Abstract:
BACKGROUND:To gain additional insight into the impact of fatigue on surgery resident proficiency, we set out to quantify its impact on behavioral and neurophysiologic measures. STUDY DESIGN:Simulations were first created using a visio-haptic joystick attached to a surgical instrument (tool) that allows realistic interactions. Before baseline (pre-call) and after call, 7 PGY1 surgery residents performed simulation tasks that required varying levels of psychomotor and cognitive skill. Residents completed 3 sessions per week for 4 weeks. Surgical proficiency was established using 5 metrics: hand movement smoothness; instrument movement smoothness; time to task completion; gesture level proficiency and cognitive errors. Data (percent change from baseline, pre-call) were analyzed using repeated measures ANOVA. While performing these tasks, the residents also wore an EEG cap (B-Alert; Advanced Brain Monitoring), the data from which provided second to second insight into the effects of workload, distraction, and attention on task performance. Mean (±SD) pre-call and post-call values for each were analyzed using repeated measures ANOVA. RESULTS:Residents experienced significant (p < 0.014) post-call erosions in surgical proficiency, punctuated by dramatic increases in cognitive errors. EEG-based attention scores showed a significant (p < 0.014) concomitant decrement of 40%; distraction/drowsiness scores increased by 91%; and workload score increased by 51%. CONCLUSIONS:Fatigue adversely affects PGY1 resident surgical proficiency and neurophysiologic performance.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Kahol K,Smith M,Brandenberger J,Ashby A,Ferrara JJdoi
10.1016/j.jamcollsurg.2011.03.028subject
Has Abstractpub_date
2011-07-01 00:00:00pages
29-34; discussion 34-6issue
1eissn
1072-7515issn
1879-1190pii
S1072-7515(11)00232-8journal_volume
213pub_type
杂志文章abstract:BACKGROUND:Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and ma...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.12.046
更新日期:2012-04-01 00:00:00
abstract::Difficult pelvic operations for malignancy or complex benign conditions can be associated with extensive blood loss. Religious beliefs that preclude transfusion and the known risks of homologous blood have prompted investigators to seek alternatives to transfusion. We used the Haemonetics-V50 Cell Separator (Haemoneti...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract:BACKGROUND:We compared the rates of stroke, death, and/or MI between men and women, stratified by symptomatic status and procedure type (carotid endarterectomy [CEA] or carotid artery stent [CAS]). STUDY DESIGN:Using the Nationwide Inpatient Sample, crude and propensity-matched rates of the composite end point of stro...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2019.02.054
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:The clinicopathologic characteristics and the expression of apomucin (MUC) in intrahepatic cholangiocarcinoma (ICC) with respect to gross morphology have not been comprehensively examined. STUDY DESIGN:We reviewed the clinical data of 98 patients with ICC who underwent resection at Seoul National University...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01343-1
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:We evaluated safety and immunogenicity observations pooled from 8 clinical trials of recombinant human thrombin (rThrombin), an active topical hemostatic agent. STUDY DESIGN:Recombinant thrombin was applied with an absorbable gelatin sponge or spray applicator during a surgical procedure (day 1). Adverse ev...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,meta分析
doi:10.1016/j.jamcollsurg.2009.09.042
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Although RBC transfusions can be lifesaving, recent evidence suggests that their use is associated with added morbidity and mortality and that a lower transfusion threshold is safe. It is unclear if this new evidence has translated into decreased RBC use among surgical patients. The purpose of this study is ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.04.002
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to ev...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01306-6
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:The destructive human consequences of terrorist bombing always challenge the medical system in diagnosis, decision making, and patient management. This injury is produced by multiple injury mechanisms, and departs from the conventional description of trauma complexity. Our objective was to characterize and c...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2004.09.003
更新日期:2004-12-01 00:00:00
abstract:BACKGROUND:Carotid endarterectomy (CEA) is an effective surgical option for stroke prophylaxis for most patients. Restenosis after CEA can lead to additional interventions and adverse outcomes, but the factors that predict restenosis are poorly understood. This study examined which risk factors, such as metabolic syndr...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.04.014
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Central morbidity and mortality conferences ensure uniform content and more participants but consume work hours in commuting for programs with multiple teaching hospitals. Internet-based televideoconferencing (TVC) technology has the potential to eliminate commuting and expand participation and retain qualit...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2010.12.002
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Injured patients cared for in trauma centers have a lower risk of death than those cared for in nontrauma centers. However, many patients are transported to a non-trauma center after injury (undertriaged) and require transfer to trauma center care. Previous analyses of undertriage focused only on survivors t...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2010.08.014
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:A minority of liver transplantation (LT) candidates pursue listing at multiple centers to achieve transplantation. The purpose of this study was to assess the characteristics and outcomes of the migrated LT candidates, that is, those who travel to secondary centers seeking LT. STUDY DESIGN:Single-center ret...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.12.056
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Controversy persists regarding digestive reconnection following subtotal gastrectomy for carcinoma. A randomized prospective trial comparing Billroth I and Billroth II procedures for mortality, digestive comfort, survival, and patterns of recurrence was conducted. STUDY DESIGN:Thirty patients underwent Bill...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:One of the most important criteria indicative of the longterm success of vaginal enlargement is the absence of postoperative contracture. Numerous procedures have been developed for reconstruction of an inadequate vagina. Some are technically complex techniques (myo- and fasciocutaneous flaps) with few posto...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01541-7
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:There are few studies that report on stenosis of the intrahepatic bile ducts associated with choledochal cysts. We investigated the presence and clinical significance of stenosis of the intrahepatic bile ducts associated with choledochal cysts. STUDY DESIGN:We examined intrahepatic bile ducts in patients wi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract:BACKGROUND:The American College of Surgeons maintains that surgical care in the US has not reached optimal safety and quality. This can be driven partially by higher-risk, emergency operations in geriatric patients. We therefore sought to answer 2 questions: First, to what degree does standardized postoperative mortali...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.10.018
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Enthusiasm for radiofrequency ablation (RFA) therapy for patients with unresectable hepatocellular carcinoma (HCC) has increased. The data for recurrence after RFA for patients with HCC is not well documented. The purpose of this study was to evaluate tumor recurrence patterns after RFA in patients with unre...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00750-6
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:Hemorrhage can modify the leukocyte-endothelial cell response leading to tissue injury. The selectin family of adhesion molecules and chemokines mediate the leukocyte-endothelial cell interaction, resulting in neutrophil sequestration and activation. This work studies whether a small molecule inhibitor of se...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00213-6
更新日期:1999-12-01 00:00:00
abstract:BACKGROUND:The technique of total mesorectal excision (TME) increases the risk of anastomotic leakage. The impact of postoperative morbidity of TME on longterm survival has never been described. We retrospectively analyzed factors that might influence survival after TME for rectal cancer, including postoperative morbid...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.07.021
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:The Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in use of regionalized surgery at high-volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the us...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.08.693
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Disposable trocars with safety shields are widely used for laparoscopic access. The aim of this study was to analyze risk factors associated with injuries resulting from their use as reported to the Food and Drug Administration. STUDY DESIGN:Manufacturers are required to report medical device-related incide...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)00913-9
更新日期:2001-06-01 00:00:00
abstract:BACKGROUND:Since 1993, the American College of Surgeons has sponsored an annual 6-day course entitled the Surgeons as Educators. The course was designed to provide academic surgeons with the knowledge and skills necessary to enhance the surgical education curriculum, teaching strategies, educational program administrat...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. STUDY DESIGN:National cohort study of US kidney transplantation programs, analyzing hospital-lev...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.12.009
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:In hepatic resection, it is important to control intrahepatic blood flow to minimize blood loss. Intermittent and selective vascular occlusion, if possible, are advisable. STUDY DESIGN:For this purpose, we created the double balloon catheter, which when introduced into a lobar or a smaller branch of the int...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Enteric drainage (ED) of pancreas allografts is an alternative to the bladder drainage (BD) technique and eliminates unique metabolic complications seen in the BD pancreas transplant recipients. Little longterm data has been reported in ED pancreas transplants. STUDY DESIGN:Of 53 patients who underwent panc...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,评审
doi:10.1016/s1072-7515(97)00110-5
更新日期:1997-12-01 00:00:00
abstract:BACKGROUND:Controversy exists over the relative advantages of open mesh repair compared with open stitching methods and the laparoscopic approach. STUDY DESIGN:Two thousand nine hundred six (2,906) consecutive unselected adult patients underwent 3,175 primary inguinal hernia repairs using polypropylene mesh, under loc...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00057-x
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:In the past, type 2 (C-peptide positive) diabetes mellitus (DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT). STUDY DESIGN:We retrospectively analyzed outcomes in SPKT recipients according to pretransplantation C-peptide levels ≥ 2.0 ng/mL or < 2.0 ng/mL. RESULTS:From Nove...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.12.020
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Sepsis from bloodstream infection (BSI) is an important cause of morbidity and mortality among surgical patients. Our hypothesis was that fever and leukocytosis during BSI would be associated with gram-negative pathogens and worse outcomes among hospitalized surgical patients. STUDY DESIGN:A prospectively c...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.01.033
更新日期:2007-05-01 00:00:00
abstract:INTRODUCTION:An effective strategy to manage acute pain while minimizing opioid exposure is needed for injured patients. In this trial, we aimed to compare two multimodal pain regimens (MMPR) in minimizing opioid exposure and relieving acute pain in a busy, urban trauma center. METHODS:This was an unblinded, pragmatic...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2020.12.014
更新日期:2020-12-29 00:00:00
abstract:BACKGROUND:The concomitant use of nonabsorbable mesh during stapled bariatric surgery has been discouraged due to potential contamination. The aim of our study was to compare and quantify the extent of bacterial load and gross contamination of the peritoneal cavity in patients undergoing laparoscopic sleeve gastrectomy...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.12.008
更新日期:2014-03-01 00:00:00