Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung
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.
Japanese thoracic surgeons have created personal relationship with European and North American surgeons. During the last 10 years, official relation between Japanese Association for Chest Surgery(JACS) and European Society of Thoracic Surgeons (ESTS) has been established besides personal interaction, and communication among the thoracic surgeons in Asia was prompted through Asia Thoracoscopic Surgery Education Program( ATEP). International relationship through academic associations is expected to contribute to encouraging general thoracic surgeons.
Morales-Cuenca, Germán; Moreno-Egea, Alfredo; Aguayo-Albasini, Jose Luis
Chronic venous insufficiency is a highly prevalent condition, with significant health and economic repercussions. Although important therapeutic developments have been introduced in recent years, the majority are dealt with by general surgeons in national health hospitals. These surgeons do not have the required and continuous training, and continue to perform classic surgery techniques. Also, their presence at scientific, organisational meetings and training is almost nil. We present an update on developments in phlebology, and tapping into the preliminary results of a national survey, we reflect on the current status of phlebology and beyond for those general surgeons who should have a role in this field.
Snyder, Charles L
Several studies have addressed the issue of manpower needs in pediatric surgery. The number of training programs has multiplied dramatically over the past decade. The distribution of surgeons is more significant than the absolute change in numbers--are major metropolitan areas seeing a more dramatic increase than less populated areas? To evaluate the geographic and demographic changes associated with this increase, we used choropleth and geomapping techniques to evaluate the change in number and distribution of American Pediatric Surgical Association (APSA) members (and by proxy, pediatric surgeons) in the United States over the past decade. Data regarding membership were obtained from APSA. In 1996, management companies changed, and accurate data for initial year of membership were only available after 1996. Online sources (www.services.alphaworks.ibm.com/manyeyes/home and www.mapresso.com) were used for data analysis. There was a 175% increase in the number of APSA members over the past decade. The geographic distribution parallels the state population to some extent but is uneven. The number of APSA members by state over time is displayed in color density maps. Predictions of prior manpower studies were generally accurate. The number of pediatric surgeons in the United States has rapidly increased in the past decade, with no sign of diminution in this trend. Increases in the number of surgeons correlates with state population, indicating a tendency for surgeons to reside in more densely populated areas, as expected. Areas with a disproportionately high or low number of surgeons can be identified via choropleth mapping.
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
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
José Antonio Hernández Varea
Full Text Available El perfil del egresado es un elemento clave para confección del currículo, y constituye el modelo de las características, conocimientos y habilidades que se aspira formar en el futuro cirujano. Dicho perfil debe responder a las necesidades sociales, permitir la planificación del proceso docente-educativo y concretar la relación universidad-sociedad. En el presente artículo se analizan, a partir de la situación actual, los antecedentes históricos del modelo de formación del especialista en cirugía general, la definición de cirugía general, los principales cambios internacionales en el modelo de formación de cirujanos y las funciones generales que se deben considerar en el perfil profesional del cirujano y su cumplimiento en el programa de cirugía.Graduate profile is a key element to make the curriculum, and it is a representation of the possible features, knowledges, and abilities in the future surgeon. Such profile must to account for social needs, to allow the planning of teaching-educational process, and to stay exactly the university-society relation. In present paper, from a current situation, are analyzed the historical backgrounds of training model of general surgery specialist, general surgery definition, the main international changes in the training model of surgeon, and its fulfillment in surgery program.
Keith, R G
Since its inception in 1977, the Canadian Association of General Surgeons (CAGS) has struggled with its responsibility to represent general surgeons in practices across this country. The CAGS has tended to be mute in the presentation of many of its accomplishments, which have improved the role of specialists in community practice, training programs and the subspecialties of general surgery. With the forthcoming changes in direction for the Royal College of Physicians and Surgeons of Canada, based on a recent external survey, the CAGS has a golden opportunity to advocate for a clear identity, autonomous from the Royal College for the purposes of scientific meetings, continuing professional development, scientific and practice affiliation with other surgical specialty societies, and new developments with corporate sector support for advancements in science technology and education. Advocacy for general surgery must be stressed as the priority for the CAGS into the future.
In this podcast, Acting Surgeon General Dr. Steven Galson discusses what you can do to protect yourself from H1N1 flu. Created: 5/13/2009 by U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC). Date Released: 5/13/2009.
The following report contains all of the recommendations of the working group on oral health that met during the Surgeon General's Workshop on Health Promotion and Aging, March 20-23, 1988, in Washington, DC, under the direction of Surgeon General C. Everett Koop and a number of leaders in geriatrics and gerontology. The working group was composed of 17 specialists, including Frank Martin, technical manager; Scott Presson, reporter; James Beck, chairman; and group members Ronald Ettinger, Jean Frazier, Mary Alice Gaston, Helen Gift, Neville Gilmore, Marc Heft, H. Asuman Kiyak, James Marshall, Roseann Mulligan, Linda Niessen, Vincent Rogers, Michele Saunders, Ruth Seigler, and Hongying Wang. The report also includes dental-related recommendations made by the working groups on medication, preventive health services, alcohol, physical fitness and exercise, injury prevention, mental health, smoking cessation, and nutrition. Eight workshops have been sponsored by the surgeon general since his appointment to office in 1981; this workshop was the first to focus on dentistry and aging.
Costa, Sílvia; Gomes, Aline; Graça, Susana; Ferreira, António; Fernandes, Gonçalo; Esteves, Joana; Costa, Alexandre; Fernandes, Paula; Castelões, Paula; Maciel, Jorge
The Abdominal Compartment Syndrome (ACS) is a clinical entity recognized for over a century, but only recently its risk criteria, monitorization and treatment have been defined by the World Society of the Abdominal Compartment Syndrome (WSACS). The general surgeon's involvement is vital since this syndrome is common in surgical patients and because its treatment may culminate in a laparostomy. 250 questionnaires of 17 questions were distributed among general surgeons attending the XXVIII Portuguese Congress of Surgery. The data were analyzed using SPSS® v16. We received 36,4% (91) of the delivered questionnaires, most of which from male surgeons (63,7%), from central hospitals (75,8%), working 42 h per week (70.3%), whose average of age was 38 years. About half of the respondents received training in Intensive Care Units. All surgeons had already heard about measuring the Intra- abdominal Pressure (IAP), which was being performed at 89% of their hospitals. About 40% of surgeons only admitted intra-abdominal hypertension above 20 mmHg (only 22% indicated the correct value of 12 mmHg). 36,3% of surgeons suggested that a decompressive laparostomy must be carried out for primary ACS if IAP greater then 20 mmHg with new organ failure; 36.3% favoured the "Vacuum-pack"-like system, and 56% only re-operate the patients "as needed". 48,4% of surgeons had already performed decompressive laparostomy, 66% of which had residence training in a ICU (p = 0,005). Respondents also pointed an average mortality related to ACS of 81% without laparostomy, and a reduction to 38,5% after performing that procedure. Only 26% of the surgeons were aware of the WSACS consensus definitions and recommendations, of those, 83% had already performed a laparostomy (Pdivulgation.
... page: https://medlineplus.gov/news/fullstory_162443.html U.S. Surgeon General Calls for Crackdown on E-Cig ... product among American teens, according to a new U.S. Surgeon General's report that calls for a crackdown ...
Schmitz, Connie C; Chow, Christopher J; Rothenberger, David A
Effective teaching for general surgery residents requires that faculty members with colorectal expertise actively engage in the education process and fully understand the current context for residency training. In this article, we review important national developments with respect to graduate medical education that impact resident supervision, curriculum implementation, resident assessment, and program evaluation. We argue that establishing a culture of respect and professionalism in today's teaching environment is one of the most important legacies that surgical educators can leave for the coming generation. Faculty role modeling and the process of socializing residents is highlighted. We review the American College of Surgeons' Code of Professional Conduct, summarize some of the current strategies for teaching and assessing professionalism, and reflect on principles of motivation that apply to resident training both for the trainee and the trainer.
Yahya, Zarif; Al-habbal, Yahya; Hassen, Sayed
Inguinal hernias involving the ureter, a retroperitoneal structure, is an uncommon phenomenon. It can occur with or without obstructive uropathy, the latter posing a trap for the unassuming general surgeon performing a routine inguinal hernia repair. Ureteral inguinal hernia should be included as a differential when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure or urinary tract infection particularly in a male. The present case describes a patient with a known ureteroinguinal hernia who proceeded to having a planned hernia repair and ureteric protection. The case is a reminder that when faced with an unexpected finding such an indirect sliding inguinal hernia, extreme care should be taken to ensure that no structures are inadvertently damaged and that a rare possibility is the entrapment of the ureter in the inguinal canal. PMID:28275027
Wing, Stephen; Beazley, Hamilton; Fine, Theodora
The Surgeon General, the Nation's top public health officer, is appointed by the President of the United States to help protect and promote the health of the Nation. The recently published "Surgeon General's Call to Action To Prevent and Reduce Underage Drinking" [ED496083] highlights underage alcohol use as a major public health and…
Aug 3, 2014 ... the data had been presented reflecting different institutions (without necessarily ... is no formal training in clinical governance to equip graduating surgeons for a ... shifting healthcare landscape, in SA and globally. Martin D ...
McHugh, S M
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.
Cater, Douglass; Strickland, Stephen
In March of 1972 the Aspen Program on Communications and Society convened a meeting which brought together the Surgeon General, staff members connected with the Surgeon General's Report on Television and Violence, and social scientists. The purpose of the meeting was to evaluate the Report, which had just been issued. This conference report…
Blankenship Charles L
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.
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 < 0.03) from the converging 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. 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. PMID:20591159
Engels, Paul T; de Gara, Chris
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.
Harrop James S
Full Text Available Abstract Background Considerable variability exists in clinical approaches to thoracolumbar fractures. Controversy in evaluation and nomenclature contribute to this confusion, with significant differences found between physicians, between different specialties, and in different geographic regions. A new classification system for thoracolumbar injuries, the Thoracolumbar Injury Severity Score (TLISS, was recently described by Vaccaro. No assessment of regional differences has been described. We report regional variability in use of the TLISS system between United States and non-US surgeons. Methods Twenty-eight spine surgeons (8 neurosurgeons and 20 orthopedic surgeons reviewed 56 clinical thoracolumbar injury case histories, which included pertinent imaging studies. Cases were classified and scored using the TLISS system. After a three month period, the case histories were re-ordered and the physicians repeated the exercise; 22 physicians completed both surveys and were used to assess intra-rater reliability. The reliability and treatment validity of the TLISS was assessed. Surgeons were grouped into US (n = 15 and non-US (n = 13 cohorts. Inter-rater (both within and between different geographic groups and intra-rater reliability was assessed by percent agreement, Cohen's kappa, kappa with linear weighting, and Spearman's rank-order correlation. Conclusion Non-US surgeons were found to have greater inter-rater reliability in injury mechanism, while agreement on neurological status and posterior ligamentous complex integrity tended to be higher among US surgeons. Inter-rater agreement on management was moderate, although it tended to be higher in US-surgeons. Inter-rater agreement between US and non-US surgeons was similar to within group inter-rater agreement for all categories. While intra-rater agreement for mechanism tended to be higher among US surgeons, intra-rater reliability for neurological status and PLC was slightly higher among non
Schmitz, Connie; Chow, Christopher; Rothenberger, David
Effective teaching for general surgery residents requires that faculty members with colorectal expertise actively engage in the education process and fully understand the current context for residency training...
Honein, Margaret A; Devine, Owen; Grosse, Scott D; Reefhuis, Jennita
According to the 2014 Surgeon General's Report, smoking in early pregnancy can cause orofacial clefts. We sought to examine the implications of this causal link for the potential prevention of orofacial clefts in the United States. Using published data on the strength of the association between orofacial clefts and smoking in early pregnancy and the prevalence of smoking at the start of pregnancy, we estimated the attributable fraction for smoking as a cause of orofacial clefts. We then used the prevalence of orofacial clefts in the United States to estimate the number of orofacial clefts that could be prevented in the United States each year by eliminating exposure to smoking during early pregnancy. We also estimated the financial impact of preventing orofacial clefts caused by maternal smoking based on a published estimate of attributable healthcare costs through age 10 for orofacial clefts. The estimated attributable fraction of orofacial clefts caused by smoking in early pregnancy was 6.1% (95% uncertainty interval 4.4%, 7.7%). Complete elimination of smoking in early pregnancy could prevent orofacial clefts in approximately 430 infants per year in the United States, and could save an estimated $40.4 million in discounted healthcare costs through age 10 for each birth cohort. Understanding the magnitude of the preventable burden of orofacial clefts related to maternal smoking could help focus smoking cessation efforts on women who might become pregnant. © 2014 Wiley Periodicals, Inc.
Shelstad, K R; Clevenger, F W
Information retrieval has progressed from a reliance on traditional print sources to the modern era of computer databases and online networks. Surgeons, many from remote areas not served by professional medical libraries, must develop and maintain skills in information retrieval and management in both electronic and standard formats. One hundred thirty-three New Mexico general surgeons were surveyed to identify their information-seeking patterns in five areas: retrieval purposes, retrieval so...
Full Text Available Abstract Background 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. Methods 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. Results 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 Conclusion 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.
Schmitz, Connie C.; Chow, Christopher J.; Rothenberger, David A
Effective teaching for general surgery residents requires that faculty members with colorectal expertise actively engage in the education process and fully understand the current context for residency training. In this article, we review important national developments with respect to graduate medical education that impact resident supervision, curriculum implementation, resident assessment, and program evaluation. We argue that establishing a culture of respect and professionalism in today's...
Shelstad, K R; Clevenger, F W
Information retrieval has progressed from a reliance on traditional print sources to the modern era of computer databases and online networks. Surgeons, many from remote areas not served by professional medical libraries, must develop and maintain skills in information retrieval and management in both electronic and standard formats. One hundred thirty-three New Mexico general surgeons were surveyed to identify their information-seeking patterns in five areas: retrieval purposes, retrieval sources, barriers to access, techniques used, and continuing education needs. Ninety-nine (74.4%) surgeons responded to the survey. Ninety-five percent utilize professional meetings, the medical literature, and physician colleagues as information sources. Only 17% utilize the outreach services of the state's only medical school library. Common retrieval barriers were practice demands (71%), isolation from medical schools (30%), computer illiteracy (28%), and rural environment (25%). Continuing education topics related to information management would be valuable to 61% of the surgeons. Sixty-nine percent believe their current ability to access biomedical information is adequate, despite most frequently accessing their personal libraries for information related to decision-making or patient management. These data suggest that, despite significant information needs, surgeons have not embraced newer forms of information retrieval. It is imperative that surgeons acquire and maintain modern information retrieval skills as a means of remaining up-to-date in their profession. Professional surgical organizations and medical librarians should collaborate on these continuing education ventures.
Chattopadhyay, Shankar Das; Karmakar, Nisith Chandra; Sengupta, Ritankar; SenGupta, Tamal Kanti; Ray, Debasis; Basus, Shibaji
The number of polytrauma patient with associated brain injury or commonly referred as 'head injury' has increased tremendously in recent times courtesy to road traffic accident or other causes. This prospective observational study was conducted in patients of head injury admitted through emergency in the department of general surgery in NRS Medical College, Kolkata during the year 2011 to determine the pattern of head injury patients admitted and nature of intervention. A total number of 3861 patients were admitted in a single year. Obviously this represents the tip of the iceburg. Traumatic brain injury was the highest in the age group of 31-40 years (33.5%) followed by 21-30 years (29.1%) in the most fruitful phase of life. The traumatic brain injury death was more common in males. The maximum number of cases was from rural areas ie, farmers and labours. To minimise the morbidity and mortality resulting from head injury there is need for better maintenance of roads, improvement of road visibility and lighting, rigid enforcement of traffic rules and imparting road safety education to school children. Despite valiant efforts and advancement in medical sciences and infrastructure in the form of neurosurgery departments and trauma care units to cope with the changing world of trauma, there still remains a huge responsibility and a definite part to be played by the general surgeons to manage head injury patient even in tertiary hospitals.
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…
Blood, Deborah J.; Snyder, Leslie B.
A study investigated the effects of the newly introduced Surgeon General's alcohol warnings and advertisements on college students. One hundred fifty-nine undergraduates in communication sciences at the University of Connecticut viewed slides of alcohol products, with or without advertisements and warnings. Following the viewings, subjects filled…
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.
Care with Physicians .................................. 47 Benefits of Specialty Care at Battalion Level...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
Sielatycki, John A; Sawyer, Jeffrey R; Mir, Hassan R
To investigate recent trends in the orthopaedic trauma workforce and to assess whether supply of orthopaedic trauma surgeons (OTS) matches the demand for their skills. Supply estimated using Orthopaedic Trauma Association (OTA) membership and American Academy of Orthopaedic Surgeons census data. The annual number of operative pelvic and acetabular fractures reported by American College of Surgeons verified trauma centers in the National Trauma Data Bank (NTDB) was used as a surrogate of demand. Because surrogates were used, the annual rate of change in OTA membership versus rate of change in operative injuries per NTDB center was compared. From 2002 to 2012, reported operative pelvic and acetabular injuries increased by an average of 21.0% per year. The number of reporting trauma centers increased by 27.2% per year. The number of OTA members increased each year except in 2009, with mean annual increase of 9.8%. The mean number of orthopaedic surgeons per NTDB center increased from 7.98 to 8.58, an average of 1.5% per year. The annual number of operative pelvic and acetabular fractures per NTDB center decreased from 27.1 in 2002 to 19.03 in 2012, down 2.0% per year. In the United States, from 2002 to 2012, the number of OTS trended upward, whereas operative pelvic and acetabular cases per reporting NTDB center declined. These trends suggest a net loss of such cases per OTS over this period.
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
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. 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. 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. 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.
Sellés Dechent, Rafael; Rueda Alcárcel, Camilo; Primo Romaguera, Vicent; Martínez Caamaño, Asunción; Asencio Arana, Francisco
The Charcot foot (CF) consists of a progressive deterioration of the bones and joints, most common in diabetic patients with advanced neuropathy. The great problem is that can be confused with other processes, delaying the diagnosis and specific treatment. The aim is to analyze the cases of CF diagnosed in our hospital and especially to highlight the role of the general surgeon. Retrospective study of all registered cases diagnosed of CF between the diabetic population of our Department of Health. A review of the literature was performed. From 2008 to 2012, there 7 cases of CF were diagnosed (prevalence 1:710). Two of the patients were diagnosed erroneously of cellulitis. The average time of delay in the diagnosis was 10 weeks (minimum 1, maximum 24). The initial treatment was immobilization of the extremity. Once the edema was eliminated, an offload orthesis was placed according to Sanders's anatomical classification. Evolution was favorable in 5 patients, 1 patient needed amputation, and other one died of acute cardiac pathology. The CF is a more frequent pathology than we believe. The general surgeon is the fundamental prop in the diagnosis and initial treatment. Before the presence of inflammation and edema of the foot in a patient with diabetes and severe neuropathy, once cellulitis, osteomyelitis, and TVP are ruled out, Charcot neuroarthropathy should be considered. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Craig, Stephen C
Joseph Lovell, trained in medicine at Harvard and in military medicine/surgery by the War of 1812, became the first Surgeon General to sit on the reorganised army staff at the tender age of 29 in 1818. With a keen intellect, medical acumen, and wartime experiences for his tools and a close supporting relationship with Commanding General Jacob Jennings Brown and Secretary of War John C Calhoun (1728-1850), Lovell constructed an efficient and effective organisational and administrative framework for the new Medical Department of the US Army. Moreover, he not only redefined the role of the American military physician but also established the professional dignity, respectability and value of the medical officer among line officers and staff. Lovell's 18-year tenure came to an abrupt end, but the operational framework he created became both foundation and legacy for his successors.
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
Ahmed, Najma; Conn, Lesley Gotlib; Chiu, Mary; Korabi, Bochra; Qureshi, Adnan; Nathens, Avery B; Kitto, Simon
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.
This report of the Surgeon General on smoking and health, Reducing Tobacco Use, appears at a time of considerable upheaval in the arena of tobacco use control and prevention. Legal and legislative efforts to protect children from tobacco initiation and to diminish the prevalence of smoking among adults are in a state of flux, with some important gains and some sobering setbacks. Major changes in the public stance of the tobacco industry have evoked a reevaluation of strategies for controlling and preventing tobacco uptake. Enormous monetary settlements have provided the resources to fuel major new comprehensive antitobacco efforts, but the ultimate cost and benefit of these resources are still to be determined. Into this changing landscape, the report introduces an assessment of information about the value and efficacy of the major approaches that have been used--educational, clinical, regulatory, economic, and comprehensive--to reduce tobacco use. The report evaluates the scientific evidence for each approach, attempts to place the approaches in the larger context of tobacco control, and provides a vision of the trajectory for tobacco use prevention and control based on these available tools. Thus, although our knowledge about tobacco control remains imperfect, we know more than enough to act now. Widespread dissemination of the approaches and methods shown to be effective in each modality and especially in combination would substantially reduce the number of young people who will become addicted to tobacco, increase the success rate of young people and adults trying to quit using tobacco, decrease the level of exposure of nonsmokers to environmental tobacco smoke, reduce the disparities related to tobacco use and its health effects among different population groups, and decrease the future health burden of tobacco-related disease and death in this country. These achievable improvements parallel the health objectives set forth in Healthy People 2010, the national
Mizrahi, Ido; Mazeh, Haggi; Levy, Yair; Karavani, Gilad; Ghanem, Muhammad; Armon, Yaron; Vromen, Amos; Eid, Ahmed; Udassin, Raphael
Appendectomy is the most common urgent procedure in children, and surgical outcomes may be affected by the surgeon's experience. This study's aim is to compare appendectomy outcomes performed by pediatric surgeons (PSs) and general surgery residents (GSRs). A retrospective review of all patients younger than 16y treated for appendicitis at two different campuses of the same institution during the years 2008-2009 was performed. Appendectomies were performed by PS in one campus and GSR in the other. Primary end points included postoperative morbidity and hospital length of stay. During the study period, 246 (61%) patients were operated by senior GSR (postgraduate year 5-7) versus 157 (39%) patients by PS. There was no significant difference in patients' characteristics at presentation to the emergency room and the rate of appendeceal perforation (11% versus 15%, P=0.32), and noninfectious appendicitis (5% versus 5% P=0.78) also was similar. Laparoscopic surgery was performed more commonly by GSR (16% versus 9%, P=0.02) with shorter operating time (54±1.5 versus 60±2.1, P=0.01). Interestingly, the emergency room to operating room time was shorter for GSR group (419±14 versus 529±24min, P<0.001). The hospital length of stay was shorter for the GSR group (4.0±0.2 versus 4.5±0.2, P=0.03), and broad-spectrum antibiotics were used less commonly (20% versus 53%, P<0.0001) and so was home antibiotics continuation (13% versus 30%, P<0.0001). Nevertheless, postoperative complication rate was similar (5% versus 7%, P=0.29) and so was the rate of readmissions (2% versus 5%, P=0.52). The results of this study suggest that the presence of a PS does not affect the outcomes of appendectomies. Copyright © 2013 Elsevier Inc. All rights reserved.
The 2014 Surgeon General's report: commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and updating the evidence on the health consequences of cigarette smoking.
Alberg, Anthony J; Shopland, Donald R; Cummings, K Michael
The question of whether cigarette smoking was associated with lung cancer was central to the expansion of epidemiology into the study of chronic diseases in the 1950s. The culmination of this era was the 1964 report of the Advisory Committee to the Surgeon General, a landmark document that included an objective synthesis of the evidence of the health consequences of smoking according to causal criteria. The report concluded that cigarette smoking was a cause of lung cancer in men and sufficient in scope that "remedial action" was warranted at the societal level. The 2014 Surgeon General's report commemorates the 50th anniversary of the 1964 report. The evidence on the health consequences of smoking has been updated many times in Surgeon General's reports since 1964. These have summarized our increasingly greater understanding of the broad spectrum of the deleterious health effects of exposure to tobacco smoke across most major organ systems. In turn, this evidence has been translated into tobacco control strategies implemented to protect the public's health. The Surgeon General report process is an enduring example of evidence-based public health in practice. Substantial progress has been made, but cigarette smoking remains one of the most pressing global health issues of our time.
Rizan, Chantelle; Phee, Jaewon; Boardman, Charlotte; Khera, Goldie
The primary aim of this study was to establish concordance of general surgeon's prescribing practice with local IV-oral antibiotic guidelines. The secondary aim was to evaluate the effect of introducing educational antibiotic measures. The Rogers Diffusion of Innovation Model was used to explore the adoption of antibiotic stewardship practices. In this prospective, cohort study, data was collected on 100 pre and 100 post awareness intervention programme patients. The educational intervention comprised raising awareness of a) the guidelines b) pre-intervention results c) introducing an IV-oral antibiotic prompt sheet. The concordance with local guidelines was compared between pre- and post-intervention groups using Fisher's Exact Test or Pearson's Chi Test (SPSS Statistics V22). The concordance of general surgical doctors with local IV-oral antibiotic guidelines was poor and did not improve significantly following the awareness intervention programme. There was no uptake of the antibiotic prompt sheet. There was a trend towards increase in the number of patients switched from IV to oral antibiotics at 48-72 h and significant increase (p review IV antibiotics. Antibiotic governance measures failed to inspire even an initial group of innovators to use the antibiotic prompt sheets. It appears educational measures are effective in improving prescribing behavior and intent amongst a group of early adopters, but this fails to reach a critical mass. In order to improve antibiotic governance and embark upon the Rogers Diffusion of Innovation Curve, more must be done to engage general surgical doctors in timely, judicious antibiotic prescribing. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Franz, Randall W
An applicant shortage for vascular surgery (VS) residencies exists despite an increase in available training positions created to meet the growing demands for vascular surgeons. After 3 years of practice as an American Board of Surgery (ABS)-certified/board-eligible general surgeon, the author of this study attended an accredited 1-year VS training fellowship and received an ABS certificate of Added Qualifications in VS. The purpose of this review was to investigate the implications completing a vascular fellowship has had on VS procedure patterns, vascular procedure competency, clinical practice, career, and lifestyle with the aim of attracting trainees to the field of VS. The author's operative logs were reviewed retrospectively to summarize vascular procedures performed before and after the vascular fellowship. Statistical analysis was performed comparing the types and volume of vascular procedures before and after the vascular fellowship. Changes in professional career and personal life also were examined. The author performed 401 vascular procedures during 2.8 years as a general surgeon. In the first 3.4 years after the vascular fellowship, vascular procedure volume increased to 1563. The mean number of vascular procedures performed per year increased from 143.2 as a general surgeon to 459.7 as a vascular surgeon. The three major differences in vascular procedures occurring after the vascular fellowship were (1) a threefold increase in the number of vascular procedures performed, (2) a shift from major open to venous and endovascular procedures, and (3) an increase in case complexity. Specializing in VS also has resulted in increased career opportunities, more career satisfaction, a direct financial benefit, and more flexibility for lifestyle and family. Because of these positive changes, the author encourages medical students and residents interested in VS to explore the specialty early, seek vascular surgeons to serve as mentors, and enter one of the new VS
Gadipelly, Srinivas; Neshangi, Srisha
Every general dental practitioner and oral and maxillofacial surgeon needs a thorough knowledge of the diagnosis and management of medical emergencies. Cardiopulmonary arrest is the most urgent of emergencies and diagnosis must be done as soon as possible. This paper discusses the importance of the International Liaison Committee on Resuscitation which forms the guidelines for cardiopulmonary resuscitation (CPR), highlighting the important changes in the guidelines of CPR from the year 2000 to 2010, the basic sequence of performing CPR and also the role of defibrillation and the use of automated external defibrillators. Finally the five part chain of survival which is of utmost importance to dental health care professionals and oral and maxillofacial surgeons. All dental health care personnel and oral & maxillofacial surgeons should recognize the importance of the changes in the guidelines of CPR, be trained and allowed to use a properly maintained defibrillator, to respond to cardiac arrest victims.
Ramin Haj Zargarbashi; Hirbod Nasiri Bonaki; Shayan Zadegan; Taghi Baghdadi; Mohammad Hossein Nabian; Mehdi Ramezan Shirazi
Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked t...
Jesse, M T; Abouljoud, M; Eshelman, A
Burnout is a response to chronic strain within the workplace characterized by feelings of inefficacy (reduced personal accomplishment), cynicism (depersonalization) and emotional exhaustion. The purpose of this study was to report prevalence and explore organizational and interpersonal contributors of burnout in transplant surgeons. We performed a national cross-sectional survey of 218 transplant surgeons on sociodemographics, professional characteristics, frequency of difficult patient interactions and comfort in dealing with difficult patient interactions, decisional authority, psychological job demands, supervisor and coworker support, with burnout as the outcome. 40.1% reported high levels of emotional exhaustion, 17.1% reported high levels of depersonalization and 46.5% reported low personal accomplishment. Greater emotional exhaustion was predicted by lower decisional authority, higher psychological work demands, and lower coworker support. Greater discomfort with difficult patient interactions and lower coworker support predicted depersonalization. Lastly, lower decisional authority, lower coworker support, less frequent difficult patient interactions but greater discomfort with difficult patient interactions predicted lower personal accomplishment. The findings of this study show that unsupportive environments with little decisional control and high work-related demands contribute to the development of burnout in transplant surgeons. Implications for interventions aimed at prevention of burnout in transplant surgeons are discussed. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
Lovrics, Peter J; Gordon, Maggie; Cornacchi, Sylvie D; Farrokhyar, Forough; Ramsaroop, Amanda; Hodgson, Nicole; Quan, May Lynn; Wright, Francis; Porter, Geoffrey
We surveyed Canadian General Surgeons to examine decision-making in early stage breast cancer. A modified Dillman Method was used for this mail survey of 1443 surgeons. Practice patterns and factors that influence management choices for: preoperative assessment, definition of margin status, surgical techniques and recommendations for re-excision were assessed. The response rate was 51% with 41% treating breast cancer. Most (80%) were community surgeons, with equal distribution of low/medium/high volume and years of practice categories. Approximately 25% of surgeons "sometimes or frequently" performed diagnostic excisional biopsies while 90% report "frequently" or "always" performing preoperative core biopsies. There was marked variation in defining negative and close margins, in the use of intra-operative margin assessment techniques and recommendations for re-excision. Responses revealed significant variation in attitudes and practices. These findings likely reflect an absence of consensus in the literature and potential gaps between best evidence and practice. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Abstract The reports of US Surgeon General on smoking are considered the authoritative statement on the scientific state of the art in this field. The previous report on nicotine addiction published in 1988 is one of the most cited references in scientific articles on smoking and often the only citation provided for specific statements of facts regarding nicotine addiction. In this commentary we review the chapter on nicotine addiction presented in the recent report of the Surgeon General. We show that the nicotine addiction model presented in this chapter, which closely resembles its 22 years old predecessor, could only be sustained by systematically ignoring all contradictory evidence. As a result, the present SG's chapter on nicotine addiction, which purportedly "documents how nicotine compares with heroin and cocaine in its hold on users and its effects on the brain," is remarkably biased and misleading.
Frenk, Hanan; Dar, Reuven
The reports of US Surgeon General on smoking are considered the authoritative statement on the scientific state of the art in this field. The previous report on nicotine addiction published in 1988 is one of the most cited references in scientific articles on smoking and often the only citation provided for specific statements of facts regarding nicotine addiction. In this commentary we review the chapter on nicotine addiction presented in the recent report of the Surgeon General. We show that the nicotine addiction model presented in this chapter, which closely resembles its 22 years old predecessor, could only be sustained by systematically ignoring all contradictory evidence. As a result, the present SG's chapter on nicotine addiction, which purportedly "documents how nicotine compares with heroin and cocaine in its hold on users and its effects on the brain," is remarkably biased and misleading.
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.
Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F
There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.
Petterson, Stephen; Burke, Matthew; Phillips, Robert; Teevan, Bridget
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.
Farzianpour, Fereshteh; Mohamadi, Efat; najafpour, Zhila; Yousefinezhadi, Taraneh; Forootan, Sara; Foroushani, Abbas Rahimi
Background and Objective: Existence of doctors with high performance is one of the necessary conditions to provide high quality services. There are different motivations, which could affect their performance. Recognizing Factors which effect the performance of doctors as an effective force in health care centers is necessary. The aim of this article was evaluate the effective factors which influence on clinical performance of general surgery of Tehran University of Medical Sciences in 2015. Methods: This is a cross-sectional qualitative-quantitative study. This research conducted in 3 phases-phases I: (use of library studies and databases to collect data), phase II: localization of detected factors in first phase by using the Delphi technique and phase III: prioritizing the affecting factors on performance of doctors by using qualitative interviews. Results: 12 articles were analyzed from 300 abstracts during the evaluation process. The output of assessment identified 23 factors was sent to surgeons and their assistants for obtaining their opinions. Quantitative analysis of the findings showed that “work qualification” (86.1%) and “managers and supervisors style” (50%) have respectively the most and the least impact on the performance of doctors. Finally 18 effective factors were identified and prioritized in the performance of general surgeons. Conclusion: The results showed that motivation and performance is not a single operating parameter and it depends on several factors according to cultural background. Therefore it is necessary to design, implementation and monitoring based on key determinants of effective interventions due to cultural background. PMID:27157161
Slavkin, H C
The Surgeon General's Report, Oral Health in America, is the first comprehensive assessment of oral, dental, and craniofacial health in the history of our nation. The intent of this first-ever Report is to alert Americans to the full meaning of oral health and its importance to general health and well-being across the lifespan. Moreover, the Report has been released at a time in human history of enormous changes as well as opportunities. The convergence of public health policies, "quality of life" expectations, global informatics, a new century of biotechnology, the completion of the Human Genome Project, changes in the management of health care, and the acknowledgment of enormous health disparities herald a call to action. These profound dynamics particularly affect children and their caregivers and the multitude of social, economic, and health issues associated with special patients and developmental disabilities. This paper will highlight the issues, provide recommendations, and suggest a call to action.
Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter;
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....
Ignjatović Ivan M.
Full Text Available Evolvement of urology as a separate scientific discipline depends on several factors. Endoscopic diagnostics, radiological diagnostics, and operative techniques in general surgery, had provided an ability to perform more complex and longer operations. Urology had evolved from the great schools of surgery in Germany and France, and their the most important surgeons, who were intersted in urological surgery. The first endoscope was introduced in 1806, and received today’s form in 1879. Application of "X" rays in medicine started in 1895, and it was later applied as a cystography, retrograde pyelography as well as intravenous urography. The most important thing for the operative technique evolution were application of anhestesia, asepsis and new hemostatic devices. During the one century long development, urology had passed the way from completely unknown field, up to the discipline with the best diagnostic preciseness.
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
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
Sobieralski, Joseph Bernard
General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and
Nassab, Reza; Navsaria, Harshad; Myers, Simon; Frame, James
The cosmetic surgery market is a rapidly growing sector of healthcare, and the use of marketing strategies is now an integral part of any cosmetic surgery practice. In this study, the authors review 50 Web sites from practitioners in London and New York to quantify the utilization of online marketing, comparing results between the United Kingdom and the 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
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
Iaria, G; Cardillo, A
The training of the transplant surgeon is one of the most difficult paths in medicine. The transplant surgeon must be trained as a general and a vascular surgeon; he has to be skilled and upgraded in transplant surgical technique; he has to decide the suitability of the donor and of the organs as well as the immunosuppressive therapy for each recipient; he must know the intensive care unit, hepatology, and nephrology. The transplant surgeon has to deal with surgical, infectious, and metabolic complications after organ transplantation. Thus, clinical formation of the transplant surgeon is multifactorial and always upgraded. However, transplants never happen in the morning; retrivals are more likely to be in the night (especially the holidays ones). "Weekend" is a word not frequently used by transplant surgeons. Moreover, when the transplant procedure happens, the normal activity of the ward and of the outpatient clinic were have to be done. The transplant surgeon must have a sort of "vocation" for such a job. Organ harvesting setting is a good proof of adaptability, always during nighttime, often in small hospitals with operating room nurses unfamiliar with the procedure, sometimes waiting for some colleagues or delaying the surgery. This vocation is enhanced by enthusiasm, but incentives are necessary to feed this love. Incentives should be professional and economic; transplant surgeons should be allowed to make clinical decisions, to choose the surgical technique of transplantation, to control the decision process. Lastly, due to the "total on call," the surgeon should profit from a right salary avoiding extramural activities.
Altieri, Maria S; Yang, Jie; Wang, Lily; Yin, Donglei; Talamini, Mark; Pryor, Aurora D
The relationships between industry and medical professionals are controversial. The purpose of our study was to evaluate surgeons' current opinions regarding the industry-surgery partnership, in addition to self-reported industry ties. After institutional review board approval, a survey was sent via RedCap to 3,782 surgeons across the United States. Univariate and multivariable regression analyses were performed to evaluate the responses. The response rate was 23%. From the 822 responders, 226 (27%) reported at least one current relationship with industry, while 297 (36.1%) had at least one such relationship within the past 3 years. There was no difference between general surgery versus other surgical specialties (P = .5). Among the general surgery subspecialties, respondents in minimally invasive surgery/foregut had greater ties to industry compared to other subspecialties (P = .001). In addition, midcareer surgeons, male sex, and being on a reviewer/editorial board were associated with having industry ties (P industry are important for innovation. Our study showed that relationships between surgeons and industry are common, because more than a quarter of our responders reported at least one current relationship. Industry relations are perceived as necessary for operative innovation. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Objectives. To assess the standard practice of care of surgeons regarding surgical antibiotic prophylaxis, to identify gaps, and to set recommendations. Methods. A retrospective analysis of data obtained from different surgical units in a single center in Qatar over a 3-month period in 2012. A total of 101 patients who underwent surgery and followed regimes for surgical prophylaxis as per hospital guidelines were included in the study. Results. The overall use of antibiotic was 89%, whereas the current practice did not match the recommended hospital protocols in 53.5% of cases. Prolonged antibiotics use (59.3% was the commonest reason for nonadherence followed by the use of an alternative antibiotic to that recommended in the protocol (31.5% and no prophylaxis was used in 9.2% of cases. The rate of compliance was significantly higher among clean surgery than clean contaminated group (P=0.03. Forty-four percent of clean and 65% of clean-contaminated procedures showed noncompliance with the recommended surgical antimicrobial prophylaxis hospital guidelines. Conclusion. Lack of adherence to hospital protocols is not uncommon. This finding remains a challenge to encourage clinicians to follow hospital guidelines appropriately and to consistently apply the surgical antibiotic prophylaxis. The role of clinical pharmacist may facilitate this process across all surgical disciplines.
Dwarswaard, J.; Hilhorst, M.; Trappenburg, M.
To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2-3 years aft
..., eating out sensibly, and getting healthy food when travelling (e.g. in airports) or out and about..., approximately 40 percent of American adults report that they do not engage in any leisure-time physical...
Nakahara, Masayuki; Yasuhara, Takao; Inoue, Takafumi; Takahashi, Yuichi; Kumamoto, Shinji; Hijikata, Yasukazu; Kusumegi, Akira; Sakamoto, Yushi; Ogawa, Koichi; Nishida, Kenki
Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A (n = 74) and B (n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: experience.
Rosen, Irving B
There is no significant biography that records the accomplishments of Sir Wilfred Trotter, who was a general surgeon in its pure sense at a time when surgical specialization was in its infancy. Trotter was born in the 1870s in England. Despite being bedridden during his childhood with a musculoskeletal condition he was able to study medicine at London University, and eventually became Professor and Chair of Surgery at the University College Hospital, a position he held until his death in November 1939. He made many contributions to surgical care, particularly in the field of oncology. He attended to many famous people, including King George V and Sigmund Freud and was greatly honoured in his own milieu. He was named honorary surgeon and Sargent Surgeon to the king. In addition, he was a thoughtful individual who addressed problems in human behaviour, contradicting the stereotype of the contemporary surgeon.
Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr
This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction.
Wex, T; Kuester, D; Meyer, F
Experimental medicine has evolved tremendously in the last few years. In particular, the introduction of novel techniques, in-vitro models, knock-out/transgenic animals and high-through put analytical methodologies have resulted in a deeper understanding of cellular pathophysiology and diseases. The daily clinical management has benefited by the introduction of biomarkers and targeted therapies. This development has been accompanied by increasing specialisation across all fields of research and medicine. Therefore, clinical-translational research requires a team of competent partners nowadays. The visceral surgeon can contribute significantly to these projects. The present review highlights several aspects of translational research and put chances and potential pitfalls into perspective in context with the work of the visceral surgeon.
Milgrom, Peter; Zero, Domenick T; Tanzer, Jason M
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.
Zargarbashi, Ramin Haj; Bonaki, Hirbod Nasiri; Zadegan, Shayan Abdollah; Baghdadi, Taghi; Nabian, Mohammad Hossein; Shirazi, Mehdi Ramezan
Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher's exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist's report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.
Toledo-Pereyra, Luis H
From time immemorial mentoring has been the angular stone sustaining the building of medical and surgical education. Good teachers are not necessarily good mentors, and good mentors are not always good teachers. A combination of both is very plausible and should be encouraged. Today, the qualities of a good mentor, in our case the surgeon-mentor, should include respect, time, commitment, trust, determination, encouragement, patience, and opportunity for independence. The mentee would need to respond to similar virtues of trust, encouragement, and respect. The reciprocal consideration of equally divided roles would be clearly desirable. Recognizing the importance of a good mentor and making this role the priority of medical schools would enhance our ability to form better professionals. It would certainly promote professionalism, better patient care, and research.
Public Health Service (DHEW), Rockville, MD.
Reported is a review of the literature regarding the relationships of the use of tobacco, especially the smoking of cigarettes, to the health of men and women, primarily in the United States. Topical divisions of the report are: Consumption of Tobacco Products in the United States; Chemical and Physical Characteristics of Tobacco and Tobacco…
... 12 Banks and Banking 5 2010-01-01 2010-01-01 false United States Treasury General Account. 561.53 Section 561.53 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY DEFINITIONS FOR REGULATIONS AFFECTING ALL SAVINGS ASSOCIATIONS § 561.53 United States Treasury General Account. The...
Bell, Richard H
Each year, approximately 1,000 graduating medical students enter training in general surgery and its related specialties and subspecialties in the United States. Traditionally, residents who want to practice vascular surgery, plastic surgery, thoracic surgery, and other specialties and subspecialties derived from general surgery have been required to complete five years of training in general surgery before embarking on further training. However, three phenomena have recently emerged that are changing the picture of surgical training: (1) proliferation of fellowships in subspecialties of general surgery, (2) increasing desire of subspecialties of general surgery for recognition as specialties in their own right, and (3) pressure to reduce or eliminate the traditional general surgery training required before specialization or subspecialization. In the meantime, and perhaps as a consequence of these changes, traditional general surgery has become less attractive as a specialty and there has been significant concern about the quality of training in general surgery. As a result of fewer trainees electing general surgery as a career, there is now increasing evidence of a shortage of surgeons who are able to handle a reasonably broad caseload of emergency care in general surgery and trauma.Many of these issues are currently being addressed by the profession. Among the initiatives underway are developing a standardized curriculum in general surgery, appropriately apportioning operative experience between residency and fellowship, considering alternative pathways for training in subspecialties, and developing a system for oversight of advanced surgical training fellowships. The system for governance of graduate surgical education in the United States is less centralized than in other countries. One initiative that has been undertaken to improve coordination of efforts between educational and regulatory bodies is the formation of the Surgical Council on Resident Education
U.S. Department of Health & Human Services — This dataset includes crude birth rates and general fertility rates in the United States since 1909. The number of states in the reporting area differ historically....
... 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... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgeon's glove. 878.4460 Section 878.4460...
... Action on Prescription Drug Abuse in Youth AGENCY: National Institute on Drug Abuse, National Institutes...: The National Institute on Drug Abuse, a Research Institute of the National Institutes of Health, is... General response to the public health problem of prescription drug abuse among youth....
Pushpa Goswami; Samreen Memon; Nand Lal Kella
Inguinal hernia is a most common surgical condition worldwide during infancy. In spite of significant improvements in pediatric surgery it still carries mortality and morbidity due to delay between diagnosis and surgical intervention. A delay in the treatment of inguinal hernia may lead to incarceration and strangulation. In developing countries like us the risk of incarceration and complications is much higher due to delay in seeking treatment due to lack of awareness among parents, general ...
Pushpa Goswami; Samreen Memon; Nand Lal Kella
Inguinal hernia is a most common surgical condition worldwide during infancy. In spite of significant improvements in pediatric surgery it still carries mortality and morbidity due to delay between diagnosis and surgical intervention. A delay in the treatment of inguinal hernia may lead to incarceration and strangulation. In developing countries like us the risk of incarceration and complications is much higher due to delay in seeking treatment due to lack of awareness among parents, general ...
Crestani, Alessandro; Rossanese, Marta; Abbinante, Maria; Calandriello, Mattia; Kungulli, Afrovita; Giannarini, Gianluca; Ficarra, Vincenzo
The widespread robotic surgery in the world highlighted the relevance of the training programs for young urologists and residents. In the last years, urologic societies and some independent robotic surgeons strongly worked to standardize some general and specific training modules. Theoretical and practical sections of robotic training programs have been recently specified. The role of simulators, dry and wet laboratories, bedside assistance, and modular (step-by-step) training at console represent the most relevant elements of robotic surgeon training. Ideally, these didactic tools should be available in modern training centers. The development of structured robotic training programs should be considered as one of the priorities that the urologic community must take into account in the near future.
The purpose of the current study was to develop and test a computerized matching-to-sample (MTS) protocol to facilitate recombinative generalization of subword units (onsets and rimes) and recognition of novel onset-rime and onset-rime-rime words. In addition, we sought to isolate the key training components necessary for recombinative generalization. Twenty-five literate adults participated. Conditional discrimination training emerged as a crucial training component. These findings support the effectiveness of MTS in facilitating recombinative generalization, particularly when conditional discrimination training with subword units is used.
Shetty Guruprasad S
Full Text Available Abstract Background The low incidence of colorectal cancer in India, coupled with absence of specialized units, contribute to lack of relevant data arising from the subcontinent. We evaluated the data of the senior author to better define the requirements that would enable development of specialized units in a country where colorectal cancer burden is increasing. Methods We retrospectively analyzed data of 401 consecutive colorectal resections from a prospective database of the senior author. In addition to patient demographics and types of resections, perioperative data like intraoperative blood loss, duration of surgery, complications, re-operation rates and hospital stay were recorded and analyzed. Results The median age was 52 years (10-86 years. 279 were males and 122 were females. The average duration of surgery was 220.32 minutes (range 50 - 480 min. The overall complication rate was 12.2% (49/401 with a 1.2% (5/401 mortality rate. The patients having complications had an increase in their median hospital stay (from 10.5 days to 23.4 days and the re-operation rate in them was 51%. The major complications were anastomotic leaks (2.5% and stoma related complications (2.7%. Conclusions This largest ever series from India compares favorably with global standards. In a nation where colorectal cancer is on the rise, it is imperative that high volume centers develop specialized units to train future specialist colorectal surgeons. This would ensure improved quality assurance and delivery of health care even to outreach, low volume centers.
Feero, W Gregory; Facio, Flavia M; Glogowski, Emily A; Hampel, Heather L; Stopfer, Jill E; Eidem, Haley; Pizzino, Amy M; Barton, David K; Biesecker, Leslie G
This study examines the analytic validity of a software tool designed to provide individuals with risk assessments for colorectal cancer based on personal health and family history information. The software is compatible with the US Surgeon General's My Family Health Portrait (MFHP). An algorithm for risk assessment was created using accepted colorectal risk assessment guidelines and programmed into a software tool (MFHP). Risk assessments derived from 150 pedigrees using the MFHP tool were compared with "gold standard" risk assessments developed by three expert cancer genetic counselors. Genetic counselor risk assessments showed substantial, but not perfect, agreement. MFHP risk assessments for colorectal cancer yielded a sensitivity for colorectal cancer risk of 81% (95% confidence interval: 54-96%) and specificity of 90% (95% confidence interval: 83-94%), as compared with genetic counselor pedigree review. The positive predictive value for risk for MFHP was 48% (95% confidence interval: 29-68%), whereas the negative predictive value was 98% (95% confidence interval: 93-99%). Agreement between MFHP and genetic counselor pedigree review was moderate (κ = 0.54). The analytic validity of the MFHP colorectal cancer risk assessment software is similar to those of other types of screening tools used in primary care. Future investigations should explore the clinical validity and utility of the software in diverse population groups.Genet Med 17 9, 753-756.
Ferraris, Victor A; Saha, Sibu P; Davenport, Daniel L; Zwischenberger, Joseph B
Most general thoracic operations in the United States are performed by general surgeons. Results obtained by those identified as general surgeons are often compared with those identified as thoracic surgeons. We interrogated the American College of Surgeons National Surgical Quality Improvement Project database over a 5-year period to compare outcomes in patients who underwent similar operations by surgeons identified as either thoracic surgeons or general surgeons. We employed propensity-score matching to minimize confounding when estimating the effect of surgeon identity on postoperative outcomes. During the study period, thoracic surgeons performed 3,263 major pulmonary or esophageal operations, and general surgeons performed 15,057 similar operations. Compared with patients operated on by general surgeons, patients operated on by thoracic surgeons had significant excess multivariate comorbidities, including insulin-dependent diabetes mellitus, chronic obstructive pulmonary disease, concurrent pneumonia, congestive heart failure, previous cardiac surgery, dialysis-dependent renal failure, disseminated cancer, prior sepsis, and previous operation within 30 days. Likewise, patients in highest risk categories had operations performed by thoracic surgeons more commonly than by general surgeons. Unadjusted comparisons for mortality and serious morbidity showed significantly worse mortality and pulmonary complications in patients operated on by thoracic surgeons. However, with propensity matching according to surgeon type, thoracic surgeons had significantly fewer serious adverse outcomes compared with general surgeons, and this decreased morbidity occurred in a higher risk cohort. Our results show that patients operated on by thoracic surgeons have higher acuity compared with patients operated on by general surgeons. When patients are matched for comorbidities and serious preoperative risk factors, thoracic surgeons have improved outcomes, especially with regard to
Klein, Michael D
For many reasons pediatric surgeons have been asked to do all general and thoracic procedures in children. The profession has responded by training more, but the core of special cases requiring pediatric surgical expertise has not changed, and there is concern that the many surgeons now in training will not each do enough cases to attain and maintain operative expertise. This presentation examines the psychological, educational, and surgical literature on the development of expertise, especially operative expertise. From this I conclude that individual surgeon volume when gained in deliberate practice with a coach and with effort is essential, and that several technologies hold promise for allowing deliberate practice in simulation environments. I propose that in order to avoid a decline in pediatric surgical operative expertise we must reorganize pediatric surgical training and practice to align with Optimal Resources for Children's Surgery and the evolution of training in general surgery. Copyright © 2016 Elsevier Inc. All rights reserved.
Hickey, Graeme L; Grant, Stuart W; Freemantle, Nick; Cunningham, David; Munsch, Christopher M; Livesey, Steven A; Roxburgh, James; Buchan, Iain; Bridgewater, Ben
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.
Clark, R; Thurston, N K
Recent technological advances in orthopaedic surgery have propelled both the volume of surgical cases and their complexity, resulting in increased costs, which should naturally result in higher incomes for surgeons. However, the transition from a fee-for-service model of physician compensation to a managed care model has resulted in major shifts in economic resource allocation. An economic model of this market based on imperfect competition shows that these changes have shifted market power from surgeons to the managed care organizations. Our model predicts that practicing surgeons will retire earlier, medical students will begin to select other specialties, and innovation will be slowed. Antitrust laws limit surgeons' ability to combat this trend through meaningful collective bargaining, creating the potential for future shortages as the baby boom generation reaches retirement age and the demand for orthopaedic services increases dramatically.
Tavares Delgado, Ademar; The ATLAS collaboration
The ATLAS Trigger Algorithms for General Purpose Graphics Processor Units Type: Talk Abstract: We present the ATLAS Trigger algorithms developed to exploit General Purpose Graphics Processor Units. ATLAS is a particle physics experiment located on the LHC collider at CERN. The ATLAS Trigger system has two levels, hardware-based Level 1 and the High Level Trigger implemented in software running on a farm of commodity CPU. Performing the trigger event selection within the available farm resources presents a significant challenge that will increase future LHC upgrades. are being evaluated as a potential solution for trigger algorithms acceleration. Key factors determining the potential benefit of this new technology are the relative execution speedup, the number of GPUs required and the relative financial cost of the selected GPU. We have developed a trigger demonstrator which includes algorithms for reconstructing tracks in the Inner Detector and Muon Spectrometer and clusters of energy deposited in the Cal...
Lee, Shih-Hung; Yeh, Chia H.; Kuo, C.-C. J.
A skimming system for movie content exploration is proposed using story units extracted via general tempo analysis of audio and visual data. Quite a few schemes have been proposed to segment video data into shots with low-level features, yet the grouping of shots into meaningful units, called story units here, is important and challenging. In this work, we detect similar shots using key frames and include these similar shots as a node in the scene transition graph. Then, an importance measure is calculated based on the total length of each node. Finally, we select sinks and shots according to this measure. Based on these semantic shots, a meaningful skims can be successfully generated. Simulation results will be presented to show that the proposed video skimming scheme can preserve the essential and significant content of the original video data.
Celso Iglesias García; María José Alonso Villa; Juan Carlos Bernaldo de Quirós; Elena Bocanegra Suárez; Julia Cueta Gonzalo; Rosario García del Valle; José Manuel González González; Álvaro Miranda García; Ana Belén Palacio Bande
Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement) with two mild behavioural inc...
... TECHNICAL SERVICES TO STATE AND LOCAL UNITS OF GOVERNMENT § 105-50.001-3 Unit of general local government. Unit of general local government means any city, county, town, parish, village, or other general... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Unit of general...
Celso Iglesias García
Full Text Available Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement with two mild behavioural incidences registered throughout the study. Conclusions: The benefits of non-smoking policy in a psychiatric unit can be significant. The introduction of smoking bans in psychiatric inpatients settings is possible and safe.
LU Lu; WANG Yiran
Military surgeons are a special group of doctors. They are both medical workers and soldiers.Their mission is to serve the wounded on the battlefield.And there is no doubt that military surgeons will save our comrades in the army. However,should a military surgeon save the wounded enemy? It is indeed a dilemma.Some may save the wounded enemy because military surgeons are doctors after all and they can't possibly abandon anybody to his fate,but some refuse to do so because military surgeons are soldiers.Therefore,some situations on the battlefield are discussed and advice is suggested for military surgeons,with heartfelt anticipation for there being less casualties on the battlefield as well as alleviating human suffering caused by war.
LU; Lu; WANG; Yiran
Military surgeons are a special group of doctors.They are both medical workers and soldiers.Their mission is to serve the wounded on the battlefield.And there is no doubt that military surgeons will save our comrades in the army.However,should a military surgeon save the wounded enemy?It is indeed a dilemma.Some may save the wounded enemy because military surgeons are doctors after all and they can’t possibly abandon anybody to his fate,but some refuse to do so because military surgeons are soldiers.Therefore,some situations on the battlefield are discussed and advice is suggested for military surgeons,with heartfelt anticipation for there being less casualties on the battlefield as well as alleviating human suffering caused by war.
Mª Teresa Martín Alonso
Full Text Available The care plan we expose is a general one applicable to all the children who are admitted in the unit, no matter what pathology they present/display, their physiopathological situation or their age. We present the common nursing actions which are applied to all the patients at the time of their admittance. The factor related to the studied problems is the hospitalization and what it has associate, from separation of the parents and rupture familiar ties, up to immobilization, the use of bloody devices and the generally hostile and stranger background.The protocol is based on the NANDA, the nursing outcomes classification NOC and the nursing intervention classification NIC. It is part of the nursing process and promotes systematized, humanistic and effective care, focuses on the child and his parents.We have selected the most relevant problems, ordered according to the deficits in the different selfcare requirements of Dorotea E. Orem. Each problem has its definition, the outcomes we pretend to reach with our care and the interventions to get the outcomes (these two last topics have the corresponding codification. In them all the most important factor is hospitalization in a unit of intensive care and the separation of the child from his habitual environment.
Hughes, Joseph D; White, Jeremy T
To evaluate the use of general-purpose graphics processing units (GPGPUs) to improve the performance of MODFLOW, an unstructured preconditioned conjugate gradient (UPCG) solver has been developed. The UPCG solver uses a compressed sparse row storage scheme and includes Jacobi, zero fill-in incomplete, and modified-incomplete lower-upper (LU) factorization, and generalized least-squares polynomial preconditioners. The UPCG solver also includes options for sequential and parallel solution on the central processing unit (CPU) using OpenMP. For simulations utilizing the GPGPU, all basic linear algebra operations are performed on the GPGPU; memory copies between the central processing unit CPU and GPCPU occur prior to the first iteration of the UPCG solver and after satisfying head and flow criteria or exceeding a maximum number of iterations. The efficiency of the UPCG solver for GPGPU and CPU solutions is benchmarked using simulations of a synthetic, heterogeneous unconfined aquifer with tens of thousands to millions of active grid cells. Testing indicates GPGPU speedups on the order of 2 to 8, relative to the standard MODFLOW preconditioned conjugate gradient (PCG) solver, can be achieved when (1) memory copies between the CPU and GPGPU are optimized, (2) the percentage of time performing memory copies between the CPU and GPGPU is small relative to the calculation time, (3) high-performance GPGPU cards are utilized, and (4) CPU-GPGPU combinations are used to execute sequential operations that are difficult to parallelize. Furthermore, UPCG solver testing indicates GPGPU speedups exceed parallel CPU speedups achieved using OpenMP on multicore CPUs for preconditioners that can be easily parallelized. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
Search Member Login Home About Mission Strategic Plan Leadership Bylaws History Past Presidents Past TeLinde Lectures Past Distinguished Surgeon ... Search Member Login Home About Mission Strategic Plan Leadership Bylaws History Past Presidents Past TeLinde Lectures Past Distinguished Surgeon ...
... skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to the need for harmony between facial appearance and function. As ... skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to the need for harmony between facial appearance and function. As ...
Full Text Available Genetic Algorithm (GA is effective and robust method for solving many optimization problems. However, it may take more runs (iterations and time to get optimal solution. The execution time to find the optimal solution also depends upon the niching-technique applied to evolving population. This paper provides the information about how various authors, researchers, scientists have implemented GA on GPGPU (General purpose Graphics Processing Units with and without parallelism. Many problems have been solved on GPGPU using GA. GA is easy to parallelize because of its SIMD nature and therefore can be implemented well on GPGPU. Thus, speedup can definitely be achieved if bottleneck in GAs are identified and implemented effectively on GPGPU. Paper gives review of various applications solved using GAs on GPGPU with the future scope in the area of optimization.
Leitch, K K; Walker, P M
Financial incentives are the only form of compensation that will motivate surgeons at an academic health sciences center to perform the tasks outlined in the hospital's mission statement. A questionnaire divided into 5 sections: demographics, compensation, time allocation, benefits and incentives, and motivational factors. The Department of Surgery, The Toronto Hospital, Toronto, Ontario. All academic surgeons (N=64) practicing at The Toronto Hospital in July 1997. Of the 64 eligible mailed surveys, there were responses for 59. Of these 59 surgeons, 48 (81%) receive compensation through a fee-for-service method. However, only 32 (54%) of the surgeons prefer the fee-for-service method, while 18 (31%) prefer salary and 9 (15%) prefer an alternative system. On average, these academic surgeons spend 44% of their time teaching or performing research, for which they receive 14% of their total income. Of the motivational factors assessed, financial bonuses are a positive motivational factor for all "surgeon tasks." In addition, task-specific motivational factors were established for research, teaching, and operating, including research facilities, mentorship and prestige, and interesting case types, respectively. Surgeons are not appropriately renumerated for time spent on academic activities, and many would prefer an alternative form of compensation to the fee-for-service method. Knowledge that surgeons are receptive to tasks supporting the hospital's mission statement leads us to conclude that appropriate motivation can shape the activity of academic surgeons. Financial rewards ranked the highest as a motivational factor for all surgeon tasks; however, task-specific motivational factors were identified. Overall, multiple factors, specifically targeted to the individual, will serve to motivate. Thus, compensation packages based on individual preferences and personal motivational factors will be the most successful.
Franko, Orrin I
The use of smartphones and their associated applications (apps) provides new opportunities for physicians, and specifically orthopaedic surgeons, to integrate technology into clinical practice. The purpose of this study was twofold: to review all apps specifically created for orthopaedic surgeons and to survey orthopaedic residents and surgeons in the United States to characterize the need for novel apps. The five most popular smartphone app stores were searched for orthopaedic-related apps: Blackberry, iPhone, Android, Palm, and Windows. An Internet survey was sent to ACGME-accredited orthopaedic surgery departments to assess the level of smartphone use, app use, and desire for orthopaedic-related apps. The database search revealed that iPhone and Android platforms had apps specifically created for orthopaedic surgery with a total of 61 and 13 apps, respectively. Among the apps reviewed, only one had greater than 100 reviews (mean, 27), and the majority of apps had very few reviews, including AAOS Now and AO Surgery Reference, apps published by the American Academy of Orthopaedic Surgeons and AO Foundation, respectively. The national survey revealed that 84% of respondents (n = 476) have a smartphone, the majority (55%) have an iPhone, and that 53% of people with smartphones already use apps in clinical practice. Ninety-six percent of respondents who use apps reported they would like more orthopaedic apps and would pay an average of nearly $30 for useful apps. The four most requested categories of apps were textbook/reference, techniques/guides, OITE/board review, and billing/coding. The use of smartphones and apps is prevalent among orthopaedic care providers in academic centers. However, few highly ranked apps specifically related to orthopaedic surgery are available, and the types of apps available do not appear to be the categories most desired by residents and surgeons.
Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M
The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of
Patrícia Lacerda Bellodi
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
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgeon's gloving cream. 878.4470 Section 878.4470...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4470 Surgeon's gloving cream. (a) Identification. Surgeon's gloving cream is an ointment intended to be used to lubricate the...
Kell, M R; Aherne, N J; Coffey, C; Power, C P; Kirwan, W O; Redmond, H P
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. 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. 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). SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.
Kell, M R
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.
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...
... Clinical Scholars in Residence Clinical Trials Methods Course Health Services Research Methods Course Surgeon Specific Registry NSQIP Annual ... Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey ...
... Care for You How to Use Apps and Social Media for Your Practice Why Participation in the STS ... STS_CTsurgery Surgeons Residents & Students Allied ... Hotel Discount for STS Members Copyright © 2016 The Society ...
On 3 March 1953 Leo Doyle died at the Mercy Hospital, Melbourne. The day before he died Leo Doyle had been operating at the Mercy Hospital when he took ill. Doyle's final illness was almost certainly the result of the severe aortic stenosis that had been developing over some years. His death at the relatively young age of 61 ended the career of a man described by Sir Gordon Gordon Taylor as the greatest technical surgeon that he had ever seen. In all likelihood Australian surgery will never see the likes of Doyle, a virtuoso surgeon, again. And yet to many of the surgeons who were Doyle's contemporaries and to those who followed him he remained somewhat of an enigma. Perhaps in some way the description of the great French surgeon Baron Dupuytren may also be applicable to Leo Doyle: known to all, loved by many, understood by few. By all accounts Leo Doyle's surgical repertoire knew no bounds. He operated with equal facility on the central nervous system, the head and neck, in the thorax, abdomen and pelvis and he was more than competent in gynaecology, urology and orthopaedics. In the latter part of his career he became, par excellence, a cancer surgeon. He was, arguably, Australia's first surgical oncologist. No procedure was deemed too complicated or demanding. Like some other superb technicians his judgement at times did not match his technical ability. Doyle was one of the first surgeons in Australia to perform hindquarter amputation and he helped to pioneer the operations of total gastrectomy and oesophagogastrectomy. An avid reader of the surgical literature, he possessed an enormous library which was matched by an equally large collection of surgical instruments. Unlike Devine he published relatively little. He was not a good clinical teacher, preferring to teach by example in the operating theatre. Although interested in music and the visual arts, surgery was his life.
de Quevedo, Francisco Vázquez
The history of the hospitals and general surgeons that best represent the centres in Madrid are here in reviewed, comprising the period between 1940 and the closure of the Hospital Clinico (1957) as well as the Hospital General (General Hospital) (1967), both in Atocha. Other hospitals which are reviewed and highlighted are: the H. de la Princesa (the Princess Hospital), the H. del Nifio Jesus (Hospital of the Child Jesus), the H. Militar (Military Hospital) and the Cruz Roja (Red Cross). Data is provided on the permanent surgeons in the following centres: H. General: J. Goyanes, J. Die, J. de la Villa, T. Rodriguez, E. Diaz, G. Bueno e H. Huerta; H. Clinico: L. de la Peña, L. Cardenal, L. Olivares, R. Argüelles, J. Estella y M. F. Zumel; H. Militar: M. G. Ulla, M. Bastos, M. G. Durán, J. S. Galindo, y A. G. Durán; Hospital de la Cruz Roja: V. M. Noguera, L. Serrada, F. Luque y L. L. Durán; H. de la Princesa: P. Cifuentes, P. G. Duarte, L. Estella y R. Aiguabella; H. del Niño Jesús: J. Garrido Lestache; H. Clinico, last time, Atocha: F. M. Lagos, R. Vara y A. de la Fuente.
Full Text Available The pectoralis major myocutaneous (PMMC flap or its modification was used in 19 cases after resectional surgery for malignancy of the oral cavity with minimal morbidity and no mortality. The resection as well as reconstruction was done by the same team consisting only of general surgeons. The final functional and cosmetic results were satisfactory. The pectoralis major myocutaneous flap is a hardy flap and can be performed with relative ease even by those not specialised in plastic surgery. This makes it an important tool for a general surgeon practicing in a country like India with its high incidence of head and neck malignancy.
Ekatah, Gregory E; Walker, Stephanie G; McDonald, James J; Dixon, J Michael; Brady, Richard R W
There continues to be a steady rise in the use of social media among healthcare professionals. We present an overview of social media use among breast surgeons within the United Kingdom including demographic variations and some of the factors that underpin these trends. The benefits and drawbacks of open social media platforms are also considered.
Snyman, Gretchen; Tucker, Joseph E L; Cimini, Massimo; Narine, Kishan; Fedak, Paul W M
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.
Grenier, Michelle; Collins, Karen; Wright, Steven; Kearns, Catherine
The purpose of this qualitative study was to assess the effectiveness of a disability sport unit in shaping perceptions of disability. Data from interviews, observations, and documents were collected on 87 elementary-aged students, one physical education teacher, and one teaching intern. Comparisons were drawn between fifth graders engaged in a five-week disability sport unit to fourth graders participating in their standard physical education curriculum. Findings revealed differences in the way fourth and fifth graders came to view individuals with disabilities. The results support an analysis of curriculum development that underscores the significance of the social model in positively impacting constructions of disability. Recommendations include the use of disability sports in physical education as an effective strategy for educating students in game play, knowledge of the Paralympics, and the inclusion of individuals with disabilities in a variety of sporting venues.
Carl, Noah; Billari, Francesco C
Generalized trust refers to trust in other members of society; it may be distinguished from particularized trust, which corresponds to trust in the family and close friends. An extensive empirical literature has established that generalized trust is an important aspect of civic culture. It has been linked to a variety of positive outcomes at the individual level, such as entrepreneurship, volunteering, self-rated health, and happiness. However, two recent studies have found that it is highly correlated with intelligence, which raises the possibility that the other relationships in which it has been implicated may be spurious. Here we replicate the association between intelligence and generalized trust in a large, nationally representative sample of U.S. adults. We also show that, after adjusting for intelligence, generalized trust continues to be strongly associated with both self-rated health and happiness. In the context of substantial variation across countries, these results bolster the view that generalized trust is a valuable social resource, not only for the individual but for the wider society as well.
Full Text Available Generalized trust refers to trust in other members of society; it may be distinguished from particularized trust, which corresponds to trust in the family and close friends. An extensive empirical literature has established that generalized trust is an important aspect of civic culture. It has been linked to a variety of positive outcomes at the individual level, such as entrepreneurship, volunteering, self-rated health, and happiness. However, two recent studies have found that it is highly correlated with intelligence, which raises the possibility that the other relationships in which it has been implicated may be spurious. Here we replicate the association between intelligence and generalized trust in a large, nationally representative sample of U.S. adults. We also show that, after adjusting for intelligence, generalized trust continues to be strongly associated with both self-rated health and happiness. In the context of substantial variation across countries, these results bolster the view that generalized trust is a valuable social resource, not only for the individual but for the wider society as well.
have undertaken to make available to the Security Council, on its call, " armed forces, assistance and facilities, and rights of passage , necessary...readiness and general locations and the nature of facilities and assistance, including rights of passage , to be made available to the Security
... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Definition of âunit of general local government.â 291.505 Section 291.505 Housing and Urban Development Regulations Relating to Housing... local government.” For purposes of this subpart, the term unit of general local government means...
... FINANCIAL ASSISTANCE, LOCAL GOVERNMENTS State and Local Governments' Responsibilities After the Department Distributes Payments § 44.56 How does a unit of general local government file a protest? The protesting local... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false How does a unit of general...
Neumeister, M W
There is significant responsibility in being a Department of Surgery Chairman within a medical school. The Chairman is appointed by the Dean of Medicine to lead surgery in a path that serves the mission of the school. The Department of Surgery Chairman is charged with facilitating the academic, operational, and programmatic surgical initiatives of the School of Medicine. Traditionally the Chairman of Surgery has been a general surgeon but now our educational and clinical experiences have changed making traditional leadership less intuitive. Plastic surgeons appointed as current Chairman of the Department of Surgery are rare in the United States. Whereas, general surgeons may have less interaction with other surgical sub-specialties today, Plastic surgeons have more interaction crossing all disciplines of surgery. Innovation and creativity that defines our discipline, seems to fit well with Department leadership where strategic planning, vision and curriculum development, and the pursuit of academic and clinical quality remain core essentials to plastic surgery. This article is an editorial of my philosophy as a plastic surgeon leading a Department of Surgery.
Chodkiewicz, Hubert M; Joseph, Aaron K
Ergonomic practice increases the productivity, quality, and longevity of the dermatologic surgeon. When used properly, magnification devices can be ergonomic and beneficial additions to the dermatologic surgeon's practice. Herein, we review the available magnification options for the dermatologic surgeon and evaluate the options based on cost, design, and functional advantages and disadvantages. Magnification for the dermatologic surgeon may be a useful tool for a healthier, more efficient, and higher-quality practice.
Individual Study Project S. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(.) S. CONTRACT OR GRANT NUMBER(&) COL Bradley H. Petersen Jr. , AR 9. PERFORMING...diagrams" seldom tell us mucL about how business is really accomplished. All potential threat and free world forces are privy to or in posession of the...the Germans lost despite this operationri 17 brilliance because of strategic incompetence. 7here is mucl to, indicate that the German General Staff
Kawase, Kazumi; Kwong, Ava; Yorozuya, Kyoko; Tomizawa, Yasuko; Numann, Patricia J; Sanfey, Hilary
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.
Tzeng, Yuan-Sheng; Chen, Shyi-Gen; Chen, Tim-Mo
Herniations of the cervical disk in plastic surgeons are far more common in practice than the paucity of reported cases would indicate. A likely explanation may be the peculiar, nonergonomic positions that plastic surgeons must hold during surgery while wearing a headlight and loupes. From January 2003 to December 2006, at Tri-Service General Hospital, Taiwan, 4 plastic surgeons experienced herniations of the cervical disk. Magnetic resonance imaging study indicated there was disk herniation or bulging with spinal cord impingement. Two plastic surgeons received cervical diskectomy, corpectomy with strut reconstruction using titanium cages. These 2 surgeons were symptom-free 2 years after their operations. The other 2 plastic surgeons were under conservative physical therapy with persistent symptoms. The clinical evidence indicated that cervical disk herniation is an occupational hazard in plastic surgeons. To prevent prolonged hyperflexion and twisting of the neck, we proposed wearing a cervical brace during surgery for the plastic surgeons at Tri-Service-General Hospital since January 2008. No more plastic surgeons have experienced herniation of the cervical disk since then. The results indicated that wearing a cervical brace may be an effective measure to protect plastic surgeons from cervical disk disease.
Leung, Ping-Chung; Biji, Sreedhar; Yeung, Chung-Kwong
The surgeon aims at a direct, complete removal of the pathology. In spite of the modern advancements of imaging facilities and precision instrumentations, unsatisfactory results and recurrences are not uncommon. This paper provides a general review of the four specific areas in surgery that would benefit from Chinese medicine. Extensive searches were made on four surgical areas based on available English language journals, viz. low-back pain, chronic ulcers, renal calculus, and enuresis in children, in the past 10 years. The quoted communications are mainly related to clinical evidences, while a smaller number of crucial laboratory reports are also included. Low-back pain, a most frequent orthopaedic problem, would benefit from acupuncture treatment. Chronic leg ulcers could achieve better results of healing using herbal supplements. Problems of renal stones, besides the conventional methods of removal, could be further supplemented with herbal drinks that aim at prevention of recurrences. Enuresis in children, an untreatable common condition, may respond well to acupuncture. Surgeons should keep an open mind. In case of difficulties, they could seriously consider options of traditional treatment.
Full Text Available Roberto Delfrate,1 Massimo Bricchi,1 Paolo Forti,1 Claude Franceschi2 1Surgery Unit, Figlie Di San Camillo Hospital, Cremona, Italy; 2Vascular Exploration Service, St Joseph Hospital, Paris, France Background: Anastomotic leak is a major complication of colorectal surgery. Among the causes of dehiscence, anastomotic ischemia seems to be fundamental and consequently so is the evaluation of the parietal flow. We proposed a new application of infrared flowmeter for the evaluation of the parietal flow at the stumps after colon resection. Objective: The aim of this study is to assess the feasibility of using an intraoperative intestinal wall flowmeter to assess arterial capillary flow in order to avoid the execution of anastomoses in poorly vascularized segments of bowel, and consequently to reduce the risk of anastomotic leakage.Methods: Retrospective analysis of two groups of patients with different methods of evaluation of colon resection stump vascularization. Ninety-two consecutive patients (Group A underwent surgical colorectal resection for cancer. In this group, we used a pulse-oximetry sensor to assess the parietal flow: once the magnitude of the colon resection was established according to surgical and oncological criteria, the exact location of the resection was adjusted according to the parietal flowmetry curve. This method was compared with 139 consecutive colorectal resections (Group B in which vascularization was assessed by checking the pulsatility of the mesenteric arteries, macroscopic wall resection stump appearance, and bleeding of the wall stump. The main outcome measure was the reduction in anastomotic dehiscence.Results: In Group A no anastomotic leakage occurred (0/92. Conversely, in Group B six anastomotic leaks occurred (6/139. The statistical analysis of the two groups thanks to the Fisher's exact test shows that P<0.05, which is statistically significant.Conclusion: We tested a new application of the pulse oximeter: the
Fernández del Castillo-Sánchez, Carlos
Our vocation has called us to become physicians and we have learned and practiced surgery as part of our medical training and knowledge. Surgery is an art expressed during each intervention carried out with effectiveness and devotion; enjoying the pleasure to perform it without hurry, with harmony, fluency and cleanness. Therefore, medicine and surgery belong to the same vocation being at service of people with the clear mission to heal patients and if we favor it, this activity will get our attention firmly and forever. A physician is a sensitive person that understands the sadness and happiness consequence of his actions at the office, operating room, research and relationships with colleagues. This provides him a pleasant experience of practicing medicine and especially surgery. Medical and surgical professions produce an irresistible attraction and they are very rewarding experiences; however, as time goes by there are effects over physician's health. Surgeons will switch from an active professional role into a passive agent and will need to assess himself and answer if he is still in optimal conditions to practice medicine. Therefore, every surgeon must be prepared to grow old from the start and preserve his Faith once retirement has been accepted as the next step in his career.
Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan
In the United States, both pediatric urologists (PUROs) and general pediatric surgeons (GPSs) perform nephrectomies in children, with PUROs performing more nephrectomies overall, most commonly for benign causes. GPSs perform more nephrectomies for malignant causes. We questioned whether the same trends persisted for partial nephrectomy. We hypothesized that PUROs performed more partial nephrectomies for all causes, including malignancy. Our primary aim was to characterize the number of partial nephrectomies performed by PUROs and GPSs. We also compared short-term outcomes between subspecialties. We analyzed the Pediatric Health Information System (PHIS), a database encompassing data from 44 children's hospitals. Patients were ≤18 years old and had a partial nephrectomy (ICD-9 procedure code 554) carried out by PUROs or GPSs between 1 January, 2004 and June 30, 2013. Queried data points included surgeon subspecialty, age, gender, 3M™ All Patient Refined Diagnosis Related Groups (3M™ APR DRG) code, severity level, mortality risk, length of stay (LOS), and medical/surgical complication flags. Data points were compared in patients on whom PUROs and GPSs had operated. Statistical analysis included the Student t test, chi-square test, analysis of covariance, and logistic regression. Results are presented in the table. While PUROs performed the majority of partial nephrectomies, GPSs operated more commonly for malignancy. For surgeries performed for non-malignant indications, PURO patients had a shorter LOS and lower complication rate after controlling for statistically identified covariates. There was no difference in LOS or complication rate for patients with malignancy. A Pediatric Health Information System study of pediatric nephrectomy demonstrated PUROs performed more nephrectomies overall, but GPSs performed more surgeries for malignancy. The difference was less dramatic for partial nephrectomies (63% GPS, 37% PURO) than for radical nephrectomies (90% GPS, 10
Amirian, Ilda; Toftegård Andersen, Lærke; Rosenberg, Jacob
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'...
Ramaniuk, Aliaksandr; Dickson, Barbara J; Mahoney, Sean; O'Mara, Michael S
Rounding by trauma surgeons is a complex multidisciplinary team-based process in the inpatient setting. Implementation of lean methodology aims to increase understanding of the value stream and eliminate nonvalue-added (NVA) components. We hypothesized that analysis of trauma rounds with education and intervention would improve surgeon efficacy. Level 1 trauma center with 4300 admissions per year. Average non-intensive care unit census was 55. Five full-time attending trauma surgeons were evaluated. Value-added (VA) and NVA components of rounding were identified. The components of each patient interaction during daily rounds were documented. Summary data were presented to the surgeons. An action plan of improvement was provided at group and individual interventions. Change plans were presented to the multidisciplinary team. Data were recollected 6 mo after intervention. The percent of interactions with NVA components decreased (16.0% to 10.7%, P = 0.0001). There was no change between the two periods in time of evaluation of individual patients (4.0 and 3.5 min, P = 0.43). Overall time to complete rounds did not change. There was a reduction in the number of interactions containing NVA components (odds ratio = 2.5). The trauma surgeons were able to reduce the NVA components of rounds. We did not see a decrease in rounding time or individual patient time. This implies that surgeons were able to reinvest freed time into patient care, or that the NVA components were somehow not increasing process time. Direct intervention for isolated improvements can be effective in the rounding process, and efforts should be focused upon improving the value of time spent rather than reducing time invested. Copyright © 2016 Elsevier Inc. All rights reserved.
Cost and logistics of implementing a tissue-based American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for general surgery residents of all clinical years.
Henry, Brandon; Clark, Philip; Sudan, Ranjan
The cost and logistics of deploying the American College of Surgeons (ACS)/Association of Program Directors in Surgery (APDS) National Technical Skills Curriculum across all training years are not known. This information is essential for residency programs choosing to adopt similar curricula. A task force evaluated the authors' institution's existing simulation curriculum and enhanced it by implementing the ACS/APDS modules. A 35-module curriculum was administered to 35 general surgery residents across all 5 clinical years. The costs and logistics were noted, and resident satisfaction was assessed. The annual operational cost was $110,300 ($3,150 per resident). Cost per module, per resident was $940 for the cadaveric module compared with $220 and $240 for dry simulation and animal tissue-based modules, respectively. Resident satisfaction improved from 2.45 to 4.78 on a 5-point, Likert-type scale after implementing the ACS/APDS modules. The ACS/APDS skills curriculum was implemented successfully across all clinical years. Cadaveric modules were the most expensive. Animal and dry simulation modules were equivalent in cost. The addition of tissue-based modules was associated with high satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.
van Wulfften Palthe, Olivier D R; Neuhaus, Valentin; Janssen, Stein J; Guitton, Thierry G; Ring, David
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 < 0.001; adjusted R(2), 0.33) was the only factor independently associated with lower 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.
DiPaola, Christian P; Dea, Nicolas; Noonan, Vanessa K; Bailey, Christopher S; Dvorak, Marcel F S; Fisher, Charles G
Surgeon-industry conflict of interest (COI) has become a source of considerable interest. Professional medical societies, industry, and policy makers have attempted to regulate potential COI without consideration for public opinion. The objective of this study was to report on the opinions of individuals representing the general public regarding surgeon-industry consulting relationships. Web-based survey. Survey was administered using a "spine Web site," and opinions are collected on surgeon-industry consulting and regulation. Associations among responses to similar questions were assessed to ensure validity and subgroup analysis performed for respondent age, sex, education, insurance, employment, and patient status. Six hundred ten of 642 surveys had complete data. The sample population comprised more females and was older and more educated than the American population. About 80% of respondents felt it was ethical and either beneficial or of no influence to the quality of health care if surgeons were consultants for surgical device companies. Most felt disclosure of an industry relationship was important and paying surgeons royalties for devices, other than those they directly implant, would not affect quality of care. Respondents support multidisciplinary surgeon-industry COI regulation and trust doctors and their professional societies to head this effort. Despite the known potential negative impact of surgeon-industry COI on patient care, this study revealed that this does not seem to be reflected in the opinion of the general public. The respondents felt that disclosure is deemed one of the most important means of self-regulation and COI management, which is in agreement with current trends of most spine societies and journals that are increasing the stringency of disclosure policies. Copyright © 2014 Elsevier Inc. All rights reserved.
... know the risks and trust a board-certified plastic surgeon to perform your cosmetic or reconstructive surgery. ASPS member surgeons have the training and experience that ... 1300 Chain Bridge Road McLean, VA 22101 (703) 790-5454 Timothy Germain ...
sensitization and the organisation of blood donation drives from the other cadres of healthcare? If we implore all our elective patients' relatives to donate a unit or more, our .... Southern African Journal of ... health advocacy is a team sport.
DiPaola, Christian P; Dea, Nicolas; Dvorak, Marcel F; Lee, Robert S; Hartig, Dennis; Fisher, Charles G
Conflict of interest (COI) as it applies to medical education and training has become a source of considerable interest, debate, and regulation in the last decade. Companies often pay surgeons as faculty for educational events and often sponsor and give financial support to major professional society meetings. Professional medical societies, industry, and legislators have attempted to regulate potential COI without consideration for public opinion. The practice of evidence-based medicine requires the inclusion of patient opinion along with best available evidence and expert opinion. The primary goal of this study was to assess the opinion of the general population regarding surgeon-industry COI for education-related events. A Web-based survey was administered, with special emphasis on the surgeon's role in industry-sponsored education and support of professional societies. A survey was constructed to sample opinions on reimbursement, disclosure, and funding sources for educational events. There were 501 completed surveys available for analysis. More than 90% of respondents believed that industry funding for surgeons' tuition and travel for either industry-sponsored or professional society educational meetings would either not affect the quality of care delivered or would cause it to improve. Similar results were generated for opinions on surgeons being paid by industry to teach other surgeons. Moreover, the majority of respondents believed it was ethical or had no opinion if surgeons had such a relationship with industry. Respondents were also generally in favor of educational conferences for surgeons regardless of funding source. Disclosures of a surgeon-industry relationship, especially if it involves specific devices that may be used in their surgery, appears to be important to respondents. The vast majority of respondents in this study do not believe that the quality of their care will be diminished due to industry funding of educational events, for surgeon
Green, David P; DeLee, Jesse C
On April 6, 1917, the United States declared war on Germany and entered what was then called the Great War. Among the first officers sent to Europe were 21 orthopaedic surgeons in the so-called First Goldthwait Unit. Prior to the war, orthopaedics had been a nonoperative "strap-and-buckle" specialty that dealt primarily with infections, congenital abnormalities, and posttraumatic deformity. The Great War changed all of that forever, creating a new surgical specialty with emphasis on acute treatment, prevention of deformity, restoration of function, and rehabilitation.
Nandi, Sumon; Bono, James V; Froimson, Mark; Jones, Morgan; Bershadsky, Boris
Femoral component size selection during total knee arthroplasty should not vary from surgeon to surgeon for patients with the same bone size. This study explored if systematic variations in femoral component size selection exist. Thirteen surgeons' choices of femoral component size (Duracon, n = 1388; Triathlon, n = 740) were analyzed using a generalized linear model with femoral component size as the dependent variable and surgeon identification, years in practice, and adult reconstruction fellowship training as the independent variables. The model adjusted for differences in bone size. It was found that more experienced surgeons implant larger femoral components. New instruments and training protocols may be necessary to adjust for surgeon experience.
Nasir, Amir R; Brenner, Sara A
The purpose of this article is to introduce the topic of nanotechnology to plastic surgeons and to discuss its relevance to medicine in general and plastic surgery in particular. Nanotechnology will be defined, and some important historical milestones discussed. Common applications of nanotechnology in various medical and surgical subspecialties will be reviewed. Future applications of nanotechnology to plastic surgery will be examined. Finally, the critical field of nanotoxicology and the safe use of nanotechnology in medicine and plastic surgery will be addressed.
Luck, Tara; Treacy, Peter John; Mathieson, Matthew; Sandilands, Jessica; Weidlich, Stephanie; Read, David
Royal Darwin Hospital (RDH) is the only major hospital for the 'Top End' of Northern Territory and Western Australia. As retrieval distances exceed 2600 km, resident generalist surgeons undertake all emergency neurosurgery. Retrospective clinical study from RDH records and review of prospectively collected datasets from RDH Intensive Care Unit and National Critical Care Trauma Response Centre for all emergency neurosurgery patients between 2008 and 2013. Data were obtained from 161 patients with 167 admissions (73% male, 39% indigenous) who underwent 195 procedures (33 per year), including burr hole, craniotomy, cerebral and posterior fossa craniectomy, elevation fracture and ventricular drain. Trauma accounted for 68%, with alcohol as a known factor in 57%. Subdural haematoma (SDH) accounted for 53%. Severity of head injury at presentation correlated with outcome (R(2) = 0.12, P 24 h (P = 0.023) and specific diagnoses of acute SDH (P = 0.006), acute-on-chronic SDH (P = 0.053) and infection (P = 0.052). Indigenous patients were younger (40 versus 55 years, P < 0.001) and more likely to have alcohol as a factor in trauma cases (71% versus 49%, P = 0.027). Time from injury to hospital was high for accidents at a remote location (12.9 versus 1.3 h, P < 0.001); however, Glasgow Outcome Scales (P = 0.13) were no different to accident at metropolitan Darwin. General surgeons at RDH perform a wide range of emergency neurosurgical procedures primarily for trauma. Factors contributing to poor outcomes included remote location of trauma and delay in reaching the hospital. Outcomes at 3 months appear acceptable. © 2015 Royal Australasian College of Surgeons.
Bumbasirević, Marko Z; Zagorac, Slavisa G; Lesić, Aleksandar R
Theodor Emil Kocher (1841-1917), born in Bern, educated in many universities in Europe. Kocher as many surgeons of that time performed orthopedic surgery, general surgery, neurosurgery and endocrine surgery, but he become famous in orthopaedic surgery and endocrine surgery. He is remember as a surgeon who described the approach to the hip joint, elbow joint, maneuver for the reduction of dislocated shoulder joint. He introduced many instruments and many of them, such as Kocher clamp is still in use. Most important Kocher work was the thyroid gland surgery, and he received the Nobel Prize for Medicine in 1909, for-in this matter. His nature of meticulous surgeon, scientific and hard working person, dedicated to his patients and students made- found him the place in a history of medicine.
Wysocki, A; Dolecki, M
During the war time when Polish borders had not been established yet, apart from having two surgical departments Jagiellonian University, Krakow had surgical departments in the Bonifratow, Izraelicki and Military Hospitals. More surgical departments were opened up in later years in pubic Health System Hospitals, among them were Narutowicz at near Pradnicka street and Sisters of Mercy at Lea street. Other well-known Krakow surgeons operated in smaller, private surgeries, such as: Dom Zdrowia (House of Health) or Zwiazkowy (Union) Clinic. At that time only 30 Surgeons worked in Kraków. They were outstanding specialists with a broad practice. Among them were Maksymilian Rutkowski, Jan Glatzel, Stanislaw Nowicki, Michal Hladij. Gradually, younger surgeons started to join them. they were: Jan Kowalczyk, Jerzy Jasienski, Stanislaw Kania, Wladyslaw Laszczak, Jozef Bugusz, Jozef Gasinski. Many of them who worked in the surgical hospitals in Krakow, left the city after obtaining a professorship (like Kornel Michejda, professor at the University of Wilno) or became heads of wards, like Zygmunt Drobniewicz, Alfons Mackowski and Tadeusz Guschlbauer. All of these surgeons were highly respected by the medical community as well as by the general public in their respective town and surrounding areas. A large income allowed that best of them to fund and supply their own wards. Occasionally, however, among the less successful surgeons, an uncompromising competition for patients developed. These events were disapproved and condemned by the medical establishment. Many surgeons led an active life outside of their profession. A surgeon with an exceptionally colorful personality was Jan Glatzel: witty, highly intelligent, a connoisseur of fine art, book lover with an active social life. Maksymilian Rutkowski was active in charitable organizations, helping to support Bratnia Pomoc Medykow. Michal Hladij, president of KS Cracovia, vice president of Krakowski Klub Automobilowy rendered his
John Finney (1863–1942) was born near Natchez, Mississippi. After receiving his medical degree from Harvard, he interned at Massachusetts General Hospital and then went to Baltimore to become one of the first interns at the new Johns Hopkins Hospital. He met William Osler the day the hospital opened and became a lifelong admirer of “the Chief.” Finney specialized in gastrointestinal surgery and was recognized for his expertise in the field. Osler recommended Finney to a physician colleague, writing, “You could not be in better hands…. Finney has been most successful and his judgment is so good.” Finney served for 33 years under William Halsted at Hopkins. After Halsted's death, Finney was offered the chair of surgery at Johns Hopkins but declined. He was a founder and first president of the American College of Surgeons. He also served as president of the American Surgical Association and the Society of Clinical Surgery. Finney became chief surgical consultant for the Allied Expeditionary Forces in World War I. He was decorated by the United States, France, and Belgium. Finney was a master surgeon and a role model for generations of students and physicians. PMID:26722185
... Foot & Ankle Surgeon? A A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle ... of conditions that affect people of every age. What education has a foot and ankle surgeon received? ...
... 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 ...
Al-Hadithy, Nada; Ghosh, Sudip
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.
Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A
Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.
Mulder, M; De Jong, E
This article describes the position of woman surgeons in the Netherlands. In 1913 the first woman, Heleen Robert, was accepted as member of the Dutch Society of Surgery. Three others, Jeanne Knoop, Frieda van Hasselt and Rosalie Wijnberg, followed during the next ten years. The nomination of Rosalie Wijnberg caused a turbulent discussion as she was working as a gynaecologist and not as a surgeon. One can wonder about this argument as other members were gynaecologists too. It seems that the male attitudes towards women were changing as more women entered the male dominated field. Nevertheless, from 1931 on, the year in which the registration of specialists was created, a number of women succeeded in obtaining a registration in surgery. Four of them were interviewed: dr. D.A.E. Norel, A.G. Wiersum-de Kwaadsteniet, J. Leeksma-Lievense and A.A. Fierstra. The general opinion still is that surgery is not a female profession. At the moment there are some twenty women working as general surgeon compared to a seven hundred men.
Jacobson, Stephen; Walline, James
In this paper we review the evolution of the Quality Educator Program (QEP), a program sponsored by the United Auto Workers (UAW)/General Motors (GM) that employs school teachers, administrators, and college and university faculty each summer in GM assembly plants. The QEP provides educators and those in industry the unique opportunity to interact…
Pinto, A; Faiz, O; Bicknell, C; Vincent, C
Healthcare professionals can be seriously affected when they are involved in major clinical incidents. The impact of such incidents on staff is of particular relevance to surgery, as the operating room is one of the highest-risk areas for serious complications. This qualitative study aimed to assess the personal and professional impact of surgical complications on surgeons. This single time point study involved semistructured, individual interviews with general and vascular surgeons, consultants and senior registrars from two National Health Service organizations in London, UK. Twenty-seven surgeons participated. Many were seriously affected by major surgical complications. Surgeons' practice was also often affected, not always in the best interest of their patients. The surgeons' reactions depended on the preventability of the complications, their personality and experience, patient outcomes and patients' reactions, as well as colleagues' reactions and the culture of the institution. Discussing complications, deconstructing the incidents and rationalizing were the most commonly quoted coping mechanisms. Institutional support was generally described as inadequate, and the participants often reported the existence of strong institutional blame cultures. Suggestions for supporting surgeons in managing the personal impact of complications included better mentoring, teamwork approaches, blame-free opportunities for the discussion of complications, and structures aimed at the human aspects of complications. Those involved in the management of surgical services need to consider how to improve support for surgeons in the aftermath of major surgical incidents. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob
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 monitored...... prospectively for 4 days: pre call, on call, post call day 1 (PC1), and post call day 2 (PC2). The urinary metabolite of melatonin and cortisol in saliva were measured to assess the circadian rhythm. Sleep and activity were measured by actigraphy. Subjective measures were assessed by the Karolinska Sleepiness...... Scale and Visual Analog Scale of fatigue, general well-being, and sleep quality. RESULTS: For both metabolite of melatonin and cortisol, a significant difference (P sleep time during the day on call...
Plastering is one of the most ancient of the building handicrafts. Plaster is the common name for calcium sulphate hemi hydrate made by heating the mineral gypsum, the common name for sulphate of lime. In the tenth century the Arabs used liquid plaster in orthopaedic treatment. At the beginning of the nineteenth century, patients with fractures of the lower extremities-and often of the upper extremities as well-were treated in bed with restriction of all activity for many weeks until the fractures united. It was the practice of surgeons to dress wounds and fractures at frequent intervals. The bandages, pads, and splints were removed, the fractures manipulated, and the dressings reapplied. The search for simpler, less cumbersome methods of treatment led to the development of occlusive dressings, stiffened at first with starch and later with plaster of Paris. The ambulatory treatment of fractures was the direct result of these innovations. Two military surgeons, Antonius Mathijsen of the Netherlands, and Nikolai Ivanovitch Pirogov of Russia, were responsible for the introduction of the new plaster bandage technique. At the beginning of the twentieth century the technique was improved by Jean-François Calot, a French surgeon, who invented the hand manufacture of plaster bandage as a roll. During the twentieth century, walking cast and ambulation for fresh fractures were developed with plaster and pin incorporated in plaster; the open fracture care concept was introduced with plaster of Paris by Trueta before the external fixation.
Patel, Rajeev; Huggard, Peter; van Toledo, Annik
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.
Tan, S K
The surgeon of the new millennium has come a long way from his humble beginnings in the Middle Ages as the lowly barber-surgeon. The skills and techniques developed by outstanding surgeons like Astley Cooper of the 19th century have withstood the test of time and have been refined by subsequent generations of surgical masters. The scientific basis of modern surgery was put on a firm footing in the early 19th century through the discovery of anaesthesia and microorganisms as a cause of many diseases and surgical complications. The 20th century brought about rapid progress in medicine, information technology (IT) and the life sciences, and closed with a big bang with the completion of the sequencing of the human genome. For the surgeon of the 21st century to remain relevant, he must embrace the concept of the Total Surgeon. Not doing so will render him irrelevant in the course of time, for having good surgical technique alone is insufficient. He must also lead in scientific endeavours to push the frontiers of the life sciences in attempts to solve the insoluble, and be scholarly in thought, attitude and behaviour. In other words, he must be a Surgeon-Scientist-Scholar.
Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels;
INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level...... 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...
Max Joseph Herman
Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.
Sharif, F; Rezaie, S; Keshavarzi, S; Mansoori, P; Ghadakpoor, S
Emotion and how people manage it is an important part of personality that would immensely affect their health. Investigations showed that emotional intelligence is significantly related to and can predict psychological health. To determine the effect of teaching emotional intelligence to intensive care unit nurses on their general health. This randomized clinical trial (registered as IRCT201208022812N9) was conducted on 52 of 200 in intensive care unit nurses affiliated to Shiraz University of Medical Sciences. They were recruited through purposeful convenience sampling and then randomly categorized into two groups. The intervention group members were trained in emotional intelligence. Bar-on emotional intelligence and Goldberg's general health questionnaires were administered to each participant before, immediately after, and one month after the intervention. While the mean score of general health for the intervention group decreased from 25.4 before the intervention, to 18.1 immediately after the intervention and to 14.6 one month later, for the control group, it increased from 22.0, to 24.2 and to 26.5, respectively (pTeaching emotional intelligence improved the general health of intensive care unit nurses.
Full Text Available Background: Emotion and how people manage it is an important part of personality that would immensely affect their health. Investigations showed that emotional intelligence is significantly related to and can predict psychological health. Objective: To determine the effect of teaching emotional intelligence to intensive care unit nurses on their general health. Methods: This randomized clinical trial (registered as IRCT201208022812N9 was conducted on 52 of 200 in intensive care unit nurses affiliated to Shiraz University of Medical Sciences. They were recruited through purposeful convenience sampling and then randomly categorized into two groups. The intervention group members were trained in emotional intelligence. Bar-on emotional intelligence and Goldberg's general health questionnaires were administered to each participant before, immediately after, and one month after the intervention. Results: While the mean score of general health for the intervention group decreased from 25.4 before the intervention, to 18.1 immediately after the intervention and to 14.6 one month later, for the control group, it increased from 22.0, to 24.2 and to 26.5, respectively (p<0.001. Conclusion: Teaching emotional intelligence improved the general health of intensive care unit nurses.
Willy, C; Gutcke, A; Klein, B; Rauhut, F; Friemert, B; Kollig, E W; Weller, N; Lieber, A
Casualties in military conflict produce patterns of injuries that are not seen in routine surgical practice at home. In an era of increasing surgical sub-specialization the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. Improvised explosive devices (IEDs) have become the modus operandi for terrorists and in the current global security situation these tactics can be equally employed against civilian targets. Therefore, knowledge and training in the management of these injuries are relevant to both military and civilian surgeons. To create this kind of military surgeon the so-called "DUO-plus" model for the training of surgical officers (specialization general surgery plus a second specialization either in visceral surgery or orthopedics/trauma surgery) has been developed in the Joint Medical Service of the German Bundeswehr. Other relevant skills, such as emergency neurotraumatology, battlefield surgery with integrated oral and craniomaxillofacial surgery and emergency gynecology, are integrated into this concept and will be taught in courses. Log books will be kept in accordance with the training curricula. On successful completion of the program medical officers will be officially appointed as Medical Officer "Einsatzchirurg" by their commanding officers for a maximum of 5 years and it will be necessary to renew it after this period. These refresher programs will require participation in visiting physicians programs in the complementary surgical disciplines in order to retain the essential specific skills.
Porter, G A; Soskolne, C L; Yakimets, W W; Newman, S C
OBJECTIVE: To determine whether surgical subspecialty training in colorectal surgery or frequency of rectal cancer resection by the surgeon are independent prognostic factors for local recurrence (LR) and survival. SUMMARY BACKGROUND DATA: Variation in patient outcome in rectal cancer has been shown among centers and among individual surgeons. However, the prognostic importance of surgeon-related factors is largely unknown. METHODS: All patients undergoing potentially curative low anterior resection or abdominoperineal resection for primary adenocarcinoma of the rectum between 1983 and 1990 at the five Edmonton general hospitals were reviewed in a historic-prospective study design. Preoperative, intraoperative, pathologic, adjuvant therapy, and outcome variables were obtained. Outcomes of interest included LR and disease-specific survival (DSS). To determine survival rates and to control both confounding and interaction, multivariate analysis was performed using Cox proportional hazards regression. RESULTS: The study included 683 patients involving 52 surgeons, with > 5-year follow-up obtained on 663 (97%) patients. There were five colorectal-trained surgeons who performed 109 (16%) of the operations. Independent of surgeon training, 323 operations (47%) were done by surgeons performing < 21 rectal cancer resections over the study period. Multivariate analysis showed that the risk of LR was increased in patients of both noncolorectal trained surgeons (hazard ratio (HR) = 2.5, p = 0.001) and those of surgeons performing < 21 resections (HR = 1.8, p < 0.001). Stage (p < 0.001), use of adjuvant therapy (p = 0.002), rectal perforation or tumor spill (p < 0.001), and vascular/neural invasion (p = 0.002) also were significant prognostic factors for LR. Similarly, decreased disease-specific survival was found to be independently associated with noncolorectal-trained surgeons (HR = 1.5, p = 0.03) and surgeons performing < 21 resections (HR = 1.4, p = 0.005). Stage (p < 0
Kong, Fanxing; Zhang, Yan Rockee; Cai, Jingxiao; Palmer, Robert D.
This study introduces a practical approach to develop real-time signal processing chain for general phased array radar on NVIDIA GPUs(Graphical Processing Units) using CUDA (Compute Unified Device Architecture) libraries such as cuBlas and cuFFT, which are adopted from open source libraries and optimized for the NVIDIA GPUs. The processed results are rigorously verified against those from the CPUs. Performance benchmarked in computation time with various input data cube sizes are compared across GPUs and CPUs. Through the analysis, it will be demonstrated that GPGPUs (General Purpose GPU) real-time processing of the array radar data is possible with relatively low-cost commercial GPUs.
After a short research in the field national insurances, the author analyses the professional physician insurance policy; the ambiguity and difficulty of contracts concerning the professional health activity of surgeon, whether as state employee or as independent professional are pointed put. With the introduction of the ministerial decree dated January 29,1992, the new labour agreement, the privacy law, the evolution of ''informed consent'', the esthetic injury concept, the safety regulations law and the administrative liability, surgeons must pay attention to draw up an insurance policy suitable to their profession.
At present, chinese general surgery should improve residency and subspecialty residencies training utilized global standards which is consisted of 3 overlapping phases.Fundamentals of surgery curriculum and surgical skills curriculum are an effective way to enhance the students' basic surgical skills and would obtain the global standards for postgraduate medical education. Working-hour restrictions and a heightened awareness of patient safety has changed resident education and training. Specialization and the current practices of general surgeons are a important problem. Postgraduate medical students program should be combined with resident training.Interprofessional education and service learning is a model for the future of health professions education. Simulation-based surgical education and simulator center has completely revolutionized the training process, especially in the laparoscopic and robotic surgery curriculum for resident training. Virtual realicy is the application of the computer aid technique in recent years, which shows its dominant position in medical education. E-learning will play an important role in the near future.%当前，我国普通外科要以国际标准完善住院医师和专科培训，涵盖医学教育连续统一体的3个阶段。外科基础课程和外科技能课程能有效地提升学生的基本手术技术和能达到全球医学教育最基本要求。医师工作时间的限制和病人安全意识的加强改变了住院医师教育和培训的模式。普通外科医师的专业化与当前的临床实践是重要问题。研究生的教育应与专科医师培训相结合。跨专业教育和学习服务是对未来医疗卫生教育的一种模式。基于虚拟技术的外科培训和模拟中心完全改变了教育的程序，特别是住院医师培训的腹腔镜和机器人外科课程。虚拟现实技术是近年出现的计算机辅助应用技术，在医学教育领域展显优势。电子学习系统将发挥重要作用。
Sérgio H. Loss
Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.
McGrath, Susan P; Taenzer, Andreas H; Karon, Nancy; Blike, George
The growing number of monitoring devices, combined with suboptimal patient monitoring and alarm management strategies, has increased "alarm fatigue," which have led to serious consequences. Most reported alarm man- agement approaches have focused on the critical care setting. Since 2007 Dartmouth-Hitchcock (Lebanon, New Hamp- shire) has developed a generalizable and effective design, implementation, and performance evaluation approach to alarm systems for continuous monitoring in general care settings (that is, patient surveillance monitoring). In late 2007, a patient surveillance monitoring system was piloted on the basis of a structured design and implementation approach in a 36-bed orthopedics unit. Beginning in early 2009, it was expanded to cover more than 200 inpatient beds in all medicine and surgical units, except for psychiatry and labor and delivery. Improvements in clinical outcomes (reduction of unplanned transfers by 50% and reduction of rescue events by more than 60% in 2008) and approximately two alarms per patient per 12-hour nursing shift in the original pilot unit have been sustained across most D-H general care units in spite of increasing patient acuity and unit occupancy. Sample analysis of pager notifications indicates that more than 85% of all alarm conditions are resolved within 30 seconds and that more than 99% are resolved before escalation is triggered. The D-H surveillance monitoring system employs several important, generalizable features to manage alarms in a general care setting: alarm delays, static thresholds set appropriately for the prevalence of events in this setting, directed alarm annunciation, and policy-driven customization of thresholds to allow clinicians to respond to needs of individual patients. The systematic approach to design, implementation, and performance management has been key to the success of the system.
Rojas Gregorio, José Ignacio
Briefing on meetings at & reports by the 65th & 66th United Nations General Assembly No relevant differences are observed or identified after perusal of the space-related resolutions and documents issued by the UN System between 2010 and 2011. The most remarkable statements remain virtually unchanged in this time period. For instance, the UN GA recognizes the common interest of all mankind in the exploration and use of outer space for peaceful purposes, and reaffirms that these shall be ca...
Full Text Available The study sought to analyse the referrals received by a psychiatric unit in a general hospital in the Western Cape by studying the referral letters and the referral responses.
Hierdie navorsing het gepoog om verwysings te ontleed wat deur 'n psigiatriese eenheid in 'n algemene hospitaal in die Wes Kaap ontvang is. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
Full Text Available Abstract Background Rapid Access Outpatient Units (RAOUs have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no qualitative data on the views of primary care practitioners regarding these types of facilities. The aim of the study was to explore the opinions of primary care practitioners regarding a newly established RAOU. Methods The RAOU was established locally at a district general hospital when inpatient beds were closed and moved to an inpatient centre, based six miles away at the tertiary teaching hospital. Qualitative, practice based group interviews with primary care practitioners (general practitioners (GPs, nurse practitioners and practice nurses on their experiences of the RAOU. The data collection consisted of three practice based interviews with 14 participants. The interviews were recorded and transcribed verbatim. Thematic content analysis was used to evaluate the data. Results There was positive feedback regarding ease of telephone access for referral, location, and the value of a service staffed by senior doctors where children could be observed, investigated and discharged quickly. There was confusion regarding the referral criteria for the assessment unit and where to send certain children. A majority of the practitioners felt the utility of the RAOU was restricted by its opening hours. Most participants felt they lacked sufficient information regarding the remit and facilities of the unit and this led to some uneasiness regarding safety and long term sustainability. Conclusion Practitioners considered that the RAOU offered a rapid senior opinion, flexible short term observation, quick access to investigations and was more convenient for patients. There were concerns regarding opening hours, safety of patients and lack of information about
Lewis, Priya; Kobayashi, Emily; Gupta, Subhas
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% (Pconscious of their online reputations. Overall, the ratings were high, regardless of the number of reviews.
Carey, J S
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.
... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Can a unit of general local government... the Interior FINANCIAL ASSISTANCE, LOCAL GOVERNMENTS State and Local Governments' Responsibilities After the Department Distributes Payments § 44.57 Can a unit of general local government appeal...
... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Can a unit of general local government... Secretary of the Interior FINANCIAL ASSISTANCE, LOCAL GOVERNMENTS State and Local Governments' Responsibilities After the Department Distributes Payments § 44.55 Can a unit of general local government...
Wasterlain, Amy S; Bello, Ricardo J; Vigdorchik, Jonathan; Schwarzkopf, Ran; Long, William J
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 (Pinnovation advances the field but support discussing the "unproven" nature of new 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. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.
Lin, Yen-Ko; Lin, Chia-Ju; Chan, Hon-Man; Lee, Wei-Che; Chen, Chao-Wen; Lin, Hsing-Lin; Kuo, Liang-Chi; Cheng, Yuan-Chia
Missed injuries sustain an important issue concerning patient safety and quality of care. The purpose of this study is to examine the effect of surgeon commitment to trauma care on missed injuries. We hypothesised that surgeons committed to the trauma service has less missed injuries than surgeons not committed to the trauma service would have. By retrospective analysis of 976 adult patients admitted to the trauma intensive care unit (ICU) at an urban, university-based trauma centre. Missed injuries were compared between two groups; in group 1 the patients were evaluated and treated by the surgeons who were committed to the trauma service and in group 2 the patients were evaluated and treated by surgeons practicing mainly in other specialties. Patients had significantly lower rates of missed major or life-threatening injuries when treated by group 1 surgeons. Logistic regression model revealed significant factors associated with missed major or life-threatening injuries including ISS and groups in which patients were treated by different group surgeons. Physicians will perform better when they are trained and interested in a specific area than those not trained, or even not having any particular interest in that specific area. Surgeons committed to the trauma service had less missed injuries in severely injured patients, and it is vital to improve patient safety and quality of care for trauma patients. Staff training and education for assessing severely injured patients and creating an open culture with detection and reduction of the potential for error are important and effective strategies in decreasing missed injuries and improving patient safety. Copyright © 2012 Elsevier Ltd. All rights reserved.
Carrasco; Flores; Aguayo; de Andres B; Moreno Egea A; Cartagena; De Vicente JP; Martin
Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.
U.S. Geological Survey, Department of the Interior — This is a GENERALIZED version of the boundaries and codes used for the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program Study-Unit...
U.S. Geological Survey, Department of the Interior — This is a GENERALIZED version of the boundaries and codes used for the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program Study-Unit...
Langenfeld, Sean J; Sudbeck, Craig; Luers, Thomas; Adamson, Peter; Cook, Gates; Schenarts, Paul J
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
Jacobson, Alexandra; Poole, Garth; Hill, Andrew G; Biggar, Magdalena
Patient care and efficiency outcomes are improved if acute patients admitted to non-specialty (outlier) wards are minimised.1 Assessment units may help to reduce numbers of outlier patients.2 A surgical assessment unit (SAU) was recently established at Middlemore Hospital. We aimed to determine the impact of its introduction on numbers of general surgery outliers on post-acute ward rounds. A 10-bed SAU was introduced in July 2015, coinciding with the closure of 20 beds on the general surgical wards. The numbers and locations of patients on post-acute ward rounds before and after the establishment of the SAU were compared. A student two-tailed t-test was used for statistical comparisons, with poutlier wards after the introduction of the SAU (mean 1.7 before vs 0.8 after, p=0.04). Despite a net reduction in general surgery beds and no change in the overall number of post-acute patients, the establishment of a SAU was associated with a reduction in outliers.
Lie Affendi Kartikahadi
Full Text Available Background Hospitalization of a child is known to be a dreadful and stressful situation for parents. One study reported that admitting a child to a general ward caused mild anxiety to mothers, while admitting a child to the pediatric intensive care unit (PICU caused moderate anxiety to mothers. Objective To compare Hamilton anxiety scores of mothers whose children were admitted to the PICU to those of mothers whose children were admitted to the general ward. Methods A cross-sectional study was done on mothers of children aged 1 month-12 years. Children were admitted to either the intensive care unit or the general ward from October 2010-January 2011. All subjects were assessed by Hamilton anxiety scores and questioned for risk factors and other causes of maternal anxiety. Consecutive sampling was used to allocate the subjects. Differences were considered statistically significant for P < 0.05. Results Of the 72 subjects, the median Hamilton anxiety score in mothers of children admitted to the PICU was 20.5 (interquartile range 14-29.75, higher than that of mothers of children admitted to the general ward (14, interquartile range 9-16.75. Mann-Whitney U test revealed a statistically significant difference in scores between the two groups (P = 0.001. Ancova multivariate analysis showed the admission location to be the only significant relationship to Hamilton anxiety score (P = 0.0001. Conclusion Hamilton anxiety scores were higher for mothers of children admitted to the PICU than that of mothers with children admitted to the general ward. [Paediatr Indones.2012;52:95-8].
BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.
Lopez, Joseph; Ahmed, Rizwan; Bae, Sunjae; Hicks, Caitlin W; El Dafrawy, Mostafa; Osgood, Greg M; Segev, Dorry L
Under the Physician Payments Sunshine Act, "payments or transfers of value" by biomedical companies to physicians must be disclosed through the Open Payments Program. Designed to provide transparency of financial transactions between medication and device manufacturers and health care providers, the Open Payments Program shows financial relationships between industry and health care providers. Awareness of this program is crucial because its interpretation or misinterpretation by patients, physicians, and the general public can affect patient care, clinical practice, and research. This study evaluated nonresearch payments by industry to orthopedic surgeons. A retrospective cross-sectional review of the first wave of Physician Payments Sunshine Act data (August through December 2013) was performed to characterize industry payments to orthopedic surgeons by subspecialty, amount, type, origin, and geographic distribution. During this 5-month period, orthopedic surgeons (n=14,828) received $107,666,826, which included 3% of those listed in the Open Payments Program and 23% of the total amount paid. Of orthopedic surgeons who received payment, 45% received less than $100 and 1% received $100,000 or more. Median payment (interquartile range) was $119 ($34-$636), and mean payment was $7261±95,887. The largest payment to an individual orthopedic surgeon was $7,849,711. The 2 largest payment categories were royalty or license fees (68%) and consulting fees (13%). During the study period, orthopedic surgeons had substantial financial ties to industry. Of orthopedic surgeons who received payments, the largest proportion (45%) received less than $100 and only 1% received large payments (≥$100,000). The Open Payments Program offers insight into industry payments to orthopedic surgeons. [Orthopedics. 2016; 39(6):e1058-e1062.]. Copyright 2016, SLACK Incorporated.
Burmester, Nicolas; Jankowski, Michael
In the field of international relations, regional organizations (ROs) are not only assumed to play an important role in the regional context, but also on the international level. A growing number of studies analyze ROs’ voting behavior in the United Nations General Assembly (UNGA) in a similar way...... to the analyses of parties in national parliaments. In this paper, we reflect on the question whether ROs can be treated as ‘political party’-like entities. First, based on literature on political parties and legislative voting, we develop two criteria to evaluate ROs in the UNGA. Second, we analyze UNGA voting...
Stone, J L
nerve regeneration and nerve grafting, and after many years of devoted research, he devised successful operations for facial nerve paralysis. For this and early vascular work, he is often credited as the first English surgeon to reintroduce classical Hunterian methods of experiment into surgery. He was honored as the founder and President of The Society of British Neurological Surgeons in 1926. Perhaps best known as a general and aural surgeon, Ballance was second only to Horsley in reputation as a pioneer British neurological surgeon. Described as a painstakingly slow but delicate and meticulous operator, Ballance made a contribution to neurosurgery and temporal bone surgery that was immense.
Full Text Available The article provides a comparative analysis of slavery in Circassia and in the territory of the slave South in the United States in 1850–1860-ies years in the context of the fight against the slave trade and slavery in the world. The article discusses the Russian-American general trends for the prohibition of slavery and the slave trade. Among the materials are Russian and foreign archival sources, documents of personal origin (memoirs, diaries of travelers as well as scientific research. The methodological basis of historical-comparative study are the principles of objectivity and historicism, suggesting an unbiased approach to the analysis of the studied problems, a critical attitude to the sources, making judgments as a result of the analysis of a set of facts, and displays the slave of phenomena in the development and the context of the historical situation. In conclusion, the authors note that slavery and the slave position in the United States and the Circassia had their differences in 1850–1860-ies. Such differences included the inability of the transition to the United States from the status of a slave in the state of the dependent peasant, which was the norm in Circassia. In the United States the slaves were brought from outside, while in Circassia the slavery occurred in the region, mainly by trapping. At the root of discrimination in the United States was the racial principle, in Circassia this is based on the religious principle. The position of slaves had their similarities. A slave was powerless property of his master, there were certain unwritten rules governing the relationship, slave owners were reluctant to bring slaves to the extreme and etc. The important similarity between the US and Circassia was the presence of their territories with a strong slave system, where slaves constituted more than 30 % of the population. In the US, it was the territory of the slave-holding South, and in Circassia – the slaveholding Ubykhia.
Lui, Darren F
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.
Zygourakis, Corinna C; Valencia, Victoria; Moriates, Christopher; Boscardin, Christy K; Catschegn, Sereina; Rajkomar, Alvin; Bozic, Kevin J; Soo Hoo, Kent; Goldberg, Andrew N; Pitts, Lawrence; Lawton, Michael T; Dudley, R Adams; Gonzales, Ralph
Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. The primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases
Kähler, Lena; Kristiansen, Maria; Rudkjøbing, Andreas; Strandberg-Larsen, Martin
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.
Full Text Available Background. Initially the course of the 2009 swine flu pandemic was uncertain and impossible to predict with any confidence. An effective prospective data resource exists in the United Kingdom (UK that could have been utilized to describe the scope and extent of the swine flu outbreak as it unfolded. We describe the 2009 swine flu outbreak in the UK as recorded daily by general practitioners and the potential use of this database for real-time tracking of flu outbreaks. Methods. Using the General Practice Research Database, a real-time general practice, electronic database, we estimated influenza incidence from July 1998 to September 2009 according to age, region, and calendar time. Results. From 1998 to2008, influenza outbreaks regularly occurred yearly from October to March, but did not typically occur from April to September until the swine flu outbreak began in April 2009. The weekly incidence rose gradually, peaking at the end of July, and the outbreak had largely dissipated by early September. Conclusions. The UK swine flu outbreak, recorded in real time by a large group of general practitioners, was mild and limited in time. Simultaneous online access seemed feasible and could have provided additional clinical-based evidence at an early planning stage of the outbreak.
Full Text Available Hospitalization of family member in intensive care can be a trigger of stress in the family. Several factors which could create a stressful situation in a family are changes of environment, rules in the ward, changes of family emotional status, changes of family member roles, changes of daily activities, changes in financial situation and health care workers' attitude when giving information on patient’s health status. This study was a cross-sectional study. The number of subjects included in this study were 60 representing families whose member was hospitalized in the General Intensive Care Unit (GICU of Dr. Hasan Sadikin General Hospital (RSHS Bandung during the period of March to May 2012. The sampling technique used was purposive sampling. The instrument used to measure the stress predictors was developed based on theoretical review and modification of family inventory live events standard instrument. Meanwhile, the instrument used for measuring the family stress was the Depression Anxiety Stress Scale 42. Data were analyzed using chi-square test and logistic regression. The results of this study showed environmental changes, rules in the ward, emotional status changes and daily activity changes significantly corelated with stress (p value 0.01, 0.04 and 0.03, respectively. In conclusion, none of the 6 family predictors dominantly predicts stress. Nurses are expected to do early detection on psychological family problems in intensive care unit and optimize supportive-educative treatment in the form of counseling for family members.
Full Text Available The General Urban Plan represents the legal ground for any development action proposed. After endorsement and approval as required by law, GUP is act of authority of local government for the area in which it applies. The aim is to establish priorities regulations applied in land use planning and construction of structures. In terms of geographical location, the administrative territory of Casimcea, Tulcea county, falls in the central Northwest Plateau Casimcei. This is the second unit of the Central Dobrogea Plateau. Geographical location in southeastern Romania, climatic and relief conditions and anthropogenic pressure, expose the village administrative territorial unit Casimcea, permanent susceptibility to produce natural and antropogenical risks. In this context, we identified the following categories of natural and anthropogenic risks: i natural risk phenomena (earthquakes, strong winds, heavy rains, floods caused by overflowing or precipitation, erosion of river banks and torrents, gravitational processes, rain droplet erosion and surface soil erosion; and ii anthropogenic risk phenomena (overgrazing, chemicals use in agriculture, road transport infrastructure and electricity, wind turbines for electricity production, waste deposits, agro-zootechnical complexs, and human cemeteries. Extending their surface was materialized by creating a map of natural and anthropogenic risk on Casimcea territorial administrative unit, explaining the share of potentially affected areas as territorial balance
SriKamkshi Kothandaraman; Balasubramanian Thiagarajan
Being a left-handed surgeon, more specifically a left-handed ENT surgeon, presents a unique pattern of difficulties.This article is an overview of left-handedness and a personal account of the specific difficulties a left-handed ENT surgeon faces.
Sharoky, Catherine E; Sellers, Morgan M; Keele, Luke J; Wirtalla, Christopher J; Karakousis, Giorgos C; Morris, Jon B; Kelz, Rachel R
We sought to compare postoperative outcomes of female surgeons (FS) and male surgeons (MS) within general surgery. FS in the workforce are increasing in number. Female physicians provide exceptional care in other specialties. Differences in surgical outcomes of FS and MS have not been examined. We linked the AMA Physician Masterfile to discharge claims from New York, Florida, and Pennsylvania (2012 to 2013) to examine practice patterns and to compare surgical outcomes of FS and MS. We paired FS and MS operating at the same hospital using cardinality matching with refined balance and compared inpatient mortality, any postoperative complication, and prolonged length of stay (pLOS) in FS and MS. Overall practice patterns differed between the 663 FS and 3219 MS. We identified 2462 surgeons (19% FS, 81% MS) at 429 hospitals who met inclusion criteria for outcomes analysis. FS were younger (mean age ± SD FS: 48.5 ± 8.4 years, MS: 54.3 ± 9.4y; P best fit for them regardless of sex.
Club) research fellowship; SSO/ ESSO fellowshipthrough its partnership with ESSO, SSO provides a grant to attend the SSO Annual Symposium; Reciprocal International Exchange Programmes with Japan, Latin America and North America (2). ESSO courses and masterclasses: expanded portfolio of courses, in- and outside Europe, basic and advanced, international faculty, multidisciplinary approach, learning methods: hands-on with human cadavers, workshops in small groups, live and case demonstrations, interactive sessions, 3D videos (for instance in 2017 ESSO course on ultrasound of breast in Barcelona, advanced course on oncoplastic surgery in Barcelona, advanced course on breast cancer surgery in Naples) (2). Trials: Interantional Nipple- Sparing Mastectomy Registry (INSPIRE), EURECCA (European Cancer Audit) project. The aim of INSPIRE is to provide pooled evidence derived from a prospective collaborative high-quality registry between international centers, oncological safety, patient- reported outcome measures, launched in March, 2016, European Breast Cancer Conference EBCC 10, Amsterdam (2). European Board of Surgery Qualification in Breast Surgery (EBSQ in BS): phase 1-eligibility assessment (CV, logbook, references); phase 2- test; phase 3- oral examination with 2 clinical cases and 1 critical review of academic paper. The applicant must hold a current license to practice as a surgeon (general or plastic or gynaecologist), demonstrate work for one year in a breast surgery unit with at least 150 new primary breast cancer cases per year, attended at least one national/ international training course in breast surgery and has attended at least one well recognized international congress. The applicant should present a signed log book for breast surgery with application; published either one paper or book chapter on breast disease Conclusions 1. The need for certified breast units: Standardised techniques by specialist breast surgeons across Europe should be the aim. 2. No man
Carstensen, Lena; Rose, Michael; Bentzon, Niels;
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......INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level...... 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...
Yule, Steven; Paterson-Brown, Simon
The importance of non-technical skills to surgical performance is gaining wide acceptance. This article discusses the core cognitive and social skills categories thought to underpin medical knowledge and surgical expertise, and describes the rise of non-technical skill models of assessment in surgery. Behavior rating systems such as NOTSS (Non-Technical Skills for Surgeons) have been developed to support education and assessment in this regard. We now understand more about these critical skills and how they impact surgery. The challenge in the future is to incorporate them into undergraduate teaching, postgraduate training, workplace assessment, and perhaps even selection.
Based on Lazarus and Folkman’s theory about stress and coping, this research aimed at answering questions related to how nurses, who work in two specialized units of a general hospital, evaluate their working environment, their health and how they manage with stressing situations. In the unit of infectious diseases, the nurses’ evaluation of their working environment did not surpass the limits of what is considered as acceptable. In the unit of hematological alterations, the results showed hi...
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.
Loughry, Thomas A.
As the volume of data acquired by space-based sensors increases, mission data compression/decompression and forward error correction code processing performance must likewise scale. This competency development effort was explored using the General Purpose Graphics Processing Unit (GPGPU) to accomplish high-rate Rice Decompression and high-rate Reed-Solomon (RS) decoding at the satellite mission ground station. Each algorithm was implemented and benchmarked on a single GPGPU. Distributed processing across one to four GPGPUs was also investigated. The results show that the GPGPU has considerable potential for performing satellite communication Data Signal Processing, with three times or better performance improvements and up to ten times reduction in cost over custom hardware, at least in the case of Rice Decompression and Reed-Solomon Decoding.
Loughry, Thomas A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
As the volume of data acquired by space-based sensors increases, mission data compression/decompression and forward error correction code processing performance must likewise scale. This competency development effort was explored using the General Purpose Graphics Processing Unit (GPGPU) to accomplish high-rate Rice Decompression and high-rate Reed-Solomon (RS) decoding at the satellite mission ground station. Each algorithm was implemented and benchmarked on a single GPGPU. Distributed processing across one to four GPGPUs was also investigated. The results show that the GPGPU has considerable potential for performing satellite communication Data Signal Processing, with three times or better performance improvements and up to ten times reduction in cost over custom hardware, at least in the case of Rice Decompression and Reed-Solomon Decoding.
Andrews, Hannah; Singh, Yogen
Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.
Lavien, Garjae; Zaid, Uwais; Peterson, Andrew C
Genitourinary prosthetics are used for correction of functional deficits and to improve the quality of lives of affected patients. General surgeons must evaluate patients scheduled for nonurologic surgery with urologic devices that can impact their perioperative management. Lack of recognition of these prosthetics preoperatively can lead to unnecessary morbidity for the patient and have legal implications for the surgeon. Close consultation with a urologist may avoid common complications associated with these devices and allows for surgical assistance when operative misadventures do occur. This article reviews 3 common urologic prosthetics: testicular prosthesis, artificial urinary sphincter, and penile prosthesis.
Porto, G G; Carneiro, S C; Vasconcelos, B C; Nascimento, M M; Leal, J L F
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.
Amilton dos Santos Jr.
Full Text Available Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02. Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5% reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.
... United Motor Manufacturing, Inc. Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and... Motor Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota...
Cosman, Bard C; Alverson, Aaron D; Boal, Peter A; Owens, Erik L; Norcross, William A
Assessment and remedial clinical education of practicing surgeons is feasible and possibly beneficial. Retrospective series. Urban academic medical center. Licensed surgeons. Structured assessment and remedial clinical education based on resident-education models. Assessment and clinical education results. Forty-seven general, general/vascular, and colorectal surgeons were assessed by the University of California, San Diego, Physician Assessment and Clinical Education program in 2000 to 2010. Forty-six (98%) were male (mean [SD] age, 54  years; range, 34-80 years). Thirty-three (70%) came from state medical board actions: 25 from California's disciplinary division, 2 from California's licensing division, 3 from other state boards, and 3 self-referred during other state board actions. Fourteen (30%) came from health care organizations: 8 from California hospitals, 3 from hospitals in other states, 2 self-referred during hospital proceedings, and 1 self-referred during a medical group investigation. Twenty-three (49%) underwent a 2-day assessment only, including a 1-hour mock oral board examination: 8 "passed" with no recommendations; 6, with minor recommendations; 6 had major recommendations; and 3 "failed." Twenty-four surgeons (51%) also completed 26 five-day clinical education programs, with 20 "passes," 1 minor recommendation, 3 major recommendations, and 2 "fails." A program of assessment and remedial clinical education of surgeons designed to meet the needs of one medical board is being used by nongovernmental organizations as well, and it seems to meet the needs of some individual surgeons. This type of program may play a role in the profession's self-regulation.
filling an active billet as a flight surgeon may be very short (i.e., immediate), as in the case of a general medical officer ( GMO ), or very long...Inexperience (9/19) • The two assigned flight surgeons are general medical officers ( GMOs ). It is difficult to complete the necessary training at a...other two are newly assigned GMOs , who are motivated but are still in the learning phase. I have no doubt they will eventually grow into outstanding
Britto, Eliane da Silva; Carvalho, Ana Maria Pimenta
Based on Lazarus and Folkman's theory about stress and coping, this research aimed at answering questions related to how nurses, who work in two specialized units of a general hospital, evaluate their working environment, their health and how they manage with stressing situations. In the unit of infectious diseases, the nurses' evaluation of their working environment did not surpass the limits of what is considered as acceptable. In the unit of hematological alterations, the results showed higher stress levels. In both units, the evaluation of their health was considered as satisfactory and the coping strategies were similar.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable powder for lubricating a surgeon's... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4480 Absorbable powder for lubricating a surgeon's glove. (a) Identification. Absorbable powder...
Gostlow, H; Marlow, N; Thomas, M J W; Hewett, P J; Kiermeier, A; Babidge, W; Altree, M; Pena, G; Maddern, G
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.
Full Text Available Abstract Objective: We evaluated the effect of surgeon experience on complication and mortality rates of carotid endarterectomy operation. Methods: Fifty-nine consecutive patients who underwent carotid endarterectomy between January 2013 and February 2016 were divided into two groups. Patients who had been operated by surgeons performing carotid endarterectomy for more than 10 years were allocated to group 1 (experienced surgeons; n=34. Group 2 (younger surgeons; n=25 consisted of patients operated by surgeons independently performing carotid endarterectomy for less than 2 years. Both groups were compared in respect of operative results and postoperative complications. Results: No intergroup difference was found for laterality of the lesion or concomitant coronary artery disease. In group 1, signs of local nerve damage (n=2; 5.9% were detected, whereas in group 2 no evidence of local nerve damage was observed. Surgeons in group 1 used local and general anesthesia in 3 (8.8% and 31 (91.2% patients, respectively, while surgeons in group 2 preferred to use local and general anesthesia in 1 (4% and 24 (96% patients, respectively. Postoperative stroke was observed in group 1 (n=2; 5.9% and group 2 (n=2; 5.8%. Conclusion: Younger surgeons perform carotid endarterectomy with similar techniques and have similar results compared to experienced surgeons. Younger surgeons rarely prefer using shunt during carotid endarterectomy. The experience and the skills gained by these surgeons during their training, under the supervision of experienced surgeons, will enable them to perform successful carotid endarterectomy operations independently after completion of their training period.
Lorincz, Attila; Langenburg, Scott; Klein, Michael D
Surgical robots are enabling devices for minimally invasive (laparoscopic) surgery (MIS). They use a computer to enhance a surgeon's skills as hand movements are transmitted to robotic arms. The computer filters tremor, which becomes important at high magnifications of 10 to 15 times available in MIS. It also provides motion scaling so that large hand movements are converted to very small movements of the robotic arm. The robotic arms also have wrists that make suturing and knot tying far more accurate and efficient. Surgical robots are currently used clinically for procedures such as MIS Nissen fundoplication, cholecystectomy, and splenectomy. Laboratory experience indicates that they may provide advantages for newborn procedures such as portoenterostomy for biliary atresia and repair of esophageal atresia and tracheoesophageal fistula. They have a potential for making possible MIS procedures, which can only be done open now, and for introducing entirely new procedures as well as for the performance of procedures by operators distant from the patient.
Lee, Jiyon; Tanaka, Elaine; Eby, Peter R; Zhou, Shouhao; Wei, Wei; Eppelheimer, Christine; Loving, Vilert A
The purpose of this study is to determine which patient- and tumor-related and clinical variables influence dedicated breast surgeons' and general surgeons' referrals for preoperative breast MRI for patients with newly diagnosed breast cancer. Surgeons who perform breast surgery responded to a survey from June 16, 2014, through August 11, 2014. Participants self-identified as breast or general surgeons and provided professional practice details. They used Likert scores (range, 1-7 with increasing likelihood to order MRI) to weigh numerous patient- and tumor-related and clinical variables. Mean likelihood scores were calculated and compared using a linear mixed model. A p ≤ 0.05 was considered statistically significant. Two hundred eighty-nine surveys from 154 (53%) breast surgeons and 135 (47%) general surgeons showed an overall likelihood to refer for patients with a BRCA mutation (mean Likert score, 6.17), familial (mean Likert score, 5.33) or personal (mean Likert score, 5.10) breast cancer history, extremely dense breasts (mean Likert score, 5.30), age younger than 40 years (mean Likert score, 5.24), axillary nodal involvement (mean Likert score, 6.22), tumor that is mammographically occult (mean Likert score, 5.62) or fixed to the pectoralis (mean Likert score, 5.49), tumor that is a candidate for neoadjuvant treatment (mean Likert score, 5.38), multifocal or multicentric disease (mean Likert score, 5.22), invasive lobular carcinoma (mean Likert score, 5.20), T3 (mean Likert score, 4.48) or T2 (mean Likert score, 4.41) tumor, triple-negative breast cancer (mean Likert score, 4.66), a patient who is a candidate for mastectomy requesting breast conservation therapy (mean Likert score, 5.27), and radiologists' recommendations (mean Likert score, 5.19). Across all patient ages, breast surgeons referred more often than did general surgeons (mean Likert score, 4.32 vs 3.92; p = 0.03), especially for patients with BRCA mutation (mean Likert score, 6.39 vs 5.93; p
马锐华; 王拥军; 曲辉; 杨中华
Background Stroke unit is the most effective treatment method to benefit stroke patients. Our study is to evaluate the early effectiveness of a hospital stroke unit (SU). Methods Three hundred and ninety-two patients who had suffered from acute strokes and who were admitted to our hospital between December 2001 and January 2003 were recruited for this controlled study. All patients were sent at random to either the SU or the general ward (GW) for treatment. The following indices were measured by: Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS). Results The mean change in BI score between the day of admission and the day of discharge was 20.00±24.36 for the SU group and 10.63±23.59 for the GW group. A difference that is statistically significant (P=0.000). The mean change in NIHSS score was -2.01±6.61 for the SU group and 0.55±7.44 for the GW group. A difference that is also statistically significant (P=0.000). Finally, the mean change in OHS score was -0.74±1.04 for the SU group and -0.28±0.98 for the GW group, also a statistically significant difference (P=0.000). Among SU patients, patient satisfaction was higher (P=0.000), the rehabilitation success rate was higher (P=0.000), and there were fewer complications (P=0.000).Conclusion Compared to GW patients, stroke patients treated in a special SU were able to return to normal daily activities earlier, with better social abilities, and have reduced neurological defects, without increasing the overall economic burden.
Carty, Matthew J; Pribaz, Julian J; Talbot, Simon G; Caterson, Edward J; Pomahac, Bohdan
Plastic surgery is presently typified by the existence of discrete clinical identities, namely that of the cosmetic plastic surgeon and the reconstructive plastic surgeon. The emergence of vascularized composite allotransplantation has been accompanied by the development of a third distinct clinical identity, that of the restorative plastic surgeon. The authors describe the core competencies that characterize this new identity, and discuss the implications of the advent of this new professional paradigm.
Dollard Sheila C
Full Text Available Abstract Background Cytomegalovirus (CMV is a common opportunistic infection among HIV-infected individuals, a major source of serious complications among organ-transplant recipients, and a leading cause of hearing loss, vision loss, and mental retardation among congenitally infected children. Women infected for the first time during pregnancy are especially likely to transmit CMV to their fetuses. More children suffer serious disabilities caused by congenital CMV than by several better-known childhood maladies such as Down syndrome or fetal alcohol syndrome Methods Using CMV seroprevalence data from the nationally representative Third National Health and Nutrition Examination Survey, we estimated CMV incidence among the general United States population and among pregnant women. We employed catalytic models that used age-specific CMV seroprevalences as cumulative markers of past infections in order to derive estimates of three basic parameters: the force of infection, the basic reproductive rate, and the average age of infection. Our main focus was the force of infection, an instantaneous per capita rate of acquisition of infection that approximates the incidence of infection in the seronegative population. Results Among the United States population ages 12–49 the force of infection was 1.6 infections per 100 susceptible persons per year (95% confidence interval: 1.2, 2.4. The associated basic reproductive rate of 1.7 indicates that, on average, an infected person transmits CMV to nearly two susceptible people. The average age of CMV infection was 28.6 years. Force of infection was significantly higher among non-Hispanic Blacks (5.7 and Mexican Americans (5.1 than among non-Hispanic Whites (1.4. Force of infection was significantly higher in the low household income group (3.5 than in the middle (2.1 and upper (1.5 household income groups. Based on these CMV incidence estimates, approximately 27,000 new CMV infections occur among seronegative
... Assessment and Safety Committee Initiatives Past Presidents Healthcare Economics Committee 2017 Tripartite Meeting Search form Search Login Join Now Find a Surgeon ASCRS Patients Members Physicians Latest ...
Sungjin Im; Pin-Yan Lu; Ya-Jun Wang
The envy-free pricing problem can be stated as finding a pricing and allocation scheme in which each consumer is allocated a set of items that maximize his/her utility under the pricing.The goal is to maximize seller revenue.We study the problem with general supply constraints which are given as an independence system defined over the items.The constraints,for example,can be a number of linear constraints or matroids.This captures the situation where items do not pre-exist,but are produced in reflection of consumer valuation of the items under the limit of resources.This paper focuses on the case of unit-demand consumers.In the setting,there are n consumers and m items; each item may be produced in multiple copies.Each consumer i ∈ [n] has a valuation vij on item j in the set Si in which he/she is interested.He/she must be allocated (if any) an item which gives the maximum (non-negative) utility.Suppose we are given an α-approximation oracle for finding the maximum weight independent set for the given independence system (or a slightly stronger oracle); for a large number of natural and interesting supply constraints,constant approximation algorithms are available.We obtain the following results.1) O(α log n)-approximation for the general case.2) O(αk)-approximation when each consumer is interested in at most k distinct types of items.3) O(αf)-approximation when each type of item is interesting to at most f consumers.Note that the final two results were previously unknown even without the independence system constraint.
Fahisham Taib; Bakht Jamal
Objective: To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized pro-forma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients’ data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline;however, different antibiotic regimes were based on physician’s preferences. The sensitivity of the current method of UTI diagnosis remained at 64%when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.
Full Text Available In this study, we present a practical implementation of prestack Kirchhoff time migration (PSTM on a general purpose graphic processing unit. First, we consider the three main optimizations of the PSTM GPU code, i.e., designing a configuration based on a reasonable execution, using the texture memory for velocity interpolation, and the application of an intrinsic function in device code. This approach can achieve a speedup of nearly 45 times on a NVIDIA GTX 680 GPU compared with CPU code when a larger imaging space is used, where the PSTM output is a common reflection point that is gathered as I[nx][ny][nh][nt] in matrix format. However, this method requires more memory space so the limited imaging space cannot fully exploit the GPU sources. To overcome this problem, we designed a PSTM scheme with multi-GPUs for imaging different seismic data on different GPUs using an offset value. This process can achieve the peak speedup of GPU PSTM code and it greatly increases the efficiency of the calculations, but without changing the imaging result.
Liu, Guofeng; Li, Chun
In this study, we present a practical implementation of prestack Kirchhoff time migration (PSTM) on a general purpose graphic processing unit. First, we consider the three main optimizations of the PSTM GPU code, i.e., designing a configuration based on a reasonable execution, using the texture memory for velocity interpolation, and the application of an intrinsic function in device code. This approach can achieve a speedup of nearly 45 times on a NVIDIA GTX 680 GPU compared with CPU code when a larger imaging space is used, where the PSTM output is a common reflection point that is gathered as I[ nx][ ny][ nh][ nt] in matrix format. However, this method requires more memory space so the limited imaging space cannot fully exploit the GPU sources. To overcome this problem, we designed a PSTM scheme with multi-GPUs for imaging different seismic data on different GPUs using an offset value. This process can achieve the peak speedup of GPU PSTM code and it greatly increases the efficiency of the calculations, but without changing the imaging result.
Substance Abuse and Mental Health Services Administration, 2012
Suicide is a serious public health problem that causes immeasurable pain, suffering, and loss to individuals, families, and communities nationwide. Many people may be surprised to learn that suicide was one of the top 10 causes of death in the United States in 2009. And death is only the tip of the iceberg. For every person who dies by suicide,…
Williams, L.; Fryer, J.; Andrew, R.; Powell, C.; Pink, J.; Elwyn, G.
BACKGROUND: Rapid Access Outpatient Units (RAOUs) have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no quali
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
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.
Brian, Tess; Adams, Brandon
The New Zealand Medical Association commits the New Zealand doctor to evidence-based medicine, scholarship, teaching, collaboration and communication. To assess this commitment, one measure, contribution to the peer-reviewed literature, was examined for one group of New Zealand doctors: plastic surgeons. Plastic surgeons with a current practising certificate were identified on the New Zealand medical register (April 2016). Scopus database was searched for publications by each. Sixty-five surgeons authored 541 unique items in 134 journals, generating 8,047 citations. Between medical graduation and specialty qualification, a mean 1.8 items were published per practitioner (range 0-11). Twenty-three practitioners (35.4%) did not publish during this time. Between specialty qualification and the end of 2015, mean number of items published per surgeon was 7.3 (range 0-97). Thirteen (20.0%) surgeons had not published since specialist qualification. The general trend was for surgeons to become less productive with increasing time in practice. Mean surgeon h-index was 4.4 (range 0-26). Four surgeons (6.2%) had not published at any time. As a group, but with exceptions and less so in later practice, New Zealand plastic surgeons would seem to demonstrate commitment to evidence-based medicine, scholarship, teaching, collaboration and communication expected of a New Zealand doctor, as evidenced by peer-review publication.
Pradarelli, Jason C; Jaffe, Gregory A; Lemak, Christy Harris; Mulholland, Michael W; Dimick, Justin B
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.
Teunis, Teun; Janssen, Stein; Guitton, Thierry G; Ring, David; Parisien, Robert
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
Sanders, M A
William Cheselden was Great Britain's foremost surgeon/scientist in the first half of the 18th century. Cheselden directly challenged the Company of Barber-Surgeons' exclusive right to control dissection in London by being the first to conduct a regular series of anatomy lectures and demonstrations outside of the Company's Hall. He incorporated his lecture syllabus into a handbook of anatomy, The Anatomy of the Humane Body, which was used by students for nearly 100 years. Cheselden also wrote the text and drew the illustrations for a majestic atlas of comparative osteology, the Osteographia, or the Anatomy of the Bones. Cheselden used his superior knowledge of anatomy to reduce the morbidity and mortality associated with perineal lithotomy, one of the few operations possible in his era. Sagacious and pragmatic, Cheselden recognized that the enlightened practice of surgery beginning to take root in 18th-century London could flourish only under an autonomous body of surgeons. Cheselden used his personal funds and political skills to urge Parliament to pass legislation for the dissolution of the combined Company of Barber-Surgeons and the establishment of separate and distinct Surgeons' and Barbers' Companies. After disjoinder of the two groups on May 2, 1745, Cheselden served as one of the Wardens of the new Company of Surgeons--a predecessor of the Royal College of Surgeons of England. In 1746, Cheselden, who helped design the first Surgeons' Hall, served as the Company's Master.
Awada, T; Liverneaux, P
In 1954, Michel Latarjet, anatomist and surgeon of Lyon, developed an original surgical technique to treat the unstable shoulder . This technique since kept his name: "Latarjet". He was a character in 1000 facets: highly skilled anatomist, skillful surgeon, talented sportsman, accomplished musician, big traveler, and many others... An eclectic life, symbol of an abundant XXth century.
Edwards, Hellen; Jørgensen, Lars Nannestad
that the risk was equal to traditional laparoscopy (3%). The fraction of surgeons willing to learn SILS and NOTES was 44.6% and 32.7%, respectively. The desire to learn was higher among less experienced and surgically active surgeons. Of the responders, 68.8% considered SILS and 43.2% considered NOTES would...
José Manuel Ríos-Yuil
Full Text Available INTRODUCTION: An aeromycological study verifies the presence and quantifies the concentration of fungal propagules in the air. It is very important in the hospital setting because of the increasing numbers of immunosuppressed and severely ill patients. The objective of this study was to determine the concentration of fungi in the air of the intensive care unit (ICU of "Dr. Manuel Gea González" General Hospital. METHODS: This is a descriptive, observational cross-sectional study. Air samples were obtained with a single stage Thermo-Andersen Viable Particle Sampler (Thermo Electron Corporation -Massachusetts, U.S.A. in a Petri dish with potato dextrose agar for 15 minutes at two different times (morning and afternoon and heights (1 and 1.5 meters. The Petri dishes were incubated for five to seven days at 27ºC, the number of colonies was counted, and the total CFU/m³ was determined. The isolated fungal genera were identified by morphological features. Epi Info v. 3.4.3 © was used for statistical analysis. RESULTS: The mean concentration of fungi in the air of the ICU was 85.08 ± 29.19 CFU/m³; while in the outside air it was 84.3 ± 17.23 CFU/m³ (p = 0.96. The fungi isolated were: Cladosporium spp., Penicillium spp., Aspergillus spp. (non-fumigatus, Fusarium spp., Exophiala spp., Syncephalastrum spp., and Acremonium spp. DISCUSSION: Fungal spores were found in the air of the ICU and Cladosporium spp. was the most frequently isolated fungi. There was no difference according to sampling time or height.
M. D. Evans
Full Text Available Introduction. The aim of this study was to examine the effect of surgeon relocation on lymph node (LN retrieval in colorectal cancer (CRC resection. Methods. The study population was 213 consecutive patients undergoing CRC resection by a single surgeon, at two units: unit one 110 operations (2002–2005 and unit two 103 (2005–2009. LN yields and case mix were compared. Results. Median LN harvests were significantly different between the two centres: unit 1: 13 nodes/patient and unit 2: 22 nodes/patient (<.001. In unit one 42% of cases were LN positive and in unit two 48% (=.398. There was no difference in case mix. Multivariate analysis identified unit (<.001 and pathologist (=.007 as independent predictors of harvest. Conclusions. A surgeon moving units can experience significantly different LN yield following CRC resection. Both units comply with national standards, but the “surgeon's results” at the two units appear to be pathologist dependent. This has implications for nodal harvest as a surrogate marker of surgical quality.
María Rita Rodríguez-Luna
Conclusion: Despite the low incidence of colonic complication and lethal colonic necrosis associated with the CER clinical use, the general surgeon needs a high index of suspicion when dealing with patients treated with CER and abdominal pain.
Drosdeck, Joseph M; Osayi, Sylvester N; Peterson, Laura A; Yu, Lianbo; Ellison, Edwin Christopher; Muscarella, Peter
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.
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.
NORMA BREDA DOS SANTOS
Full Text Available Abstract In 1975, Brazil voted in favor of the United Nations General Assembly resolution 3379 (XXX, equating Zionism with a form of racism. Focusing on the decision-making process of president Ernesto Geisel's (1974-1979 foreign policy, "responsible pragmatism", this article discusses how the ultimate decision to vote in favor of resolution was taken taking into account mainly US-Brazil relationship.
This unit is intended to provide high school students with a general knowledge of the history and culture of India. Lessons include: (1) "Early India"; (2) "Indian Civilization 1500 BC - 500 AD: Hinduism"; (3) "Buddhism"; (4) "Indian Empires"; (5) "Indian Empires, Continued"; (6)…
Mielke, Jens; Kalangu, Kazadi K N
The moral dilemmas faced by surgeons worldwide who treat patients infected with the human immunodeficiency virus (HIV) can be viewed against the background of experience in sub-Saharan countries, where the community prevalence is in excess of 25% (90% of hospital inpatients). When seeking consent for an HIV test before surgery, frank communication regarding the surgeons' perspective of risks to themselves and the patient is helpful. When consent for a test must be obtained from a substitute decision-maker, the surgeon should consider if the patient would want the decision-maker to know the result. Understanding the natural history of HIV in the surgical setting can help deal with the uncertainties encountered and should be a research priority for developing countries. International professional organizations are useful platforms for the exchange of ideas when surgeons encounter uncertainty by increasing access to journals and creating opportunities for discussion. Although supervisory bodies in some parts of the world prevent HIV-infected surgeons from putting patients at risk by offering surgery, the withdrawal of their services in developing countries can cause more harm than good. Surgeons in that position may be entitled to offer surgery but only with full disclosure of the risk of HIV infection to the patient. The decision-making process known as "accountability for reasonableness" allows surgeons to determine fairness, legitimacy, and acceptability when making resource allocation decisions involving patients with HIV.
Ozturk, Sinan; Karagoz, Huseyin; Zor, Fatih
Since the days of Sushruta, innovation has shaped the history of plastic surgery. Plastic surgeons have always been known as innovators or close followers of innovations. With this descriptive international survey study, the authors aimed to evaluate the future of plastic surgeons by analyzing how plastic surgery and plastic surgeons will be affected by new trends in medicine. Aesthetic surgery is the main subclass of plastic surgery thought to be the one that will change the most in the future. Stem cell therapy is considered by plastic surgeons to be the most likely "game changer." Along with changes in surgery, plastic surgeons also expect changes in plastic surgery education. The most approved assumption for the future of plastic surgery is, "The number of cosmetic nonsurgical procedures will increase in the future." If surgeons want to have better outcomes in their practice, they must at least be open minded for innovations if they do not become innovators themselves. Besides the individual effort of each surgeon, international and local plastic surgery associations should develop new strategies to adopt these innovations in surgical practice and education.
James Simmons began his career in the US Army as a laboratory officer and his assignments progressed into tropical medicine research. His interests and work evolved into preventive medicine (PM, as the Army termed public health), and he took both a PhD and a Doctorate in Public Health. As the Army's leading PM officer he was appointed head of PM in 1940 and guided the Army's PM effort through World War II. His responsibility ran from gas masks through healthy nutrition and occupational health to an enormous variety of diseases; by the war's end, the breadth and importance of PM was reflected in the Preventive Medicine Division, having fully one-sixth of all military personnel at the Surgeon General's Office. Simmons used his strong professional credentials to tap into civilian medicine for expertise the Army lacked and he established organizations that survive to this day. After retirement, he sought to expand the field of public health and raise another generation of public health physicians.
Full Text Available Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8 vs. 15 (13-15, p<0.0001, median APACHE II score was higher (20 (15-26 vs. 10 (8-13, p<0.0001 and median duration of ICU stay was longer (27 (5-62,5 vs. 2 (1-5, p<0.0001 than those in the survival group. The most common etiology of trauma was traffic accidents (47.2% and 52.7% of patients had head trauma. The rate of patients with any fracture was significantly higher in the survival group (66.7% vs. 33.3%, p=0.007. The rate of erythrocyte suspension, fresh frozen plasma, trombocyte suspension and albumin were 38.9%, 27.8%, 0.9% and 8.3%, respectively in all group. The number of patients invasive mechanically ventilated was 27.8% and median length of stay of these patients were 5 (1.75-33.5 days. The rate of operated patients was 42.6%. The rate of tracheostomy, renal replacement therapy, bronchoscopy and percutaneous endoscopic gastrostomy enforcements were higher in the death group. The advanced age (p=0.016, OR: 1.054; 95% CI: 1.010-1100 and low GCS (p<0.0001, OR: 0.583; 95% CI: 0.456-0.745 were found to be independent risk factors the ICU mortality of trauma patients in logistic regression analysis. Conclusion: We believe that the determination of these risk factors affecting
Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup
Background: A large proportion of surgeons performing minimally invasive surgery (MIS) experience musculoskeletal pain in the upper body possibly due to awkward and long-term static positions. This can be detrimental for workability and health. The objective of the present review is to sum up...... 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...
Willy, Christian; Schneider, Peter; Engelhardt, Michael; Hargens, Alan R; Mubarak, Scott J
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.
Adkinson, Joshua M; Chung, Kevin C
The Affordable Care Act is the largest and most comprehensive overhaul of the United States health care industry since the inception of the Medicare and Medicaid. Contained within the 10 titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. Copyright © 2014 Elsevier Inc. All rights reserved.
Electricity Sector engineers, who provided day-to-day technical supervision and implementation management of GRD’s plan to bring Units 5 and 6 online ...telephone, mail, fax, and online contacts from people in Iraq, the United States, and throughout the world. Second quarter Reporting As of June 30, 2007...Investigative Task Force for Iraq Reconstruction SPOC Sector Project and Contracting Office Contractor TAMU Texas A&M University TBI Trade Bank of Iraq
Sector engineers, who provided day-to-day technical supervision and implementation management of GRD’s plan to bring Units 5 and 6 online . GRD...fax, and online contacts from people in Iraq, the United States, and throughout the world. Second quarter Reporting As of June 30, 2007, SIGIR...Task Force for Iraq Reconstruction SPOC Sector Project and Contracting Office Contractor TAMU Texas A&M University TBI Trade Bank of Iraq TF-BSO
Toft, Anne Elisabeth
The chapter presents the overall academic aims of the teaching at Unit 1b and how these were implemented in the curriculum for 2009/2010. The section includes considerations about learning targets, method, discourse, pedagogy and didactics.......The chapter presents the overall academic aims of the teaching at Unit 1b and how these were implemented in the curriculum for 2009/2010. The section includes considerations about learning targets, method, discourse, pedagogy and didactics....
Karabdic, Ilirijana Haxhibeqiri; Veljovic, Fikret; Straus, Slavenka
Introduction: Most everyday activities, performed over a long period leads to performance degradation of skeletal muscles as well as spinal column which is reflected in the reduction of maximum force, reduction of the speed of response, reducing control of the movement etc. Although until now many mathematical models of muscles are developed, very small number takes into account the fatigue, and those models that take into account changes in the characteristics of muscles for extended activities, generally considered tiring under certain conditions. Given that the current models of muscle fatigue under arbitrary conditions of activation and load are very limited, this article presents a new model that includes scale of muscles overload. Material and Methods: There are three female cardiac surgeons working performing these surgeries in operating rooms, and their average anthropometric measures for this population is: a) Weight: 62 kg; b) Height: 166 cm. Age: 45 taken in the calculation within the CATIA software, that entity is entitled to 50% of healthy female population that is able to execute these and similar jobs. During the surgery is investigated the two most common positions: position “1” and “2”. We wish to emphasize that the experiment or surgical procedure lasted for two positions for five hours, with the position “1” lasted 0.5 hours, and position “2” lasted about 4.5 hours. The additional load arm during surgery is about 1.0 kg. Results: The analysis was done in three positions: “Operating position 1”, “Operating position 2 ‘, and each of these positions will be considered in its characteristic segments. These segments are: when the body takes the correct position, but is not yet burdened with external load, then when the surgeon receives the load and the third position when the load is lifted at the end of the position. Calculation of internal energy used on the joints is carried out in the context of software analysis of this
Karabdic, Ilirijana Haxhibeqiri; Veljovic, Fikret; Straus, Slavenka
Most everyday activities, performed over a long period leads to performance degradation of skeletal muscles as well as spinal column which is reflected in the reduction of maximum force, reduction of the speed of response, reducing control of the movement etc. Although until now many mathematical models of muscles are developed, very small number takes into account the fatigue, and those models that take into account changes in the characteristics of muscles for extended activities, generally considered tiring under certain conditions. Given that the current models of muscle fatigue under arbitrary conditions of activation and load are very limited, this article presents a new model that includes scale of muscles overload. There are three female cardiac surgeons working performing these surgeries in operating rooms, and their average anthropometric measures for this population is: a) Weight: 62 kg; b) Height: 166 cm. Age: 45 taken in the calculation within the CATIA software, that entity is entitled to 50% of healthy female population that is able to execute these and similar jobs. During the surgery is investigated the two most common positions: position "1" and "2". We wish to emphasize that the experiment or surgical procedure lasted for two positions for five hours, with the position "1" lasted 0.5 hours, and position "2" lasted about 4.5 hours. The additional load arm during surgery is about 1.0 kg. The analysis was done in three positions: "Operating position 1", "Operating position 2 ', and each of these positions will be considered in its characteristic segments. These segments are: when the body takes the correct position, but is not yet burdened with external load, then when the surgeon receives the load and the third position when the load is lifted at the end of the position. Calculation of internal energy used on the joints is carried out in the context of software analysis of this model using CATIA R5v19. The proposed model is based on CATIA software
Oliveira, Marcos Aurélio Barboza de; Alves, Fernanda Tomé; Silva, Marcos Vinícius Pinto e; Croti, Ulisses Alexandre; Godoy, Moacir Fernandes de; Braile, Domingo Marcolino
The professional activity that the cardiovascular surgeon performs is much more than a simple gesture to mechanically operate the patient's heart. There is in every act of intraoperative most notions of physiology and physics than we generally realize. This paper discusses, in the light of mathematics, on the dynamics of fluids, ie blood, focused on invasive measurements of blood pressure, the effect of vessel size on its internal resistance and the flow passing through it in conversion of various units of measurements of pressure and resistance, blood viscosity and its relationship to the vessel, hemodilution, differences in laminar and turbulent flow, velocity and blood pressure and wall tension after a stenosis and the origin of poststenotic aneurysm. This study is not to enable the reader to the knowledge of all physics, but to show it as a useful tool in explaining phenomena known in the routine of cardiovascular surgery.
Foss, K R; Tenholder, M F
The positive effect of family support on the outcome from serious illness that requires intensive care has been recognized by clinicians for decades. We have all seen that family visitation and an intensive care environment more similar to that of a general ward (sunlight, radio, television) can benefit patients with psychosis related to intensive care. The severity of illness of the individual patient exerts a powerful stress on the family unit, but it has been difficult to measure this effect. We used a 40-question family needs survey with a degree of importance scale to compare the intensive care unit (ICU) with the general ward in terms of impact on the family. Five needs were found to discriminate these two environments. The family members of patients in an ICU considered it very important (1) for staff to give directions on what to do at the bedside, (2) to receive more support from their own family unit, (3) to have a place to be alone as a family unit in the hospital, (4) to be informed in advance of any transfer plan, and (5) to have flexibility in the time allowed for visitation. Family members are willing to accept decreased visitation time if the physicians and nurses can equate this decrease with the complexity of care in the ICU. The results of this survey have helped us modify and individualize our approach based on family expectations especially when patients are transferred from the general ward to the ICU or from the ICU to the ward.
Smith, Claire S; Guyton, Kristina; Pariser, Joseph J; Siegler, Mark; Schindler, Nancy; Langerman, Alexander
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.
Tribute to Sir Donald Ross by David Wheatley, as read by Robert Kleinloog, President, Society of Cardiothoracic Surgeons of South Africa at the Annual Congress of the South African Heart Association 19 October 2014.
... The Research Foundation of the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American ... W. OIympic Blvd Suite 600 Los Angeles, CA 90064 USA email@example.com Tel: (310) 437- ...
Mung'ayi, V; Karuga, R
There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. Cross sectional observational study. The general intensive care unit, Aga Khan University Hospital,Nairobi. Admitting physicians from all specialties in the general intensive care unit. The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement.
Griffiths, Richard W
Arthur Rainsford Mowlem, the junior of the 'big four' plastic surgeons, with Harold Delf Gillies, Thomas Pomfret Kilner and Archibald Hector McIndoe, came to prominence managing casualties of the Second World War. Rainsford Mowlem's ancestor was John Mowlem, the creator of the construction firm. Rainsford worked his passage to the United Kingdom from New Zealand in 1927 and did not return to New Zealand but retired at the age of 60 to enjoy 23 more years in Spain. He was the driving force between 1934 and 1939 at the Plastic Surgery Unit at St James's Hospital, Balham, and instigated the North London Plastic Surgery Unit at Hill End, St Albans, from 1939 to 1953 and subsequently developed the Unit after moving to Mount Vernon Hospital, Northwood, Middlesex. After successfully hosting the International Meeting of Plastic Surgeons in London in 1959, he received recognition and honours in America but soon afterwards he surprised colleagues by retiring in 1962. Despite his significant contributions, he did not receive national honours but his life outside surgery was active including Trusteeship of the Mowlem Estate at Swanage in Dorset for 40 years.
Full Text Available In this article a phenomenological qualitative research study is discussed. More attention will be given to the methodology of the research. The objectives of the study are two-fold: firstly to explore and describe the experience of registered nurses nursing in the adult intensive care unit (this is the first phase of the research and to describe guidelines based on the information obtained in the first phase to support the nurses in the form of a support programme in the second phase. The units of research are the registered nurses in the intensive care unit. The characteristics of the unit of research led to the emergence of a qualitative phenomenological research design of an explorative, descriptive and contextual nature. In the discussion of research methodology attention will be given to phase one: data gathering (ethical considerations and informed consent; purposive selection, phenomenological interviews and field notes; data analysis (Tesch’s method of data analysis, methods to ensure trustworthiness, organisation of raw data and integration of findings supported by literature. Five themes were identified through the data analysis: impaired communication with management; discrimination: white on black racism; lack of fair, competitive remuneration and disregard for professional worth; non-conducive physical environment, and stressful working environment. Phase two: Guidelines were described to support the registered nurses in the intensive care unit based on the information obtained in phase one of the research.
Signature of the Collaboration Agreement between THE UNITED NATIONS INSTITUTE FOR TRAINING AND RESEARCH (UNITAR), by Mr Carlos Lopes (UN Assistant Secretary-General and Executive Director of UNITAR) and by the Director General of CERN, Mr Robert Aymar
Signature of the Collaboration Agreement between THE UNITED NATIONS INSTITUTE FOR TRAINING AND RESEARCH (UNITAR), by Mr Carlos Lopes (UN Assistant Secretary-General and Executive Director of UNITAR) and by the Director General of CERN, Mr Robert Aymar
Taylor, F E; Webb, G A M
The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) was established by the General Assembly in 1955 to report on the exposure of man to ionising radiation. In the subsequent twenty years the Committee has covered most aspects of the subject with repeated reviews of the levels of exposure from fallout due to weapons testing. The Committee is currently preparing a further report on doses from all sources and an evaluation of their biological effects. This is expected to be published in 1977. To aid it in compiling this report the Committee requested Member States of the UN to submit national data on a wide range of sources of exposure. The Board was asked by the Foreign and Commonwealth Office to collate the information requested from the United Kingdom. Data were available in the scientific literature on some topics, such as medical irradiation and environmental radioactivity. On some other topics, particularly occupational exposure, data have been collected but seldom publishe...
Should the surgeon or the general practitioner (GP follow up patients after surgery for colon cancer? A randomized controlled trial protocol focusing on quality of life, cost-effectiveness and serious clinical events
Full Text Available Abstract Background All patients who undergo surgery for colon cancer are followed up according to the guidelines of the Norwegian Gastrointestinal Cancer Group (NGICG. These guidelines state that the aims of follow-up after surgery are to perform quality assessment, provide support and improve survival. In Norway, most of these patients are followed up in a hospital setting. We describe a multi-centre randomized controlled trial to test whether these patients can be followed up by their general practitioner (GP without altering quality of life, cost effectiveness and/or the incidence of serious clinical events. Methods and Design Patients undergoing surgery for colon cancer with histological grade Dukes's Stage A, B or C and below 75 years of age are eligible for inclusion. They will be randomized after surgery to follow-up at the surgical outpatient clinic (control group or follow-up by the district GP (intervention group. Both study arms comply with the national NGICG guidelines. The primary endpoints will be quality of life (QoL (measured by the EORTC QLQ C-30 and the EQ-5D instruments, serious clinical events (SCEs, and costs. The follow-up period will be two years after surgery, and quality of life will be measured every three months. SCEs and costs will be estimated prospectively. The sample size was 170 patients. Discussion There is an ongoing debate on the best method of follow-up for patients with CRC. Due to a wide range of follow-up programmes and paucity of randomized trials, it is impossible to draw conclusions about the best combination and frequency of clinic (or family practice visits, blood tests, endoscopic procedures and radiological examinations that maximize the clinical outcome, quality of life and costs. Most studies on follow-up of CRC patients have been performed in a hospital outpatient setting. We hypothesize that postoperative follow-up of colon cancer patients (according to national guidelines by GPs will not have
Domes, Christopher M; Kruger, Cori L
Effective treatment of orthopedic injuries requires a multidisciplinary team, including physical and occupational therapists, athletic trainers, massage therapists, and acupuncturists. Orthopedic surgeons commonly encounter these practitioners but may not be familiar with the training, credentialing, and most importantly, the appropriate use of members of this team. There are general similarities in practice locations as well as types of symptoms addressed by the providers discussed, which include the treatment of physical pain, evaluation and treatment of physical impairment, and some facilitation of adaptation to the limitations caused by injuries. Across the 5 types of providers discussed there are widely varying training and licensing requirements, specializations, and continuing education requirements to maintain licensure. This article provides a focused review of these members of the multidisciplinary team and highlights the current American Academy of Orthopaedic Surgeons recommendations for the use of occupational and physical therapists for orthopedic conditions, including hip fractures, total hip arthroplasty, and anterior cruciate ligament reconstruction.
Gfrerer, Lisa; Mattos, David; Mastroianni, Melissa; Weng, Qing Y; Ricci, Joseph A; Heath, Martha P; Lin, Alex; Specht, Michelle C; Haynes, Alex B; Austen, William G; Liao, Eric C
Outcome studies of immediate implant-based breast reconstruction have focused largely on patient factors, whereas the relative impact of the surgeon as a contributing variable is not known. As the procedure requires collaboration of both a surgical oncologist and a plastic surgeon, the effect of the surgeon team interaction can have a significant impact on outcome. This study examines outcomes in implant-based breast reconstruction and the association with patient characteristics, surgeon, and surgeon team familiarity. A retrospective review of 3142 consecutive implant-based breast reconstruction mastectomy procedures at one institution was performed. Infection and skin necrosis rates were measured. Predictors of outcomes were identified by unadjusted logistic regression followed by multivariate logistic regression. Surgeon teams were grouped according to number of cases performed together. Patient characteristics remain the most important predictors for outcomes in implant-based breast reconstruction, with odds ratios above those of surgeon variables. The authors observed significant differences in the rate of skin necrosis between surgical oncologists with an approximately two-fold difference between surgeons with the highest and lowest rates. Surgeon teams that worked together on fewer than 150 procedures had higher rates of infection. Patient characteristics are the most important predictors for surgical outcomes in implant-based breast reconstruction, but surgeons and surgeon teams are also important variables. High-volume surgeon teams achieve lower rates of infection. This study highlights the need to examine modifiable risk factors associated with optimum implant-based breast reconstruction outcomes, which include patient and provider characteristics and the surgical team treating the patient. Risk, III.
Luciani, Eugene W
Whether new to private practice or a seasoned practitioner, an oral and maxillofacial surgeon (OMS) needs to understand how to handle complicated and often stressful negotiations of contracts for which he or she usually is untrained. This article is designed to give a general understanding of certain common contractual language. It is not comprehensive in scope, but it attempts to cover contracts that are most often seen by an OMS in practice. It is a general discussion of common legal concepts that could face an OMS, but it is not, nor is it intended to be, legal advice.
... gated community, mobile home park, or garden apartment); provided however, that MDU shall not include..., Exemption from 76.70 Channel access enforcement 76.10 Communities, Designated 76.51 Community, Principal contour 76.5 Community unit 76.5 Consumer education-selector switches 76.66 Cross-ownership 76.501...
Statistics for 1999 showed that Helen Joseph Hospital admits on the average 53 new .... Lund C & Flisher AJ. South African Mental Health Process Indicators. .... paper) will fall well on the ears of general hospital management. Moosa and ...
Siddiqui, Talha Mufeed; Khan, Rabia; Batool, Kanza
The aim of the study was to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cross-sectional study was conducted to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cluster-sampling technique was used and 200 dental surgeons from six different dental institutions were selected. A self-constructed questionnaire was distributed to the dental surgeons that comprised 20 closed-ended questions. The data was entered and analyzed for frequency and percentages by using Statistical Package for the Social Sciences (SPSS) version 19. The results showed that 76 (38%) dental surgeons took the responsibility of managing pediatric patient when given; 68 (34%) dental surgeons allowed the parents in the clinic; 111 (55.5%) dental surgeons are of the view that colorful and fun environment in dental clinic make the child at ease; 59 (29.5%) always demonstrate the dental procedure to the child to eradicate imaginary fears; 94 (47.0%) dental surgeons preferred the child to be treated in general anesthesia (GA) to avoid difficult behavior of the child; 135 (67.5%) dental surgeons did not show syringe needle or any instrument to the child. All the members of dental profession must be aware of patient perceptions, preferences, and fear to meet patient’s needs. Dental studies should include guidelines and techniques to train the upcoming dentists for excellent practice in pediatric dentistry. How to cite this article Wali A, Siddiqui TM, Khan R, Batool K. Knowledge, Attitude, and Practices of Dental Surgeons in managing Child Patients. Int J Clin Pediatr Dent 2016;9(4):372-378. PMID:28127171
Full Text Available Abstract Background The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. 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 physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. Conclusion The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.
LR Henry, LB Helou, NP Solomon, A Chang, SK Libutti, A Stojadinovic
Full Text Available Background: Heterogeneity of surgical care exists among surgeons regarding the conduct of thyroidectomy and parathyroidectomy.Aim: To identify the current patterns of technical conduct of operation amongst surgeons performing thyroidectomy or parathyroidectomy.Methods: A survey was designed and beta-tested on five surgical oncologists for face validity and usability. The final version of this survey was constructed and disseminated using the professional version of the internet-based survey mechanism Survey Monkey and consisted of two eligibility questions and 22 questions regarding thyroidectomy/parathyroidectomy treatment patterns. The survey was disseminated electronically to American Association of Endocrine Surgeons (AAES and American College of Surgeons (ACS members. Survey results were collected, tabulated and analyzed. Responses among groups were compared using two sample T- tests. Significant responses were subsequently analyzed in generalized linear models to ascertain if significance remained with control of covariates.Results: Of 420 initial web survey visits, 236 (56.2% surveys were completed. The majority of respondents reported being 'fellowship trained', experienced and 'high-volume' surgeons. The most common fellowship trainings were endocrine (46%, oncology (22%, head & neck (13%, or combinations of the three fellowships (14%. Most surgeons reported that they dissect the course of the recurrent laryngeal nerve (RLN without using neuromonitoring. Nearly a third of respondents reported routinely using the Harmonic scalpel during the conduct of the operations. Significant differences emerged regarding operative technique according to residency training type, fellowship training, surgeon volume, and practice setting, but only those associated with residency training type and annual surgeon surgical volume remained significant within generalized linear models.Conclusion: Most surgeons who responded to this survey do not routinely
Frost, Chelsea; Mesfin, Addisu
Various websites are dedicated to rating physicians. The goals of this study were to: (1) evaluate the prevalence of orthopedic surgeon ratings on physician rating websites in the United States and (2) evaluate factors that may affect ratings, such as sex, practice sector (academic or private), years of practice, and geographic location. A total of 557 orthopedic surgeons selected from the 30 most populated US cities were enrolled. The study period was June 1 to July 31, 2013. Practice type (academic vs private), sex, geographic location, and years since completion of training were evaluated. For each orthopedic surgeon, numeric ratings from 7 physician rating websites were collected. The ratings were standardized on a scale of 0 to 100. Written reviews were also collected and categorized as positive or negative. Of the 557 orthopedic surgeons, 525 (94.3%) were rated at least once on 1 of the physician rating websites. The average rating was 71.4. The study included 39 female physicians (7.4%) and 486 male physicians (92.6%). There were 204 (38.9%) physicians in academic practice and 321 (61.1%) in private practice. The greatest number of physicians, 281 (50.4%), practiced in the South and Southeast, whereas 276 (49.6%) practiced in the West, Midwest, and Northeast. Those in academic practice had significantly higher ratings (74.4 vs 71.1; P<.007). No significant difference based on sex (72.5 male physicians vs 70.2 female physicians; P=.17) or geographic location (P=.11) were noted. Most comments (64.6%) were positive or extremely positive. Physicians who were in practice for 6 to 10 years had significantly higher ratings (76.9, P<.01) than those in practice for 0 to 5 years (70.5) or for 21 or more years (70.7).
commander whose book Learning to Eat Soup with a Knife, was widely read by military leaders serving in Afghanistan and Iraq. Dr. Nagl also...sustainment training for units while deployed to Malaya.23 Arthur Campbell , a company commander in the Suffolk Regiment who served in Malaya in the early 1950s...Learning to Eat Soup with a Knife: Counterinsurgency Lessons from Malaya and Vietnam, comparing the Malayan Emergency and Vietnam War is akin to
terminated the contract for convenience . State also funded three capital-improvement projects—a potable-water tower, a commercial power upgrade, and...Million 37 SIGAR OVERSIGHT ACTIVITIES REPORT TO THE UNITED STATES CONGRESS I OCTOBER 30, 2014 convenience . INL paid AWCC $18.5 million of the $20.2...Abduzaziz, the owner of Aziz Restaurant and a bazaar, who was allegedly engaging in various criminal schemes on BAF, including vehicle thefts. The TCN
Koehn, Jacqueline K; Kuchenbecker, Katherine J
Clinical robotic surgery systems do not currently provide haptic feedback because surgical instrument interactions are difficult to measure and display. Our laboratory recently developed a technology that allows surgeons to feel and/or hear the high-frequency vibrations of robotic instruments as they interact with patient tissue and other tools. Until now, this type of feedback had not been carefully evaluated by users. We conducted two human-subject studies to discover whether surgeons and non-surgeons value the addition of vibration feedback from surgical instruments during robotic surgery. In the first experiment, 10 surgeons and 10 non-surgeons (n = 20) used an augmented Intuitive da Vinci Standard robot to repeatedly perform up to four dry-lab tasks both with and without haptic and audio feedback. In the second experiment, 68 surgeons and 26 non-surgeons (n = 94) tested the same robot at a surgical conference: each participant spent approximately 5 min performing one or two tasks. Almost all subjects in both experiments (95 and 98 %, respectively) preferred receiving feedback of tool vibrations, and all subjects in the second experiment thought it would be useful for surgeons to have the option of such feedback. About half of the subjects (50, 60 %) preferred haptic and audio feedback together, and almost all the rest (45, 35 %) preferred haptic feedback alone. Subjects stated that the feedback made them more aware of tool contacts and did not interfere with use of the robot. There were no significant differences between the responses of different subject populations for any questions in either experiment. This study illustrates that both surgeons and non-surgeons prefer instrument vibration feedback during robotic surgery. Some participants found audio feedback useful but most preferred haptic feedback overall. This strong preference for tool vibration feedback indicates that this technology provides valuable tactile information to the surgeon.
Buttenfield, B.P.; Stanislawski, L.V.; Brewer, C.A.
This paper reports on generalization and data modeling to create reduced scale versions of the National Hydrographic Dataset (NHD) for dissemination through The National Map, the primary data delivery portal for USGS. Our approach distinguishes local differences in physiographic factors, to demonstrate that knowledge about varying terrain (mountainous, hilly or flat) and varying climate (dry or humid) can support decisions about algorithms, parameters, and processing sequences to create generalized, smaller scale data versions which preserve distinct hydrographic patterns in these regions. We work with multiple subbasins of the NHD that provide a range of terrain and climate characteristics. Specifically tailored generalization sequences are used to create simplified versions of the high resolution data, which was compiled for 1:24,000 scale mapping. Results are evaluated cartographically and metrically against a medium resolution benchmark version compiled for 1:100,000, developing coefficients of linear and areal correspondence.
Williams, Katherine; Schneider, Brandon; Lajos, Paul; Marin, Michael; Faries, Peter
The increase in prevalence of certain cardiovascular risk factors increases susceptibility to vascular disease, which may create demand for surgical intervention. In our study, data collected by the American Association of Medical Colleges Physician Specialty Databook of 2012, the United States Census Bureau, and other nationwide organizations were referenced to calculate future changes in vascular surgeon supply and prevalence of people at risk for vascular disease. In 2010, there were 2853 active vascular surgeons. By 2040, the workforce is expected to linearly rise to 3573. There will be an exponential rise in people with cardiovascular risk factors. Adding to concern, in 2030, an estimated 3333 vascular surgeons will be available for 180,000,000 people with at least one risk factor for peripheral arterial disease. The paucity of properly trained surgeons entering the workforce needs to be addressed before this shortage becomes a larger burden on healthcare providers and governmental spending. © The Author(s) 2015.
Jaffe, Gregory A; Pradarelli, Jason C; Lemak, Christy Harris; Mulholland, Michael W; Dimick, Justin B
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.
Mavroudis, Constantine; Williams, William G
The Congenital Heart Surgeons' Society is a group of over 100 pediatric heart surgeons representing 72 institutions that specialize in the treatment of patients with congenital heart defects. The Society began in 1972 and incorporated as a not-for-profit charitable organization in 2004. It has become the face and voice of congenital heart surgery in North America. In 1985, the Society established a data center for multicenter clinical research studies to encourage congenital heart professionals to participate in improving outcomes for our patients. The goals of the Congenital Heart Surgeons' Society are to stimulate the study of congenital cardiac physiology, pathology, and management options which are instantiated in data collection, multi-institutional studies, and scientific meetings. Honest and open discussion of problems with possible solutions to the challenges facing congenital heart professionals have been the strength of the Congenital Heart Surgeons' Society. It is imperative for the growth of an organization to know from where it came in order to know to where it is going. The purpose of this article is to review the history of the Congenital Heart Surgeons' Society. © The Author(s) 2015.
刘金硕; 刘天晓; 吴慧; 曾秋梅; 任梦菲; 顾宜淳
对GPU(graphic process unit)、基于GPU的通用计算(general purpose GPU,GPGPU)、基于GPU的编程模型与环境进行了界定；将GPU的发展分为4个阶段,阐述了GPU的架构由非统一的渲染架构到统一的渲染架构,再到新一代的费米架构的变化；通过对基于GPU的通用计算的架构与多核CPU架构、分布式集群架构进行了软硬件的对比.分析表明:当进行中粒度的线程级数据密集型并行运算时,采用多核多线程并行；当进行粗粒度的网络密集型并行运算时,采用集群并行；当进行细粒度的计算密集型并行运算时,采用GPU通用计算并行.最后本文展示了未来的GPGPU的研究热点和发展方向--GPGPU自动并行化、CUDA对多种语言的支持、CUDA的性能优化,并介绍了GPGPU的一些典型应用.%This paper defines the outline of GPU(graphic processing unit) , the general purpose computation, the programming model and the environment for GPU. Besides, it introduces the evolution process from GPU to GPGPU (general purpose graphic processing unit) , and the change from non-uniform render architecture to the unified render architecture and the next Fermi architecture in details. Then it compares GPGPU architecture with multi-core GPU architecture and distributed cluster architecture from the perspective of software and hardware. When doing the middle grain level thread data intensive parallel computing, the multi-core and multi-thread should be utilized. When doing the coarse grain network computing, the cluster computing should be utilized. When doing the fine grained compute intensive parallel computing, the general purpose computation should be adopted. Meanwhile, some classical applications of GPGPU have been mentioned. At last, this paper demonstrates the further developments and research hotspots of GPGPU, which are automatic parallelization of GPGPU, multi-language support and performance optimization of CUDA, and introduces the classic
and to introduce salt-tolerant Bermuda grass into Iraq674 Th e PRT also met with German investors in- terested in establishing car dealerships in... Triangle Institute International SET Security Escort Team SIGAR Special Inspector General for Afghanistan Reconstruction SIGIR Special Inspector
Pizer, William; Burtraw, Dallas; Harrington, Winston; Newell, Richard; Sanchirico, James; Toman, Michael
This document provides technical documentation for work using detailed sectoral models to calibrate a general equilibrium analysis of market and non-market sectoral policies to address climate change. Results of this work can be found in the companion paper, "Modeling Costs of Economy-wide versus Sectoral Climate Policies Using Combined Aggregate-Sectoral Model".
Research examined how three middle school teachers included students with disabilities in their general education classrooms. Purposive sampling was used to select a sixth grade science teacher, seventh grade social studies teacher, and eighth grade math teacher whose classrooms were identified as exemplifying the characteristics of inclusive…
... Tanning is not a safe way to get vitamin D. The best way to protect your skin from UV rays is by using effective sun ... skin. Although it is important to get enough vitamin D, the safest way is through what you eat. Tanning ... IN What can policymakers do? • ...
Public Health Service (DHEW), Rockville, MD.
This book is divided into three sections. In the first section the health consequences of smoking are delineated. Part two contains discussions of the behavioral and biological aspects of smoking. The final section is devoted to educational opportunities for preventing addiction to tobacco. (JD)
Danelisen, D; Zigić, B; Rac, S
Contemporary way of living accompanied by everday frustrations, a frequent use of medicaments, an easy application of corticosteroids, complexity of an opeation, so as an increased incidence of polytraumas --those are the factors responsible for an increasing rate of stress ulcus. The rate of 54 verified stress ulcus in the period from 1969-1979 in Regional Medical Centre of Banja Luka, at Surgical Department, are very often indicative of this disease. Thirty eight operatively treated patients are indicative of severity of this disease. The authors are reporting their experiences in resolving this disease by method of vagotomy with partial gastrectomy in comparison to simple sutures of acutely developed ulcus in addition to PS vagotomy. Perforation, which has, usually, been bigger than the chronic ulcus, we had in 31 cases. If the reports of the world authors are reliable, perforation occurs in 5% of cases only, therefore it is clear how many such conditions has remained undetected or treated under various other "working" diagnoses: (DIC, consumer coagulopathy, fibrinolysis, etc.". The stress ulcus is the disease which is a danger to any patient at Surgical Department.
Full Text Available Aim: Hernia surgery is the second most common surgical intervention performed by general surgeons following emergent surgeries. Shouldice herniorraphy is a classical surgery which is in the high tension repair group. This technique should be known by every surgeon. Also being an alternative method, it can be a necessity in cases in which tension free methods can not be performed. In the present study we investigated the advantages, disadvantages and complications of the Shouldice herniorraphy and Lichtenstein technique with the review of the technical literature. Material and Method: We compared 75 patients who were diagnosed with inguinal hernia and treated with Lichtenstein herniorraphy with 33 patients who were treated with Shouldice herniorraphy in Samsun Bafra Public Hospital between April 2007 and May 2008. Age, sex, hernia type, anesthesia method, mean hospitalisation length, early and late post operative complications were recorded. Result: Early post operative complications were urinary retention, wound infection and hematoma. The patients under spinal anesthesia with urinary retention were treated with urinary catheterization. Superficial wound infection was treated with drainage and antibiotic threapy. Among late postoperative complications; we observed paresthesia in the thigh in one patient in the Shouldice group and relapse hernia in one patient in the Lichtenstein group. Discussion: We suggest that this surgical technique which should be known by every surgeon should be taught to new surgery attenders as an alternative technique. This technique can be an alternative method and also may be the first choice in patients in whom tension free methods can not be applicated.
Kaplan, Sigal; Prato, Carlo Giacomo
Introduction: Recent years have witnessed a growing interest in improving bus safety operations worldwide. While in the United States buses are considered relatively safe, the number of bus accidents is far from being negligible, triggering the introduction of the Motor-coach Enhanced Safety Act...... that accident severity increases: (i) for young bus drivers under the age of 25; (ii) for drivers beyond the age of 55, and most prominently for drivers over 65 years old; (iii) for female drivers; (iv) for very high (over 65 mph) and very low (under 20 mph) speed limits; (v) at intersections; (vi) because...
St Julien, Jamii B; Aldrich, Melinda C; Sheng, Shubin; Deppen, Stephen A; Burfeind, William R; Putnam, Joe B; Lambright, Eric S; Nesbitt, Jonathan C; Grogan, Eric L
Obesity has become a major epidemic in the United States. Although research suggests obesity does not increase major morbidity or mortality after thoracic operations, it likely results in greater use of health care resources. We examined all patients in The Society of Thoracic Surgeons General Thoracic Surgery database with primary lung cancer who underwent lobectomy from 2006 to 2010. We investigated the impact of body mass index (BMI) on total operating room time using a linear mixed-effects regression model and multiple imputations to account for missing data. Secondary outcomes included postoperative length of stay and 30-day mortality. Covariates included age, sex, race, forced expiratory volume, smoking status, Zubrod score, prior chemotherapy or radiation, steroid use, number of comorbidities, surgical approach, hospital lobectomy volume, hospital percent obesity, and the addition of mediastinoscopy or wedge resection. A total of 19,337 patients were included. The mean BMI was 27.3 kg/m2, with 4,898 patients (25.3%) having a BMI of 30 kg/m2 or greater. The mean total operating room time, length of stay, and 30-day mortality were 240 minutes, 6.7 days, and 1.8%, respectively. For every 10-unit increase in BMI, mean operating room time increased by 7.2 minutes (range, 4.8 to 8.4 minutes; pobese patients did not affect the association between BMI and operative time. Body mass index was not associated with 30-day mortality or increased length of stay. Increased BMI is associated with increased total operating room time, regardless of institutional experience with obese patients. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Emelyanov, V. N.; Karpenko, A. G.; Kozelkov, A. S.; Teterina, I. V.; Volkov, K. N.; Yalozo, A. V.
Computational methods are widely used in prediction of complex flowfields associated with off-normal situations in aerospace engineering. Modern graphics processing units (GPU) provide architectures and new programming models that enable to harness their large processing power and to design computational fluid dynamics (CFD) simulations at both high performance and low cost. Possibilities of the use of GPUs for the simulation of external and internal flows on unstructured meshes are discussed. The finite volume method is applied to solve three-dimensional unsteady compressible Euler and Navier-Stokes equations on unstructured meshes with high resolution numerical schemes. CUDA technology is used for programming implementation of parallel computational algorithms. Solutions of some benchmark test cases on GPUs are reported, and the results computed are compared with experimental and computational data. Approaches to optimization of the CFD code related to the use of different types of memory are considered. Speedup of solution on GPUs with respect to the solution on central processor unit (CPU) is compared. Performance measurements show that numerical schemes developed achieve 20-50 speedup on GPU hardware compared to CPU reference implementation. The results obtained provide promising perspective for designing a GPU-based software framework for applications in CFD.
Janssen, S.J.; Teunis, T.; Guitton, T.G.; Ring, D.; Biert, J.
BACKGROUND: 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. QUESTIONS/PURPOSES: (1) Are surgeons more likely to reco
McComb, Sara A; Lemaster, Matthew; Henneman, Elizabeth A; Hinchey, Kevin T
This study examines nurse-physician teamwork and collaboration, a critical component in the delivery of safe patient care, on general medical units. To that end, we assess shared mental models and mutual trust, 2 coordinating mechanisms that help facilitate teamwork, among nurses and physicians working on general medical units. Data were collected from 37 nurses and 42 physicians at an urban teaching medical center in the Northeastern United States. Shared mental model questionnaire items were iteratively developed with experts' input to ensure content validity. Mutual trust items were adapted from an existing scale; items were reliable. Data were analyzed using χ and independent 2-tailed t tests. Physicians and nurses reported significant differences in their perceptions of the professional responsible for a variety of roles (e.g., advocating for the patient [P = 0.0007], identifying a near miss/error [P = 0.003]). Medication reconciliation is only role for which nurses perceive less responsibility than physicians perceive nurses have. Regarding mutual trust, both groups reported significantly more trust within their own professions; both groups reported similar levels of trust in physicians, with physicians reporting significantly less trust in their nursing colleagues than nurses perceive (P collaboration, more work is needed. To that end, we propose increasing knowledge about their respective roles, providing opportunities for nurse and physician collaboration through rounding or committee work and enhancing the preparedness and professionalism of interactions.
Tong, Erica Y; Roman, Cristina P; Smit, De Villiers; Newnham, Harvey; Galbraith, Kirsten; Dooley, Michael J
A partnered medication review and charting model involving a pharmacist and medical officer was implemented in the Emergency Short Stay Unit and General Medicine Unit of a major tertiary hospital. The aim of the study was to describe the safety and effectiveness of partnered medication charting in this setting. A partnered medication review and charting model was developed. Credentialed pharmacists charted pre-admission medications and venous thromboembolism prophylaxis in collaboration with the admitting medical officer. The pharmacist subsequently had a clinical discussion with the treating nurse regarding the medication management plan for the patient. A prospective audit was undertaken of all patients from the initiation of the service. A total of 549 patients had medications charted by a pharmacist from the 14th of November 2012 to the 30th of April 2013. A total of 4765 medications were charted by pharmacists with 7 identified errors, corresponding to an error rate of 1.47 per 1000 medications charted. Partnered medication review and charting by a pharmacist in the Emergency Short Stay and General Medicine unit is achievable, safe and effective. Benefits from the model extend beyond the pharmacist charting the medications, with clinical value added to the admission process through early collaboration with the medical officer. Further research is required to provide evidence to further support this collaborative model. Copyright © 2015. Published by Elsevier Ltd.
livestock can be raised more economically in confi nement imported 12,400 Hungarian fi ngerlings to • cross-breed with heat -resistant Iraqi carp to...local population, who are primarily engaged in trading, farming, and raising sheep and calves . Th e Deputy Inspector General for Iraq July2009.indb...the challenges Basrah faced in unemployment, corruption, and fi scal stress .716 Security Security improved slightly, with four bombs exploding this
Bliss, J A; Caputy, G G
We as plastic surgeons are engrossed and consumed by our quest to optimize patient care. In so doing, we are often distracted by that aspect of our practice which has direct bearing on patient care yet for which we are the least prepared--the business aspect. The entire population of Canadian plastic surgeons was surveyed in an effort to establish real and perceived needs of this group with respect to the business management of their practices. The survey elicited demographic information, information on business educational background, interest, and current commitment in acquiring business knowledge, and a final category of questions dealing with how well these surgeons function as business managers. Of the 315 plastic surgeons surveyed, 122 (39 percent) responded, which, in and of itself, indicates an interest in this aspect of their practices. Twelve respondents were excluded from the study for various reasons. Eighty of the 110 remaining respondents (72 percent) used a hospital-integrated facility for both emergency and elective outpatient procedures. Eighty-four of the 110 respondents (76 percent) indicated that 10 percent of their hours per week of inpatient booked operating time was canceled. Ninety-three percent of respondents felt that a business course to familiarize surgeons with common business situations and areas of personal finance would be beneficial. Few were previously educated in business, and similarly, few had great ongoing interest in business, although the majority of respondents used publications specifically dealing with financial matters (provided by the Canadian Medical Association). Twenty-three percent of respondents saw themselves in a growing role as businesspeople; 24 percent felt this dual role was enjoyable, while 29 percent felt this role was forced on them. A total of 21 percent of respondents did not see themselves as businesspeople at all. The six basic functions of a manager (planning, acquiring, organizing, actuating
MacLean, L D
Most countries have mastered the art of cost containment by global budgeting for public expenditure. It is not as yet clear whether the other option, managed care, or managed competition will accomplish cost control in America. Robert Evans, a Canadian health care expert, remains skeptical. He says, "HMO's are the future, always have been and always will be." With few exceptions, the amount spent on health care is not a function of the system but of the gross domestic product per person. Great Britain is below the line expected for expenditure, which may be due to truly impressive waiting lists. The United States is above the line, which is probably related to the overhead costs to administer the system and the strong demand by patients for prompt and highly sophisticated diagnostic measures and treatments. Canada is on the line, but no other country has subscribed to the Canadian veto on private insurance. Reform or changes are occurring in all countries and will continue to do so. For example, we are as terrified of managed care in Canada as you are of our brand of socialized insurance. We distrust practice by protocol just as you abhor waiting lists. From my perspective as a surgeon, I envision an ideal system that would cover all citizens, would maintain choice of surgeon by patients, would provide mechanisms for cost containment that would have the active and continuous participation of the medical profession, and would provide for research and development. Any alteration in health care delivery in the United States that compromises biomedical research and development will be a retrogressive, expensive step that could adversely affect the health of nations everywhere. Finally, a continuing priority of our training programs must be to ensure that the surgeon participating in this system continues to treat each patient as an individual with concern for his or her own needs.
Levidiotou, Stamatina; Galanakis, Emmanouil; Vrioni, Georgia; Papamichael, Dimitrios; Nakos, Georgios; Stefanou, Dimitrios
In an Intensive Care Unit, three patients were found infected and two colonized with multiresistant Acinetobacter baumannii within a period of one week. To identify the outbreak source, two surveillance studies were performed concerning patients and the environment. Genotyping of isolates was performed by random amplification of polymorphic DNA analysis (RAPD). Environmental sampling failed to yield A. baumannii, with the exception of a single sample from a trunking. RAPD-fingerprinting yielded identical patterns for all patient isolates including the trunking isolate, thus confirming the suspected cluster. Since the strain from the trunking had a susceptibility pattern and a RAPD pattern identical to that of the strains isolated from the patients, we believe that this was the likely source of the outbreak. In conclusion, A. baumannii outbreaks may be quickly controlled by appropriate action of the hospital infection staff. RAPD-fingerprinting may provide a useful and rapid identification technique for the epidemiological investigation of a hospital outbreak.
Dindar, Saleh; Nguyen, Thien; Peters, Jörg
Enabling surgeon-educators to themselves create virtual reality (VR) training units promises greater variety, specialization, and relevance of the units. This paper describes a software bridge that semi-automates the scene-generation cycle, a key bottleneck in authoring, modeling, and developing VR units. Augmenting an open source modeling environment with physical behavior attachment and collision specifications yields single-click testing of the full force-feedback enabled anatomical scene.
Patrick J Stokes
Full Text Available Background Establishment of the Acute Surgical Unit (ASU has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34 – item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on – call rostering and workload, academic pursuits, surgical training, work – life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on – call rostering, improved surgical training and higher levels of job satisfaction and overall work – life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on – call rostering, work – life balance and overall job satisfaction.
Welch, James; Kanter, Benjamin; Skora, Brooke; McCombie, Scott; Henry, Isaac; McCombie, Devin; Kennedy, Rosemary; Soller, Babs
Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. An on-body wireless monitoring system was used to continually assess heart rate, respiratory rate, SpO2 and noninvasive blood pressure in the general ward of ten hospitals between April 1, 2014 and January 19, 2015. These data, 94,575 h for 3430 patients are contained in a large database, accessible with cloud computing tools. Simulation scenarios assessed the total alarm rate as a function of threshold and annunciation delay (s). The total alarm rate of ten alarms/patient/day predicted from the cloud-hosted database was the same as the total alarm rate for a 10 day evaluation (1550 h for 36 patients) in an independent hospital. Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.
McLawhorn, Alexander S; De Martino, Ivan; Fehring, Keith A; Sculco, Peter K
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.
Bass, Judith K; Bornemann, Thomas H; Burkey, Matthew; Chehil, Sonia; Chen, Lenis; Copeland, John R M; Eaton, William W; Ganju, Vijay; Hayward, Erin; Hock, Rebecca S; Kidwai, Rubeena; Kolappa, Kavitha; Lee, Patrick T; Minas, Harry; Or, Flora; Raviola, Giuseppe J; Saraceno, Benedetto; Patel, Vikram
Mental, neurological, and substance use (MNS) disorders are leading causes of the global burden of disease and profoundly impact the social and economic well-being of individuals and communities. The majority of people affected by MNS disorders globally do not have access to evidence-based interventions and many experience discrimination and abuses of their human rights. A United Nations General Assembly Special Session (UNGASS) is needed to focus global attention on MNS disorders as a core development issue requiring commitments to improve access to care, promote human rights, and strengthen the evidence on effective prevention and treatment.
Jalaliniya, Shahram; Pederson, Thomas
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...
Full Text Available Antibiotic prescription habits, cost pattern, and the prospective intervention in an Intensive Care Unit were analyzed. Methods: Data on antibiotic utilization and costs were collected prospectively from individual electronic charts from August 2003 to January 2004, and retrospectively from August to December 2002. Results: A total of 180 and 107 patients were surveyed in 2002 and 2003. In 2002, Piperacillin-Tazobactam (13.8% and Imipenem/Cilastin (11.2% were the most prescribed medications; while, in 2003, Vancomycin (12.6% and Imipenem/Cilastin (11.3% were prescribed, respectively. Total defined daily dose (DDD and Drug Utilization 90% (DU90% index for 2002 and 2003 were 2031.15 and 2325.90 DDDs (p>0.1 and 1777.57 and 2079.61 DU90%, respectively (p>0.1. The Median Total Cost /100 admission days (CI 95% were NIS13,310 (11,110;18,420 and NIS13,860 (6,710;18,020 (p=0.66, respectively. Conclusions: Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at minimizing the future emergence of bacterial resistance and futile expenses.
Osman Ersoy; Bulent Sivri; Yusuf Bayraktar
Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.
Hockenberry, Jason M; Helmchen, Lorens A
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.
Full Text Available Introduction: A pilomatrixoma is a benign appendage tumour related to hair cells matrix. Most of the literature review about pilomatrixoma is in the form of case reports with fewer cohort studies. The objective of this cohort is to study the variable demographic characteristics, presentation and histopathology of this condition among a larger group of patients. Materials and Methods: We conducted a retrospective study of patients who had excision of pilomatrixoma between February 1998 and August 2011 in a District General Hospital in UK. Results: The study included 67 patients with histopathologically diagnosed pilomatrixoma. The mean age was 32 years. Male to Female ratio was 35:32. The average diameter of the lesion at presentation was 13 mm (range: 2-30 mm. 66 of 67 (98.5% patients presented with solitary lesion, while 1 patient (1.5% had two lesions. Conclusion: Pilomatrixoma is not an uncommon benign lesion. It is more common in the maxillofacial area.
Johnson, Kathy A.; Shek, Molly
Astronauts in a space station are to some extent like patients in an intensive care unit (ICU). Medical support of a mission crew will require acquisition, transmission, distribution, integration, and archiving of significant amounts of data. These data are acquired by disparate systems and will require timely, reliable, and secure distribution to different communities for the execution of various tasks of space missions. The goal of the Comprehensive Medical Information System (CMIS) Project at Johnson Space Center Flight Medical Clinic is to integrate data from all Medical Operations sources, including the reference information sources and the electronic medical records of astronauts. A first step toward the full CMIS implementation is to integrate and organize the reference information sources and the electronic medical record with the Flight Surgeons console. In order to investigate this integration, we need to understand the usability problems of the Flight Surgeon's console in particular and medical information systems in general. One way to achieve this understanding is through the use of user and task analyses whose general purpose is to ensure that only the necessary and sufficient task features that match users capacities will be included in system implementations. The goal of this summer project was to conduct user and task analyses employing cognitive engineering techniques to analyze the task of the Flight Surgeons and Biomedical Engineers (BMEs) while they worked on Console. The techniques employed were user interviews, observations and a questionnaire to collect data for which a hierarchical task analysis and an information resource assessment were performed. They are described in more detail below. Finally, based on our analyses, we make recommendations for improvements to the support structure.
Wangensteen, O W
Surgeons will do well to remember that the two most important contributions to the growth and extension of surgery came from two disciplines, not then regarded as the most innovative. Anesthesia came from dentistry, the work primarily of W.T.G. Morton of Boston; prophylactic surgical antisepsis originated with the obstetrician Semmelweis, who developed a scheme of prophylactic chemical antisepsis that still remains the core of surgical antisepsis. In the mid 1880's, largely as a result of the work of Chamberland and others of the Pasteur school, surgeons in France and Germany substituted thermal for chemical antisepsis, whenever applicable. Whereas Lister's influence was tremendous in fostering acceptance of antisepsis by surgeons, by the end of his professorial career he had begun his capitulation to prophylactic antisepsis, which was complete by 1896 to the very practices that Semmelweis had proved the value of almost five decades previously. These were 19th century innovations. The greatest boon to surgery's advance in this century has been control of cellulitic infections through chemotherapeutic agencies, the sulfonamides and antibiotics. The tremendous upsurge of interest in research at the end of World War II brought surgeons to a fuller realization of the significant part they could play in the advance of their discipline. Intimate alignment of surgeons with physiologists of the circulation begot intracardiac surgery, a significant innovation with consequences of tremendous import for greater medicine's advance. Today, surgeons attacking the problem of tissue transplantation are aligning themselves with biochemists, geneticists, immunologists, experimental pathologists, and pharmacologists in their broad approach to the phenomenon of allograft rejection. The great extension of vascular surgery since World War II has made jewelers of surgeons of small tubular structures. The technical phases of these demanding operative procedures have largely been overcome
Sheikh, Asfandyar; Ali, Sajid; Ejaz, Sadaf; Farooqi, Marium; Ahmed, Syed Salman; Jawaid, Imran
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
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
Rhee, Daniel; Papandria, Dominic; Yang, Jessica; Zhang, Yiyi; Ortega, Gezzer; Colombani, Paul M; Chang, David C; Abdullah, Fizan
Improved surgical outcomes in children have been associated with pediatric surgical specialization, previously defined by surgeon operative volume or fellowship training. The present study evaluates pediatric surgical outcomes through classifying surgeons by degrees of pediatric versus adult operative experience. A cross-sectional study was performed using nationally representative hospital discharge data from 1998 to 2007. Patients under 18 years of age undergoing inpatient operations in neurosurgery, otolaryngology, cardiothoracic, general surgery, orthopedic surgery, and urology were included. An index was created, calculating the proportion of children treated by each surgeon. In-hospital mortality and length of stay were compared by index quartiles. Multivariate analysis was adjusted for patient and hospital characteristics. A total of 119,164 patients were operated on by 13,141 surgeons. Within cardiothoracic surgery, there were 1.78 (p=0.02) and 2.61 (ppediatric specialization respectively with the highest quartile. For general surgery, a 2.15 (p=0.04) increase in odds for mortality was found when comparing surgeons between the lowest and the highest quartiles. Comparing the least to the most specialized surgeons, length of stay increased 1.14 days (p=0.02) for cardiothoracic surgery, 0.58 days (p=0.04) for neurosurgery, 0.23 days (p=0.02) for otolaryngology, and decreased by 1.06 days (psurgery. The present study demonstrates that surgeons caring preferentially for children-as a proportion of their overall practice-generally have improved mortality outcomes in general and cardiothoracic surgery. These data suggest a benefit associated with increased referral of children to pediatric practitioners, but further study is required. Copyright © 2013 Elsevier Inc. All rights reserved.
Obi, S N; Waboso, P; Ozumba, B C
Our objective was to evaluate the level of occupational risk, attitude and behaviour of surgeons towards HIV-infected patients. A questionnaire survey of 264 randomly selected surgeons in training or in practice in five different health institutions in southeast Nigeria within a five-month period was carried out. A 94% response rate was obtained with completed questionnaires from 264 surgeons. The respondents included obstetricians and gynaecologists (n = 78), general surgeons (n = 121), orthopaedic surgeons (n = 40), dental surgeons (n = 10), ophthalmologists (n = 6), urologists (n = 5), and ear, nose and throat surgeons (n = 4). Of them, 31% (n = 82) were qualified surgeons in practice, while the remaining 69% (n = 182) were resident surgeons in training. In the past five years, 40.2% (n = 106) and 26% (n = 70) of the respondents reported needle-stick injuries and blood splash, respectively, during surgery. The majority of the victims were resident surgeons, obstetricians and gynaecologists, and orthopaedic surgeons. Level of clinical experience and high patient blood loss are likely to contribute to this observation. In all, 89% (n = 236) were engaged in the risky practice of operating on patients with open wounds in their hand and the wounds were contaminated with blood in 5% of cases. During surgical procedures, all (100%) respondents wore protective apron, 65.2% (n = 172) wore double gloves and 30.3% (n = 80) used protective goggles. The use of double gloves and protective eye wear increased remarkably over the past decade, probably because the fear of occupational transmission of HIV was substantial. In total, 83% (n = 220) of the respondents had some reservations about treating patients infected with HIV, while 13.3% (n = 35) viewed them with fear. The remaining 3.4% (n = 9) had a more positive attitude towards HIV-infected patients. Further, 92% advocated preoperative screening, with special precaution during surgery, if the results are positive. In
Full Text Available Introduction: The family planning centres must be upgraded to a cornerstone of primary health care, and prevent, advise and protect the citizen's health while reducing hospitalization costs for hospitals. Aim: The purpose of this literature review is the family planning centre development in general hospital of Argolida that has a similar clinic. Material and Methods: Literature review was conducted of published English and Greek Articles from bibliographic databases Medline, Google Scholar and Scopus for the period 2001-2014, using keywords like: "Family Planning», «SWOT analysis", "functional design" "prevention", "health promotion", "economic cost". The option of creating inpatient center was made after analysis SWOT, by defining objectives, performance indicators and existing alternatives. Also the timing of implementation and functional design, provide the springboard effort for effective operation. Conclusions: The development of family planning centres in the country and abroad is designed to address very important problems in the bud, in order to improve the quality of citizens' health, then reduce the financial burden on the health system as a result of prevention, and contribute indirectly to the mental balance of citizens.
Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A
A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.
Full Text Available OBJECTIVES: Analysis of discrepancies between patient and surgeon expectations before total hip arthroplasty (THA should enable a better understanding of motives of dissatisfaction about surgery, but this question has been seldom studied. Our objectives were to compare surgeons' and patients' expectations before THA, and to study factors which affected surgeon-patient agreement. METHODS: 132 adults (mean age 62.8+/-13.7 years, 52% men on waiting list for THA in three tertiary care centres and their 16 surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (range 0-100. Patients' and surgeons' answers were compared, for the total score and for the score of each item. Univariate analyses tested the effect of patients' characteristics on surgeons' and patients' expectations separately, and on surgeon-patient differences. RESULTS: Surgeon and patient expectations' mean scores were high (respectively 90.9+/-11.1 and 90.0+/-11.6 over 100. Surgeons' and patients' expectations showed no systematic difference, but there was little agreement on Bland and Altman graph and correlation coefficient was low. Patients had higher expectations than surgeons for sports. Patients rated their expectations according to trust in physician and mental quality of life, surgeons considered disability. More disabled patients and patients from a low-income professional category were often "more optimistic" than their surgeons. CONCLUSION: Surgeons and patients often do not agree on what to expect from THA. More disabled patients expect better outcomes than their surgeons.
Full Text Available INTRODUCTION: Staff time is a relevant resource in the delivery of health care interventions. Its measurement is a prerequisite for unit costing but usually complex. The aim of this study was to analyse the distribution of surgeons' work time among types and places of activities. A second aim was to use these data to calculate costs per unit of output. METHODS: A self-reporting work sampling study was carried out at a department of Urology. All of twelve surgeons involved in clinical care participated in a two-week analysis of their work time. RESULTS: A total of 2,485 data-points were collected, representing about 1,242 hours of work time. Surgeons spent the greater part of their work time in direct patient care, but substantial shares were required for documentation and organisation. Assistants were mainly required at the wards and consultants at the operating theatre and the outpatient unit. Staff costs of surgeons were 32 € and 29 € per patient day at the wards, respectively, 1.30 € per minute at the operating theatre and 32 € per visit at the outpatient unit. CONCLUSION: Results provided a basis for costing of health care interventions at the study site. However, future research should focus on the establishment of standardised terminology in order to increase transferability of results.
Troppmann, Kathrin M; Palis, Bryan E; Goodnight, James E; Ho, Hung S; Troppmann, Christoph
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 career to their own children. On multivariate analysis, significant risk factors were nonuniversity practice (OR 2.5) and dissatisfaction with reimbursement (OR 3.4). In all, 33.5% did not achieve 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.
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.
Park, Sung-Yeon; Park, SangHee
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.
The facial plastic surgeon potentially has a conflict of interest when confronted with the patients requesting surgery, due to the personal gain attainable by agreeing to perform surgery. The aim of this review is to discuss the potential harm the surgeon can inflict by carrying out facial plastic surgery, beyond the standard surgical complications of infection or bleeding. It will discuss the desire for self-improvement and perfection and increase in the prevalence facial plastic surgery. We address the principles of informed consent, beneficence and non-maleficence, as well as justice and equality and how the clinician who undertakes facial plastic surgery is at risk of breaching these principles without due care and diligence.
Bernstein, Joseph; Derman, Peter
The Balanced Budget Act of 1997 mandated reductions in physician reimbursement. This reduction in payments could be envisioned to limit expenditures on 2 counts: first, individual fees would be lower, producing inherent savings. Furthermore, reducing fees should depress the incentive to work, thereby generating additional savings from reduced output. A rival point of view holds that lower fees might paradoxically lead to greater spending because surgeons compensate for per-case reductions by performing more cases. If this income-targeting hypothesis is correct, lower per-case fees leads to increased volume. Increased work output has particularly sizable economic effects in fields like orthopedic surgery because the total cost of orthopedic interventions is usually many times larger than the physician's fee (largely owing to the cost of implants). As such, increases in work volume more than negate the potential savings from lower surgeon's fees.This phenomenon was studied in the context of total knee arthroplasty. In the decade spanning 1996 to 2005, inflation-adjusted physician reimbursement decreased by approximately 5% per year, leading to a cumulative drop in reimbursement from $2847 to $1685. Nonetheless, because the number of procedures performed increased from 253,841 to 498,169 and because payments to hospitals far exceeded payments to surgeons, total expenditures for total knee arthroplasty increased dramatically: more than $7.1 billion additional was spent on hospital payments. Continuing to pay surgeons less is apt to continue to cost more. Counter to intuition, the best strategy for controlling overall spending might be higher, not lower, surgical fees.
Evans, Roger G; Johnston, Colin I
On the morning of Friday June 9, Professor John Ludbrook died peacefully in his sleep at the age of 87. John will be deeply missed by his family, friends and colleagues. John Ludbrook had a long and distinguished career as a teacher, educator, surgeon, physiologist and lastly as a statistician. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Chen, Jenny T; Israel, Jacqueline S; Poore, Samuel O; Rao, Venkat K
The Patient Protection and Affordable Care Act, sometimes referred to as Obamacare, was signed into law on March 23, 2010. It represents the most extensive overhaul of the country's health care system since the passage of Medicare and Medicaid in 1965. The Affordable Care Act has two goals. The first goal is to reduce the uninsured population in the United States. Key elements to covering the uninsured include the following: (1) expanding Medicaid coverage for low-income individuals and (2) establishing health insurance marketplaces for moderate-income individuals with subsidies and tax cuts in an effort to make health insurance more affordable. The second goal of the Affordable Care Act is to address concerns about quality and the overall cost of U.S. health care. It is imperative that plastic surgeons thoroughly understand the impact that the Affordable Care Act will undoubtedly have on the country, on our patients, and on our clinical practices. Plastic surgery will see many changes in the future. This will include an overall increase in the number of insured patients, a push toward joining accountable care organizations, and a shift in payment systems to bundled reimbursement for episodes of care. In this article, the authors describe how these changes are likely to occur and what plastic surgeons must do to be part of the change.
Brooks, P J
Hip resurfacing has been proposed as an alternative to traditional total hip arthroplasty in young, active patients. Much has been learned following the introduction of metal-on-metal resurfacing devices in the 1990s. The triad of a well-designed device, implanted accurately, in the correct patient has never been more critical than with these implants. Following Food and Drug Administration approval in 2006, we studied the safety and effectiveness of one hip resurfacing device (Birmingham Hip Resurfacing) at our hospital in a large, single-surgeon series. We report our early to mid-term results in 1333 cases followed for a mean of 4.3 years (2 to 5.7) using a prospective, observational registry. The mean patient age was 53.1 years (12 to 84); 70% were male and 91% had osteoarthritis. Complications were few, including no dislocations, no femoral component loosening, two femoral neck fractures (0.15%), one socket loosening (0.08%), three deep infections (0.23%), and three cases of metallosis (0.23%). There were no destructive pseudotumours. Overall survivorship at up to 5.7 years was 99.2%. Aseptic survivorship in males under the age of 50 was 100%. We believe this is the largest United States series of a single surgeon using a single resurfacing system.
Adam, A; Spencer, K; Moon, S; Jacub, I
Mobile phone applications (Apps) have become a vital assistant to medical personnel in today's technologically advanced era. The utility of Apps with case logbook capabilities has not yet been explored. To assess and evaluate all currently available surgical and procedural case logbook Apps. A comprehensive search was conducted in April 2015 on the Android Play Store, iTunes (Apple App Store, iOS), and BlackBerry World for surgical and/or procedural logbooks. The search terms'surgical logbook', 'logbook', 'procedure logbook' and 'surgical log' were used. Apps which could not be utilized as a surgical/procedural logbook were excluded. Each App was individually assessed and rated using preset criteria, by the unit consultant, registrars, and medical officer. In total, 2 740 Apps were assessed. After applying our exclusion criteria, only 16 Apps were relevant, and 11 suitable for critical review. Data sizes ranged from 510Kb to 12.2Mb. Costing of the Apps ranged from ZAR 0.00 to ZAR 105.32. The overall study scores revealed the following top five rated Apps: Surgical Logbook by Surgilog; Surgeon Logbook Pro; Surgery Notebook, Surgical Logbook, and Universal Logbook. The current mobile Apps available are efficient in replacing traditional case logbooks. The use of the 'Smart Logbook' may become common practice in the life of the modern-day surgeon.
Full Text Available Sedation permits patients to tolerate the various treatment modalities to which they are subjected. However it may sometimes cause prolonged sedation in critically ill patients. Flumazenil, a benzo¬diazepine antagonist, reverses midazolam-induced sedation and amnesia. We prospectively designed a double-blind randomized study to evaluate the effects of flumazenil on thirty (30 Iranian General Intensive Care Unit (ICU patients. They were requiring mechanical ventilation for more than 12 hours and they were sedated by midazolam infusions. Sedation levels were measured hourly during the infusion, at the end of the infusion, and at 5, 15, 30, 60, and 120 min after cessation of the mida¬zolam infusion. Reversal of sedation was observed in all patients who received flumazenil, and re-sedation occurred in seven of these patients. Reversal was not seen in any of the patients who receiv-ed placebo.
... Reconstruction Surgery Questions to Ask Your Surgeon About Breast Reconstruction If you’ve had surgery to treat your ... reconstruction. Finding the right plastic surgeon for your breast reconstruction If you decide to have breast reconstruction, you’ ...
Okafor, Chika C; Lefebvre, Sandra L; Pearl, David L; Yang, Mingyin; Wang, Mansen; Blois, Shauna L; Lund, Elizabeth M; Dewey, Cate E
Calcium oxalate urolithiasis results from the formation of aggregates of calcium salts in the urinary tract. Difficulties associated with effectively treating calcium oxalate urolithiasis and the proportional increase in the prevalence of calcium oxalate uroliths relative to other urolith types over the last 2 decades has increased the concern of clinicians about this disease. To determine factors associated with the development of calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States, a retrospective case-control study was performed. A national electronic database of medical records of all dogs evaluated between October 1, 2007 and December 31, 2010 at 787 general care veterinary hospitals in the United States was reviewed. Dogs were selected as cases at the first-time diagnosis of a laboratory-confirmed urolith comprised of at least 70% calcium oxalate (n=452). Two sets of control dogs with no history of urolithiasis diagnosis were randomly selected after the medical records of all remaining dogs were reviewed: urinalysis examination was a requirement in the selection of one set (n=1808) but was not required in the other set (n=1808). Historical information extracted included urolith composition, dog's diet, age, sex, neuter status, breed size category, hospital location, date of diagnosis, and urinalysis results. Multivariable analysis showed that the odds of first-time diagnosis of calcium oxalate urolithiasis were significantly (P30 mg/dL (OR: 1.55, 1.04-2.30). Patient demographics and urinalysis results are important factors that can support risk assessment and early identification of canine oxalate urolithiasis. Therefore, periodic urolith screening and monitoring of urine parameters should be encouraged for dogs at risk of developing these uroliths.
Palleschi, Lorenzo; De Alfieri, Walter; Salani, Bernardo; Fimognari, Filippo Luca; Marsilii, Alberto; Pierantozzi, Andrea; Di Cioccio, Luigi; Zuccaro, Stefano Maria
To investigate the characteristics of patients who regain function during hospitalization and the differences in terms of functional outcomes between patients admitted to geriatric and general medicine units. Multicenter, prospective cohort study. Acute care geriatric and medical wards of five Italian hospitals. One thousand forty-eight elderly patients hospitalized for acute medical diseases. Functional status 2 weeks before hospital admission (baseline), at admission, and at discharge, as measured using the Barthel Index (BI). Geriatric patients were older (P<.001) and had lower preadmission functional levels (P<.001) than medical patients. Between baseline and discharge, 43.2% of geriatric and 18.9% of medical patients declined in physical function. In the subpopulation of 464 patients who had declined before hospitalization (between baseline and admission), 59% improved during hospitalization (45% of geriatric and 75% of medical patients), whereas only approximately 1% declined further. High baseline function (odds ratio (OR)=1.03, 95% confidence interval (CI)=1.02-1.04, per point of BI) and greater functional decline before hospitalization (OR 0.95, 95% CI 0.94-0.97, per % point of BI decline) were significant predictors of in-hospital functional improvement; type of hospital ward and age were not. Although geriatric patients have overall worse functional outcomes, in-hospital functional recovery may be frequent even in geriatric units, particularly in patients with greater preadmission functional loss and high baseline level of function. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
Conde Mui\\~no, Patricia; The ATLAS collaboration
General purpose Graphics Processor Units (GPGPU) are being evaluated for possible future inclusion in an upgraded ATLAS High Level Trigger farm. We have developed a demonstrator including GPGPU implementations of Inner Detector and Muon tracking and Calorimeter clustering within the ATLAS software framework. ATLAS is a general purpose particle physics experiment located on the LHC collider at CERN. The ATLAS Trigger system consists of two levels, with level 1 implemented in hardware and the High Level Trigger implemented in software running on a farm of commodity CPU. The High Level Trigger reduces the trigger rate from the 100 kHz level 1 acceptance rate to 1 kHz for recording, requiring an average per-event processing time of ~250 ms for this task. The selection in the high level trigger is based on reconstructing tracks in the Inner Detector and Muon Spectrometer and clusters of energy deposited in the Calorimeter. Performing this reconstruction within the available farm resources presents a significant ...
Willy, Christian; Hauer, Thorsten; Huschitt, Niels; Palm, Hans-Georg
the training of military surgeons (specialisation general surgery plus a second sub-specialisation either in visceral surgery or orthopaedics/trauma surgery) has been developed in the Joint Medical Service of the German Bundeswehr. Other relevant skills, such as emergency neurotraumatology, battlefield surgery with integrated oral and craniomaxillofacial surgery, and emergency gynaecology are also integrated into this concept and will be addressed in special courses. On successful completion of this training programme, military surgeons will be officially appointed as "Einsatzchirurg" for a duration of 5 years. After this time, it will be obligatory to renew this "combat ready" status. The buildings and materials in German military medical treatment facilities provide for excellent working conditions. The training programme for military surgeons in its end-2010 version has been designed specifically with data about injury pattern and non-battle diseases as well as the political situation and professional requirements in the civilian sphere in mind.
Pellegrini, Vincent D
A mentor serves as role model, counselor, and advocate for an understudy or protégé. The art and science of mentoring have been investigated most thoroughly in the educational literature, yet there are unique situational and individual considerations in the surgical arena that may warrant special consideration. The general attributes of successful mentors are not foreign to academic surgeons but may require deliberate cultivation to optimize mentorship in the context of academic medicine. Moreover, the stages of productive mentoring may be counter to the learned adaptive behaviors and instinctive personality traits of some accomplished surgeon educators. Indeed, examples of failed mentorship are common in our medical centers and, specifically, in surgical training programs. The behavioral adaptation that supports surgical decision-making under conditions of incomplete data and unusual stress often devalues succession planning and derivation of satisfaction from the success of other members of the team. Accordingly, fostering effective mentoring relationships in academic surgery will require a concerted effort to develop appropriate behaviors conducive to the mentoring process. The personal and professional growth of our students as well as the succession planning for our specialty are dependent upon the successful creation of an environment conducive to mentoring in academic orthopaedics.
Neuhaus, Susan J
The war service of Lilian Violet Cooper, the first female surgeon of the Royal Australasian College of Surgeons, is well recognized. Not so well known however, are the other pioneering female doctors who also undertook work as military surgeons during World War I. At least four of the 14 Australian female doctors that undertook overseas war service during World War I were engaged as surgeons and treated Australian, British and Allied casualties. These women operated in London, in Egypt and on the frontlines of the Macedonian campaign. While none of these other women became Fellows of the Royal Australasian College of Surgeons, their war efforts deserve recognition.
Gómez-Sánchez, Mario; Soulé-Egea, Mauricio; Herrera-Alarcón, Valentín; Barragán-García, Rodolfo
The Syntax score has been established as a tool to determine the complexity of coronary artery disease and as a guide for decision-making among coronary artery bypass surgery and percutaneous coronary intervention. The purpose of this review is to systematically examine what the Syntax score is, and how the surgeon should integrate the information in the selection and treatment of patients. We reviewed the results of the SYNTAX Trial, the clinical practice guidelines, as well as the benefits and limitations of the score. Finally we discuss the future directions of the Syntax score.
Harris, Ian A; Harris, Anita M; Naylor, Justine M; Adie, Sam; Mittal, Rajat; Dao, Alan T
We surveyed 331 patients undergoing total hip or knee arthroplasty pre-operatively, and patients and surgeons were both surveyed 6 and 12 months post-operatively. We identified variables (demographic factors, operative factors and patient expectations) as possible predictors for discordance in patient-surgeon satisfaction. At 12 months, 94.5% of surgeons and 90.3% of patients recorded satisfaction with the outcome. The discordance between patient and surgeon satisfaction was mainly due to patient dissatisfaction-surgeon satisfaction. In an adjusted analysis, the strongest predictors of discordance in patient-surgeon satisfaction were unmet patient expectations and the presence of complications. Advice to potential joint arthroplasty candidates regarding the decision to proceed with surgery should be informed by patient reported outcomes, rather than the surgeon's opinion of the likelihood of success.
Anderson, Cheryl I; Gupta, Rama N; Larson, Joseph R; Abubars, Omar I; Kwiecien, Andrew J; Lake, Alexander D; Hozain, Ahmed E; Tanious, Adam; O'Brien, Trevor; Basson, Marc D
Advancing surgical technology and decreasing resident learning hours have limited exposure to perioperative training, necessitating more effective and efficient perioperative teaching by faculty surgeons. Participation in collaborative efforts and process improvement can change behaviors and enhance teaching. To promote deliberate teaching of residents, change resident perception of their teachers, and produce sustainable improvements by objectively measuring surgeons' perioperative teaching performance. This 3-phase observational study of surgeons' perioperative teaching behaviors included university-based surgeons, general surgery residents, and preclinical student observers and involved elective cases at a 600+ bed tertiary hospital. Initially, we measured teaching behaviors by surgeons unaware of study objectives, provided aggregate and confidential individual feedback, and developed standardized preoperative briefings and postoperative debriefings. Phase 2 applied a deliberate teaching model and reinforced behaviors with continuous process improvement efforts (Plan, Do, Check, Act) and repeat observations. Phase 3 used resident prompts to enhance teaching behaviors and demonstrate sustainability. Resident surveys conducted 3 times assessed perceptions of deliberate guidance by faculty when compared with national benchmarks. Introduction of deliberate faculty preprocedural focusing and postprocedural reinforcement to facilitate resident learning. More frequent and complete perioperative teaching by faculty and the perception of enhanced teaching by residents. Faculty more commonly and more completely performed the 10-step preoperative briefings and postoperative debriefings (P teaching styles significantly improved and residents' survey-reported assessments of faculty teaching improved over national data for describing procedural steps (P = .02) and requests for resident self-evaluation (P = .006). Objective recording of teaching behavior frequency
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: firstname.lastname@example.org [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)
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
Full Text Available One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months.To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care.Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309. Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%.The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4. The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008. The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded.The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation.ClinicalTrials.gov NCT01136148.
Full Text Available BACKGROUND: Efforts to provide a valid picture of surgeons' individual performance evolution should frame their outcomes in relation to what is expected depending on their experience. We derived the learning curve of young thyroidectomy surgeons as a baseline to enable the accurate assessment of their individual outcomes and avoid erroneous conclusions that may derive from more traditional approaches. METHODS: Operative time and postoperative recurrent laryngeal nerve palsy of 2006 patients who underwent a thyroidectomy performed by 19 young surgeons in five academic hospitals were monitored from April 2008 to December 2009. The database was randomly divided into training and testing datasets. The training data served to determine the expected performance curve of surgeons during their career and factors influencing outcome variation using generalized estimating equations (GEEs. To simulate prospective monitoring of individual surgeon outcomes, the testing data were plotted on funnel plots and cumulative sum charts (CUSUM. Performance charting methods were utilized to present outcomes adjusted both for patient case-mix and surgeon experience. RESULTS: Generation of performance curves demonstrated a gradual reduction in operative time from 139 (95% CI, 137 to 141 to 75 (71 to 80 minutes, and from 15.7% (15.1% to 16.3% to 3.3% (3.0% to 3.6% regarding the nerve palsy rate. Charts interpretation revealed that a very young surgeon had better outcomes than expected, whereas a more experienced surgeon appeared to be a poor performer given the number of years that he had already spent in practice. CONCLUSIONS: Not considering the initial learning curve of surgeons exposes them to biased measurement and to misinterpretation in assessing their individual performance for thyroidectomy. The performance chart represents a valuable tool to monitor the outcome of surgeons with the expectation to provide safe and efficient care to patients.
Dunbar, Michael; Newman, Jared M; Khlopas, Anton; Chughtai, Morad; Martinez, Nick; Bhowmik-Stoker, Manoshi; Mont, Michael A
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.
Full Text Available Windblown hand is a term used in many instances to describe ulnar deviations of the fingers with or without other malformations. In 1994 Wood reviewed all of the descriptions of cases of windblown hand and pointed out how many variants of congenital ulnar drift there are, suggesting that the many variations seen may all belong to a larger type of arthrogryposis. While the most common cause of ulnar deviation of the fingers is rheumatoid arthritis, it can also be caused by other conditions such as windblown hand or Jaccoud’s arthropathy. While most hand surgeons are familiar with presentations of congenital ulnar drift, few of them are knowledgeable about Jaccoud’s arthropathy as this is usually discussed within medical communities such as Rheumatology. We present a case of a surgeon who has had noticeable ulnar deviation of the digits at the level of the metacarpophalangeal joint since his early 20s. We propose that the current case is a demonstration of a type of windblown hand that has some hereditary component but is not immediately obvious at birth and presents physically more like Jaccoud’s arthropathy than traditional windblown hand.
Brown, John W
In this article, I will outline the origin of cardiothoracic surgical (CTS) training at Indiana University (IU) and its evolution to the present. I will describe my educational background, surgical training in this specialty, and my role as an educator of CT surgeons. I will describe our faculty and the structure of the CTS residency. Finally, I will describe a newly adopted smart phone "App" called SIMPL, which allows the resident and faculty to quickly (50% of the most critical aspects of each surgical procedure, the resident's performance during the critical portion of the operation from poor to excellent, and the degree of difficulty of the operation from simple to complex. The attending surgeon and the resident data are then forwarded to the SIMPL database where the SIMPL software aggregates data for each resident and procedure producing a report at the end of the rotation of the resident's performance relative to his peers. This additional evaluation process will better ensure that our CTS residents are "practice ready" when they complete their training.
Smith, D E
The current generation of surgeons may remember Denis Browne only as an inventor of surgical instruments which few people use, an innovator of procedures condemned as inadequate, and a personality bristling with controversy: a maverick indeed. And yet this assessment belies his influence as the founder of modern paediatric surgery in the development of British surgery. Further, his innovative operations in a range of paediatric lesions were revolutionary in the context of the time. Browne was born in 1892 and educated in Australia, although his whole surgical career was in England. He had a remarkable family background; unique Australian experiences in childhood, when he commenced to display independence and individuality of spirit, through University, where he gained 'Blues' in tennis and shooting, to war, where he served in Gallipoli and France; and to controversies that surrounded him in his battle to establish paediatric surgery as a legitimate surgical discipline. He certainly had a prickly personality and a particular venom reserved for orthopaedic surgeons and anatomists, but his achievements may have been possible only by one possessed of such a strong and towering character.
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.
Curtis, Jack J; McKenney-Knox, Charlotte A; Wagner-Mann, Colette C
Because of the infrequent application of cardiac assist devices for postcardiotomy heart failure, most published reports include the results of learning curves from multiple surgeons. Between October 1986 and June 2001, a single surgeon used 35 Sarns Centrifugal Pumps as ventricular assist devices in 21 patients with severe hemodynamic compromise after open heart surgery (0.88% incidence). Patients' ages ranged from 39 to 77 (mean, 59.6 years). Three patients required right ventricular assist devices, 4 left ventricular assist devices, and 14 had biventricular assist devices. For all, the indication for application was inability to wean from cardiopulmonary bypass despite multiple inotropes and intraaortic balloon pumping. All were expected to be intraoperative deaths without further mechanical assistance. Patients were assisted from 2 to 434 h (median, 48 h). Fifteen patients (71.4%) were weaned from device(s), and 11 patients (52.4%) were hospital survivors. Actuarial survival in those dismissed from the hospital was 78% at 5 years and 39% at 10 years. Patients facing certain demise after cardiac surgery can be salvaged with temporary centrifugal mechanical assist. Results are competitive with that achieved with more sophisticated devices. Hospital survivors enjoy reasonable longevity.
Sivapalan, Murugesu; Wood, Eric F.; Beven, Keith J.
One of the shortcomings of the original theory of the geomorphologic unit hydrograph (GUH) is that it assumes that runoff is generated uniformly from the entire catchment area. It is now recognized that in many catchments much of the runoff during storm events is produced on partial areas which usually form on narrow bands along the stream network. A storm response model that includes runoff generation on partial areas by both Hortonian and Dunne mechanisms was recently developed by the authors. In this paper a methodology for integrating this partial area runoff generation model with the GUH-based runoff routing model is presented; this leads to a generalized GUH. The generalized GUH and the storm response model are then used to estimate physically based flood frequency distributions. In most previous work the initial moisture state of the catchment had been assumed to be constant for all the storms. In this paper we relax this assumption and allow the initial moisture conditions to vary between storms. The resulting flood frequency distributions are cast in a scaled dimensionless framework where issues such as catchment scale and similarity can be conveniently addressed. A number of experiments are performed to study the sensitivity of the flood frequency response to some of the 'similarity' parameters identified in this formulation. The results indicate that one of the most important components of the derived flood frequency model relates to the specification of processes within the runoff generation model; specifically the inclusion of both saturation excess and Horton infiltration excess runoff production mechanisms. The dominance of these mechanisms over different return periods of the flood frequency distribution can significantly affect the distributional shape and confidence limits about the distribution. Comparisons with observed flood distributions seem to indicate that such mixed runoff production mechanisms influence flood distribution shape. The
Full Text Available Teshome Abebe, Mullu Girmay, Girma G/Michael, Million Tesfaye Department of Anesthesia, Jimma University, Jimma, Ethiopia Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH, Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009–2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%, with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10–14 years (38.8%. Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3% of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively. Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. Keywords: trauma, critical care, pediatric, ICU, ventilation, oxygenation
In 1998 the United Nations General Assembly Special Session resolved that governments would reduce drug production and consumption greatly within 10 years. With that period now elapsed, there is an interest in reviewing how successful this was and considering how drug policy could be improved. The demand for drugs in the world has stabilized mainly as a result of the interaction of epidemic forces, culture and economic development. Supply has become more concentrated and the menu of drugs has changed surprisingly slowly. Drug policy is shifting to a more explicitly tolerant configuration in Europe and a few other countries, but retains its ferocity in most of the world. The most prominent innovations under discussion have limited potential effects (heroin maintenance), have as yet been unproductive of policy interventions ('addiction is a brain disease') or have no political appeal (legalization). The option with the most scope is increased effort at diverting arrested drug users out of criminal justice systems. No prevention, treatment or enforcement strategies have demonstrated an ability to substantially affect the extent of drug use and addiction. The best that government interventions can do is to reduce the damaging consequences of drug use and drug control. More attention should be given to reductions in the intensity of drug enforcement, which has many unintended adverse consequences and yields few of the claimed gains.
Matmari, Lakshmi; Uyeno, Jennifer; Heck, Carol S
To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning.
Donzelli, Alberto; Sghedoni, Donatella; Carelli, Francesco A; Chirchiglia, Saverio; Manunta, Paolo
The Clinical Pathway (in its complete definition Diagnostic, Clinical and Therapeutic Pathway - Percorso Diagnostico Terapeutico Assistenziale - PDTA), originally started to deal with the newly diagnosed hypertensive patient, developed also recommendations for the first-line drugs in case of specific indications/contraindications and organ damages. It has been developed by a working group of specialists in cardiology, nephrology, internal medicine (faculty included) designated by their hospitals (both public and private accredited), including all the main city hospitals, by general practitioners designated by the Medical Unions SNAMI, FIMMG, SMI and SiMI and by public health doctors belonging to the Local Health Unit of Milan, who have coordinated the proceedings and have guaranteed that possible conflicts of interest of single participants could not interfere with the PDTA, anyway approved by all in July 2009. The PDTA deals with the measuring and self- home-monitoring of blood pressure (BP) and the diagnosis of hypertension; it revises, sometimes "dries up" and rationalizes the recommendations for diagnostic tests and specialist evaluations; it develops prevention and non-pharmacological treatments, proposing also tools for patients and for prescribing correct nutrition and physical activity and a structured program for BP monitoring; but the main feature is the innovations brought in the proposed drug treatment in comparison with the current clinical practice.
Oladosu, Gbadebo A [ORNL; Rose, Adam [University of Southern California, Los Angeles; Bumsoo, Lee [University of Illinois
The foot and mouth disease (FMD) virus has high agro-terrorism potential because it is contagious, can be easily transmitted via inanimate objects and can be spread by wind. An outbreak of FMD in developed countries results in massive slaughtering of animals (for disease control) and disruptions in meat supply chains and trade, with potentially large economic losses. Although the United States has been FMD-free since 1929, the potential of FMD as a deliberate terrorist weapon calls for estimates of the physical and economic damage that could result from an outbreak. This paper estimates the economic impacts of three alternative scenarios of potential FMD attacks using a computable general equilibrium (CGE) model of the US economy. The three scenarios range from a small outbreak successfully contained within a state to a large multi-state attack resulting in slaughtering of 30 percent of the national livestock. Overall, the value of total output losses in our simulations range between $37 billion (0.15% of 2006 baseline economic output) and $228 billion (0.92%). Major impacts stem from the supply constraint on livestock due to massive animal slaughtering. As expected, the economic losses are heavily concentrated in agriculture and food manufacturing sectors, with losses ranging from $23 billion to $61 billion in the two industries.
... meet for my affected remediation material management units? 63.7886 Section 63.7886 Protection of... meet for my affected remediation material management units? (a) For each remediation material... material management units exempted under paragraph (c) or (d) of this section. (b) For each affected...
Ferraris, Victor A.; Ferraris, Suellen P.; Wehner, Paulette S.; Setser, Edward R.
The accuracy of risk adjustment is important in developing surgeon profiles. As surgeon profiles are obtained from observational, nonrandomized data, we hypothesized that selection bias exists in how patients are matched with surgeons and that this bias might influence surgeon profiles. We used the Society of Thoracic Surgeons risk model to calculate observed to expected (O/E) mortality ratios for each of six cardiac surgeons at a single institution. Propensity scores evaluated selection bias that might influence development of risk-adjusted mortality profiles. Six surgeons (four high and two low O/E ratios) performed 2298 coronary artery bypass grafting (CABG) operations over 4 years. Multivariate predictors of operative mortality included preoperative shock, advanced age, and renal dysfunction, but not the surgeon performing CABG. When patients were stratified into quartiles based on the propensity score for operative death, 83% of operative deaths (50 of 60) were in the highest risk quartile. There were significant differences in the number of high-risk patients operated upon by each surgeon. One surgeon had significantly more patients in the highest risk quartile and two surgeons had significantly less patients in the highest risk quartile (p < 0.05 by chi-square). Our results show that high-risk patients are preferentially shunted to certain surgeons, and away from others, for unexplained (and unmeasured) reasons. Subtle unmeasured factors undoubtedly influence how cardiac surgery patients are matched with surgeons. Problems may arise when applying national database benchmarks to local situations because of this unmeasured selection bias. PMID:23204823
Reinstein, Dan Z; Yap, Timothy E; Carp, Glenn I; Archer, Timothy J; Gobbe, Marine
To measure and compare the interobserver reproducibility of manifest refraction according to a standardized protocol for normal preoperative patients in a refractive surgery practice. Private clinic, London, United Kingdom. Retrospective case series. This retrospective study comprised patients attending 2 preoperative refractions before laser vision correction. The first manifest refraction was performed by 1 of 7 optometrists and the second manifest refraction by 1 of 2 surgeons, all trained using a standard manifest refraction protocol. Spherocylindrical data were converted into power vectors for analysis. The dioptric power differences between observers were calculated and analyzed. One thousand nine hundred twenty-two consecutive eyes were stratified into a myopia group and a hyperopia group and then further stratified by each surgeon-optometrist combination. The mean surgeon-optometrist dioptric power difference was 0.21 diopter (D) (range 0.15 to 0.32 D). The mean difference in spherical equivalent refraction was 0.03 D, with 95% of all refractions within ±0.44 D for all optometrist-surgeon combinations. The severity of myopic or hyperopic ametropia did not affect the interobserver reproducibility of the manifest refraction. There was close agreement in refraction between surgeons and optometrists using a standard manifest refraction protocol of less than 0.25 D. This degree of interobserver repeatability is similar to that in intraobserver repeatability studies published to date and may represent the value of training and the use of a standard manifest refraction protocol between refraction observers in a refractive surgery practice involving co-management between surgeons and optometrists. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
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. PMID:28529421
Cristancho, Sayra; Fenwick, Tara
The process of 'becoming' shapes professionals' capability, confidence and identity. In contrast to notions of rugged individuals who achieve definitive status as experts, 'becoming' is a continuous emergent condition. It is often a process of struggle, and is always interminably linked to its environs and relationships. 'Becoming' is a way of understanding the tensions of everyday practice and knowledge of professionals. In this paper, we explore the notion of 'becoming' from the perspective of surgeons. We suggest that 'becoming', as theorised by Deleuze, offers a more nuanced understanding than is often represented using conventional vocabularies of competence, error, quality and improvement. We develop this conception by drawing from our Deleuze-inspired study of mapping experience in surgery. We argue for Deleuzian mapping as a method to research health professionals' practice and experience, and suggest the utility of this approach as a pedagogical tool for medical education.
Venugopal, M; Sagesh, M
Foreign body oesophagus is one among the common otorhinolaryngology emergencies that we come across. Artificial partial denture impaction in the oesophagus is often an ENT surgeon's nightmare. This study was done in the department of otorhinolaryngology, Government Medical College Kozhikode for a period of 2 years. All patients presented with history of accidental swallowing of partial denture followed by dysphagia. Radiological evaluation was done and subsequently oesophagoscopy and removal of the denture was done. In failed cases exploration and removal of foreign body was required. Complications were found in partial denture with metal wire clasps. It is better to avoid using malfitting dentures with small base, those with metal wire clasps and be cautious of using dentures in alcoholics and unconscious patients.
Mello, Amílcar D'Avila de
In Brazil's sixteenth-century history, very few references are made to health professionals. On the expedition of Edward Fenton, dispatched by the English Crown in 1582 to set up a trading post in Asia, was the famous barber-surgeon and physician John Banister. The naval squadron, diverted from its original route to repeat the feats of Sir Francis Drake, stopped over in Africa, crossed the Atlantic and anchored off the Santa Catarina coast in Brazil. In these waters, the expedition degenerated into piracy and returned unsuccessful to Europe. John Banister is considered the person who liberated English anatomy from mediaeval slavery, shedding upon it the light of the Renaissance. It was the first time that anyone of this importance in the area of health had visited these latitudes.
Smith Peter G
Full Text Available Abstract Background There has been concern that the incidence of autism and other pervasive developmental disorders (PDDs is increasing. Previous studies have been smaller, restricted to autism (excluding other pervasive developmental disorders such as Asperger's syndrome, included boys only, or have not been based on a national sample. We investigated time trends in the rates of diagnosis of pervasive developmental disorders. Methods We analysed the rates of first diagnosis of pervasive developmental disorders among people registered with a practice contributing to the United Kingdom General Practice Research Database during the period 1988 to 2001. We included 1410 cases from over 14 million person-years of observation. The main outcome measures were rates of diagnosis of pervasive developmental disorders by year of diagnosis, year of birth, gender and geographical region. Results The rate increased progressively from 0.40/10,000 person-years (95% CI 0.30 to 0.54 in 1991 to 2.98/10,000 (95% CI 2.56 to 3.47 in 2001. A similar change occurred in the age standardised incidence ratios, from 35 (95% CI: 26–47 in 1991 to 365 (95% CI: 314–425 in 2001. The temporal increase was not limited to children born during specific years nor to children diagnosed in a specific time period. The rate of diagnosis of PDDs other than autism rose from zero for the period 1988–1992 to 1.06/10,000 person-years in 2001. The rate of diagnosis of autism also increased but to a lesser extent. There was marked geographical variation in rates, with standardised incidence ratios varying from 66 for Wales to 141 for the South East of England. Conclusions Better ascertainment of diagnosis is likely to have contributed to the observed temporal increase in rates of diagnosis of PDD, but we cannot exclude a real increase.
Wakeam, Elliot; Feinberg, Stan
Surgeon unemployment has become a crisis within Canadian surgery in recent years. Without dedicated governmental workforce planning, ensuring that new residency graduates can find employment will require new models of employment. Practice sharing, whereby a new graduate and a senior surgeon partner to divide their practices, allows the senior surgeon to wind down and the newer surgeon to ramp up. Importantly, this arrangement builds in formal mentoring, which is so important in the early years of starting a surgical practice. Practice sharing may be a solution for the workforce issues currently afflicting new surgical graduates across Canada.
Reddy, Vikram; Coffey, M Justin
Several studies have identified an increased risk of suicide among patient populations which a plastic surgeon may have a high risk of encountering: women undergoing breast augmentation, cosmetic surgery patients, and breast cancer patients. No formal guidelines exist to assist a plastic surgeon when faced with such a patient, and not every plastic surgery team has mental health clinicians that are readily accessible for consultation or referral. The goal of this clinical guide is to offer plastic surgeons a set of practical approaches to manage potentially suicidal patients. In addition, the authors review a screening tool, which can assist surgeons when encountering high-risk patients.
Ulf Martin Schilling
Objective: To assess the capability of operating abdominal and orthopaedic surgeons to analyze a set of standardized ECG. Methods: Twenty operating abdominal and orthopaedic surgeons at a university hospital were included. Each participant analyzed a set of five standardized ECG with an answering scheme for eight different items, giving a maximum score of 40. The answers were matched according to specialty and experience of the doctors of less than 5 years, between 5 and 10 years or more than 10 years. The reference standard was set by two independent consultants in cardiology. Results: The mean overall score was 25.25 (63.13%±4.78%) varying between 38 (95%) and 20(50%). Abdominal surgeons performed a mean score of 27.625 (69.06%±9.53%), and orthopaedic surgeons 23.67 points (59.17%±3.69%). The difference between the performance of abdominal and orthopaedic surgeons was not significant (P=0.09). 20/20 surgeons identified ST-elevation and no surgeon accepted the ECG showing acute ST-elevation myocardial infarction as normal. Conclusions: Abdominal and orthopaedic surgeons provided an answering scheme are able to interprete the ECG and identify both the normal and the ECG showing life-threatening pathology. The hypothesis that surgeons were unable to interprete the ECG must be rejected.
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.
Comptroller General of the U.S., Washington, DC.
This General Accounting Office (GAO) document is a summary of a GAO report that discusses: (1) the implications if the United States converts to the metric system of weights and measures; and (2) the conversion experiences of other countries. Topics covered include national policy, impact on industry and the public, benefits, advantages,…
Chokshi, Nikunj K; Behar, Solomon; Nager, Alan L; Dorey, Fred; Upperman, Jeffrey S
Contemporary events in the United States (eg, September 2001, school shootings), Europe (eg, Madrid train bombings), and the Middle East have raised awareness of mass casualty events and the need for a capable disaster response. Recent natural disasters have highlighted the poor preparation and infrastructure in place to respond to mass casualty events. In response, public health policy makers and emergency planners developed plans and prepared emergency response systems. Emergency response providers include first responders, a subset of emergency professionals, including firemen, law enforcement, paramedics, who respond to the incident scene and first receivers, a set of healthcare workers who receive the disaster victims at hospital facilities. The role of pediatric surgeons in mass casualty emergency response plans remains undefined. The authors hypothesize that pediatric surgeons' training and experience will predict their willingness and ability to be activated first receivers. The objective of our study was to determine the baseline experience, preparedness, willingness, and availability of pediatric surgeons to participate as activated first receivers. After institutional review board approval, the authors conducted an anonymous online survey of members of the American Pediatric Surgical Association in 2007. The authors explored four domains in this survey: (1) demographics, (2) disaster experience and perceived preparedness, (3) attitudes regarding responsibility and willingness to participate in a disaster response, and (4) availability to participate in a disaster response. The authors performed univariate and bivariate analyses to determine significance. Finally, the authors conducted a logistic regression to determine whether experience or preparedness factors affected the respondent's availability or willingness to respond to a disaster as a first receiver The authors sent 725 invitations and received 265 (36.6 percent) completed surveys. Overall, the
Borracci, Raúl A; Ferraina, Pedro; Arribalzaga, Eduardo B; Poveda Camargo, Ricardo L
Since the number of applicants to residencies in general surgery in Argentina seems to be decreasing, we designed this work with the objective of studying the factors considered undesirable by students when choosing surgery as a specialty. Between March and April 2012, one-hundred students were surveyed with a structured questionnaire with true/false binary answers in an observational case-control design. The survey contained 26 statements that made reference to characteristics of surgery as a specialty, or about the personality and lifestyle of surgeons, as they could be perceived by students. As a control group the same survey was applied to 20 surgeons who were in contact with the students and that could represent a role model for them during their rotation in surgery. Comparison between students and surgeons showed no difference in most answers, except in «surgery has poor reimbursement» (OR: 8,9; P=.0001), «there is not enough job demand» (OR: 8,1; P=.015), «surgery restrains intellectual development» (OR: 17,5; P=.014), «surgeons have too many non-scheduled activities» (OR: 9,36; P=.024), «they have a limited patient-physician relationship» (OR: 3,61; P=.009), «they have little time for family» (OR: 4,27; P=.036) and «they are exposed to infectious diseases» (OR: 5,90; P=.007). Women would be as interested as men in working as surgeons; a remarkable fact when considering that the surgical specialties have been predominantly filled by men. The fact that surgeons mostly coincide with the views of students means that role models should be reviewed to promote vocations. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.
Harris, Norman O.; And Others
A programed course in general histology was completely developed by dental schools in the United States and Brazil. A group of international experts specified the course objectives, wrote and taped scripts for a series of 28 lectures of 50 minutes each, developed slides to accompany the lectures, prepared microphotographs and scripts to explain…
Stokes, T.; Tarrant, C.; Mainous, A.G.; Schers, H.J.; Freeman, G.; Baker, R.
PURPOSE: We determined the reported value general practitioners/family physicians in 3 different health care systems place on the various types of continuity of care. METHODS: We conducted a postal questionnaire survey in England and Wales, the United States, and The Netherlands. The participants we
... General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North America, NPA Coatings, Inc., and Premier... Motor Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota...
... General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North America, NPA Coatings, Inc., Premier... of General Motors Corporation and Toyota Motor Corporation, including on-site leased workers...
Shepherd, Jonathan P.; Kantartzis, Kelly L.; Lee, Ted; Bonidie, Michael J.
Background and Objective: Hysterectomy is one of the most common surgical procedures women will undergo in their lifetime. Several factors affect surgical outcomes. It has been suggested that high-volume surgeons favorably affect outcomes and hospital cost. The objective is to determine the impact of individual surgeon volume on total hospital costs for hysterectomy. Methods: This is a retrospective cohort of women undergoing hysterectomy for benign indications from 2011 to 2013 at 10 hospitals within the University of Pittsburgh Medical Center System. Cases that included concomitant procedures were excluded. Costs by surgeon volume were analyzed by tertile group and with linear regression. Results: We studied 5,961 hysterectomies performed by 257 surgeons: 41.5% laparoscopic, 27.9% abdominal, 18.3% vaginal, and 12.3% robotic. Surgeons performed 1–542 cases (median = 4, IQR = 1–24). Surgeons were separated into equal tertiles by case volume: low (1–2 cases; median total cost, $4,349.02; 95% confidence interval [CI] [$3,903.54–$4,845.34]), medium (3–15 cases; median total cost, $2,807.90; 95% CI [$2,693.71–$2,926.93]) and high (>15 cases, median total cost $2,935.12, 95% CI [$2,916.31–$2,981.91]). ANOVA analysis showed a significant decrease (P < .001) in cost from low-to-medium– and low-to-high–volume surgeons. Linear regression showed a significant linear relationship (P < .001), with a $1.15 cost reduction per case with each additional hysterectomy. Thus, if a surgeon performed 100 cases, costs were $115 less per case (100 × $1.15), for a total savings of $11,500.00 (100 × $115). Conclusion: Overall, in our models, costs decreased as surgeon volume increased. Low-volume surgeons had significantly higher costs than both medium- and high-volume surgeons.
Wyrzykowski, Amy D; Han, E; Pettitt, B J; Styblo, T M; Rozycki, G S
The objective of this study was to determine the profile (credentials, training, and type of practice) of female academic general surgeons and factors that influenced their career choice. A survey was sent to female academic surgeons identified through general surgery residency programs and American medical schools. The women had to be Board eligible/certified by the American Board of Surgery or equivalent Board and have an academic appointment in a Department of Surgery. Data were analyzed using the SPSS program. Two hundred seventy women (age range, 32-70 years) completed the survey (98.9% response rate). Fellowships were completed by 82.3 per cent (223/270), most commonly in surgical critical care. There were 134 (50.2%, 134/367) who had two or more Board certificates, most frequently (46%, 61/134) in surgical critical care. Full-time academic appointments were held by 86.7 per cent of women, most as assistant professors, clinical track; only 12.4 per cent were tenured professors. The majority of women described their practice as "general surgery" or "general surgery with emphasis on breast." The most frequent administrative title was "Director." Only three women stated that they were "chair" of the department. The top reason for choosing surgery was "gut feeling," whereas "intellectual challenge" was the reason they pursued academic surgery. When asked "Would you do it again?", 77 per cent responded in the affirmative. We conclude that female academic surgeons are well trained, with slightly more than half having two or more Board certificates; that most female academic surgeons are clinically active assistant or associate professors whose practice is "general surgery," often with an emphasis on breast disease; that true leadership positions remain elusive for women in academic general surgery; and that 77 per cent would choose the same career again.
Stafford, Renae E; Dreesen, Elizabeth B; Charles, Anthony; Marshall, Harry; Rudisill, Michele; Estes, Eithiel
The American Board of Surgery has adopted the Maintenance of Certification requirement for surgeons. It requires continuous professional development (CPD) using active and passive learning modalities in contrast to traditional continuing medical education (CME). The Rural Trauma Team Development Course developed by the American College of Surgeons Committee on Trauma is a CPD learning activity. We provided 22 free courses between May 2007 and June 2009 to trauma care providers at 11 affiliated community and critical access hospitals. The course was taught on-site by an interdisciplinary group and at least one trauma surgeon was faculty. Free Category I CME credits and continuing education units were provided. Two hundred thirty-four providers attended and the majority were RNs (60%) and emergency medical technicians (21.8%). Only 18 were physicians (7.7%) and none were surgeons. The majority felt that they would change their practice as a result of the course but cited the lack of attendance at the course by emergency physicians and surgeons as a deficit. It may be that surgeons have barriers such as time away from a practice to attending these newer types of educational opportunities. Those who develop and offer these courses may need to develop different strategies to reach this target audience.
Vanderbilt, Allison A; Isringhausen, Kim T; VanderWielen, Lynn M.; Wright, Marcie S.; Slashcheva, Lyubov D.; Madden, Molly A.
Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, ...
Adamson, Peter A; Zavod, Matthew B
Beauty is a mystery that has been with us for ages. Scholars and scientists have investigated its roots and effects, and its presence is ubiquitous. Has the construct of beauty changed over time? Is our sense of beauty learned or innate? What IS beauty, and can we quantify it? A substantial amount of work supports a Darwinian theory of selection, which predicts a survival advantage based on physical attractiveness. However, there is evidence that certain perceptions of beauty change with time. Indeed, the recent globalization of modern society has wrought changes in our perceptions of beauty. Are patients electing cosmetic surgery procuring a survival advantage, or are they bypassing genetics and setting a new standard for beauty? As facial plastic surgeons, we must be poised to respond to this metamorphosis and understand its roots. Although there is some equivocation and debate about this elusive subject, it is our duty to stay abreast of the current dynamic to make sound judgments that are in the best interests of our patients.
Baig, Nabeel Naeem; Aleem, Sajid Atif
To determine the frequency of different occupational hazards among dental surgeons in Karachi. Cross-sectional survey. Amulticenter study conducted at Ameen Diabetic and Dental Hospital, Dental OPD, Karachi Medical and Dental College, and Abbasi Shaheed Hospital, Karachi, from February to March 2014. Dentists, practicing in different areas of Karachi, were given a self-administered questionnaire. It comprised of a form containing information about the socio-demographic profile of dentists and questionnaires regarding occupational hazards experienced in practice. Atotal of 130 dentists, involved in clinical practice, were randomly selected. There were 45 (35%) males and 85 (65%) females. The average age was 39 ±5.76 years. Out of 130 dentists, 93.8% (122/130) had occupational hazard during practice. Cervical back pain was observed in 81.96% dentists followed by knee / elbow joint pain in 53.27%, eye infection in 44.615%, impaired hearing in 40.98%, psychological stress in 41.80% and material allergy was 12.29%. Various spinal and joint pains, eye infections, impaired hearing, stress and material allergy represented occupational hazard to 93.8% of the surveyed dentists.
Conclusion: Our results show a dearth of awareness among surgeons regarding diathermy. Given our findings, we urge a shift in attitude towards diathermy, with surgeons adopting a more cautious and safe approach to diathermy use. We recommend that formal training be introduced as a hospital based initiative.
Ulf Martin Schilling
Conclusions: Abdominal and orthopaedic surgeons provided an answering scheme are able to interprete the ECG and identify both the normal and the ECG showing life-threatening pathology. The hypothesis that surgeons were unable to interprete the ECG must be rejected.
Olakowski, Marek; Hładoń, Aleksandra; Seweryn, Mariusz; Ciosek, Jakub; Świątkiewicz, Wojciech
In Polish society Stereotypes about the surgeons are deeply rooted, which could really affect their relationship with the patient and the entire treatment process. The aim of the study was to evaluate the results of an opinion survey on the image of the surgeon and operative treatment.
Manning, Blaine T; Ahn, Junyoung; Bohl, Daniel D; Mayo, Benjamin C; Louie, Philip K; Singh, Kern
A prospective questionnaire. The aim of this study was to evaluate factors that patients consider when selecting a spine surgeon. The rise in consumer-driven health insurance plans has increased the role of patients in provider selection. The purpose of this study is to identify factors that may influence a patient's criteria for selecting a spine surgeon. Two hundred thirty-one patients who sought treatment by one spine surgeon completed an anonymous questionnaire consisting of 26 questions. Four questions regarded demographic information; 16 questions asked respondents to rate the importance of specific criteria regarding spine surgeon selection (scale 1-10, with 10 being the most important); and six questions were multiple-choice regarding patient preferences toward aspects of their surgeon (age, training background, etc.). Patients rated board certification (9.26 ± 1.67), in-network provider status (8.10 ± 3.04), and friendliness/bedside manner (8.01 ± 2.35) highest among factors considered when selecting a spine surgeon. Most patients (92%) reported that 30 minutes or less should pass between check-in and seeing their surgeon during a clinic appointment. Regarding whether their spine surgeon underwent training as a neurosurgeon versus an orthopedic surgeon, 25% reported no preference, 52% preferred neurosurgical training, and 23% preferred orthopedic training. Our findings suggest that board certification and in-network health insurance plans may be most important in patients' criteria for choosing a spine surgeon. Advertisements were rated least important by patients. Patients expressed varying preferences regarding ideal surgeon age, training background, proximity, medical student/resident involvement, and clinic appointment availability. The surgeon from whom patients sought treatment completed an orthopedic surgery residency; hence, it is notable that 52% of patients preferred a spine surgeon with a neurosurgical background. In the context
Richards, Robin; McLeod, Robin; Latter, David; Keshavjee, Shaf; Rotstein, Ori; Fehlings, Michael G; Ahmed, Najma; Nathens, Avery; Rutka, James
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.
Kałuzny, Jakub J; Eliks, Iwona; Mierzejewski, Andrzej; Kałuzny, Bartłomiej
To compare patient's pain and surgeon's comfort during ECCE performed under retrobulbar anesthesia and phacoemulsification under topical anesthesia. 120 patients scheduled for planned routine cataract extraction were divided in 2 groups: group 1-60 eyes, ECCE under retrobulbar anesthesia and group II-60 eyes, phacoemulsification under topical anesthesia. Immediately after operation patients were asked, to answer questions about their feeling during surgery. Simultaneously, the surgeon filled up the questionnaire, concerning patients behavior during the entire procedure. Statistically significant higher level of pain was reported in group I (ECCE). The most painful moment of the procedure was retrobulbar injection. During surgery pain feeling in both groups was similar. Both types of anesthesia provided very good level of surgeon's comfort. The longer operation, the higher level of pain and lower surgeon's comfort were reported in both groups. Patients having ECCE performed under retrobulbar anesthesia reported more pain comparing to phacoemulsification under topical anesthesia. Both anesthesia methods provided high level of surgeon's comfort.
Cannon, Jeremy W; Teff, Richard J
By 1942, Loyal Davis had firmly established himself as a preeminent civilian neurosurgeon. With military operations rapidly escalating, he was recruited to serve in the European Theater of Operations as a consultant to the Surgeon General. Davis brought tremendous experience, insight, and leadership to this position; however, he found the military system in which he was suddenly immersed inefficient and impassive. His requests for even basic equipment became mired in endless bureaucracy even as his communiqués to the Chief Surgeon in the European Theater and to the Surgeon General's staff in Washington seemed to fall short of their intended recipients. Then, when he attempted to vent his frustrations to his academic colleagues, he was nearly court-martialed. Notwithstanding, Davis became the first to formally recognize high-altitude frostbite and also developed protective headgear for airmen, and later in his service, he joined a contingent of senior medical leaders who visited the Soviet Union to study their system of combat casualty care. Subsequent to his service on active duty, Davis returned to his academic practice at Northwestern where he used his position as editor of Surgery, Gynecology, and Obstetrics to advocate for change within the military medical corps. Others like Davis have contributed greatly to the advancement of combat casualty care both during active service and long after their time in uniform. This paper examines the lessons from Davis's experiences as a military neurosurgeon and his continued advocacy for change in the medical corps along with additional recent examples of change effected by former military surgeons. For those currently serving, these lessons illustrate the value of contributing wherever a need is recognized, and for those who have served in the past, they demonstrate the importance of having a continued voice with junior combat surgeons and the military leadership.
McCartan, D P
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.
Full Text Available Background: Development of infection in burned patients is a crucial matter because it may increase morbidity and mortality. Factors contributing to high risk for infections are disrupted skin barrier, dysfunction of the immune system and prolonged hospitalization. Crowded hospital condition and transfer of patients from one unit to another can affect development of infection caused by environmental factors. The aim of the study was to identify the antimicrobial suspectibility of bacterial isolated from Burn Unit in Dr. Hasan Sadikin General Hospital, Bandung. Methods: A descriptive study was carried out in Burn Unit Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from June to September 2013. A total of 30 environment samples were collected and cultured to identify the bacterias. Futhermore, the colonies found, underwent antimicrobial susceptibility test. Results: Most common bacteria found from the environmental samples in Burn Unit was Staphylococcus saprophyticus (24%. Other bacterias found were Klebsiella pneumonia (17%, Acinetobacter baumanii (15%, Staphylococcus epidermidis (12%, Bacillus sp.(12%, Pseudomonas sp.(7%, Staphylococcus aureus (5%, Enterobacter aerogenes (5% and Serratia sp. (2%. Some bacteria still had good sensitivity to antibiotics while the Enterobacteriaceae were almost completely resistant to antimicrobial used in the study. Conclusions: The most common bacteria found from the environment samples in Burn Unit is Staphylococcuss aprophyticus. Additionally, Klebsiella pneumoniae as one of the Enterobacteriaceae groups, appears as an emerging hospital associated infection pathogen with their resistant to many antimicrobials.
Kordahi, Anthony M.; Hoppe, Ian C.; Lee, Edward S.
Background: Reduction mammoplasty is an often-performed procedure by plastic surgeons and increasingly by general surgeons. The question has been posed in both general surgical literature and plastic surgical literature as to whether this procedure should remain the domain of surgical specialists. Some general surgeons are trained in breast reductions, whereas all plastic surgeons receive training in this procedure. The National Surgical Quality Improvement Project provides a unique opportuni...
Khera, G; Wild, J R L; Fitzgerald, J E F
The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. With a membership of over 2000 surgical trainees from all ten surgical specialities, the association provides support at both regional and national levels throughout the United Kingdom and Republic of Ireland. Originally founded in 1976, ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and speciality associations. The 2012 Annual Conference in Cardiff City Hall brought together nearly 700 delegates for an educational weekend programme with expert guest speakers. Clinical updates were complimented by debates on current training in surgery, and the weekend included 6 pre-conference courses covering a diverse range of topics including laparoscopic skills, surgical drawing and a masterclass in journal club. A record number of 1168 abstract submissions were received and those successful competed for 18 awards representing £3500 in trainee prizes and bursaries. As the only national surgical trainee meeting for all specialities, ASiT continues to grow and we look forward to an even larger and more successful conference next year.
M M Zameer
Conclusion: This is the first study which objectively highlights that most surgeons are happy professionally and financially in due course of time and demolishes the common belief that pediatric surgeons are unsatisfied. It also acts as a point of reference and encouragement to newer aspirants in pediatric surgery.
... General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North America, and NPA Coatings, Inc., and On... Manufacturing, Inc., formerly a joint ] venture of General Motors Corporation and Toyota Motor...
Williams, Thomas E; Sun, Benjamin; Ross, Patrick; Thomas, Andrew M
To estimate the cardiovascular workforce needed by 2030 to meet the needs of our population and to quantify its costs. Our field is changing. The volume of surgery and the nature of the surgery are changing. The nation's population grew from 227,000,000 to 282,000,000 between 1980 and 2000, and by 2030 the population is estimated to be 364,000,000. At the same time, the applications for fellowship in our specialty are decreasing at an alarming rate. The American Board of Thoracic Surgery has certified 4500 cardiothoracic surgeons since 1975, but only 1300 in the last 10 years. The US Department of Health and Human Services predicts only 3620 full-time cardiothoracic surgeons in 2020. Will we have enough cardiovascular and thoracic surgeons? Retrospective examination of the pertinent literature and with a modified Richard Cooper's economic trend analysis, a population algorithm with a ratio of physicians to population of 1.42 per 100,000. Each thoracic surgeon is predicted to practice 30 years from Board certification to retirement. The Balanced Budget Act will not be revised; therefore, we will certify 100 graduates from our programs per year. The assumed salaries will be 50,000 dollars with benefits of 30% and 15,000 dollars of additional Direct Medical Education costs. The population in 2030 will be 364,000,000 with 5169 cardiothoracic surgeons needed at that time. Unfortunately, there will be approximately only 3200 cardiothoracic surgeons in practice with a shortage of approximately 2000. To maintain our current status per 100,000 population from 2011 to 2030, we will have to train 4000 residents. The total person years would be approximately 28,000. The cost for this is more than 2,000,000,000 dollars. The annual cost for this training prorated over 20 years would be more than 110,000,000 dollars. We must train approximately 4000 surgeons, an extra 100 per year, in our specialty to meet the needs of the population by 2030. That will cost approximately 2
Lim, Ji Young
The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.
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.
Full Text Available In an international context embracing the idealist concepts of harmony, cooperation, structural peace, illegality of war, the United Nations Organization has created a system of peaceful settlement of disputes, based on principles of justice and international law. In this framework, the organs bearing the responsibility of peaceful resolution of conflicts are the International Court of Justice, the Security Council, the General Assembly and the Secretary-General. The latter has a unique position, triggering a spectacular evolution of its role in the maintenance of international peace and security. The challenges of the international environment and the outstanding ways in which they were addressed by the distinctive personalities that filled the function of the Secretary General, creating precedents and influencing its future development, have led to a continuous enlargement of its role. The purpose of the present paper is that of defining the role of the Secretary-General in the system of peaceful settlement of international disputes created by the United Nations, by analysing the relevant provisions consecrated in the Charter and by revealing and explaining the outstanding evolution of this institution, with an emphasis on the relations of mutual influence between the High Official, on one side, the Security Council and the General Assembly, on the other.
French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B
Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.
... General Motors Corporation, and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, and Toyota Engineering and Manufacturing North America, Fremont, CA; Amended... and Toyota Motor Corporation, including on-site leased workers from Corestaff and ABM...
Wallace, Ryan J
Emergency Locator Transmitters (ELT) are generally the primary tool for locating distressed aircrews following an aircraft accident. In 2009, the International COSPAS-SARSAT organization ordered the cessation of 121.5 MHz ELT satellite monitoring to alleviate systemic false alarms and encourage pilots to upgrade ELTs to modern 406 MHz models. While most nations acquiesced to the mandate, the United States encountered severe resistance from pilot groups. As a result, 121.5 MHz ELTs are still i...
Wu, Timothy; Chaer, Rabih A; Salvo, Nichol L
Both vascular surgeons and podiatric physicians care for patients with diabetic foot ulcerations (DFUs), one of today's most challenging health-care populations in the United States. The prevalence of DFUs has steadily increased, along with the rising costs associated with care. Because of the numerous comorbidities affecting these patients, it is necessary to take a multidisciplinary approach in the management of these patients. Such efforts, primarily led by podiatric physicians and vascular surgeons, have been shown to effectively decrease major limb loss. Establishing an interprofessional partnership between vascular surgery and podiatric medicine can lead to an improvement in the delivery of care and outcomes of this vulnerable patient population.
Cole, Jana; Isik, Frank
The Human Genome Project was launched in 1989 in an effort to sequence the entire span of human DNA. Although coding sequences are important in identifying mutations, the static order of DNA does not explain how a cell or organism may respond to normal and abnormal biological processes. By examining the mRNA content of a cell, researchers can determine which genes are being activated in response to a stimulus. Traditional methods in molecular biology generally work on a "one gene: one experiment" basis, which means that the throughput is very limited and the "whole picture" of gene function is hard to obtain. To study each of the 60,000 to 80,000 genes in the human genome under each biological circumstance is not practical. Recently, microarrays (also known as gene or DNA chips) have emerged; these allow for the simultaneous determination of expression for thousands of genes and analysis of genome-wide mRNA expression. The purpose of this article is twofold: first, to provide the clinical plastic surgeon with a working knowledge and understanding of the fields of genomics, microarrays, and bioinformatics and second, to present a case to illustrate how these technologies can be applied in the study of wound healing.
Pittner, Andrew C; Sullivan, Brian R
Purpose Comparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification. Patients and methods A retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation. Results Total room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each Pcataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparities of performance. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training. PMID:28203055
Anderson-Wurf, Jane; McGirr, Joe; Seal, Alexa; Harding, Catherine
A study of orthopedic surgeons in rural and regional Southeast Australia to determine attitudes to investigation and management of osteoporosis found they believe follow-up in regard to osteoporosis after MTF is important; responsibility for follow-up diagnosis and management lies with primary health care and current communication systems are poor. The investigation and treatment of osteoporosis after minimal trauma fracture (MTF) is regarded as sub-optimal. There is strong evidence of the benefit of identifying and treating osteoporosis after MTF, and there has been discussion of the possible role that orthopedic surgeons might play in the management of osteoporosis after MTF. The study surveyed orthopedic surgeons in rural and regional Southeast Australia to determine their attitudes to investigation and management of osteoporosis, the role health professionals should play, and the communication and co-ordination of follow-up care. A survey was developed and piloted prior to being posted to 69 orthopedic surgeons asking for their opinions about the general management of osteoporosis, and the roles and responsibilities of health professionals in dealing with osteoporosis following an MTF. Responses were received from 42 participants (60.8%) with the majority of respondents agreeing that it is important to treat osteoporosis following MTF. Less than 15% of respondents felt that it was their responsibility to initiate discussion or treatment or investigation after MTF. No respondent felt that the coordination of osteoporosis care was good and 45% stated it was poor. Communication after discharge is mostly left to the hospital (30%), while 20% stated they did not follow up at all. This study shows that many rural orthopedic surgeons believe that follow-up in regard to osteoporosis after MTF is important, that responsibility for follow-up diagnosis and management of osteoporosis lies with primary health care and the current communication systems are poor.
Eastley, Nicholas; Newey, Martyn; Ashford, Robert U
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
Noguchi, Kenji; Handley, Ian M; Albarracín, Dolores
A series of studies examined whether political participation can emerge from general patterns of indiscriminate activity. In the first two studies, general action tendencies were measured by combining national and state-level indicators of high activity (e.g., impulsiveness, pace of life, and physical activity) from international and U.S. data. This action-tendency index positively correlated with a measure of political participation that consisted of voting behaviors and participation in political demonstrations. The following two experimental studies indicated that participants exposed to action words (e.g., go, move) had stronger intentions to vote in an upcoming election and volunteered more time to make phone calls on behalf of a university policy than participants exposed to inaction words did (e.g., relax, stop). These studies suggest that political participation can be predicted from general tendencies toward activity present at the national and state levels, as well as from verbal prompts suggestive of activity.
Conclusion: In some procedures types a significant part of the variability in operative time is due to the interaction between the surgeon and anesthesiologist. Reviewing operative records should allow identification of efficient/inefficient combinations.
Cahill, Patrick J; Refakis, Christian; Storey, Eileen; Warner, William C
A concussion is a relatively common sports-related injury that affects athletes of all ages. Although orthopaedic surgeons are not expected to replace sports medicine physicians and neurologists with regard to the management of concussions, orthopaedic surgeons, particularly those who are fellowship-trained in sports medicine, must have a current knowledge base of what a concussion is, how a concussion is diagnosed, and how a concussion should be managed. Orthopaedic surgeons should understand the pathophysiology, assessment, and management of concussion so that they have a basic comprehension of this injury, which is at the forefront of the academic literature and North American media. This understanding will prepare orthopaedic surgeons to work in concert with and assist sports medicine physicians, athletic trainers, and physical therapists in providing comprehensive care for athletes with a concussion.
Friedberg, Mark W; Pronovost, Peter J; Shahian, David M; Safran, Dana Gelb; Bilimoria, Karl Y; Elliott, Marc N; Damberg, Cheryl L; Dimick, Justin B; Zaslavsky, Alan M
On July 14, 2015, ProPublica published its Surgeon Scorecard, which displays "Adjusted Complication Rates" for individual, named surgeons for eight surgical procedures performed in hospitals. Public reports of provider performance have the potential to improve the quality of health care that patients receive. A valid performance report can drive quality improvement and usefully inform patients' choices of providers. However, performance reports with poor validity and reliability are potentially damaging to all involved. This article critiques the methods underlying the Scorecard and identifies opportunities for improvement. Until these opportunities are addressed, the authors advise users of the Scorecard-most notably, patients who might be choosing their surgeons-not to consider the Scorecard a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide. The authors hope that this methodological critique will contribute to the development of more-valid and more-reliable performance reports in the future.
Van Hee, R
The author gives here some considerations about A. Vesalius through his life and his works as a surgeon. He was the father of the anatomical revolution against Galen but was also an eminent clinician and surgeon. He was immediately able to adapt his surgical practice whenever the promising methodology was identified (see Consilia). The author concludes with a critical analysis of the Chirurgia magna in septem libros digesta attributed to A. Vesalius.
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.
Full Text Available Background: Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons’ attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment. Methods: Orthopaedic surgeons members of the Science and Variation Group and Ankle Platform (N =350 completed demographics, and a 4-part survey assessing the degree to which surgeons notice, assess, screen and refer for psychological treatments, as well ranked ordered barriers to engaging in these processes. Results: As a group surgeons were neutral to referral for psychological treatment and formal screening of psychological factors, and somewhat likely to notice and discuss psychological factors. Surgeons were more likely to refer for psychological treatment if they engaged in research, or if they reside in South America as opposed to North America. The highest ranked barriers to screening, noticing, discussing and referring for psychological treatment were lack of time, stigma and feeling uncomfortable. Conclusion: Overall surgeons are likely to notice and discuss psychological factors, but less likely to formally screen or refer for psychological treatment. Transition to biopsychosocial models should focus on problem solving these barriers by teaching surgeons communication skills to increase comfort with discussing psychoemotional factors associated with orthopedic problems. The use of empathic communication can be very helpful in normalizing the difficulty of coping with an orthopedic condition, and may facilitate referral.
Kinahan, James C; MacHale, Siobhan
Surgeons frequently treat the consequences of self-harm. Self-harm is a common problem and presentations to Irish hospitals are increasing. It increases the risk of suicide and is associated with long term morbidity. Appropriate management can improve the prognosis. Surgeons require a number of skills to appropriately manage patients who self-harm. In this review we outline those skills including diagnosis, communication, capacity and risk assessment.
Chae, Yoojung; Gentry, Marcia
This study examined differences between Korean and US gifted and general students' perceptions constructs related to motivation and learning, using the Student Perceptions of Classroom Quality (SPOCQ) instrument. SPOCQ assesses students' perceptions of appeal, challenge, choice, meaningfulness, and academic self-efficacy. Measurement equality…
Wallace, Ryan J.
The purpose of this study was to determine the impact of advanced search and rescue devices and techniques on search duration for general aviation aircraft crashes. The study assessed three categories of emergency locator transmitters, including 121.5 MHz, 406 MHz, and GPS-Assisted 406 MHz devices. The impact of the COSPAS-SARSAT organization…
... Motor Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor... and Toyota Motor Corporation, including on-site leased workers from Corestaff, Fremont, California... assemble the Toyota Corolla and the Toyota Tacoma and used to assemble the Pontiac Vibe. The...
interrogate and to examine those individuals, and every gesture, every question, every maneuver they did, was jealously kept in our minds. However even at an early stage, we clearly perceived, the differences between medical branches and practitioners, and involuntarily, every one was leaning towards this or that specialty. It was during those years when 7 wonderful persons and excellent surgeons, crossed the path of my life, inspiring me to follow their steps and to embrace a surgical career. Two were classic academicians, Dr. Manuel Aguilar Bonilla and Dr. Andres Vesalio Guzman Calleja, 3 were determined, tireless and highly skilled, Dr. Longino Soto Pacheco, Dr. Claudio Orlich Carranza, y el Dr. Carlos Prada Diaz, and 2 were, although well prepared, unassuming, practical and openly friendly, Dr. Fernando Valverde Soley y el Dr. Randall Ferris Iglesias....
Full Text Available Unilateral anterior cruciate ligament (ACL tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2% surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2% preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58% or hamstring autograft (41% were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.
Cochran, Amalia; Elder, William B
Surgeons are the physicians with the highest rates of documented disruptive behavior. We hypothesized that a unified conceptual model of disruptive surgeon behavior could be developed based on specific individual and system factors in the perioperative environment. Semi-structured interviews were conducted with 19 operating room staff of diverse occupations at a single institution. Interviews were analyzed using grounded theory methods. Participants described episodes of disruptive surgeon behavior, personality traits of perpetrators, environmental conditions of power, and situations when disruptive behavior was demonstrated. Verbal hostility and throwing or hitting objects were the most commonly described disruptive behaviors. Participants indicated that surgical training attracts and creates individuals with particular personality traits, including a sense of shame. Interviewees stated this behavior is tolerated because surgeons have unchecked power, have strong money-making capabilities for the institution, and tend to direct disruptive behavior toward the least powerful employees. The most frequent situational stressors were when something went wrong during an operation and working with unfamiliar team members. Each factor group (ie, situational stressors, cultural conditions, and personality factors) was viewed as being necessary, but none of them alone were sufficient to catalyze disruptive behavior events. Disruptive physician behavior has strong implications for the work environment and patient safety. This model can be used by hospitals to better conceptualize conditions that facilitate disruptive surgeon behavior and to establish programs to mitigate conduct that threatens patient safety and employee satisfaction. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Bertges Yost, W; Eshelman, A; Raoufi, M; Abouljoud, M S
This study examines burnout in a national sample of transplant surgeons. Data analyses were conducted on a sample of 209 actively practicing transplant surgeons. Measures included the Maslach Burnout Inventory, a demographic survey, and the Surgeon Coping Inventory. Burnout was reflected in 38% of surgeons scoring high on the Emotional Exhaustion dimension, whereas 27% showed high levels of Depersonalization, and 16% had low levels of Personal Accomplishment. Several significant predictors of emotional exhaustion were identified and included questioning one's career choice, giving up activities, and perceiving oneself as having limited control over the delivery of medical services (R2= 0.43). Those who perceived themselves as having a higher ability to control delivery of medical services and who felt more appreciated by patients had lower levels of depersonalization and were less likely to question their career choice (R2= 0.16). Surgeons with high personal accomplishment experienced greater professional growth opportunities, perceived their institution as supportive, felt more appreciated by patients, and were less likely to question their career (R2= 0.24). The prioritization of goals to reflect both professional and personal values accounted for a significant amount of the variance in predicting both emotional exhaustion and personal accomplishment in separate regression equations. Recommendations to decrease burnout would include greater institutional support, increased opportunities for professional growth, and greater surgeon control over important services to facilitate efficient work. Coping strategies to moderate stress and burnout are also beneficial and should include prioritizing goals to reflect both professional and personal values.
Bogdanova, Rositsa; Boulanger, Pierre; Zheng, Bin
Minimally invasive surgery (MIS) poses visual challenges to the surgeons. In MIS, binocular disparity is not freely available for surgeons, who are required to mentally rebuild the 3-dimensional (3D) patient anatomy from a limited number of monoscopic visual cues. The insufficient depth cues from the MIS environment could cause surgeons to misjudge spatial depth, which could lead to performance errors thus jeopardizing patient safety. In this article, we will first discuss the natural human depth perception by exploring the main depth cues available for surgeons in open procedures. Subsequently, we will reveal what depth cues are lost in MIS and how surgeons compensate for the incomplete depth presentation. Next, we will further expand our knowledge by exploring some of the available solutions for improving depth presentation to surgeons. Here we will review the innovative approaches (multiple 2D camera assembly, shadow introduction) and devices (3D monitors, head-mounted devices, and auto-stereoscopic monitors) for 3D image presentation from the past few years.
Maytham, Gary; Kessaris, Nicos
Individual performance indicators for cardiac surgeons in the UK were published in 2004. A comprehensive update published in 2009 reported statistically significant decreases in mortality rates suggesting that the publication of this data may have contributed to this improvement in outcomes. In view of this, the authors present an assessment of the attitudes of cardiac surgeons to individual performance tables, having performed this by sending questionnaires exploring the surgeon's views on performance tables to UK cardiac surgeons in 2005 and 2009. The responses demonstrated that whilst the majority of cardiac surgeons (68.8%) were initially opposed to performance tables, the number welcoming their introduction increased significantly (22.9-48.5%) over the four-year period. The attitude of the consultants towards the possible effect of this data on the management of high-risk patients also changed, with fewer consultants believing they would (P=0.0001) or may (P=0.023) avoid these patients. The observed change in attitude of cardiac surgeons may be due to acclimatization to an established system of audit, improved mortality rates, a desire for more transparency following the Bristol Enquiry, or improved risk stratification. These findings may be of benefit to those tasked with initiating these indicators elsewhere.
Kang, Sang Hee; Boo, Yoon Jung; Lee, Ji Sung; Han, Hyung Joon; Jung, Cheol Woong; Kim, Chong Suk
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.
SCOTT A. HAYWARD CT MARO0 119935 A REPORT PRESENTED TO THE GRADUATE COMMITTEE OF THE DEPARTMENT OF CIVIL ENGINEERING IN PARTIAL FULFILLMENT OF THE...an officer of the Civil Engineer Corps, United States Navy or another officer or representative of the Government, as Resident Officer in Charge of...Awlo 9 ay dfll it C nt bcor mahflP" U _ L3.7.. 7A.3.3. nooposa Arhiec Owe Arhiec Contrato ACbntratioor relo..nc cnt Oed~e prepared NOrnobl4 Becme
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.
O'Gorman, Jennifer R; O'Leary, Orla; Finner, Natalie; Quinn, Anne; O'Gorman, Clodagh S
The aim of this study was to assess the carbohydrate and insulin knowledge of the staff at Children's Ark at the University Hospital, Limerick. Carbohydrate counting and insulin dose calculations based on carbohydrates and blood sugars are integral to intensive insulin management of type 1 diabetes mellitus (T1DM). The PedCarbQuiz, a validated questionnaire, was modified, and applied to the staff on our general paediatrics ward. 48/70 eligible staff responded (rate 68 %). Overall knowledge was good: 75.5 % was the average score for correctly identifying foods containing carbohydrate. However, poor scores were obtained for calculating multiple items and meal values (average score 29 %), and exact values of insulin required (average score 38 %). These results highlight the need for re-education among staff on a general paediatrics ward, to empower ward staff to contribute effectively to the education and management of patients with T1DM.
of a general staff, reasons for such an organization, and the actual develorinent of the staff compared to the design. After the Amnerican Civil War...organization, and the actual development of the staff compared to the design. After the American Civil War a group of reformers assessed the performance of...and prohib- ited it from interfering with the bureaus and their administration. The bureau chiefs regarded the Act as their "Magna Carta " essentially
Zameer, M. M.; Rao, Sanjay; Vinay, C.; D’Cruz, Ashley
Introduction: Much is debated on the quality of life of pediatric surgeons practicing in India, all based on anecdotal and personal experiences. There is no systematic study on this. This study addresses this and attempts to glean a clearer picture of the life as a pediatric surgeon in India. Methodology: This questionnaire-based study was administered via an online survey to all Indian Association of Pediatric Surgeons members. The responses were anonymous and investigators blinded. Data were collated and analyzed using STAT11.1. Results: A total of 173 pediatric surgeons responded. Eighty-six percent were men. About 73.7% of the surgeons were between 31 and 50 years of age. Almost 63.4% practiced in urban areas, whereas 36% in other smaller towns. About 0.6% reported that their practice was rural. Almost 26.4% were in private/solo practices, whereas 53.4% were in institution-based practice. Almost 80% felt that they were adequately trained while starting their practice. About 78% are professionally satisfied with their work. Only 44.5% of surgeons felt that they were compensated adequately financially. Reading was the favorite pass time. Almost 40% of the surgeons felt that they were either overweight or obese. About 41% of the surgeons exercise more than 3 times a week. Only 11.4% smoke, whereas 36% drink. Fifty-three percent of surgeons felt that their personal savings were adequate. Seventy-six percent use Facebook. Sixty-eight percent were satisfied with their quality of life. Age was significantly associated with professional satisfaction, financial satisfaction, and quality of life and all improve as one's age progresses. None were affected with one's gender, type of practice, and the place of practice. Age, weight, exercise, and one's savings significantly affected ones quality of life. Conclusion: This is the first study which objectively highlights that most surgeons are happy professionally and financially in due course of time and demolishes the common
Pasquale, LisaMarie Di; Ferneini, Elie M
For the oral and maxillofacial surgeon, many patients will be on heparin products during surgery. So far, there is no standardized approach to treating anticoagulated patients during oral and maxillofacial surgical procedures. When a patient is on heparin therapy, heparin may be stopped 4 to 6 hours before surgery and resumed once hemostasis is achieved, usually within 24 hours. If low-molecular-weight heparin is administered, the treatment is generally stopped at least 12 hours before surgery and then resumed in a similar fashion. Local measures are generally enough to provide adequate hemostasis. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available High-resolution ultrasound has gained increasing popularity as an aid in the diagnosis of rotator cuff pathology. With the advent of portable machines, ultrasound has become accessible to clinicians. Aim: This study was conducted to evaluate the accuracy and reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist. Materials and Methods: Seventy patients undergoing shoulder arthroscopy for rotator cuff pathology underwent preoperative ultrasonography (US. All patients were of similar demographics and pathology. The surgeon used a Sonosite Micromax portable ultrasound machine with a 10-MHz high frequency linear array transducer and the radiologist used a 9-12 MHz linear array probe on a Siemens Antares machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared. Results: The sensitivity in detecting full thickness tears was similar for both the surgeon (92% and the radiologist (94%. The radiologist had 100% sensitivity in diagnosing partial thickness tears, compared to 85.7% for the surgeon. The specificity for the surgeon was 94% and 85% for the radiologist. Discussion: Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution portable ultrasound in the outpatient setting. Conclusion: Office ultrasound, by a trained clinician, is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics.
Richards, Misty; Hori, Hiroaki; Sartorius, Norman; Kunugi, Hiroshi
Cross-cultural differences in attitudes toward schizophrenia are suggested, while no studies have compared such attitudes between the United States and Japan. In our previous study in Japan (Hori et al., 2011), 197 subjects in the general population and 112 physicians (excluding psychiatrists) enrolled in a web-based survey using an Internet-based questionnaire format. Utilizing the identical web-based survey method in the United States, the present study enrolled 172 subjects in the general population and 45 physicians. Participants' attitudes toward schizophrenia were assessed with the English version of the 18-item questionnaire used in our previous Japanese survey. Using exploratory factor analysis, we identified four factors labeled "social distance," "belief of dangerousness," "underestimation of patients' abilities," and "skepticism regarding treatment." The two-way multivariate analysis of covariance on the four factors, with country and occupation as the between-subject factors and with potentially confounding demographic variables as the covariates, revealed that the general population in the US scored significantly lower than the Japanese counterparts on the factors "social distance" and "skepticism regarding treatment" and higher on "underestimation of patients' abilities." Our results suggest that culture may have an important role in shaping attitudes toward mental illness. Anti-stigma campaigns that target culture-specific biases are considered important.
Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290
Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M
Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.
Eric M. Foote
Full Text Available Background: The lower respiratory tract infection (LRTI-associated hospitalization rate in American Indian and Alaska Native (AI/AN children aged <5 years declined during 1998–2008, yet remained 1.6 times higher than the general US child population in 2006–2008. Purpose: Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years. Methods: A retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009–2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998–1999 rates prior to pneumococcal conjugate vaccine introduction. Results: The average annual LRTI-associated hospitalization rate declined from 1998–1999 to 2009–2011 in AI/AN (35%, p<0.01 and the general US child population (19%, SE: 4.5%, p<0.01. The 2009–2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6–14.8. The Alaska (38.9 and Southwest regions (27.3 had the highest rates. The disparity was greatest for infant (<1 year pneumonia-associated and 2009–2010 H1N1 influenza-associated hospitalizations. Conclusions: Although the LRTI-associated hospitalization rate declined, the 2009–2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children.
Full Text Available Objective: Robotic surgical systems offer better workplace in order to relieve surgeons from prolonged physical efforts and improve their surgical outcomes. However, robotic surgery could produce musculoskeletal disorders due to the prolonged sitting position of the operator, the fixed position of the console viewer and the movements of the limbs. Until today, no one study has been reported concerning the association between robotics and musculoskeletal pain. The aim of this work was verify the prevalence of musculoskeletal disorders among Italian robotic surgeons. Material and methods: Between July 2011 and April 2012 a modified Standardized Nordic Questionnaire was delivered to thirty-nine Italian robotic centres. Twentytwo surgeons (56% returned the questionnaires but only seventeen questionnaires (43.5% were evaluable. Results: Seven surgeons (41.2% reported musculoskeletal disorders, by since their first use of the robot which significantly persisted during the daily surgical activity (P < 0.001. Regarding the body parts affected, musculoskeletal disorders were mainly reported in the cervical spine (29.4% and in the upper limbs (23.5%. Six surgeons (35.3% defined the robotic console as less comfortable or neither comfortable/uncomfortable with a negative influence on their surgical procedures. Conclusions: In spite of some important limitations, our data showed musculoskeletal disorders due to posture discomfort with negative impact on daily surgical activity among robotic surgeons. These aspects could be due to the lack of ergonomic seat and to the fixed position of the console viewer which could have produced an inadequate spinal posture. The evaluation of these postural factors, in particular the development of an integrated and more ergonomic chair, could further improve the comfort feeling of the surgeon at the console and probably his surgical outcomes.
Hina, Miss; Hourigan, Jon S; Moore, Richard A; Stanley, J Daniel
Anorectal procedures are often performed in an outpatient setting using a variety of anesthetic techniques. One technique that has not been well studied is surgeon-administered conscious sedation along with local anesthetic. The purpose of this study was to evaluate the use of this technique with emphasis on safety, efficacy, and patient satisfaction. Chart review was performed on 133 consecutive patients who had anorectal procedures at an outpatient surgery center. Additionally, 65 patients were enrolled prospectively and completed a satisfaction survey. Inclusively, charts of 198 patients who underwent outpatient anorectal surgery under conscious sedation and local anesthesia under the direction of a colorectal surgeon from 2004 through 2008 were reviewed. Parameters related to patient and procedural characteristics, safety, efficacy, and satisfaction were evaluated. Surgeon-administered sedation consisted of combined fentanyl and midazolam in 90 per cent. Eighty per cent of procedures were performed in the prone position and 23 per cent were in combination with an endoscopic procedure. Eighty-two per cent were classified as American Society of Anesthesiologists Grade 1 or 2. Transient mild hypoxemia or hypotension occurred in 4 and 3 per cent of the patients, respectively. Mean operative time was 29 minutes with a mean stay in the postanesthesia care unit of 37 minutes. There were no early major cardiac or respiratory complications. Ninety-seven per cent of the patients surveyed reported a high degree of satisfaction. Surgeon-administered conscious sedation with local anesthesia was well tolerated for outpatient anorectal surgeries. Additional studies are needed to confirm the safety and efficacy of this technique.
Kuhls, Deborah A; Campbell, Brendan T; Burke, Peter A; Allee, Lisa; Hink, Ashley; Letton, Robert W; Masiakos, Peter T; Coburn, Michael; Alvi, Maria; Lerer, Trudy J; Gaines, Barbara A; Nance, Michael L; Schuerer, Douglas J E; Palmieri, Tina L; Davis, James W; Geehan, Douglas M; Elsey, James K; Sutton, Beth H; McAndrew, Mark P; Gross, Ronald I; Reed, Donald N; Van Boerum, Don H; Esposito, Thomas J; Albrecht, Roxie M; Sarani, Babak; Shapiro, David S; Wiggins-Dohlvik, Katie; Stewart, Ronald M
In the United States, there is a perceived divide regarding the benefits and risks of firearm ownership. The American College of Surgeons Committee on Trauma Injury Prevention and Control Committee designed a survey to evaluate Committee on Trauma (COT) member attitudes about firearm ownership, freedom, responsibility, physician-patient freedom and policy, with the objective of using survey results to inform firearm injury prevention policy development. A 32-question survey was sent to 254 current U.S. COT members by email using Qualtrics. SPSS was used for χ exact tests and nonparametric tests, with statistical significance being less than 0.05. Our response rate was 93%, 43% of COT members have firearm(s) in their home, 88% believe that the American College of Surgeons should give the highest or a high priority to reducing firearm-related injuries, 86% believe health care professionals should be allowed to counsel patients on firearms safety, 94% support federal funding for firearms injury prevention research. The COT participants were asked to provide their opinion on the American College of Surgeons initiating advocacy efforts and there was 90% or greater agreement on 7 of 15 and 80% or greater on 10 of 15 initiatives. The COT surgeons agree on: (1) the importance of formally addressing firearm injury prevention, (2) allowing federal funds to support research on firearms injury prevention, (3) retaining the ability of health care professionals to counsel patients on firearms-related injury prevention, and (4) the majority of policy initiatives targeted to reduce interpersonal violence and firearm injury. It is incumbent on trauma and injury prevention organizations to leverage these consensus-based results to initiate prevention, advocacy, and other efforts to decrease firearms injury and death. Prognostic/epidemiologic study, level I; therapeutic care, level II.
Julian F. Guest
Full Text Available Soft tissue sarcomas are a rare type of cancer generally treated with palliative chemotherapy when in the advanced stage. There is a lack of published health utility data for locally advanced “inoperable”/metastatic disease (ASTS, essential for calculating the cost-effectiveness of current and future treatments. This study estimated time trade-off (TTO and standard gamble (SG preference values associated with four ASTS health states (progressive disease, stable disease, partial response, complete response among members of the general public in the UK (n=207. The four health states were associated with decreases in preference values from full health. Complete response was the most preferred health state (mean utility of 0.60 using TTO. The second most preferred health state was partial response followed by stable disease (mean utilities were 0.51 and 0.43, respectively, using TTO. The least preferred health state was progressive disease (mean utility of 0.30 using TTO. The utility value for each state was significantly different from one another (P<0.001. This study demonstrated and quantified the impact that different treatment responses may have on the health-related quality of life of patients with ASTS.
Andersen, Morten Jon; Gromov, Kirill; Brix, Michael
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...
Andersen, M. J.; Gromov, K.; Brix, M.
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...
Daley, Brian J; Cecil, William; Cofer, Joseph B; Clarke, P Chris; Guillamondegui, Oscar
Ranking of surgeons and hospitals focuses on procedure volume and hospitality. The National Surgical Quality Improvement Program provides vetted outcomes of surgical quality and therefore can direct improvement. Our statewide collaborative's analysis creates personalized surgeon data to drive quality improvement. Statewide National Surgical Quality Improvement Program data generated specific measures from 103,656 general/vascular cases and identified individual surgeon's outcome of occurrences and length of procedure. We assumed a normal distribution and called the top 2.5 per cent as exemplars and the bottom 2.5 per cent as outliers. For length of operation, a standard duration was calculated, and identified outliers as longer than the 95th percentile of the upper confidence interval/procedure. Since 2009, sharing best practice reduced statewide mortality rate by 31.5 per cent and postoperative morbidity by 33.3 per cent. For length of surgery, long outliers have more complications (urinary tract infection, organ space/surgical site infection, sepsis, septic shock, prolonged intubation, pneumonia, deep venous thrombosis, deep incisional infection, and wound disruption). No significant trends in surgeon performance were seen over 24 months. A statewide collaborative has resulted in substantial risk-adjusted reductions in surgical morbidity and mortality. These results of the individual surgeon demonstrate best practices are shared, a proven tool for improvement in our collaborative.
Full Text Available Abstract Background Over the course of the past 40 years, there have been a significant number of changes in the way in which lymphomatous disease is diagnosed and managed. With the advent of computed tomography, there is little role for staging laparotomy and the surgeon's role may now more diagnostic than therapeutic. Aims To review all cases of lymphoma diagnosed at a single institution in order determine the current role of the surgeon in the diagnosis and management of lymphoma. Patients and methods Computerized pathology records were reviewed for a five-year period 1996 to 2000 to determine all cases of lymph node biopsy (incisional or excisional in which tissue was obtained as part of a planned procedure. Cases of incidental lymphadenopathy were thus excluded. Results A total of 297 biopsies were performed of which 62 (21% yielded lymphomas. There were 22 females and 40 males with a median age of 58 years (range: 19–84 years. The lymphomas were classified as 80% non-Hodgkin's lymphoma, 18% Hodgkin's lymphoma and 2% post-transplant lymphoproliferative disorder. Diagnosis was established by general surgeons (n = 48, ENT surgeons (n = 9, radiologists (n = 4 and ophthalmic surgeons (n = 1. The distribution of excised lymph nodes was: cervical (n = 23, inguinal (n = 15, axillary (n = 11, intra-abdominal (n = 6, submandibular (n = 2, supraclavicular (n = 2, periorbital (n = 1, parotid (n = 1 and mediastinal (n = 1. Fine needle aspiration cytology had been performed prior to biopsy in only 32 (52% cases and had suggested: lymphoma (n = 10, reactive changes (n = 13, normal (n = 5, inadequate (n = 4. The majority (78% of cervical lymph nodes were subjected to FNAC prior to biopsy whilst this was performed in only 36% of non-cervical lymphadenopathy. Conclusion The study has shown that lymphoma is a relatively common cause of surgical lymphadenopathy. Given the limitations of FNAC, all suspicious lymph nodes should be biopsied following FNAC even
1.The Role of the United Nations (UN) The word is undergoing major development,major changes and major adjustments.The trend of peace,development and cooperation is gaining momentum.Multi-polarity and economic globalization are deepening.New changes are taking place in global economic governance,and emerging economies are engaged in dynamic cooperation.All these have brought valuable opportunities to the development of all countries.On the other hand,the world still suffers from the underlying impact of the financial crisis.Global recovery is confronted with the uncertainties created by acute debt crisis,rising commodity prices and inflationary pressure around the world.In this context,major economies should continue to strengthen macroeconomic policy coordination so as to ensure strong,sustainable and balanced growth of the world economy.The international security situation has become more complex.Regional hotspot issues keep flaring up,and turbulence continues in West Asia and North Africa,Non-traditional security issues such as climate change,energy security,food security,terrorism and nuclear safety are becoming more pronounced.In sum,there are a growing array of destabilizing factors and uncertainties in the world and a long way to go before lasting peace and common development can be achieved.
Cox, Mitchell A
The Large Hadron Collider at CERN generates enormous amounts of raw data which present a serious computing challenge. After planned upgrades in 2022, the data output from the ATLAS Tile Calorimeter will increase by 200 times to 41 Tb/s! ARM processors are common in mobile devices due to their low cost, low energy consumption and high performance. It is proposed that a cost-effective, high data throughput Processing Unit (PU) can be developed by using several consumer ARM processors in a cluster configuration to allow aggregated processing performance and data throughput while maintaining minimal software design difficulty for the end-user. This PU could be used for a variety of high-level functions on the high-throughput raw data such as spectral analysis and histograms to detect possible issues in the detector at a low level. High-throughput I/O interfaces are not typical in consumer ARM System on Chips but high data throughput capabilities are feasible via the novel use of PCI-Express as the I/O interface t...
Cox, Mitchell Arij; The ATLAS collaboration; Mellado Garcia, Bruce Rafael
The Large Hadron Collider at CERN generates enormous amounts of raw data which present a serious computing challenge. After Phase-II upgrades in 2022, the data output from the ATLAS Tile Calorimeter will increase by 200 times to 41 Tb/s! ARM processors are common in mobile devices due to their low cost, low energy consumption and high performance. It is proposed that a cost-effective, high data throughput Processing Unit (PU) can be developed by using several consumer ARM processors in a cluster configuration to allow aggregated processing performance and data throughput while maintaining minimal software design difficulty for the end-user. This PU could be used for a variety of high-level functions on the high-throughput raw data such as spectral analysis and histograms to detect possible issues in the detector at a low level. High-throughput I/O interfaces are not typical in consumer ARM System on Chips but high data throughput capabilities are feasible via the novel use of PCI-Express as the I/O interface ...
Olabi, Nassim F; Jones, James E; Saxen, Mark A; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Schrader, Stuart M; Tomlin, Angela M
The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.
Howell, Joel D
When established ward patients are unexpectedly transferred to an intensive care unit (ICU), the ward team should continue to follow them. Although there may be reasons not to do so, the advantages outweigh the obstacles. Great pedagogic value can be gained from following patients after acute decompensation, but a more important reason is that by following patients into the ICU, the ward team can enact for both patients and their families the twin virtues of caring and continuity. Doing so also demonstrates the highest ideals of medicine-that we are focused not on defined areas of turf, but on our patient's well-being. It shows that we are not merely doing narrowly defined "shift work," but that we truly care about our patients. Rounding on established patients who have been transferred into the ICU is the sort of behavior that undergirds the fundamental bases of professionalism. It takes a few minutes from a busy day, but it can be incredibly beneficial for families, patients, and the ideals of medicine.
Schwabegger, Anton H
Minimally invasive repair of pectus excavatum (MIRPE) or similar procedures for pectus excavatum (PE) repair, nowadays no longer performed by one single speciality, may not always achieve sufficient aesthetic results, particularly in the infrapectoral or infraxiphoidal region. Reasons for this include the diaphragm inhibiting correct positioning of the bars, as well as asymmetric deformities which may still be present after remodelling attempts. Furthermore, some cases develop a mild recurrence or partial concavity once the correction bar is removed. However, any secondary re-do MIRPE procedure remains risky because of adhesions between the pleura, lung, pericardium, thoracic wall as residuals from the primary intervention. Treatment options as secondary correction for these deformities may include open access surgery, resection or reshaping of deformed costal cartilage. Moreover, augmentation of a residual concave area can be achieved by autologous transplantation of resected over-abundant cartilage, as well as by liposhifting or implantation of customized alloplastics. A physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques in order to provide the best options for a variety of expressions of anterior wall deformities. Among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. An appropriate technique, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be selected carefully based on the heterogeneity of symptoms, severity, expectations and surgical skill in addition to the available equipment. Out of a variety of such ancillary procedures available and based on experience within general plastic reconstructive surgery, some techniques for PE repair are explained and illustrated here with their advantages and disadvantages.
Full Text Available Andrew C Pittner,1 Brian R Sullivan2 1Department of Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Maywood, 2Edward Hines Jr VA Hospital, Ophthalmology Section, Hines, IL, USA Purpose: Comparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS versus conventional phacoemulsification.Patients and methods: A retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation.Results: Total room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each P<0.05. Mean duration for manual completion of anterior capsulotomy was shorter in the laser group (P<0.001. There were no statistically significant differences in the individual steps of nucleus removal, cortical removal, or intraocular lens placement. Surgical complication rates were not significantly different between the groups.Conclusion: In early cases, resident completion of femtosecond cataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the
Mutiso Victoria N
Full Text Available Abstract Background Physical disorders are commonly comorbid with depression in children attending general medical facilities. However, the depression component is rarely recognised. Methods A questionnaire on sociodemographics and history of presenting medical conditions was administered together with the Children's Depression Inventory (CDI to all 11-year-old to 17-year-old children attending at nine medical facilities. Results In all, 408 children were recruited from 9 health facilities. Whereas the clinicians diagnosed a mental disorder in only 2.5% of the sample studied, 41.3% had CDI scores that suggested mild to moderate depression. The highest proportion of children with depressive symptomatology was found at the Kenyatta National and Teaching Referral Hospital. Conclusion Although prevalence rate for depression among children is high, detection rates remain low. This finding has clinical practice and policy implications within and outside Kenya.
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
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
Full Text Available Abstract Background In Greece, primary care is still developing. The aim of this study was to define the epidemiologic profile of common otorhinolaryngological, head and neck disorders in order to help general practitioners to deal with them in a primary care future. Methods A total of 6771 patients attended the Otorhinolaryngology emergency department of the University General Hospital of Heraklion (Crete, between January and December 2004. All cases were included in this retrospective study. The registry of the Otorhinolaryngology emergency department was analysed and age, sex, seasonality and clinical diagnosis were tabulated. All patients were evaluated by Otorhinolaryngologists. The classification of the cases was based on the main symptom or clinical sign that conditioned the reason for seeking care. Diagnoses were also coded according to the International Classification of Diseases (ICD-10. Results The male to female ratio was 1:1. The mean age for females was 36.3 years standard deviation (SD: 21.1 and for males was 36.8 years (SD = 22.0. Eight hundred eighty six patients (13.1% formed the paediatric sub-group. Over 60% of the cases were classified in ten major groups of diagnosis. Acute tonsillitis (12.3% and acute pharyngitis (9.0% were the most common causes of all medical visits, followed by otitis media (7.6% and external ear canal obstruction by ear wax (6.2%. Oedema of the larynx was detected in 0.4%. A negative diagnosis of otorhinolaryngological, head and neck disorder was formulated in 553 patients (8.2%. Hospitalization rate was 5.2%. The highest rate of visits was registered in March. Conclusion Most patients used the facility as a primary care service. Real emergencies were a minority. Recovering data about which areas of Otorhinolaryngology deserve more emphasis might help primary health care providers to diagnose and manage the common otorhinolaryngological, head and neck disorders properly.
de Micheli-Serra, Alfredo
The origins of New Spain Inquisition whose jurisdiction extended also to Philippine Islands, are related herein. Physicians and surgeons who worked as Inquisition officers are discussed, from the first Dr. Juan de la Fuente who was appointed on May 9, 1572, to Dr. Pedro del Castillo, appointed on September 24, 1644. Likewise, physicians and surgeons judged by the Holy Office are mentioned. During the XVI century, those judged were few and insignificant personages, the first was the Irish Protestant William Corniels a barber surgeon, who arrived with the John Hawkins' pirate fleet in 1568 and settled in Guatemala. Some physicians and surgeons were judged as "Judaizers" during the first half of the XVII century. Many physicians and surgeons were prosecuted in Mexico, as well as in the Philippine Islands, in the second half of the XVIII century because they were Freemasons or supporters of French Revolution ideology. Among those was the unfortunate Dr. Enrique Esteban Morel, who introduced into Mexico the method of antivariolar inoculation at the time of the great epidemic out-break of 1779. It should be a gesture of justice to build a memorial in the ancient Inquisition Palace to honor this Public Health's worthy physician.
Cochran, Amalia; Elder, William B
Surgeons are the physician group most commonly identified as "disruptive physicians." The aim of this study was to develop a conceptual model of the results of disruptive surgeon behavior and to identify the coping strategies used by perioperative staff. Perspectives of 19 individuals of diverse occupations in the perioperative setting were drawn together using a grounded theory methodology. Effects of disruptive behavior described by participants included shift in attention from the patient to the surgeon, increased mistakes during procedures, deterrence from careers in surgery, and diminished respect for surgeons. Individual coping strategies employed in the face of intimidation include talking to colleagues, externalizing the behavior, avoidance of perpetrators, and warning others. Using grounded theory analysis, we were able to elucidate the impact of disruptive surgeon behavior in the perioperative environment. This conceptual model may be used to understand and counter the negative effects of manipulation and intimidation of hospital staff and trainees and to build on current programmatic strengths to improve surgical environments and training. Copyright © 2015 Elsevier Inc. All rights reserved.
Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C
Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.
Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup
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...
Warner, Ellen; Yee, Samantha; Kennedy, Erin; Glass, Karen; Foong, Shu; Seminsky, Maureen; Quan, May Lynn
Guidelines recommend that oncologists discuss treatment-related fertility issues with young cancer patients as early as possible after diagnosis and, if appropriate, expedite referral for fertility preservation (FP). This study sought to determine the attitudes and practices of Canadian breast surgeons regarding fertility issues, as well as barriers to and facilitators of fertility discussion and referrals. Semistructured telephone interviews were conducted with 28 site lead surgeons (SLSs) at 28 (97 %) of 29 centers (25 % cancer centers, 64 % teaching hospitals) across Canada participating in RUBY, a pan-Canadian research program for young women with breast cancer. In addition, 56 (65 %) of 86 of their surgical colleagues (non-site lead surgeons [NSLSs]) completed an online survey of their oncofertility knowledge, attitudes, and practices. Of the 28 SLSs (43 % male, 36 % in practice knowledge, 25 % discussed fertility only if mentioned by the patient, 21 % believed fertility discussion and referral were the mandate of the medical oncologist, and 45 % did not know of an FP center in their area. More than 80 % of the NSLSs (54 % male, 30 % in practice knowledge was low among the SLSs, especially the NSLSs, and barriers to referral were identified. An oncofertility knowledge translation intervention specifically for breast surgeons is being developed to increase surgeon knowledge and awareness of oncofertility issues and referral.
Gould, Stephen Jay; Lloyd, Elisabeth A.
Two major clarifications have greatly abetted the understanding and fruitful expansion of the theory of natural selection in recent years: the acknowledgment that interactors, not replicators, constitute the causal unit of selection; and the recognition that interactors are Darwinian individuals, and that such individuals exist with potency at several levels of organization (genes, organisms, demes, and species in particular), thus engendering a rich hierarchical theory of selection in contrast with Darwin’s own emphasis on the organismic level. But a piece of the argument has been missing, and individuals at levels distinct from organisms have been denied potency (although granted existence within the undeniable logic of the theory), because they do not achieve individuality with the same devices used by organisms and therefore seem weak by comparison. We show here that different features define Darwinian individuality across scales of size and time. In particular, species-individuals may develop few emergent features as direct adaptations. The interactor approach works with emergent fitnesses, not with emergent features; and species, as a consequence of their different mechanism for achieving individuality (reproductive exclusivity among subparts, that is, among organisms), express many effects from other levels. Organisms, by contrast, suppress upwardly cascading effects, because the organismic style of individuality (by functional integration of subparts) does not permit much competition or differential reproduction of parts from within. Species do not suppress the operation of lower levels; such effects therefore become available as exaptations conferring emergent fitness—a primary source of the different strength that species achieve as effective Darwinian individuals in evolution. PMID:10518549
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.
Conway, Sadie H; Cayuela, Ana; Delclos, George L; Pompeii, Lisa A; Ronda, Elena
The relationship between hours worked per week and self-reported general health (SRGH) has not been assessed in Latin American immigrant and native workers across host countries. Cross-sectional study of the association between long work hours (LWH) (i.e., >51 hr per week) and poor SRGH using data from 2,626 workers in the United States (immigrants = 10.4%) and 8,306 workers in Spain (immigrants = 4.1%). Both countries' natives working >51 hr per week had increased odds of reporting poor SRGH compared to those working fewer hours (U.S.: OR = 1.59; 95%CI = 1.01-2.49; Spain: OR = 2.17; 95%CI = 1.71-2.75); when stratified by sex, increased odds also were observed among immigrant female workers in Spain (OR = 3.47; 95%CI = 1.15-10.5). LWH were associated with differential health outcomes in populations of native and Latin American immigrant workers in the United States and Spain, which may reflect social or occupational inequalities in general or resulting from the 2008 financial crisis. Am. J. Ind. Med. 59:1105-1111, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Education in the knowledge, skills, and attitudes necessary for a surgeon to perform at an expert level in the operating room, and beyond, must address all potential cognitive and technical performance gaps, professionalism and personal behaviors, and effective team communication. Educational strategies should also seek to replicate the stressors and distractions that might occur during a high-risk operation or critical care event. Finally, education cannot remain fixed in an apprenticeship model of "See one, do one, teach one," whereby patients are exposed to the risk of harm inherent to any learning curve. The majority of these educational goals can be achieved with the addition of simulation-based education (SBE) as a valuable adjunct to traditional training methods. This article will review relevant principles of SBE, explore currently available simulation-based educational tools for pediatric surgeons, and finally make projections for the future of SBE and performance assessments for pediatric surgeons.
Ruiz de Angulo, David; Munitiz, Vicente; Ortiz, M Ángeles; Martínez de Haro, Luisa F; Frutos, M Dolores; Hernández, Antonio; Parrilla, Pascual
Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
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.
Bork, U; Koch, M; Büchler, M W; Weitz, J
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.
Criss, Cory N; Gadepalli, Samir K
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.
Weng, Hui-Ching; Steed, James F.; Yu, Shang-Won; Liu, Yi-Ten; Hsu, Chia-Chang; Yu, Tsan-Jung; Chen, Wency
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.…
Eman Mohamed Mortada
Full Text Available Background and rationale of the study: Although Sharps injuries are a preventable hazard faced by medical personnel in the operating room yet it continues to be one of the hidden problems among HCP. The potential consequence of such injuries includes transmission of blood-borne pathogens with detrimental effects. Despite the advances in technology and increased awareness of medical staff, annually around 600 thousand to one million workers are affected thus considered as one of the most serious threats facing health care workers specially surgeon.Methodology: a cross sectional study of Zagazig University Hospitals surgical departments. Using a sample composed of 287 surgeons randomly chosen from different surgical departments. A questionnaire assessed in addition to personal and professional characteristics, the history of sharp injuries, types of instrument causing the injury, their post exposure prophylaxis including reporting. The results: There were total 287 surgeons participated in this study. (47% of the respondent surgeons had been exposed to at least one episode of sharp injury in the preceding 3 months and most of the exposures (68% occurred in the operation room. The injury was mainly caused during suturing (83%. The commonest devices, accused in most of the injuries were suturing needle and scalpel (74 and 59%. The majority of the surgeons (62% didn’t report the SI and it was largely explained by the majority of the sampled respondents (89% were not aware of the reporting system existing in their hospital.Conclusions: The most common reason of underreporting in our study was the lack of awareness that all injuries must be reported.Recommendations: The observed high level of under reporting reflects the need for education on prevention. Our results can guide in planning an education program for the surgeons to increase awareness about dangers of sharp injuries and help improve the reporting strategy and other potential
Krieger, Lloyd M
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.
Full Text Available Patient-specific bone and joint replacement implants lead to better functional and aesthetic results than conventional methods , , . 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.
Hamer, Peter W; Holloway, Richard H; Crosthwaite, Gary; Devitt, Peter G; Thompson, Sarah K
Achalasia is a motility disorder encountered by surgeons during the investigation and treatment of dysphagia. Recent advances in manometry technology, a widely accepted new classification system and a new treatment rapidly gaining international acceptance, have changed the working knowledge required to successfully manage patients with achalasia. We review the Chicago classification subtypes of achalasia with type II achalasia being a predictor of success and type III achalasia a predictor of treatment failure. We review per-oral endoscopic myotomy as an emerging treatment option and its potential for improving the treatment of type III achalasia. © 2016 Royal Australasian College of Surgeons.
Daniels, Alan H; Kuris, Eren O; Palumbo, Mark A
Workers' compensation is an employer-funded insurance program that provides financial and medical benefits for employees injured at work. Because many occupational injuries are musculoskeletal in nature, the orthopaedic surgeon plays an important role in the workers' compensation system. Along with establishing the correct diagnosis and implementing an appropriate treatment plan, the clinician must understand the fundamental components of the workers' compensation system to manage an injured employee. Ultimately, effective claim management requires collaboration among the employer, the employee, the legal representatives, the insurance company, and the orthopaedic surgeon.
Terhune, E Bailey; Cannamela, Peter C; Johnson, Jared S; Saad, Charles D; Barnes, John; Silbernagel, Janette; Faciszewski, Thomas; Shea, Kevin G
As value becomes a larger component of heath care decision making, cost data can be evaluated for regional and physician variation. Value is determined by outcome divided by cost, and reducing cost increases value for patients. "Third-party spend" items are individual selections by surgeons used to perform procedures. Cost data for third-party spend items provide surgeons and hospitals with important information regarding care value, potential cost-saving opportunities, and the total cost of ownership of specific clinical decisions. To perform a cost review of isolated rotator cuff repair within a regional 7-hospital system and to document procedure cost variation among operating surgeons. Economic and decision analysis; Level of evidence, 4. Current Procedural Terminology (CPT) codes were used to retrospectively identify subjects who received an isolated rotator cuff repair within a 7-hospital system. Cost data were collected for clinically sensitive third-party spend items and divided into 4 cost groups: (1) suture anchors, (2) suture-passing devices and needles, (3) sutures used for cuff repair, and (4) disposable tools or instruments. A total of 62 isolated rotator cuff repairs were performed by 17 surgeons over a 13-month period. The total cost per case for clinically sensitive third-party spend items (in 2015 US dollars) ranged from $293 to $3752 (mean, $1826). Four surgeons had a mean procedure cost that was higher than the data set mean procedure cost. The cost of an individual suture anchor ranged from $75 to $1775 (mean, $403). One disposable suture passer was used, which cost $140. The cost of passing needles ranged from $140 to $995 (mean, $468). The cost per repair suture (used to repair cuff tears) varied from $18 to $298 (mean, $61). The mean suture (used to close wounds) cost per case was $81 (range, $0-$454). A total of 316 tools or disposable instruments were used, costing $1 to $1573 per case (mean, $624). This study demonstrates significant cost
S O Ajike
Full Text Available Background:Ameloblastoma is a benign but locally aggressive odontogenic tumour. Worldwide, maxillary ameloblastoma is rare but its late detection renders adequate treatment difficult. Majority occur in the mandible with about 5-20% occurring in the maxillary bone. Objective: The purpose of this study was to analyze 21 cases of maxillary ameloblastoma seen and managed at the Oral and Maxillofacial Unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria and Alba Clinic and Medical Centre, Kaduna, Nigeria. Study Design:A retrospective study of cases of maxillary ameloblastoma from all cases of ameloblastoma seen from January 1993 to August 2008. Data with respect to patient′s sex, age, tumour location, clinical presentation, radiologic features, biological and histopathologic type, surgical treatment and recurrences were analyzed. Results:Out of 350 cases of ameloblastoma seen within the period, 21(6% Patients were with maxillary am eloblastoma. Of the 21 cases, there were 13 males and 8 females, a male female ratio of 1.6 to 1, with an age range of 17-55 years (mean = 38.14, peaking at the 4 th and 5 th decades of life (61.9%. Tumour duration was from 3 months to 14 years. There were 18 unilateral and 3 bilateral swellings. Clinically, maxillary ameloblastoma presented with grotesque swellings, with antral involvement in 19 cases, teeth mobility/exfoliation. Radiologically, there were 20 multilocular and 1 unilocular radiolucent lesions. The most common histopathologic type was follicular (11, 52.4%.there were 22 procedures done on 21 patients; 21 maxillectomies and 1 enucleation. Follow up period of 18 patients was between 3 months and 10 years from which 3(16.7% recurrences were observed. Conclusion:Ameloblastum a is uncommon in the maxilla. While maxillary ameloblastoma is indistinguishable histologically from its mandibular counterpart, it is very lethal. An excellent result achieved in this study was due to the radical mode of
Ru Shing Ng
Full Text Available AbstractSurgical site infections are the most common nosocomial infection among surgical patients. Patients who experience surgical site infections are associated with prolonged hospital stay, rehospitalisation, increased morbidity and mortality, and costs. Consequently, surgical antimicrobial prophylaxis (SAP, which is a very brief course of antibiotic given just before the surgery, has been introduced to prevent the occurrence of surgical site infections. The efficacy of SAP depends on several factors, including selection of appropriate antibiotic, timing of administration, dosage, duration of prophylaxis and route of administration. In many institutions around the globe, evidence-based guidelines have been developed to advance the proper use of SAP. This paper aims to review the studies on surgeons’ adherence to SAP guidelines and factors influencing their adherence. A wide variation of overall compliance towards SAP guidelines was noted, ranging from 0% to 71.9%. The misuses of prophylactic antibiotics are commonly seen, particularly inappropriate choice and prolonged duration of administration. Lack of awareness of the available SAP guidelines, influence of initial training, personal preference and influence from colleagues were among the factors which hindered the surgeons’ adherence to SAP guidelines. Immediate actions are needed to improve the adherence rate as inappropriate use of SAP can lead to the emergence of a strain of resistant bacteria resulting in a number of costs to the healthcare system. Corrective measures to improve SAP adherence include development of guidelines, education and effective dissemination of guidelines to targeted surgeons and routine audit of antibiotic utilisation by a dedicated infection control team.
It is chronically surplus of doctors in the world of cardiac surgery. There are too many cardiac surgeons because cardiac surgery requires a large amount of manpower resources to provide adequate medical services. Many Japanese cardiac surgeons do not have enough opportunity to perform cardiac surgery operations, and many Japanese cardiac surgery residents do not have enough opportunity to learn cardiac surgery operations. There are physician assistants and nurse practitioners in the US. Because they provide a part of medical care to cardiac surgery patients, American cardiac surgeons can focus more energy on operative procedures. Introduction of cardiac surgery specialized nurse practitioner is essential to deliver a high quality medical service as well as to solve chronic problems that Japanese cardiac surgery has had for a long time.
Adquisición de la competencia traductológica: propuesta de una unidad didáctica de traducción general/Acquisition de la compétence traductologique: Proposition d'une unité didactique de la traduction générale/Acquisition of Translatological Competence: Teaching Unit Proposal for General Translation
Ahmed Kamal Zaghloul
...: Didáctica, traducción general, competencia traductológica, enfoque por tareas, traducción de viñetas. Acquisition de la compétence traductologique: Proposition d'une unité didactique de la traduction générale RÉSUMÉ Dans cette étude, nous proposons une unicité didactique à propos de la traduction directe de l'espagnol vers l'arabe...
Do geography and resources influence the need for colostomy in Hirschsprung′s disease and anorectal malformations? A Canadian association of paediatric surgeons: Association of paediatric surgeons of Nigeria survey
Lukman O. Abdur-Rahman
Full Text Available Background: This survey compared surgical management of Hirschsprung′s disease (HD and anorectal malformations (ARM in high and low resource settings. Materials and Methods: An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS and the Association of Paediatric Surgeons of Nigeria (APSON. Results: The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97. Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05 and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05. Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%. CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P < 0.05. The frequency of colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources. Conclusions: Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care.
Full Text Available Abstract Background Sickness certification is a frequent and sometimes problematic task for orthopaedic surgeons. Our aim was to explore how orthopaedic surgeons view their sick-listing commission and sick-listing practice. Methods Semi-structured interviews with seventeen orthopaedic surgeons from five orthopaedic clinics in four Swedish counties. The focus was on the experiences of these physicians in relation to handling of sickness certification. Phenomenographic analysis was performed to reveal differences in existing views. Results The orthopaedic surgeons' views on sick-listing seemed mainly to be a consequence of how they perceived their role in the healthcare system. Three categories were found: The "isolated specialists", whose work and responsibilities were confined to the orthopaedic clinic, and did not really include sickness certification; the "orthopaedic advisers", who saw themselves mainly as advice-givers in the general health care system and perceived sickness certification as part of their job; the "system-integrated physicians", who perceived the orthopaedic clinic as one part of the healthcare system and whose ultimate goal was to get the patient well functioning in her life again with regained work ability, seeing sick-listing as one of the instruments to achieve this. Some informants described difficulties in handling conflicting opinions with patients in relation to the need for sick-leave. Conclusion Orthopaedic surgeons certify a large proportion of total sickness benefits. Some orthopaedic surgeons may certify sickness benefits sub-optimally for patients and society due to a narrow view of their role in the health care system or due to poor skills in handling discordant opinions with the patient. This problem can be addressed at the level of the individual physician and at the system level.
2 October 2013 - Israel Ambassador to the United Nations Office and other International Organizations at Geneva E. Manor on the occasion of the inauguration of the "Israel at CERN" Industrial Exhibition with CERN Director-General R. Heuer.
2 October 2013 - Israel Ambassador to the United Nations Office and other International Organizations at Geneva E. Manor on the occasion of the inauguration of the "Israel at CERN" Industrial Exhibition with CERN Director-General R. Heuer.
Goldenberg, R A
This paper presents the surgical anatomy of the skull base and infratemporal fossa. The information has been derived from the author's own experience in surgical and cadaver dissection, standard anatomical references, and selected experience of other skull base surgeons. Because the lateral approach has become the utilitarian method of exposure, the intricate detailed anatomy is demonstrated from this view at five levels of dissection, so the surgeon may gain a practical understanding of the surgical relationship of critical structures. Consistent anatomical landmarks can be used by the surgeon in the location of these critical structures. The styloid process, sphenoidal spine, and middle meningeal artery identify the internal carotid artery as it enters the carotid canal. The bony or fibrous septum that divides the jugular foramen into neural and vascular compartments may be used to better identify nerves IX, X, and XI. The zygomatic root is useful for location of the middle fossa dura. The lateral pterygoid plate leads directly to the foramen ovale. The increased precision of dissection permitted by use of the microscope requires an increased level of knowledge of anatomical structures in this area. It is hoped that the information presented in this paper will assist surgeons in the meticulous and thorough removal of skull base tumors and in the preservation of neural and vascular structures that are presently being sacrificed.
Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.
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...
Damsgaard, Else Marie; Borris, Lars; Duus, Benn; van der Mark, Susanne
Close collaboration between geriatricians and orthopaedic surgeons on elderly patients with hip fractures reduces mortality, the number of complications, and the length of hospital stay and increases the functional abilities of the patients. In some Danish hospitals the two groups of doctors work closely together, in others there are few or no geriatricians.
As an orthopaedic surgeon who has treated numerous cases of clubfoot in his career, the author knows that it takes exceptional parents to deal with the challenges of having a child born with a clubfoot. However, it should be noted that a clubfoot diagnosis does not mean a life of pain, deformity, and disability for a child. Today's treatment…
Christiansen, Niels Hørbye; Job, Jonas Hultmann; Klyver, Katrine;
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...
Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.
AIM: Ultrasound has a well-established role in the diagnostic assessment of acute abdominal pain where some ultrasonically easily-accessible organs account for several diagnostic possibilities. The objective of the present study was to evaluate whether surgeons without ultrasound experience could...
Aug 11, 2006 ... HIV I AIDS is a manageable disease with a reasonable expectation that affected ... the potential risk of an HIV-positive surgeon transmitting .... much-publicised Florida (USA) dentist transmitting HIV to a patient,? There has ...
Jalaliniya, Shahram; Pederson, Thomas
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...
Van Kasteren, J.
Many surgeons find it difficult to perform laparoscopies, operations performed inside the abdominal cavity without opening the abdominal wall. These keyhole operations are particularly taxing due to a lack of depth perception and impaired hand-eye coordination. Consequently, the method has been used
Subjects: One hundred and sixty seven surgeons(study group)and l93 ... Nigeria. The aim of this study is to determine the prevalence ... MATERIALS AND METHODS ..... C.J. Immune status in preschool children born after mass hepatitis B.
Renshaw, Domeena C.
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…
Pean, Christian A; Goch, Abraham; Christiano, Anthony; Konda, Sanjit; Egol, Kenneth
There continues to be controversy over whether operative delay is necessary for patients on antiplatelet therapy, particularly for elderly patients with hip fractures. This study sought to assess current clinical practices of orthopedic surgeons regarding perioperative management of these patients. A 12-question, Web-based survey was distributed to orthopedic surgeons via e-mail. Questions regarding timing of surgery assumed patients were on antiplatelet therapy and assessed attitudes toward emergent and nonemergent orthopedic cases as well as operative delay for specific closed fracture types. Responses were compared using unpaired, 2-tailed Student t tests for continuous variables and Pearson chi-square tests with odds ratios (ORs) and 95% confidence intervals (CIs) for categorical variables. Statistical significance was defined as a P value antiplatelet therapy with closed hip fractures did not require operative delay. Surgeons who opted for surgical delay in hip fractures were more likely to delay surgery in other lower extremity fracture types (OR = 16.4, 95% CI 4.48-60.61, P antiplatelet therapy. Over a quarter of surgeons continue to opt for surgical delay in patients with hip fracture. This survey highlights the need to formulate and better disseminate practice management guidelines for patients with fracture on antiplatelet therapy, particularly given the aging population in the United States.
Yanagawa, Bobby; Ruel, Marc; Bonneau, Christopher; Lee, Myunghyun M; Chung, Jennifer; Al Shouli, Sadek; Fagan, Andrew; Al Khalifa, Abdulwahab; White, Christopher W; Yamashita, Michael H; Currie, Maria E; Teoh, Hwee; Mewhort, Holly E M; Verma, Subodh
Dual antiplatelet therapy is the cornerstone treatment for patients with acute coronary syndrome. Recent Canadian Guidelines recommend the use of dual antiplatelet therapy for 1 year after coronary artery bypass grafting in patients with acute coronary syndrome, but considerable variability remains. We performed a survey of 75 Canadian cardiac surgeons to assess the use of dual antiplatelet therapy. Whereas 58.6% of respondents indicated that the benefits of dual antiplatelet therapy were seen irrespective of how patients were managed after acute coronary syndrome, 36.2% believed that the benefits of dual antiplatelet therapy were limited to those treated medically or percutaneously. In regard to the timing of dual antiplatelet therapy administration, 57% of respondents indicated that dual antiplatelet therapy should be given upstream in the emergency department, whereas 36.2% responded that dual antiplatelet therapy should be given only once the coronary anatomy has been defined. The majority surveyed (81%) weighed bleeding risk as being more important than ischemic risk reduction. In stable patients after acute coronary syndrome, the majority of surgeons would wait approximately 4 days after the last dose of P2Y12 antagonist before coronary artery bypass grafting. Only 44.6% indicated that they routinely use dual antiplatelet therapy postrevascularization in the setting of acute coronary syndrome. Rather, most surgeons use dual antiplatelet therapy for select patients, such as those with a stented vessel without a bypass graft, endarterectomy, or off-pump coronary artery bypass grafting. Cardiac surgeons exhibit variation in their attitudes and practice patterns toward dual antiplatelet therapy after coronary artery bypass grafting, and in approximately half of cases, their practice does not adhere to current guideline recommendations. New trials focusing on coronary artery bypass grafting cases in their primary analysis and educational initiatives for surgeons
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
现代GPU不仅是功能强劲的图形处理引擎,也是具有强大计算性能和存储带宽的高度并行可编程器件,能够与CPU构建完整的异构处理系统.而将GPU用于图形处理以外的计算,一般称之为GPU通用计算(General-Purpose computing on Graphics Processing Unit,GPGPU).对GPU通用计算的概念及分类、硬件架构及工作机制、软件环境及处理模型进行详细的研究,期望为GPU通用计算在航空嵌入式计算领域的进一步应用提供参考.
Iyer, Sravisht; Derman, Peter; Sandhu, Harvinder S
The U.S. Centers for Medicare & Medicaid Services (CMS) recently released the Open Payments database (OPD) detailing payments from industry to physicians and teaching hospitals. We seek here to provide an overview of the data with a focus on the orthopaedic community. We analyzed payments in the OPD from August 1 to December 31, 2013. The OPD consists of three individual databases: General Payments, Research Payments, and Ownership. Physician identification number, physician specialty, payment type, and payment value were collected. Physicians assigned to multiple specialties were excluded. Comparisons were made between orthopaedic surgeons and the remainder of the top fifteen specialties by payment value. In all, 2,697,015 payments with physicians were recorded; 491,223 of these payments (18.2%) were made to physicians with multiple listed specialties and were excluded. Excluding these potentially misattributed payments did not have a significant impact on the trends identified, and $394.5 million in payments remained. Orthopaedic surgeons represented 3.4% of payments but 25.6% of value, and 13,347 orthopaedic surgeons (68.9% of all active orthopaedic surgeons) were listed in the OPD. Payments over $10,000 represented only 1.6% of payments to orthopaedic surgeons but 75.5% of value. The majority of these payments (56.1%) were royalties. The median payment value for orthopaedic surgeons listed in the OPD was $38.11, with two payments per surgeon; the median aggregated value was $132.56 per surgeon. Orthopaedic surgeons listed in the OPD were more likely to receive payments for travel compared with all other specialties (p orthopaedic surgeons and industry are highly prevalent. A small subset of orthopaedic surgeons received large royalties, which accounted for a majority of the transactional value provided by industry. Orthopaedic surgeons were the recipients of more payments for travel and for royalties than all other specialties except neurological surgery
Lee, Seul; Oh, HyunSoo; Suh, YeonOk; Seo, WhaSook
To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward. Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers. A nonequivalent control group, nonsynchronised pretest-post-test design was adopted. The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer. This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention. Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress. The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress
Greco,Salvatore; Mesiar, Radko; Rindone, Fabio
Aggregation functions on [0,1] with annihilator 0 can be seen as a generalized product on [0,1]. We study the generalized product on the bipolar scale [–1,1], stressing the axiomatic point of view. Based on newly introduced bipolar properties, such as the bipolar increasingness, bipolar unit element, bipolar idempotent element, several kinds of generalized bipolar product are introduced and studied. A special stress is put on bipolar semicopulas, bipolar quasi-copulas and bipolar copulas.
Greco, Salvatore; Mesiar, Radko; Rindone, Fabio
Aggregation functions on [0,1] with annihilator 0 can be seen as a generalized product on [0,1]. We study the generalized product on the bipolar scale [–1,1], stressing the axiomatic point of view. Based on newly introduced bipolar properties, such as the bipolar increasingness, bipolar unit element, bipolar idempotent element, several kinds of generalized bipolar product are introduced and studied. A special stress is put on bipolar semicopulas, bipolar quasi-copulas and bipolar copulas.
Cohen, Philip; Slim, Karem; Soulier, Laure; Theissen, Alexandre
Throughout the perioperative period, anesthetists and surgeons jointly provide care for patients. The advances in medicine and surgery, the practice of perioperative quality medicine and the recent application of enhanced recovery program after surgery have necessitated strengthening the place of each in its area of expertise while developing the spirit team and communication. Thus, alongside the surgeon who was once considered the head of the surgical team, the anesthetist's role has been to consolidate for the management of the surgical patient and had his spot empower themselves in the eye of the patient with the birth an own contract with the patient (due in particular to the obligation to preanesthetic consultation by the decree of December 5, 1994). This has led to a new division of responsibility between these actors: jurisprudence has abandoned the exclusive responsibility of the surgeon, devoted own responsibility of the anesthetist with a division (if any) of responsibility between the anesthetist and the surgeon. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Taubate (Sureste de Brasil, 2005-2006. Las evidencias fueron obtenidas por medio de entrevistas, observación participante y palestras sobre el proyecto de la unidad psiquiátrica para el cuerpo clínico del hospital. RESULTADOS: La inversión del órgano gestor posibilitó que las concepciones estigmatizantes presentes en la cultura del hospital estudiado (violencia, debilidad moral e intratabilidad fueran resignificadas por medio de discusiones clínicas y sanitarias, viabilizando la implantación de la unidad psiquiátrica. El análisis mostró que esas concepciones eran reactualizadas por el contexto asistencial, en el cual el acceso de los portadores de trastornos mentales era restringido. CONCLUSIONES: La postura asumida por el órgano gestor, que decidió por el financiamiento adecuado de la unidad psiquiátrica y ejerció su ascendencia sobre el hospital prestador, fue decisiva para el desenlace del caso. La principal dificultad para la implantación de las unidades psiquiátricas no es el estigma presente en la cultura de los hospitales generales, pero una limitación de orden estratégica: la falta de una política afirmativa para esas unidades.OBJECTIVE: To comprehend the stigma against people with mental disorders still persists in the culture of general hospitals and acts as a limiting factor in the implementation of psychiatric units in general hospitals in Brazil. METHODOLOGICAL PROCEDURES: A qualitative social survey was outlined based on action research strategy as of the agreement to adopt a psychiatric unit in a general hospital in Taubaté, Southeastern Brazil. Data was obtained through interviews, participant observation and talks on the psychiatric unit project given to the hospital's clinical staff. RESULTS: The investment made by the healthcare authority enabled the stigmatizing conceptions (violence, moral weakness and untreatability present in the hospital culture in question to be resignified by means of clinical and sanitary discussions, which
In this paper, a class of quasi-linear Rie mann-Hilbert problems for general holomorphic functions in the unit disk was studied. Under suitable hypotheses, the existence of solutions of the Hardy class H2 to this problem was proved by means of Tikhonov' s fixed point theorem and corresponding theories for general holomorphic functions