Arch Surg Chicago
-
To evaluate the effects of resident duty-hours restrictions on teaching faculty, patient care, and the institutional climate at a single center. ⋯ Surgeons reported a particularly negative effect from resident duty-hours reform, especially within the areas of job satisfaction, time for teaching, and workload. Efforts to counteract these effects will be critical to maintain and recruit teaching faculty.
-
Comparative Study
Increased hospital morbidity among trauma patients with diabetes mellitus compared with age- and injury severity score-matched control subjects.
We hypothesized that patients with diabetes mellitus (DM) have worse outcomes following trauma compared with patients without a history of DM. ⋯ Patients with DM exposed to trauma have greater hospital morbidity resulting from longer intensive care unit stay, increased ventilator support, and more complications.
-
Comparative Study
Testing for substance use in trauma patients: are we doing enough?
Only a fraction of trauma patients are being tested for substance use, and the proportion of those tested may have decreased over time. ⋯ Only a small proportion of patients who are admitted with injuries are tested for substance use. The proportion of patients tested for drugs has decreased significantly during the past 6 years. Routine testing would maximize identification of patients who may benefit from interventions. Several obstacles exist to routine screening, including legal and physician-related barriers. Future efforts to facilitate routine testing of trauma patients for substance use should concentrate on protecting patient confidentiality and educating physicians on the techniques and benefits of brief interventions.
-
Patient-based outcomes, such as impaired quality of life (QOL) and depression, may adversely affect the clinical course of patients with peripheral arterial disease (PAD). Disease severity indices, including the ankle brachial index, are only partially associated with these outcomes. ⋯ Type-D personality independently predicted individual differences in impaired QOL and depressive symptoms in patients with PAD above and beyond ankle brachial index. It is important to account for personality when evaluating patient-based outcomes in the context of PAD.
-
Comparative Study
Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration.
The more rapid and less complicated recovery after palliative stent insertion compared with surgery may theoretically facilitate the early administration of chemotherapy. ⋯ Insertion of SEMS should be the first step to treat obstructing colon cancer with nonresectable synchronous metastases because it allows chemotherapy to be administered earlier, may increase the resectability rate of metastases, and favorably impacts survival. The risk of tumor perforation while receiving chemotherapy requires attention.