American journal of surgery
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Bronchoalveolar lavage (BAL) is recommended to facilitate the diagnosis of ventilator-associated pneumonia (VAP). It is unclear if bilateral sampling improves the accuracy of BAL. ⋯ Bilateral BAL improves the accuracy of bronchoscopy in diagnosing VAP. Unilateral BAL may be insensitive in patients with clinically significant contralateral infection.
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Studies have identified clinical predictors to guide radiologic evaluation of the cervical spine in geriatric patients. We hypothesized that clinical predictors are not adequate in the identification of cervical spine fractures in geriatric blunt trauma patients with low-energy mechanism. ⋯ Clinical predictors appear inadequate for the evaluation of the cervical spine in geriatric trauma patients with low-energy mechanism.
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We assessed educational needs with regard to leadership, communication, and emotional intelligence (EI) among surgical residents. ⋯ Surgical residents believed that leadership skills are important and scored strongly on both an EI self-assessment and the EQ-i. Specific individual differences in subscale scores can potentially identify areas for direct educational intervention.
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Trauma surgery has changed significantly over the past decade. Nonoperative evidence-based algorithms have become common and surgical trauma volume has become increasingly difficult to maintain. The acute care surgery (ACS) model, which integrates trauma, critical care, and emergency surgery, has been proposed as a future model of trauma practice. ⋯ Surgical practice in a county-run trauma hospital can be similar to the ACS model, with positive results in terms of clinical volume and physician satisfaction. As clinical practices shift to the ACS model, there are lessons to be learned from currently existing, thriving, long-standing similar prototypes.