Archives of surgery (Chicago, Ill. : 1960)
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Review
Requirement of perioperative stress doses of corticosteroids: a systematic review of the literature.
To determine the requirement for perioperative supplemental (stress) doses of corticosteroids in patients receiving long-term corticosteroid therapy and undergoing a surgical procedure. Corticosteroids are among the most commonly prescribed medications and will predictably result in suppression of the hypothalamic-pituitary-adrenal axis with long-term use. Patients receiving therapeutic dosages of corticosteroids frequently require surgery; these patients are almost universally treated with stress doses of corticosteroids during the perioperative period. ⋯ Patients receiving therapeutic doses of corticosteroids who undergo a surgical procedure do not routinely require stress doses of corticosteroids so long as they continue to receive their usual daily dose of corticosteroid. Adrenal function testing is not required in these patients because the test is overly sensitive and does not predict which patient will develop an adrenal crisis. Patients receiving physiologic replacement doses of corticosteroids owing to primary disease of the hypothalamic-pituitary-adrenal axis, however, require supplemental doses of corticosteroids in the perioperative period.
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To determine the association of the American College of Surgeons (ACS) designation with outcomes in patients, specifically those with severe traumatic brain injuries. ⋯ Patients with severe traumatic brain injury treated in ACS-designated level 1 trauma centers have better survival rates and outcomes than those treated in ACS-designated level 2 centers.
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To identify predictors of attrition during graduate medical education (GME) in a single medical school cohort of contemporary US medical school graduates. ⋯ Academically highly qualified graduates and graduates who chose training in general surgery or in a 5-year surgical specialty were at increased risk of attrition during GME.