The Journal of surgical research
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Since the resident physician 80-h/wk restriction was implemented on July 1, 2003, little has been learned about the impact of this reform on patient outcomes after coronary artery bypass grafting (CABG). ⋯ The implementation of the resident work-hour reform in teaching hospitals did not affect mortality rates in CABG patients but was associated with increased morbidity. Further studies are needed to identify the reasons for the post-reform increase in postoperative complications at teaching hospitals.
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We compared the abilities of surgeons and of an established risk model to predict operative mortality after aortic valve replacement (AVR), and we investigated scenarios that give rise to discrepancies between these predictions. ⋯ Both surgeons and the CICSP model performed well in risk-stratifying AVR patients, but the surgeons tended to overestimate the risk. The CICSP model did not capture some disease entities considered relevant in estimating mortality by surgeons.
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Real-time ultrasound guidance of central venous catheter (CVC)/peripherally inserted central catheter (PICC) insertion improves safety and efficacy. We hypothesized that a more robust ultrasound surveillance technique incorporating thoracic, vascular, and cardiac views-the CVC sono-would avoid the need for chest radiography to realize cost and efficiency gains. ⋯ A novel ultrasound technique, CVC sono eliminated the need for chest radiography in most patients after CVC/PICC insertion, saving time and money. Those with multiple indwelling central catheters may still require post-insertion conventional chest radiography.
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Thrombelastography (TEG) allows for rapid global assessment of coagulation function. Our previous work demonstrated that a hypercoagulable state identified by TEG's G value was associated with thromboembolic events in a cohort of critically ill surgical patients despite routine chemoprophylaxis. We hypothesized that a hypercoagulable state could be differentiated into enzymatic or platelet etiology through the use of thrombus velocity curves; specifically the time to maximum rate of thrombus generation (TMRTG) and the novel TEG parameter, delta. (Delta) ⋯ Delta reflects changes in thrombin generation as measured by TMRTG, allowing for differentiation of enzymatic from platelet hypercoagulability. Future studies will be required to validate these findings.
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Residents' duty-hour limitations and the trends towards closed-staffing for surgical critical care (SCC) have reshaped educational paradigms. No study has yet addressed the impact of these changes on resident SCC training. In our study, we investigated residents' experiences and perceptions of SCC education and practice. ⋯ Senior residents reported greater comfort with SCC management despite the lack of senior SCC rotations, whilst dedicated training time for junior residents appears to be declining. Residents wish subspecialist care for their critically ill patients, but the low interest in SCC fellowships suggests future physician shortages in this subspecialty.