American journal of surgery
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The Residency Review Committee-Surgery (RRC--S), 1 of 10 surgical specialties of the Accreditation Council for Graduate Medical Education (ACGME) has monitored the surgical volume of all general surgical residents closely. As a consequence of the reduction of duty hours with the limitation of an 80-hour work-week (averaged over 4 weeks), we were interested in the impact of these restrictions on surgical (volume) experience since its first year of implementation (2003--2004). Therefore, we evaluated the surgical volume of general surgical services since the implementation of the ACGME duty-hour restrictions and compared this volume with that of previous years without these duty limits. ⋯ RRCs that evaluate general surgery and surgical specialties have responded aggressively and professionally to implement the duty-hour standards per the ACGME. This brief report should be considered an interim communication to evaluate the surgical experience impact for programs currently under the restriction of duty-hour limits. The data provided in the first year of evaluation since the implementation of the 80-hour work-week restriction policy suggest that there has been no significant change in the overall surgical experience for major procedures (per resident), nor has there been a negative impact on Chief Resident surgical experience. A continuum of the prospective evaluation process is required by the RRC-S and other surgical specialties to ensure that requisite surgical volume is maintained throughout the entire 5 years of clinical surgery.
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Comparative Study
Sex differences in cytokine production and surface antigen expression of peripheral blood mononuclear cells after surgery.
Several clinical and epidemiological studies have observed a better outcome after sepsis in women than in men. The purpose of this study was to determine if these sex differences are observed in cytokine responses and the surface antigen expression of monocytes. In addition, the clinical courses of male and female patients after gastrointestinal surgery were compared. ⋯ Both TNF-alpha and interleukin-10 production of PBMCs and both TLR-2 and CD16 expression on monocytes were significantly higher in women than in men on the day before surgery. Excessive TNF-alpha and suppressive IFN-gamma production of PBMCs, as well as a decrease in HLA-DR expression on monocytes, occurred more often in men than in women after surgery, suggesting that these factors all contribute to an increased susceptibility of men to develop systemic inflammatory response syndrome or postoperative infectious complications.
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It is known that emergency surgery for colorectal cancer is associated with high morbidity and mortality. The aim of this study was to assess the presentation, treatment, and outcome of patients with complicated colorectal cancer. Risk factors for morbidity and mortality were also evaluated. ⋯ Emergency surgery for complicated colorectal carcinoma carries high rates of morbidity and mortality. To achieve improvements in outcome, intensive treatment after surgery in patients with risk factors is recommended.
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Standardized short courses in laparoscopic cholecystectomy aim to teach laparoscopic skills to surgical trainees, although end-of-course assessments of performance remain subjective. The current study aims to objectively assess psychomotor skills acquisition of trainees attending laparoscopic cholecystectomy courses. ⋯ Objective validated methods can be used to assess learning of psychomotor skills on courses. In addition to providing participants with an insight into their skills, these data can be used to demonstrate course efficacy.
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Care of the injured patient has been a focal point of surgical training at the University of Louisville. Under the direction of Dr. Hiram C. ⋯ Summaries of contributions to the peer-reviewed literature or to hospital programs by former trainees who specialized in pediatric surgery are presented. Topics include the treatment of pediatric solid-organ injury, pelvic fracture, pellet-gun injury, and caustic cutaneous burns. The impact of the pediatric Trauma Service at Kosair Children's Hospital in Louisville, KY, with an emphasis on compassionate care and the development of a bereavement intervention program, also is presented.