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Abington, PA, United States

Valentine R.J.,University of Texas Southwestern Medical Center | Jones A.,American Board of Surgery | Biester T.W.,American Board of Surgery | Cogbill T.H.,Gundersen Lutheran Medical Center | And 2 more authors.
Annals of Surgery

Objective: To assess changes in general surgery workloads and practice patterns in the past decade. Background: Nearly 80% of graduating general surgery residents pursue additional training in a surgical subspecialty. This has resulted in a shortage of general surgeons, especially in rural areas. The purpose of this study is to characterize the workloads and practice patterns of general surgeons versus certified surgical subspecialists and to compare these data with those from a previous decade. Methods: The surgical operative logs of 4968 individuals recertifying in surgery 2007 to 2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional American Board of Medical Specialties certificates (GS+). Data from GS surgeons were also compared with data from GS surgeons recertifying 1995 to 1997. Independent variables were compared using factorial ANOVA. Results: GS surgeons performed a mean of 533 ± 365 procedures annually. Women GS performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to men GS (P < 0.001). GS surgeons recertifying at 10 years performed more abdominal, alimentary tract and laparoscopic procedures compared to those recertifying at 20 or 30 years (P < 0.001). Rural GS surgeons performed far more endoscopic procedures and fewer abdominal, alimentary tract, and laparoscopic procedures than urban counterparts (P < 0.001). The United States medical school graduates had similar workloads and distribution of operations to international medical graduates. Compared to 1995 to 1997, GS surgeons from 2007 to 2009 performed more procedures, especially endoscopic and laparoscopic. GS+ surgeons performed 15% to 33% of all general surgery procedures. Conclusions: GS practice patterns are heterogeneous; gender, age, and practice setting significantly affect operative caseloads. A substantial portion of general surgery procedures currently are performed by GS+ surgeons, whereas GS surgeons continue to perform considerable numbers of specialty operations. Reduced general surgery operative experience in GS+ residencies may negatively impact access to general surgical care. Similarly, narrowing GS residency operative experience may impair specialty operation access. © 2011 by Lippincott Williams & Wilkins. Source

Kurian A.A.,Abington Memorial Hospital
Journal of surgical education

OBJECTIVES: To determine if laparoscopic colectomy is safer and more effective than open colectomy in patients older than 80 years of age. METHODS: An operating room database of all colectomies performed on patients >or=80 years, from January 2002 to September 2007, was analyzed retrospectively. Data reviewed included type of operation, type of resection, length of procedure, length of stay (LOS), estimated blood loss, American Society of Anesthesiologists (ASA) grade, diagnosis, complications, mortality rates, and discharge destination, with p-values <0.05 considered significant. RESULTS: One hundred thirty-nine patients underwent open procedures (Open group) during the study period versus 150 patients who underwent laparoscopic procedures (Lap group). Of the Lap group, 15 patients were converted to open cases. Forty-four patients from the Open group were excluded from the analysis as they were treated emergently, leaving 95 patients in the Open group. The mortality for open procedures was significantly higher at 9/95 (9.4%), compared with 3/150 (2%) following laparoscopic procedures (p = 0.0132). LOS was significantly longer for open procedures (11.16 days) versus laparoscopic procedures (7.11 days), p = 0.0001. Open procedures were associated with an increased risk of postoperative ileus (p < 0.02). The Open group had a higher likelihood of discharge to a nursing facility (43/87) than the Lap group (33/147), p < 0.0001. There were no significant differences in the length of procedure, estimated blood loss and postoperative complications. CONCLUSIONS: Laparoscopic colectomy is a safer option that offers an improved outcome compared with open colectomy in elderly patients. Significant improvements in LOS, mortality rates, and discharge destination were observed. Copyright (c) 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. Source

Clause K.J.,Abington Memorial Hospital
The Pennsylvania nurse

As the primary contact in the health care system, nurses can play a role in combating this crime and assisting the victims. Assessment for abuse, neglect, trauma, recurrent sexually transmitted infections (STIs) and fear of a controlling partner is critical. Following up on "red flags" and understanding methods of safe questioning can make the difference between slavery and recovery for victims. Nurses must also know the professional referrals in their areas once a potential victim has been identified. This may be a very dangerous undertaking and must be handled by experienced personnel. Referrals to forensic nurses or physicians, domestic violence professionals or law enforcement may be indicated. Initially, a nurse may want to consult with the agency social worker for guidance. Human trafficking is a human rights crime. Unfortunately, it is more prevalent in all types of communities than most people suspect. Nurses can be heroes to the victims through understanding of this crime and vigilance in the assessment and care of all people they encounter in their practices. To learn more or to help with this cause, visit the Somaly Mam Foundation at www.somaly.org or the U.S. Department of State at www. state.gov. Source

Murayama K.M.,Abington Memorial Hospital
American Journal of Surgery

By the nature of their career choice, surgeons are leaders at a variety of levels. The rise to leadership positions in surgery often requires scaling a steep pyramid. Many young surgeons are poorly prepared for what is frequently a competition with their peers. Some of the qualities young surgeons must possess to ascend the leadership pyramid are summarized by the "HOPES" of leadership: Honesty, recognition of Opportunity, having a Plan, knowing your Environment, and Self-assessment. © 2014 Elsevier Inc.All rights reserved. Source

Home healthcare and hospice clinicians face many challenges in the complex healthcare system caring for patients and their families in the home environment. One of those challenges is providing culturally competent care for an increasingly diverse population. This article will highlight free, easily accessible, online resources to assist clinicians and organizations to assess organizational and individual cultural competence and provide many resources for cultural competency education programs. © 2014 Lippincott Williams & Wilkins. Source

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