American journal of surgery
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Randomized Controlled Trial
Usefulness of LigaSure for liver resection: analysis by randomized clinical trial.
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Meeting the educational needs and requirements of surgical resident physicians while achieving optimal patient care is a challenge for program directors. Midlevel practitioners (MLPs) were employed by a large community teaching hospital to augment the surgical teaching service, to improve continuity of patient care, and to provide resident physicians with greater flexibility to participate in classroom, operative, and clinical educational experiences. The MLPs were carefully integrated into the surgical program by creating the necessary buy-in, developing positive relationships, decreasing resistance, and reinforcing acceptance when demonstrated. ⋯ Instituting the program required providing financial justification to administration and flexibility in meeting the diverse needs of the four teams. As a result, surgical resident physicians have been sufficiently freed from service activities to be able to capitalize on learning activities that range from surgeries to conferences. MLPs can be integrated into a surgical teaching program and become a positive force in the education of resident physicians.
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The classic position for subclavian venipuncture is the Trendelenberg position, with the head turned away and placement of a shoulder roll (SR). The purpose of this study was to determine whether this position results in the largest cross-sectional area (CSA) of the subclavian vein (SV). ⋯ The classic recommended maneuvers of turning the head and placing an SR significantly reduce the CSA of the SV. Positioning patients in Trendelenberg with the head turned away without an SR optimizes SV size. Positioning patients in this manner may serve to reduce the morbidity associated with percutaneous access of the SV.
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Comparative Study
Risk-scoring methods in predicting the immediate outcome after emergency open repair of ruptured abdominal aortic aneurysm.
Rupture of an abdominal aortic aneurysm (RAAA) is associated with a risk of death approaching 80%. Prediction of immediate postoperative death in this condition assumes obvious relevance because it may be helpful in preoperative risk stratification. ⋯ The present study showed that the Glasgow aneurysm score and, to a somewhat lower extent, the Hardman score are valuable predictors of immediate postoperative death after emergency open repair of RAAA.
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Comparative Study
The prevalence of germline BRCA1 and BRCA2 mutations in young women with breast cancer undergoing breast-conservation therapy.
Germline mutations of BRCA1 and BRCA2 increase the risk for breast cancer. Mutation carriers selecting breast-conservation therapy (BCT) for treatment of operable breast cancer experience a higher rate of new primary breast cancers. We sought to determine the frequency of BRCA1/BRCA2 mutations in women who underwent BCT. Genetic testing results were compared with the prior probability of mutations in either gene. ⋯ BRCA1 and BRCA2 mutations are common (9%) among unselected young breast cancer patients undergoing BCT.