Current surgery
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Randomized Controlled Trial Clinical Trial
Fluid administration during abdominal surgery influences on coagulation in the postoperative period.
Postoperative coagulopathy is an important concern for patients after major surgery. Our objective was to define the factors that correlate with postoperative deterioration in coagulation. ⋯ Administration of more than 3-l crystalloids or 500-ml colloids during abdominal surgery correlates with postoperative coagulopathy.
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New York State Code 405 and societal/political pressure have led the RRC and ACGME to mandate strict limitations on resident work hours. In an attempt to meet these limitations, we have switched from the previous Q3 call schedule to a specialized night float (NF) system, the continuity-care system (CCS). The purpose of this CCS is to maximize resident duty time spent on direct patient care, operative experience, and outpatient clinics, while reducing duty hours spent on performing routine tasks and call coverage. The implementation of the CCS is the fundamental step in the restructuring of our residency program. In addition to a change in the call system, we added physician assistants to aid in performing some service tasks. We performed a 360 degrees evaluation of this work in progress. ⋯ The institution of a specialized NF or CCS for in-house coverage of general surgical services in a large metropolitan university hospital has had initial success in meeting the mandated changes in resident work hours. The CCS reduced resident fatigue, improved quality of resident life, and improved patient care as judged by patients and nurse.
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Case Reports
Negative pressure post-extubation pulmonary edema complicating appendectomy in a young patient: case report.
Negative-pressure pulmonary edema after endotracheal intubation is an uncommon and potentially serious complication of patients undergoing general anesthesia for different surgical procedures. We report a case of a healthy 20-year-old male patient with the diagnosis of acute appendicitis. The patient was submitted to appendectomy under general anesthesia and developed negative-pressure pulmonary edema immediately after extubation. The present paper reports this potentially serious complication illustrating the main radiological findings consistent with alveolar hemorrhage in this setting and the treatment performed.
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The Accreditation Council for Graduate Medical Education (ACGME) has challenged program directors to assess their residents' core competencies, including communication and interpersonal skills (CIS). We report our institution's experience using a series of standardized patient encounters in an objective structured clinical examination (OSCE) to evaluate CIS in surgical residents. ⋯ The standardized patient-based OSCE is an effective method to assess communication and interpersonal skills and provides useful information for curriculum review.