American journal of surgery
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Comparative Study
The physiological effects of hyperosmolar resuscitation: 5% vs 3% hypertonic saline.
Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma. ⋯ The 5%NS has sustained higher serum osmolarity and serum sodium concentration within the first 72 hours without any increase in adverse effects in comparison with 3%NS.
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Comparative Study
Incidence of overall complications and symptomatic tracheal stenosis is equivalent following open and percutaneous tracheostomy in the trauma patient.
While percutaneous tracheostomy (PT) is becoming the procedure of choice for elective tracheostomy, there is little late complication data. This study compared incidence of, and factors contributing to, tracheal stenosis following PT or open tracheostomy (OT). ⋯ Risk of tracheal stenosis should not impact the decision to perform an OT or PT.
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The leadership of the surgical community is actively engaged in improving the preparation of incoming residents to assume responsibility and accountability for key elements of care and stewardship. To better prepare for this transition, it is essential that all matriculants to surgery residency successfully complete a preparatory course of blended learning that specifically addresses the essential components of quality care and patient safety before the start of their training. ⋯ We strongly endorse this effort and encourage medical schools to adopt this or a similar program. We stand ready to assist medical schools and medical students in the implementation of this important initiative.
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Recent years have seen a significant drop in applications to surgical residencies. Existing research has yet to explain how medical students make career decisions. This qualitative study explores students' perceptions of surgery and surgeons, and the influence of stereotypes on career decisions. ⋯ Strong stereotypes of surgery deterred students from a surgical career. As a field, surgery must actively engage medical students to encourage participation and dispel negative stereotypes that are damaging recruitment into surgery.
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Historical Article
A historical review of classic articles in surgery field.
Surgery is one of the most rapidly developing specialties in the past century. Diagnostic methods, operation technique, and knowledge of the diseases are changing continuously. In the academic history, lots of classic papers brought advances for surgery. They were accepted and cited numerously by the medical specialists all over the world. Citation analysis reflects the recognition a work has received in the scientific community by its peers. ⋯ Totally 36 articles have been cited at least 1,000 times since their publication to the year 2011. According to their citation histories, 35 articles were further evaluated. These topmost articles covered 8 subspecialties of surgery and were published in 17 journals. The publication year varied from 1940 to 1999 and the articles provided different level of evidence, most of which are retrospective studies of case series. Six articles were research articles including animal model, histology analysis, and laboratory research. The others were clinical articles. From the results of citation analysis, the classic articles are not always in top citations. In addition, some of these articles have no citations after several years post their publication. The introduction of a commonly used classification or scoring system is a major factor in propelling citation by other authors. The most cited articles in surgery present their long academic life in spite of their level of evidence and journal impact factor in which they were published.