Abstract:
OBJECTIVE:To review retrospectively a 4-year experience with pediatric surgical networking at a major academic medical center in the Midwest. BACKGROUND:The growth of managed care in the United States during the past decade has had a major impact on the practice of medicine in general, but especially on academic medicine. In some academic medical centers, the loss of market share has not only affected clinical activity but has also compromised the educational and research missions of these institutions. METHODS:At the authors' institution, a networking strategy in pediatric surgery was established in 1993 and implemented on July 1, 1994. In 1994, one new satellite practice was established; over the next 4 years, four additional practices were added, including one in another state. To assess the impact on financial status, clinical activity, education, and academic productivity, the following parameters were analyzed: gross and net revenue, surgical cases, clinic visits, ranking of the pediatric surgery residency, publications, grant support, and development and endowment funds. RESULTS:Gross and net revenue increased from $3,273,000 and $302,000 in 1993 to $10,087,000 and $2,826,000, respectively, in 1998. Surgical cases and clinic visits increased from 1240 and 3751 in 1993 to 5872 and 11,604, respectively, in 1998. At the medical center's children's hospital, surgical cases and clinic visits increased from 1240 and 3751 to 2592 and 4729 during the same time period. During this 4-year period, the faculty increased from 4 to 11. Since 1997, the National Resident Matching Program has provided data on how pediatric surgery residency candidates ranked a training program. In 1997, this program received the second-most one to five rankings; in 1998, it tied for first. This exceeds the faculty's perception of previous years' rankings. Publications increased from 26 in 1993 to a peak number of 62 in 1996; in 1997 and 1998 the publications were 48 and 37, respectively. External grant support increased from $139,882 in 1993 to a total of $6,109,971 in 1998. Development and endowment funds increased from $103,559 in 1993 to $2,702,2777 in 1998. CONCLUSIONS:Pediatric surgical networking at the authors' institution has had a markedly positive impact on finances, clinical activity, education, and academic productivity during a 4-year period. The residency training program appears to have improved in popularity among candidates, probably because of the increased referral of complex cases to the medical center from the various networking satellites. External grant support and basic laboratory research significantly increased, most likely because of the greater number of faculty with protected time for research recruited. Development and endowment funds dramatically grew because of the excellent fiscal health of the pediatric surgical program. This experience may serve as a model for other academic surgical specialties.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Coran AG,Blackman PM,Sikina C,Harmon CM,Lelli JL Jr,Geiger JD,Hirschl RB,Teitelbaum DH,Polley TZ Jr,Golladay ES,Austin E,Adelman SHdoi
10.1097/00000658-199909000-00006subject
Has Abstractpub_date
1999-09-01 00:00:00pages
331-7; discussion 337-9issue
3eissn
0003-4932issn
1528-1140journal_volume
230pub_type
杂志文章abstract:OBJECTIVE:To determine whether the immune system limits or improves the therapeutic efficacy of an adenovirus vector expressing the herpes simplex thymidine kinase (HSVtk) gene in a subcutaneous tumor model. BACKGROUND DATA:Enhanced immune reactions against tumors may be therapeutically useful. However, recent studies...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199509000-00008
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the contribution of the hepatic artery, gastroduodenal artery, and portal vein to the microvascular blood flow in the common bile duct (CBD). BACKGROUND:Biliary complications are a common cause of graft loss after liver transplantation. The occurrence is, partly, attrib...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824714d0
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVES:The authors determined the effect of complications on length of stay (LOS) in surgical patients. SETTING:From 1987 to 1990, in the Professional General Surgical Unit of Royal Victoria Hospital, a retrospective survey was conducted on 5128 consecutively admitted patients with 396 different diagnosis; 228 dif...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199412000-00006
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:This study aimed to identify risk factors for recurrence after pancreatic resection for intraductal papillary mucinous neoplasm (IPMN). SUMMARY BACKGROUND DATA:Long-term follow-up data on recurrence after surgical resection for IPMN are currently lacking. Previous studies have presented mixed results on the ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004427
更新日期:2020-11-17 00:00:00
abstract:OBJECTIVE:We compared the effects of intravenous administration of 6% hydroxyethyl starch (maize-derived) in 0.9% saline (Voluven; Fresenius Kabi, Runcorn, United Kingdom) and a "balanced" preparation of 6% hydroxyethyl starch (potato-derived) [Plasma Volume Redibag (PVR); Baxter Healthcare, Thetford, United Kingdom] o...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000324
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVE:The effects of interleukin (IL)-6 in the injured patient are examined in an attempt to clarify the potential pathophysiologic role of IL-6 in the response to injury. SUMMARY BACKGROUND DATA:Interleukin-6 is an integral cytokine mediator of the acute phase response to injury and infection. However, prolonged ...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199611000-00009
更新日期:1996-11-01 00:00:00
abstract::The importance of prostacyclin (PGI2) and thromboxane (Tx) medication of depressed cardiac performance during abdominal aortic aneurysm operative surgery was studied by contrasting the effects of 650 mg aspirin administered 12 hours before operation to that of a placebo. In 11 patients who received a placebo, the stab...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-198111000-00008
更新日期:1981-11-01 00:00:00
abstract::The records of 238 patients with the diagnosis of small bowel obstruction at the University of Illinois Hospital from 1967 through the spring of 1976 were reviewed. Mortality, intra-operative management, and clinical findings were evaluated. Previous reports list a mortality of gangrenous small bowel obstruction, seco...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197802000-00017
更新日期:1978-02-01 00:00:00
abstract::In construction of the eosphagojejunostomy after total gastrectomy, the EEA stapled (US Surgical Corporation, Norwalk, CT) and the two-layer interrupted 3-0 Dexon anastomoses are compared concerning the radiological appearance, breaking strength, circulation, and collagen concentration. Thirty female pigs were used. A...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198604000-00017
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVE:Our goal was to describe contemporary management and in-hospital mortality associated with blunt thoracic aortic intimal tears (IT) within the American College of Surgeons Trauma Quality Improvement Program. SUMMARY BACKGROUND DATA:The evidence basis for nonoperative expectant management of traumatic IT of t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004415
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:To review the literature on current management of hepatocellular carcinoma (HCC). BACKGROUND:Hepatocellular carcinoma represents one of the most common malignancies worldwide with a rising incidence in western countries. There have been substantial advances in the surgical and medical treatment of HCC within...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e31820d944f
更新日期:2011-03-01 00:00:00
abstract::Fifty-one adult patients were referred for surgical treatment during the time period from July 1980 to November 1985. The average age was 59 +/- 6 years (19-70 years). All patients had symptomatic ventricular tachycardia that was refractory to standard or experimental drug therapy. On the basis of patient condition, s...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198606000-00013
更新日期:1986-06-01 00:00:00
abstract:OBJECTIVE:To evaluate whether intravascular volume expansion would improve renal blood flow and function during prolonged CO2 pneumoperitoneum. SUMMARY BACKGROUND DATA:Although laparoscopic living donor nephrectomies have a considerably reduced risk of complications for the donors, significant concerns exist regarding...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200002000-00007
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVE:To critically review the theoretical and actual risks and benefits of accelerated partial breast irradiation (APBI) after breast-conserving surgery. SUMMARY BACKGROUND DATA:Because of rapid evolution of radiation therapy techniques related to brachytherapy and three-dimensional conformal radiation therapy, A...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/01.sla.0000114219.71899.13
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:To review a single center's experience and outcome with living donor transplants. SUMMARY BACKGROUND DATA:Outcome after living donor transplants is better than after cadaver donor transplants. Since the inception of the authors' program, they have performed 2,540 living donor transplants. For the most recent...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200108000-00004
更新日期:2001-08-01 00:00:00
abstract::To evaluate the patency of PTFE (Gore-tex) as a femoropopliteal bypass, a prospective randomized trial was performed between PTFE and saphenous vein. Forty-nine consecutive patients with intermittent claudication, rest pain, or tissue loss due to an occlusion of the superficial femoral artery entered the study. Random...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198512000-00020
更新日期:1985-12-01 00:00:00
abstract:OBJECTIVE:To estimate long-term mortality following major burn injury compared with matched controls. SUMMARY BACKGROUND DATA:The effect of sustaining a major burn injury on long-term life expectancy is poorly understood. METHODS:Using health administrative data, all adults who survived to discharge after major burn ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002722
更新日期:2019-06-01 00:00:00
abstract::Fifteen patients who had a prior portasystemic shunt underwent orthotopic liver transplantation. Shunt types were portacaval in six patients, H-graft mesocaval in six, distal splenorenal in two, and proximal splenorenal in one. Mean blood loss and hospital stay were highest in the portacaval group. Retransplants (two ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198901000-00008
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study is to determine the characteristics and frequency of intraoperative safety threats and resilience supports using a human factors measurement tool. BACKGROUND:Human factors analysis can provide insight into how system elements contribute to intraoperative adverse events. Empiric ev...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003616
更新日期:2019-10-04 00:00:00
abstract:OBJECTIVE:The central question tested in this study was whether dichloromethylene-diphosphonate (CL2MDP) liposome-mediated elimination of hepatic and splenic macrophages would influence zymosan-induced bacterial translocation and the zymosan-induced generalized inflammatory response. SUMMARY BACKGROUND DATA:Both an un...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199312000-00014
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVE:The objective of this study is to investigate the prevalence and disparity of chronic opioid usage in surgical patients and the potential risk factors associated with chronic opioid usage. BACKGROUND:Chronic opioid usage is common in surgical patients; however, the characteristics of opioid usage in surgical...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001780
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:A prospective consecutive study was planned to evaluate the postpancreaticoduodenectomy (PD) oral intake tolerance. The occurrence of delayed gastric emptying (DGE), as defined by the International Study Group of Pancreatic Surgery (ISGPS), and the amount of dietary intake were analyzed. The risk factors for ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181a63c4c
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:To investigate Fas and FasL expression in pancreatic tissues and cultured pancreatic cancer cell lines, and to assess the ability of anti-Fas antibodies to induce apoptosis. SUMMARY BACKGROUND DATA:Activation of the Fas receptor by Fas-ligand (FasL) results in apoptosis, and dysregulation of this pathway may...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200003000-00010
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To analyze long-term weight loss, changes in comorbidities and quality of life, and late complications after laparoscopic and open gastric bypass. SUMMARY BACKGROUND DATA:Early results from our prospective randomized trial comparing the outcome of laparoscopic versus open gastric bypass demonstrated less pos...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000197381.01214.76
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:This article describes a preliminary work on virtual reality applied to liver surgery and discusses the repercussions of assisted surgical strategy and surgical simulation on tomorrow's surgery. SUMMARY BACKGROUND DATA:Liver surgery is considered difficult because of the complexity and variability of the org...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199811000-00001
更新日期:1998-11-01 00:00:00
abstract:OBJECTIVES:To develop, validate, and implement a competency assessment tool (CAT) for technical surgical performance in the context of a summative assessment process for the National Training Programme in Laparoscopic Colorectal Surgery (NTP). BACKGROUND:The NTP is an educational initiative by the National Cancer Acti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318275b72a
更新日期:2013-03-01 00:00:00
abstract::A study of 103 cases of acute occlusion of the superior mesenteric artery is presented. The relation of site of occlusion to etiology, extent of infarction, and survival following resection and revascularization is described. Included is an analysis of the technical factors contributing to successful revascularization...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197812000-00003
更新日期:1978-12-01 00:00:00
abstract::The accuracy of endoscopy and directed biopsy in the differential diagnosis of gastric lesions was evaluated by comparing the diagnoses of one endoscopic procedure (endoscopy and multiple directed biopsies) with the definitive diagnoses in 333 patients. The overall endoscopic and bioptic accuracy rate for all patients...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198202000-00018
更新日期:1982-02-01 00:00:00
abstract:OBJECTIVE:To determine prevalence of documented preoperative code status discussions and post-operative outcomes (specifically mortality, readmission and discharge disposition) of patients with completed Medical Orders for Life-Sustaining Treatments (MOLST) forms before surgery. SUMMARY OF BACKGROUND DATA:A MOLST form...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004675
更新日期:2020-12-18 00:00:00
abstract::One hundred sixty-three patients undergoing reoperative parathyroidectomy were evaluated before and after operation to determine the incidence of, risk factors for, and morbidity of vocal cord paralysis. These patients were compared to 77 patients undergoing initial parathyroid operation, only one of whom had vocal co...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198603000-00011
更新日期:1986-03-01 00:00:00