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The longitudinal study of surgical residents, 1994 to 1996

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第6期188卷 575-585页

作者： Kwakwa, F Jonasson, O Amer Coll Surg Chicago IL 60611 USA

Background: The American College of Surgeons (ACS) has conducted a detailed annual survey of residents enrolled in surgical graduate medical education (GME) programs since 1982 and has regularly published the resulting data as the Longitudinal Study of Surgical Residents. This report documents surgical resident enrollment and graduation for the academic years 1994-95 and 1995-96. Study Design: The Medical Education Research and Information Database of the American Medical Association was supplemented by the existing ACS Resident Masterfile and by personal contact with program directors and their staffs to verify accuracy and completeness of reporting. Each resident was tracked individually through surgical GME. Results: The total number of surgical residents graduating from surgical GME in 1995 and 1996 has not changed since 1982. Most graduates of surgical residency programs are in obstetrics and gynecology, followed by general surgery;demographic analysis of the graduating cohort shows that most are Caucasian male graduates of US or Canadian medical schools, and that their age at graduation is 33 to 35 years. International medical graduates (IMG) make up 8.9% of entering surgical residents and 6% of graduates. Osteopathic medical school graduates account for 1.2% to 1.3% of entering and graduating surgical residents. Women represent 27% of entering and 23% to 24% of graduates of surgical GME. The largest number and proportion of women in surgical GME are enrolled in obstetrics and gynecology residency programs, where they make up the majority of entering and graduating classes. When all other surgical residency program enrollments are considered together, women make up 17% and 16% of entering residents in 1994 and 1995 respectively, and 13% and 14% of graduates in those years. Conclusions: Surgical GME enrollment and graduation is stable. Few women and ethnic minorities are enrolled in surgical residency programs. IMG enrollment and graduation in surgical GME is l

关键词：数据收集教育医学研究生/统计学和数值数据人种群/统计学和数值数据实习医师和住院医师职务/统计学和数值数据纵向研究性别因素专业外科/教育专业外科/统计学和数值数据美国成年人女(雌)性人类男(雄)性

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Anastomotic diameters and strictures following esophagectomy and total gastrectomy in 256 patients

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WORLD JOURNAL OF SURGERY 2000年第1期24卷 78-85页

作者： Johansson, J Zilling, T von Holstein, CS Johnsson, F Öberg, S Walther, B Univ Lund Dept Surg S-22185 Lund Sweden

The prevalence of anastomotic strictures in esophageal anastomoses provides us with limited information about the anastomotic healing process. This prospective study evaluates the exact esophageal anastomotic diameters in 256 patients who underwent esophagectomy and esophagogastrostomy without pyloroplasty (n = 107) or total gastrectomy and Roux reconstruction (12 = 149). NO perioperative chemoradiotherapy was given. Anastomotic strictures and diameters were assessed during endoscopy by a separately inserted (inflated to the anastomotic width) balloon catheter. The anastomotic diameters increased significantly during the first postoperative year in the esophagectomy (p = 0.001) and gastrectomy (p < 0.001) groups. The anastomoses in the gastrectomy group were significantly wider than those in the esophagectomy group 3 (25.7 versus 19.9 mm), 6 (28.5 versus 22.0 mm), and 12 (30.5 versus 23.3 mm) months after surgery (p < 0.001). Neither the anastomotic site (neck or chest) in the esophagectomy group (p = 0.176) nor that in the gastrectomy group (abdomen or chest) (p = 0.577) influenced the anastomotic diameter. Benign anastomotic strictures were most frequently found after 3 months and after esophagectomy. Esophagojejunostomies performed with 2 linear stapling devices or cartridge size 28 mm showed the widest anastomoses with only 1 stricture. Esophagogastric anastomoses following esophagectomy are narrower and develop more strictures than esophagojejunal anastomoses after total gastrectomy, but both dilate during the first year.

关键词：方差分析吻合术外科/方法吻合术外科/统计学和数值数据卡方分布食管狭窄/病因学食管狭窄/病理学食管切除术/副作用食管切除术/方法食管切除术/统计学和数值数据食管镜检查随访研究胃切除术/副作用胃切除术/方法胃切除术/统计学和数值数据手术后并发症/病因学手术后并发症/病理学前瞻性研究缝合技术/统计学和数值数据成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Dental infection control at the year 2000 - Accomplishment recognized

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第9期130卷 1291-1298页

作者： Molinari, JA Univ Detroit Mercy Dept Biomed Sci Sch Dent Detroit MI 48219 USA

Health care providers have strived to address the many elements necessary to achieve effective infection control. Historical progress in microbiology and hospital asepsis provided the foundation for advances in dental preventive practices. Evidence supporting the application of current practices includes a long history of scientific and clinical investigations, technological advances in equipment and materials, and periodic publication of updated recommendations by professional health care organizations.

关键词：无菌术设备污染/预防和控制手套外科/统计学和数值数据坚持准则感染控制口腔防护服/统计学和数值数据灭菌/方法综合预防人类

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Fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease

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WORLD JOURNAL OF SURGERY 2000年第1期24卷 125-129页

作者： Yamamoto, T Keighley, MRB Queen Elizabeth Hosp Dept Surg Birmingham B15 2TH W Midlands England

The aim of this study was to examine the fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. One hundred thirty patients who underwent total colectomy between 1970 and 1997 were reviewed;65 patients underwent end ileostomy with an oversewn rectal stump (TC+I) kind 65 had ileorectal anastomosis (IRA). Patients treated by TC+I had significantly more rectal involvement (93%) than those having IRA (43%) (p < 0,0001), The incidence of ileal disease at the time of colectomy was similar (TC+I 34% versus IRA 32%;p = 0.99). Rectal recurrence requiring proctectomy was significantly more common after TC+I (51%) than after IRA(26%) (p = 0.01), whereas ileal recurrence requiring resection was significantly more common after IRA (45%) than after TC+I (18%) (p = 0.002). Using Kaplan-Meier methods, the 10-year cumulative probability of proctectomy was significantly higher after TC+I than IRA (58% versus 22%;p = 0.0001), whereas the ill-year cumulative probability of ileal resection was significantly higher after IRA than TC+I (37% versus 18%;p = 0.03). In conclusion, the proctectomy rate is higher after colectomy and ileostomy probably due to a higher incidence of preoperative rectal involvement. By contrast, the ileal recurrence rate is higher after colectomy and IRA.

关键词：吻合术外科/方法吻合术外科/统计学和数值数据卡方分布结肠切除术/方法结肠切除术/统计学和数值数据 Crohn病/外科学随访研究回肠/外科学手术后并发症/流行病学直肠/外科学复发回顾性研究统计学非参数青少年成年人老年人女(雌)性人类男(雄)性中年人

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Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery

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BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 1999年第4期37卷 316-319页

作者： Avery, CME Taylor, J Johnson, PA Queen Victoria Hosp E Grinstead RH19 3DN Sussex England Univ London Kings Coll Hosp London England Royal Surrey Cty Hosp Guildford Surrey England

The treatment of some maxillofacial fractures has an incidence of glove perforation as high as 50%, with over 80% going unnoticed at the time of operation. We investigated double gloving and a glove perforation indication system to ascertain whether the latter offered any additional protection. 1061 gloves used for 113 patients were examined, The outer glove perforation rate was significantly higher than the inner glove (0.48 compared with 0.10, P<0.0001). There were fewer unnoticed perforations in the glove perforation indication group than the standard surgical glove group (19% compared with 79%, P<0.0001). The indication system was most effective in wet operating fields. The perforation rate varied with the type of fracture and treatment. Mandibular fractures that were "hand-held', while bone-plated had a lower mean number of outer glove perforations/operation than fractures treated with temporary intermaxillary fixation (0.43 compared with 4.62, P<0.0001).

关键词：卡方分布设备失效/统计学和数值数据骨折固定术内手套外科/统计学和数值数据手术期间下颌骨折/外科学上颌面部损伤/外科学前瞻性研究人类

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Difficulties in obtaining informed consent by psychiatrists, surgeons and obstetricians gynaecologists

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HEALTH CARE ANALYSIS 1996年第1期4卷 65-71页

作者： Kent, G SHEFFIELD CTR HLTH & RELATED RES SHEFFIELDS YORKSHIREENGLAND

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A national study: The use of specialty surgical teams

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Journal of Hospital Marketing 1997年第1期12卷 79-89页

作者： Boissoneau, R. Sprengel, A.D. Snell, W.E. RBI Consulting Chandler AZ United States

Perioperative nursing is changing in response to the increasing complexity of patient care during diverse, specialized surgical procedures. As a result, designated specialty surgical teams have developed to fulfill needs of patients, nurses and surgeons. This exploratory, descriptive study examined reasons for implementing specialty surgical teams, the frequency and RN composition of such teams and their benefits. Data concerning the prevalence and specific use of specialty surgical teams are necessary to validate and redefine the nature and role of specialized perioperative nurses. Results of the U.S. study generally paralleled the Missouri study although findings were not as pronounced. Clearly though, in both studies, specialty surgical teams are perceived very positively by study respondents.

关键词：卫生保健调查卫生服务研究病人医疗小组/利用围手术期护理/人力围手术期护理/统计学和数值数据质量保证卫生保健问卷调查专业外科/人力专业外科/统计学和数值数据胸外科学/人力胸外科学/统计学和数值数据美国人类

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