Surgery
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Practice Guideline
Interventions to address challenges associated with the transition from residency training to independent surgical practice.
Concerns regarding preparation of residents for independent surgical practice are widespread and support for junior surgeons entering practice is variable across institutions and practices. The American College of Surgeons (ACS) Division of Education partnered with the Accreditation Council for Graduate Medical Education (ACGME) to convene a National Invitational Conference to define key issues relating to the transition to practice and develop recommendations to address various challenges. ⋯ The recommendations from the conference should be of great help in addressing various challenges associated with the transition from surgery residency to independent practice.
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Readmission is frequent in hepatopancreatobiliary (HPB) surgery. Medicare began penalizing hospitals recently for excess readmission for specific diagnoses, including some operative procedures. We sought to define the incidence and risk factors for readmission after HPB surgery. ⋯ Outpatient complications were by far the strongest risk factor for readmission. Decreasing complications as well as improving outpatient case management to prevent and treat postdischarge complications hold considerable promise in the efforts to decrease readmission.
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Since acute care surgery (ACS) was conceptualized a decade ago, the specialty has been adopted widely; however, little is known about the structure and function of ACS teams. ⋯ Despite rapid adoption of ACS, its implementation varies widely. Standardization of scope of practice, continuity of care, and registry development may improve EGS outcomes and allow the specialty to thrive.
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Estimates of the number of firearm-related injuries widely vary. Although focus has been primarily on deaths, the societal cost of caring for victims of these injuries is largely unknown. Our goal was to estimate the economic impact of nonfatal, firearm-related injuries in the United States based on recent, publically available data. ⋯ Firearm-related injuries are a major economic burden to not only the American health care system but also to American society. The incidence of these injuries has decreased slightly from 2006 to 2010, with no change in the economic burden. Research aimed at understanding the associated financial, social, health, and disability-related issues related to firearm injuries is necessary and would likely enhance our knowledge of the causes of these events, and may accelerate development of interventions and policies to decrease the staggering medical and societal cost of gun violence.