American journal of surgery
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The objective of this study was to evaluate implementation of an innovative intervention designed to prevent complications and stimulate early rehabilitation among frail elderly inpatients. ⋯ The CareWell in Hospital program was implemented satisfactorily. Although the low baseline delirium incidence (11%), higher comorbidity, and an increasing learning curve during a restricted implementation period potentially influenced the overall effects, this integrated care program may have beneficial effects on outcomes among frail elderly surgical patients.
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The leadership of the surgical community is actively engaged in improving the preparation of incoming residents to assume responsibility and accountability for key elements of care and stewardship. To better prepare for this transition, it is essential that all matriculants to surgery residency successfully complete a preparatory course of blended learning that specifically addresses the essential components of quality care and patient safety before the start of their training. ⋯ We strongly endorse this effort and encourage medical schools to adopt this or a similar program. We stand ready to assist medical schools and medical students in the implementation of this important initiative.
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Comparative Study
The physiological effects of hyperosmolar resuscitation: 5% vs 3% hypertonic saline.
Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma. ⋯ The 5%NS has sustained higher serum osmolarity and serum sodium concentration within the first 72 hours without any increase in adverse effects in comparison with 3%NS.
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Recent years have seen a significant drop in applications to surgical residencies. Existing research has yet to explain how medical students make career decisions. This qualitative study explores students' perceptions of surgery and surgeons, and the influence of stereotypes on career decisions. ⋯ Strong stereotypes of surgery deterred students from a surgical career. As a field, surgery must actively engage medical students to encourage participation and dispel negative stereotypes that are damaging recruitment into surgery.
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Randomized Controlled Trial
High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: a prospective, randomized, double-blind, controlled, single-site trial.
Perioperative supplemental oxygen has been proposed to decrease the incidence of surgical site infection (SSI) in colorectal surgery with controversial results. We have assessed the influence of hyperoxygenation on SSI by using the most homogeneous study population. ⋯ Supplemental 80% FiO2 reduced postoperative SSI with few risks to the patient and little associated cost.