Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Surgeons”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 793 records · Page 44Linked to original sources

The relationship between surgeon and basic scientist.

Basic science research has always been the cornerstone of a solid academic career, even for surgeons. In the past, many cardiothoracic and cardiovascular surgeons have used the large animal laboratory to design surgical operations, refine extracorporeal circulation, improve myocardial protection or simply validate clinical concepts. Today, funding for large animal research has almost disappeared. The basic science areas of 'cellular, molecular, genomics or gene therapy' must be involved to be considered for national or even local funding. This endeavor requires a new generation of surgical scientists and perhaps even more importantly, a new environment for the performance of such research. Academic surgery does not exist without active and long-standing commitment to research. Clinical research focusing on patient outcome remains an important task of the academic surgeon but this paper will focus on the relationship between surgeons and basic scientists and shall concentrate primarily on translational research and its challenge now and in the future. The collaboration between basic scientist and clinician is more essential than ever, because the society still optimally rewards science that has potential clinical applicability [1]. Even within surgical departments, active support and very close contact with PhDs can be essential for the clinical faculty members to be productive, using cellular and molecular techniques. In cardiovascular medicine and biology, there is a great potential to prevent or treat diseases with these techniques. The potential to modify ischemia-reperfusion, inflammation, angiogenesis, restenosis, organ tolerance or cardiomyocyte transplantation to remodel ventricles will be accomplished by a better understanding of cardiovascular biology. Surgeons must plan for a speciality that may look quite different in the next future.

Animals↗

Effect of the diameter of the endoscope and of surgeon training on the duration and quality of laparoscopic surgery in a rabbit model.

STUDY OBJECTIVE: To evaluate the effect of diameter of the endoscope on the duration and quality of laparoscopic surgery. DESIGN: Prospective, randomized trial (Canadian Task Force classification I). SETTING: Centre for Surgical Technologies. SUBJECTS: Sixty adult, female, New Zealand, white rabbits. INTERVENTION: Two series of laparoscopic nephrectomies, one each performed by an experienced and an inexperienced surgeon comparing 10-, 5-, 4-, and 2-mm endoscopes. MEASUREMENTS AND MAIN RESULTS: Besides duration of surgery and occurrence of bleeding, the quality of dissection was scored by adding scores of dissection of renal vessels, ureters, and kidneys. During consecutive nephrectomies, the duration of surgery (p = 0. 001) and occurrence of bleeding (p = 0.02) decreased, whereas the quality of dissection increased (p = 0.002), demonstrating the learning curve, mainly for the less experienced surgeon. Duration of surgery (p = 0.04) decreased and quality of dissection increased (p = 0.05) when the larger endoscope was used. This was the case only for the less experienced surgeon, whereas for the experienced surgeon it had only a slight effect on learning curve. CONCLUSION: These results confirm a learning curve of nephrectomy consisting of some 20 animals. In addition, the endoscope diameter and thus quality of image affect both duration and quality of surgery, especially for less experienced surgeons.

Animals↗

Occupational blood exposure and HIV infection among oral and maxillofacial surgeons.

OBJECTIVE: The purpose of this study was to examine occupational blood exposure and the seroprevalence of HIV infection among oral and maxillofacial surgeons. STUDY DESIGN: Three hundred twenty-one oral and maxillofacial surgeons attending an annual meeting voluntarily and anonymously participated in an HIV serosurvey and completed a questionnaire assessing practice and demographic factors. Statistical tests included the Wilcoxon rank-sum test and the chi-squared test. RESULTS: Eighty percent of those who completed the survey reported one or more blood-skin contacts within the previous month. The mean number of percutaneous injuries within the previous year was 2.36 +/- 0.2. Wire was most commonly associated with percutaneous injuries. Oral maxillofacial surgeons who reported three or more percutaneous injuries performed more fracture reductions than oral and maxillofacial surgeons reporting no percutaneous injuries (p < 0.01). No participant was HIV-positive; the upper limit of the 95% confidence interval was 1.15%. CONCLUSION: The findings suggest that the occupational risk for HIV infection in oral surgery is very low even though most oral and maxillofacial surgeons experienced blood contact. Associations of percutaneous injuries with fracture reductions and wire may assist in the development of new techniques and equipment to minimize blood exposures.

Adult↗

Children's surgery performed by adult general surgeons in Scotland: the present and future.

OBJECTIVE: The aim of this study was to determine the extent and the future of paediatric surgery performed in Scotland outside of the designated surgical paediatric centres. MATERIALS AND METHODS: An anonymous questionnaire was sent to all 111 Scottish members of the Association of Surgeons of Great Britain and Ireland. There was a response rate of 69%. RESULTS: Overall, 45% of responders operated on children. This was independent of the surgeon's age but was related to the type of hospital that the surgeon worked in. Eighty-four per cent of responders had a lower age limit under which they would not operate and 94% stated that there were specific circumstances where they would not operate. A mean of 18.5 elective procedures (range 0-250, median two) and six emergency procedures (range 0-30, median five) were carried out by each surgeon operating on children under the age of five per annum. Only 13% of responders thought that their successor would operate on children. CONCLUSIONS: Non-specialist paediatric surgery in Scotland is currently provided by a significant number of surgeons whose successors will not continue to provide a comparative paediatric service. This has implications for local provision of care, emergency management and capacity of existing children's hospitals in the future.

Adult↗

Anaesthetists' and surgeons' estimation of preoperative anxiety by patients submitted for elective surgery in a university hospital.

BACKGROUND AND OBJECTIVE: Preoperative anxiety is a challenging concept in the preoperative care of patients. The hypothesis of this study was that the doctors are able to estimate their patients' preoperative anxiety. METHODS: A prospective clinical trial was performed on 67 adult patients and 26 paired anaesthetists and surgeons. The patients filled out two separate visual analogue scales for anxiety for the planned anaesthesia and surgery. After that the 'anxiety subscale' of the Hospital Anxiety and Depression's Scale was completed and a list of fearsome items was presented as the patients were asked to choose two conditions they considered the most frightening. Finally the patients were asked to select one or more items from a list of things, which they considered likely to relieve their preoperative anxiety. Similarly, the participating doctors were asked to estimate their patients' anxiety, guess their fearful conditions and their anxiety-relieving requests. RESULTS: Median scores for anxiety as estimated with visual analogue scales by anaesthetists, surgeons and patients for anaesthesia were 34, 36 and 6, respectively; and for surgery 53, 47 and 9, respectively. The anxiety subscale of the Hospital Anxiety and Depression's Scale 8.9 +/- 4.2, 8.6 +/- 4.6 and 6.5 +/- 4.5 (mean +/- SD), respectively. Doctors' scores were significantly higher than the patients' scores (P < 0.05). Thus, the anaesthetists and the surgeons were unable to estimate their patients anxiety on any of the scales used (Kendall's tau < 0.25; P < 0.05). The proportion of correct estimation of the fearsome items was 20% for both the anaesthetists and the surgeons. CONCLUSIONS: Both anaesthetists and surgeons overestimated their patients' preoperative anxiety by a wide margin and poorly predicted their patients' feared conditions and their desire for relief of anxiety.

Anesthesia↗

Summary of the 2000 Surgeon General's listening session: toward a national action plan on overweight and obesity.

OBJECTIVE: To provide insight into discussions at the Surgeon General's Listening Session, "Toward a National Action Plan on Overweight and Obesity," and to complement The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. RESEARCH METHODS AND PROCEDURES: On December 7 and 8, 2000, representatives from federal, state, academic, and private sectors attended the Surgeon General's Listening Session and were given an opportunity to recommend what to include in a national plan to address overweight and obesity. The public was invited to comment during a corresponding public comment period. The Surgeon General's Listening Session was also broadcast on the Internet, allowing others to view the deliberations live or access the archived files. Significant discussion points from the Listening Session have been reviewed by representatives of the federal agencies and are the basis of this complementary document. RESULTS: Examples of issues, strategies, and barriers to change are discussed within five thematic areas: schools, health care, family and community, worksite, and media. Suggested cooperative or collaborative actions for preventing and decreasing overweight and obesity are described. An annotated list of some programmatic partnerships is included. DISCUSSION: The Surgeon General's Listening Session provided an opportunity for representatives from family and community groups, schools, the media, the health-care environment, and worksites to become partners and to unite around the common goal of preventing and decreasing overweight and obesity. The combination of approaches from these perspectives offers a rich resource of opportunity to combat the public health epidemic of overweight and obesity.

Body Mass Index↗

Operative field contamination by the sweating surgeon.

BACKGROUND: There are a number of factors relating to the host, bacteria and wound that are important in the development of wound infection. The effect of the surgeon sweating has not been previously reported. METHODS: Ten surgeons performed a mock total hip joint operation under sterile conditions while not sweating and then repeated the operation while sweating. Settle plates were used to quantify the bacterial counts in the operative field in both phases. RESULTS: For each subject a mean of 3.3 colony forming units (c.f.u.) were present in the non-sweating phase and 6.9 c.f.u. were present in the sweating phase (P < 0.05). Organisms grown were normal skin flora. CONCLUSION: The sweating surgeon may be more likely to contaminate the surgical field than the non-sweating surgeon. It is important for orthopaedic surgeons, especially those performing joint replacement surgery, to be aware of this and to take measures to minimize sweating in the operating theatre.

Adult↗

Future potential of endovascular techniques for vascular surgeons.

In his presidential address to the American Association for Vascular Surgery in 2000, the late Dr. John Porter announced that there was insufficient time in the vascular training program to entertain endovascular technology because of the volume of vascular surgery techniques that must be learned. His philosophy accurately depicted the prevailing attitude of vascular surgical academia until very recently, and this restrictive stance has caused gradual but profound diminution in the caseload of vascular surgeons who are not trained in endovascular surgery techniques. Ultimately, the reluctance of vascular surgeons to expand their skill sets to include expertise in percutaneous interventions has enhanced the two competing disciplines of cardiology and radiology. As an early proponent of exploring endovascular therapy and its attendant tools and devices, my personal experience--both favorable and unfavorable--has provided me with a degree of perspective about the current status of endovascular surgery and enough background to speculate about the future role of the vascular surgeon in the treatment of arterial and venous disease. Parenthetically, it is encouraging that over the last few years, many educators in the field of vascular surgery have adopted a much more enlightened viewpoint regarding endovascular procedures. Hopefully, the pendulum has not already swung too far out of balance, and vascular surgeons will still have the opportunity to participate fully in the future of this exciting endovascular field. The following observations, ideas, and suggestions may pertain more to young trainees about to enter practice than to seasoned vascular surgeons.

Angiography↗

The surgeon as a hand patient: the clinical and psychological impact of hand and wrist fractures.

To gain insight into the management of patients with hand and wrist injuries, a series of clinical and psychological analyses was performed on 9 surgeons, each of whom underwent operative fixation of a hand or wrist fracture. The results of these analyses suggest that the functional outcome after hand surgery was affected by the surgeons' personality, motivation, and ability to accept and adapt to the injury; the nature of the injury; and the importance of the hand to the surgeons' careers. Surgeons are highly motivated and compulsive individuals who consider their career involvement a major source of identity and self-worth. Most returned to their operative duties ahead of the schedule set by their hand surgeons (average, 25 days after surgery), regarded their injuries as a positive challenge, and changed their lifestyles after injury to protect their hands.

Adult↗

Variability of inguinal hernia surgical technique: A survey of North American pediatric surgeons.

BACKGROUND/PURPOSE: The tradition of learning from mentors is a unique aspect of surgical training. With this in mind, the authors sought to document our roots by analyzing the technical variability of how pediatric surgeons perform their most frequent operation, the inguinal hernia, and compare these data with the original description by Drs William Ladd and Robert Gross. METHODS: A survey compiling the operative steps of an inguinal hernia repair as well as several key clinical situations involving hernias was mailed to pediatric surgeons in North America. These results then were compared with the original inguinal hernia technique by Drs Ladd and Gross. Results are recorded as the percent who concurred with their original description. RESULTS: A total of 447 of 640 (70%) surveys were returned. Geneologic data show that 81% of surgeons' hernia lineage could be traced to Drs Ladd and Gross. When compared with all respondents, Drs Ladd and Gross' hernia repair steps included incising Scarpa's fascia (61%), defining the external ring by pushing down with retractors (34%), incising the external oblique with scissors (18%), identifying the ileoinguinal nerve (81%), cleaning one underside of the external oblique (22%), bluntly spreading the cremasteric fibers (90%), elevating the sac with sharp dissection of the vessels (53%), opening the sac and inserting the forefinger into it (0%), bluntly dissecting the sac with forefinger and gauze (0%), ligating the sac with single ligature (22%) without twisting it (34%), leaving the distal sac untouched other than to drain fluid (78%), not inspecting the testicle (79%), performing a formal floor repair bringing external and internal oblique down to Poupart's ligament (10%), tightening the internal ring in both boys and girls (19% and 41%), using no local anesthetic (14%), closing Scarpa's fascia (94%), closing the skin with interrupted subcuticular sutures (49%), covering the incision with Collodion (48%), using the Stiles' dressing (0%), and only exploring the contralateral side if a hernia is suggested by history or physical examination (87% for boys, 60% for girls). The various other options surgeons use for their technique and their management decisions also are described. CONCLUSIONS: There is significant variability in the way pediatric surgeons perform inguinal herniorraphy. The differences from Drs Ladd and Gross' original description likely result from evolving techniques, experiences, and analysis of outcomes.

Child, Preschool↗

The market for pediatric surgeons: an updated survey of recent graduates.

PURPOSE: The aim of this study was to identify the demand for pediatric surgeons as perceived by recent graduates of North American pediatric surgery training programs. METHODS: A survey was mailed to every pediatric surgeon who completed a certified training program in North America between 1998 and 2000; 81% of 83 responded. Data from the previous survey of 1992 through 1997 graduates provided longitudinal comparisons. The data were analyzed using univariate and bivariate statistical analysis. RESULTS: The number of graduates was 28, 31, and 24 for 1998, 1999, and 2000, respectively, down from 35 graduates in 1997. All found positions in pediatric surgery, and first-year incomes continue to rise. Fewer graduates (54%) desired an academic position coupled with research compared with previous survey respondents (64%), and 69% were able to find such a position. A practice at a university children's hospital remained the most desired by over 80%, but only 38% obtained positions in this type of practice. However, 55% were able to find a position in a children's hospital (university or community), which had declined gradually to a low of 32% in 1997. The 1998 to 2000 graduates perceive a much stronger demand for pediatric surgeons compared with previous survey respondents (46% v 14%), and greater than 50% felt that too few pediatric surgeons were being trained. CONCLUSIONS: The market demand for pediatric surgeons remains strong as measured by employment and income. The perception of the market by the 1998 through 2000 graduates is positive, which contrasts with the 1992 through 1997 graduates. However, there continues to be significant market changes including a proliferation of positions at community Children's hospitals.

Adult↗

The disproportion of female and male surgeons in cardiothoracic surgery.

In ancient times, female medical practitioners and female surgeons were well known. With the introduction of medicine as an academic course and the ban on women studying, the medical career became virtually impossible for women. This condition changed with the general admission for women to colleges, in Germany in 1908. The current situation of women in surgery is presented here, with cardiovascular surgery as an example. Of 302 active cardiothoracic and cardiac surgeons 4.6% are female. According to an inquiry of all German heart institutes, there are 20 female senior registrars and 27 female surgeons as well as 162 female assistants. Most of the medical directors do have a positive opinion about female surgeons, but criticize that only a few women who apply for actually finish surgical training. One reason for this may be the greater difficulties for women to take care of a family and become a surgeon simultaneously. In this regard, an improvement in the position of female doctors is desirable.

Cardiology↗

The distribution of shoulder replacement among surgeons and hospitals is significantly different than that of hip or knee replacement.

Practice is the repetition of an action to improve its quality. The value of the practice effect is recognized in sports, music, and surgery. The number of times a surgical procedure is performed may have a bearing on how well it is done. We investigated the relative frequency with which hip, knee, and shoulder replacements are performed by individual surgeons. The 1998 database of the Center for Medical Consumers in New York State revealed that over 40% of hip or knee replacement surgeons performed 10 or more replacements. In contrast, only 10 shoulder replacement surgeons (3%) performed 10 or more such procedures; 75% performed only one or two. The distribution of shoulder replacement among surgeons was statistically different than for hip or knee replacement (P <.0001). These findings suggest the need for robust educational programs to minimize the potential adverse effects of low surgeon volume for the patients undergoing these procedures.

Arthroplasty, Replacement↗

The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer.

BACKGROUND: This study explores the volume-mortality relationship for 3 groups of cancer procedures to determine whether higher-volume hospitals, higher-volume surgeons, or both are associated with lower in-hospital mortality. METHODS: New York's Statewide Planning and Research Cooperative System was used to identify more than 32,000 hospital inpatients with a cancer diagnosis who underwent colectomy, lobectomy of the lung, or gastrectomy between January 1, 1994, and December 31, 1997. The association of in-hospital mortality rates with provider (hospital and surgeon) volume was examined after adjusting for differences in age, demographics, organ metastasis, socioeconomic status, and comorbidities. RESULTS: For hospital volume for gastrectomy, the highest-volume quartile had an absolute risk-adjusted mortality rate that was 7.1% lower (P <.0001) than the lowest-volume quartile, although the overall mortality rate for the procedure was only 6.2%. For surgeon volume for colectomy, the highest- and lowest- volume quartiles differed by 1.9% (P <.0001), although the procedure mortality rate was only 3.5%. For hospital volume for lung lobectomy, the absolute difference in mortality was 1.7%. Patients undergoing operations performed by high-volume surgeons in high-volume hospitals usually had significantly lower risk-adjusted mortality rates than did patients who had low-volume surgeons or who were in low-volume hospitals, or both. CONCLUSIONS: For all 3 procedure groups, the risk-adjusted in-hospital mortality is significantly lower when the procedures are performed by high-volume providers.

Colectomy↗

Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection?

BACKGROUND: Although recent studies have reported that high-volume surgeons and hospitals have better outcomes for colon cancer resections, it remains unclear whether there are other factors that are more important than volume. This study aims to evaluate the importance of the volume variables relative to other factors in an attempt to target specific areas for improving outcomes. METHODS: Using nationwide data from the Healthcare Cost and Utilization Program, full-model logistic regression was performed on all patients undergoing colon cancer resection. In hospital mortality was regressed against more than 30 different independent variables, including demographic factors (eg, age, gender, race, ethnicity, and socioeconomic status), burden of morbid and comorbid disease (prevalence and severity), and provider variables (eg, hospital size, location, teaching status, hospital and surgeon volume). A separate baseline probability analysis was then performed to compare the relative importance for all predictor variables. RESULTS: The sample size for this analysis was 22,408; 622 in-hospital deaths occurred (2.8%). Average age was 70 years old, 51% of particIpants were male, and 60% had at least 1 comorbid disease. An operation was elective (64%), urgent (19%), or emergency (15%). The significant predictors for mortality (at P <.05) included age, gender, comorbid disease (ie, cardiovascular, pulmonary, liver), operation severity (ie, emergency, urgent), and volume (both hospital and surgeon). The baseline probability analysis shows that the mortality for a baseline case is 12/1000. If this baseline case goes to a high-volume hospital or surgeon, the mortality will decrease to 11/1000 and 10/1000, respectively. If a patient with a baseline case of colon cancer also has coexistent liver disease or requires an emergency operation, mortality increases to 44/1000 and 45/1000, respectively. Overall, the volume variables, although statistically significant, have a relatively smaller effect on outcome compared with other factors. CONCLUSIONS: Whereas other factors have a stronger association with outcome than volume, volume is the only acutely mutable variable. Although the regionalization controversy (ie, using only high-volume surgeons or hospitals) is not solved with our findings, this study elucidates and compares the relative importance of several different factors on outcome, which is essential when considering the conclusions and implications of this type of policy-relevant outcomes research.

Aged↗

Factors determining survival after ruptured aortic aneurysm: the hospital, the surgeon, and the patient.

The 10-year experience of a single community was reviewed and a multivariate analysis was performed to determine the relative importance of clinical and environmental factors in mortality after ruptured abdominal aortic aneurysm resection. Ruptured aneurysms were repaired in 243 patients in six area hospitals (one university, five community) by 25 surgeons (16 vascular, 9 general). Overall, 30-day mortality was 55% (133/243). Although the mortality by hospital ranged from 44% to 68%, these differences were not statistically significant. However, significant variations occurred in the mortality rates of individual surgeons, ranging from 44% to 73%. The mortality rate for the vascular surgeons was less than that of the general surgeons, 51% versus 69% (p less than 0.05). Clinical factors were evaluated, and the most significant parameters were systolic blood pressure, presence of chronic obstructive lung disease, and history of chronic renal insufficiency. These results support the implication that the degree of specialization of the surgeon and the preexisting health of the patient are the most important determinants of survival after ruptured abdominal aortic aneurysm. The size and sophistication of the hospital appear to be less influential factors.

Aged↗

Valentine Mott. American surgeon pioneer.

Valentine Mott (1785-1865) was considered one of the most influential American surgical leaders of his time. Originally from Long Island, New York, he proceeded from a Quaker medical family and received a classical education from an elementary seminary. After completing an apprenticeship under his cousin, well-respected surgeon Valentine Seaman, he attended and received his medical degree from Columbia Medical College in 1806. Months later, he left for London, where he studied surgery under the superb guidance of the surgical star Sir Astley Cooper. Other noted English and Scottish surgeons actively participated in his education as well. By 1809, Valentine Mott returned to New York City. Various coveted surgical posts at Columbia, Rutgers Medical College of New Jersey, and University City of New York were occupied by Professor Mott. Valentine Mott was certainly the first American to ligate successfully a great number of large arteries. Because of Valentine Mott's extraordinary vascular surgery work, the distinguished surgeon and historian, Ira Rutkow, believes Mott should be named the father of American vascular surgery. I concur with his recommendation. In addition, Valentine Mott performed an incredible number of lithotomies with good results, and nearly 1000 amputations and other operations, such as surgery of the face, nose, and mandible. He was a continuously dedicated, highly committed, and skillful surgeon, who knew anatomy extremely well and was a considerate professional with his patients and colleagues-a great example for aspiring surgeons to follow.

History, 19th Century↗

Prospective multicentre trials in developing countries: willingness of surgeons to participate.

OBJECTIVE: To assess the feasibility of conducting a multicentre study among surgeons in Turkey. DESIGN: Prospective open multicentre study. SETTING: Teaching hospitals in Turkey. SUBJECTS: Surgeons working in 23 university and 15 state hospitals. INTERVENTIONS: Surgeons willing to participate were asked to look for the presence of Meckel's diverticulum in all patients undergoing laparotomy. MAIN OUTCOME MEASURES: To find out the number of surgeons willing to participate in the study and once they agreed to see how they fulfilled the requirements. RESULTS: 14 agreed to participate (12 from universities and 2 from state hospitals) and completed the study. A total of 2781 patient records were collected. University hospitals were more willing to participate than state hospitals (52% compared with 13%) but state hospitals contributed 20% of the patients. The number of patients contributed in the first and second halves of the study did not differ, reflecting no diminution of the enthusiasm. CONCLUSION: This study, with no financial support, showed that it is possible to conduct multicentre studies among surgeons in developing countries such as Turkey. Increased awareness of the importance of publication may have helped to obtain this result.

Adult↗