%), years of experience (early-career 64%, mid-career 63%, and late-career 75%) and case volume (low-volume 69%, mid-volume 60%, and high-volume 71%). Following this was costs for US surgeons (47%) and implant survivorship for international surgeons (57%). While costs were the next highest area for specific Company-loyal surgeons (57%), implant survivorship was the next highest area for the other two cohorts. Implant survivorship was the second most important area of improvement regardless of years of experience and for low- and mid-volume surgeons. Surgeons identified functional outcomes as the most important area needing improvement. Cost of implants was more important for American as compared to international surgeons.

  20. Perspectives of being spouse, parent, and surgeon.

    Science.gov (United States)

    Murtha, Yvonne

    2013-10-01

    Achieving a balance between one's career and personal life is a never-ending challenge. As a surgeon, add-on cases and double-booked clinics can lead to long hours at work and make availability for family time unpredictable. It may seem like the threat of interruption because of patient needs always loom. Disruptions to family time extend beyond the long hours spent in surgery and clinics. Inattentiveness at home because of the technology tethers that keep one available for constant questions and patient care issues can also distract from time spent with family. Although the practice of an orthopaedic trauma surgeon can involve unpredictable schedules and patient care issues, there are means of mitigating the chaos that can envelop one's personal life as a result of a chosen career track. Clear priorities and expectations in both personal and professional arenas can improve the work-life balance. Flexible jobs that allow for more time with family do exist. Negotiating for this flexibility and self-assurance in holding fast to personal ideals are important in achieving a successful balance.

  1. The world's best-known surgeon.

    Science.gov (United States)

    Walt, A J

    1983-10-01

    Henry Norman Bethune was born in Ontario in 1890 and was to become the best-known physician in the world. Bethune, a thoracic surgeon, spent his professional life in Detroit and Montreal, with these periods separated by a year spent as a patient in a tuberculosis sanatorium. This was where his interest in pulmonary disease was stimulated. Pioneer thoracic surgeon, councillor to the American Association for Thoracic Surgery, artist, poet, polemist, conservative-turned-communist, iconoclast, and soldier, Bethune was a highly complex individual. Diverting his energies from surgery to social issues during the depression, Bethune participated in the Spanish Civil War, at which time he designed the world's first mobile blood transfusion unit. Eight months later, Bethune joined Mao Tse-tung's Eight Route Army in China. In 1939 he died of septicemia acquired from a sliver of infected bone while he was operating on a wounded Chinese patient. Bethune's fame today derives principally from the popularization of his accomplishments by Mao, whom he met once and who subsequently decreed that all in China should learn about him. Bethune's posthumous influence played an important role in the reopening of relations between China and the West.

  2. [Influence of surgeon specialization upon the results of colon cancer surgery. Usefulness of propensity scores].

    Science.gov (United States)

    Martínez-Ramos, D; Escrig-Sos, J; Miralles-Tena, J M; Rivadulla-Serrano, M I; Daroca-José, J M; Salvador Sanchís, J L

    2008-07-01

    surgeon influence on colorectal cancer surgery outcomes has been repeatedly studied in the scientific literature, but conclusions have been contradictory. Here we study whether surgeon specialization is a determinant factor for outcome in these patients. The importance of propensity scores (PS) in surgical research is also studied. a retrospective study was performed and medical records were reviewed for 236 patients who were intervened for colon cancer in Castellon General Hospital (Spain). Cases were divided into two groups (specialist and non-specialist surgeons), and both 5-year surveillance and disease free survival were compared. Comparisons were first made with no adjustments, and then subsequently using PS analysis. the initial (non-adjusted) analysis was clearly favourable for the specialist surgeon group (5-year surveillance, 64.3 vs. 79.3%, p = 0.028). After adjusting for PS no statistical significance was obtained. surgeon specialization had no significant impact on patient outcome after colon cancer surgery. Propensity score analysis is an important tool in the analysis of surgical non-randomized studies, particularly when events under scrutiny are rare.

  3. Burnout in the Plastic Surgeon: Implications and Interventions.

    Science.gov (United States)

    Prendergast, Christina; Ketteler, Erika; Evans, Gregory

    2017-03-01

    A career as a plastic surgeon is both rewarding and challenging. The road to becoming a surgeon is a long arduous endeavor and can bring significant challenges not only to the surgeon but their family. A study by the American College of Surgeons (ACS) suggested that over 40% of surgeons experience burnout and a recent survey of American Society of Plastic Surgeons (ASPS) showed that more than one-fourth of plastic surgeons have signs of professional burnout. Burnout is a state of physical and mental exhaustion. The three main components of burnout are emotional exhaustion, depersonalization, and reduced personal accomplishment. Exhaustion occurs as a result of emotional demands. Depersonalization refers to a cynical, negative or a detached response to patient care. The reduced accomplishment refers to a belief that one can no longer work effectively. There has been a recent explosion in the literature characterizing burnout within the surgical profession. Reports of burnout, burnout victims, and burnout syndrome are filling the medical literature, books, blogs, and social media across all different specialties. Burnout in a plastic surgeon has negative and potentially fatal repercussions to the surgeon, their family, their patients, their staff, colleagues, coworkers, and their organization. To date, there are a limited number of publications addressing burnout in the plastic surgery community. The goals of this paper are to review the symptoms of burnout, its effect on plastic surgeons, and discuss potential solutions for burnout prevention and physician wellness.

  4. MIV Project: Executive Summary

    DEFF Research Database (Denmark)

    Ravazzotti, Mariolina T.; Jørgensen, John Leif; Neefs, Marc

    1997-01-01

    Under the ESA contract #11453/95/NL/JG(SC), aiming at assessing the feasibility of Rendez-vous and docking of unmanned spacecrafts, a reference mission scenario was defined. This report gives an executive summary of the achievements and results from the project.......Under the ESA contract #11453/95/NL/JG(SC), aiming at assessing the feasibility of Rendez-vous and docking of unmanned spacecrafts, a reference mission scenario was defined. This report gives an executive summary of the achievements and results from the project....

  5. Executive dysfunction, brain aging, and political leadership.

    Science.gov (United States)

    Fisher, Mark; Franklin, David L; Post, Jerrold M

    2014-01-01

    Decision-making is an essential component of executive function, and a critical skill of political leadership. Neuroanatomic localization studies have established the prefrontal cortex as the critical brain site for executive function. In addition to the prefrontal cortex, white matter tracts as well as subcortical brain structures are crucial for optimal executive function. Executive function shows a significant decline beginning at age 60, and this is associated with age-related atrophy of prefrontal cortex, cerebral white matter disease, and cerebral microbleeds. Notably, age-related decline in executive function appears to be a relatively selective cognitive deterioration, generally sparing language and memory function. While an individual may appear to be functioning normally with regard to relatively obvious cognitive functions such as language and memory, that same individual may lack the capacity to integrate these cognitive functions to achieve normal decision-making. From a historical perspective, global decline in cognitive function of political leaders has been alternatively described as a catastrophic event, a slowly progressive deterioration, or a relatively episodic phenomenon. Selective loss of executive function in political leaders is less appreciated, but increased utilization of highly sensitive brain imaging techniques will likely bring greater appreciation to this phenomenon. Former Israeli Prime Minister Ariel Sharon was an example of a political leader with a well-described neurodegenerative condition (cerebral amyloid angiopathy) that creates a neuropathological substrate for executive dysfunction. Based on the known neuroanatomical and neuropathological changes that occur with aging, we should probably assume that a significant proportion of political leaders over the age of 65 have impairment of executive function.

  6. Should advertising by aesthetic surgeons be permitted?

    Directory of Open Access Journals (Sweden)

    Neeraj Nagpal

    2017-01-01

    Full Text Available Cosmetic, aesthetic and cutaneous surgical procedures require qualified specialists trained in the various procedures and competent to handle complications. However, it also requires huge investments in terms of infrastructure, trained staff and equipment. To be viable advertising is essential to any establishment which provides cosmetic and aesthetic procedures. Business men with deep pockets establish beauty chains which also provide these services and advertise heavily to sway public opinion in their favour. However, these saloons and spas lack basic medical facilities in terms of staff or equipment to handle any complication or medical emergency. To have a level playing field ethical advertising should be permitted to qualified aesthetic surgeons as is permitted in the US and UK by their respective organisations.

  7. Norman Bethune, Canadian surgeon: his Chinese connection.

    Science.gov (United States)

    Summers, G V

    1983-07-01

    Norman Bethune, a Canadian thoracic surgeon who dabbled in painting, poetry, criticism, teaching and invention, was a member of the Communist Party of Canada. He became involved in two civil wars on opposite sides of the world and amassed both criticism and respect from colleagues and national leaders. The author describes Bethune's time in China, during which he developed front line field hospitals for Mao Tse-tung and his guerrillas in their struggle against the Japanese during 1938 and 1939. His efforts in China on behalf of the wounded brought him into contact with the primitive military medicine of the country and the poverty of its people; it earned for him a local reputation as saviour and benefactor and gave him an honoured place in Chinese military history.

  8. Surgeon-level reporting presented by funnel plot is understood by doctors but inaccurately interpreted by members of the public.

    Science.gov (United States)

    Bhalla, Ashish; Mehrotra, Prerna; Amawi, Falah; Lund, Jonathan N

    2015-01-01

    Risk-adjusted outcome data for general surgeons practicing in the United Kingdom were published for the first time in 2013 with the aim of increasing transparency, improving standards, and providing the public with information to aid decision making. Most specialties used funnel plots to present their data. We assess the ability of members of the public (MoP), medical students, nonsurgical doctors (NSD), and surgeons to understand risk-adjusted surgical outcome data. A fictitious outcome dataset was created and presented in the form of a funnel plot to 10 participants from each of the aforementioned group. Standard explanatory text was provided. Each participant was given 5 minutes to review the funnel plot and complete a questionnaire. For each question, there was only 1 correct answer. Completion rate was 100% (n = 40). No difference existed between NSD and surgeons. A significant difference for identification of the "worst performing surgeon" was noted between surgeons and MoP (p plot significantly "more difficult" to interpret than surgeons did (p < 0.01) and NSD (p < 0.01). MoP found these data significantly more "difficult to understand" and were less likely to both spot "outliers" and use this data to inform decisions than doctors. Surgeons should be aware that outcome data may require an alternative method of presentation to be understood by MoP. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. Executions in The Bahamas

    Directory of Open Access Journals (Sweden)

    Lofquist, William Steele

    2010-01-01

    Full Text Available The stories of those who have been executed in the Bahamas are heretofore untold. In telling these stories and in linking them to the changing course of Bahamian history, the present research adds an important dimension to our understanding of Bahamian history and politics. The major theme of this effort is that the changing practice of the death penalty is much more than a consequence of changes in crime. The use of the death penalty parallels the changing interests of colonial rulers, the changing practice of slavery, and the changing role of the Bahamas in colonial and regional affairs. Four distinctive eras of death penalty practice can be identified: (1 the slave era, where executions and commutations were used liberally and with a clear racial patterning; (2 a long era of stable colonialism, a period of marginalization and few executions; (3 an era of unstable colonialism characterized by intensive and efficient use of the death penalty; and (4 the current independence era of high murder rates and equally high impediments to the use of executions.

  10. School Executive Website Study

    Science.gov (United States)

    Thiede, Robert

    2009-01-01

    The School Executive Website will be a one-stop, online site for officials who are looking for educational data, best practices, product reviews, school documents, professional opinions, and/or job-related networking. The format of the website is designed in certain sections similar to other current and popular websites, such as Angie's List.com,…

  11. Healthcare. Executive Summary

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  12. Risk of ionising radiation to trainee orthopaedic surgeons.

    Science.gov (United States)

    Khan, Ishrat A; Kamalasekaran, Senthil; Fazal, M Ali

    2012-02-01

    We undertook this study to determine the amount of scattered radiation received by the primary surgeon, assistant and patient during dynamic hip screw fixation for proximal femoral fractures. Data was collected from fifty patients. Five registrars were included as operating surgeon and four senior house officers as assistant surgeon. Radiation was monitored by thermo luminescent dosimeters placed on the surgeon and assistant. The approximate distance of surgeon and assistant from the operative site was measured. A dosimeter on the unaffected hip of patients measured the radiation to the patient. The results show that the surgeon's dominant hand receives the highest dose of radiation and radiation exposure is dependent on the experience of the operator. Our study concludes that exposure to radiation during this procedure is well below the toxic levels; however greater awareness is needed for harmful effects of exposure to long term low dose radiation.

  13. EXECUTIVE FUNCTIONING IN SCHIZOPHRENIA

    Directory of Open Access Journals (Sweden)

    Gricel eOrellana

    2013-06-01

    Full Text Available The executive function (EF is a set of abilities, which allows us to invoke voluntary control of our behavioral responses. These functions enable human beings to develop and carry out plans, make up analogies, obey social rules, solve problems, adapt to unexpected circumstances, do many tasks simultaneously and locate episodes in time and place. EF includes divided attention and sustained attention, working memory, set-shifting, flexibility, planning and the regulation of goal directed behavior and can be defined as a brain function underlying the human faculty to act or think not only in reaction to external events but also in relation with internal goals and states. EF is mostly associated with dorsolateral prefrontal cortex (PFC. Besides EF, PFC is involved in self-regulation of behavior, i.e. the ability to regulate behavior according to internal goals and constraints, particularly in less structured situations. Self-regulation of behavior is subtended by ventral medial /orbital PFC. Impairment of EF is one of the most commonly observed deficits in schizophrenia through the various disease stages. Impairment in tasks measuring conceptualization, planning, cognitive flexibility, verbal fluency, ability to solve complex problems and working memory occur in schizophrenia. Disorders detected by executive tests are consistent with evidence from functional neuroimaging, which have shown PFC dysfunction in patients while performing these kinds of tasks. Schizophrenics also exhibit deficit in odor identifying, decision-making and self-regulation of behavior suggesting dysfunction of the orbital PFC. However, impairment in executive tests is explained by dysfunction of prefronto-striato-thalamic, prefronto-parietal and prefronto-temporal neural networks mainly. Disorders in executive functions may be considered central facts with respect to schizophrenia and it has been suggested that negative symptoms may be explained by that executive dysfunction.

  14. 77 FR 62211 - Senior Executive Services (SES) Performance Review Board: Update

    Science.gov (United States)

    2012-10-12

    ... AGENCY FOR INTERNATIONAL DEVELOPMENT Senior Executive Services (SES) Performance Review Board... International Development, Office of Inspector General's Senior Executive Service Performance Review Board... Performance Review Boards. The board shall review and evaluate the initial appraisal of each USAID OIG senior...

  15. Mentorship as Experienced by Women Surgeons in Japan.

    Science.gov (United States)

    Yorozuya, Kyoko; Kawase, Kazumi; Akashi-Tanaka, Sadako; Kanbayashi, Chizuko; Nomura, Sachiyo; Tomizawa, Yasuko

    2016-01-01

    Women have accounted for over 30% of new medical students since 1995 in Japan. Establishing support systems for women surgeons to continue their work is a major issue in Japan. Mentorship can be one of the most effective means to help women surgeons to continue their work. The purpose of this study was to clarify the current status of mentorship among Japanese women surgeons and to discuss the role of mentors for women surgeons. Invitation letters were sent to all female members of the Japan Association of Women Surgeons in April 2011. An 84-item questionnaire survey was sent to those who agreed to participate in this study via the internet. Fifty-five surgeons participated in this study, a response rate of 48.7%. Sixty-seven percent of respondents found it difficult to continue in their job; 85% thought mentorship was necessary for women surgeons to progress in their careers; and 84% reported that they already had a mentor. Respondents thought that a mentor helped them to advance their clinical career, to stay in their job, and to provide moral support. However, mentors appeared to be less useful in helping them to advance their research career, to network, to increase their status, and to achieve a work-life balance. This study revealed areas where mentors appeared to be less helpful to women surgeons. The survey gave an indication of how to help improve and develop the career and personal life of women surgeons in Japan.

  16. [Management abilities of the head surgeon: essential for survival!].

    Science.gov (United States)

    Jähne, J

    2012-04-01

    Due to increased economic challenges in the management of hospitals head surgeons do not only need excellent surgical expertise but also significant management qualities. The personality of head surgeons should include authenticity, sincerity, fairness and the ability to cooperate. Visionary leadership, strategic thinking and strategic management of the personnel are further prerequisites for success. Besides good abilities in communication head surgeons need knowledge of the operating figures for interpretation. To keep up with the own capabilities time and self-management is essential. A survival as head surgeon is likely if these qualities and abilities exist.

  17. 76 FR 61346 - Senior Executive Service Performance Review Board

    Science.gov (United States)

    2011-10-04

    ... DEPARTMENT OF DEFENSE Office of the Secretary Senior Executive Service Performance Review Board AGENCY: Department of Defense Office of Inspector General, Department of Defense (DoD). ACTION: Notice. SUMMARY: This notice announces the appointment of the members of the Senior Executive Service (SES...

  18. Validation of a Comprehensive Executive Learning and Development Measure

    Science.gov (United States)

    Akrofi, Solomon; Clarke, Nicholas; Vernon, Guy

    2011-01-01

    Evaluating the returns on intangible assets in general and executive human capital in particular is still a challenging endeavour. One possible means of addressing this challenge involves developing a broad measure of executive learning and development (L&D), encapsulating both the formal and informal activities that closely reflect the dynamic…

  19. 75 FR 55816 - Senior Executive Service Performance Review Board Membership

    Science.gov (United States)

    2010-09-14

    ... DEPARTMENT OF THE INTERIOR Council of the Inspectors General on Integrity and Efficiency Senior..., each agency is required to establish one or more Senior Executive Service (SES) performance review boards. The purpose of these boards is to review and evaluate the initial appraisal of a senior executive...

  20. 78 FR 52513 - Senior Executive Service Performance Review Board Membership

    Science.gov (United States)

    2013-08-23

    ... COUNCIL OF THE INSPECTORS GENERAL ON INTEGRITY AND EFFICIENCY Senior Executive Service Performance... Management, each agency is required to establish one or more Senior Executive Service (SES) performance review boards. The purpose of these boards is to review and evaluate the initial appraisal of a senior...

  1. Case scheduling preferences of one Surgeon's cataract surgery patients.

    Science.gov (United States)

    Dexter, Franklin; Birchansky, Lee; Bernstein, James M; Wachtel, Ruth E

    2009-02-01

    The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility. Fifty cataract surgery patients seen by a surgeon at his main office during a 6-mo period responded to a marketing survey. All the patients had Medicare insurance and supplemental insurance permitting surgery at any facility. A telephone questionnaire included four vignettes describing different choices in the scheduling of cataract surgery. Respondents were asked how far they would be willing to travel for one option instead of another. For example, "Your surgery will be on Thursday in three weeks at 2 pm. You can drink water until 9 am. You arrive at 10 am, because your surgery might start early. If you travel farther, you would arrive at 8 am for 9 am surgery." The median (50th percentile) additional travel time was 60 min (lower 95% confidence bound >or=52 min) for each of four options: to receive care on a day chosen by the patient instead of assigned by the physician, to receive care at a single site instead of both the surgeon's office and a surgery center at a different location, to combine the examination and the surgery into a single visit instead of two visits, and to have surgery in the morning instead of the afternoon. The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.

  2. Executive control of attention in narcolepsy.

    Directory of Open Access Journals (Sweden)

    Sophie Bayard

    Full Text Available BACKGROUND: Narcolepsy with cataplexy (NC is a disabling sleep disorder characterized by early loss of hypocretin neurons that project to areas involved in the attention network. We characterized the executive control of attention in drug-free patients with NC to determine whether the executive deficits observed in patients with NC are specific to the disease itself or whether they reflect performance changes due to the severity of excessive daytime sleepiness. METHODOLOGY: Twenty-two patients with NC compared to 22 patients with narcolepsy without cataplexy (NwC matched for age, gender, intellectual level, objective daytime sleepiness and number of sleep onset REM periods (SOREMPs were studied. Thirty-two matched healthy controls were included. All participants underwent a standardized interview, completed questionnaires, and neuropsychological tests. All patients underwent a polysomnography followed by multiple sleep latency tests (MSLT, with neuropsychological evaluation performed the same day between MSLT sessions. PRINCIPAL FINDINGS: Irrespective of diagnosis, patients reported higher self-reported attentional complaints associated with the intensity of depressive symptoms. Patients with NC performed slower and more variably on simple reaction time tasks than patients with NwC, who did not differ from controls. Patients with NC and NwC generally performed slower, reacted more variably, and made more errors than controls on executive functioning tests. Individual profile analyses showed a clear heterogeneity of the severity of executive deficit. This severity was related to objective sleepiness, higher number of SOREMPs on the MSLT, and lower intelligence quotient. The nature and severity of the executive deficits were unrelated to NC and NwC diagnosis. CONCLUSIONS: We demonstrated that drug-free patients with NC and NwC complained of attention deficit, with altered executive control of attention being explained by the severity of objective

  3. What executives should remember.

    Science.gov (United States)

    Drucker, Peter F

    2006-02-01

    In more than 30 essays for Harvard Business Review, Peter Drucker (1909-2005) urged readers to take on the hard work of thinking--always combined, he insisted, with decisive action. He closely analyzed the phenomenon of knowledge work--the growing call for employees who use their minds rather than their hands--and explained how it challenged the conventional wisdom about the way organizations should be run. He was intrigued by employees who knew more about certain subjects than their bosses or colleagues but who still had to cooperate with others in a large organization. As the business world matured in the second half of the twentieth century, executives came to think that they knew how to run companies--and Drucker took it upon himself to poke holes in their assumptions, lest organizations become stale. But he did so sympathetically, operating from the premise that his readers were intelligent, hardworking people of goodwill. Well suited to HBR's format of practical, idea-based essays for executives, his clear-eyed, humanistic writing enriched the magazine time and again. This article is a compilation of the savviest management advice Drucker offered HBR readers over the years--in short, his greatest hits. It revisits the following insightful, influential contributions: "The Theory of the Business" (September-October 1994), "Managing for Business Effectiveness" (May-June 1963), "What Business Can Learn from Nonprofits" (July-August 1989), "The New Society of Organizations" (September-October 1992), "The Information Executives Truly Need" (January-February 1995), "Managing Oneself" (March-April 1999 republished January 2005), "They're Not Employees, They're People" (February 2002), "What Makes an Effective Executive" (June 2004).

  4. INTERNATIONALIZATION OF CHINESE EXECUTIVES

    OpenAIRE

    Lingfang Fayol-Song

    2012-01-01

    Over the last two decades, Chinese nationals have increasingly been employed by multinational companies (MNCs) operating in China taking positions previously occupied by foreign expatriates from investor countries. The development of local managers has therefore become crucial in the field of human resource management because the success of these companies depends greatly upon the ability and competence of their executive management class. The present paper addresses the issue of how to devel...

  5. The attitude and perceptions of work-life balance: a comparison among women surgeons in Japan, USA, and Hong Kong China.

    Science.gov (United States)

    Kawase, Kazumi; Kwong, Ava; Yorozuya, Kyoko; Tomizawa, Yasuko; Numann, Patricia J; Sanfey, Hilary

    2013-01-01

    The objective of the present study was to explore how women surgeons manage their work-life balance in three environmental and cultural settings. Members of the Japan Association of Women Surgeons (JAWS), the United States of America (US) based Association of Women Surgeons (AWS), and the Women's Chapter of the College of Surgeons of Hong Kong (WCHK) were surveyed. Among 822 women surgeons contacted, 252 responded (response rate 31.8 %; 55.5 % JAWS, 28.2 % AWS, and 25.3 % WCHK). Japanese women surgeons think that work is the number one priority, whereas US and Hong Kong China (HK) respondents think the number one priority is home life. Work satisfaction level was generally high among women surgeons in all countries; however, 19 % of US surgeons are somewhat dissatisfied with their work and 76.1 % think that men are treated more favorably than women at work. Whereas 51.6 % of Japanese women surgeons think that men are treated more favorably than women at home, at the same time they placed more importance on the role of women in the family. More than half of Japanese women surgeons are "uncertain" about their career path in the future, whereas 55.2/87.1 % of US/HK respondents are optimistic. All surgeons recommended expanding support for child rearing or nursing care during work hours, promoting a flexible work schedule and changing some of the older conventional ideas about gender role. It is essential to address women surgeons' concerns to enable them to have a clearer vision and a challenging career, and to be more certain about their personal and professional goals.

  6. Concurrent Models for Object Execution

    OpenAIRE

    Diertens, Bob

    2012-01-01

    In previous work we developed a framework of computational models for the concurrent execution of functions on different levels of abstraction. It shows that the traditional sequential execution of function is just a possible implementation of an abstract computational model that allows for the concurrent execution of functions. We use this framework as base for the development of abstract computational models that allow for the concurrent execution of objects.

  7. (Mis)perceptions about intimate partner violence in women presenting for orthopaedic care: a survey of Canadian orthopaedic surgeons.

    Science.gov (United States)

    Bhandari, Mohit; Sprague, Sheila; Tornetta, Paul; D'Aurora, Valerie; Schemitsch, Emil; Shearer, Heather; Brink, Ole; Mathews, David; Dosanjh, Sonia

    2008-07-01

    Domestic violence is the most common cause of nonfatal injury to women in North America. In a review of 144 such injuries, the second most common manifestation of intimate partner violence was musculoskeletal injuries (28%). The American Academy of Orthopaedic Surgeons is explicit that orthopaedic surgeons should play a role in the screening and appropriate identification of victims. We aimed to identify the perceptions, attitudes, and knowledge of Canadian orthopaedic surgeons with regard to intimate partner violence. We surveyed members of the Canadian Orthopaedic Association to identify attitudes toward intimate partner violence. With use of a systematic random sample, 362 surgeons were mailed questionnaires. The questionnaire consisted of three sections: (1) the general attitude of the orthopaedic surgeon toward intimate partner violence, (2) the attitude of the orthopaedic surgeon toward victims and batterers, and (3) the clinical relevance of intimate partner violence in orthopaedic surgery. Up to three follow-up mailings were performed to enhance response rates. A total of 186 orthopaedic surgeons responded (a response rate of 51%), and 167 (91%) of them were men. Most orthopaedic surgeons (95%) estimated that <10% of their patients were victims of intimate partner violence, and most respondents (80%) believed that it was exceedingly rare (a prevalence of <1%). The concept of mandatory screening for intimate partner violence was met with uncertainty by 116 surgeons (64%). Misconceptions were perpetuated by surgeons who believed that inquiring about intimate partner violence was an invasion of the victim's privacy, that investigating intimate partner violence was not part of their duty, that victims choose to be a victim, and that victims play a proactive role in causing their abuse. By the completion of the survey, the majority of surgeons (91%) believed that knowledge about intimate partner violence was relevant to their surgical practice. Discomfort with

  8. [Surgeons and Neurosurgeons as Nobel Prize Winners].

    Science.gov (United States)

    Chrastina, Jan; Jančálek, Radim; Hrabovský, Dušan; Novák, Zdeněk

    Since 1901 Nobel Prize is awarded for exceptional achievements in physics, chemistry, literature, peace, economy (since 1968) and medicine or physiology. The first aim of the paper is to provide an overview of surgeons - winners of Nobel Prize for medicine or physiology. Although the prominent neurosurgeons were frequently nominated as Nobel Prize candidates, surprisingly no neurosurgeon received this prestigious award so far despite that the results of their research transgressed the relatively narrow limits of neurosurgical speciality.The most prominent leaders in the field of neurosurgery, such as Victor Horsley, Otfrid Foerster, Walter Dandy and Harvey Cushing are discussed from the point of their nominations. The overview of the activity of the Portuguese neurologists and Nobel Prize Winter in 1949 Egas Moniz (occasionally erroneously reported as neurosurgeon) is also provided. Although his work on brain angiography has fundamentally changed the diagnostic possibilities in neurology and neurosurgery, he was eventually awarded Nobel Prize for the introduction of the currently outdated frontal lobotomy.The fact that none of the above mentioned prominent neurosurgeons has not been recognised by Nobel Prize, may be attributed to the fact that their extensive work cannot be captured in a short summary pinpointing its groundbreaking character.

  9. Nanotechnology tolls the bell for plastic surgeons.

    Science.gov (United States)

    Salehahmadi, Zeinab; Hajiliasgari, Fatemeh

    2013-06-01

    Nanotechnology is an emerging discipline, having power to revolutionarize every scientific field to a very deep level which previously thought to be a science fiction. Having a great potential to beneficially change the way a disease is diagnosed, treated and prevented, nanotechnology practically impacts on state of the art healthcare technologies and plays a crucial role in changing the field of surgery. Surgeons are constantly looking for minimally invasive ways to treat their patients, as recovery is faster when a lesser trauma is inflicted upon a patient, scarring is lessened and there are usually fewer complications in the aftermath of the operation. Through nanotechnology, tiny biosensors could be constructed which could take these factors into account, thus shortening the patient recovery period and saving hospitals money, reducing infection rates within the hospital, reducing the waiting lists for operation and allowing doctors to treat more patients in the same period of time. This review employs a thematic analysis of online series of academic papers focuses on the potentials of nanotechnology in surgery, especially in plastic surgery and addresses the possible future prospects of nanotechnology in this field.

  10. Augmented reality for the surgeon: Systematic review.

    Science.gov (United States)

    Yoon, Jang W; Chen, Robert E; Kim, Esther J; Akinduro, Oluwaseun O; Kerezoudis, Panagiotis; Han, Phillip K; Si, Phong; Freeman, William D; Diaz, Roberto J; Komotar, Ricardo J; Pirris, Stephen M; Brown, Benjamin L; Bydon, Mohamad; Wang, Michael Y; Wharen, Robert E; Quinones-Hinojosa, Alfredo

    2018-04-30

    Since the introduction of wearable head-up displays, there has been much interest in the surgical community adapting this technology into routine surgical practice. We used the keywords augmented reality OR wearable device OR head-up display AND surgery using PubMed, EBSCO, IEEE and SCOPUS databases. After exclusions, 74 published articles that evaluated the utility of wearable head-up displays in surgical settings were included in our review. Across all studies, the most common use of head-up displays was in cases of live streaming from surgical microscopes, navigation, monitoring of vital signs, and display of preoperative images. The most commonly used head-up display was Google Glass. Head-up displays enhanced surgeons' operating experience; common disadvantages include limited battery life, display size and discomfort. Due to ergonomic issues with dual-screen devices, augmented reality devices with the capacity to overlay images onto the surgical field will be key features of next-generation surgical head-up displays. Copyright © 2018 John Wiley & Sons, Ltd.

  11. Exposure of the orthopaedic surgeon to radiation

    Energy Technology Data Exchange (ETDEWEB)

    Katoh, Kiyonobu; Koga, Takamasa; Matsuzaki, Akio; Kido, Masaki; Satoh, Tetsunori [Fukuoka Univ. (Japan). Chikushi Hospital

    1995-09-01

    We monitored the amount of radiation received by surgeons and assistants during surgery carried out with fluoroscopic assistance. The radiation was monitored with the use of MYDOSE MINIX PDM107 made by Aloka Co. Over a one year period from Aug 20, 1992 to Aug 19, 1993, a study was undertaken to evaluate exposure of the groin level to radiation with or without use of the lead apron during 106 operation (Group-1). In another group, radiation was monitored at the breast and groin level outside of the lead apron during 39 operations (Group-2). In Group-1, the average exposure per person during one year was 46.0 {mu}SV and the average exposure for each procedure was 1.68 {mu}SV. The use of the lead apron affirmed its protective value; the average radiation dose at the groin level out-side of the apron was 9.11 {mu}SV, the measured dose beneath the apron 0.61 {mu}SV. The average dose of exposure to the head, breast at groin level outside of the lead apron, were 7.68 {mu}SV, 16.24 {mu}SV, 32.04 {mu}SV respectively. This study and review of the literature indicate that the total amount of radiation exposure during surgery done with fluoroscopic control remains well within maximum exposure limits. (author).

  12. Exposure of the orthopaedic surgeon to radiation

    International Nuclear Information System (INIS)

    Katoh, Kiyonobu; Koga, Takamasa; Matsuzaki, Akio; Kido, Masaki; Satoh, Tetsunori

    1995-01-01

    We monitored the amount of radiation received by surgeons and assistants during surgery carried out with fluoroscopic assistance. The radiation was monitored with the use of MYDOSE MINIX PDM107 made by Aloka Co. Over a one year period from Aug 20, 1992 to Aug 19, 1993, a study was undertaken to evaluate exposure of the groin level to radiation with or without use of the lead apron during 106 operation (Group-1). In another group, radiation was monitored at the breast and groin level outside of the lead apron during 39 operations (Group-2). In Group-1, the average exposure per person during one year was 46.0 μSV and the average exposure for each procedure was 1.68 μSV. The use of the lead apron affirmed its protective value; the average radiation dose at the groin level out-side of the apron was 9.11 μSV, the measured dose beneath the apron 0.61 μSV. The average dose of exposure to the head, breast at groin level outside of the lead apron, were 7.68 μSV, 16.24 μSV, 32.04 μSV respectively. This study and review of the literature indicate that the total amount of radiation exposure during surgery done with fluoroscopic control remains well within maximum exposure limits. (author)

  13. Development and evaluation of accessories to improve the posture of veterinary surgeons in surgical procedures conducted in the field

    Directory of Open Access Journals (Sweden)

    V.A.S. Vulcani

    Full Text Available ABSTRACT The study was conducted based on the information collected on rural properties in the state of Goiás, during practical classes of Surgical Clinic in Large Animals at the Veterinary Hospital of the Escola de Veterinária e Zootecnia of the Universidade Federal de Goiás and during the implementation of outreach projects developed by the institution. An acropostite-phimosis surgical procedure in the bulls in the field was selected, lasting over 30 minutes and requiring movements, posture and strength on the part of the surgeon. Devices were proposed and developed to provide improved comfort and safety to surgeons. The first device was a stool to be used by the professional during the execution of the surgical intervention. The use enabled the surgeon to sit down and rest their feet on the ground, reducing knee bending and distributing the support forces in various muscle groups. For the movement restriction of the surgeon, another accessory was developed to support the foreskin of the animal. Made of wood, this other device serves as a support for keeping the foreskin away from the ground and close to the surgeon. Its length, width and thickness established a good relation with the stool height, providing minimal discomfort to the professional. The third device was designed to assist in the immobilization of the animal and increase safety for the patient and surgical team. A fourth accessory was designed to protect the scapular region and avoid the occurrence of injuries in the radial nerve, myopathies and traumas during the rollover or prolonged stay of the animal in lateral decubitus. The choice of the shape, dimensions and softness of the device was mainly based on the weight of the animal. Such devices have proven to be effective, reducing the time of surgery, making cervical and lumbar movement easier, in addition to providing better support to the surgeon, reducing risks of musculoskeletal diseases.

  14. Executive Energy Leadership Academy | NREL

    Science.gov (United States)

    Executive Energy Leadership Academy Executive Energy Leadership Academy NREL's Executive Energy Leadership Academy is a nationally renowned program that provides non-technical business, governmental, and foreground. Leadership Program The Leadership Program is designed for community and industry leaders with an

  15. Surgeons' Leadership Styles and Team Behavior in the Operating Room.

    Science.gov (United States)

    Hu, Yue-Yung; Parker, Sarah Henrickson; Lipsitz, Stuart R; Arriaga, Alexander F; Peyre, Sarah E; Corso, Katherine A; Roth, Emilie M; Yule, Steven J; Greenberg, Caprice C

    2016-01-01

    The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations. We videorecorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p leadership and its impact on team performance in the operating room. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development, therefore, has the potential to improve the efficiency and safety of operative care. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. ORIGINAL ARTICLES Surgeons and HIV: South African attitudes

    African Journals Online (AJOL)

    2009-02-01

    Feb 1, 2009 ... Local policies and those from developed countries may not .... National Health Act 61 of 2003, such information (surgeon HIV ... specialist surgeon trainees established that 91% did not think .... 2008 Report on the Global AIDS ... Schulman KA, McDonald RC, Lynn LA, Frank I, Christakis NA, Schwartz JS.

  17. The anatomy lessons of the Amsterdam Guild of Surgeons

    NARCIS (Netherlands)

    IJpma, F.F.A.

    2014-01-01

    Mandatory lessons in anatomy, taught by the praelector anatomiae (lecturer in anatomy) of the Amsterdam Guild of Surgeons, were an important part of the surgical training starting in the 16th century. We describe how surgeons were trained approximately 350 years ago at the Surgeons’ Guild. The role

  18. Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty.

    Science.gov (United States)

    Wasterlain, Amy S; Bello, Ricardo J; Vigdorchik, Jonathan; Schwarzkopf, Ran; Long, William J

    2017-09-01

    Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (Pnew implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 2017; 40(5):e825-e830.]. Copyright 2017, SLACK Incorporated.

  19. Effect of Individual Surgeons and Anesthesiologists on Operating Room Time

    NARCIS (Netherlands)

    van Eijk, Ruben P A; van Veen-Berkx, Elizabeth; Kazemier, Geert; Eijkemans, Marinus J C

    BACKGROUND:: Variability in operating room (OR) time causes overutilization and underutilization of the available ORs. There is evidence that for a given type of procedure, the surgeon is the major source of variability in OR time. The primary aim was to quantify the variability between surgeons and

  20. Review of CD Rom: The Virtual Surgeon: ACL Reconstruction ...

    African Journals Online (AJOL)

    THE VIRTUAL SURGEON: ACL RECONSTRUCTION Professor George Bentley ChM FRCS, Russell E LVindsor MD, Mr Andrew Williams FRCS(0rth); 4150 + VAT(UK) The Virtual Surgeon - 3D Anatomy of the Knee 469 + VAT(UK). TVF Multimedia Ltd, 375 City Road, London, EClV lNB, UK ...

  1. Role of Surgeons in Determining Outcome of Histopathology ...

    African Journals Online (AJOL)

    Conclusion: To ensure the quality of histopathological diagnosis with minimal turnaround time, the surgeon plays a vital role by ensuring adequate and prompt fixation of tissue biopsies, put in the right container and accompanied by well labeled request cards. Keywords: Formalin, fixative, outcome, pathologist, surgeon ...

  2. Ultrasound of the acute abdomen performed by surgeons in training

    DEFF Research Database (Denmark)

    Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.

    2008-01-01

    , specificity and kappa-agreement of the surgeon performed ultrasound examination was 1.00 (0.77-1.00), 0.96 (0.79-0.99), 0.94 (0.3-1.00) and 0.40 (0.12-0.77), 0.97 (0.83-0.99), 0.44 (0.00-0.96); respectively. Visualization of the common bile duct was poor having 73% non-diagnostic surgeon-performed ultrasound...... perform valid abdominal ultrasound examinations of patients referred with acute abdominal pain. METHODS: Patients referred with acute abdominal pain had an ultrasound examination by a surgeon in training as well as by an experienced consultant radiologist whose results served as the gold standard. All...... participating surgeons were without any pre-existing ultrasound experience and received one hour of introduction to abdominal ultrasound. RESULTS: Thirty patients underwent 40 surgeon performed and 30 radiologist performed ultrasound examinations. Regarding gallstone and cholecholecystitis the sensitivity...

  3. Disparities between resident and attending surgeon perceptions of intraoperative teaching.

    Science.gov (United States)

    Butvidas, Lynn D; Anderson, Cheryl I; Balogh, Daniel; Basson, Marc D

    2011-03-01

    This study aimed to assess attending surgeon and resident recall of good and poor intraoperative teaching experiences and how often these experiences occur at present. By web-based survey, we asked US surgeons and residents to describe their best and worst intraoperative teaching experiences during training and how often 26 common intraoperative teaching behaviors occur in their current environment. A total of 346 residents and 196 surgeons responded (51 programs; 26 states). Surgeons and residents consistently identified trainee autonomy, teacher confidence, and communication as positive, while recalling negatively contemptuous, arrogant, accusatory, or uncommunicative teachers. Residents described intraoperative teaching behaviors by faculty as substantially less frequent than faculty self-reports. Neither sex nor seniority explained these results, although women reported communicative behaviors more frequently than men. Although veteran surgeons and current trainees agree on what constitutes effective and ineffective teaching in the operating room, they disagree on how often these behaviors occur, leaving substantial room for improvement. Published by Elsevier Inc.

  4. Toward late career transitioning: a proposal for academic surgeons.

    Science.gov (United States)

    Richards, Robin; McLeod, Robin; Latter, David; Keshavjee, Shaf; Rotstein, Ori; Fehlings, Michael G; Ahmed, Najma; Nathens, Avery; Rutka, James

    2017-09-01

    In the absence of a defined retirement age, academic surgeons need to develop plans for transition as they approach the end of their academic surgical careers. The development of a plan for late career transition represents an opportunity for departments of surgery across Canada to initiate a constructive process in cooperation with the key stakeholders in the hospital or institution. The goal of the process is to develop an individual plan for each faculty member that is agreeable to the academic surgeon; informs the surgical leadership; and allows the late career surgeon, the hospital, the division and the department to make plans for the future. In this commentary, the literature on the science of aging is reviewed as it pertains to surgeons, and guidelines for late career transition planning are shared. It is hoped that these guidelines will be of some value to academic programs and surgeons across the country as late career transition models are developed and adopted.

  5. Perspectives of Orthopedic Surgeons on Racial/Ethnic Disparities in Care.

    Science.gov (United States)

    Adelani, Muyibat A; O'Connor, Mary I

    2017-08-01

    Racial/ethnic disparities in healthcare, including orthopedics, have been extensively documented. However, the level of knowledge among orthopedic surgeons regarding racial/ethnic disparities is unknown. The purpose of this study is to determine the views of orthopedic surgeons on (1) the extent of racial/ethnic disparities in orthopedic care, (2) patient and system factors that may contribute, and (3) the potential role of orthopedic surgeons in the reduction of disparities. Three hundred five members of the American Orthopaedic Association completed a survey to assess their knowledge of racial/ethnic disparities and their perceptions about the underlying causes. Twelve percent of respondents believe that patients often receive different care based on race/ethnicity in healthcare in general, while 9 % believe that differences exist in orthopedic care in general, 3 % believe that differences exist within their hospitals/clinics, and 1 % reported differences in their own practices. Despite this, 68 % acknowledge that there is evidence of disparities in orthopedic care. Fifty-one percent believe that a lack of insurance significantly contributes to disparities. Thirty-five percent believe that diversification of the orthopedic workforce would be a "very effective" strategy in addressing disparities, while 25 % percent believe that research would be "very effective" and 24 % believe that surgeon education would be "very effective." Awareness regarding racial/ethnic disparities in musculoskeletal care is low among orthopedic surgeons. Additionally, respondents were more likely to acknowledge disparities within the practices of others than their own. Increased diversity, research, and education may help improve knowledge of this problem.

  6. Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.

    LENUS (Irish Health Repository)

    McCartan, D P

    2012-02-01

    Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.

  7. Social Media Use among United Kingdom Vascular Surgeons: A Cross-Sectional Study.

    Science.gov (United States)

    Cochrane, Andrew R; McDonald, James J; Brady, Richard R W

    2016-05-01

    Engagement with social media (SM) is increasing within the general population and medical professionals. Overall, SM engagement is divided between closed, private networks and open, public platforms, such as LinkedIn and Twitter. As engagement with SM is known to vary between specialties, this study was undertaken to evaluate the uptake of SM among vascular surgeons and to describe user demographics associated with SM engagement. Vascular surgeons were identified from the 2013 Vascular Society of Great Britain and Ireland Quality Improvement Project and cross-referenced with the General Medical Council registry. Identified individual surgeons were manually searched for on common SM platforms and via Google to identify both SM profiles and personal/partnership practice websites. In total, 472 surgeons (442 men, 93.6%) from 112 National Health Service Trusts were identified. Three hundred forty (63.7%) graduated from UK universities with a mean graduating year of 1987 (range 1969-2000). Cumulatively, they performed 36,300 procedures (mean 72/surgeon; range 3-257). Overall, SM engagement was 47.4%; 217 (46.0%) had LinkedIn accounts and 23 (4.8%) had Twitter profiles. LinkedIn users had a mean of 69 connections (range 0-500+) and had a mean graduating year of 1988 (range 1969-2000). Twitter users had a mean of 258 followers (range 2-2424) and had tweeted a mean of 450 times (range 0-2865); they graduated more recently than their non-Twitter engaged colleagues (mean graduation 1991 vs. 1987, P = 0.006). Overall, SM usage was associated with a more recent graduation (P = 0.038) and with working in the private sector (21.4% vs. 13.7%, P = 0.029). There were demographic differences between those who had LinkedIn and Twitter accounts. Twitter and LinkedIn engagement among vascular surgeons is higher than that of other surgical specialties. There is a significant link between the experience of the surgeon and with SM use. Copyright © 2016 Elsevier Inc. All rights

  8. Attitudes and beliefs about placebo surgery among orthopedic shoulder surgeons in the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Karolina Wartolowska

    Full Text Available To survey surgeons on their beliefs and attitudes towards the use of placebo in surgery.British orthopedic shoulder surgeons, attending a national conference in the United Kingdom, were asked to complete a self-report online questionnaire about their beliefs and attitudes towards the use of placebo related to surgical intervention. The survey included questions about ethical issues, the mechanism of placebo effects, and any concerns regarding its use.100 surgeons who participated in the survey believed that placebo surgery is ethically acceptable (96%, especially as a part of a clinical trial (46%. Respondents thought that a placebo effect in surgery is real i.e. has a scientific basis (92%, that placebo can be therapeutically beneficial (77%, and that it involves psychological mechanisms (96%. Over half of the respondents (58% have used a surgical procedure with a significant placebo component at least once in their professional career. Their main concern about placebo use in surgery was that it might involve an element of deception.Surgeons generally agreed that a placebo component to surgical intervention might exist. They also supported placebo use in clinical trials and considered it ethical, providing it does not involve deception of patients. More studies are needed, particularly among other surgical specialties and with larger numbers of participants, to better understand the use of placebo in surgery.

  9. Who should lead a trauma team: surgeon or non surgeon? A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Shahab Hajibandeh

    2017-05-01

    Full Text Available Background: Presence of a trauma team leader (TTL in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data. Results: Three retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR: 0.82, 95% confidence interval (CI 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03. Conclusions: Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare

  10. China's SOE Executives

    DEFF Research Database (Denmark)

    Brødsgaard, Kjeld Erik; Hubbard, Paul; Cai, Guilong

    2017-01-01

    Drawing on a database tracking the career of 1,250 top Chinese executives from 1,084 publicly-listed state-owned enterprises (SOEs), this article analyzes differences in career incentives for subsidiaries controlled by the central government compared to those controlled by local governments. It a...... of promotion. However, in the case of central SOE subsidiaries, leaders are more likely to be promoted based on financial performance. For both central and local 'direct' SOE groups age is a significant negative factor for promotion, whereas tenure is a significant positive factor....

  11. Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications.

    Science.gov (United States)

    Mehta, Ambar; Xu, Tim; Hutfless, Susan; Makary, Martin A; Sinno, Abdulrahman K; Tanner, Edward J; Stone, Rebecca L; Wang, Karen; Fader, Amanda N

    2017-05-01

    Hysterectomy is among the most common major surgical procedures performed in women. Approximately 450,000 hysterectomy procedures are performed each year in the United States for benign indications. However, little is known regarding contemporary US hysterectomy trends for women with benign disease with respect to operative technique and perioperative complications, and the association between these 2 factors with patient, surgeon, and hospital characteristics. We sought to describe contemporary hysterectomy trends and explore associations between patient, surgeon, and hospital characteristics with surgical approach and perioperative complications. Hysterectomies performed for benign indications by general gynecologists from July 2012 through September 2014 were analyzed in the all-payer Maryland Health Services Cost Review Commission database. We excluded hysterectomies performed by gynecologic oncologists, reproductive endocrinologists, and female pelvic medicine and reconstructive surgeons. We included both open hysterectomies and those performed by minimally invasive surgery, which included vaginal hysterectomies. Perioperative complications were defined using the Agency for Healthcare Research and Quality patient safety indicators. Surgeon hysterectomy volume during the 2-year study period was analyzed (0-5 cases annually = very low, 6-10 = low, 11-20 = medium, and ≥21 = high). We utilized logistic regression and negative binomial regression to identify patient, surgeon, and hospital characteristics associated with minimally invasive surgery utilization and perioperative complications, respectively. A total of 5660 hospitalizations were identified during the study period. Most patients (61.5%) had an open hysterectomy; 38.5% underwent a minimally invasive surgery procedure (25.1% robotic, 46.6% laparoscopic, 28.3% vaginal). Most surgeons (68.2%) were very low- or low-volume surgeons. Factors associated with a lower likelihood of undergoing minimally

  12. Characterizing and fostering charity care in the surgeon workforce.

    Science.gov (United States)

    Wright, D Brad; Scarborough, John E

    2011-07-01

    We sought to determine which demographic and practice characteristics are associated with both a surgeon's willingness to provide any charity care as well as the amount of charity care provided. Although it is known that surgeons tend to provide a greater amount of charity care than other physicians, no studies have attempted to look within the surgeon population to identify which factors lead some surgeons to provide more charity care than others. Using 4 rounds of data from the Community Tracking Study, we employ a 2-part multivariate regression model with fixed effects. A greater amount of charity care is provided by surgeons who are male, practice owners, employed in academic medical centers, or earn a greater proportion of their revenue from Medicaid. Surgeons who work in a group HMO are significantly less likely to provide any charity care. Personal resources (eg, time and money) had a minimal association with charity care provision. Surgeons whose characteristics are associated with a greater propensity for charity care provision as suggested by this study, should be considered as a potential source for building the volunteer workforce.

  13. Surgeons' Leadership Styles and Team Behavior in the Operating Room

    Science.gov (United States)

    Hu, Yue-Yung; Parker, Sarah Henrickson; Lipsitz, Stuart R; Arriaga, Alexander F; Peyre, Sarah E; Corso, Katherine A; Roth, Emilie M; Yule, Steven J; Greenberg, Caprice C

    2016-01-01

    Background The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards, whereas transformational (team-oriented) leaders inspire performance beyond expectations. Study Design We video-recorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon-researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information-sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (MLQ) was correlated with surgeon behavior (SLI) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. Results All surgeons scored similarly on transactional leadership (2.38-2.69), but varied more widely on transformational leadership (1.98-3.60). Each 1-point increase in transformational score corresponded to 3× more information-sharing behaviors (psupportive behaviors (pleadership and its impact on team performance in the OR. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development therefore has the potential to improve the efficiency and safety of operative care. PMID:26481409

  14. Ethical challenges in surgery as narrated by practicing surgeons

    Directory of Open Access Journals (Sweden)

    Nordam Ann

    2005-02-01

    Full Text Available Abstract Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. Methods Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.

  15. Comprehensive feedback on trainee surgeons' non-technical skills

    DEFF Research Database (Denmark)

    Spanager, Lene; Dieckmann, Peter; Beier-Holgersen, Randi

    2015-01-01

    OBJECTIVE: This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons' non-technical skills. METHODS: Trainee surgeons and their supervisors used the Non...... qualitatively analyzed for content and feedback style. Usefulness was investigated using a scale from 1 to 5 and written comments were qualitatively analyzed. RESULTS: Six trainees and six supervisors participated in eight feedback conversations. Eighty questionnaires (response rate 83 percent) were collected...

  16. The effect of clinical academic service contracts on surgeon satisfaction.

    Science.gov (United States)

    Clifton, Joanne; Bradley, Christine; Cadeliña, Rachel; Hsiang, York

    2007-06-01

    The purpose of this study was to determine the satisfaction of members of an academic department who are funded by a Clinical Academic Service Contract (CASC), compared with those who are not. We mailed a satisfaction questionnaire designed to examine surgeons' perceived effect of CASCs on their participation in their division or department and on professional activities (research, teaching, clinical) to members of the surgery department who perform operative interventions. We analyzed responses from CASC and non-CASC members, using t tests for continuous variables and chi-square tests for categorical variables. Four of 9 operative divisions (cardiac, thoracic, neurosurgery, pediatric surgery) are CASC-funded, and 5 are not (general, plastic, otolaryngology, urology, vascular). The response rate after 3 mailings was 59%. CASC responders agreed on the need for the following: improved focus and resolution of issues (p academic and administrative activities (p leisure time (p < 0.004). Responders disagreed that morale was low (p < 0.001). They were satisfied with the following: professional activities (p < 0.019), increased research activities (p < 0.001), quality of research (p < 0.001), more presentations (p < 0.025), increased teaching time (p < 0.004) and ability to care for their patients (p < 0.001). CASC responders were significantly more satisfied with their professional activities and more optimistic in their divisional roles than were non-CASC responders. Based on these results, all departmental members who perform operative interventions should consider being on a CASC.

  17. Society of American Gastrointestinal and Endoscopic Surgeons

    Science.gov (United States)

    ... E. Matthew Ritter, MD; and Thadeus L Keyword(s): 3D, AASLD, ABS flex endo curriculum, accreditation, Accutouch, ACG, ... fundoplication, general surgery, HH, hiatal closure, mesh complications, prosthetic reinforcement, redo SAGES 2016 Presidential Address: Out of ...

  18. 76 FR 55677 - Senior Executive Service (SES) Performance Review Board

    Science.gov (United States)

    2011-09-08

    ... GENERAL SERVICES ADMINISTRATION [Notice-CPO-2011-01; Docket 2011-0006; Sequence 15] Senior Executive Service (SES) Performance Review Board AGENCY: General Services Administration. ACTION: Notice. SUMMARY: Notice is hereby given of the appointment of new members to the General Services Administration...

  19. Knowledge deficiency of work-related radiation hazards associated with psychological distress among orthopedic surgeons

    Science.gov (United States)

    Fan, Guoxin; Wang, Yueye; Guo, Changfeng; Lei, Xuefeng; He, Shisheng

    2017-01-01

    Abstract Knowledge and concern degree about work-related radiation hazards remained unknown among orthopedic surgeons. The aim of the cross-sectional study is to investigate whether the knowledge degree of work-related radiation is associated with psychological distress among orthopedic surgeons. This cross-sectional study sent electronic questionnaire via WeChat to orthopedic surgeons nationwide. Concern and knowing degree over radiation exposure was evaluated by a single self-reported question. Professional evaluation of concern degree was reflected by general psychological distress, which was assessed with the Kessler 10 scale (K10) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Only 43.23% (115/266) respondents knew well about radiation and a total of 78.20% (208/266) respondents considered radiation exposure as a great concern. Among those who reported concerns about radiation exposure, a total of 57.69% (120/208) respondents reported knowing little about radiation. Respondents who reported concerns over radiation exposure were significantly associated with higher scores on CES-D and K10 (P < .05). Among respondents who reported concerns over radiation exposure, those who have fewer knowledge about radiation, had higher CES-D and K10 scores than those who knew well about radiation (P < .05). Among respondents who reported no concerns over radiation exposure, those who knew little about radiation still had higher CES-D and K10 scores (P < .05). Fewer radiation knowledge tends to induce more radiation concerns associated with higher psychological distress in orthopedic surgeons. Radiation knowledge should be enhanced for surgeons who daily work with radiation-related fluoroscopy. PMID:28538368

  20. Women in academic general surgery.

    Science.gov (United States)

    Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

    2004-04-01

    To portray the professional experiences of men and women in academic general surgery with specific attention to factors associated with differing academic productivity and with leaving academia. A 131-question survey was mailed to all female (1,076) and a random 2:1 sample of male (2,152) members of the American College of Surgeons in three mailings between September 1998 and March 1999. Detailed questions regarding academic rank, career aspirations, publication rate, grant funding, workload, harassment, income, marriage and parenthood were asked. A five-point Likert scale measured influences on career satisfaction. Responses from strictly academic and tenure-track surgeons were analyzed and interpreted by gender, age, and rank. Overall, 317 surgeons in academic practice (168 men, 149 women) responded, of which 150 were in tenure-track positions (86 men, 64 women). Men and women differed in academic rank, tenure status, career aspirations, and income. Women surgeons had published a median of ten articles compared with 25 articles for men (p career satisfaction was high, but women reported feeling career advancement opportunities were not equally available to them as to their male colleagues and feeling isolation from surgical peers. Ten percent to 20% of surgeons considered leaving academia, with women assistant professors (29%) contemplating this most commonly. Addressing the differences between men and women academic general surgeons is critical in fostering career development and in recruiting competitive candidates of both sexes to general surgery.

  1. Skeletal metastases - the role of the orthopaedic and spinal surgeon.

    Science.gov (United States)

    Eastley, Nicholas; Newey, Martyn; Ashford, Robert U

    2012-09-01

    Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. Several key principals should be adhered to whenever operating on skeletal metastases. Discussions should be held early with an appropriate multi-disciplinary team prior to intervention. Detailed pre-assessment is essential to gauge a patient's suitability for surgery - recovery from elective surgery must be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours must be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion prior to a pathological fracture reduces morbidity and length of hospital stay. Regardless of a lesion or pathological fracture's location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should allow full weight bearing or return to function immediately. Post-operative radiotherapy should be utilised in all cases to minimise disease progression. Spinal surgery should be considered for those with spinal pain due to potentially reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention

  2. Physician preference items: what factors matter to surgeons? Does the vendor matter?

    Directory of Open Access Journals (Sweden)

    Burns LR

    2018-01-01

    Full Text Available Lawton R Burns,1 Michael G Housman,2 Robert E Booth,3 Aaron M Koenig4 1Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, 2Singularity University, Moffett Field, CA, 33B Orthopaedics, Langhorne, PA, 4Harvard Medical School, Massachusetts General Hospital, Wang Ambulatory Care Center, Boston, MA, USA Background: The USA devotes roughly $200 billion (6% of annual national health expenditures to medical devices. A substantial proportion of this spending occurs during orthopedic (eg, hip and knee arthroplasties – two high-volume hospital procedures. The implants used in these procedures are commonly known as physician preference items (PPIs, reflecting the physician’s choice of implant and vendor used. The foundations for this preference are not entirely clear. This study examines what implant and vendor characteristics, as evaluated by orthopedic surgeons, are associated with their preference. It also examines other factors (eg, financial relationships and vendor tenure that may contribute to implant preference. Methods: We surveyed all practicing orthopedic surgeons performing 12 or more implant procedures annually in the Commonwealth of Pennsylvania. The survey identified each surgeon’s preferred hip/knee vendor as well as the factors that surgeons state they use in selecting that primary vendor. We compared the surgeons’ evaluation of multiple characteristics of implants and vendors using analysis of variance techniques, controlling for surgeon characteristics, hospital characteristics, and surgeon–vendor ties that might influence these evaluations. Results: Physician’s preference is heavily influenced by technology/implant factors and sales/service factors. Other considerations such as vendor reputation, financial relationships with the vendor, and implant cost seem less important. These findings hold regardless of implant type (hip vs knee and specific vendor. Conclusion: Our

  3. Workload and quality of life of surgeons. Results and implications of a large-scale survey by the German Society of Surgery.

    Science.gov (United States)

    Bohrer, Thomas; Koller, Michael; Schlitt, Hans Juergen; Bauer, Hartwig

    2011-06-01

    Quality of life is of vital importance for patients undergoing surgery. However, little is known about the quality of life of surgeons who are facing a stressful and dramatically changing working environment. For this reason, this large-scale study investigated the quality of life (QL) of surgeons in Germany in the context of occupational, private, and system-related risk factors. The study population consisted of attendees (surgeons, non-surgical physicians, medical students) of the nine major annual conferences of the German Society of Surgery between 2008 and 2009. Participants filled in a single questionnaire including study-specific questions (demographic variables, professional position, and occupational situation) and a standardized quality of life instrument (Profiles of quality of life of the chronically ill, PLC). Surgeons' responses with regard to their professional situation and their quality of life were contrasted with those of the two controls (non-surgical physicians, medical students). Furthermore, PLC scores were compared with German population reference data and with reference data of several patient groups. Individuals (3,652) (2,991 surgeons, 561 non-surgical physicians, 100 medical students) participated in this study. The average age of surgeons and non-surgeons was in the low forties. In terms of professional qualifications, the majority of surgeons were residents (30%) and the majority of non-surgeons consultants in private practice (38%). Sixty-eight percent of the surgeons, only 39% of the non-surgeons worked more than 60 h per week on average (p family life due to work overload, more so than non-surgeons (74% vs. 59%, p quality of life as worse than that of the general public (non-surgeons, 22%; p quality of life even lower than that of their patients (non-surgeons, 17%; p quality of life questionnaire confirmed these results, showing score values lower than those of the German population reference data and of several patient

  4. Risks and opportunities for plastic surgeons in a widening cosmetic medicine market: future demand, consumer preferences, and trends in practitioners' services.

    Science.gov (United States)

    D'Amico, Richard A; Saltz, Renato; Rohrich, Rod J; Kinney, Brian; Haeck, Phillip; Gold, Alan H; Singer, Robert; Jewell, Mark L; Eaves, Felmont

    2008-05-01

    The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery launched a joint Cosmetic Medicine Task Force to address the growing trend of non-plastic surgeons entering the cosmetic medicine field. The task force commissioned two surveys in 2007 to determine consumer attitudes about choosing cosmetic medicine providers and to learn about the cosmetic services that plastic surgeons offer. The first survey obtained responses from 1015 women who had undergone a cosmetic procedure or were considering having one within 2 years. The second survey obtained responses from 260 members of the two societies. Compared with other practitioners, plastic surgeons enjoy higher rates of satisfaction among their patients who undergo noninvasive procedures. Injectables present a particularly promising market for plastic surgeons. Half of consumers surveyed said they were very concerned about complications associated with injectables, and generally, the higher the perceived risk of the procedure, the higher the likelihood that a patient would choose a plastic surgeon to perform it. In addition, injectables were among the noninvasive treatments most frequently being considered by consumers. However, almost half of consumers said that if they had a positive experience with a non-plastic surgeon core provider for a noninvasive procedure, that physician would likely be their first choice for a surgical procedure. These findings suggest that plastic surgeons, and especially those who are building young practices, must expand their offerings of nonsurgical cosmetic services to remain at the core of the cosmetic medicine field.

  5. The surgeon's perspective: promoting and discouraging factors for choosing a career in surgery as perceived by surgeons.

    Directory of Open Access Journals (Sweden)

    Julia C Seelandt

    Full Text Available BACKGROUND: The aim of this study was to identify the factors perceived by surgeons that promote surgery as an attractive or unattractive career choice for today's graduates. In addition, it examined whether the perspectives of surgeons in different professional situations converges. The content of work, contextual work conditions, and calling to this job are discussed in the context of choosing surgery as a career. METHODS: Eight hundred sixty-nine surgeons were asked to answer open-ended questions regarding the factors that promote surgery as an attractive or unattractive career choice for today's graduates. Four hundred ninety-two surgeons participated, and 1,525 statements were analyzed using Mayring's content-analyses method. Chi-square tests were used to analyze the differences among hierarchical positions. RESULTS: With respect to the factors that promote surgery as a profession, 40.8% (209/492 of the surgeons stated that surgery is a calling, 29.1% (149/492 of the surgeons provided at least one argument related to the positive task characteristics, and 12.9% (66/492 of the surgeons provided statements related to the positive contextual factors. With respect to the factors that discourage surgery as a profession, 45.7% (234/492 of the surgeons provided at least one argument related to the discouraging work characteristics, and 67.6% (346/492 of the surgeons provided problematic contextual characteristics. CONCLUSION: This study emphasizes the importance of the calling to surgery as an important factor for choosing surgery as a career. However, the extensive workload, training, and poor work-family balance have been identified as factors that discourage graduates from choosing surgery as a career. The identified positive factors could be used to attract and maintain graduates in surgical disciplines.

  6. The surgeon's perspective: promoting and discouraging factors for choosing a career in surgery as perceived by surgeons.

    Science.gov (United States)

    Seelandt, Julia C; Kaderli, Reto M; Tschan, Franziska; Businger, Adrian P

    2014-01-01

    The aim of this study was to identify the factors perceived by surgeons that promote surgery as an attractive or unattractive career choice for today's graduates. In addition, it examined whether the perspectives of surgeons in different professional situations converges. The content of work, contextual work conditions, and calling to this job are discussed in the context of choosing surgery as a career. Eight hundred sixty-nine surgeons were asked to answer open-ended questions regarding the factors that promote surgery as an attractive or unattractive career choice for today's graduates. Four hundred ninety-two surgeons participated, and 1,525 statements were analyzed using Mayring's content-analyses method. Chi-square tests were used to analyze the differences among hierarchical positions. With respect to the factors that promote surgery as a profession, 40.8% (209/492) of the surgeons stated that surgery is a calling, 29.1% (149/492) of the surgeons provided at least one argument related to the positive task characteristics, and 12.9% (66/492) of the surgeons provided statements related to the positive contextual factors. With respect to the factors that discourage surgery as a profession, 45.7% (234/492) of the surgeons provided at least one argument related to the discouraging work characteristics, and 67.6% (346/492) of the surgeons provided problematic contextual characteristics. This study emphasizes the importance of the calling to surgery as an important factor for choosing surgery as a career. However, the extensive workload, training, and poor work-family balance have been identified as factors that discourage graduates from choosing surgery as a career. The identified positive factors could be used to attract and maintain graduates in surgical disciplines.

  7. Build and Execute Environment

    Energy Technology Data Exchange (ETDEWEB)

    2017-04-21

    At exascale, the challenge becomes to develop applications that run at scale and use exascale platforms reliably, efficiently, and flexibly. Workflows become much more complex because they must seamlessly integrate simulation and data analytics. They must include down-sampling, post-processing, feature extraction, and visualization. Power and data transfer limitations require these analysis tasks to be run in-situ or in-transit. We expect successful workflows will comprise multiple linked simulations along with tens of analysis routines. Users will have limited development time at scale and, therefore, must have rich tools to develop, debug, test, and deploy applications. At this scale, successful workflows will compose linked computations from an assortment of reliable, well-defined computation elements, ones that can come and go as required, based on the needs of the workflow over time. We propose a novel framework that utilizes both virtual machines (VMs) and software containers to create a workflow system that establishes a uniform build and execution environment (BEE) beyond the capabilities of current systems. In this environment, applications will run reliably and repeatably across heterogeneous hardware and software. Containers, both commercial (Docker and Rocket) and open-source (LXC and LXD), define a runtime that isolates all software dependencies from the machine operating system. Workflows may contain multiple containers that run different operating systems, different software, and even different versions of the same software. We will run containers in open-source virtual machines (KVM) and emulators (QEMU) so that workflows run on any machine entirely in user-space. On this platform of containers and virtual machines, we will deliver workflow software that provides services, including repeatable execution, provenance, checkpointing, and future proofing. We will capture provenance about how containers were launched and how they interact to annotate

  8. Migration to the ICD-10 coding system: A primer for spine surgeons (Part 1).

    Science.gov (United States)

    Rahmathulla, Gazanfar; Deen, H Gordon; Dokken, Judith A; Pirris, Stephen M; Pichelmann, Mark A; Nottmeier, Eric W; Reimer, Ronald; Wharen, Robert E

    2014-01-01

    On 1 October 2015, a new federally mandated system goes into effect requiring the replacement of the International Classification of Disease-version 9-Clinical Modification (ICD-9-CM) with ICD-10-CM. These codes are required to be used for reimbursement and to substantiate medical necessity. ICD-10 is composite with as many as 141,000 codes, an increase of 712% when compared to ICD-9. Execution of the ICD-10 system will require significant changes in the clinical administrative and hospital-based practices. Through the transition, diminished productivity and practice revenue can be anticipated, the impacts of which the spine surgeon can minimizeby appropriate education and planning. The advantages of the new system include increased clarity and more accurate definitions reflecting patient condition, information relevant to ambulatory and managed care encounters, expanded injury codes, laterality, specificity, precise data for safety and compliance reporting, data mining for research, and finally, enabling pay-for-performance programs. The disadvantages include the cost per physician, training administrative staff, revenue loss during the learning curve, confusion, the need to upgrade hardware along with software, and overall expense to the healthcare system. With the deadline rapidly approaching, gaps in implementation result in delayed billing, delayed or diminished reimbursements, and absence of quality and outcomes data. It is thereby essential for spine surgeons to understand their role in transitioning to this new environment. Part I of this article discusses the background, coding changes, and costs as well as reviews the salient features of ICD-10 in spine surgery.

  9. Guidelines for Automation Project Execution

    OpenAIRE

    Takkinen, Heidi

    2011-01-01

    The purpose of this Master’s thesis was to create instructions for executing an automation project. Sarlin Oy Ab needed directions on how to execute an automation project. Sarlin is starting up a new business area offering total project solutions for customers. Sarlin focuses on small and minor automation projects on domestic markets. The thesis represents issues related to project execution starting from the theory of the project to its kick-off and termination. Site work is one importan...

  10. Role of Surgeons in Determining Outcome of Histopathology ...

    African Journals Online (AJOL)

    fixative used, types of specimen containers and appropriate labeling of containers. ... specimen and with wide mouth and tight fitting lid) and adequacy of container .... surgeons in this respect is a reflection of greater availability of prepared ...

  11. Radiation dose to surgeons in theatre | van der Merwe | South ...

    African Journals Online (AJOL)

    Thermoluminescent dosimeter measurements of accumulated dose to specific anatomical regions of a neurosurgeon, gastroenterologist and orthopaedic surgeon performing fluoroscopy on 39 patients undergoing treatment for back pain, 7 for endoscopic retrograde cholangiopancreatography procedures, and 48 for ...

  12. Hepatitis-B Vaccination Status Among Dental Surgeons in Benin ...

    African Journals Online (AJOL)

    hanumantp

    consensus about vaccination rates among dental professionals in the literature as dental surgeons ..... Research Category of the Hatton poster competition in the 3rd. African Middle East ... Community Dent Oral Epidemiol. 1987;15:125-7. 6.

  13. Predictors of pediatric surgeons' career satisfaction: a national survey

    African Journals Online (AJOL)

    Pediatric surgeons were satisfied with professional career. (77%), and 88% would chose the same ... exists between expectations and real income. Ann Pediatr .... single institution employment (no extra job) (P= 0.015432) are factors related to ...

  14. Editor, Executive and Entrepreneur

    DEFF Research Database (Denmark)

    Bøe-Lillegraven, Tor; Wilberg, Erik

    2016-01-01

    To survive in today’s increasingly complex business environments, firms must embrace strategic paradoxes: contradictory yet interrelated objectives that persist over time. This can be one of toughest of all leadership challenges, as managers must accept inconsistency and contradictions....... In this article, we develop and empirically test a set of hypotheses related to ambidexterity, a key example of a paradoxical strategy. Through our analysis of data from a survey of executive leaders, we find a link between organizational ambidexterity and strategic planning, suggesting that the complexities...... of navigating in explorative ventures require more explicit strategy work than the old certainties of a legacy business. We identify and discuss inherent paradoxes and their implications for firm performance in 22 industry-specific strategies, where empirical industry data shows a pattern of conflict between...

  15. Executable Use Cases

    DEFF Research Database (Denmark)

    Jørgensen, Jens Bæk; Bossen, Claus

    2004-01-01

    and into the work processes they're to support. However, prototypes typically provide an explicit representation only of the system itself. Executable use cases, on the other hand, can also describe the environment. EUCs are designed to: narrow the gap between informal ideas about requirements and the formalization...... modeling. This article describes a case study in which developers used EUCs to prototype an electronic patient record system for hospitals in Aarhus, Denmark.......Many software experts argue that when we design a new system, we should create an explicit description of the environment in which the proposed system is to be used. The argument becomes crucial for pervasive computing, which aims to tightly integrate systems into their environments...

  16. Examining the relation between ratings of executive functioning and academic achievement: Findings from a cross-cultural study

    OpenAIRE

    Thorell, Lisa B.; Veleiro, Alberto; Siu, Angela F. Y.; Mohammadi, Hiwa

    2012-01-01

    The present study investigated the relation between academic performance and ratings of executive functioning in children aged 6?11 from four countries: Sweden, Spain, Iran, and China. Ratings of executive functioning were made by both parents and teachers using the Childhood Executive Functioning Inventory (CHEXI). The results showed that the Chinese sample was generally rated as having more executive deficits compared to the other samples. The finding that executive functioning deficits are...

  17. Executive Orders-Barack Obama

    Data.gov (United States)

    National Archives and Records Administration — Executive orders are official documents, numbered consecutively, through which the President of the United States manages the operations of the Federal Government....

  18. Two executives, one career.

    Science.gov (United States)

    Cunningham, Cynthia R; Murray, Shelley S

    2005-02-01

    For six years, Cynthia Cunningham and Shelley Murray shared an executive job at Fleet Bank. One desk, one chair, one computer, one telephone, and one voice-mail account. To their clients and colleagues, they were effectively one person, though one person with the strengths and ideas of two, seamlessly handing projects back and forth. Although their department was dissolved after the bank merged with Bank of America, the two continue to consider themselves a package-they have one resume, and they are seeking their next opportunity together. Their choice to share a job was not only a quality-of-life decision but one intended to keep their careers on course: "Taking two separate part-time jobs would have thrown us completely off track" they write in this first-person account."We're both ambitious people, and neither of us wanted just a job. We wanted careers" In this article, the two highly motivated women reveal their determination to manage the demands of both family and career. Flextime,telecommuting, and compressed workweeks are just some of the options open to executives seeking greater work/ life balance, and the job share, as described by Cunningham and Murray, could well be the next solution for those wishing to avoid major trade-offs between their personal and professional lives. Cunningham and Murray describe in vivid detail how they structured their unusual arrangement, how they sold themselves to management, and the hurdles they faced along the way. Theirs is a win-win story, for the company and for them.

  19. Disclosure of Individual Surgeon's Performance Rates During Informed Consent

    Science.gov (United States)

    Burger, Ingrid; Schill, Kathryn; Goodman, Steven

    2007-01-01

    Objective: The purpose of the paper is to examine the ethical arguments for and against disclosing surgeon-specific performance rates to patients during informed consent, and to examine the challenges that generating and using performance rates entail. Methods: Ethical, legal, and statistical theory is explored to approach the question of whether, when, and how surgeons should disclosure their personal performance rates to patients. The main ethical question addressed is what type of information surgeons owe their patients during informed consent. This question comprises 3 related, ethically relevant considerations that are explored in detail: 1) Does surgeon-specific performance information enhance patient decision-making? 2) Do patients want this type of information? 3) How do the potential benefits of disclosure balance against the risks? Results: Calculating individual performance measures requires tradeoffs and involves inherent uncertainty. There is a lack of evidence regarding whether patients want this information, whether it facilitates their decision-making for surgery, and how it is best communicated to them. Disclosure of personal performance rates during informed consent has the potential benefits of enhancing patient autonomy, improving patient decision-making, and improving quality of care. The major risks of disclosure include inaccurate and misleading performance rates, avoidance of high-risk cases, unjust damage to surgeon's reputations, and jeopardized patient trust. Conclusion: At this time, we think that, for most conditions, surgical procedures, and outcomes, the accuracy of surgeon- and patient-specific performance rates is illusory, obviating the ethical obligation to communicate them as part of the informed consent process. Nonetheless, the surgical profession has the duty to develop information systems that allow for performance to be evaluated to a high degree of accuracy. In the meantime, patients should be informed of the quantity of

  20. Surgeons' Emotional Experience of Their Everyday Practice - A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Massimiliano Orri

    Full Text Available Physicians' emotions affect both patient care and personal well-being. Surgeons appear at particularly high risk, as evidenced by the high rate of burnout and the alarming consequences in both their personal lives and professional behavior. The aim of this qualitative study is to explore the emotional experiences of surgeons and their impact on their surgical practice.27 purposively selected liver and pancreatic surgeons from 10 teaching hospitals (23 men, 4 women participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and thematically analyzed independently by 3 researchers (a psychologist, a psychiatrist, and a surgeon. 7 themes emerged from the analysis, categorized in 3 main or superordinate themes, which described surgeons' emotional experience before, during, and after surgery. Burdensome emotions are present throughout all 3 periods (and invade life outside the hospital-surgeons' own emotions, their perception of patients' emotions, and their entwinement. The interviewees described the range of emotional situations they face (with patients, families, colleagues, the influence of the institutional framework (time pressure and fatigue, cultural pressure to satisfy the ideal image of a surgeon, as well as the emotions they feel (including especially anxiety, fear, distress, guilt, and accountability.Emotions are ubiquitous in surgeons' experience, and their exposure to stress is chronic rather than acute. Considering emotions only in terms of their relations to operative errors (as previous studies have done is limiting. Although complications are quite rare events, the concern for possible complications is an oppressive experience, regardless of whether or not they actually occur.

  1. Workload assessment of surgeons: correlation between NASA TLX and blinks.

    Science.gov (United States)

    Zheng, Bin; Jiang, Xianta; Tien, Geoffrey; Meneghetti, Adam; Panton, O Neely M; Atkins, M Stella

    2012-10-01

    Blinks are known as an indicator of visual attention and mental stress. In this study, surgeons' mental workload was evaluated utilizing a paper assessment instrument (National Aeronautics and Space Administration Task Load Index, NASA TLX) and by examining their eye blinks. Correlation between these two assessments was reported. Surgeons' eye motions were video-recorded using a head-mounted eye-tracker while the surgeons performed a laparoscopic procedure on a virtual reality trainer. Blink frequency and duration were computed using computer vision technology. The level of workload experienced during the procedure was reported by surgeons using the NASA TLX. A total of 42 valid videos were recorded from 23 surgeons. After blinks were computed, videos were divided into two groups based on the blink frequency: infrequent group (≤ 6 blinks/min) and frequent group (more than 6 blinks/min). Surgical performance (measured by task time and trajectories of tool tips) was not significantly different between these two groups, but NASA TLX scores were significantly different. Surgeons who blinked infrequently reported a higher level of frustration (46 vs. 34, P = 0.047) and higher overall level of workload (57 vs. 47, P = 0.045) than those who blinked more frequently. The correlation coefficients (Pearson test) between NASA TLX and the blink frequency and duration were -0.17 and 0.446. Reduction of blink frequency and shorter blink duration matched the increasing level of mental workload reported by surgeons. The value of using eye-tracking technology for assessment of surgeon mental workload was shown.

  2. Social networks uncovered: 10 tips every plastic surgeon should know.

    Science.gov (United States)

    Dauwe, Phillip; Heller, Justin B; Unger, Jacob G; Graham, Darrell; Rohrich, Rod J

    2012-11-01

    Understanding online social networks is of critical importance to the plastic surgeon. With knowledge, it becomes apparent that the numerous networks available are similar in their structure, usage, and function. The key is communication between Internet media such that one maximizes exposure to patients. This article focuses on 2 social networking platforms that we feel provide the most utility to plastic surgeons. Ten tips are provided for incorporation of Facebook and Twitter into your practice.

  3. Meta-Analysis of Surgeon Burnout Syndrome and Specialty Differences.

    Science.gov (United States)

    Bartholomew, Alex J; Houk, Anna K; Pulcrano, Marisa; Shara, Nawar M; Kwagyan, John; Jackson, Patrick G; Sosin, Michael

    2018-02-27

    Surgeon burnout compromises the quality of life of physicians and the delivery of care to patients. Burnout rates and interpretation of the Maslach Burnout Inventory (MBI) complicates the interpretation of surgeon burnout. The purpose of this study is to apply a standardized interpretation of severe surgeon burnout termed, "burnout syndrome" to analyze inherent variation within surgical specialties. A systematic literature search was performed using MEDLINE, PsycINFO, and EMBASE to identify studies reporting MBI data by surgical specialty. Data extraction was performed to isolate surgeon specific data. A meta-analysis was performed. A total of 16 cross-sectional studies were included in this meta-analysis, totaling 3581 subjects. A random effects model approximated burnout syndrome at 3.0% (95% CI: 2.0%-5.0%; I 2 = 78.1%). Subscale analysis of emotional exhaustion, depersonalization, and personal accomplishment indicated subscale burnout in 30.0% (CI: 25.0%-36.0%; I 2 = 93.2%), 34.0% (CI: 25.0%-43.0%; I 2 = 96.9%), and 25.0% (CI: 18.0%-32.0%; I 2 = 96.5%) of surgeons, respectively. Significant differences (p burnout termed "burnout syndrome," although surgeon burnout may occur in up to 34% of surgeons, characterized by high burnout in 1 of 3 subscales. Surgical specialties have significantly different rates of burnout subscales. Future burnout studies should target the specialty-specific level to understand inherent differences in an effort to better understand methods of improving surgeon burnout. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. Cardiac surgeons and the quality movement: the Michigan experience.

    Science.gov (United States)

    Prager, Richard L; Armenti, Frederick R; Bassett, Joseph S; Bell, Gail F; Drake, Daniel; Hanson, Eric C; Heiser, John C; Johnson, Scott H; Plasman, F B; Shannon, Francis L; Share, David; Theurer, Patty; Williams, Jaelene

    2009-01-01

    The Michigan Society of Thoracic and Cardiovascular Surgeons created a voluntary quality collaborative with all the cardiac surgeons in the state and all hospitals doing adult cardiac surgery. Utilizing this collaborative over the last 3 years and creating a unique relationship with a payor, an approach to processes and outcomes has produced improvements in the quality of care for cardiac patients in the state of Michigan.

  5. High occupational stress and low career satisfaction of Korean surgeons.

    Science.gov (United States)

    Kang, Sang Hee; Boo, Yoon Jung; Lee, Ji Sung; Han, Hyung Joon; Jung, Cheol Woong; Kim, Chong Suk

    2015-02-01

    Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the Korean occupational stress scale (KOSS). The mean KOSS score was 49.31, which was higher than the average of Korean occupational stress (45.86) or that of other specialized professions (46.03). Young age, female gender, long working hours, and frequent night duties were significantly related to the higher KOSS score. Having spouse, having hobby and regular exercise decreased the KOSS score. Multiple linear regression analysis showed that long working hours and regular exercise were the independent factors associated with the KOSS score. Less than 50% of surgeons answered that they would become a surgeon again. Most surgeons (82.5%) did not want to recommend their child follow their career. Korean Surgeons have high occupational stress and low level of career satisfaction.

  6. Ergonomics in the operating room: protecting the surgeon.

    Science.gov (United States)

    Rosenblatt, Peter L; McKinney, Jessica; Adams, Sonia R

    2013-01-01

    To review elements of an ergonomic operating room environment and describe common ergonomic errors in surgeon posture during laparoscopic and robotic surgery. Descriptive video based on clinical experience and a review of the literature (Canadian Task Force classification III). Community teaching hospital affiliated with a major teaching hospital. Gynecologic surgeons. Demonstration of surgical ergonomic principles and common errors in surgical ergonomics by a physical therapist and surgeon. The physical nature of surgery necessitates awareness of ergonomic principles. The literature has identified ergonomic awareness to be grossly lacking among practicing surgeons, and video has not been documented as a teaching tool for this population. Taking this into account, we created a video that demonstrates proper positioning of monitors and equipment, and incorrect and correct ergonomic positions during surgery. Also presented are 3 common ergonomic errors in surgeon posture: forward head position, improper shoulder elevation, and pelvic girdle asymmetry. Postural reset and motion strategies are demonstrated to help the surgeon learn techniques to counterbalance the sustained and awkward positions common during surgery that lead to muscle fatigue, pain, and degenerative changes. Correct ergonomics is a learned and practiced behavior. We believe that video is a useful way to facilitate improvement in ergonomic behaviors. We suggest that consideration of operating room setup, proper posture, and practice of postural resets are necessary components for a longer, healthier, and pain-free surgical career. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  7. A Modular Laparoscopic Training Program for Pediatric Surgeons

    Science.gov (United States)

    Wasa, Masafumi; Takiguchi, Shuji; Taniguchi, Eiji; Soh, Hideki; Ohashi, Shuichi; Okada, Akira

    2003-01-01

    Objectives: A structured endoscopic training program for pediatric surgeons has not yet been established. This study was conducted to develop a modular training program (MTP) for pediatric surgeons and to evaluate its effectiveness for surgeons with and without previous experience in laparoscopic surgery. Methods: Nine pediatric surgeons participated in the study. They were divided into 2 groups: group A (n=4), surgeons who had experienced more than 10 cases of laparoscopic surgery prior to MTP; group B (n=5), those who had experienced fewer than 10 cases. They participated in a standardized MTP workshop, which consisted of 2 “see-through” and 3 “laparoscopic” tasks. Each participant's psychomotor skills were evaluated objectively before and after MTP with a computer-generated virtual simulator and were evaluated for precision, efficiency, and speed. Results: In participants, speed was significantly enhanced after MTP. In group A, no differences were observed after MTP, whereas significant improvements were noted in efficiency and speed after MTP in group B. Before MTP, efficiency was significantly higher in group A than in group B; however, no difference remained between the 2 groups after MTP. Conclusions: MTP is effective for nonlaparoscopic pediatric surgeons to become familiar with basic endoscopic skills. PMID:12722996

  8. Implementation of an acute care emergency surgical service: a cost analysis from the surgeon's perspective.

    Science.gov (United States)

    Anantha, Ram Venkatesh; Parry, Neil; Vogt, Kelly; Jain, Vipan; Crawford, Silvie; Leslie, Ken

    2014-04-01

    Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings. This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ(2) test. Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p Cost-modelling analysis demonstrates that these services have cost-savings potential for the health care system without reducing overall surgeon billing.

  9. The contribution of executive control to semantic cognition: Convergent evidence from semantic aphasia and executive dysfunction.

    Science.gov (United States)

    Thompson, Hannah E; Almaghyuli, Azizah; Noonan, Krist A; Barak, Ohr; Lambon Ralph, Matthew A; Jefferies, Elizabeth

    2018-01-03

    Semantic cognition, as described by the controlled semantic cognition (CSC) framework (Rogers et al., , Neuropsychologia, 76, 220), involves two key components: activation of coherent, generalizable concepts within a heteromodal 'hub' in combination with modality-specific features (spokes), and a constraining mechanism that manipulates and gates this knowledge to generate time- and task-appropriate behaviour. Executive-semantic goal representations, largely supported by executive regions such as frontal and parietal cortex, are thought to allow the generation of non-dominant aspects of knowledge when these are appropriate for the task or context. Semantic aphasia (SA) patients have executive-semantic deficits, and these are correlated with general executive impairment. If the CSC proposal is correct, patients with executive impairment should not only exhibit impaired semantic cognition, but should also show characteristics that align with those observed in SA. This possibility remains largely untested, as patients selected on the basis that they show executive impairment (i.e., with 'dysexecutive syndrome') have not been extensively tested on tasks tapping semantic control and have not been previously compared with SA cases. We explored conceptual processing in 12 patients showing symptoms consistent with dysexecutive syndrome (DYS) and 24 SA patients, using a range of multimodal semantic assessments which manipulated control demands. Patients with executive impairments, despite not being selected to show semantic impairments, nevertheless showed parallel patterns to SA cases. They showed strong effects of distractor strength, cues and miscues, and probe-target distance, plus minimal effects of word frequency on comprehension (unlike semantic dementia patients with degradation of conceptual knowledge). This supports a component process account of semantic cognition in which retrieval is shaped by control processes, and confirms that deficits in SA patients reflect

  10. Operating lists are created by rational algorithms and use of power. What can a social scientific view offer surgeons?

    Science.gov (United States)

    Engelmann, Carsten; Grote, Gudela; Geyer, Siegfried; Ametowobla, Dzifa

    2017-02-01

    Algorithms for surgical operation planning are evidence-based. However, choices sometimes have to be made between medically equal solutions e.g. for staffing of sought-after operations. Such decisions are heavily influenced by micropolitics and power. The article examines the array of highly manipulated processes around operation theatre allocation of convenient time slots or staff, which play out in various ways in all of the world's main regional surgical cultures. Essay supported by empiric data from an ethnographic power-analysis targeted to senior executive surgeons. Operations were categorized into "Interesting" (i.e. career-promoting) and "Uninteresting" (i.e. routine) operations. Fifty nine executives responded. Only one respondent contested the categorization of operations into Interesting and Uninteresting. The two categories were staffed according to significantly different criteria (p academic investigation into the typically tacit micro-political mechanisms in List-making. Developing such research further may potentially concern the practice and outcome of surgery.

  11. Isn't it time to start speaking about "European surgeons"?

    Directory of Open Access Journals (Sweden)

    Lazzareschi Daniel

    2009-07-01

    Full Text Available Abstract Background Emergency surgery has become a neglected specialization in Europe and in many other parts of the world. In certain medical fields, emergency surgery isn't even considered an autonomous specialization. However every emergency surgeon must have a good formation in General Surgery but exist huge disparities between different European surgical formative systems. Methods An analysis of the main problems of the European surgical formative system was conducted. Results This discrepancy between formative systems is absolutely unacceptable and presents a notable hazard for the European Union, considering that surgical certifications are reciprocally recognized between programs within all European Union states. Conclusion Considering the increasing possibilities to move inside the European Union, is necessary to improve the European surgical formative system to warrant an uniform formation for all surgeons.

  12. Executive Function and Adaptive Behavior in Muenke Syndrome.

    Science.gov (United States)

    Yarnell, Colin M P; Addissie, Yonit A; Hadley, Donald W; Guillen Sacoto, Maria J; Agochukwu, Nneamaka B; Hart, Rachel A; Wiggs, Edythe A; Platte, Petra; Paelecke, Yvonne; Collmann, Hartmut; Schweitzer, Tilmann; Kruszka, Paul; Muenke, Maximilian

    2015-08-01

    To investigate executive function and adaptive behavior in individuals with Muenke syndrome using validated instruments with a normative population and unaffected siblings as controls. Participants in this cross-sectional study included individuals with Muenke syndrome (P250R mutation in FGFR3) and their mutation-negative siblings. Participants completed validated assessments of executive functioning (Behavior Rating Inventory of Executive Function [BRIEF]) and adaptive behavior skills (Adaptive Behavior Assessment System, Second Edition [ABAS-II]). Forty-four with a positive FGFR3 mutation, median age 9 years, range 7 months to 52 years were enrolled. In addition, 10 unaffected siblings served as controls (5 males, 5 females; median age, 13 years; range, 3-18 years). For the General Executive Composite scale of the BRIEF, 32.1% of the cohort had scores greater than +1.5 SD, signifying potential clinical significance. For the General Adaptive Composite of the ABAS-II, 28.2% of affected individuals scored in the 3rd-8th percentile of the normative population, and 56.4% were below the average category (General Executive Composite and the ABAS-II General Adaptive Composite. Individuals with Muenke syndrome are at an increased risk for developing adaptive and executive function behavioral changes compared with a normative population and unaffected siblings. Published by Elsevier Inc.

  13. Supervised Exercise Therapy for Intermittent Claudication Is Increasingly Endorsed by Dutch Vascular Surgeons.

    Science.gov (United States)

    Hageman, David; Lauret, Gert-Jan; Gommans, Lindy N M; Koelemay, Mark J W; van Sambeek, Marc R H M; Scheltinga, Marc R M; Teijink, Joep A W

    2018-02-01

    Although supervised exercise therapy (SET) is generally accepted as an effective noninvasive treatment for intermittent claudication (IC), Dutch vascular surgeons were initially somewhat hesitant as reported by a 2011 questionnaire study. Later on, a nationwide multidisciplinary network for SET was introduced in the Netherlands. The aim of this questionnaire study was to determine possible trends in conceptions among Dutch vascular surgeons regarding the prescription of SET. In the year of 2015, Dutch vascular surgeons, fellows, and senior residents were asked to complete a 26-item questionnaire including issues that were considered relevant for prescribing SET such as patient selection criteria and comorbidity. Outcome was compared to the 2011 survey. Data of 124 respondents (82% males; mean age 46 years; 64% response rate) were analyzed. SET referral rate of new IC patients was not different over time (2015: 81% vs. 2011: 75%; P = 0.295). However, respondents were more willing to prescribe SET in IC patients with chronic obstructive pulmonary disease (2015: 86% vs. 2011: 69%; P = 0.002). Nevertheless, a smaller portion of respondents found that SET was also indicated for aortoiliac disease (2015: 63% vs. 2011: 76%; P = 0.049). Insufficient health insurance coverage and/or personal financial resources were the most important presumed barriers preventing patients from initiating SET (80% of respondents). Moreover, 94% of respondents judged that SET should be fully reimbursed by all Dutch basic health insurances. The concept of SET for IC is nowadays generally embraced by the vast majority of Dutch vascular surgeons. SET may have gained in popularity in IC patients with cardiopulmonary comorbidity. However, SET remains underutilized for aortoiliac disease. Reimbursement is considered crucial for a successful SET implementation. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Preventing surgical site infections: a surgeon's perspective.

    OpenAIRE

    Nichols, R. L.

    2001-01-01

    Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. National studies have defined the patients at highest risk for infection in general and in many specific operative procedures. Advances in risk assessment comparison may involve use of the standardized infection ratio, procedure-specific risk factor collection, and logistic regression models. Adherence to recommendations in the 1999 Centers for Disease Contro...

  15. Disciplining and Screening Top Executives

    NARCIS (Netherlands)

    S. Dominguez Martinez (Silvia); O.H. Swank (Otto); B. Visser (Bauke)

    2006-01-01

    textabstractBoards of directors face the twin task of disciplining and screening executives. To perform these tasks directors do not have detailed information about executives' behaviour, and only infrequently have information about the success or failure of initiated strategies, reorganizations,

  16. Developmental Changes in Executive Functioning

    Science.gov (United States)

    Lee, Kerry; Bull, Rebecca; Ho, Ringo M. H.

    2013-01-01

    Although early studies of executive functioning in children supported Miyake et al.'s (2000) three-factor model, more recent findings supported a variety of undifferentiated or two-factor structures. Using a cohort-sequential design, this study examined whether there were age-related differences in the structure of executive functioning among…

  17. Psychophysical workload in the operating room: primary surgeon versus assistant.

    Science.gov (United States)

    Rieger, Annika; Fenger, Sebastian; Neubert, Sebastian; Weippert, Matthias; Kreuzfeld, Steffi; Stoll, Regina

    2015-07-01

    Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting. Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed. Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands (p NASA-TLX sum score (p < 0.01; η(2) = 0.287). Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload assessment was shown.

  18. The discussion of execution about HAF603 of 2008 edition

    International Nuclear Information System (INIS)

    Shen Wei; Lu Gaoshang; Sun Haipeng

    2010-01-01

    The general situation about nuclear power welder qualification standards of 1995 and 2008 editions is introduced in this paper, and the differences between them are analyzed. Combining with the practical experiences in the supervisions of welder qualification, the authors point out the main problems faced in the execution of 2008 edition HAF603, and put forward the advices and opinions in the execution of 2008 edition HAF603. (authors)

  19. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

    DEFF Research Database (Denmark)

    Andersen, Morten Jon; Gromov, Kirill; Brix, Michael

    2014-01-01

    INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture......-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Müller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries...

  20. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

    DEFF Research Database (Denmark)

    Andersen, M. J.; Gromov, K.; Brix, M.

    2014-01-01

    INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture......-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Muller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries...

  1. Early executive function predicts reasoning development.

    Science.gov (United States)

    Richland, Lindsey E; Burchinal, Margaret R

    2013-01-01

    Analogical reasoning is a core cognitive skill that distinguishes humans from all other species and contributes to general fluid intelligence, creativity, and adaptive learning capacities. Yet its origins are not well understood. In the study reported here, we analyzed large-scale longitudinal data from the Study of Early Child Care and Youth Development to test predictors of growth in analogical-reasoning skill from third grade to adolescence. Our results suggest an integrative resolution to the theoretical debate regarding contributory factors arising from smaller-scale, cross-sectional experiments on analogy development. Children with greater executive-function skills (both composite and inhibitory control) and vocabulary knowledge in early elementary school displayed higher scores on a verbal analogies task at age 15 years, even after adjusting for key covariates. We posit that knowledge is a prerequisite to analogy performance, but strong executive-functioning resources during early childhood are related to long-term gains in fundamental reasoning skills.

  2. The executive leader in the postcrisis era

    Directory of Open Access Journals (Sweden)

    Bazarov, Tahir Y.

    2013-06-01

    Full Text Available This article describes psychological challenges that executive leaders of companies face nowadays. The study of the social context is based on changes that took place with the development of information technologies. The analysis touches upon such phenomena as virtualization, involvement in the external sociocommunicative environment, and the emergence of multiple identity. It is suggested that in order to adapt to changing conditions one should follow the path of self-development—in particular, to develop attention, imagination, and willpower. In connection with the traits generally attributed to executive leaders, the article emphasizes self-adjustment; common sense as an integral part of intuition, emotions, and imagination; and the readiness to make choices in fifty-fifty situations.

  3. Projections of Demand for Cardiovascular Surgery and Supply of Surgeons.

    Science.gov (United States)

    Lee, Jung Jeung; Park, Nam Hee; Lee, Kun Sei; Chee, Hyun Keun; Sim, Sung Bo; Kim, Myo Jeong; Choi, Ji Suk; Kim, Myunghwa; Park, Choon Seon

    2016-12-01

    While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040-an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309-an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors

  4. Projections of Demand for Cardiovascular Surgery and Supply of Surgeons

    Directory of Open Access Journals (Sweden)

    Jung Jeung Lee

    2016-12-01

    Full Text Available Background: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. Methods: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. Results: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Conclusion: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time

  5. Practice Patterns and Job Satisfaction of Mohs Surgeons.

    Science.gov (United States)

    Kohli, Nita; Golda, Nicholas

    2018-01-01

    There is a paucity of data on Mohs surgery workforce patterns. To identify if gender differences exist in practice patterns of Mohs surgeons, factors that influence these differences, and factors influencing job satisfaction among Mohs surgeons. An electronic survey was distributed to dermatology organizations targeting members of the American College of Mohs Surgery (ACMS), from October 2015 to April 2016. Two hundred twenty-seven ACMS members responded; 37% were women. Twenty-five percent of women and 19% of men work part time. Thirty-seven percent of women practice in academia versus 22% of men. Forty-three percent of women and 23% of men identified children as a factor affecting their ability to work full time. Gender comparisons for current job satisfaction show 57% of men and 35% of women being very satisfied. Supervision/feedback/recognition adds to satisfaction at a higher rate for women (53%) than for men (29%). For both genders combined, work content, patient base, and autonomy had the highest average job satisfaction ratings. Gender differences exist in practice patterns and job satisfaction of Mohs surgeons. This study demonstrates factors that could influence job satisfaction among female Mohs surgeons-knowledge that is important to individuals who lead, mentor, or supervise female Mohs surgeons.

  6. Productivity change of surgeons in an academic year.

    Science.gov (United States)

    Nakata, Yoshinori; Watanabe, Yuichi; Otake, Hiroshi; Nakamura, Toshihito; Oiso, Giichiro; Sawa, Tomohiro

    2015-01-01

    The goal of this study was to calculate total factor productivity of surgeons in an academic year and to evaluate the effect of surgical trainees on their productivity. We analyzed all the surgical procedures performed from April 1 through September 30, 2013 in the Teikyo University Hospital. The nonradial and nonoriented Malmquist model under the variable returns-to-scale assumptions was employed. A decision-making unit is defined as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of physicians who assisted in surgery, and the time of surgical operation from skin incision to skin closure. The output was defined as the surgical fee for each surgery. April is the beginning month of a new academic year in Japan, and we divided the study period into April to June and July to September 2013. We computed each surgeon's Malmquist index, efficiency change, and technical change. We analyzed 2789 surgical procedures that were performed by 105 surgeons. The Malmquist index of all surgeons was significantly greater than 1 (p = 0.0033). The technical change was significantly greater than 1 (p productive in the beginning months of a new academic year. The main factor of this productivity loss is considered to be surgical training. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  7. Effect of Thoracic Surgeons on Lung Cancer Patients’ Survival

    Directory of Open Access Journals (Sweden)

    Ning LI

    2018-02-01

    Full Text Available Background and objective Surgeons are the direct decision-makers and performers in the surgical treatment of patients with lung cancer. Whether the differences among doctors affect the survival of patients is unclear. This study analyzed the five-year survival rates of different thoracic surgeries in patients undergoing surgery to assess the physician's impact and impact. Methods A retrospective analysis of five years between 2002-2007 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, for surgical treatment of lung cancer patients. According to different surgeons grouping doctors to compare the basic information of patients, surgical methods, short-term results and long-term survival differences. Results A total of 712 patients treated by 11 experienced thoracic surgeons were included in this study. The patients have nosignificant difference with gender, age, smoking, pathological type between groups. There were significant differences in clinical staging, surgery type, operation time, blood transfusion rate, number of lymph node dissection, palliative resection rate, postoperative complications and perioperative mortality. There was a significant difference in five-year survival rates among patients treated by different doctors. This difference can be seen in all clinical stage analyzes with consistency. In the multivariate analysis, it was suggested that surgeon was an independent factor influencing the prognosis of patients. Conclusion Thoracic surgeon has a significant effect on the therapeutic effect of lung cancer patients.

  8. Postoperative electrolyte management: Current practice patterns of surgeons and residents.

    Science.gov (United States)

    Angarita, Fernando A; Dueck, Andrew D; Azouz, Solomon M

    2015-07-01

    Managing postoperative electrolyte imbalances often is driven by dogma. To identify areas of improvement, we assessed the practice pattern of postoperative electrolyte management among surgeons and residents. An online survey was distributed among attending surgeons and surgical residents at the University of Toronto. The survey was designed according to a systematic approach for formulating self-administered questionnaires. Questions addressed workload, decision making in hypothetical clinical scenarios, and improvement strategies. Of 232 surveys distributed, 156 were completed (response rate: 67%). The majority stated that junior residents were responsible for managing electrolytes at 13 University of Toronto-affiliated hospitals. Supervision was carried out predominately by senior residents (75%). Thirteen percent reported management went unsupervised. Approximately 59% of residents were unaware how often attending surgeons assessed patients' electrolytes. Despite the majority of residents (53.7%) reporting they were never given tools or trained in electrolyte replacement, they considered themselves moderately or extremely confident. The management of hypothetical clinical scenarios differed between residents and attending surgeons. The majority (50.5%) of respondents considered that an electrolyte replacement protocol is the most appropriate improvement strategy. Electrolyte replacement represents an important component of surgeons' workload. Despite reporting that formal training in electrolyte management is limited, residents consider themselves competent; however, their practice is highly variable and often differs from pharmacologic-directed recommendations. Optimizing how postoperative electrolytes are managed in surgical wards requires building a framework that improves knowledge, training, and limits unnecessary interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Musculoskeletal pain among surgeons performing minimally invasive surgery

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup

    2017-01-01

    BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons. In this ......BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons......, and comparative data on surgeons' physical workload with robotic-assisted laparoscopy and conventional laparoscopy. Studies only describing a single surgical modality were excluded. We applied the checklist, STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), to assess the quality...... fulfilled the criteria of STROBE, with an average score of 13 (range 10-16) out of 18. DISCUSSION: Results, mainly self-reported measures, suggest that robotic-assisted laparoscopy is less strenuous compared with conventional laparoscopy. However, results are limited by the large methodological...

  10. The opinion and experiences of Dutch orthopedic surgeons and radiologists about diagnostic musculoskeletal ultrasound imaging in primary care: a survey.

    Science.gov (United States)

    Scholten-Peeters, Gwendolijne G M; Franken, Nicole; Beumer, Annechien; Verhagen, Arianne P

    2014-04-01

    The use of diagnostic musculoskeletal ultrasound (DMUS) in primary health care has increased in the recent years. Nevertheless, there are hardly any data concerning the reliability, accuracy and treatment consequences of DMUS used by physical therapists or general practitioners. Moreover, there are no papers published about how orthopedic surgeons or radiologists deal with the results of DMUS performed in primary care. Therefore, our aim is to evaluate the opinion, possible advantages or disadvantages and experiences of Dutch orthopedic surgeons and radiologists about DMUS in primary care. A cross-sectional survey in which respondents completed a self-developed questionnaire to determine their opinion, experiences, advantages, disadvantages of performing DMUS in primary care. Questionnaires were sent to 838 Dutch orthopedic surgeons and radiologists of which 213 were returned (response rate 25.4%). Our respondents saw no additional value for health care for diagnostic DMUS in primary care. DMUSs were generally repeated in secondary care. They perceived more disadvantages than advantages of performing DMUS in primary care. Mentioned disadvantages were: 'false positive results' (71.4%), 'lack of experience' (70%), 'insufficient education' (69.5%), not able to relate the outcomes of DMUS with other forms of diagnostic imaging' (65.7%), and 'false negative results' (65.3%). Radiologists and orthopedic surgeons sampled in the Netherlands show low trust in DMUS knowledge of physical therapists and general practitioners. The results should be interpreted with caution because of the small response rate and the lack of representativeness to other countries. Published by Elsevier Ltd.

  11. Educating the surgeon-scientist: A qualitative study evaluating challenges and barriers toward becoming an academically successful surgeon.

    Science.gov (United States)

    Kodadek, Lisa M; Kapadia, Muneera R; Changoor, Navin R; Dunn, Kelli Bullard; Are, Chandrakanth; Greenberg, Jacob A; Minter, Rebecca M; Pawlik, Timothy M; Haider, Adil H

    2016-12-01

    The advancement of surgical science relies on educating new generations of surgeon-scientists. Career development awards (K Awards) from the National Institutes of Health, often considered a marker of early academic success, are one way physician-scientists may foster skills through a mentored research experience. This study aimed to develop a conceptual framework to understand institutional support and other factors leading to a K Award. A national, qualitative study was conducted with academic surgeons. Participants included 15 K Awardees and 12 surgery department Chairs. Purposive sampling ensured a diverse range of experiences. Semistructured, in-depth telephone interviews were conducted. Interviews were audio recorded and transcribed verbatim, and 2 reviewers analyzed the transcripts using Grounded Theory methodology. Participants described individual and institutional factors contributing to success. K Awardees cited personal factors such as perseverance and team leadership skills. Chairs described the K Awardee as an institutional "investment" requiring protected time for research, financial support, and mentorship. Both K Awardees and Chairs identified a number of challenges unique to the surgeon-scientist, including financial strains and competing clinical demands. Institutional support for surgeons pursuing K Awards is a complex investment with significant initial costs to the department. Chairs act as stewards of institutional resources and support those surgeon-scientists most likely to be successful. Although the K Award pathway is one way to develop surgeon-scientists, financial burdens and challenges may limit its usefulness. These findings, however, may better prepare young surgeons to develop career plans and identify new mechanisms for academic productivity. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons.

    Science.gov (United States)

    Ichikawa, Nobuki; Homma, Shigenori; Yoshida, Tadashi; Ohno, Yosuke; Kawamura, Hideki; Kamiizumi, You; Iijima, Hiroaki; Taketomi, Akinobu

    2018-01-01

    The use of laparoscopic colectomy is becoming widespread and acquisition of its technique is challenging. In this study, we investigated whether supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The outcomes of 23 right colectomies and 19 high anterior resections for colon cancers performed by five novice surgeons (experience level of <10 cases) between 2014 and 2016 were assessed. A laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System (Japan Society for Endoscopic Surgery) participated in surgeries as the teaching assistant. In the right colectomy group, one patient (4.3%) required conversion to open surgery and postoperative morbidities occurred in two cases (8.6%). The operative time moving average gradually decreased from 216 to 150 min, and the blood loss decreased from 128 to 28 mL. In the CUSUM charts, the values for operative time decreased continuously after the 18th case, as compared to the Japanese standard. The values for blood loss also plateaued after the 18th case. In the high anterior resection group, one patient (5.2%) required conversion to open surgery and no postoperative complication occurred in any patient. The operative time moving average gradually decreased from 258 to 228 min, and the blood loss decreased from 33 to 18 mL. The CUSUM charts showed that the values of operative time plateaued after the 18th case, as compared to the Japanese standard. In the CUSUM chart for blood loss, no distinguishing peak or trend was noted. Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The trainee's learning curve in this study represents successful mentoring by the laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System.

  13. A plastic surgeon's guide to applying smartphone technology in patient care.

    Science.gov (United States)

    Workman, Adrienne D; Gupta, Subhas C

    2013-02-01

    The vast array of information technology available to plastic surgeons continues to expand. With the recent introduction of smartphone application ("app") technology to the market, the potential for incorporating both social media and app technology into daily practice exists. The authors describe and evaluate the smartphone applications most pertinent to plastic surgery. Smartphone apps from all available markets were analyzed for various factors, including popularity among general consumers, ease of use, and functionality. Using various advertising guidelines from plastic surgery societies as well as the US Food and Drug Administration, each app's content was further analyzed within the context of ethical obligations. The apps with the highest number of ratings were those offering the option to upload photos and morph each photo according to the user's own preference. The title of apps also appears to play a role in popularity. A majority of apps demonstrated the same features available on websites. The applicability of social media marketing via smartphone apps has the potential to change future patient-surgeon interactions by offering more personalized and user-friendly encounters. The role of smartphone apps is important to the future of plastic surgery as long as plastic surgeons maintain an active role in the development of these apps to ensure their value.

  14. Surgical amputation of the digit: an investigation into the technical variations among hand surgeons.

    Science.gov (United States)

    Li, Andrew; Meunier, Matthew; Rennekampff, Hans-Oliver; Tenenhaus, Mayer

    2013-01-01

    Digital injuries are common and frequently complicate occupational hazards and trauma. The management of these injuries often necessitates digital amputation, and a variety of different amputation techniques are advocated and employed by hand surgeons. In this survey study, we investigate the variation in technical detail among a group of hand surgeons when performing digital amputations, specifically the preferred management of the residual articular cartilage, transected nerves, and phalangeal contouring. We reviewed the literature on techniques in digital amputation and created a 7-question survey that targeted controversial issues within this specific topic. We then sent this survey electronically to the members of the American Society for Surgery of the Hand and reviewed the responses of the respondents (n = 592, 20%). There was a mixed response regarding whether or not to remove the articular cartilage when disarticulating, nearly a 50% split between the respondents. Most would perform a "pull and resect" technique for transected nerves. Phalangeal contouring was generally agreed upon, though the technique in doing so varied from performing condylectomies, to bony contouring only, to some combination of both. We detected a substantial variation in technique among our group of hand surgeons regarding the treatment of articular cartilage and the method of phalangeal contouring. There was more consensus regarding the treatment of transected nerve. It is interesting that to date, the aforementioned issues in digital amputation have not been critically evaluated by definitive and well-controlled studies.

  15. Exploring Surgeons' Perceptions of the Role of Simulation in Surgical Education: A Needs Assessment

    Directory of Open Access Journals (Sweden)

    Marcia Clark

    2011-11-01

    Full Text Available Introduction: The last two decades have seen the adoption of simulation-based surgical education in various disciplines. The current study’s goal was to perform a needs assessment using the results to inform future curricular planning and needs of surgeons and learners. Methods: A survey was distributed to 26 surgeon educators and interviews were conducted with 8 of these surgeons.  Analysis of survey results included reliability and descriptive statistics. Interviews were analyzed for thematic content with a constant comparison technique, developing coding and categorization of themes. Results: The survey response rate was 81%. The inter-item reliability, according to Cronbach’s alpha was 0.81 with strongest agreement for statements related to learning new skills, training new residents and the positive impact on patient safety and learning.   There was less strong agreement for maintenance of skills, improving team functioning and reducing teaching in the operating room. Interview results confirmed those themes from the survey and highlighted inconsistencies for identified perceived barriers and a focus on acquisition of skills only.  Interview responses specified concerns with integrating simulation into existing curricula and the need for more evaluation as a robust educational strategy. Conclusion: The findings were summarized in four themes: 1 use of simulation, 2 integration into curriculum, 3 leadership, and 4 understanding gaps in simulation use. This study exemplifies a mixed-methods approach to planning a surgical simulation program through a general needs assessment.

  16. Towards a model of surgeons' leadership in the operating room.

    Science.gov (United States)

    Henrickson Parker, Sarah; Yule, Steven; Flin, Rhona; McKinley, Aileen

    2011-07-01

    There is widespread recognition that leadership skills are essential for effective performance in the workplace, but the evidence detailing effective leadership behaviours for surgeons during operations is unclear. Boolean searches of four on-line databases and detailed hand search of relevant references were conducted. A four stage screening process was adopted stipulating that articles presented empirical data on surgeons' intraoperative leadership behaviours. Ten relevant articles were identified and organised by method of investigation into (i) observation, (ii) questionnaire and (iii) interview studies. This review summarises the limited literature on surgeons' intraoperative leadership, and proposes a preliminary theoretically based structure for intraoperative leadership behaviours. This structure comprises seven categories with corresponding leadership components and covers two overarching themes related to task- and team-focus. Selected leadership theories which may be applicable to the operating room environment are also discussed. Further research is required to determine effective intraoperative leadership behaviours for safe surgical practice.

  17. [How much business management does a surgeon need?].

    Science.gov (United States)

    Bork, U; Koch, M; Büchler, M W; Weitz, J

    2010-08-01

    The present day healthcare system in Germany is rapidly changing, even more so after the introduction of diagnosis-related groups. The basic requirements for every surgeon remain manual skills, a profound clinical knowledge and the ability for clinical decision-making even in difficult situations. However, these key elements of surgical education no longer fulfill the requirements for today's leaders in surgery. New requirements, consisting of administrative duties, strategic decision-making and department management are too complex to be made only intuitively. Nowadays surgeons also need a profound education in management skills and knowledge of economic mechanisms in order to run an efficient, profitable, patient-oriented surgical department. Every surgeon who aims at obtaining a leadership position should acquire the necessary knowledge and skills.

  18. Was the real Sherlock Holmes a pediatric surgeon?

    Science.gov (United States)

    Raffensperger, John

    2010-07-01

    This article reviews the pioneering efforts of Joseph Bell, the model for Sherlock Holmes, in the surgical care of children during the antiseptic era. I reviewed biographies of Sir Arthur Conan Doyle; the biography of Joseph Bell; his surgical textbook, Edinburgh Medical Journals; and the history of the Royal Edinburgh Hospital for Sick Children. Dr Bell was a colleague of Joseph Lister and one of the first surgeons to apply antiseptic methods to operations involving children. He was the surgeon appointed to the first surgical ward of the Royal Edinburgh Hospital for Sick Children; in that role, he cared for many children with surgical diseases. Dr Joseph Bell, by his compassion for children and his surgical skill, was indeed a pioneer pediatric surgeon. Copyright 2010 Elsevier Inc. All rights reserved.

  19. Cost analysis when open surgeons perform minimally invasive hysterectomy.

    Science.gov (United States)

    Shepherd, Jonathan P; Kantartzis, Kelly L; Ahn, Ki Hoon; Bonidie, Michael J; Lee, Ted

    2014-01-01

    The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether traditionally open surgeons lower costs when performing laparoscopy versus robotics. Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route. A total of 4,871 hysterectomies were performed: 34.2% open, 50.7% laparoscopic, and 15.1% robotic. Laparoscopic hysterectomy had the lowest total costs (P depreciation included (P < .001) but similar costs if these variables were excluded. Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy.

  20. Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons

    Directory of Open Access Journals (Sweden)

    GD Taylor

    1994-01-01

    Full Text Available Several studies have shown that wound infection (surgical site infection [ ssi ] rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001, 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8, 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96 and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0. In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002. ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.

  1. Sponsoring surgeons; an investigation on the influence of the da Vinci robot.

    Science.gov (United States)

    Criss, Cory N; Gadepalli, Samir K

    2017-08-26

    The integrity of the medical literature about robotic surgery remains unclear despite wide-spread adoption. We sought to determine if payment from Intuitive Surgical Incorporated (ISI) affected quality of the research produced by surgeons. Publicly available financial data from the CMS website regarding the top-20 earners from ISI for 2015 was gathered. Studies conducted by these surgeons were identified using PubMed. Inclusion criteria consisted of publications about the da Vinci ® robot on patient outcomes. The primary outcome of our study was if the study conclusion was positive/equivocal/negative towards the robot. Secondary outcomes included authorship, sponsorship, study controls, and disclosure. The top earners received $3,296,844 in 2015, with a median of $141,959. Sub-specialties included general surgery (55%), colorectal (20%), thoracic (15%), and obstetrics/gynecology (10%). Of the 37 studies, there was 1 RCT, with observational studies comprising the rest. The majority of the studies (n = 16, 43%) had no control population, with 11 (30%) comparing to same institution/surgeon, Though ISI sponsored only 6 (16%) studies, all with positive conclusions, 27 (73%) studies had positive conclusions for robot use, 9 (24%) equivocal, and only 1 (3%) negative. Overall, 13 earners had lead authorship and 11 senior. This initial pilot study highlights a potential bias as current literature published by benefactors demonstrates low quality and highly positive conclusions towards approval of the robot. This substantiates the need for a large, systematic review of the potential influence of sponsoring surgeons on medical literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. How Surgeons Conceptualize Talent: A Qualitative Study Using Sport Science as a Lens.

    Science.gov (United States)

    Jensen, Rune Dall; Christensen, Mette Krogh; LaDonna, Kori A; Seyer-Hansen, Mikkel; Cristancho, Sayra

    Debates prevail regarding the definition of surgical talent, and how individuals with the potential to become talented surgeons can be identified and developed. However, over the past 30 years, talent has been studied extensively in other domains. The objectives of this study is to explore notions of talent in surgery and sport in order to investigate if the field of surgical education can benefit from expanding its view on talented performances. Therefore, this study aims to use the sport literature as a lens when exploring how surgeons conceptualize and define talent. Semi-structured interviews were conducted with a sample of 11 consultant surgeons from multiple specialties. We used constructivist grounded theory principles to explore talent in surgery. Ongoing data analysis refined the theoretical framework and iteratively informed data collection. Themes were identified iteratively using constant comparison. The setting included 8 separate hospitals across Canada and Denmark. A total of 11 consultant surgeons from 6 different surgical subspecialties (urology, orthopedic surgery, colorectal surgery, general surgery, vascular surgery, head & neck surgery) were included. We identified three key elements for conceptualizing surgical talent: (1) Individual skills makes the surgical prospect "good", (2) a mixture of skills gives the surgical prospect the potential to become talented, and (3) becoming talented may rely on the fit between person and environment. We embarked on a study aimed at understanding talent in surgery. Talent is a difficult construct to agree on. Whether in medicine or sports, debates about talent will continue to persist, as we all perceive talent differently. While we heard different opinions, three key ideas summarize our participants' discussions regarding surgical talent. These findings resonate with the holistic ecological approach from sport science and hence highlight the limits of a reductionist approach while favoring the individual

  3. Executive Orders from 1994-2013

    Data.gov (United States)

    National Archives and Records Administration — The President of the United States manages the operations of the Executive branch of Government through Executive orders. After the President signs an Executive...

  4. The Effect of Surgeon Empathy and Emotional Intelligence on Patient Satisfaction

    Science.gov (United States)

    Weng, Hui-Ching; Steed, James F.; Yu, Shang-Won; Liu, Yi-Ten; Hsu, Chia-Chang; Yu, Tsan-Jung; Chen, Wency

    2011-01-01

    We investigated the associations of surgeons' emotional intelligence and surgeons' empathy with patient-surgeon relationships, patient perceptions of their health, and patient satisfaction before and after surgical procedures. We used multi-source approaches to survey 50 surgeons and their 549 outpatients during initial and follow-up visits.…

  5. Non-technical skills of surgical trainees and experienced surgeons.

    Science.gov (United States)

    Gostlow, H; Marlow, N; Thomas, M J W; Hewett, P J; Kiermeier, A; Babidge, W; Altree, M; Pena, G; Maddern, G

    2017-05-01

    In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees. Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared. For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score -0·015 units per year), implementing and reviewing decisions (-0·020 per year), establishing a shared understanding (-0·014 per year), setting and maintaining standards (-0·024 per year), supporting others (-0·031 per year) and coping with pressure (-0·015 per year). The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  6. Surgeon Scientists Are Disproportionately Affected by Declining NIH Funding Rates.

    Science.gov (United States)

    Narahari, Adishesh K; Mehaffey, J Hunter; Hawkins, Robert B; Charles, Eric J; Baderdinni, Pranav K; Chandrabhatla, Anirudha S; Kocan, Joseph W; Jones, R Scott; Upchurch, Gilbert R; Kron, Irving L; Kern, John A; Ailawadi, Gorav

    2018-04-01

    Obtaining National Institutes of Health (NIH) funding over the last 10 years has become increasingly difficult due to a decrease in the number of research grants funded and an increase in the number of NIH applications. National Institutes of Health funding amounts and success rates were compared for all disciplines using data from NIH, Federation of American Societies for Experimental Biology (FASEB), and Blue Ridge Medical Institute. Next, all NIH grants (2006 to 2016) with surgeons as principal investigators were identified using the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Results (NIH RePORTER), and a grant impact score was calculated for each grant based on the publication's impact factor per funding amount. Linear regression and one-way ANOVA were used for analysis. The number of NIH grant applications has increased by 18.7% (p = 0.0009), while the numbers of funded grants (p rate of funded grants with surgeons as principal investigators (16.4%) has been significantly lower than the mean NIH funding rate (19.2%) (p = 0.011). Despite receiving only 831 R01s during this time period, surgeon scientists were highly productive, with an average grant impact score of 4.9 per $100,000, which increased over the last 10 years (0.15 ± 0.05/year, p = 0.02). Additionally, the rate of conversion of surgeon scientist-mentored K awards to R01s from 2007 to 2012 was 46%. Despite declining funding over the last 10 years, surgeon scientists have demonstrated increasing productivity as measured by impactful publications and higher success rates in converting early investigator awards to R01s. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Comparing industry compensation of cardiothoracic surgeons and interventional cardiologists.

    Science.gov (United States)

    Parreco, Joshua; Donath, Elie; Kozol, Robert; Faber, Cristiano

    2017-02-01

    The purpose of this study was to compare payment trends between cardiothoracic surgeons and interventional cardiologists using the Open Payments website made available for the public by the Center for Medicare and Medicaid Services. Data were extracted from the second release of the Open Payments database, which includes payments made between August 1, 2013 and December 31, 2014. Total payments to individual physicians were aggregated based on specialty, region of the country, and payment type. The Gini index was calculated for each specialty to measure income disparity. A Gini index of 1 indicates all the payments went to one individual, whereas a Gini index of 0 indicates all individuals received equal payments. During the study period of interest, data were made available for 3587 (80%) cardiothoracic surgeons compared with 2957 (99%) interventional cardiologists. Mean total payments to cardiothoracic surgeons were $7770 (standard deviation, $52,608) compared with a mean of $15,221 (standard deviation, $98,828) for interventional cardiologists. The median total payments to cardiothoracic surgeons was $1050 (interquartile range, $233-$3612) compared with $1851 (interquartile range, $607-$5462) for interventional cardiologists. The overall Gini index was 0.932, whereas the Gini index was 0.862 for interventional cardiologists and 0.860 for cardiothoracic surgeons. The vast majority of interventional cardiologists and cardiothoracic surgeons received payments from drug and device manufacturers. The mean total payments to interventional cardiologists were higher than any other specialty. However, like cardiothoracic surgery, they were among the most equitably distributed compared with other specialties. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Does sleep deprivation impair orthopaedic surgeons' cognitive and psychomotor performance?

    Science.gov (United States)

    O'Brien, Michael J; O'Toole, Robert V; Newell, Mary Zadnik; Lydecker, Alison D; Nascone, Jason; Sciadini, Marcus; Pollak, Andrew; Turen, Clifford; Eglseder, W Andrew

    2012-11-07

    Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained. We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center. Testing sessions used handheld computers to administer validated cognitive and psychomotor function tests. We conducted a multivariate analysis to examine the independent association between test performance and multiple covariates, including the amount of sleep the night before testing. Our analysis demonstrated that orthopaedic surgeons who had slept four hours or less the night before the test had 1.43 times the odds (95% confidence interval, 1.04 to 1.95; p = 0.03) of committing at least one error on an individual test compared with orthopaedic surgeons who had slept more than four hours the previous night. The Running Memory test, which assesses sustained attention, concentration, and working memory, was most sensitive to deterioration in performance in participants who had had four hours of sleep or less; when controlling for other covariates, the test demonstrated a 72% increase in the odds of making at least one error (odds ratio, 1.72 [95% confidence interval, 1.02 to 2.90]; p = 0.04). No significant decrease in performance with sleep deprivation was shown with the other three tests. Orthopaedic trauma surgeons showed deterioration in performance on a validated cognitive task when they had slept four hours or less the previous night. It is unknown how performance on this test relates to surgical performance.

  9. A young surgeon's perspective on alternate surgical training pathways.

    Science.gov (United States)

    Sutherland, Michael J

    2007-02-01

    Most residents in training today are in focused on their training, and the thoughts of changing the structure of residencies and fellowships is something that they are ambivalent about or have never heard anything about. The small minority who are vocal on these issues represent an activist group supporting change. This group is very vocal and raises many of the excellent questions we have examined. In discussion with residents, some feel that shortened training will help with the financial issues facing residents. However, many people today add additional years to their training with research years or "super" fellowships. The residents demonstrate that they want to get the skill sets that they desire despite the added length of training. This is unlikely to change even if the minimum number of years of training changes with the evolution of tracked training programs. Medical students, in the Resident and Associate Society of the American College of Surgeons survey, did not indicate that shortened training would have an affect on decision to pursue or not pursue a surgical career. If the focus of these changes is to encourage medical students to pursue a residency in surgical specialties, we may need to look at other options to increase medical student interest. Medical students indicated that lifestyle issues, types of clinical problems, stress-related concerns, and interactions with the surgical faculty were far more important in their decision to enter a surgical specialty than work hours or duration of training. If we are to make a difference in the quality and quantity of applicants for surgical residencies, then changes in the structure of residencies do not seem to be the most effective way to accomplish this. We should possibly focus more on faculty and medical student interaction and the development of positive role models for medical students to see surgeons with attractive practices that minimize some of the traditionally perceived negative stereotypes

  10. Cosmetic surgery in times of recession: macroeconomics for plastic surgeons.

    Science.gov (United States)

    Krieger, Lloyd M

    2002-10-01

    Periods of economic downturn place special demands on the plastic surgeon whose practice involves a large amount of cosmetic surgery. When determining strategy during difficult economic times, it is useful to understand the macroeconomic background of these downturns and to draw lessons from businesses in other service industries. Business cycles and monetary policy determine the overall environment in which plastic surgery is practiced. Plastic surgeons can take both defensive and proactive steps to maintain their profits during recessions and to prepare for the inevitable upturn. Care should also be taken when selecting pricing strategy during economic slowdowns.

  11. Surgeon and Safari: producing valuable bodies in Johannesburg.

    Science.gov (United States)

    Mazzaschi, Andrew

    2011-01-01

    This essay explores how concepts of value and cheapness circulate around the bodies of clients of the Johannesburg-based cosmetic surgery tourism company Surgeon and Safari. I show how the production of a luxurious experience and the mitigation of risk take place within a transnational network enabled by the presence of medical tourism in multiple locales. By placing Surgeon and Safari's activities within the context of the neoliberalization of health care in South Africa, I explore how the division between private versus public health spaces functions as both a technique of valuing clients' bodies and as a process of racialization.

  12. Inventing our future: training the next generation of surgeon innovators.

    Science.gov (United States)

    Krummel, Thomas M; Gertner, Michael; Makower, Josh; Milroy, Craig; Gurtner, Geoff; Woo, Russell; Riskin, Daniel J; Binyamin, Gary; Connor, Jessica Anne; Mery, Carlos M; Shafi, Bilal M; Yock, Paul G

    2006-11-01

    Current surgical care and technology has evolved over the centuries from the interplay between creative surgeons and new technologies. As both fields become more specialized, that interplay is threatened. A 2-year educational fellowship is described which teaches both the process and the discipline of medical/surgical device innovation. Multi-disciplinary teams (surgeons, engineers, business grads) are assembled to educate a generation of translators, who can bridge the gap between scientific and technologic advances and the needs of the physician and the patient.

  13. Patient-specific hip prostheses designed by surgeons

    Directory of Open Access Journals (Sweden)

    Coigny Florian

    2016-09-01

    Full Text Available Patient-specific bone and joint replacement implants lead to better functional and aesthetic results than conventional methods [1], [2], [3]. But extracting 3D shape information from CT Data and designing individual implants is demanding and requires multiple surgeon-to-engineer interactions. For manufacturing purposes, Additive Manufacturing offers various advantages, especially for low volume manufacturing parts, such as patient specific implants. To ease these new approaches and to avoid surgeon-to-engineer interactions a new design software approach is needed which offers highly automated and user friendly planning steps.

  14. American College of Surgeons remains committed to patient safety.

    Science.gov (United States)

    Russell, Thomas R; Jones, R Scott

    2006-11-01

    Since 1913 the American College of Surgeons has addressed patient safety as a top priority, so they are pleased to contribute this article offering the College's perspective on this critical subject. More specifically, this piece reviews the College's perennial efforts to ensure surgeons and hospitals access to scientifically verifiable standards, availability of effective quality improvement tools, and a better understanding of errors in care. Additionally, they examine the cultural changes required within surgery and provide an overview of the College's recent initiatives in research, accreditation, and education.

  15. Television and children's executive function.

    Science.gov (United States)

    Lillard, Angeline S; Li, Hui; Boguszewski, Katie

    2015-01-01

    Children spend a lot of time watching television on its many platforms: directly, online, and via videos and DVDs. Many researchers are concerned that some types of television content appear to negatively influence children's executive function. Because (1) executive function predicts key developmental outcomes, (2) executive function appears to be influenced by some television content, and (3) American children watch large quantities of television (including the content of concern), the issues discussed here comprise a crucial public health issue. Further research is needed to reveal exactly what television content is implicated, what underlies television's effect on executive function, how long the effect lasts, and who is affected. © 2015 Elsevier Inc. All rights reserved.

  16. Executive Schedule C System (ESCS)

    Data.gov (United States)

    Office of Personnel Management — Used to store information on Federal employees in the Senior Executive Service (SES) and appointed employees in the Schedule C System. Every four years, just after...

  17. Innovative behavior in nurse executives.

    Science.gov (United States)

    Adams, C E

    1994-05-01

    This study addresses the problem-solving styles of hospital nurse executives and explores the relationship between problem-solving style and leader effectiveness. The Kirton Adaption-Innovation Inventory (KAI) and the Leader Effectiveness and Adaptability Description-Self (LEAD-S) were the instruments used to survey nurse executives from 66 medium-sized urban California hospitals. The majority of respondents used innovative approaches, but no correlation was found between problem-solving style and leader effectiveness.

  18. Executive functions in anorexia nervosa

    OpenAIRE

    Jauregui-Lobera, Ignacio

    2014-01-01

    Introduction: The pathophysiologic mechanisms that account for the development and persistence of anorexia nervosa (AN) remain unclear. With respect to the neuropsychological functioning, the executive functions have been reported to be altered, especially cognitive flexibility and decision-making processes. Objectives: The aim of this study was to review the current state of the neuropsychological studies focused on anorexia nervosa, especially those highlighting the executive functions. Met...

  19. Supervision of execution of dismantling

    International Nuclear Information System (INIS)

    Canizares, J.

    2015-01-01

    Enresa create and organizational structure that covers various areas involved in effective control of Decommissioning Project. One area is the Technical Supervision of Works Decommissioning Project, as Execution Department dependent Technical Management. In the structure, Execution Department acts as liaison between the project, disciplines involved in developing and specialized companies contracted work to achieve your intended target. Equally important is to ensure that such activities are carried out correctly, according to the project documentation. (Author)

  20. A competence executive coaching model

    Directory of Open Access Journals (Sweden)

    Pieter Koortzen

    2010-07-01

    Research purpose: The purpose of this article is to address the training and development needs of these consulting psychologists by presenting a competence executive coaching model for the planning, implementation and evaluation of executive coaching interventions. Research design, approach and method: The study was conducted while one of the authors was involved in teaching doctoral students in consulting psychology and executive coaching, specifically in the USA. The approach involved a literature review of executive coaching models and a qualitative study using focus groups to develop and evaluate the competence executive coaching model. Main findings: The literature review provided scant evidence of competence executive coaching models and there seems to be a specific need for this in the training of coaches in South Africa. Hence the model that was developed is an attempt to provide trainers with a structured model for the training of coaches. Contribution/value-add: The uniqueness of this competence model is not only described in terms of the six distinct coaching intervention phases, but also the competencies required in each.

  1. The Risk Preferences of U.S. Executives

    DEFF Research Database (Denmark)

    Brenner, Steffen

    2015-01-01

    In this paper, I elicit risk attitudes of U.S. executives by calibrating a subjective option valuation model for option exercising data (1996 to 2008), yielding approximately 65,000 values of relative risk aversion (RRA) for almost 7,000 executives. The observed behavior is generally consistent...... with moderate risk aversion and a median (mean) RRA close to one (three). Values are validated for chief executive officers (CEOs) by testing theory-based predictions on the influence of individual characteristics on risk preferences such as gender, marital status, religiosity, and intelligence. Senior managers...... such as CEOs, presidents, and chairpersons of the boards of directors are significantly less risk averse than non-senior executives. RRA heterogeneity is strongly correlated with sector membership and firm-level variables such as size, performance, and capital structure. Alternative factors influencing option...

  2. Cognitive programs: Software for attention's executive

    Directory of Open Access Journals (Sweden)

    John K Tsotsos

    2014-11-01

    Full Text Available What are the computational tasks that an executive controller for visual attention must solve? This question is posed in the context of the Selective Tuning model of attention. The range of required computations go beyond top-down bias signals or region-of-interest determinations, and must deal with overt and covert fixations, process timing and synchronization, information routing, memory, matching control to task, spatial localization, priming, and coordination of bottom-up with top-down information. During task execution, results must be monitored to ensure the expected results. This description includes the kinds of elements that are common in the control of any kind of complex machine or system. We seek a mechanistic integration of the above, in other words, algorithms that accomplish control. Such algorithms operate on representations, transforming a representation of one kind into another, which then forms the input to yet another algorithm. Cognitive Programs (CPs are hypothesized to capture exactly such representational transformations via stepwise sequences of operations. CPs, an updated and modernized offspring of Ullman's Visual Routines, impose an algorithmic structure to the set of attentional functions and play a role in the overall shaping of attentional modulation of the visual system so that it provides its best performance. This requires that we consider the visual system as a dynamic, yet general-purpose processor tuned to the task and input of the moment. This differs dramatically from the almost universal cognitive and computational views, which regard vision as a passively observing module to which simple questions about percepts can be posed, regardless of task. Differing from Visual Routines, CPs explicitly involve the critical elements of Visual Task Executive, Visual Attention Executive, and Visual Working Memory. Cognitive Programs provide the software that directs the actions of the Selective Tuning model of visual

  3. Hot and cold executive functions in youth with psychotic symptoms.

    Science.gov (United States)

    MacKenzie, L E; Patterson, V C; Zwicker, A; Drobinin, V; Fisher, H L; Abidi, S; Greve, A N; Bagnell, A; Propper, L; Alda, M; Pavlova, B; Uher, R

    2017-12-01

    Psychotic symptoms are common in children and adolescents and may be early manifestations of liability to severe mental illness (SMI), including schizophrenia. SMI and psychotic symptoms are associated with impairment in executive functions. However, previous studies have not differentiated between 'cold' and 'hot' executive functions. We hypothesized that the propensity for psychotic symptoms is specifically associated with impairment in 'hot' executive functions, such as decision-making in the context of uncertain rewards and losses. In a cohort of 156 youth (mean age 12.5, range 7-24 years) enriched for familial risk of SMI, we measured cold and hot executive functions with the spatial working memory (SWM) task (total errors) and the Cambridge Gambling Task (decision-making), respectively. We assessed psychotic symptoms using the semi-structured Kiddie Schedule for Affective Disorders and Schizophrenia interview, Structured Interview for Prodromal Syndromes, Funny Feelings, and Schizophrenia Proneness Instrument - Child and Youth version. In total 69 (44.23%) youth reported psychotic symptoms on one or more assessments. Cold executive functioning, indexed with SWM errors, was not significantly related to psychotic symptoms [odds ratio (OR) 1.36, 95% confidence interval (CI) 0.85-2.17, p = 0.204). Poor hot executive functioning, indexed as decision-making score, was associated with psychotic symptoms after adjustment for age, sex and familial clustering (OR 2.37, 95% CI 1.25-4.50, p = 0.008). The association between worse hot executive functions and psychotic symptoms remained significant in sensitivity analyses controlling for general cognitive ability and cold executive functions. Impaired hot executive functions may be an indicator of risk and a target for pre-emptive early interventions in youth.

  4. Are ENT surgeons in the UK at risk of stress, psychological morbidities and burnout? A national questionnaire survey.

    Science.gov (United States)

    Vijendren, Ananth; Yung, Matthew; Shiralkar, Uttam

    2018-02-01

    Work-related stress, psychological disorders and burnout are common occupational disorders affecting UK doctors. To date, there are no studies looking at these psychosocial morbidities amongst ENT surgeons worldwide. The General Health Questionnaire-12 (GHQ-12) and abbreviated Maslach Burnout Inventory (aMBI) were incorporated into a questionnaire on occupational diseases amongst ENT surgeons and distributed to the entire membership of ENT-UK. The survey study also acquired demographic data on grade of respondent, years of experience in ENT and subspecialty interest. We received 108 (8.1% response rate) appropriately filled GHQ-12 and 121 (9.0% response rate) aMBI questionnaires. 61 respondents (56.5%) on the GHQ-12 were at high risk of developing stress and psychological morbidity and 35 (28.9%) had high enough aMBI scores to suggested burnout. When comparing scores of both GHQ-12 and aMBI with grade of respondent, years of experience in ENT and subspecialty, statistical difference was only found on the risk of stress and psychiatric disorders amongst paediatric ENT surgeons (7 high risk vs 0 low risk, p = 0.02), however the number of these respondents was small (7 in total). Both questionnaires had been validated for use within our population. We found high incidence rates of stress and psychological morbidity (56.5%) and a burnout prevalence rate of 28.9% amongst our responding cohort of UK Oto-rhino-laryngologists. No meaningful differences were found between stress, psychological morbidity and burnout with grade of ENT surgeon, years of experience in ENT and subspecialty within ENT. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  5. Robotics in General Surgery

    OpenAIRE

    Wall, James; Chandra, Venita; Krummel, Thomas

    2008-01-01

    In summary, robotics has made a significant contribution to General Surgery in the past 20 years. In its infancy, surgical robotics has seen a shift from early systems that assisted the surgeon to current teleoperator systems that can enhance surgical skills. Telepresence and augmented reality surgery are being realized, while research and development into miniaturization and automation is rapidly moving forward. The future of surgical robotics is bright. Researchers are working to address th...

  6. Body Dysmorphia, the Plastic Surgeon, and the Counselor.

    Science.gov (United States)

    Renshaw, Domeena C.

    2003-01-01

    Misperceived ugliness is called body dysmorphia or dysmorphophobia, often only diagnosed after several discontented return visits to a plastic surgeon who refers the patient for counseling--rarely welcome referrals by the patient when they are convinced the problem is physical and not psychological. Careful listening and patient acceptance are…

  7. Job Hazards Analysis Among A Group Of Surgeons At Zagazig ...

    African Journals Online (AJOL)

    ... 75% respectively. Conclusion: Job hazards analysis model was effective in assessment, evaluation and management of occupational hazards concerning surgeons and should considered as part of hospital wide quality and safety program. Key Words: Job Hazard Analysis, Risk Management, occupational Health Safety.

  8. National survey of surgeons\\' attitudes to laparoscopic surgical ...

    African Journals Online (AJOL)

    Aim. Laparoscopic surgery forms an integral component of modern surgical practice. The perception exists that laparoscopic training in South Africa has been unplanned and under-resourced. This study set out to assess the opinions of surgeons and surgical trainees with regard to the various facets of laparoscopic surgical ...

  9. Coaching Surgeons: Is Culture Limiting Our Ability to Improve?

    Science.gov (United States)

    Mutabdzic, Dorotea; Mylopoulos, Maria; Murnaghan, Michael Lucas; Patel, Priyanka; Zilbert, Nathan; Seemann, Natashia; Regehr, Glenn; Moulton, Carol-Anne

    2015-08-01

    To explore surgeons' perceptions of and potential concerns about coaching. There is growing recognition that the traditional model of continuing professional development is suboptimal. This has led to increasing interest in alternative strategies that take place within the actual practice environment such as coaching. However, if coaching is to be a successful strategy for continuing professional development, it will need to be accepted by surgeons. This was a qualitative interview-based study using a constructivist grounded theory approach. Participants included 14 surgeons from University of Toronto-affiliated hospitals. Participants expressed 3 main concerns about coaching: questioning the value of technical improvement ("As you get older if you don't have the stimulation from surgery to get better or to do things that are different and you are so good at so much, why bother [with coaching]?" P009), worry about appearing incompetent ("I think it would be perceived as either a sign of weakness or a sign of inability" P532), and concern about losing autonomy ("To me that would be real coaching where it's self-identified, I'm motivated, I find the person and then they coach me" P086). Coaching faces unique challenges in the context of a powerful surgical culture that values the portrayal of competency and instills the value of surgical autonomy. This study suggests that hanging on to these tightly held values of competency and autonomy is actually limiting the ways, and extent to which, surgeons can improve their practice.

  10. Factors Influencing Patient Selection of a Foot and Ankle Surgeon.

    Science.gov (United States)

    Manning, Blaine T; Bohl, Daniel D; Wang, Kevin C; Hamid, Kamran S; Holmes, George B; Lee, Simon

    2017-09-01

    An increasingly consumer-centric health insurance market has empowered patients to select the providers of their choice. There is a lack of studies investigating the rationale by which patients select a foot and ankle surgeon. In the present study, 824 consecutive new patients seeking treatment from 3 foot-ankle surgeons were consecutively administered an anonymous questionnaire prior to their first appointment. It included rating the importance of 15 factors regarding specialist selection on a 1 to 10 scale, with 10 designated " Very important" and 1 designated " Not important at all." The remaining questions were multiple choice regarding patient perspectives on other surgeon aspects (appointment availability, waiting room times, clinic proximity, etc). Of 824 consecutive patients administered the survey, 305 (37%) responded. Patients rated board certification (9.24 ± 1.87) and on-site imaging availability (8.48 ± 2.37)-on a 1 to 10 scale, with 10 designated "Very important- as the 2 most important criteria in choosing a foot and ankle surgeon. Patients rated advertisements as least important. Among the patients, 91% responded that a maximum of 30 minutes should elapse between clinic check-in and seeing their physician; 61% responded that a maximum of 20 minutes should elapse between clinic check-in and seeing their physician. In the context of an increasingly consumer-driven paradigm of health care delivery and reimbursement, it is important to understand patients' preferences in specialist selection. Level III: Prospective questionnaire.

  11. Hypertensive Patient in the Surgical Ward – What the Surgeon ...

    African Journals Online (AJOL)

    Two cases of hypertension are presented to emphasize the need for the surgeons to pay adequate attention to these purely medical conditions that may have a devastating adverse effect on the outcome of surgery. The article also highlights the serious constraints that still characterize the management of these patients in ...

  12. Perspectives of the surgeons, anaesthetists, and pharmacists on ...

    African Journals Online (AJOL)

    Post-operative pain is best managed by a multi-disciplinary team approach. An extensive review of the literature indicated that little is known about the roles of surgeons, anaesthetists, and pharmacists regarding post-operative pain management in Ghana. Therefore, this study was undertaken in order to fully understand ...

  13. Optimal Brain Surgeon on Artificial Neural Networks in

    DEFF Research Database (Denmark)

    Christiansen, Niels Hørbye; Job, Jonas Hultmann; Klyver, Katrine

    2012-01-01

    It is shown how the procedure know as optimal brain surgeon can be used to trim and optimize artificial neural networks in nonlinear structural dynamics. Beside optimizing the neural network, and thereby minimizing computational cost in simulation, the surgery procedure can also serve as a quick...

  14. Safety of the surgeon: 'Double-gloving' during surgical procedures

    African Journals Online (AJOL)

    during exposure to blood and body fluids are now mandatory. Intact surgical gloves can ... HIV/AIDS infection is for the surgeon to 'double-glove' – wear two standard gloves on .... sharp fractured bones or bony structures.[12,16,17] The rate of ...

  15. Professional interpersonal dynamics and burnout in European transplant surgeons.

    Science.gov (United States)

    Jesse, Michelle T; Abouljoud, Marwan; Eshelman, Anne; De Reyck, Chantal; Lerut, Jan

    2017-04-01

    Burnout within the health professions has become an increasingly important topic. Evidence suggests there are differences in burnout across different countries. Research has yet to examine burnout in transplant surgeons throughout Europe. A cross-sectional survey of transplant surgeons across Europe. Survey included sociodemographics, professional characteristics, frequency and discomfort with difficult patient interactions (PI), decisional autonomy, psychological job demands (PJD), support (coworker, supervisor, and hospital administration), and burnout including emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). One hundred and eight transplant surgeons provided data; 33 (30.6%) reported high EE, 19 (17.6%) reported high DP, and 29 (26.9%) reported low PA. Three hierarchical multiple linear regressions examined the burnout subscales as outcomes (EE, DP, and PA), and predictors selected based upon theoretical relationships with the outcomes. Greater PJD, greater discomfort in managing difficult PI, and lower levels of perceived supervisor support (SS) predicted greater EE. Only decisional autonomy significantly predicted DP, accounting for a small proportion of the variance. None of the steps for PA were significant. Given prior research on burnout, there were several surprising findings from this study. For example, the relatively low levels of EE compared to U.S. physicians and surgeons. At this time, we can only hypothesize why this finding occurred but there are multiple possible explanations including cultural effects, response bias, or other factors unknown at this time. Research is needed to attempt to clarify these findings. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Can statisticians beat surgeons at the planning of operations?

    NARCIS (Netherlands)

    Joustra, Paul; Meester, Reinier; van Ophem, Hans

    2013-01-01

    The planning of operations in the Academic Medical Center is primarily based on the assessments of the length of the operation by the surgeons. We investigate whether duration models employing the information available at the moment the planning is made, offer a better alternative. Our empirical

  17. Can statisticians beat surgeons at the planning of operations?

    NARCIS (Netherlands)

    Joustra, P.; Meester, R.; van Ophem, H.

    2011-01-01

    The planning of operations in the Academic Medical Center is primarily based on the assessments of the length of the operation by the surgeons. We investigate whether duration models employing the information available at the moment the planning is made, offer a better alternative. Our empirical

  18. Practice activity trends among oral and maxillofacial surgeons in Australia

    Directory of Open Access Journals (Sweden)

    Teusner Dana N

    2004-12-01

    Full Text Available Abstract Background The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time. Methods All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Results Data were available from 79 surgeons from 1990 (response rate = 73.8% and 116 surgeons from 2000 (response rate = 65.1%. The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 ± 0.05 services per visit in 1990 to 1.66 ± 0.06 services per visit in 2000, reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 ± 286 services per year in 1990 and 4,503 ± 367 services per year in 2000. Time devoted to work showed no significant change over time (1,682 ± 75 hours per year in 1990 and 1,681 ± 94 hours per year in 2000, while the number of visits per week declined (70 ± 4 visits per week in 1990 to 58 ± 4 visits per week in 2000. Conclusions The apparent stability in the volume of services provided per year reflected a counterbalancing of increased services provided per visit and a decrease in the number of visits supplied.

  19. The paediatric surgeon and his working conditions in Francophone ...

    African Journals Online (AJOL)

    Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1st May to 30th October 2008. The African Society of paediatric ...

  20. Antimicrobial Stewardship: A Call to Action for Surgeons

    Science.gov (United States)

    Duane, Therese M.; Catena, Fausto; Tessier, Jeffrey M.; Coccolini, Federico; Kao, Lillian S.; De Simone, Belinda; Labricciosa, Francesco M.; May, Addison K.; Ansaloni, Luca; Mazuski, John E.

    2016-01-01

    Abstract Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients. PMID:27828764

  1. Occupational Exposure to the Risk of HIV Infection Among Surgeons ...

    African Journals Online (AJOL)

    The majority (97%) incorrectly estimated the sero-conversion rate with exposure to a patient with HIV. The most popular recommendation was availability of surgical gloves followed by health education to raise the level of awareness of medical personnel. Conclusion: The high rate of needlestick injuries among surgeons in ...

  2. Role of the plastic surgeon in a cancer hospital

    International Nuclear Information System (INIS)

    Sinclair, M.H.

    1979-01-01

    This paper discusses and illustrates the complicated problems faced by the plastic surgeon in a cancer hospital. His patients are often weakened, both physically and psychologically, not only by the cancer itself, but also by extensive ablative surgery. The goal of the plastic surgeon is rehabilitation of the patient after he is cured of cancer. Good planning with the cancer surgeon before the ablative operation is very important, as is immediate repair, whenever possible. The simplest procedure with the fewest stages that can accomplish satisfactory repair in the shortest time should be chosen, as we can never, even after the most extensive cancer operation, be sure that no recurrence will appear. Partial surgical repair and the use of a prosthesis should be considered for complicated defects in old and weak patients. Postoperative radiation therapy, if indicated, can be given after the flap has healed into the defect but before the pedicle is separated. The plastic surgeon should always be aware that his most important goal is speedy and satisfactory rehabilitation of the patient

  3. PREVALENCE OF HEPATITIS B VIRUS MARKERS IN SURGEONS ...

    African Journals Online (AJOL)

    hi-tech

    Objective: To determine the prevalence of hepatitis B virus (HBV) markers in surgeons in a major city in Nigeria. ... Interventions: Blood samples were taken from subjects and analysed for hepatitis B virus markers ( HBsAg, antiHBs and .... Lagos was comparable to those of Romieu et al (10) who found HBsAg seropositivity ...

  4. Computer technology and the surgeon: what the resident needs to ...

    African Journals Online (AJOL)

    Though a compliment to the surgeon, it has its problems including overwhelming information requiring careful scrutiny; computer fraud, hacking and viruses; copyright laws; the 'threat' of a well-informed patient population; and the risk of over dependence. Surgery in Nigeria and most of African is yet to maximize its benefits.

  5. Mentoring the modern African surgeon: A call to arms!

    African Journals Online (AJOL)

    2011-01-16

    Jan 16, 2011 ... Hospital, Nairobi, 2-University of Nairobi, Kenya, 3-King Khalid University, UAE. Correspondence: Dr. Miriam Mutebi, Aga Khan. University Hospital. P.O. Bx 30270 .... Galukande M, Kijjambu S, Luboga S Improving recruitment of surgical trainees and training of surgeons in Uganda. East. Cent Afr J Surg.

  6. General edition program

    International Nuclear Information System (INIS)

    Vaturi, Sylvain

    1969-01-01

    Computerized edition is essential for data processing exploitation. When a more or less complex edition program is required for each task, then the need for a general edition program become obvious. The aim of this study is to create a general edition program. Universal programs are capable to execute numerous and varied tasks. For a more precise processing, the execution of which is frequently required, the use of a specialized program is preferable because, contradictory to the universal program, it goes straight to the point [fr

  7. Improving surgeon utilization in an orthopedic department using simulation modeling

    Directory of Open Access Journals (Sweden)

    Simwita YW

    2016-10-01

    Full Text Available Yusta W Simwita, Berit I Helgheim Department of Logistics, Molde University College, Molde, Norway Purpose: Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time.Methods: The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization.Results: The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services.Conclusion: This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. Keywords: waiting time, patient, health care process

  8. Surgeon Experience and Complications of Transvaginal Prolapse Mesh.

    Science.gov (United States)

    Kelly, Erin C; Winick-Ng, Jennifer; Welk, Blayne

    2016-07-01

    To measure the proportion of women with transvaginal prolapse mesh complications and their association with surgeon volume. We conducted a retrospective, population-based cohort study of all women who underwent a mesh-based prolapse procedure using administrative data (hospital procedure and physician billing records) between 2002 and 2013 in Ontario, Canada. The primary outcome was surgical revision of the mesh. Primary exposure was surgeon volume: high (greater than the 75th percentile, requiring a median of five [interquartile range 5-6] procedures per year) and very high (greater than the 90th percentile, requiring a median of 13 [interquartile range 11-14] procedures per year) volume mesh implanters were identified each year. Primary analysis was an adjusted Cox proportional hazards model. A total of 5,488 women underwent mesh implantation by 1 of 368 unique surgeons. Median follow-up time was 5.4 (interquartile range 3.0-8.0) years. We found that 218 women (4.0%) underwent mesh reoperation a median of 1.17 (interquartile range 0.58-2.90) years after implantation. The hazard of reoperation for complications was only lower for patients of very high-volume surgeons (3.0% [145/3,001] compared with 4.8% [73/2,447], adjusted hazards ratio 0.59, 95% confidence interval 0.40-0.86). In multivariable modeling, younger age, concomitant hysterectomy, blood transfusion, and increased medical comorbidity were all associated with vaginal mesh reoperation. Approximately 5% of women who underwent mesh-based prolapse surgery required reoperation for a mesh complication within 10 years. The risk of reoperation was lowest for surgeons performing 14 or more procedures per year.

  9. 26 CFR 1.6050M-1 - Information returns relating to persons receiving contracts from certain Federal executive agencies.

    Science.gov (United States)

    2010-04-01

    ... any other rule of contract law, express or implied, the amount of money or other property obligated... of this section— (1) Federal executive agency. The term “Federal executive agency” means— (i) Any... Commission. (2) Contract—(i) General rule. The term “contract” means an obligation of a Federal executive...

  10. The safe use of surgical energy devices by surgeons may be overestimated.

    Science.gov (United States)

    Ha, Ally; Richards, Carly; Criman, Erik; Piaggione, Jillian; Yheulon, Christopher; Lim, Robert

    2018-03-01

    Surgical energy injuries are an underappreciated phenomenon. Improper use of surgical energy or poor attention to patient safety can result in operating room fires, tissue injuries, and interferences with other electronic devices, while rare complications can be devastatingly severe. Despite this, there is no current standard requirement for educating surgeons on the safe use of energy-based devices or evaluation of electrosurgery (ES) education in residency training, credentialing, or practice. The study aimed to assess the current baseline knowledge of surgeons and surgical trainees with regards to ES across varying experiences at a tertiary level care center. Surgeons and surgical trainees from seven surgical specialties (General Surgery, Cardiothoracic Surgery, Vascular Surgery, Obstetrics/Gynecology, Orthopedic Surgery, Urology, and Otorhinolaryngology) at a tertiary level care hospital were tested. Testing included an evaluation regarding their background training and experiences with ES-related adverse events and a 15 multiple-choice-question exam testing critical knowledge of ES. A total of 134 surveys were sent out with 72 responses (53.7%). The mean quiz score was 51.5 ± 15.5% (passing score was 80%). Of staff surgeons, 33/65 (50.8%) completed the survey with mean and median scores of 54.9 and 53.3%, respectively (range 33.3-86.7%). Of surgical trainees, 39/69 (56.5%) completed the survey with mean and median scores of 48.6 and 46.7%, respectively (range 13.3-80.0%). There were no statistically significant differences based on training status (p = 0.08), previous training (p = 0.24), number of cases (p = 0.06), or specialty (p = 0.689). Surgeons and surgical trainees both have a significant knowledge gap in the safe and effective use of surgical energy devices, regardless of surgical specialty and despite what they feel was adequate training. The knowledge gap is not improved with experience. A formal surgical energy education program

  11. Prospective associations between bilingualism and executive function in Latino children: sustained effects while controlling for biculturalism.

    Science.gov (United States)

    Riggs, Nathaniel R; Shin, Hee-Sung; Unger, Jennifer B; Spruijt-Metz, Donna; Pentz, Mary Ann

    2014-10-01

    The study purpose was to test 1-year prospective associations between English-Spanish bilingualism and executive function in 5th to 6th grade students while controlling for biculturalism. Participants included 182 US Latino students (50 % female). Self-report surveys assessed biculturalism, bilingualism, and executive function (i.e., working memory, organizational skills, inhibitory control, and emotional control, as well as a summary executive function score). General linear model regressions demonstrated that bilingualism significantly predicted the summary executive function score as well as working memory such that bilingual proficiency was positively related to executive function. Results are the first to demonstrate (a) prospective associations between bilingualism to executive function while controlling for the potential third variable of biculturalism, and (b) a principal role for working memory in this relationship. Since executive function is associated with a host of health outcomes, one implication of study findings is that bilingualism may have an indirect protective influence on youth development.

  12. Surgeons' attitude toward a competency-based training and assessment program: results of a multicenter survey.

    Science.gov (United States)

    Hopmans, Cornelis J; den Hoed, Pieter T; Wallenburg, Iris; van der Laan, Lijkckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; van Lanschot, Jan J B; Ijzermans, Jan N M

    2013-01-01

    Currently, most surgical training programs are focused on the development and evaluation of professional competencies. Also in the Netherlands, competency-based training and assessment programs were introduced to restructure postgraduate medical training. The current surgical residency program is based on the Canadian Medical Education Directives for Specialists (CanMEDS) competencies and uses assessment tools to evaluate residents' competence progression. In this study, we examined the attitude of surgical residents and attending surgeons toward a competency-based training and assessment program used to restructure general surgical training in the Netherlands in 2009. In 2011, all residents (n = 51) and attending surgeons (n = 108) in 1 training region, consisting of 7 hospitals, were surveyed. Participants were asked to rate the importance of the CanMEDS competencies and the suitability of the adopted assessment tools. Items were rated on a 5-point Likert scale and considered relevant when at least 80% of the respondents rated an item with a score of 4 or 5 (indicating a positive attitude). Reliability was evaluated by calculating the Cronbach's α, and the Mann-Whitney test was applied to assess differences between groups. The response rate was 88% (n = 140). The CanMEDS framework demonstrated good reliability (Cronbach's α = 0.87). However, the importance of the competencies 'Manager' (78%) and 'Health Advocate' (70%) was undervalued. The assessment tools failed to achieve an acceptable reliability (Cronbach's α = 0.55), and individual tools were predominantly considered unsuitable for assessment. Exceptions were the tools 'in-training evaluation report' (91%) and 'objective structured assessment of technical skill' (82%). No significant differences were found between the residents and the attending surgeons. This study has demonstrated that, 2 years after the reform of the general surgical residency program, residents and attending surgeons in a large

  13. Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

    DEFF Research Database (Denmark)

    Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels

    2015-01-01

    surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all...... of implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast...... symmetrisation procedures were performed by plastic surgeons. Breast surgeons had sought more specific education, both international observerships and specific courses. In both groups of surgeons, the majority expressed that both tumour removal and reconstruction should be performed by doctors of their own...

  14. Description of Mexican Cleft Surgeons' Experience With Foreign Surgical Volunteer Missions in Mexico.

    Science.gov (United States)

    Schoenbrunner, Anna R; Kelley, Kristen D; Buckstaff, Taylor; McIntyre, Joyce K; Sigler, Alicia; Gosman, Amanda A

    2018-05-01

    Mexican cleft surgeons provide multidisciplinary comprehensive cleft lip and palate care to children in Mexico. Many Mexican cleft surgeons have extensive experience with foreign, visiting surgeons. The purpose of this study was to characterize Mexican cleft surgeons' domestic and volunteer practice and to learn more about Mexican cleft surgeons' experience with visiting surgeons. A cross-sectional validated e-mail survey tool was sent to Mexican cleft surgeons through 2 Mexican plastic surgery societies and the Asociación Mexicana de Labio y Paladar Hendido y Anomalías Craneofaciales, the national cleft palate society that includes plastic and maxillofacial surgeons who specialize in cleft surgery. We utilized validated survey methodology, including neutral fact-based questions and repeated e-mails to survey nonresponders to maximize validity of statistical data; response rate was 30.6% (n = 81). Mexican cleft surgeons performed, on average, 37.7 primary palate repairs per year with an overall complication rate of 2.5%; 34.6% (n = 28) of respondents had direct experience with patients operated on by visiting surgeons; 53.6% of these respondents performed corrective surgery because of complications from visiting surgeons. Respondents rated 48% of the functional outcomes of visiting surgeons as "acceptable," whereas 43% rated aesthetic outcomes of visiting surgeons as "poor"; 73.3% of respondents were never paid for the corrective surgeries they performed. Thirty-three percent of Mexican cleft surgeons believe that there is a role for educational collaboration with visiting surgeons. Mexican cleft surgeons have a high volume of primary cleft palate repairs in their domestic practice with good outcomes. Visiting surgeons may play an important role in Mexican cleft care through educational collaborations that complement the strengths of Mexican cleft surgeons.

  15. Supramodal Executive Control of Attention

    Directory of Open Access Journals (Sweden)

    ALFREDO eSPAGNA

    2015-02-01

    Full Text Available The human attentional system can be subdivided into three functional networks of alerting, orienting, and executive control. Although these networks have been extensively studied in the visuospatial modality, whether the same mechanisms are deployed across different sensory modalities remains unclear. In this study we used the attention network test for visuospatial modality, in addition to two auditory variants with spatial and frequency manipulations to examine cross-modal correlations between network functions. Results showed that among the visual and auditory tasks the effects of executive control, but not effects of alerting and orienting were significantly correlated. These findings suggest that while alerting and orienting functions rely more upon modality specific processes, the executive control of attention coordinates complex behavior via supramodal mechanisms.

  16. The medicolegal landscape of spine surgery: how do surgeons fare?

    Science.gov (United States)

    Makhni, Melvin C; Park, Paul J; Jimenez, Jesus; Saifi, Comron; Caldwell, Jon-Michael; Ha, Alex; Figueroa-Santana, Bianca; Lehman, Ronald A; Weidenbaum, Mark

    2018-02-01

    Because of the limited and confidential nature of most legal data, scarce literature is available to physicians about reasons for litigation in spine surgery. To optimally compensate patients while protecting physicians, further understanding of the medicolegal landscape is needed for high-risk procedures such as spine surgery. Based on these, surgeons can explore ways to better protect both their patients and themselves. To characterize the current medicolegal environment of spine surgery by analyzing a recent dataset of malpractice litigation. A retrospective study. All malpractice cases involving spine surgery available to public query between the years of 2010 and 2014. Case outcome for spine surgery malpractice cases between the years of 2010 and 2014. WestlawNext was used to analyze spine surgery malpractice cases at the state and federal level between the years 2010 and 2014. WestlawNext is a subscription-based, legal search engine that contains publicly available federal and state court records. All monetary values were inflation adjusted for 2016. One hundred three malpractice cases were categorized by case descriptors and outcome measures. Claims were categorized as either intraoperative complaints or preoperative complaints. Rulings in favor of the defendant (surgeon) were noted in 75% (77 of 103) of the cases. Lack of informed consent was cited in 34% of cases. For the 26 cases won by the plaintiff, the average amount in settlement was $2,384,775 versus $3,945,456 in cases brought before a jury. Cases involving consent averaged a compensation of $2,029,884, whereas cases involving only intraoperative complaints averaged a compensation of $3,667,530. A significant correlation was seen between increased compensation for plaintiffs and cases involving orthopedic surgeons (p=.020) or nerve injury (p=.005). Wrong-level surgery may be associated with lower plaintiff compensation (p=.055). The length of cases resulting in defense verdicts averaged 5.51 years

  17. Perceptions of conflict of interest: surgeons, internists, and learners compared.

    Science.gov (United States)

    de Gara, Christopher J; Rennick, Kim C; Hanson, John

    2013-05-01

    Making a conflict of interest declaration is now mandatory at continuing medical education CME accredited events. However, these declarations tend to be largely perfunctory. This study sought to better understand physician perceptions surrounding conflict of interest. The same PowerPoint (Microsoft, Canada) presentation (http://www.youtube.com/watch?v=mQSOvch7Yg0&feature=g-upl) was delivered at multiple University of Alberta and Royal College CME-accredited events to surgeons, internists, and learners. After each talk, the audience was invited to complete an anonymous, pretested, and standardized 5-point Likert scale (strongly disagree to strongly agree) questionnaire. A total of 136 surveys were analyzed from 31 surgeons, 49 internists, and 56 learners. In response to the question regarding whether by simply making a declaration, the speaker had provided adequate proof of any conflicts of interest, 71% of surgeons thought so, whereas only 35% of internists and 39% of learners agreed or strongly agreed (P = .004). Further probing this theme, the audience was asked whether a speaker must declare fees or monies received from industry for consulting, speaking, and research support. Once again there was a variance of opinion, with only 43% of surgeons agreeing or strongly agreeing with this statement; yet, 80% of internists and 71% of learners felt that such a declaration was necessary (P = .013). On the topic of believability (a speaker declaration makes him or her and the presentation more credible), the 3 groups were less polarized: 50% of surgeons, 41% of internists, and 52% of learners (P = .2) felt that this was the case. Although two thirds of surgeons (68%) and learners (66%) and nearly all internists (84%) felt that industry-sponsored research was biased, these differences were not significant (P = .2). Even when they are completely open and honest, conflict of interest declarations do not negate the biases inherent in a speaker's talk or research when it is

  18. Executive coaching in diversity from the systems psychodynamic perspective

    Directory of Open Access Journals (Sweden)

    Lerato Motsoaledi

    2012-03-01

    Research purpose: The purpose of this research was to describe the application of systems psychodynamic role analysis and to determine its trustworthiness in assisting executives to work effectively with conscious and unconscious diversity dynamics in their organisations. Motivation for the study: Executives generally struggle to understand the deeper meaning of diversity behaviour that manifests inside and around them, leading to conflict. Without understanding the unconscious meaning of the behaviour, organisations founder easily. Awareness of below-the-surface behaviour leads to insight and taking responsibility for diversity-related behaviours. Research design, approach and method: The researcher coached six executives in South African state departments over a period of 10 months. The coaching addressed and analysed the executives’ organisational roles. She analysed the data using discourse analysis. Main findings: Themes relating to the diversity dynamics of gender, race, ethnicity, authority, disability, language, age, de-authorisation of diversity work and the coaching process emerged. The coaching assisted the executives to gain insights into below-the-surface diversity dynamics, to address diversity in a sustained manner and to take up their organisational roles more effectively. Practical/managerial implications: Coached executives will have a more objective and dynamic experience of diversity issues that manifest in organisations, between colleagues and within themselves. Contribution/value-add: Executive coaching from a systems psychodynamic perspective displays trustworthiness in improving participants’ diversity awareness, especially with regard to gender, race, ethnicity and authorisation.

  19. The global health workforce shortage: role of surgeons and other providers.

    Science.gov (United States)

    Sheldon, George F; Ricketts, Thomas C; Charles, Anthony; King, Jennifer; Fraher, Erin P; Meyer, Anthony

    2008-01-01

    The debate over the status of the physician workforce seems to be concluded. It now is clear that a shortage of physicians exists and is likely to worsen. In retrospect it seems obvious that a static annual production of physicians, coupled with a population growth of 25 million persons each decade, would result in a progressively lower physician to population ratio. Moreover, Cooper has demonstrated convincingly that the robust economy of the past 50 years correlates with demand for physician services. The aging physician workforce is an additional problem: one third of physicians are over 55 years of age, and the population over the age of 65 years is expected to double by 2030. Signs of a physician and surgeon shortage are becoming apparent. The largest organization of physicians in the world (119,000 members), the American College of Physicians, published a white paper in 2006 titled, "The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation's Health Care" [37]. The American College of Surgeons, the largest organization of surgeons, has published an article on access to emergency surgery [38], and the Institute of Medicine of the National Academies of Science has published a book on the future of emergency care (Fig. 10). The reports document diminished involvement and availability of emergency care by general surgeons, neurologic surgeons, orthopedists, hand surgeons, plastic surgeons, and others. The emergency room has become the primary care physician after 5 PM for much of the population. A survey done by the Commonwealth Fund revealed that less than half of primary care practices have an on-call arrangement for after-hours care. Other evidence of evolving shortage are reports of long wait times for appointments, the hospitalist movement, and others. The policies for the future should move beyond dispute over whether or not a shortage exists. The immediate need is for the United States, as a society, to commit to

  20. Executive Headteachers: What's in a Name? Executive Summary

    Science.gov (United States)

    Theobald, Katy; Lord, Pippa

    2016-01-01

    Executive headteachers (EHTs) are becoming increasingly prevalent as the self-improving school system matures; there are over 620 EHTs in the school workforce today; and the number recorded in the School Workforce Census (SWC) has increased by 240 per cent between 2010 and 2014. The role is still evolving locally and nationally and, as EHTs take…

  1. ADAMS executive and operating system

    Science.gov (United States)

    Pittman, W. D.

    1981-01-01

    The ADAMS Executive and Operating System, a multitasking environment under which a variety of data reduction, display and utility programs are executed, a system which provides a high level of isolation between programs allowing them to be developed and modified independently, is described. The Airborne Data Analysis/Monitor System (ADAMS) was developed to provide a real time data monitoring and analysis capability onboard Boeing commercial airplanes during flight testing. It inputs sensor data from an airplane performance data by applying transforms to the collected sensor data, and presents this data to test personnel via various display media. Current utilization and future development are addressed.

  2. The Other Side of the Tradeoff: The Impact of Risk on Executive Compensation

    OpenAIRE

    Rajesh Aggarwal; Andrew A. Samwick

    1998-01-01

    The principal-agent model of executive compensation is of central importance to the modern theory of the firm and corporate governance, yet the existing empirical evidence supporting it is quite weak. The key predication of the model is that the executive's pay-performance sensitivity is decreasing in the variance of the firm's performance. We demonstrate strong empirical confirmation of this prediction using a comprehensive sample of executives at large corporations. In general, the pay-perf...

  3. Strategy Execution: An integrative perspective and method for the knowledge-based economy

    OpenAIRE

    Strikwerda, J.

    2017-01-01

    Within the field of business administration, in research and in the practice of business, the issue of strategy execution lacks a generally accepted paradigm. Strategy execution so far has not received the attention it should be given in view of its critical role in the performance of the firm, especially with the growth of complexity in organizations. The attention that is usually given to strategy execution in the strategy literature and especially in popular management books is, with a few...

  4. Perils, pitfalls, and benefits of a surgeon as a health system employee: the contracting process.

    Science.gov (United States)

    Graebner, Nancy K

    2011-06-01

    One would be hard pressed today to find a general surgeon or subspecialty-trained general surgeon who has not been approached by a health system to discuss employment. The majority of physicians find these initial discussions with a hospital administrator daunting at best regardless of whether they are just finishing residency or fellowship training or have had many successful years of private practice under their belt. Just as real estate has the mantra of "location, location, location," I would suggest that physician employment by a health system should have the mantra of "relationship, relationship, relationship." The following tips provide guidance on how to better understand the potential perils, pitfalls, and benefits of specific content sections of a standard template employment agreement between a health system and a physician. Physicians should review, understand, and be ready to engage in dialogue with the hospital administrator before involving attorneys. My experience is that if the dialogue begins with the attorneys representing each party, the opportunity to fully develop a partnership relationship between the parties is either lost or at minimum severely delayed in its development.

  5. Function of "nontrauma" surgeons in level I trauma centers in the United States.

    Science.gov (United States)

    Pate, J W

    1997-06-01

    Although the general "trauma" surgeon is usually the team leader in level I trauma centers, the use of surgical subspecialists and nonsurgeons is frequently ill-defined. This study was done to gain data in regard to actual use of subspecialists in busy centers. First, a survey of the patterns of staffing in 140 trauma centers was elicited by mail questionnaire, supplemented by telephone cells. Second, records of 400 consecutive patients at the Elvis Presley Trauma Center were reviewed to determine the use of subspecialists during the first 24 hours of care of individual patients. There were differences in the use of surgical subspecialists and nonsurgeons at different centers: in receiving, admitting, operating, and critical care areas and in privileges for admission and attending of inpatients. Consultation "guidelines" are used for many specific injuries. At our center, a mean of 1.92 subspecialists, in addition to general surgeons, were involved in the early care of each patient. Problems exist in many centers regarding the use of subspecialists, especially for management of facial and chest injuries. In some centers nonsurgeons function in the intensive care unit, and as admitting and attending physicians of trauma patients.

  6. The delivery of general paediatric surgery in Ireland: a survey of higher surgical trainees.

    LENUS (Irish Health Repository)

    Boyle, E

    2012-12-01

    The delivery of general paediatric surgery is changing in Ireland. Fewer paediatric surgical procedures are being performed by newly appointed consultant general surgeons, resulting in increased referrals to the specialist paediatric surgeons of uncomplicated general paediatric surgical problems. We surveyed current higher surgical trainees about their views on provision of paediatric surgical services.

  7. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

    DEFF Research Database (Denmark)

    Andersen, M. J.; Gromov, K.; Brix, M.

    2014-01-01

    INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture-related...... surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... procedures by junior residents grew from 30% during to 40% (p related surgery. The extent of supervision was generally high; however, a third of the primary procedures performed by junior...

  8. Executive summary. Session summaries

    International Nuclear Information System (INIS)

    2011-01-01

    The possibility of stopping and/or delaying the progression of a core melt accident by the use of a recovered water source or by taking benefit of specific engineered systems is taken into account in a number of PSA (Probabilistic Safety Assessment) studies. The likelihood to stop the progression of a core melt-down accident by water injection is generally considered as high in the early phase of core degradation and depends on reactor specific features, nevertheless even in later sequences, e.g. during the relocation in the lower head, cooling still can be achieved but depends on reactor specific features and the accident scenario.. Ongoing, starting and planned experimental programmes address the coolability issues in the different relevant configurations, i.e. reflooding of bundles, debris beds, molten pools and Reactor Pressure Vessel external cooling. There is still a difficulty with present models to predict reliably if reflooding during the early core degradation would or not trigger a cladding oxidation runaway. Whether this is due to deficiencies in thermal-hydraulics description or problems for taking into account the oxidation of melts is a matter of discussion. The code developments are promisingly directed towards a more mechanistic approach using a porous medium modelling able to treat the different configurations of a degraded core. Secondly, the models to describe adequately the relocation of parts of the molten core to the lower head and the debris bed formation still need further development and qualification. Their validation is expected against the results of ongoing experimental programmes. The transposition of results to the reactor scale where multi-dimensional effects are expected needs to be evaluated, all the more as larger scale experiments are probably not feasible

  9. Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part. 2: personal life.

    Science.gov (United States)

    Kawase, Kazumi; Nomura, Kyoko; Tominaga, Ryuji; Iwase, Hirotaka; Ogawa, Tomoko; Shibasaki, Ikuko; Shimada, Mitsuo; Taguchi, Tomoaki; Takeshita, Emiko; Tomizawa, Yasuko; Nomura, Sachiyo; Hanazaki, Kazuhiro; Hanashi, Tomoko; Yamashita, Hiroko; Kokudo, Norihiro; Maeda, Kotaro

    2018-03-01

    To assess the true conditions and perceptions of the personal lives of men and women working as surgeons in Japan. In 2014, all e-mail subscribed members of the Japan Surgical Society (JSS, n = 29,861) were invited to complete a web-based survey. The questions covered demographic information, work environment, and personal life (including marital status, childcare, and nursing care for adult family members). In total, 6211 surgeons (5586 men and 625 women) returned the questionnaires, representing a response rate of 20.8%. Based on the questionnaire responses, surgeons generally prioritize work and spend most of their time at work, although women with children prioritize their family over work; men spend significantly fewer hours on domestic work/childcare than do their female counterparts (men 0.76 h/day vs. women 2.93 h/day, p women surgeons, regardless of their age or whether they have children, place more importance on the role of women in the family. The personal lives of Japanese surgeons differed significantly according to gender and whether they have children. The conservative idea that women should bear primary responsibility for the family still pertains for both men and women working as surgeons in Japan.

  10. Game theory: applications for surgeons and the operating room environment.

    Science.gov (United States)

    McFadden, David W; Tsai, Mitchell; Kadry, Bassam; Souba, Wiley W

    2012-11-01

    Game theory is an economic system of strategic behavior, often referred to as the "theory of social situations." Very little has been written in the medical literature about game theory or its applications, yet the practice of surgery and the operating room environment clearly involves multiple social situations with both cooperative and non-cooperative behaviors. A comprehensive review was performed of the medical literature on game theory and its medical applications. Definitive resources on the subject were also examined and applied to surgery and the operating room whenever possible. Applications of game theory and its proposed dilemmas abound in the practicing surgeon's world, especially in the operating room environment. The surgeon with a basic understanding of game theory principles is better prepared for understanding and navigating the complex Operating Room system and optimizing cooperative behaviors for the benefit all stakeholders. Copyright © 2012 Mosby, Inc. All rights reserved.

  11. Albert Ross Tilley: The legacy of a Canadian plastic surgeon.

    Science.gov (United States)

    Mowbrey, Kevin

    2013-01-01

    The present article chronicles the career of Dr Albert Ross Tilley, one of the most important Canadian plastic surgeons of the 20th century. Tilley is most well known for his innovations of burn management during World War II and his treatment of a group of burn patients known affectionately as the 'Guinea Pig Club'. In addition to the superb surgical skills he applied to the physical wounds of his patients, Tilley was also a pioneer of caring for the emotional and psychological afflictions suffered by many airmen of World War II. As one of the founding fathers of the Canadian Society of Plastic Surgeons, Tilley's work was instrumental in establishing the specialty and ensured its prosperity for years to come. Serving in the capacity of leader, educator and innovator, Tilley remains one of Canada's most decorated physicians, and his body of work encompasses contributions to the medical field that remain significant and beneficial to patient care to this day.

  12. The veterinary surgeon in natural disasters: Italian legislation in force.

    Science.gov (United States)

    Passantino, A; Di Pietro, C; Fenga, C; Passantino, M

    2003-12-01

    Law No. 225/1992 established a National Service of Civil Protection, with the important role of 'safeguarding life, goods, settlements and the environment from damage deriving from natural disasters, catastrophes and calamities' (art. 1). This law arranges civil protection as a co-ordinated system of responsibilities administrated by the state, local and public authorities, the world of science, charitable organisations, the professional orders and other institutions, and the private sector (art. 6). The President of the Republic's Decree No. 66/1981 'Regulation for the application of Law No. 996/1970, containing norms for relief and assistance to populations hit by natural disasters--Civil Protection' mentions veterinary surgeons among the people that are called upon to intervene. In fact, in natural disasters the intervention of the veterinary surgeon is of great importance. The authors examine these laws and other legislation relating to the National Service of Civil Protection.

  13. Surgeon Design Interface for Patient-Specific Concentric Tube Robots.

    Science.gov (United States)

    Morimoto, Tania K; Greer, Joseph D; Hsieh, Michael H; Okamura, Allison M

    2016-06-01

    Concentric tube robots have potential for use in a wide variety of surgical procedures due to their small size, dexterity, and ability to move in highly curved paths. Unlike most existing clinical robots, the design of these robots can be developed and manufactured on a patient- and procedure-specific basis. The design of concentric tube robots typically requires significant computation and optimization, and it remains unclear how the surgeon should be involved. We propose to use a virtual reality-based design environment for surgeons to easily and intuitively visualize and design a set of concentric tube robots for a specific patient and procedure. In this paper, we describe a novel patient-specific design process in the context of the virtual reality interface. We also show a resulting concentric tube robot design, created by a pediatric urologist to access a kidney stone in a pediatric patient.

  14. [Pierre Mornard (1883-1929), unrecognized plastic surgeon].

    Science.gov (United States)

    Glicenstein, J

    2017-02-01

    Many operations of aesthetic surgery were described between 1920 and 1930. Several French surgeons are recognized as pioneers of the speciality. Pierre Mornard (1883-1929) published numerous articles of plastic and aesthetic surgery between 1925 and 1929 the date of his death. The articles were illustrated with drawings of surgery he had practiced. He described in 1929 the first abdominoplasty with umbilical transposition. Pierre Mornard can be considered a pioneer of aesthetic surgery. Copyright © 2016. Published by Elsevier Masson SAS.

  15. A basic introduction to statistics for the orthopaedic surgeon.

    Science.gov (United States)

    Bertrand, Catherine; Van Riet, Roger; Verstreken, Frederik; Michielsen, Jef

    2012-02-01

    Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values.

  16. Project Muskan : Social responsibility of the plastic surgeon

    Directory of Open Access Journals (Sweden)

    Bhatt Yogesh

    2008-01-01

    Full Text Available Although exact statistics are not available, Indian plastic surgeons see around 7,00,000-8,00,000 burn admissions annually with around 10,00,000 cleft patients yet to be operated. In spite of this voluminous load, India does not have national health programs for the various deformities Indian plastic surgeons typically treat. As Plastic Surgeons, it is our social responsibility to treat these patients and bring ′ muskan ′ (smile in Hindi back into their lives. Project Muskan was initiated as an innovative model for targeting these patients and is probably one of its kind in the field of plastic surgery in our country. It is unique because it is a perfect collaboration of government institutions, a Non Government Organization (NGO, and cooperative sectors providing free health care at the doorstep. Identification of the patients was done with the help of the extensive milk dairy network in the state of Gujarat. Provision of transport and other facilities was done by the NGOs and quality health care provision was taken care of by the government hospital. Project Muskan started from a single village but now covers around 3000 villages and tribal areas of Gujarat. It is a system that can be easily reproducible in all hospitals and has reestablished the faith of the common man in government institutes.

  17. The effects of tenure and promotion on surgeon productivity.

    Science.gov (United States)

    Lam, Adam; Heslin, Martin J; Tzeng, Ching-Wei D; Chen, Herbert

    2018-07-01

    Studies investigating the impact of promotion and tenure on surgeon productivity are lacking. The aim of this study is to elucidate the relationship of promotion and tenure to surgeon productivity. We reviewed data for the Department of Surgery at our institution. Relative value units (RVUs) billed per year, publications per year, and grant funding per year were used to assess productivity from 2010 to 2016. We analyzed tenure-track (TT) and non-tenure-track (NT) surgeons and compared the productivity within these groups by rank: assistant professor (ASST), associate professor (ASSOC), and full professor (FULL). Kruskal-Wallis and Mann-Whitney U tests were used to assess significance and relationships between the groups. A TT faculty was promoted if they produced more research, with the highest publication rates in TT FULL. TT faculty publishing rates increased from ASST to ASSOC (1 versus 2, P = 0.006) and from ASSOC to FULL (2 versus 4, P production (RVUs) was highest between TT ASSOC and NT FULL. TT faculty increased productivity between ASST and ASSOC (7023 versus 8384, P = 0.001) and decreased between ASSOC and FULL (8384 versus 6877, P production and grant funding, whereas NT FULL has the highest clinical production. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Sarcoidosis in a dental surgeon: a case report

    Directory of Open Access Journals (Sweden)

    Mattia Daniele

    2010-08-01

    Full Text Available Abstract Introduction Although the causes of sarcoidosis are still unknown, past and current studies have provided evidence that this disease may be associated with occupational exposure to specific environmental agents. We describe a case of sarcoidosis in a dental surgeon with long exposure to inorganic dusts. To the best of our knowledge, this is the first report of this kind in the literature. Case presentation At the beginning of 2000, a 52-year-old Caucasian man, who worked as a dental surgeon, presented with shortness of breath during exercise, cough and retrosternal pain. After diagnosis of sarcoidosis, a scanning electronic microscopy with X-ray microanalysis of biopsy specimens was used in order to determine whether the disease could be traced to an occupational environmental agent. Results showed the presence of inorganic dust particles within sarcoidotic granulomas, and demonstrated that the material detected was identical to that found in a powder used by our patient for several years. Conclusions Although these results cannot be considered as definitive proof, they do however provide strong evidence that this disease may be associated with material used by dental surgeons.

  19. THE CHAPLAIN-GENERAL

    African Journals Online (AJOL)

    Brigadier and the Director of Logistics and Fi- nance with the rank of Colonel. The Chaplains Service in the Combat. Services. The Chaplain-General is responsible for the short and long-term planning of the Chaplains. Service and for the execution of the approved policy in respect of religious and church affairs in the South ...

  20. 17 CFR 200.16 - Executive Assistant to the Chairman.

    Science.gov (United States)

    2010-04-01

    ... of the laws and its relations with the public, industry, and the Congress. The Executive Assistant is... Commission, members of the staff, and/or representatives of the public on matters arising with regard to... cases in which the Chairman or the General Counsel has determined that separation of functions...

  1. Cannabinoid modulation of executive functions

    NARCIS (Netherlands)

    Pattij, T.; Wiskerke, J.; Schoffelmeer, A.N.M.

    2008-01-01

    Executive functions are higher-order cognitive processes such as attention, behavioural flexibility, decision-making, inhibitory control, planning, time estimation and working memory that exert top-down control over behaviour. In addition to the role of cannabinoid signaling in other cognitive

  2. Acellular Dermal Matrix in Reconstructive Breast Surgery: Survey of Current Practice among Plastic Surgeons

    Directory of Open Access Journals (Sweden)

    Ahmed M. S. Ibrahim, MD

    2015-04-01

    Conclusions: Plastic surgeons currently use ADM in breast reconstruction for both immediate and staged procedures. Of those responding, a majority of plastic surgeons will incorporate drains and use postoperative antibiotics for more than 48 hours.

  3. Executive Summary - Overview

    International Nuclear Information System (INIS)

    2005-01-01

    the years 2003-2004, is presented below. The scientific activities of the Institute in 2004 are structured into 7 main topics and sub-divided into 48 tasks. More detailed reports on these activities, including the project title, name of task leader, main objectives, budget, involvement in national and international projects, technical infrastructure, related publications, main achievements, plans for the incoming years and long term plans, are presented. In 2004 IFJ was awarded by Professor Kleiber, the Minister of Scientific Research and Information Technology, for successfully entering five major projects of the 6th Framework European Program. According to the current requirements of the Ministry of Scientific Research and Information Technology, the quality of scientific output of Poland's research establishments is currently measured chiefly by the number of ISI-listed publications. Over the two-year period (years 2003 and 2004) our research staff had published 322 and 366 papers in international journals listed in the Philadelphia ISI Master list, and 139 and 116 other publications, in the form of books, reviews, chapters in scholarly textbooks, papers and reports. Apart from scientific departments, the Institute has three technical sections. The main accelerator facilities in the IFJ are the AIC-144 isochronous cyclotron, the 2.5 MeV proton Van de Graaff accelerator and a 14 MeV neutron generator. A list of our major research facilities and of their general specifications, is given. Two EU-accredited Dosimetry Laboratories, providing individual and environmental dosimetry and calibration of radiation protection instruments, operate at the Institute. A radiation monitoring station at the IFJ provides continuous data on ambient dose rate and on the radioactive contamination of air to the Polish National Atomic Agency. The Institute is able to provide regional authorities with radiation emergency support, should such need arise. Advanced post-graduate courses in

  4. Knowledge deficiency of work-related radiation hazards associated with psychological distress among orthopedic surgeons: A cross-sectional study.

    Science.gov (United States)

    Fan, Guoxin; Wang, Yueye; Guo, Changfeng; Lei, Xuefeng; He, Shisheng

    2017-05-01

    Knowledge and concern degree about work-related radiation hazards remained unknown among orthopedic surgeons. The aim of the cross-sectional study is to investigate whether the knowledge degree of work-related radiation is associated with psychological distress among orthopedic surgeons. This cross-sectional study sent electronic questionnaire via WeChat to orthopedic surgeons nationwide. Concern and knowing degree over radiation exposure was evaluated by a single self-reported question. Professional evaluation of concern degree was reflected by general psychological distress, which was assessed with the Kessler 10 scale (K10) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Only 43.23% (115/266) respondents knew well about radiation and a total of 78.20% (208/266) respondents considered radiation exposure as a great concern. Among those who reported concerns about radiation exposure, a total of 57.69% (120/208) respondents reported knowing little about radiation. Respondents who reported concerns over radiation exposure were significantly associated with higher scores on CES-D and K10 (P < .05). Among respondents who reported concerns over radiation exposure, those who have fewer knowledge about radiation, had higher CES-D and K10 scores than those who knew well about radiation (P < .05). Among respondents who reported no concerns over radiation exposure, those who knew little about radiation still had higher CES-D and K10 scores (P < .05). Fewer radiation knowledge tends to induce more radiation concerns associated with higher psychological distress in orthopedic surgeons. Radiation knowledge should be enhanced for surgeons who daily work with radiation-related fluoroscopy.

  5. Achilles tenotomy as an office procedure and current practising trends among New Zealand orthopaedic surgeons.

    Science.gov (United States)

    Agius, Lewis; Wickham, Angus; Walker, Cameron; Knudsen, Joshua

    2018-05-18

    Percutaneous Achilles tenotomy (PAT) is performed during the final phase of casting with Ponseti method. Several settings have been proposed as venues for this procedure, however it is increasingly being performed in theatre under a general anaesthetic (GA). General anaesthesia, however, is expensive and not without risks. The purpose of the present study was to compare results of outpatient releases to theatre releases, and assess current practising trends among orthopaedic surgeons. Retrospective comparison of patients with idiopathic clubfoot managed by Ponseti method who had Achilles tenotomy performed in outpatient clinic and in theatre. Surveys were sent to all POSNZ members to determine current practising trends in New Zealand. Parental satisfaction surveys were performed. Comparative cost analysis was performed using hospital billing information. The current study includes 64 idiopathic congenital clubfeet (19 bilateral cases). PAT was performed on 26 clubfeet under local anaesthetic in an outpatient setting, and 33 clubfeet under GA in a theatre setting. There was no significant difference for post-operative complications, or recurrence (p=0.67). Those in theatre group were exposed to a greater number of general anaesthetics before the age of four. Among practising New Zealand paediatric orthopaedic surgeons, 77.78% perform this in theatre under general anaesthesia, while only 22.22% perform PAT in outpatient clinic. The main barriers included concerns regarding pain control, concerns regarding incomplete release, concerns regarding distress to family and concerns regarding sterility. Parental satisfaction surveys found pain management to be excellent. Financial data was analysed and indicative costs were $6,061 NZD per procedure in theatre, compared to $378 NZD per procedure in clinic. PAT performed in a clinic setting is both safe and efficacious with results comparative to that performed in theatre. There was no difference in post

  6. Strategy Execution : An integrative perspective and method for the knowledge-based economy

    NARCIS (Netherlands)

    Strikwerda, J.

    2017-01-01

    Within the field of business administration, in research and in the practice of business, the issue of strategy execution lacks a generally accepted paradigm. Strategy execution so far has not received the attention it should be given in view of its critical role in the performance of the firm,

  7. 17 CFR 143.7 - Delegation of authority to the Executive Director.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Delegation of authority to the... JURISDICTION General Provisions § 143.7 Delegation of authority to the Executive Director. (a) The Commission... Commission employee under the Executive Director's supervision as he or she may designate, authority to take...

  8. Life History Theory and Social Deviance: The Mediating Role of Executive Function

    Science.gov (United States)

    Wenner, C. J.; Bianchi, J.; Figueredo, A. J.; Rushton, J. Philippe; Jacobs, W. J.

    2013-01-01

    The present work examined predicted relations among Life History strategies, Executive Functions, socially antagonistic attitudes, socially antagonistic behaviors, and general intelligence. Life History (LH) theory predicts that Executive Functions and socially antagonistic attitudes and behaviors underpin an interrelated and coherent set of…

  9. To What Extent Can Motor Imagery Replace Motor Execution While Learning a Fine Motor Skill?

    NARCIS (Netherlands)

    Sobierajewicz, Jagna; Szarkiewicz, Sylwia; Prekoracka-Krawczyk, Anna; Jaskowski, Wojciech; van der Lubbe, Robert Henricus Johannes

    2016-01-01

    Motor imagery is generally thought to share common mechanisms with motor execution. In the present study, we examined to what extent learning a fine motor skill by motor imagery may substitute physical practice. Learning effects were assessed by manipulating the proportion of motor execution and

  10. Execute-Only Attacks against Execute-Only Defenses

    Science.gov (United States)

    2016-02-18

    strongest implementations of execute-only defenses: it exploits novel hardware features to incorporate non-readable code to prevent direct information...build two proof-of- concept exploits that can achieve control flow hijacking on a system protected by full- featured Readactor. • We evaluate the...According to the CVE [31], 123 such arbitrary read vulnerabilities were reported between January and September of 2015, in Firefox (CVE-2015-4495

  11. The natural language of the surgeon's clinical note in outcomes assessment: a qualitative analysis of the medical record.

    Science.gov (United States)

    Miller, J Michael; Velanovich, Vic

    2010-06-01

    Physician-generated clinical notes are the central document in recording the clinical decision-making and outcome of care. This is particularly true in an environment where outcomes assessment is becoming increasingly important. The hypothesis of this study is that these notes are inadequate to assess patient-centered outcomes and determine surgeons' core competencies. We preformed a retrospective review of postoperative clinical notes of general surgery patients for a 1-month period. Information from these notes underwent qualitative analysis using the reductionist thematic approach for patient-centered and physician-centered outcomes. Outcomes included 2 physician-centered items (physical examination and objective tests) and 3 patient-centered items (postoperative complications, functional status, and satisfaction). The presence or absence of each item in the clinical note was recorded. Six hundred eighty-one patients of 18 general surgeons were included. Among the surgeons, 28% failed to document symptomatic change in even 1 patient; similarly, 67% failed to document functional change, and 50% failed to document satisfaction. Among all 681 clinical notes only 7% of records mentioned symptomatic change, 1% functional change, 87% physical examination, 26% objective tests, and 3% patient satisfaction. These results were not affected by procedure type or number of patients seen. In general surgery practice, the surgeon's clinical note is a poor measure of physician-centered or patient-centered outcomes, implying that an audit of clinical notes would be an inaccurate method to assess patient outcomes. This has implications for issues surrounding maintenance of certification. Copyright 2010 Elsevier Inc. All rights reserved.

  12. Different views about work-hour limitations in medicine: a qualitative content analysis of surgeons', lawyers', and pilots' positive and negative arguments.

    Science.gov (United States)

    Businger, Adrian P; Kaderli, Reto M

    2014-01-01

    Whereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate. The aim of the present study was to evaluate arguments in favour of and against work-hour limitations in medicine given by Swiss surgeons, lawyers, and pilots. An electronic questionnaire survey with four free-response items addressing the question of what arguments speak in favour of or against work-hour limitations in general and in medicine was sent to a random sample of board-certified surgeons, lawyers in labour law, and pilots from SWISS International Airlines Ltd. In all, 279/497 (56%) of the respondents answered the survey: 67/117 surgeons, 92/226 lawyers, and 120/154 pilots. Support for work-hour limitations in general and in medicine was present and higher among lawyers and pilots than it was in surgeons (pwork-family balance," whereas the lack of "flexibility" was the most important argument against. Surgeons expected more often that their "education" and the "quality of their work" would be threatened (p<0.001). Work-hour limitations should be supported in medicine also, but a way must be found to reduce problems resulting from discontinuity in patient care and to minimise the work in medicine, which has no education value.

  13. Executive function in fibromyalgia: Comparing subjective and objective measures.

    Science.gov (United States)

    Gelonch, Olga; Garolera, Maite; Valls, Joan; Rosselló, Lluís; Pifarré, Josep

    2016-04-01

    There is evidence to suggest the existence of an executive dysfunction in people diagnosed with fibromyalgia, although there are certain inconsistencies between studies. Here, we aim to compare executive performance between patients with fibromyalgia and a control group by using subjective and objective cognitive tests, analyzing the influence of patient mood on the results obtained, and studying associations between the two measures. 82 patients diagnosed with fibromyalgia and 42 healthy controls, matched by age and years of education, were assessed using the Behavioral Rating Inventory of Executive Function - Adult Version (BRIEF-A) as a subjective measure of executive functioning. A selection of objective cognitive tests were also used to measure a series of executive functions and to identify symptoms of depression and anxiety. Patients with fibromyalgia perceived greater difficulties than the control group on all of the BRIEF-A scales. However, after adjustments were made for depression and anxiety the only differences that remained were those associated with the working memory scale and the Metacognition and Global Executive Composite index. In the case of the objective cognitive tests, a significantly worse overall performance was evidenced for the fibromyalgia patients. However, this also disappeared when adjustments were made for depression and anxiety. After this adjustment, fibromyalgia patients only performed significantly worse for the interference effect in the Stroop Test. Although there were no significant associations between most of the objective cognitive tests and the BRIEF-A scales, depression and anxiety exhibited strong associations with almost all of the BRIEF-A scales and with several of the objective cognitive tests. Patients with fibromyalgia showed executive dysfunction in subjective and objective measures, although most of this impairment was associated with mood disturbances. Exceptions to this general rule were observed in the

  14. Effects of alcoholism severity and smoking on executive neurocognitive function.

    Science.gov (United States)

    Glass, Jennifer M; Buu, Anne; Adams, Kenneth M; Nigg, Joel T; Puttler, Leon I; Jester, Jennifer M; Zucker, Robert A

    2009-01-01

    Neurocognitive deficits in chronic alcoholic men are well documented. Impairments include memory, visual-spatial processing, problem solving and executive function. The cause of impairment could include direct effects of alcohol toxicity, pre-existing cognitive deficits that predispose towards substance abuse, comorbid psychiatric disorders and abuse of substances other than alcohol. Cigarette smoking occurs at higher rates in alcoholism and has been linked to poor cognitive performance, yet the effects of smoking on cognitive function in alcoholism are often ignored. We examined whether chronic alcoholism and chronic smoking have effects on executive function. Alcoholism and smoking were examined in a community-recruited sample of alcoholic and non-alcoholic men (n = 240) using standard neuropsychological and reaction-time measures of executive function. Alcoholism was measured as the average level of alcoholism diagnoses across the study duration (12 years). Smoking was measured in pack-years. Both alcoholism and smoking were correlated negatively with a composite executive function score. For component measures, alcoholism was correlated negatively with a broad range of measures, whereas smoking was correlated negatively with measures that emphasize response speed. In regression analyses, both smoking and alcoholism were significant predictors of executive function composite. However, when IQ is included in the regression analyses, alcoholism severity is no longer significant. Both smoking and alcoholism were related to executive function. However, the effect of alcoholism was not independent of IQ, suggesting a generalized effect, perhaps affecting a wide range of cognitive abilities of which executive function is a component. On the other hand, the effect of smoking on measures relying on response speed were independent of IQ, suggesting a more specific processing speed deficit associated with chronic smoking.

  15. Vectorization vs. compilation in query execution

    NARCIS (Netherlands)

    J. Sompolski (Juliusz); M. Zukowski (Marcin); P.A. Boncz (Peter)

    2011-01-01

    textabstractCompiling database queries into executable (sub-) programs provides substantial benefits comparing to traditional interpreted execution. Many of these benefits, such as reduced interpretation overhead, better instruction code locality, and providing opportunities to use SIMD

  16. ARC Code TI: IPG Execution Service

    Data.gov (United States)

    National Aeronautics and Space Administration — The Execution Service allows users to submit, monitor, and cancel complex jobs. Each job consists of a set of tasks that perform actions such as executing...

  17. Executive Information Systems' Multidimensional Models

    Directory of Open Access Journals (Sweden)

    2007-01-01

    Full Text Available Executive Information Systems are design to improve the quality of strategic level of management in organization through a new type of technology and several techniques for extracting, transforming, processing, integrating and presenting data in such a way that the organizational knowledge filters can easily associate with this data and turn it into information for the organization. These technologies are known as Business Intelligence Tools. But in order to build analytic reports for Executive Information Systems (EIS in an organization we need to design a multidimensional model based on the business model from the organization. This paper presents some multidimensional models that can be used in EIS development and propose a new model that is suitable for strategic business requests.

  18. An Algoritm for the Alocation Optimization of Trading Executions

    Directory of Open Access Journals (Sweden)

    Claudiu Vinte

    2006-02-01

    Full Text Available In this paper, I wish to propose the Integer Allocation employing Tabu Search in conjunction with Simulated Annealing Heuristics for optimizing the distribution of trading executions in investors’ accounts. There is no polynomial algorithm discovered for Integer Linear Programming (a problem which is NP-complete. Generally, the practical experience shows that large-scale integer linear programs seem as yet practically unsolvable or extremely time-consuming. The algorithm described herein proposes an alternative approach to the problem. The algorithm consists of three steps: allocate the total executed quantity proportionally on the accounts, based on the allocation instructions (pro-rata basis; construct an initial solution, distributing the executed prices; improve the solution iteratively, employing Tabu Search in conjunction with Simulated Annealing heuristics.

  19. Bile duct reconstruction by a young surgeon in living donor liver transplantation using right liver graft.

    Science.gov (United States)

    Kim, Jong Man; Cho, Wontae; Kwon, Choon Hyuck David; Joh, Jae-Won; Park, Jae Berm; Ko, Justin Sangwook; Gwak, Mi Sook; Kim, Gaab Soo; Kim, Sung Joo; Lee, Suk-Koo

    2014-09-01

    Biliary strictures and bile leaks account for the majority of biliary complications after living donor liver transplantation (LDLT). The aim of this study was to examine differences in biliary complications after adult LDLTs were performed by an experienced senior surgeon and an inexperienced junior surgeon. Surgeries included bile duct reconstruction after adult LDLT using a right liver graft, and risk factors for biliary stricture were identified. We retrospectively reviewed the medical records of 136 patients who underwent LDLT in order to identify patients who developed biliary complications. The senior surgeon performed 102 surgeries and the junior surgeon performed 34 surgeries. The proportion of patients with biliary stricture was similar between the senior and the junior surgeons (27.5% vs 26.5%; P = 0.911). However, the incidence of biliary leakage was higher in patients of the junior surgeon than in those of the senior surgeon (23.5% vs 2.9%; P = 0.001). The frequency of percutaneous drainage was also higher for the junior surgeon than the senior surgeon because of the junior surgeon's high leakage rate of the drainage. When the junior surgeon performed bile duct anastomosis, biliary leakage occurred in 7 patients between the 11th and 20th cases. However, biliary leakage occurred in only 1 case thereafter. Bile duct reconstruction performed by beginner surgeons in LDLT using right lobe grafts should be cautiously monitored and observed by a senior surgeon until an inexperienced junior surgeon has performed at least 20 cases, because of the high incidence of biliary leakage related to surgeon's inexperience in bile duct reconstructions in LDLT.

  20. Evaluating the Training Needs of Active Duty and Reserve Military General Surgeons

    Science.gov (United States)

    1998-06-01

    Speaker - Legal Advocates Seminar: "Motor Vehicle Crash Analysis."Sheraton Bal Harbor. Miami Beach, FL. January 30t. 1997 SICU Infections Course...Surgical Intensive Care Data Managem3nt System." London, England. June 2nd. 1981 VII Reuni6n Nacional de Medicina CrItica y Terapia Intensiva...Asociaci6n Mexicana de Medicine Critica y Terapia Intensive. Curso de Actualizaci6n Profesional en Medicina CrItica: "Development of Intensive Care Systems

  1. The surgeon general's "epidemiologic criteria for causality": a criticism of Burch's critique.

    Science.gov (United States)

    Lilienfeld, A M

    1983-01-01

    In this paper, it has not been possible to critically and objectively assess each of the points made by Burch, since it would be time-consuming both for this author as well as for the reader. However, the major areas of concern expressed by Burch have been reviewed and evaluated. This has in many instances required going back to the original reports of studies to which Burch refers. In doing so, it came as a complete surprise to note that Burch has incompletely presented the findings of several studies or has omitted discussing others more fully. This is, needless to say, most disturbing. In viewing the issue of the causal interpretation of the cigarette smoking--lung cancer relationship, it would appear that Burch would not be satisfied unless there is a randomized controlled experiment in humans. However, since such an experiment seems hardly feasible, one must depend upon a synthesis of findings of epidemiologic observations, experimental work on animals and studies of chemical constituents of tobacco and cigarette smoke. However, these do not seem to satisfy Burch, who has developed a theoretical conceptual framework for the etiology of cancer and many other diseases, based upon statistical models and equations. Such an approach is extremely limited. Scientific information and inferences are in the public domain, thereby allowing criticism and evaluation. It is customary, in the experimental sciences, for a scientist who is dissatisfied with the findings of another scientist, to attempt to repeat the experiment to see if his findings are the same or different. This should also be expected in the cigarette smoking-lung cancer issue.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Surgeon General Outlines Opioid Plan | NIH MedlinePlus the Magazine

    Science.gov (United States)

    Skip to main content NIH MedlinePlus the Magazine NIH MedlinePlus Salud Download the Current Issue PDF [3.1 mb] Trusted Health Information from the National Institutes of Health Home Current Issue ...

  3. The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking, 2007

    Science.gov (United States)

    Powell, Patricia A., Ed.; Faden, Vivian B., Ed.; Wing, Stephen, Ed.

    2007-01-01

    This "Call to Action" serves as a reminder that underage drinking has serious social costs and tragic consequences, demonstrating the importance of prevention. Underage alcohol use is not inevitable, and schools, parents, and other adults are not powerless to stop it. The latest research demonstrates a compelling need to address alcohol use early,…

  4. Executable Operational Semantics of Solidity

    OpenAIRE

    Jiao, Jiao; Kan, Shuanglong; Lin, Shang-Wei; Sanan, David; Liu, Yang; Sun, Jun

    2018-01-01

    Bitcoin has attracted everyone's attention and interest recently. Ethereum (ETH), a second generation cryptocurrency, extends Bitcoin's design by offering a Turing-complete programming language called Solidity to develop smart contracts. Smart contracts allow creditable execution of contracts on EVM (Ethereum Virtual Machine) without third parties. Developing correct smart contracts is challenging due to its decentralized computation nature. Buggy smart contracts may lead to huge financial lo...

  5. Executive compensation: a calibration approach

    OpenAIRE

    Ivilina Popova; Joseph G. Haubrich

    1998-01-01

    We use a version of the Grossman and Hart principal-agent model with 10 actions and 10 states to produce quantitative predictions for executive compensation. Performance incentives derived from the model are compared with the performance incentives of 350 firms chosen from a survey by Michael Jensen and Kevin Murphy. The results suggest both that the model does a reasonable job of explaining the data and that actual incentives are close to the optimal incentives predicted by theory.

  6. 36th ATLANTA EXECUTIVE SEMINAR

    Science.gov (United States)

    2011-04-04

    assignments as an Army Division G-4, Divisional Support Battalion Commander, Divisional Material Readiness officer, and Support Battalion Executive...Battalion; Corps Material Management Officer, Corps Support Command; Fort Hood, Texas • Jul 1991 – Jun 1994: Research Analyst, Office of Economic and...LABBLEE Corp, Raytheon, Labat-Anderson Inc., KPMG , Huber Corp, The Boeing Company, and Philadelphia Electric Company. He has also served on a

  7. Financial accounting for radiology executives.

    Science.gov (United States)

    Seidmann, Abraham; Mehta, Tushar

    2005-03-01

    The authors review the role of financial accounting information from the perspective of a radiology executive. They begin by introducing the role of pro forma statements. They discuss the fundamental concepts of accounting, including the matching principle and accrual accounting. The authors then explore the use of financial accounting information in making investment decisions in diagnostic medical imaging. The paper focuses on critically evaluating the benefits and limitations of financial accounting for decision making in a radiology practice.

  8. Executive pay and shareholder litigation

    OpenAIRE

    Lin Peng; Ailsa Röell

    2008-01-01

    The paper examines the impact of executive compensation on private securities litigation. We find that incentive pay in the form of options increases the probability of securities class action litigation, holding constant a wide range of firm characteristics. We further document that there is abnormal upward earnings manipulation during litigation class periods and that insiders exercise more options and sell more shares during class periods, but that this activity is largely driven by pre-ex...

  9. Experience with Remote Job Execution

    International Nuclear Information System (INIS)

    Lynch, Vickie E.; Cobb, John W; Green, Mark L.; Kohl, James Arthur; Miller, Stephen D.; Ren, Shelly; Smith, Bradford C.; Vazhkudai, Sudharshan S.

    2008-01-01

    The Neutron Science Portal at Oak Ridge National Laboratory submits jobs to the TeraGrid for remote job execution. The TeraGrid is a network of high performance computers supported by the US National Science Foundation. There are eleven partner facilities with over a petaflop of peak computing performance and sixty petabytes of long-term storage. Globus is installed on a local machine and used for job submission. The graphical user interface is produced by java coding that reads an XML file. After submission, the status of the job is displayed in a Job Information Service window which queries globus for the status. The output folder produced in the scratch directory of the TeraGrid machine is returned to the portal with globus-url-copy command that uses the gridftp servers on the TeraGrid machines. This folder is copied from the stage-in directory of the community account to the user's results directory where the output can be plotted using the portal's visualization services. The primary problem with remote job execution is diagnosing execution problems. We have daily tests of submitting multiple remote jobs from the portal. When these jobs fail on a computer, it is difficult to diagnose the problem from the globus output. Successes and problems will be presented

  10. Quality improvement 101 for surgeons: Navigating the alphabet soup.

    Science.gov (United States)

    Santore, Matthew T; Islam, Saleem

    2015-12-01

    It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Global plastic surgeons images depicted in motion pictures.

    Science.gov (United States)

    Hwang, Se Jin; Park, Sowhey; Hwang, Kun

    2013-03-01

    Motion pictures are made to entertain and enlighten people, but they are viewed differently by different people. What one considers to be a tearjerker may induce giggles in another. We have gained added interest in this because our professional pictures contain plastic surgery in their venue. We have recently reviewed 21 motion pictures that were made from 1928 to 2006 and that includes plastic surgical procedures in their content. As a habit, we tried to analyze them from a surgical point of view. About one third (35.7%) of the patients were criminals, whereas 14.3% of them were spies. One third of the procedures were done by illegitimate "surgeons," whereas a quarter of the procedures (25%) were performed by renowned surgeons. Surgeons who were in love with the patients did the rest (25%) of the operations. The complication rate was 14.3%; the surgery was successful in 85.7% of cases, but were the patients happy with the results? This was not the case in the movies. Only 7.7% were happy; 14.5 % of them were eminently unhappy. Why the discrepancy? It is difficult to analyze the minds of the people in the film, but considering that the majority of the characters in the films were rather unsavory, one may deduce that a crooked mind functions differently. Motion pictures have advanced greatly in the past several decades with the advent of improved mechanical and electronic devices, and plastic surgery as also advanced in tandem. This surgical field has become a common procedure in our daily life. It is readily available and mostly painless. However, the public sees it in only one way, that is, that the performing physicians are highly compensated. Very few consider the efforts and the suffering that accompanies each and every surgical procedure as it is performed. Perhaps, it is too much to hope for a day that will come when we will see a film that portrays the mental anguish that accompanies each and every procedure the plastic surgeon makes.

  12. Photoshop tips and tricks every facial plastic surgeon should know.

    Science.gov (United States)

    Hamilton, Grant S

    2010-05-01

    Postprocessing of patient photographs is an important skill for the facial plastic surgeon. Postprocessing is intended to optimize the image, not change the surgical result. This article refers to use of Photoshop CS3 (Adobe Systems Incorporated, San Jose, CA, USA) for descriptions, but any recent version of Photoshop is sufficiently similar. Topics covered are types of camera, shooting formats, color balance, alignment of preoperative and postoperative photographs, and preparing figures for publication. Each section presents step-by-step guidance and instructions along with a graphic depiction of the computer screen and Photoshop tools under discussion. Copyright 2010 Elsevier Inc. All rights reserved.

  13. Robotics & artificial intelligence : The future of surgeons & surgery

    Directory of Open Access Journals (Sweden)

    K I Mathai

    2016-01-01

    Robots have evolved as dextrous, fatigue and tremor free surgical tools. The data crunching capability of computers is improving in speed and in capability for machine learning. Human surgical maturity on the other hand is attained and matures through phases of information assimilation, knowledge consolidation and attainment of surgical wisdom. Human surgeons at the helm will, in this decade harness robotic capabilities and information template paradigms to fine tune many procedures and to augment surgical reach. Quantum leaps and paradigm shifts towards robotic surgical autonomy may be neither desirable nor practical.

  14. How pediatric surgeons use social media to attract new patients.

    Science.gov (United States)

    Romano, Ron; Baum, Neil

    2014-08-01

    Social media has changed the landscape of online interaction for all doctors including pediatric surgeons. Of course the public including our patients and potential new patients having immediate access to these sites through mobile devices and iPads has contributed immensely to this phenomenon. Nonetheless, it seems that we are all rushing to get in front of our target audience and to engage in a relationship with them in a cost-effective fashion. This article will discuss the role of the Internet and media and how you can use this technology to attract new pediatric patients to your practice. Georg Thieme Verlag KG Stuttgart · New York.

  15. [The role of university hospital executive board members].

    Science.gov (United States)

    Debatin, J F; Rehr, J

    2009-09-01

    Demographic changes and medical progress in combination with vastly altered regulatory and economic environments have forced considerable change in the structure of German university hospitals in recent years. These changes have affected medical care as well as research and medical school training. To allow for more flexibility and a higher level of reactivity to the changing environment German university hospitals were transferred from state agencies to independent corporate structures. All but one remains wholly owned by the respective state governments. The governing structure of these independent medical hospitals consists of an executive board, generally made up of a medical director, a financial director, a director for nursing, and the dean of the medical faculty. In most hospitals, the medical director serves as chief executive officer. The regulations governing the composition and responsibility of the members of the executive board differ from state to state. These differences do affect to some degree the interactive effectiveness of the members of the executive boards. Modalities that stress the overall responsibility for all board members seem to work better than those that define clear portfolio limits. Even more than organizational and regulatory differences, the effectiveness of the work of the executive boards is influenced by the personality of the board members themselves. Success appears to be a clear function of the willingness of all members to work together.

  16. Compare of Executive Function in Bipolar I Disorder and Schizophrenia

    Directory of Open Access Journals (Sweden)

    Mohammad Reza khodaei-Ardakani

    2013-10-01

    Full Text Available Objective: There is evidence for differential executive function in Bipolar I Disorder (BID and schizophrenia that may tend different cognitive deficits and abnormalities. The objective of this sudsy was to compare the executive function of BID and schizophrenic patients. Materials & Methods: We studied 50 patients with BID, and 50 with schizophrenia participants in outpatients' clinic of Rouzbeh hospital. All participants completed the Wisconsin Card Sorting Test (WCST the Persian version. The participants were mach in three basic variables which had most contributions in cognitive conditions in patients. They were Age, educational status and period of illness. Results: The two patient groups had compared performance on the WCST in compared with general population (P<0/05. In the WCST, schizophrenic patients showed impairment executive function than BID patients (P<0/05. Conclusion: findings indicated that schizophrenic patients had more dysfunctions executive function than the Bipolar disorder I patients. Although, both disorders may show impairment in executive function, but the dysfunction in schizophrenia greater than Bipolar I Disorder patients.

  17. Sexual Harassment and Organizational Outcomes Executive Summary

    Science.gov (United States)

    2011-10-01

    quid pro quo type of Sexual harassment and Organizational, 4 sexual harassment (e.g., sexual coercion). This should drive organizational efforts to... Sexual Harassment and Organizational Outcomes Executive Summary Charlie L. Law DEFENSE EQUAL...Executive Summary] No. 99-11 Sexual harassment and Organizational, 2 Executive Summary Issue

  18. Assessing Executive Functioning: A Pragmatic Review

    Science.gov (United States)

    Hass, Michael R.; Patterson, Ashlea; Sukraw, Jocelyn; Sullivan, Brianna M.

    2014-01-01

    Despite the common usage of the term "executive functioning" in neuropsychology, several aspects of this concept remain unsettled. In this paper, we will address some of the issues surrounding the notion of executive functioning and how an understanding of executive functioning and its components might assist school-based practitioners…

  19. 40 CFR 68.155 - Executive summary.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Executive summary. 68.155 Section 68...) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.155 Executive summary. The owner or operator shall provide in the RMP an executive summary that includes a brief description of the following...

  20. Feasibility of an AI-Based Measure of the Hand Motions of Expert and Novice Surgeons

    Directory of Open Access Journals (Sweden)

    Munenori Uemura

    2018-01-01

    Full Text Available This study investigated whether parameters derived from hand motions of expert and novice surgeons accurately and objectively reflect laparoscopic surgical skill levels using an artificial intelligence system consisting of a three-layer chaos neural network. Sixty-seven surgeons (23 experts and 44 novices performed a laparoscopic skill assessment task while their hand motions were recorded using a magnetic tracking sensor. Eight parameters evaluated as measures of skill in a previous study were used as inputs to the neural network. Optimization of the neural network was achieved after seven trials with a training dataset of 38 surgeons, with a correct judgment ratio of 0.99. The neural network that prospectively worked with the remaining 29 surgeons had a correct judgment rate of 79% for distinguishing between expert and novice surgeons. In conclusion, our artificial intelligence system distinguished between expert and novice surgeons among surgeons with unknown skill levels.