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Exactly what are outstanding encounter identity recognizers (SFIR) made from?
Purpose Limited data exist on the efficacy of high- compared to low-volume US-guided corticosteroid injections (CI) in the subacromial-subdeltoid (SA-SD) bursa. Our purpose was to compare the short- and long-term efficacy of low- and high-volume injections, by using a capacity reference of SA-SD bursa volume, as assessed on cadaveric specimens. Method Within two years, 136 patients (63 males, 73 females; mean age 46.11 ± 10.28 years) who underwent SA-SD bursa US-guided CI for subacromial impingement, rotator cuff tendinopathy or shoulder overuse were prospectively included. Patients were randomly assigned to low-volume (1 mL triamcinolone acetonide/40 mg) or high-volume (1 mL triamcinolone acetonide/40 mg, 9 mL anaesthetic agents) groups (67 and 69 patients, respectively). Visual Analogue Scores (VAS) were recorded at baseline, 30 min, 3 weeks, 3 months, 6 months and 1 year post-treatment. Predictors of complete recovery (VAS ≤ 2) at 1 year were analysed with multivariate Cox regression analysis. SA-SD bursa cadaveric dissection in 10 specimens was performed for volume assessment. Results Injection volume was the only predictor of complete pain resolution at 1 year. High-volume CI yielded higher chances of early pain recovery (2.837 HR, 95% CI 1.737-4.633, P less then .001). Mean VAS scores at baseline and subsequent time-points were 6, 2.6, 2.2, 2, 1.6 and 1 for the high-volume and 7.8, 7.3, 4.7, 3.2, 2.5 and 1.8 for the low-volume group, respectively (P less then .001, at all time-points). Cadaveric measurements showed a minimum SA-SD bursa volume of approximately 6.9 mL. Conclusions High-compared to low-volume US-guided CI are superior for achieving early pain recovery.Background Case number requirements by the Accreditation Council for Graduate Medical Education (ACGME) have recently changed in general surgery residency and pediatric surgery fellowship. Overall, pediatric surgery fellowship case volumes remain high, but there may be limited exposure to many index cases. see more We hypothesize that pediatric antireflux surgery is decreasing nationally, and this trend is independent of the fluctuating number of pediatric surgery fellows. Materials and methods A review of publicly available ACGME case reports from 2003 to 2018 was performed. Both open and laparoscopic antireflux surgery cases were evaluated. Analyzed data included average case number per fellow, minimum and maximum case numbers, and number of fellows each year. Simple and multiple linear regression analyses were performed. Results We identified a significant relationship (P less then 0.001) between the total number of antireflux procedures and the years of operation. The slope coefficient was -1.45, meaning the number of operations decreased by an average of 1.45 per year from 2003 to 2018 . The number of fellows fluctuated during this time period (range 24-45). With multiple linear regression analysis, we found that the number of fellows did not affect the decline of antireflux surgery seen over the years (P = 0.91). Conclusions Case numbers continue to be an important topic in ACGME discussions for surgical residency and subspecialty fellowships. Our review has shown a national decline in the number of pediatric antireflux surgeries performed in pediatric surgery fellowship. Identifying additional trends in surgical management of diseases may aid in the evolution of the pediatric surgery curriculum.Background Surgeon educators express concern about trainees' sense of patient ownership. We aimed to compare resident and faculty perceptions on residents' sense of personal responsibility for patient outcomes and to correlate patient ownership with resident and residency characteristics. Methods An anonymous electronic questionnaire surveyed 373 residents and 390 faculty at seven academic surgery residencies across the United States. We modified an established psychological ownership scale to measure patient ownership among surgical trainees. Results Respondents included 123 residents and 136 faculty (response rate 33% and 35%, respectively). Overall, 78.0% of faculty agreed that residents took personal responsibility for patient outcomes, but only 26.4% thought residents felt a similar or higher degree of patient ownership compared with themselves. Faculty underestimated the proportion of residents that routinely checked on their patients when off-duty (36.8 versus 92.6%, P less then 0.001). Higher means on the patient ownership scale correlated with female sex (5.9 versus. 5.5 for males, P = 0.009), advanced post graduate year level (5.3, 5.5, 5.7, 5.8, 6.1, for post graduate year 1-5, respectively, P = 0.02), and the sense that patient outcomes affected the resident respondent's mood (5.8 versus 4.8 for those whose mood was not affected, P less then 0.001). In addition, trainees who perceived better resident camaraderie (P = 0.004), faculty mentorship (P less then 0.001), and that their program provided appropriate autonomy (P = 0.03) felt greater responsibility for patient outcomes. Conclusions Most faculty agree that residents assume personal responsibility for patient outcomes, but many still underestimate residents' sense of patient ownership. Certain modifiable aspects of residency culture including camaraderie, mentorship, and autonomy are associated with patient ownership among trainees.Background Obesity is often associated with comorbidities that limit remnant liver recovery after hepatectomy. The extent to which obesity, in the absence of comorbidities, impacts surgical risk after hepatectomy is unknown. We hypothesized that an obese population without major comorbidities would not be at increased risk of adverse outcomes after hepatectomies. Methods We performed a retrospective analysis identifying patients who underwent hepatectomies from the American College of Surgeons National Surgical Quality Improvement Program data set 2005-2017. Outcomes of interest included the following mortality, any morbidity, critical care complications, and failure to discharge home. Body mass index (BMI) was the primary variable of interest, grouped as ≥35 and less then 35 based on bivariate tests of associations with candidate cut-off points. In attempt to isolate the effect of obesity on outcomes among patients "without major comorbidities" (WOC), we included patients without diabetes, chronic obstructive pulmonary disease, renal insufficiency, and nonsmokers; remaining patients were grouped as "with major comorbidities" (WC).
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