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At least 559 records · Page 31Linked to original sources
PubMed1993

General surgeons' attitudes to the treatment and prevention of abdominal adhesions.

A questionnaire survey of general surgeons was undertaken to estimate the incidence of abdominal adhesions as a clinical problem and to establish current attitudes to the treatment of adhesional bowel obstruction and the prevention of adhesion formation. Replies were received from 362 of 416 surgeons (response rate 87%). In all, 76% (95% confidence limits, 72%-80%) of surgeons operate upon at least two patients each year with adhesional small bowel obstruction and 31% (26-36) operate upon more than five patients. More than five patients are admitted each year with suspected adhesional bowel obstruction by 64% (59-69) of surgeons and 35% (30-40) of surgeons found adhesions to be a problem during a non-adhesion-related laparotomy in more than five patients each year. This represents an estimated annual incidence of between 12,000 and 14,000 adhesion-related clinical problems in the United Kingdom. A number of preventive measures, such as the wearing of starch-free gloves (78% of surgeons; 95% CL 74%-82%), peritoneal lavage (68%; 63-73) and placement of the omentum beneath the wound closure (90%; 87-93) are generally accepted, whereas routine wetting of swabs (39%; 34-44) and the role of non-essential adhesiolysis (49%; 44-54) are controversial. Routine small bowel plication (1%; 0-2) and intubation (2%; 0-5) are rarely used. This survey gives an indication of the large burden on patients and the health services caused by abdominal adhesions, and demonstrates surgeons' wide variety of approaches to both the treatment and prevention of adhesion formation.

Attitude of Health Personnel↗
PubMed1996

How many general surgeons do you need in rural areas? Three approaches to physician resource planning in southern Manitoba.

OBJECTIVE: To assess critically the results of using three different approaches to planning for the number of general surgeons in rural areas. DESIGN: Estimates of the number of general surgeons needed using a ratio approach, a and a population-needs-based approach. SETTING: Rural southern Manitoba. OUTCOME MEASURE: Number of general surgeons needed. RESULTS: The ratio approach supported the recruitment of 7.8 to 14.5 additional general surgeons to rural southern Manitoba. The repatriation approach suggested that the area might support five additional general surgeons, if residents could be persuaded to undergo their surgery closer to home. The population-needs-based approach suggested that the health status of area residents was similar to that of residents of other areas of the province and that they had a higher rate of surgery than residents of other areas; no additional surgeons were apparently needed. CONCLUSIONS: Each method has certain advantages, and none is necessarily useful in isolation. Hence, the most effective approach to planning for general surgeons is likely a combination of all three methods. Other factors that may be important include the type of payment structure and the need for professional groups to monitor variations in rates of surgery.

Aged↗
PubMed1996

Trauma experience of Navy surgeons: assessment and commentary.

Numerous reports have suggested that surgical readiness during Operation Desert Storm was poor. We surveyed active duty Navy surgeons to assess current trauma experience and capability. A survey concerning trauma and critical care experience, as well as self-rating of skills, was mailed to all active duty surgeons (n = 185) in 1993. The response rate was 79% (146/185). A high turnover rate of surgeons was indicated by: (1) 51% (75/146) of surgeons had less than 3 years of experience following residency; and (2) only 42% (61/146) had served in the Gulf War. Only 12% of active duty surgeons (18/146) were involved in trauma care. Only 10% (14/146) had performed more than 20 operations for trauma in the preceding 1 years, and 85% (124/146) had performed fewer than 10 operations. In the preceding 5 years, 84% (122/146) had performed fewer than 100 operations for trauma, and 42% (61/146) had performed none. Critical care experience ranged from 0 to 20 patients per month (mean = 3). Despite limited recent experience, 84% (123/146) of respondents rated their trauma skills as adequate (n = 43), good (n = 49), or excellent (n = 31). We conclude that most Navy surgeons have minimal recent experience in trauma care. A high rate of turnover mandates training strategies that provide an ongoing exposure to injured patients. This could be accomplished by designating military hospitals as trauma centers or by placing military surgeons in civilian trauma centers.

Clinical Competence↗
PubMed1997

[Complication rate in laparoscopic cholecystectomy not different for residents in training and surgeons].

OBJECTIVE: To assess the difference in safety of laparoscopic cholecystectomy performed by residents and staff surgeons. SETTING: St. Antonius Hospital, Nieuwegein, the Netherlands. DESIGN: Retrospective study. METHOD: Results of 649 laparoscopic cholecystectomies performed by staff surgeons experienced in laparoscopic surgery, by residents under supervision of a staff surgeon, by residents without supervision and by inexperienced surgeons, were compared. RESULTS: Patients were comparable, except for liver function disorders and raised sedimentation rates, of which there were more in the group operated by the non-supervised residents, compared with the staff surgeons. Average operation time was 57 minutes in all four groups. Non-supervised residents had more retained stones than staff surgeons (19 vs 6%) and reported more bleeding during surgery than staff surgeons (21 vs 8%). Conversion rate was the same (3.9%) in all four groups. Complications occurred in 5.7%; this also was the same in the four groups. CONCLUSION: Residents following a traditional surgical training without practice on animals, perform laparoscopic cholecystectomy as quickly as and with the same conversion and complication rates as their teachers.

Cholecystectomy, Laparoscopic↗
PubMed1997

An orthopedic surgeon survey on the treatment of displaced femoral neck fracture: opposing views.

OBJECTIVE: To examine the reasons for practice variation in the treatment of displaced femoral neck fractures. DESIGN: A survey, asking surgeons to choose either hemiarthroplasty or internal fixation for 2 different female patients with a displaced femoral neck fracture. SETTING: The Canadian Orthopaedic Association Meeting, Halifax, May 1995. PATIENTS: The scenario in the first patient was of an independent 70-year-old woman with no pre-existing medical conditions. The scenario in the second patient was of a housebound 84-year-old woman with co-morbidity. MAIN OUTCOME MEASURES: Proportion of surgeons choosing either hemiarthroplasty or internal fixation for each case scenario. Distribution of reasons to explain the treatment decision. RESULTS: Ninety-nine surgeons responded. For the case of the 70-year-old woman, 47% chose hemiarthroplasty and 53% chose internal fixation (p = 0.60), and for the 84-year-old woman, 96% chose hemiarthroplasty. These findings were consistent within the subgroups of teaching surgeons and community practice surgeons. Surgeons with 10 years or less of practice tended to favour hemiarthroplasty whereas those with more than 15 years' practice favoured internal fixation. Important reasons for treatment choice were avoidance of reoperation in the hemiarthroplasty group (85%) and better hip function in the fixation group (83%), durability (83%) and ease of revision (77%). CONCLUSION: The surgeon's interpretation of the importance of reoperation and function underlies the differences in treatment decision regarding the management of femoral neck fractures in elderly patients.

Aged↗
PubMed1997

William Cheselden (1688-1752): humane anatomist and master surgeon.

William Cheselden (1688-1752) as a young man had a considerable reputation as an anatomist. He was one of the first to give a regular series of lecture/demonstrations and he incorporated this material into a basic text The Anatomy of the Humane Body, which was extremely popular and was in print for 100 years. He was even better known as a surgeon, being on the staff of three teaching hospitals and recognized as the most skillful lithotomist of his time. His achievements are on record and he must be regarded as one of the greatest of British surgeons. Perhaps his greatest impact was his strong advocacy for the separation of surgeons from the Barber-Surgeons Company. He realised how much this long-established relationship was delaying the advancement of surgeons and surgery, and his vigorous action resulted in an Act of Parliament that severed the old ties and established in 1745 the Corporation of Surgeons, forerunner of the Royal College of Surgeons of England.

Anatomy↗
PubMed1997

Decisions about treatment of aortoiliac claudication: the current practice among Swedish vascular surgeons.

OBJECTIVE: To find out what information vascular surgeons consider before they decide on treatments for intermittent claudication. SUBJECTS: 25 randomly selected vascular surgeons who participate in the Swedish Vascular Registry. METHOD: Interviews about what information and investigations the surgeons would need before they make recommendations for treatment of 6 test cases. MAIN OUTCOME MEASURES: The pattern of numbers and types of questions and of recommendations for treatment. RESULTS: Surgeons asked a median of five questions (range 0-13) before they came to a decision. Only 9% of those questions concerned the patients' preferences. Open surgery was recommended in 59 of the 150 consultations (39.3%), for some by none and for others by up to 80% of surgeons. CONCLUSIONS: Vascular surgeons primarily consider the patient's history and physical findings when treating claudication. They pay little attention to the preferences of the patients. Vascular surgeons in Sweden differ considerably in their patterns of questioning and do not agree about the treatment of intermittent claudication in individual patients.

Aged↗
PubMed1997

Survey of cardiac surgeons' perceptions of the addition of ASA to warfarin for patients with mechanical heart valves.

Evidence suggests that the addition of acetylsalicylic acid (ASA) to warfarin therapy among patients with mechanical heart valves may reduce mortality, at a slightly higher bleeding risk. A survey was conducted of North American cardiac surgeons to assess whether they routinely use ASA in conjunction with anticoagulants among such patients. From a list of 142 cardiac surgeons and centres, questionnaires were successfully transmitted by fax to 137. Respondents were surveyed about their prescribing habits of both warfarin and ASA among patients with mechanical heart valves. Information collected included the target international normalized ratio (INR) and reasons for not routinely prescribing ASA, when applicable. One hundred and eighteen cardiac surgeons (86%) returned the questionnaire: 75% were American and 25% Canadian. All surgeons (100%) stated that they use warfarin for patients with mechanical valves, but there was little consensus about the target INR. Only 25 respondents (21%) routinely used ASA in conjunction with anticoagulants, while 90 (76%) said they would not. The most common reason cited for withholding ASA was the perceived increased risk of bleeding (49% of nonusers), while another 23% felt that there is no benefit. Of the 90 surgeons who would not routinely prescribe ASA, 50 (55%) would on occasion. The most commonly used dose of ASA was 80 to 100 mg daily (79%). Low dose ASA, in conjunction with warfarin, is underused by North American cardiac surgeons for the prevention of systemic thromboembolism among patients with mechanical heart valves. Most surgeons avoid ASA out of concern for the increased risk of hemorrhage and a belief that there is no benefit. These perceptions are not supported by recent scientific data, however.

Anticoagulants↗
PubMed1998

Subfascial endoscopic perforator vein surgery (SEPS): current practice among British surgeons.

Subfascial endoscopic perforator vein surgery (SEPS) has recently caused considerable interest among British surgeons. There are no data indicating which, if any, patients benefit from SEPS. A series of 47 British surgeons, identified as having taken up SEPS, were sent a questionnaire asking about their current practice; 26 were returned completed (55% response rate). Of those surgeons replying, 22 (85%) had performed their first SEPS procedure within the previous 21 months, 18 (69%) within the previous 9 months. Most surgeons had performed five procedures (range 1-52). The most common indication for SEPS was venous ulceration with proven incompetent perforators (eight surgeons), but there was a wide diversity of other indications used to select patients for SEPS. Only nine surgeons had changed their indications for surgery with the advent of SEPS, yet their predicted number of SEPS procedures was far greater than the number of open procedures they currently performed. Out of 26 surgeons, 25 intend to continue performing SEPS. Prospective studies are needed to identify which patients might benefit from this new procedure.

Attitude of Health Personnel↗
PubMed1998

Concordance in communication between surgeon and patient.

OBJECTIVES: To examine (1) the capability of using interactive voice response (IVR) system technology for clinical research studies involving assessment of clinician-patient interactions and (2) the concordance of surgeons and their breast cancer patients about the content of a postbiopsy pre-treatment decision meeting. DESIGN: A descriptive comparison of the perceptions of 2 volunteer groups--surgeons and their patients--using interactive voice technology. SETTING: Surgeons' offices. PARTICIPANTS: Twenty-six dyads of surgeons and their patients with newly diagnosed breast cancer. OUTCOME MEASURES: Concordance as determined through a 15-item patient questionnaire and a parallel 11-item surgeon questionnaire addressing surgical and psychosocial aspects of breast cancer treatment. RESULTS: Fifty-four percent to 100% of the 26 dyads indicated concordance about treatment preference, treatment choice, how treatment was chosen, preference for how treatment was chosen, time for discussion about treatment, and discussion about lymph-node removal. Only 27% to 50% of dyads agreed about patient understanding of lymph-node removal, the thoroughness of discussions about adjuvant treatment, the thoroughness of discussion about emotional coping, and the sufficiency of time for the discussion of patient's concerns. In these areas of disagreement surgeons often underestimated the patient's ability to understand and underestimated the patient's perception of the thoroughness of discussions about the psychosocial aspects of the illness (concerns and coping). CONCLUSION: Surgeons and patients demonstrated concordance on their perceptions of the type of treatment desired and needed but were discordant on their perceptions of the degree of patients' understanding about post-treatment and psychosocial issues.

Breast Neoplasms↗
PubMed1999

Intraoperative stress experienced by surgeons and assistants.

BACKGROUND AND OBJECTIVE: To determine the intraoperative stress on surgeons and assistants during cataract surgery, 12 surgeons and 3 assisting nurses were assessed based on their level of professional experience. METHODS: Surgeons were classified as inexperienced, intermediate, or experienced. Nurse assistants were classified as inexperienced or experienced. The intraoperative heart rates and urine adrenaline levels of each participant were measured. RESULTS: Inexperienced surgeons and nurse assistants had the highest heart rates at the beginning of surgery, and the rates tended to decrease toward the end of surgery. All values were higher than the other two groups throughout surgery. In surgeons with intermediate experience, the heart rates were not as high as in the inexperienced personnel; however, the heart rates were high throughout the surgery. The heart rate in one intermediate surgeon was markedly increased when a surgery was simultaneously broadcast on closed-circuit television. In experienced surgeons and a nurse assistant, the measurements increased slightly. CONCLUSIONS: The variations in heart rates and urine adrenaline levels showed characteristic patterns based on the experience of the surgical personnel.

Adult↗
PubMed1994

Comparison of flow cytometry with the surgeon regarding ability to predict the ultimate success of surgery for proliferative vitreoretinopathy.

OBJECTIVE: To analyze vitreous specimens obtained from human eyes with proliferative vitreoretinopathy (PVR) by use of flow cytometery (FC) to compare the capacity of FC with that of the surgeon's in predicting the ultimate outcome after PVR surgery. METHODS: Thirty-one vitreous aspirates were obtained at vitrectomy or from postoperative fluid-gas exchanges for complicated retinal detachment due to PVR. Samples were analyzed by FC for the concentration of total and proliferating cells. These measurements were compared with the surgeon's preoperative prognosis (good, poor, or indeterminate) for the ultimate result. At 12 weeks, the eyes were evaluated for clinical outcome. An unsuccessful outcome was one in which the retina was attached with macular pucker or hypotony or was anatomically detached. Anatomic attachment of the retina anterior and posterior to the scleral buckle without these findings was considered a successful outcome. RESULTS: Flow cytometry was capable of quantifying the concentration of total and proliferating cells in eyes with PVR. Eyes destined for an ultimately successful outcome demonstrated fewer total and proliferating cells than did eyes destined for an unsuccessful outcome. No differences were observed between eyes destined for development of macular pucker and those destined for anatomic redetachment. The surgeon was able to accurately predict a good or a poor outcome in 64.5% of the cases, with a sensitivity of 92% and a specificity of 89%. Using the total number of recovered cells, FC was able to correctly predict a good or a bad outcome with a 77% accuracy, whereas the surgeon was able to do so with a 65% accuracy. Combining the surgeon's prediction with the result of FC increased the diagnostic power of the prediction to 87%. CONCLUSIONS: The diagnostic power of FC was similar to that of the surgeon's in predicting ultimate outcome, but the two techniques probably evaluate different features of the disease process. The combination of the two techniques was the most powerful approach to the prediction of ultimate outcome after PVR surgery.

Cell Count↗
PubMed2005

Are young surgeons competent to perform alimentary tract surgery?

BACKGROUND: Assessment of competency during residency training has received increased attention recently. There has been less attention given to the competency of residents after training. HYPOTHESIS: Patient outcomes for alimentary tract surgery (ATS) should be similar for surgeons who recently completed their residency training compared with more experienced surgeons, indicating that the younger surgeons had achieved clinical competency on completion of their residency training. DESIGN: Retrospective analysis of Illinois inpatient discharge data (January 1, 1996-December 31, 1999). SETTING: All 205 nonfederal acute care hospitals in Illinois. PATIENTS: The patients were 120 160 adult Illinois residents who underwent ATS in Illinois. MAIN OUTCOME MEASURES: Mortality rate, morbidity rate, and hospital length of stay. RESULTS: Regression analyses demonstrated that surgeon experience was a significant determinant of mortality and morbidity rates, with worse outcomes observed for patients of young surgeons undergoing high-complexity ATS (ie, procedures other than appendectomy and cholecystectomy). CONCLUSIONS: For high-complexity ATS, there was a significant disparity in outcomes between young and more experienced surgeons, whereas for low-complexity ATS, there was no disparity. Attention to competency during residency training is warranted, especially as it relates to high-complexity ATS. Furthermore, patient outcomes provide an opportunity to assess competency after training that can complement assessments during training and together identify educational strengths and weaknesses of residency training.

Adult↗
PubMed1992

A national survey of surgeons' attitudes about patients with human immunodeficiency virus infections and acquired immunodeficiency syndrome.

We conducted a national survey to learn about surgeons' attitudes toward patients with human immunodeficiency virus infection and with acquired immunodeficiency syndrome. We received 1039 (72%) responses from 1451 potential respondents. Seventy-four percent (766 of 1028) of surgeons were in favor of routine human immunodeficiency virus testing of patients, yet only 6% did so routinely and another 6% did so selectively. Most (88%) surgeons believed that patients had a right to know if their surgeon was infected with the human immunodeficiency virus and would agree to be tested if so requested by a patient. Most (72%) surgeons also believed that surgeons with the human immunodeficiency virus should have their operating privileges restricted. Only 8% knew the risk of acquiring human immunodeficiency virus infection if they sustained a percutaneous injury with contaminated blood, and only 61% were familiar with the Centers for Disease Control guidelines on universal precautions. The respondents also believed that others were "making the rules" for them while they were "taking the risks."

Acquired Immunodeficiency Syndrome↗
PubMed1993

Accuracy of ultrasound in the diagnosis of acute appendicitis compared with the surgeon's clinical impression.

OBJECTIVE: To compare the accuracy of the surgeon's clinical diagnosis of acute appendicitis with that of an ultrasonographic examination of the abdomen. DESIGN: Prospective trial. SETTING: US Navel Hospital, San Diego, Calif. PATIENTS: One hundred ten patients admitted to the hospital with suspected appendicitis from May 1990 to June 1992. INTERVENTION: Symptoms and signs for each patient were recorded, along with the surgeon's clinical impression of immediate surgery or observation. The patient then underwent an ultrasound examination performed by a staff radiologist. On the basis of the ultrasound findings the patient was placed into one of three categories: appendicitis, normal examination results, or other conditions. Patients with an ultrasound-based diagnosis of appendicitis proceeded to the operation, regardless of the surgeon's clinical impression. Those with other conditions diagnosed with ultrasonography were treated as was appropriate for the condition. RESULTS: The ultrasound-derived diagnosis of appendicitis had a sensitivity of 85.5%, a specificity of 84.4%, a positive predictive value of 88.3%, a negative predictive value of 80.1%, and an overall accuracy of 85.0%. The surgeon's clinical impression at the time of admission had a sensitivity of 62.9%, a specificity of 82.2%, a positive predictive value of 82.9%, a negative predictive value of 61.7%, and an overall accuracy of 71.2%. CONCLUSION: The overall accuracy of ultrasonography in the diagnosis of appendicitis was statistically superior to that of the surgeon's clinical impression (P < .0001). However, 24% of the patients with normal ultrasound findings were ultimately found to have appendicitis at operation, emphasizing the point that ultrasonography cannot be relied on to the exclusion of the surgeon's careful and repeated evaluation.

Acute Disease↗
PubMed1995

Analysis of American College of Surgeons trauma consultation program.

OBJECTIVE: To identify the criteria deficiencies found during peer consultation of hospitals and the relationship to subsequent verification. METHODS: Between September 1987 and December 1992, 52 hospitals had consultation visits using American College of Surgeons criteria. Each report was studied for deficiencies, frequency of deficiencies, and relationship to verification. RESULTS: There are 108 American College of Surgeons criteria. Thirty-five different criteria deficiencies were found. The number of deficiencies per hospital ranged from zero to 12. The more frequent deficiencies included a lack of the following: quality improvement, 35 (67%); trauma service, 20 (38%); trauma surgeon in emergency department, 20 (38%); 24-hour operating room availability, 17 (33%); trauma registry, 17 (33%); trauma continuing medical education, 16 (31%); trauma director, 15 (29%); computed tomography technician in hospital, 15 (29%); research, 14 (27%); trauma coordinator, 14 (27%); and neurosurgeon availability, 13 (25%). No hospital that lacked commitment of surgeons (n = 12) or hospital (n = 3) requested a verification visit. Twenty-four hospitals (46%) achieved verification by February 1994. Twenty-eight hospitals had six or fewer deficiencies, with 19 (68%) verified. Twenty-four hospitals had seven or more deficiencies, with only five (21%) subsequently verified. Verification visits followed consultation by 3 to 52 months. Two hospitals with nine deficiencies were verified after 30 and 48 months, although one failed its first verification visit. CONCLUSIONS: American College of Surgeons consultation assists hospitals to identify their trauma center capability and appears to improve their ability to pass subsequent trauma center verification. Most criteria deficiencies are correctable. Lack of commitment by the surgeons or hospital is difficult to correct. There is an inverse relationship between the number of deficiencies and subsequent verification.

General Surgery↗
PubMed1993

Absence of HIV transmission from an infected orthopedic surgeon. A 13-year look-back study.

OBJECTIVE: To determine the risk of human immunodeficiency virus (HIV) transmission from an HIV-infected orthopedic surgeon to patients undergoing invasive procedures. DESIGN: Retrospective epidemiologic follow-up study. PARTICIPANTS: A total of 2317 former patients on whom the orthopedic surgeon performed invasive procedures between January 1, 1978, and June 30, 1991 [corrected]. MAIN OUTCOME MEASURES: HIV infection or death from an acquired immunodeficiency syndrome (AIDS)-defining tumor or opportunistic infection. RESULTS: An orthopedic surgeon voluntarily withdrew from practice after testing positive for HIV. Testing for HIV was performed on 1174 former patients, representing 50.7% of patients on whom the orthopedic surgeon performed invasive procedures during the 13.5-year period. Patients were tested from each year and from each category of invasive procedure. All patients were HIV-negative by enzyme-linked immunosorbent assay. Two former patients reported known HIV infection prior to surgery. Review of AIDS case registries and vital records failed to detect cases of HIV infection among former surgical patients. The estimated cost of the initial patient notification and testing was $158,500. The patient notification and testing were conducted while maintaining the confidentiality of the orthopedic surgeon who was an active participant in the planning and execution of the study. CONCLUSIONS: The risk of HIV transmission from an HIV-infected surgeon who adheres to recommended infection control practices is extremely low. Notification and HIV testing of former patients in this setting is both disruptive and expensive and is not routinely recommended.

AIDS Serodiagnosis↗
PubMed1999

Evaluation of a telerobotic system to assist surgeons in microsurgery.

A tool was developed that assists surgeons in manipulating surgical instruments more precisely than is possible manually. The tool is a telemanipulator that scales down the surgeon's hand motion and filters tremor in the motion. The signals measured from the surgeon's hand are transformed and used to drive a six-degrees-of-freedom robot to position the surgical instrument mounted on its tip. A pilot study comparing the performance of the telemanipulator system against manual instrument positioning was conducted at the University of Southern California School of Medicine. The results show that a telerobotic tool can improve the performance of a microsurgeon by increasing the precision with which he can position surgical instruments, but this is achieved at the cost of increased time in performing the task. We believe that this technology will extend the capabilities of microsurgeons and allow more surgeons to perform highly skilled procedures currently performed only by the best surgeons. It will also enable performance of new surgical procedures that are beyond the capabilities of even the most skilled surgeons.

Evaluation Studies as Topic↗