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Anchorage, AK, United States

Macedo F.I.,Providence Surgery Centers
World Journal of Hepatology | Year: 2013

Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence, and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common. Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes. © 2013 Baishideng. Source


Walsh C.P.,Detroit Medical Center Providence Hospital Orthopaedic Surgery Residency Program | Hubbard J.C.,Wayne State University | Nessler J.P.,St. Cloud Orthopaedics | Markel D.C.,Providence Surgery Centers
Journal of Arthroplasty | Year: 2015

Modular neck femoral stems have been associated with adverse local tissue reactions (ALTR), leading to a voluntary recall, but these effects have not been well-characterized. A retrospective review of intraoperative findings and cobalt/chromium levels was performed in 103 hips undergoing revision for ALTR. The average preoperative serum cobalt level was 7.6. μg/L (range 1.1-23. μg/L) and chromium level was 1.8. μg/L (range 0.1-6.8. μg/L). Metallic sludge was noted in 100%, synovitis in 98%, pericapsular rind in 82%, and calcar erosion in 85%. An osteotomy was required for removal in 44%. We concluded that revision of modular neck femoral stems is associated with increased preoperative metal ion levels and stem-neck corrosion. Despite advanced stem explantation techniques, osteotomy was frequently required, leading to increased morbidity. © 2014 Elsevier Inc. Source


Taggarshe D.,Providence Surgery Centers | Mittal V.,Providence Surgery Centers
Journal of Surgical Education | Year: 2012

OBJECTIVE: The American Board of Surgery (ABS) provides program directors with ABS In-Training Examination (ABSITE) scores in the following forms: Percent correct score and percentile score. It is of interest to note how residency programs utilize the different forms of ABSITE scores in assessment of surgical residents for progression in training. We conducted a survey of program directors to ascertain the present situation. METHODS: A structured questionnaire was sent to all program director members of the Association of Program Directors in Surgery. RESULTS: 114/210 program directors (54%) answered the survey. To assess residents, 3 programs used only the percentage correct score, 23 programs used only the percentile score, and 88 programs used both scores. The majority (70/89 or 79%) of the programs used a 30th percentile score as the minimum passing score. 88/111 (79%) programs had a remedial process for residents with poor performance on ABSITE. 60 percent of the programs had never used poor ABSITE performance to defer individual resident promotion. Programs that used ABSITE performance for remediation and deferral of promotion did it based on percentile score rather than percent correct score. Program directors felt that the better indicator of a resident's knowledge and progression in surgical residency was percent correct score (42%) vs percentile score (32%), while 10% felt that neither was an adequate indicator. CONCLUSIONS: ABSITE score is being used as one of the measures to assess residents. Programs need to ensure that an effective remedial process is in place to assist residents with poor performance. © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. Source


Taggarshe D.,Providence Surgery Centers | Mittal V.,Providence Surgery Centers
Journal of Surgical Education | Year: 2011

Background The implementation of the 80-hour week compounded by the need for the current trainee to be well versed technically with the newer developments in surgery has resulted in limited time for didactic education. Commercial American Board of Surgery in Training examination (ABSITE) review courses are flourishing and may seem to be filling the gap in didactic education. Objective This study ascertained the opinion of the general surgery program directors across the country on the role of the review courses in the ABSITE performance of a surgical resident. Methods A questionnaire was designed and sent out to all program directors using online survey. Results Sixty-five of 242 program directors completed the questionnaire. Fifty-seven percent belonged to university-based surgical residency programs. Seventy-two percent used ABSITE performance as a measure while evaluating the resident for promotion. Although 60% agreed that review courses help the performance of the residents, 80% did not have any institutional or regional review courses. Ninety percent allowed their residents to attend commercial review courses but 60% did not reimburse them. Conclusions Program directors do feel that ABSITE by itself is important in evaluating the progression of surgical residents and has a correlation with the boards' pass percentile. Due to the limited hours available for didactics in current surgical residency, intensive review course over a 2- to 3-day period may help the surgical residents to perform better. In the current economy, review courses offered by a consortium of programs geared toward improving ABSITE performance and conducted by the surgical faculty may be of essence. © 2011 Association of Program Directors in Surgery. Source


Subhas G.,Providence Surgery Centers | Mittal V.K.,Providence Surgery Centers
American Surgeon | Year: 2011

The field of postgraduate minimally invasive surgery training has undergone substantial growth and change. A survey was sent to all program directors in surgery. Minimally invasive training patterns, facilities, their views, and performance of residents were examined. Ninety-five directors (38%) responded to the questionnaire. Of these, 51 per cent (n = 48) had a program size of three to four residents and 33 per cent (n = 31) had a program size of five to six residents. In 3 per cent of programs (n = 3), residents could not achieve the minimum Accreditation Council for Graduate Medical Education required numbers for advanced laparoscopic cases. Only 47 per cent of programs (n = 45) had dedicated rotations in minimally invasive surgery, ranging from 2 to 11 months. Up to 10 per cent (n = 9) of program directors felt that the current training in minimally invasive surgery was insufficient. Fifty-five per cent (n = 52) felt that laparoscopic adhesiolysis was an advanced laparoscopic procedure, and 33 per cent (n = 31) felt that there should be a separate minimum requirement for each of the commonly performed basic and advanced laparoscopic cases by Accreditation Council for Graduate Medical Education. Fifty-six per cent (n = 53) of programs were performing robotic surgery. Minimally invasive surgery training for surgical residents needs to increase opportunities so that they are able to perform laparoscopic procedures with confidence. There should be specific number requirements in each category of individual basic and advanced laparoscopic procedures. Source

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