Surgery
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To further understand how faculty promote resident autonomy in the operating room (OR), we explored their perceptions, and those of senior residents, on the behaviors and techniques they employ to foster independence. ⋯ Our results suggest that increased autonomy depends greatly on establishing a trusting relationship between faculty and resident; a partnership that can only happen when time is given for trust to mature. Program directors must work to refine the training paradigm in order to build relationships. Residents can also be coached to demonstrate increased OR preparedness.
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Longitudinal, risk-adjusted measurement of outcomes of carotid artery (CA) surgery is necessary for the evaluation of quality performance and for the assessment of strategies of quality improvement. ⋯ In CA surgery, more AOs occur in the 90 days after discharge than during the inpatient period of care. ReAdm-90 remains the major cause for AOs and represents the greatest opportunity for improvement in the care of CA surgery patients.
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Hypothermia is a well-known risk factor for postoperative complications because it prolongs the monocyte inflammatory response. The purpose of this study was to investigate whether temperature-activated ion channels (transient receptor protein channels [TRP] A1 and V1) mediate the effects of temperature on monocytes. ⋯ These results demonstrate that hypothermia mediates its effects on monocytes through TRPA1. Blockade of TRPA1 or activation of TRPV1 may be used to modify the effects of hypothermia on the monocyte inflammatory response.
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There is currently little information regarding the impact of procedure volume on outcomes after open inguinal hernia repair in the United States. Our hypothesis was that increasing procedure volume is associated with lesser rates of reoperation and resource use. ⋯ Surgeon volume <25 cases per year for open inguinal hernia repair was independently associated with greater rates of reoperation for recurrence, worse operative efficiency, and greater health care costs. Referral to surgeons who perform ≥25 inguinal hernia repairs per year should be considered to decrease reoperation rates and resource use.