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At least 433 records · Page 24Linked to original sources
PubMed2002

Prevention of venous thromboembolism in Wales: results of a survey among general surgeons.

OBJECTIVE: To examine the current attitudes towards the prevention of venous thromboembolism among a cohort of surgeons. DESIGN: A postal survey, comprising a questionnaire covering various aspects of venous thromboembolism prophylaxis was sent to all (n=84) consultant general surgeons in Wales. RESULTS: Replies were received from 57 surgeons (68%), all of whom routinely used prophylaxis, the most frequent modalities used being heparin (100%) and graded compression stockings (79%). A combination of physical and pharmacological methods was used by over 89% of surgeons, with 60% starting prophylaxis more than two hours before operation. All surgeons continued prophylaxis after surgery, 53% until patients were mobile, 45% until they were discharged, and one surgeon continued prophylaxis for seven days after discharge. The thrombosis risk factors considered most important by surgeons when deciding about prophylaxis were (i) a previous history of venous thromboembolism, (ii) hypercoagulability, and (iii) malignancy. CONCLUSIONS: This study confirms that Welsh surgeons conform to standard methods, but also highlights some uncertainties that are present in current surgical practice. Those who responded all routinely used prophylaxis, the timing of which was variable. The main risk factors identified when considering prophylaxis were previous history of deep vein thrombosis/pulmonary embolism, hypercoagulability, and the presence of malignancy. Suggestions for future practice are made.

Anticoagulants↗
PubMed2003

Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates?

BACKGROUND: Studies that are the basis of recommended volume thresholds for CABG surgery are outdated and not reflective of recent advances in the field. This study examines both hospital and surgeon volume-mortality relations for CABG surgery through the use of a population-based clinical data set. METHODS AND RESULTS: Data from New York's clinical CABG surgery registry from 1997 to 1999 (total number of procedures, 57 150) were used to examine the individual and combined impact of annual hospital volume and annual surgeon volume on in-hospital mortality rates after adjusting for differences in severity of illness. Significantly lower risk-adjusted mortality rates occurred above all annual hospital volume thresholds between 200 and 800 and above all surgeon volume thresholds between 50 and 200. The number needed to treat (NNT) at higher-volume providers to avoid a death was minimized for a hospital threshold volume of 100 (NNT=50) and a surgeon threshold volume of 50 (NNT=118). The risk-adjusted mortality rate (RAMR) for patients undergoing surgery performed by surgeons with volumes of > or =125 in hospitals with volumes of > or =600 was 1.89%. The RAMR was significantly higher (2.67%) for patients undergoing surgery performed by surgeons with volumes of <125 in hospitals with volumes of <600. CONCLUSIONS: Higher-volume surgeons and hospitals continue to have lower risk-adjusted mortality rates, and patients undergoing surgery performed by higher-volume surgeons in higher-volume hospitals have the lowest mortality rates.

Coronary Artery Bypass↗
PubMed1991

Selection process for surgeons in the Asymptomatic Carotid Atherosclerosis Study.

BACKGROUND AND PURPOSE: The Asymptomatic Carotid Atherosclerosis Study is a prospective, multicenter, randomized clinical trial of carotid endarterectomy for the treatment of asymptomatic hemodynamically significant stenosis. This report describes the selection process for participating surgeons in the trial. METHODS: The Surgical Management Committee established guidelines for minimal annual experience and maximum neurological morbidity and mortality for surgeons to qualify to participate in the study. For approval, a surgeon must perform at least 12 carotid endarterectomies per year. Based on a review of the surgeon's last 50 consecutive endarterectomies, the combined neurological morbidity and mortality rate must be no greater than 5% for all indications and no greater than 3% for endarterectomies performed on asymptomatic patients. RESULTS: One hundred sixty-four surgeons from 48 centers applied for approval: 117 were approved, 17 were rejected, and 30 were not reviewed. The 117 approved surgeons submitted a total of 5,641 endarterectomies with a combined mortality and neurological morbidity rate of 2.3% for the variety of indications for operation. CONCLUSIONS: This overall experience with carotid endarterectomy is one of the largest series reported to date. The data from approved surgeons are well within the range of acceptable neurological morbidity and mortality rates recommended by the Stroke Council of the American Heart Association, which attests to the overall quality of the surgeons participating in the study.

Carotid Artery Diseases↗
PubMedDate not supplied

Preoperative HIV antibody testing: the views of surgeons and patients.

Fifty surgeons and 72 preoperative patients in 2 central London hospitals were asked their views on preoperative HIV antibody testing, who is at risk of HIV infection and HIV test counseling. A substantial proportion of both surgeons and preoperative patients, 48% and 54% respectively, supported compulsory HIV antibody testing without patient consent. They believed this should occur as a routine practice prior to surgery. However, surgeons and patients differed in the preoperative patients to be considered for such testing. All surgeons advocating compulsory testing believed that it was only necessary for those patients belonging to high risk groups whilst preoperative patients believed that all patients should be HIV tested prior to surgery. Surgeons and patients also differed in their views on who was at risk of HIV infection. Surgeons believed those at risk to be members of identifiable risk groups whilst patients believed everyone was at risk, especially those engaging in high risk behaviours. Finally, when asked which health professionals they thought should be involved in HIV test counselling, both surgeons and patients agreed that hospital doctors, including surgeons themselves, should take on the responsibility of test counselling. The implications of this and routine HIV antibody testing are discussed.

AIDS Serodiagnosis↗
PubMed2003

Role of surgeon volume in radical prostatectomy outcomes.

PURPOSE: To examine the effect of hospital and surgeon volume on postoperative outcomes and to determine whether hospital or surgeon volume is the stronger predictor. PATIENTS AND METHODS: Using 1997 to 1998 claims data from a national 5% random sample of Medicare beneficiaries, we identified 2,292 men who underwent radical prostatectomy at 1,210 hospitals by 1,788 surgeons. Hospitals were classified as high (> or = 60 per year) or low (< 60 per year) volume according to radical prostatectomy experience over the 2-year period. Surgeons were classified as high (> or = 40 per year) or low (< 40 per year) volume. Multivariate logistic regression was performed to control for patient demographics and comorbidities when assessing the association of hospital and surgeon volume with in-hospital complications, length of stay, and anastomotic stricture rates. In-hospital complications included cardiac, respiratory, vascular, wound, genitourinary, and miscellaneous surgical and medical conditions. RESULTS: High-volume surgeons had half the complication risk (odds ratio [OR] = 0.53; 95% confidence interval [CI], 0.32 to 0.89) and shorter lengths of stay (4.1 v 5.2 days, P =.03) compared with low-volume surgeons. High-volume hospital patients tended to have fewer anastomotic strictures (OR = 0.72; 95% CI, 0.49 to 1.04). Patient age (> or = 75 years) was associated with more complications (OR = 1.9; 95% CI, 1.39 to 2.70), more anastomotic strictures (OR = 2.2; 95% CI, 1.54 to 3.15), and longer hospital stays (parameter estimate = 2.26; 95% CI, 1.75 to 2.77). CONCLUSION: Surgeon volume is inversely related to in-hospital complications and length of stay in men undergoing radical prostatectomy. Hospital volume is not significantly associated with outcomes after adjusting for physician volume. Further study is necessary to elucidate the mechanism of the volume-outcome effect.

Aged↗
PubMed2003

Managing risk and expected financial return from selective expansion of operating room capacity: mean-variance analysis of a hospital's portfolio of surgeons.

UNLABELLED: Surgeons using the same amount of operating room (OR) time differ in their achieved hospital contribution margins (revenue minus variable costs) by >1000%. Thus, to improve the financial return from perioperative facilities, OR strategic decisions should selectively focus additional OR capacity and capital purchasing on a few surgeons or subspecialties. These decisions use estimates of each surgeon's and/or subspecialty's contribution margin per OR hour. The estimates are subject to uncertainty (e.g., from outliers). We account for the uncertainties by using mean-variance portfolio analysis (i.e., quadratic programming). This method characterizes the problem of selectively expanding OR capacity based on the expected financial return and risk of different portfolios of surgeons. The assessment reveals whether the choices, of which surgeons have their OR capacity expanded, are sensitive to the uncertainties in the surgeons' contribution margins per OR hour. Thus, mean-variance analysis reduces the chance of making strategic decisions based on spurious information. We also assess the financial benefit of using mean-variance portfolio analysis when the planned expansion of OR capacity is well diversified over at least several surgeons or subspecialties. Our results show that, in such circumstances, there may be little benefit from further changing the portfolio to reduce its financial risk. IMPLICATIONS: Surgeon and subspecialty specific hospital financial data are uncertain, a fact that should be taken into account when making decisions about expanding operating room capacity. We show that mean-variance portfolio analysis can incorporate this uncertainty, thereby guiding operating room management decision-making and reducing the chance of a strategic decision being made based on spurious information.

Analysis of Variance↗
PubMed1993

Radiation exposure to the hands of orthopaedic surgeons during procedures under fluoroscopic X-ray control.

The hands of the surgeon are most likely to be directly exposed to ionizing radiation during fluoroscopic screening in the orthopaedic theatre. There is however little information available on the level of exposure to radiation during the normal working pattern of individual surgeons. The purpose of this study was to directly measure the radiation exposure to the hands during fluoroscopic screening in a series of consecutive cases over a month in order to establish whether these staff need to be designated classified persons, and if not, whether they need to be routinely monitored. Extremity monitoring was carried out using thermoluminescent dosimeters. The dosimeter was secured to the operating surgeon's dominant index finger. 44 procedures were carried out by nine different surgeons. The total radiation dose received per surgeon ranged from 48-2329 microSv. In 80% of procedures the dose of radiation to the surgeon's hand was less than 100 microSv. The extrapolated annual dose, even for the surgeon with the highest radiation exposure, was well below the annual dose limit for extremities of 500 mSv per year recommended by the International Commission on Radiological Protection, and embodied in the Ionizing Radiations Regulations 1985. Despite the relatively low doses of radiation received by surgeons in this study, occupational exposure to all personnel should be kept to the lowest practicable levels, and a review of procedures, including dose measurements, from time to time is advised.

Fingers↗
PubMed2005

The relation between surgeon volume and outcome following off-pump vs on-pump coronary artery bypass graft surgery.

STUDY OBJECTIVE: Off-pump coronary artery bypass graft (CABG) surgery has been recently reintroduced into clinical practice. In light of the relatively low level of experience of most cardiac surgeons with off-pump CABG surgery, and the exceptional technical challenge of working on a "beating heart," off-pump CABG surgery presents a unique opportunity to explore the effect of surgeon case volume on surgical outcome after controlling for the effects of patient case mix and hospital volume. DESIGN: A retrospective cohort study analyzing the association between surgeon volume and in-hospital mortality rate for off-pump and on-pump CABG surgery using random-effects logistic regression modeling. SETTING AND PATIENTS: The analyses were based on the New York State clinical CABG surgery registry. The study sample consisted of 36,930 patients undergoing isolated CABG surgery between 1998 and 1999 that was performed by 181 surgeons at 33 hospitals. INTERVENTIONS: None. RESULTS: There is no association between the number of CABG procedures performed off-pump by an individual surgeon and in-hospital mortality rates (p = 0.93) after controlling for hospital CABG surgery volume and patient-level risk factors. There is also no association between the off-pump CABG surgery mortality rate and the total number of both off-pump and on-pump CABG surgery cases (p = 0.78). In the on-pump CABG surgery cohort, surgeons performing a high volume of CABG procedures had significantly lower risk-adjusted mortality rates among their patients compared to those performing a very low volume, a low-volume, and a medium volume of CABG procedures (p < 0.006). CONCLUSION: For off-pump CABG surgery, surgeons performing a high volume of procedures do not have better mortality outcomes than those performing a low volume of procedures. However, higher surgeon case volumes are associated with lower mortality rates for on-pump CABG surgery. The absence of a volume-outcome association for off-pump CABG surgery is especially surprising in light of the more technically demanding nature of off-pump CABG surgery compared to on-pump CABG surgery.

Cohort Studies↗
PubMed2000

Informed proxy consent: communication between pediatric surgeons and surrogates about surgery.

OBJECTIVE: Informed consent for surgical procedures requires that the procedures are explained and that the patient understands the procedures and risks and agrees to undergo them. Proxy consent occurs when an individual is provided with the legal right to make decisions on behalf of another. This study was conducted to determine how surgeons communicate information to obtain an informed proxy consent, and to investigate how that information is received and processed by surrogates responsible for providing such consent. STUDY DESIGN: Twenty English-speaking parents or legal guardians and 5 surgeons in an urban pediatric hospital were interviewed before, and 2 to 4 weeks after, the surgical procedure. In addition, the interview between the surgeon and surrogate, when consent was obtained, was audiotaped and subsequently analyzed. Semistructured interviews were used to elicit the motivations and influences on the surrogates to consent to the procedure. The same methodology was used to elicit the corresponding impressions of the surgeons. The data were analyzed using descriptive statistics and crosstabulations. RESULTS: Demographic data did not influence the results. Although there was concordance between the surrogate's understanding of the procedure and the surgeon's impression of this understanding, only 3 of 17 surrogates could recall any specifics of the explained procedure. Contrary to the stated belief of surgeons, surrogates consulted with a variety of others, including medical and paramedical professionals, family members, and spiritual leaders. CONCLUSIONS: Communication plays an important role within the surrogate-surgeon dyad. Psychologic variables such as expectations, and the perception of both the surrogates and the surgeons, influence the amount of information that is proffered and the manner in which it is received. Improved communication may be achieved by use of visual aids, discussion of anesthesia and the postoperative course, recognition of the circumstances around the discussion, such as timing and location of the discussion, and personalization of the discussion.

Adolescent↗
PubMed1995

The practice of prophylactic mastectomy: a survey of Maryland surgeons.

OBJECTIVES: Bilateral prophylactic mastectomy is a drastic breast cancer preventive option for which indications are not standardized and efficacy has not been proven. To estimate the magnitude of this controversial practice, surgeons were surveyed on their recommendations about and performance of prophylactic mastectomy. METHODS: A cross-sectional survey was sent to general surgeons (n = 522), plastic surgeons (n = 80), and gynecologists (n = 801) licensed to practice in Maryland in 1992. Proportions responding were 41.9%, 66.3%, and 54.9%, respectively. In addition, there were 30 respondents who identified "other" as their specialty. The respondents were asked about the role of bilateral prophylactic mastectomy and the number of times they had recommended and performed it in a year. RESULTS: Seven hundred forty-two surgeons responded (51.8%). More plastic surgeons (84.6%) than general surgeons (47.0%) and gynecologists (38.3%) agreed that bilateral prophylactic mastectomy has a role in the care of high-risk women. Eighty-one percent of plastic surgeons had recommended the procedure, compared with 38.8% of general surgeons and 17.7% of gynecologists. CONCLUSIONS: Indications and practice patterns reveal heterogeneity of medical opinion and practice of prophylactic mastectomy. This study raises the need for better evaluation of the efficacy and appropriateness of prophylactic mastectomy.

Breast Neoplasms↗
PubMed2006

Knowledge and opinions of orthopaedic surgeons concerning medical evaluation and treatment of patients with osteoporotic fracture.

BACKGROUND: With the exponential increase in osteoporotic fractures, orthopaedic surgeons are in a logical position to become more involved in the medical treatment of this disease. However, it has been hypothesized that surgeons may not be inclined to initiate such treatment if they do not view medical interventions as an extension of their surgical opportunities. The objective of this study was to determine the knowledge and opinions of orthopaedic surgeons with regard to their opportunities for initiating medical treatment of patients with an osteoporotic fracture. METHODS: A survey consisting of twenty-two questions was administered to 171 orthopaedic surgeons in Utah, Idaho, and Wyoming. RESULTS: Of the 171 surveys that were mailed, 107 usable surveys were returned (a 63% response rate). A majority of the orthopaedic surgeons thought that it was appropriate to expand their orthopaedic practice to include prescribing pharmacological treatments for osteoporosis (68% agreed or strongly agreed with that statement). However, 47% were concerned enough about adverse events related to some conventional pharmacological treatments that they would rather avoid prescribing them. Of the surgeons who were willing to prescribe these treatments, 74% felt most comfortable prescribing bisphosphonates and >77% felt most comfortable prescribing calcium and vitamin-D supplements. Fifty-one percent considered an apparent osteoporotic fracture and several other clinical risk factors for osteoporosis as sufficient evidence for initiating pharmacological treatments, whereas 72% thought that a bone-density scan should be made before initiating treatment. Although 32% thought that all nonoperative treatment should be the responsibility of a primary care provider, 63% thought that the orthopaedic surgeon should initiate a workup to look for secondary causes of the osteoporosis and should begin medical treatment of patients with an osteoporotic fracture before referring them. CONCLUSIONS: Although a majority of orthopaedic surgeons believe that they should expand their role in the medical treatment of patients with an osteoporotic fracture, many do not institute medical treatment and think that the patient's primary care providers should be responsible for medical care.

Absorptiometry, Photon↗
PubMed2006

Surgeon's radiation exposure during percutaneous vertebroplasty.

OBJECT: In this study the authors evaluated levels of radiation exposure to surgeons' protected and unprotected hands during fluoroscopically assisted vertebroplasty. METHODS: The amount of radiation administered to 30 patients during 41 procedures in a controlled prospective trial over 6 months was assessed, comparing radiation exposure to the right and left hands in two neurosurgeons. Effective skin doses were evaluated using thermoluminescent finger dosimeters (ring dosimeters). The ratios of finger dosimeter exposure were compared between the glove-protected and unprotected left hands of two surgeons and both unprotected right hands. In addition, dose-area product (DAP) and fluoroscopy times were recorded in all patients. The mean treatment-effective dose to the surgeons' hands was 0.49 +/- 0.4 mSv in the glove-protected left hand and 1.81 +/- 1.31 mSv in the unprotected left hand (p < 0.05). The mean effective hand doses were 0.59 +/- 0.55 mSv in the unprotected right hand of the glove-protected surgeon and 0.62 +/- 0.55 mSv in the unprotected right hand of the control surgeon. The total corresponding fluoroscopy time was 38.55 minutes for the protected surgeon and 41.23 minutes for the unprotected one (p > 0.05). Lead glove shielding resulted in a radiation dose reduction of 75%. The total DAP for all procedures was 256,496 mGy/cm2 and 221,408 mGy/cm2 (p > 0.05) for the protected and unprotected surgeons, respectively. CONCLUSIONS: This study emphasizes the importance of surgeons wearing lead glove protection on their leading hands during percutaneous vertebroplasty procedures and demonstrates a 75% reduction rate of exposure to radiation.

Aged↗
PubMed1995

Participation in sports after hip and knee arthroplasty: review of literature and survey of surgeon preferences.

OBJECTIVE: To summarize previously published findings and to present the opinions of a group of reconstructive orthopedic surgeons from a single institution on participation in sports after hip or knee arthroplasty. DESIGN: We reviewed the literature pertaining to participation in sports after hip or knee arthroplasty and surveyed a group of orthopedic surgeons about their recommendations for resumption of various sports activities by patients who had undergone total hip or knee arthroplasty. MATERIAL AND METHODS: A computerized literature search was performed, and salient issues about participation in sports after joint replacement procedures were synthesized. At the Mayo Clinic, 28 orthopedic surgeons (13 consultants and 15 fellows or residents) completed a single-page questionnaire that requested a recommendation ("yes," "no," or "depends") about patients resuming participation in 28 common sports after recovery from total hip or knee arthroplasty. Staff surgeon responses were compared with responses from fellows and residents by using the Mann-Whitney U test. Sports in which 75% of surgeons would not allow participation were identified as "not recommended," whereas sports in which 75% of surgeons would allow participation were labeled as "recommended." RESULTS: Fellows and residents were less likely than staff surgeons to allow return to cross-country skiing after total knee arthroplasty. Otherwise, responses from consultant surgeons and from fellows and residents did not differ significantly. Recommended sports included sailing, swimming laps, scuba diving, cycling, golfing, and bowling after hip and knee replacement procedures and also cross-country skiing after knee arthroplasty. Sports not recommended after hip or knee arthroplasty were running, waterskiing, football, baseball, basketball, hockey, handball, karate, soccer, and racquetball. CONCLUSION: After hip or knee arthroplasty, participation in no-impact or low-impact sports can be encouraged, but participation in high-impact sports should be prohibited.

Hip Prosthesis↗
PubMed2002

Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons.

OBJECTIVE: To understand better the barriers among orthopedic surgeons and primary care physicians in identifying and treating possible osteoporosis in patients hospitalized with a fragility fracture sustained spontaneously or from a fall no greater than standing height. METHODS: A 1-page, 7-question survey was sent to 35 admitting orthopedic surgeons and 75 primary care physicians at a midwestern managed care organization in March 2001. Returned surveys were collected until 30 days had passed since the mailing. Primary care physicians were board-certified family practitioners and internal medicine physicians. All orthopedists were admitting surgeons in the hospital system. Responders were anonymous, and posted surveys were returned to the Orthopaedic Collaborative Practice office. The surveys were color-coded to separate responses from orthopedic surgeons and primary care physicians. RESULTS: Thirty-one surveys were returned: 23 (31%) from primary care physicians and 8 (23%) from orthopedic surgeons. Survey respondents agreed that the responsibility for postfracture attention to nutritional needs, including calcium and vitamin D, rested with the primary care provider. When asked about barriers to recommending bone mineral density testing with dual energy x-ray absorptiometry, 9 primary care physicians (39%) thought this type of testing was unnecessary for treatment, and 4 primary care physicians (17%) thought a barrier was caused by patient frailty. Primary care physicians indicated that potential adverse effects of medication (n=14 [61%]) and cost of therapy (n=13 [57%]) were the main factors limiting treatment. When asked to identify the single most important barrier in treatment, 14 physicians (61%) indicated cost was the greatest deterrent. Twenty-one primary care physicians (91%) reported they would be more likely to treat a patient with osteoporosis if a safe medication with proven fracture risk reduction were available. Primary care physicians indicated they were more likely to treat independently living adults (n=12 [52%]) and women compared with men (n=15 [65%]). All orthopedic surgeons (n=8) were willing for all patients to be evaluated in consultation with a nurse practitioner. Primary care respondents were less apt to agree with a nurse practitioner referral (n=5 [22%]). Both primary care physicians (n=16 [70%]) and orthopedic surgeons (n=4 [50%]) agreed that there is a need for increased primary care education about managing osteoporosis in patients hospitalized with low-impact fracture. CONCLUSIONS: Orthopedic surgeons were consistent in their opinion that postfracture attention to osteoporosis should rest with the primary care physician. Primary care physicians agree but report that cost and possible adverse effects of medication are major barriers to this care. Despite therapies for high-risk postfracture patients showing relative safety and proven efficacy in reducing future fractures, deterrents to this care are focused on cost and potential adverse effects. Further education is needed to promote a standard of care for the postfracture patient that is directed toward the prevention of a subsequent fracture.

Aged↗
PubMed1995

Screening surgeons for HIV infection. A cost-effectiveness analysis.

UNLABELLED: OBJECTIVE. To determine the cost-effectiveness of a policy to screen surgeons for human immunodeficiency virus (HIV) infection to prevent transmission of HIV to patients having invasive procedures. DESIGN: Cost-effectiveness analysis. RESULTS: A one-time national screening program would identify approximately 137 surgeons with HIV infection (range, 28 to 423 surgeons) and would prevent approximately 4.3 infections (range, 1.9 to 21.3 infections) in patients treated by infected surgeons and 0.9 infections (range, 0 to 12.9 infections) in sexual partners of infected surgeons at a direct cost of $8.1 million and an induced cost of approximately $44 million. It would result in expenditures of $458,000 per year of life saved (range, $147,000 to $687,000 per year of life saved), whereas an annual screening program would result in expenditures of approximately $1.1 million per year of life saved (range, $338,000 to $1,886,000 per year of life saved). If the prevalence of HIV infection in surgeons is estimated to be three times our base-case estimate (an increase from 0.1% to 0.3%), annual screening would result in expenditures of approximately $741,000 per year of life saved. If the probability of seroconversion after a patient is exposed to a contaminated instrument is increased to 5.0% from our base-case estimate of 0.29%, an annual screening program would still cost more than $228,000 per year of life saved. CONCLUSION: Screening surgeons for HIV to prevent transmission of HIV to patients having invasive procedures requires expenditures per year of life saved that are considerably in excess of those of most accepted health interventions. Surveillance studies of patients treated by surgeons infected with HIV should be continued to confirm that transmission of HIV to patients having invasive procedures is rare.

Cost-Benefit Analysis↗
PubMed1999

Communication between surgeons and patients in routine office visits.

BACKGROUND: Research conducted in primary care settings has demonstrated that effective communication enhances patient recall of information, compliance, satisfaction, psychologic well-being, and biomedical outcomes. However, surgeons face communication challenges that are unique to the surgical situation. This study provides the first description of routine communication between community-practicing surgeons and their patients. METHODS: Audiotapes of 676 routine office visits with 29 general surgeons and 37 orthopedic surgeons were coded for structure and content. Descriptive analysis of quantitative data is supplemented by illustrative examples of dialog selected to represent typical patterns of communication. RESULTS: The mean visit length was 13 minutes. Surgeons talked more than patients, with typical surgical consultations containing relatively high amounts of patient education and counseling. Consultations had a narrow biomedical focus with little discussion of the psychologic aspects of patient problems. The affective tone of visits was generally positive, with few instances of overt criticism or disagreement by either party. However, surgeons infrequently expressed empathy toward patients, and social conversation was brief. CONCLUSIONS: The study underscores the differences in both the content and process of routine surgical visits compared with primary care visits. On the basis of this work, it seems particularly important for surgeons to develop skills that enhance patient education and counseling. Further research is needed to understand the influences of surgeons' communication on patient behavioral, psychologic, and biomedical outcomes.

Communication↗
PubMed2000

Diagnostic alternatives used by veterinary surgeons for the recording of udder diseases in the Norwegian Health Card System for Cattle.

A questionnaire, in which 7 cases of udder disease were described, was distributed to 890 veterinarians in Norway. They were requested to classify the cases according to the diagnostic alternatives listed in the Norwegian Health Card System for Cattle (NHCSC). The NHCSC recordings are used for progeny testing of bulls, for disease monitoring, and for research purposes. The aim of this study was to evaluate the quality of the recordings for udder diseases. The questionnaire was answered by 633 veterinary surgeons. Four cases of clinical mastitis (CM) with abnormal secretion as well as other clinical signs of inflammation were correctly classified as CM by almost 100% of the veterinary surgeons. A cow in the final stage of lactation, showing no clinical signs except for clots in the milk, was considered not to be a clinical case by more than 25% of the veterinary surgeons. A typical case of subclinical mastitis (SM) was reported as SM by 83% of the veterinary surgeons, and as CM by 16%. A subclinical case with a recent history of clots in the secretion was classified as SM by 66% of the veterinary surgeons, but almost 40% either reported CM as their sole diagnosis or considered the case to be CM in combination with SM. Of the clinical cases, those exhibiting marked local signs of inflammation and a systemic reaction were correctly classified as acute clinical mastitis (ACM) by 96%-98% of the veterinary surgeons. In the NHCSC, the diagnostic alternatives for cases of CM are ACM and chronic clinical mastitis (CCM). One case, for which the diagnosis subacute clinical mastitis was appropriate according to standard definitions, was classified as CCM by 66%, and as ACM by 6%. Based on the information given in the questionnaire, the diagnosis for 2 of the clinical cases could have been either ACM or CCM, and for both cases each of these 2 alternatives was reported by more than 43% of the veterinary surgeons. A teat lesion, which was present together with ACM in one cow, was reported by 91% of the veterinary surgeons.

Animals↗
PubMed1997

[Near relations of Georges Mareschal, first surgeon of Louis XIV and Louis XV (1658-1736)].

Georges Mareschal, First Surgeon to Louis XIV and then to Louis XV, exercised a great influence on some near relations of his, who, like him, became excellent surgeons. A nephew of his, Martin Guérin, probably Marie Roger's sister's son, Mareschal's wife, distinguished himself as a surgeon. His uncle made him Ordinary Surgeon of the "hôpital de la Charité" in Paris. His hand was "swift and skilful". He gave treatment to Colonel de Fénelon, a French archbishop's great-nephew, war wounded in 1713. And he operated on James Edward Stuart of England for "fistula", the "Old Pretender" or the "Chevalier de Saint-Georges", in Avignon, in 1716. Martin Guérin's eldest son, Georges Guérin, was also a highly esteemed surgeon. On and after 1733, he was successively a surgical departmental head of the Italian Army, a chief-surgeon of the "Hôpital de la Charité" in Paris, a surgical officer of the second Musketeer Company. He was ennobled by Louis XV and received the ribbon of the "Ordre de Saint-Michel". One of Georges Guérin's sisters married the surgeon Sauveur-François Morand, who achieved celebrity for the diversity of his operations and his works. He delivered a funeral oration in praise of Georges Mareschal, at the meeting of the "Académie royale de chirurgie" on June 18th 1737. His son, a medical doctor, Clément Morand, and his son-in-law, the surgeon Sabatier, were not second to him as far as talent is concerned. Mareschal's fourth near relative, an anatomist, got himself talked about in connection with an autopsy. He was the husband of one of Elisabeth du Brun's daughters, Mareschal's sister.

Famous Persons↗