Intranasal lidocaine for the treatment of migraine headache: a randomized, controlled trial.
Administration; Adolescent; Adult; Anesthetics; Confidence Intervals; Double-Blind Method; Female; Hospitals; Humans; Intranasal; Lidocaine/*administration & dosage; Local; Male; Middle Aged; Migraine without Aura/diagnosis/*drug therapy; Ohio; Pain Measurement; Patient Satisfaction; Reference Values; Severity of Illness Index; Teaching; Treatment Outcome
OBJECTIVE: To evaluate the effect of intranasal lidocaine for immediate relief (5 minutes) of migraine headache pain. METHODS: A randomized, double-blind, placebo-controlled clinical trial at two university-affiliated community teaching hospitals enrolled patients 18-50 years old with migraine headache as defined by the International Headache Society. Patients who were pregnant, lactating, known to abuse alcohol or drugs, or allergic to one of the study drugs, those who used analgesics within two hours, or those with a first headache were excluded. Statistical significance was assessed by using chi-square or Fisher's exact test for categorical variables and Student's t-test for continuous variables. Patients rated their pain on a 10-centimeter visual analog scale (VAS) prior to drug administration and at 5, 10, 15, 20, and 30 minutes after the initial dose. Medication was either 1 mL of 4% lidocaine or normal saline (placebo) intranasally in split doses 2 minutes apart and intravenous prochlorperazine. Medications were packaged so physicians and patients were unaware of the contents. Successful pain relief was achieved if there was a 50% reduction in pain score or a score below 2.5 cm on the VAS. RESULTS: Twenty-seven patients received lidocaine and 22 placebo. No significant difference was observed between groups in initial pain scores, 8.4 (95% CI = 7.8 to 9.0) lidocaine and 8.6 (95% CI = 8.0 to 9.2) placebo (p = 0.75). Two of 27 patients (7.4%, 95% CI = 0.8, 24.3) in the lidocaine group and three of 22 patients (13.6%, 95% CI = 2.8 to 34.9) in the placebo group had immediate successful pain relief (p = 0.47), with average pain scores of 6.9 (95% CI = 5.9 to 7.8) and 7.0 (95% CI = 5.8 to 8.2), respectively. No difference in pain relief was detected at subsequent measurements. CONCLUSION: There was no evidence that intranasal lidocaine provided rapid relief for migraine headache pain in the emergency department setting.
Blanda M; Rench T; Gerson L W; Weigand J V
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2001
2001-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2001.tb02111.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2001.tb02111.x</a>
The dermatologist's academic portfolio: a template for documenting scholarship and service.
Humans; *Career Mobility; *Faculty; Teaching; *Dermatology; *Documentation; Medical
The clinician-teacher of dermatology often seeks recognition for academic efforts, the most visible of which is a university appointment with the potential for promotion. Success in achieving this goal requires careful planning to ensure effective involvement in academic pursuits that serve the mission of the university, and there must be concomitant documentation of this involvement. The template in this article provides one format for organizing an academic portfolio that stimulates prospective documentation and enhances the possibility of academic advancement.
Brodell Robert T; Alam Murad; Bickers David R
American journal of clinical dermatology
2003
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2165/00128071-200304110-00001" target="_blank" rel="noreferrer noopener">10.2165/00128071-200304110-00001</a>
Surgical autonomy: A resident perspective and the balance of teacher development with operative independence.
Teaching; Autonomy; Operative independence; Resident education; Resident training
BACKGROUND: This study aims to understand the perspectives of operative autonomy of surgical residents at various postgraduate levels. METHODS: Categorical general surgery residents at a single academic residency were invited to participate in focus groups to discuss their opinions and definitions of operative autonomy. Employing constructivist thematic analysis, focus groups were audio recorded, transcribed, and inductively analyzed using a constant comparative technique. RESULTS: Twenty clinical surgical residents participated in 6 focus groups. Overarching themes identified include autonomy as a dynamic, progressive path to operative independence and the complex interaction of resident-as-teacher development and operative autonomy. Four within operative case themes were intrinsic factors, extrinsic factors, autonomy promoting or inhibiting behaviors, and the relationship between residents and attendings. CONCLUSION: Residents define operative autonomy as a progressive and dynamic pathway to operative independence. Teacher development is viewed as both an extension beyond operative independence and potentially in conflict with their colleagues' development.
Cassidy DJ;McKinley SK;Ogunmuyiwa J;Mullen JT;Phitayakorn R;Petrusa Emil;Kim MJ
American Journal of Surgery
2020
2020-10-22
journalArticle
<a href="http://doi.org/10.1016/j.amjsurg.2020.10.024" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2020.10.024</a>
Patient Hand-Off iNitiation and Evaluation (PHONE) study: A randomized trial of patient handoff methods.
*Internship and Residency; *Medical errors; *Patient handoff; *Patient outcomes; *Patient safety; *Physician communication; *Sign-out; Female; Hospitals; Humans; Length of Stay; Male; Medical Errors/prevention & control; Middle Aged; Patient Handoff/*organization & administration; Patient Outcome Assessment; Patient Safety; Prospective Studies; Teaching; United States
BACKGROUND: As residency work hour restrictions have tightened, transitions of care have become more frequent. Many institutions dedicate significant time and resources to patient handoffs despite the fact that the ideal method is relatively unknown. We sought to compare the effect of a rigorous formal handoff approach to a minimized but focused handoff process on patient outcomes. METHODS: A randomized prospective trial was conducted at a large teaching hospital over ten months. Patients were assigned to services employing either formal or focused handoffs. Residents were trained on handoff techniques and then observed by trained researchers. Outcome data including mortality, negative events, adverse events, and length of stay were collected and compared between formal and focused handoff groups using t-tests and a multivariate regression analysis. RESULTS: A total of 5157 unique patient-admissions were stratified into the two study groups. Focused handoffs were significantly shorter and included fewer patients (mean 6.3 patients discussed over 6.7 min vs. 35.2 patients over 20.6 min, both p \textless 0.001). Adverse events occurred during 16.7% of patient admissions. While overall length of stay was slightly shorter in the formal handoff group (5.50 days vs 5.88 days, p = 0.024) in univariate analysis only, there were no significant differences in patient outcomes between the two handoff methods (all p \textgreater 0.05). CONCLUSIONS: This large randomized trial comparing two contrasting handoff techniques demonstrated no clinically significant differences in patient outcomes. A minimalistic handoff process may save time and resources without negatively affecting patient outcomes.
Clanton Jesse; Gardner Aimee; Subichin Michael; McAlvanah Patrick; Hardy William; Shah Amar; Porter Joel
American journal of surgery
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.amjsurg.2016.10.015" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2016.10.015</a>
How to perform Contrast-Enhanced Ultrasound (CEUS).
cancer; guidelines; teaching; ultrasonography
"How to perform contrast-enhanced ultrasound (CEUS)" provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.
Dietrich Christoph F; Averkiou Michalakis; Nielsen Michael Bachmann; Barr Richard G; Burns Peter N; Calliada Fabrizio; Cantisani Vito; Choi Byung; Chammas Maria C; Clevert Dirk-Andre; Claudon Michel; Correas Jean Michel; Cui Xin-Wu; Cosgrove David; D'Onofrio Mirko; Dong Yi; Eisenbrey JohnR; Fontanilla Teresa; Gilja Odd Helge; Ignee Andre; Jenssen Christian; Kono Yuko; Kudo Masatoshi; Lassau Nathalie; Lyshchik Andrej; Franca Meloni Maria; Moriyasu Fuminori; Nolsoe Christian; Piscaglia Fabio; Radzina Maija; Saftoiu Adrian; Sidhu Paul S; Sporea Ioan; Schreiber-Dietrich Dagmar; Sirlin Claude B; Stanczak Maria; Weskott Hans-Peter; Wilson Stephanie R; Willmann Juergen Karl; Kim Tae Kyoung; Jang Hyun-Jung; Vezeridis Alexandar; Westerway Sue
Ultrasound international open
2018
2018-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1055/s-0043-123931" target="_blank" rel="noreferrer noopener">10.1055/s-0043-123931</a>
The Academic Health Department: the process of maturation.
*Public Health Administration; Academic Medical Centers; Accreditation; Education; Epidemiological Research; Experiential Learning; Government Agencies – Classification; Humans; Interinstitutional Relations; Interinstitutional Relations – Trends; Local Government; Medical; Outcomes (Health Care); Patient Protection and Affordable Care Act; Preventive Health Care – Education; Professional Development; Public Health – Education; Public Health Administration; Public Health Professional/methods/*organization & administration; Public Health/*organization & administration; Quality of Health Care; Schools; State Government; Teaching; United States; Universities/organization & administration
The Academic Health Department (AHD) involves an arrangement between a governmental health agency and an academic institution, which provides mutual benefits in teaching, service, research, and practice. From its initial development in the mid-1980s as the public health equivalent of the relationship between a teaching hospital and a medical school, the AHD concept has evolved to include multiple levels of governmental public health agencies (local, state, and federal) as well as multiple academic institutions (public health, medicine, and primary care medical residencies). Throughout the decade of the 2000s, multiple influences have impacted both the quality and quantity of AHDs, leading to an expansion of AHDs through the Council on Linkages' AHD Learning Community. The value of the AHD–as described from prior studies as well as the AHD case examples in this current special issue–is evident in its impact on the quality of educational experiences and workforce development, agency and academic accreditation, practice-based research, and the potential to influence health reform.
Erwin Paul Campbell; Keck C William
Journal of public health management and practice : JPHMP
2014
2014-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PHH.0000000000000016" target="_blank" rel="noreferrer noopener">10.1097/PHH.0000000000000016</a>
Difficulty in predicting bacteremia in elderly emergency patients.
80 and over; Aged; Bacteremia/*diagnosis/microbiology; Bacteriological Techniques; Blood Chemical Analysis; Cognition Disorders/diagnosis; Confidence Intervals; Escherichia coli/isolation & purification; Female; Hospitals; Humans; Male; Odds Ratio; Predictive Value of Tests; Regression Analysis; Retrospective Studies; Sensitivity and Specificity; Teaching; Urinary Tract Infections/microbiology
STUDY OBJECTIVES: To characterize the clinical presentation and identify factors predictive of bacteremia in elderly patients. DESIGN: Retrospective review of emergency department charts, hospital records, and microbiology reports. SETTING: Community teaching hospital with annual ED census of 65,000 adults. PARTICIPANTS: Seven hundred fifty elderly patients (aged 65 to 99 years) who were evaluated by the emergency physician, had blood cultures obtained in the ED, and were hospitalized with a suspected infectious process during a 12-month period. MEASUREMENTS: Records were analyzed for demographic information, underlying diseases, clinical presentation, laboratory findings, sources of infection, and causative organisms. Using contingency tables, 79 patients with positive blood cultures were compared with a random sample of 136 patients with sterile blood cultures to identify clinical variables significantly (P less than .05) associated with bacteremia. Logistic regression analysis was performed with significant factors to develop a model to predict bacteremia. Sensitivity, specificity, and predictive values were calculated for the model. MAIN RESULTS: The prevalence of bacteremia was 10.6%. Escherichia coli was the most commonly isolated pathogen (29% of cases), and the urinary tract was the most common source of infection (44.3% of cases). Logistic regression analysis showed that altered mental status (odds ratio, 2.88; 95% confidence interval [Cl], 1.52 to 5.50), vomiting (odds ratio, 2.63; 95% Cl, 1.16 to 6.15), and WBC band forms of more than 6% (0.06) (odds ratio, 3.50; 95% Cl, 1.58 to 5.27) were independent predictors of bacteremia. The presence of at least one of these three factors had a sensitivity of 0.85 (95% Cl, 0.75 to 0.92) and a specificity of 0.46 (95% Cl, 0.38 to 0.55) for predicting bacteremia in the study group. The positive predictive value was 0.16 (95% Cl, 0.12 to 0.19) and the negative predictive value was 0.96 (95% Cl, 0.94 to 0.98) for the ED patient group that met inclusion criteria. CONCLUSION: Elderly patients fail to manifest identifiable clinical features indicative of bloodstream infection. The sensitivity and specificity of the best statistical model for identifying bacteremic elderly patients suggest that clinical indicators alone are unreliable predictors of bacteremia in the geriatric ED population studied.
Fontanarosa P B; Kaeberlein F J; Gerson L W; Thomson R B
Annals of emergency medicine
1992
1992-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(05)81032-7" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)81032-7</a>
Nosocomial fungemia in a large community teaching hospital.
Adult; Humans; Middle Aged; Retrospective Studies; Teaching; Amphotericin B/therapeutic use; *Cross Infection; Candidiasis/complications/drug therapy/*etiology/mortality; Hematologic Diseases/complications/drug therapy/*etiology/mortality; Sepsis/complications; Community; *Hospitals
This report reviews 48 episodes of hospital-acquired fungemia that occurred over a four-year period at a large community teaching hospital. The incidence of hospital-acquired fungemia increased eightfold during the study period. Candida albicans (58%), Candida tropicalis (25%), and Candida parapsilosis (15%) were the most common fungal pathogens isolated from blood cultures. Twenty-one patients (44%) had concomitant bacteremia. Intravascular catheters (100%), antibiotic administration (98%), urinary catheters (81%), surgical procedures (65%), parenteral alimentation (60%), and corticosteroid administration (54%) were the most common predisposing factors. The overall mortality rate was 75%. Hospitalization on the medical service, age greater than 60 years, and hospital stay less than 100 days were associated with a significantly increased mortality rate.
Harvey R L; Myers J P
Archives of Internal Medicine
1987
1987-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archinte.147.12.2117" target="_blank" rel="noreferrer noopener">10.1001/archinte.147.12.2117</a>
Discussion of learning assessments in postgraduate teaching and learning curricula.
Humans; Curriculum; Educational Measurement; *Curriculum; Education; Internship and Residency; *Learning; *Teaching; Learning; Teaching; Pharmacy; Graduate/*organization & administration
Hoover Matthew J; Peeters Michael J
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
2015
2015-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2146/ajhp140631" target="_blank" rel="noreferrer noopener">10.2146/ajhp140631</a>
Feminist criticism in literature and medicine.
Female; Humans; United States; Attitude of Health Personnel; *Medicine in Literature; Teaching; *Literature; *Women's Rights; Women's Health; Ethics; Medical; Modern
Wear D
The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha
1994
1905-6
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Attitudes of female nurses and female residents toward each other: a qualitative study in one U.S. teaching hospital.
*Attitude of Health Personnel; *Internship and Residency; *Physician-Nurse Relations; Australia; Communication; Female; Focus Groups; Gender Identity; Hospitals; Humans; Male; Norway; Nurses/*psychology; Physicians; Sexual Behavior; Teaching; United States; Women/*psychology
PURPOSE: To describe the attitudes of female nurses and female resident physicians toward each other in surgery, internal medicine, obstetrics-gynecology, and emergency medicine in one Midwest teaching hospital in the United States. METHOD: Using a qualitative methodology, 51 women were interviewed in 2002: 28 nurses and 23 residents. Questions were asked to determine if and how female nurses and female residents believed gender was a factor in their interprofessional relationships, how each described their relationship with the other, the kind of assistance female nurses provide to female residents, the kind of assistance sought by female residents, and the strengths and challenges of the female nurse-female resident relationship. Data were analyzed using NUD*IST software. RESULTS: Consistent with similar studies conducted in Norway and Australia, the results include the following: For female nurses, occupation is secondary to gender, which is to say that gender is the most important link between female nurses and female residents. For female residents, gender is secondary to occupation/occupational status. CONCLUSIONS: With the number of female residents increasing each year in hospitals, this relationship should be further examined so that dysfunctional communication patterns between the two groups can be challenged.
Wear Delese; Keck-McNulty Cynthia
Academic medicine : journal of the Association of American Medical Colleges
2004
2004-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00001888-200404000-00004" target="_blank" rel="noreferrer noopener">10.1097/00001888-200404000-00004</a>
Hidden in plain sight: the formal, informal, and hidden curricula of a psychiatry clerkship.
*Clinical Clerkship; *Curriculum; Attitude of Health Personnel; Clinical Competence; Faculty; Focus Groups; Humans; Internship and Residency; Intuition; Learning; Medical; Mentors; Physician-Patient Relations; Physician's Role; Psychiatry/*education; Students; Teaching; Time Factors; United States
PURPOSE: To examine perceptions of the formal, informal, and hidden curricula in psychiatry as they are observed and experienced by (1) attending physicians who have teaching responsibilities for residents and medical students, (2) residents who are taught by those same physicians and who have teaching responsibilities for medical students, and (3) medical students who are taught by attendings and residents during their psychiatry rotation. METHOD: From June to November 2007, the authors conducted focus groups with attendings, residents, and students in one midwestern academic setting. The sessions were audiotaped, transcribed, and analyzed for themes surrounding the formal, informal, and hidden curricula. RESULTS: All three groups offered a similar belief that the knowledge, skills, and values of the formal curriculum focused on building relationships. Similarly, all three suggested that elements of the informal and hidden curricula were expressed primarily as the values arising from attendings' role modeling, as the nature and amount of time attendings spend with patients, and as attendings' advice arising from experience and intuition versus "textbook learning." Whereas students and residents offered negative values arising from the informal and hidden curricula, attendings did not, offering instead the more positive values they intended to encourage through the informal and hidden curricula. CONCLUSIONS: The process described here has great potential in local settings across all disciplines. Asking teachers and learners in any setting to think about how they experience the educational environment and what sense they make of all curricular efforts can provide a reality check for educators and a values check for learners as they critically reflect on the meanings of what they are learning.
Wear Delese; Skillicorn Jodie
Academic medicine : journal of the Association of American Medical Colleges
2009
2009-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ACM.0b013e31819a80b7" target="_blank" rel="noreferrer noopener">10.1097/ACM.0b013e31819a80b7</a>
Short-term functional decline and service use in older emergency department patients with blunt injuries.
*Activities of Daily Living; 80 and over; 80 and Over; Academic Medical Centers; Activities of Daily Living; Aged; Bone/physiopathology/therapy; Clinical Assessment Tools; Comorbidity; Confidence Intervals; Descriptive Statistics; Emergency Care – In Old Age; Emergency Patients – In Old Age; Emergency Service; Family; Female; Fisher's Exact Test; Fractures; Functional Status – In Old Age; Geriatric Assessment; Geriatric Functional Assessment; Health Resource Utilization – In Old Age; Hospital/*statistics & numerical data; Hospitals; Human; Humans; Logistic Models; Logistic Regression; Longitudinal Studies; Male; Mental Status Schedule; Nonpenetrating – In Old Age; Nonpenetrating/*physiopathology/*therapy; OARS Multidimensional Functional Assessment Questionnaire; Odds Ratio; Ohio; Outcome Assessment; Outpatients; P-Value; Predictive Value of Tests; Prospective Studies; Questionnaires; Record Review; ROC Curve; Scales; Summated Rating Scaling; Surveys and Questionnaires; T-Tests; Teaching; Treatment Outcome; Treatment Outcomes; Wounds
BACKGROUND: Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. OBJECTIVES: The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. METHODS: This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were \textgreater or = 65 years old, with blunt injuries \textless48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. RESULTS: A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). CONCLUSIONS: Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.
Wilber Scott T; Blanda Michelle; Gerson Lowell W; Allen Kyle R
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00799.x</a>
Laparoscopic cholecystectomy in a community hospital: experience with 600 laparoscopic cholecystectomies.
Cholecystectomy; Cholecystectomy/statistics & numerical data; Community; Female; Hospitals; Humans; Intraoperative Complications/epidemiology; Laparoscopic/mortality/*statistics & numerical data; Male; Middle Aged; Postoperative Complications/epidemiology; Retrospective Studies; Teaching
We reviewed 600 patients who underwent laparoscopic cholecystectomy (LC) in a teaching community hospital from May 1990 to August 1992. The safety, efficacy, morbidity, and mortality of LC, as performed by one surgeon or under his direct supervision, were studied. Five hundred forty-eight patients (91.3%) were treated electively; 52 (8.7%) were admitted for acute cholecystitis (41) or gallstone pancreatitis (11). Mean operating time was 54 min, with a range of 20 to 145 min. Twenty-four (4%) patients required conversion to traditional (open) cholecystectomy. Operative cholangiograms were completed in 106 patients. These revealed choledocholithiasis in 7. Five hundred thirty-seven patients (89.5%) were discharged within 24 h and 564 (94%) within 48 h. The overall morbidity of 9.2% compared favorably with both open and laparoscopic series previously reported. Three patients (0.5%) had small lacerations of the anterior wall of the common duct. Two were recognized and repaired immediately. The third patient came for treatment on the fifth postoperative day and was stented by a T-tube. There was 1 death in this group–a myocardial infarction on postoperative day 4.
Williams G B; Silverman R S
Journal of laparoendoscopic surgery
1994
1994-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/lps.1994.4.101" target="_blank" rel="noreferrer noopener">10.1089/lps.1994.4.101</a>
Awarding faculty rank to non-tenured physician faculty in a consortium medical school.
Humans; United States; *Career Mobility; Workforce; Research; Teaching; Writing; Committee Membership; Family Practice/*statistics & numerical data; Volunteers/statistics & numerical data; *Schools; Faculty; Medical/statistics & numerical data; Medical/*organization & administration/standards/statistics & numerical data
Many medical schools struggle to identify an appropriate system to award faculty rank to non-tenured physician faculty. A key element needs to be balanced recognition of teaching and scholarly activities. At the Northeastern Ohio Universities College of Medicine (NEOUCOM), clinical teaching is accomplished predominantly by volunteer physician faculty whose major responsibilities are patient care and teaching. In addition to our system for awarding rank to faculty in a tenure track, NEOUCOM devised a system for awarding faculty rank to volunteer, non-tenure physician faculty that equitably recognizes teaching, service, and scholarly activity with assigned "units" of accomplishment for each criterion. We now have an effective two-track system for our non-tenure physician faculty that objectively assesses and recognizes academic productivity in all three areas and standardizes requirements for promotion. This paper discusses 3 years of experience with this two-track system and its effect on the rank of physician faculty in the Department of Family Medicine.
Williamson Jay C; Schrop Susan Labuda; Costa Anthony J
Family medicine
2008
2008-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).