Archives of surgery (Chicago, Ill. : 1960)
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To determine if the lower mortality often observed in teaching-intensive hospitals is because of lower complication rates or lower death rates after complications (failure to rescue) and whether the benefits at these hospitals accrue equally to white and black patients, since black patients receive a disproportionate share of their care at teaching-intensive hospitals. ⋯ Survival after surgery is higher at hospitals with higher teaching intensity. Improved survival is because of lower mortality after complications (better failure to rescue) and generally not because of fewer complications. However, this better survival and failure to rescue at teaching-intensive hospitals is seen for white patients, not for black patients.
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Multicenter Study
Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care.
Lack of access to surgical care is a public health crisis in developing countries. There are few data that describe a nation's ability to provide surgical care. This study combines information quantifying the infrastructure, human resources, interventions (ie, procedures), emergency equipment and supplies for resuscitation, and surgical procedures offered at many government hospitals in Sierra Leone. ⋯ There are severe shortages in all aspects of infrastructure, personnel, and supplies required for delivering surgical care in Sierra Leone. While it will be difficult to improve the infrastructure of government hospitals, training additional personnel to deliver safe surgical care is possible. The situational analysis tool is a valuable mechanism to quantify a nation's surgical capacity. It provides the background data that have been lacking in the discussion of surgery as a public health problem and will assist in gauging the effectiveness of interventions to improve surgical infrastructure and care.
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To develop and implement a team-training curriculum. We hypothesized that better interactions between personnel would lead to improved patient safety, increased efficiency, and better staff satisfaction. ⋯ Our team-training program resulted in moderate compliance with behaviors taught in the curriculum. Even with only moderate compliance, we demonstrated improved perceptions of teamwork.
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To clarify the usefulness of ultrasonography (US) as a diagnostic instrument for intraperitoneal free air (IPFA), which is thought to be useful in the fields of emergency medicine and traumatology. ⋯ Ultrasonography is useful for the diagnosis of IPFA with acute abdominal pain or blunt trauma, except in patients with gastrointestinal perforation without IPFA.
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Changes in medical education require a rethinking of our training paradigm. We implemented a protected block curriculum for postgraduate year (PGY)-1 and PGY-2 surgery residents. ⋯ A protected block curriculum enhanced surgical residents' learning compared with a traditional model. Improvement in medical knowledge was easiest to measure, but performance in other Accreditation Council for Graduate Medical Education competency areas also demonstrated improvement.