Journal of the American College of Surgeons
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Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic shock, early (< 24 hours) changes in cytokine production are an index of the systemic inflammatory response syndrome. However, their predictive value in trauma patients remains to be fully elucidated. ⋯ These data provide insight into cytokine expression during traumatic shock that can enable earlier identification of patients at risk for development of MOF.
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The concept of increased medical errors in July, secondary to new residents (the "July phenomenon"), often receives considerable attention without supporting evidence. A recent study reported a 41% increase in mortality during July and August in general surgery patients. The objective of this study was to determine if a July phenomenon existed in a Level I trauma center with an attending present at all times. ⋯ The July phenomenon does not exist at this Level I trauma center with in-hospital attending supervision.
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In response to new Accreditation Council for Graduate Medical Education requirements about simulation skill laboratories, programs are incorporating simulation into residents' training. Despite substantial research on simulators, few data exist to support the effectiveness of simulation skills curricula. We report on an Objective Structured Assessment of Technical Skills (OSATS) used to assess residents' needs and evaluate a curriculum designed to increase proficiency. ⋯ Our results suggest that the simulation curriculum helped PGY1 residents attain basic surgical skills at levels consistent with PGY2 and PGY3 residents as measured by an OSATS. Only PGY3 residents performed at the 75% criterion.