Surgery
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We tested the hypotheses that an increase in systemic thrombin activity occurs in both disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype and in acute coagulopathy of trauma shock (ACoTS), and that the patients diagnosed as having ACoTS overlap or are identical with those diagnosed as having DIC. ⋯ Normal prothrombinase activity and insufficient control of coagulation give rise to systemic increase in thrombin generation and its activity in patients with DIC with the fibrinolytic phenotype at an early phase of trauma. The same is true in patients with ACoTS, and shutoff of thrombin generation was not observed.
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The American College of Surgeons (ACS) and the Association of Program Directors in Surgery (APDS) jointly developed a standardized skills curriculum for surgical residents. This program was intended to be affordable, reproducible, reliable, and proficiency-based. Some experts have proposed mandating that all residency programs implement the curriculum. Although general surgery program directors have supported uniformly the use of simulation in training, one third of general surgery residencies have no simulation curricula. Our goal was to identify barriers to the implementation of the ACS/APDS curriculum. ⋯ The ACS/APDS skills curriculum has a substantial resource commitment associated with its implementation. These capital, instrument, and personnel costs present a major challenge to residency programs that want to adopt this program. Faculty participation in the program poses an additional logistic challenge. Last, resident involvement must be scheduled within the 80-h work-week limit, impacting resident availability for their obligations of patient care. Re-examination of the scope and complexity appears warranted, along with development of low-fidelity substitutions for the proposed modules as well as opportunities for resource-sharing.
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Interprofessional education (IPE) in health care describes a process for training that places health care learners from different professional disciplines into an environment or situation in which shared or linked educational goals are pursued. IPE represents a new way of thinking about education as a value proposition directed at high-quality interprofessional patient care and as such is an innovative strategy endorsed in statements by the Institute of Medicine and the World Health Organization. The requirements of the American College of Surgeons-accredited Education Institutes (ACS-AEIs) for Comprehensive (Level I) accreditation state that education and training activities at the accredited institutes (simulation centers) must be multidisciplinary in nature. Until recently, concepts of shared interprofessional educational goals and facilitation of interdisciplinary colearning have not been addressed explicitly by the Consortium of ACS-AEIs. ⋯ These IPE experiences in the ACS-AEIs reflect varied and robust approaches to integrated interdisciplinary teaching and learning. Demands and directives to increase these types of educational activities in the near future will have to be met with a wider range of offerings and greater specific knowledge and expertise within the ACS-AEI Consortium.
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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technique in trauma; however, the physiologic sequelae have not been well quantified. The objectives of this study were to characterize the burden of reperfusion and organ dysfunction of REBOA incurred during 30 or 90 min of class IV shock in a survivable porcine model of hemorrhage. ⋯ REBOA in shock improves MCAP and is associated with a greater lactate burden; however, this lactate burden returned to control levels within the study period. Ultimately, prolonged REBOA is a survivable and potentially life-saving intervention in the setting of hemorrhagic shock and cardiovascular collapse in the pig.
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Portal vein embolization (PVE) is an effective procedure to increase the future remnant liver (FRL) before major hepatectomy. A controversial issue is that PVE may stimulate tumor growth and can be associated with poor prognosis after liver resection for colorectal liver metastases (CRLM). The aim of this study was to evaluate the impact of PVE on long-term survival following major hepatectomy for CRLM. ⋯ This study showed that PVE did not affect overall survival and specific liver-disease-free survival in patients undergoing right or right-extended hepatectomy for unilobar, right-sided CRLM.