American journal of surgery
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Academic surgeons are required to fulfill three basic, interconnected responsibilities: patient care, teaching, and research. Increased demands for patient care and its revenue have severely curtailed the time available to pursue research projects. In order for trainees and junior faculty to discover the fulfillment research can provide, their time must be protected to allow them to find good mentors, projects, and funding essential for success in academic surgery.
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Limitation of resident duty hours continues to be a national concern with weekly work hour limits legislated in New York State. The Residency Review Committee for Surgery monitors programs for working conditions and will be enforcing new regulations from the Accreditation Council for Graduate Medical Education. Other sources of resident stress must also be addressed.
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Health workforce studies have mostly predicted an oversupply of physicians, a shortage of primary care doctors, and an excess of specialists. As the target date of many of these studies is now passed, it is clear that we are evolving into a shortage of physicians, especially specialists, and that primary care will increasingly be done by nonphysician clinicians. The "knowledge society" requires a different workforce than that predicted by most health planners.
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The term secondary abdominal compartment syndrome (ACS) has been applied to describe trauma patients who develop ACS but do not have abdominal injuries. The purpose of this study was to describe major trauma victims who developed secondary ACS during standardized shock resuscitation. ⋯ Secondary ACS is an early but, if appropriately monitored, recognizable complication in patients with major nonabdominal trauma who require aggressive resuscitation.
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Traditional surgical teaching stresses that hypotension is an indicator of loss of circulating blood volume. The purpose of this study is to critically evaluate hypotensive injured children for evidence of a hemorrhagic insult. ⋯ Hypotension should not be viewed only as a potential marker of loss of circulating volume, but also as a possible indicator of head injury in young trauma victims.