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PURPOSE: The modern American surgeon is immersed in an ever-deepening sea of printed and electronic information. Although publishers know how many books and journals they sell, and journals can quote their calculated impact factor, no information exists whatsoever about what surgeons read. Which surgical journals are "popular," and how does it compare with their impact factor (IF)? Our objective was to assess the sources of information and reading habits of American surgeons and to compare the "popularity" of journals with their IFs.A questionnaire was mailed to 1000 American surgeons, randomly selected from a list provided by the American College of Surgeons.A total of 418 surgeons responded, and 371 responses could be analyzed (37%). The leading sources of medical information were medical literature (93%), professional meetings (88%), and CME courses (69%). The average time per surgeon/month dedicated to medical literature was 14 hours (range, 1 to 120). Peer-reviewed journals were read by 95%, textbooks by 68%, and update series by 60% of the respondents. The three most popular surgical journals were Annals of Surgery (IF, 5.40), selected by 60%; Journal of the American College of Surgery (IF, 1.87), selected by 48%; and Archives of Surgery (IF, 2.53), selected by 36%. The most popular subspecialty journals were Cancer (IF, 3.66), selected by 31%; Critical Care Medicine (IF, 3.74), selected by 17%; and Gastroenterology (IF, 10.33), selected by 12%. The New England Journal of Medicine (IF, 28.66), selected by 67%, and the Journal of the American Medical Association (IF, 9.55), selected by 66%, were the most popular general medical journals, followed by Mayo Clinic Proceedings (IF, 1.98), selected by 16%. Among the "leaders" on the IF list for international, British medical and surgical journals were Lancet (IF, 11.79), selected by 5%, and British Journal of Surgery (IF, 2.38), selected by 0.5% of the respondents.Those American surgeons responding consider published literature as their chief source of information, especially peer-reviewed journals. Overall, they ignore non-United States publications and select the journals they read without considering its IF.
We conducted a survey to examine surgeons' opinions and criticisms of patient evaluations done by anesthesiologists prior to surgery. We sent questionnaires to 117 departments of general surgery in Japanese university hospitals. We received answers from 77% of the departments. We analyzed their answers, and compared the answers with those from a similar survey done in 1995 by Japan Society of Anesthesiology, one in which anesthesiologists were asked to evaluate themselves. Our most significant findings were as follows. (1) Although most of surgeons were satisfied with their own preanesthetic evaluation of their patients, 30% of the departments reported postponement of surgery due to the need of further examination during recent 2 months and the occurrence of peri-operative myocardial infarction during recent 2 years, (2) The 1995 survey indicated that 46 percent of anesthesiology departments had explained the major perioperative risk, but a half of the 46% had done so without discussing the risk with responsible surgeons. Furthermore, the present survey showed that only 17% of the surgery departments had been aware of such explanation done by anesthesiologists. (3) One-third of the anesthesiology departments did not document the text of the preanesthetic explanation to patients. In our opinion, the final responsibility for the patient's peri-operative care is primarily the surgeon's at present in Japan, although each specialist including the anesthesiologist and the cardiologist should share the responsibility. If the anesthesiologist explain the major peri-operative risk to the patient without first obtaining the surgeon's permission to do so, the patient may become confused about who is responsible for his or her care. It should be made clear to the patient what responsibility each doctor has. It is also important that all explanations given to a patient and the consent to anesthesia given by a patient be properly documented. Japanese anesthesiologists and surgeons need to work far more closely together with regard to pre-anesthetic evaluation and explaining patients about their peri-operative risk.
The relationship between the Canadian Association of General Surgeons and the community surgeon is a symbiotic one. Despite the controversy about medical costs and the oversupply of physicians, there is and will continue to be an increased need for general surgeons in Canada. Highly trained general surgeons are needed in medium-sized and smaller communities where the bulk of general surgery is done. The Canadian Association of General Surgeons sponsors research in education that will affect surgical knowledge and the training and future of community surgeons.
OBJECTIVE: To determine whether surgeons who had received appropriate training in the technique of total thyroidectomy could continue to perform the procedure with minimal morbidity after moving to a provincial surgical practice. DESIGN: Comparison of the complication rates from total thyroidectomy between a specialized endocrine surgical unit and provincial centers. SETTING AND PATIENTS: Six hundred fifty patients undergoing total thyroidectomy by two surgeons over a 5-year period in the endocrine surgical unit at Royal North Shore Hospital, St Leonards, Australia, were compared with 120 patients undergoing total thyroidectomy by seven provincial surgeons who were former trainees in the unit. MAIN OUTCOME MEASURES: Indications for surgery and specific complications of thyroidectomy including recurrent laryngeal nerve palsy, permanent hypoparathyroidism, and postoperative bleeding. RESULTS: Each of the seven surgeons in provincial practice performed only between two and 16 thyroidectomies annually. The percentage of total thyroidectomies for benign and malignant disease was identical for both the endocrine surgical unit and provincial center groups (44%). There was no difference in the incidence of recurrent laryngeal nerve palsy, permanent hypoparathyroidism, or postoperative bleeding between the two groups. CONCLUSION: Total thyroidectomy is an operation that always engenders controversy relating to the morbidity of recurrent laryngeal nerve and parathyroid injury. Surgeons who have completed a well-designed training program and who have become proficient at total thyroidectomy as trainees will remain proficient at the procedure despite practicing in a provincial center. Achieving a low morbidity rate demands meticulous attention to operative technique and anatomical detail.
Various factors are influencing the Swiss health care system, and therefore, surgeons' actual and future profession. Initiated by the current president of the Swiss Society of Surgery, a group of eight young Swiss surgeons constituted the ad hoc committee "Chirurgie 2020". The goal was to develop several scenarios of the surgeon's professional situation in 20 years. The future direction of surgery will be markedly influenced by medical innovation, political and economic relationships between Switzerland and Europe. However, the development of health care costs represents the most powerful factor predicting all further changes. The current situation of today's surgeons is best characterised as "hamsters in the treadmill" who try to fulfill a multitude of diverging tasks causing major demotivation. In order to retain a leading role in the health care system, surgeons must take part in social and political activities. To provide an excellent curriculum, university and county hospitals must join together to form clinical and educational networks. A clearly defined and structured curriculum must be introduced by the Swiss Society of Surgery. From our current point of view, only everyone's strong personal commitment will help to find solutions and to improve the current and future situation. In particular, today's surgical residents must actively take part in the development of tomorrow's surgery.
PURPOSE: To compare the occurrence at magnetic resonance (MR) imaging of clinically important knee abnormalities in patients referred by orthopedic surgeons with that in patients referred by other physicians. MATERIALS AND METHODS: Knee MR images in all patients referred for evaluation of internal derangement for 12 months were retrospectively reviewed. Meniscus, ligament, and articular cartilage abnormalities were tabulated. The numbers of abnormalities detected in the patients referred by orthopedic surgeons were compared with those in the patients referred by all other physicians by using chi(2) analysis. Significance was defined at P less than .05. RESULTS: Knee MR images in 439 patients were reviewed; 328 patients were referred by orthopedic surgeons, and 111 were referred by other physicians. There was no significant difference in the rates of occurrence of meniscus tear (149 [45%; orthopedic surgeon referrals] vs 50 [45%; other physician referrals], P = .96); ligament tear (82 [25%] vs 21 [19%], P = .25); isolated hyaline cartilage defect (77 [23%] vs 20 [18%], P = .29); meniscus or ligament tear (167 [51%] vs 55 [50%], P = .86); or meniscus, ligament, or articular cartilage tear (242 [74%] vs 72 [65%], P = .34). The proportion of patients who subsequently underwent surgery of the knee was also similar (39% [118 of 300] vs 28% [23 of 82], P = .14). CONCLUSION: There was no significant difference in the occurrences of clinically important knee internal derangement at MR imaging between patients referred by orthopedic surgeons and those referred by other physicians.
A survey of members of the American Association of Hip and Knee Surgeons was done to document surgeons' attitudes and practices regarding discussion of return to sexual activity, timing of return, and safety of various sexual positions for patients after total hip arthroplasty. Surveys were returned by 254 of 821 surgeons (31%). Two hundred thirty-three (80%) surgeons reported they rarely or never discuss sexual activity with their patients who have had hip arthroplasty. Of surgeons who stated they did discuss this topic, 96% spent 5 minutes or less. Most respondents (67%) recommended delaying return to sexual activity until 1-3 months postoperatively. Fifty-one respondents (20%) reported knowledge of patients experiencing dislocation of the total hip replacement during sexual activity. Five specific sexual positions for men and three positions for women were considered acceptable by more than 90% of respondents. Most agreed that sexual activity could be resumed safely 1-3 months postoperatively if acceptable positions were used.
BACKGROUND: The American College of Surgeons Oncology Group (ACOSOG) represents an organized effort by surgeons to participate in clinical trials research. To assess the quality of trial conduct by surgeons on a national level and the feasibility of improvement through education, this study examined the findings of the Quality Assurance Audit Program of the ACOSOG over time. STUDY DESIGN: Outcomes of 249 routine audits conducted from 2001 to 2004 were reviewed for major and minor deficiencies and overall performance (acceptable versus unacceptable) in compliance with regulatory requirements (REG) and patient case review (PCR). RESULTS: From 2001 to 2004, active trials have increased. Major deficiencies in REG fell from 31% to 20% for IRB documentation (p = 0.002) and from 31% to 9% for informed consent (p < 0.001). The major deficiency rates in PCR decreased from 21% to 6% (patient consent), 16% to 7% (eligibility), 13% to 7% (treatment), 34% to 6% (outcomes), 6% to 1% (toxicity), and 16% to 3% (data). During 2001 to 2004, the overall acceptable performance rates were 82%, 72%, 84%, and 92%, respectively, in REG (p = 0.093), and significantly improved in PCR (47%, 55%, 77%, 94%, respectively; p < 0.001). No difference was detected in acceptable rates between academic versus community sites, for either REG (86% versus 76%, respectively; odds ratio: 1.91; 95% CI: 0.87 to 4.19) or PCR (63% versus 68%, respectively; odds ratio: 0.81; 95% CI: 0.42 to 1.53). CONCLUSIONS: Despite initial deficiencies, surgical trials are now conducted with high standards nationwide. In response to educational programs, surgeon performance in clinical trials has measurably improved. Quality assurance audits have served both surveillance and educational roles.
BACKGROUND: Reconstruction of the burn patient presents a challenge to the burns surgeon. The variety of issues and the timing of surgery can be a daunting task. A group of 11 patients who were injured 1 year previously at the time of the Bali bomb blast were reviewed. METHODS: A customised assessment form was developed in order to quantify the patient's perceived need for reconstruction. Each patient was asked to prioritise, in order of preference any injured area they might consider for further surgery. These patients were then assessed independently by a consultant plastic and reconstructive surgeon and a senior trainee, using an identical form. The surgeons were asked to prioritise, in order of preference any area they might consider for further surgery and to indicate from a list the procedure they would employ. This list ranged from simple excision to free flap encompassing the entire reconstructive ladder. RESULTS: The patients all showed a strong reluctance to undergo further reconstruction. However there was a strong correlation between the surgeons, concurring on issues of function but there were discrepancies regarding "aesthetic" reconstruction. CONCLUSIONS: This study highlights the absolute need for secondary burns reconstruction to be a patient driven service.
OBJECTIVE: To determine the level of training of General Surgeons in the UK in the Advanced Trauma Life Support (ATLS) course and their involvement with hospital trauma teams. METHODS: Postal questionnaire sent to General Surgical Consultants and Higher Surgical Trainees (HSTs). RESULTS: 58% of General Surgeons who responded had attended ATLS, but only 30% of those who had been Consultants for more than 10 years. Eighty-seven percent considered the course 'essential' or 'some value'. Sixty-one percent of hospitals represented had a trauma team. A Consultant General Surgeon was a member of the team in 50% and the General Surgical HST in 82%. CONCLUSION: ATLS has been widely accepted by General Surgical Trainees and recently appointed Consultants. The trauma team approach to resuscitation has yet to become fully established in the UK and there is limited input from Consultant General Surgeons.
OBJECTIVE: Medical practice governance is made more challenging by the fact that many procedures may be performed by various medical or surgical specialties. Thyroid cancer surgery is performed by both physicians with general surgery (GS) and those with otolaryngology/head and neck surgery (HNS) credentials. Analyses describing differences in practice patterns between the 2 services have not been published previously. PATIENTS AND METHODS: The records of the Tumor Registry at the Naval Medical Center San Diego were reviewed for patients presenting with thyroid cancer between January 1, 1990, and December 31, 1999. The review included all patients undergoing partial or total thyroidectomy, and the operative techniques and complications were noted. RESULTS: Of the 178 patients who underwent thyroid cancer surgery in this period, charts were available for 136 (n = 87 HNS, n = 49 GS, 1 combined HNS/GS). There was no difference between the 2 services in terms of the percentage of patients undergoing lymph node sampling (P = 1.000), but each had different approaches to sampling techniques. Head and neck surgeons performed more total thyroidectomies (P < .001) and referred patients more frequently for postoperative radioiodine (P = .025); they resected 426 nodes in 32 patients (mean 13.3, median 6.5), of which 120 (28.2%) were positive. General surgeons resected 28 nodes in 11 patients (median 2.0, mean 2.6), of which 12 (42.8%) were positive (P = .009). Other variables were similar for services, including inpatient hospital days, estimated blood loss, number of patients with temporary hypoparathyroidism, and duration of hypocalcemia. CONCLUSION: In this cohort, otolaryngologists/head and neck surgeons and general surgeons have a significantly different approach with respect to lymph node sampling in the surgical therapy of thyroid cancer. Outcomes appear independent of technique.
Surgeon John Thomson (1847-1909), a Scot who made his life's work in Queensland, was a pioneer surgeon, radiologist and bacteriologist, and one of the founders of the St John Ambulance movement in Australia and the Railway Ambulance Corps. He was variously President of the British Medical Association (Queensland Branch), the Medical Board of Queensland, the Medico-Ethical Association, and the Intercolonial Medical Congress, which was held in Brisbane in 1899. A pioneer military surgeon in this country, he was the foundation Principal Medical Officer (as Surgeon-Major) of the Queensland Ambulance Corps within the Queensland Defence Force. His advocacy for a university north of Sydney was one of the factors which led to the foundation of the University of Queensland, a body which honoured him by the establishment of the John Thomson Lectureship, which for half a century was its most prestigious public oration. The life and times of this singular doctor exemplify one small class of pre-Federation medical pioneers whose professional outreach established a number of voluntary organisations which have blossomed in Australian society to the present day.
The treatment of oral and related cancer has evolved greatly since the early part of the 20th century. Today, some oral and maxillofacial surgeons include oral cancer surgery as a normal part of their practice. This article will discuss 3 pioneers, Elmer C. Hume, Fred Henny, and Claude La Dow, who shared a career-long commitment to oral cancer surgery, trained future leaders of the specialty, and retained their professional identity within dentistry and oral surgery. Their lives and contributions are profiled within the context of the political climate of oral surgery at the time. Oral cancer surgery within the discipline of oral and maxillofacial surgery declined later in the 20th century as this activity increased among head and neck surgeons based in general surgery and later, otolaryngology. Simultaneously, the interest of American oral surgeons was drawn toward orthognathic surgery and the landmark presentation by Hugo Obwegeser at Walter Reed Army Medical Center in June 1966 signaled the beginning of a shift in the focus of the specialty. The close of the 20th century has witnessed a renaissance of interest in oral cancer surgery within American oral and maxillofacial surgery.
BACKGROUND: Several models that integrate trauma and emergency general surgery (EGS) have been proposed to provide a diverse and challenging operative practice for trauma surgeons and improve recruitment. In July 2002, our institution established a 24/7 EGS consult service, staffed primarily by critical care/trauma surgeons (CCTS). The objective of this report was to evaluate the impact of this new service on CCTS, general surgeons (GS) and the hospital. METHODS: All admissions to CCTS and GS from July 1, 2000 to June 30, 2003 were reviewed by querying hospital and physician databases for demographics, diagnoses, operative intervention(s), and resource utilization. Data were analyzed using nonparametric methods. RESULTS: [See ]. 9,405 admissions were identified, with GS and EGS admissions increasing over time. In July 2002, EGS became a separate service and captured 26% of GS admissions. Hospital-wide trauma admissions remained stable despite a slight decrease in trauma admissions to CCTS. A decrease in trauma operations by CCTS was offset by an increased EGS operative volume. EGS included "bread and butter" GS procedures including appendectomies and cholecystectomies and complex surgical procedures. EGS patients were often sicker with more than 50% requiring ICU admission compared with GS admissions of which only 10% required ICU care.(Table is included in full-text article.) CONCLUSIONS: Departmental restructuring to include an EGS service: 1) increased CCTS volume despite decreased CCTS trauma admissions and operations; 2) increased elective GS volume; 3) generated increased use of ICU and operating room resources; and 4) demonstrated that CCTS with broad operative GS backgrounds and critical care knowledge can effectively staff an EGS service.
This account of the Edinburgh surgeon, Alexander Wood (1725-1807), brings together information from a number of sources including the diaries of his friend and patient, James Boswell, and anecdotes recorded by James Paterson who wrote the biographical notes for Kay's Portraits. Wood was a fashionable eccentric who took a sheep and raven on his home visits and he was as popular with the poor and working classes as he was with more well-to-do patients. He was a Deacon of the Incorporation of Surgeons and one of the first Surgeons-in-Ordinary at Edinburgh Royal Infirmary. His clinical skills were admired by patients and colleagues alike and he did much to enrich the life of the Edinburgh medical fraternity.
In summary, immunization against HBV appears to be the most effective method of preventing transmission of HBV from patients to members of the surgical team. Such immunization is also the most effective way to reduce the risk of transmission of HBV from surgeons to patients. Eventually, by virtue of voluntary or required immunization, essentially all surgeons will be immunized. Until that time, HBV is likely to remain a threat to surgeons. The College and its appropriate committees will continue to monitor the data and update these recommendations accordingly.