Abstract：
BACKGROUND:Training surgeons in vital decision-making skills remains unstructured. We aimed to map a process of care from the perspective of surgical decision making and test whether it could be deconstructed into an accessible format for trainees. METHODS:Semistructured interviews were conducted with 10 experienced surgeons by using symptomatic gallstones as a clinical exemplar. Data were analyzed by 2 independent reviewers to identify decisions, cues, and decision rules, with further thematic analysis of selected decisions. RESULTS:Eighteen specific decisions were identified in 6 or more transcripts, with significant interreviewer reliability (Spearman's rho = .65, P = .004, n = 17, 1 outlier excluded). These were arranged to form a "decision map." Two main decision strategies were described. CONCLUSIONS:We identified and mapped the decisions made in the care of patients with symptomatic gallstone disease. The interpretation of competency at any procedure should include the surgeon's ability to make appropriate decisions at all stages of patient care.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Jacklin R,Sevdalis N,Darzi A,Vincent Cdoi
10.1016/j.amjsurg.2007.02.016subject
Has Abstractpub_date
2008-05-01 00:00:00pages
689-96issue
5eissn
0002-9610issn
1879-1883pii
S0002-9610(07)00837-9journal_volume
195pub_type
杂志文章,多中心研究abstract：BACKGROUND:We investigated whether or not interleukin-8 (IL-8) and granulocyte elastase (GE) can be associated with pulmonary complication after esophagectomy (the most common cause of postoperative death). METHODS:We measured serial changes in the IL-8 concentration and GE activity in the plasma and bronchoalveolar l...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00558-4
更新日期：2001-02-01 00:00:00
abstract：:Familial visceral myopathy is a form of chronic intestinal pseudoobstruction in which fibrosis of the smooth muscle of the alimentary tract causes protean symptoms of disordered visceral motility. Based on our 8 year observation of six members of one family with familial visceral myopathy and review of the few well-do...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90017-0
更新日期：1985-07-01 00:00:00
abstract：:The mesocaval graft for portal decompression is applicable in infants and children with portal hypertension secondary to extrahepatic or intrahepatic causes. It is recommended in patients in whom extensive previous surgery in the portahepatis (Kasai procedure) would make dissection of the portal vein difficult and end...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(78)90011-9
更新日期：1978-01-01 00:00:00
abstract：:Splenectomy results in a lifelong risk of overwhelming infection in the adult as well as the child. This has prompted our current enthusiasm for splenic salvage in trauma patients. A number of alternatives to total splenectomy exist; however, the complications that result from splenic salvage must not exceed the risk ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90556-6
更新日期：1982-12-01 00:00:00
abstract：:Thirty extrathoracic operations in twenty-six patients with occlusive disease involving the primary branches of the aortic arch were reviewed. Spanning a fourteen year experience, these operations included carotid-subclavian artery bypass, retrograde common carotid artery thrombectomy, carotid-carotid artery bypass, a...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(76)90056-8
更新日期：1976-08-01 00:00:00
abstract：:A 24-year-old woman with no significant past medical or surgical history presented with diffuse abdominal pain and distention with decreased frequency of bowel movements for 1 month. A computerized tomography scan showed a massively dilated cecum suggesting obstruction. Exploratory laparotomy revealed bowel obstructio...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.10.030
更新日期：2012-11-01 00:00:00
abstract：:A recent retrospective study proposed that the following screening criteria be used in identifying critically ill trauma patients receiving aminoglycosides who are at significant risk to develop renal dysfunction: (1) post-admission shock, (2) minimum serum concentration more than 2 mg/L, and (3) diagnosis of septicem...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章
doi：10.1016/s0002-9610(05)81007-4
更新日期：1990-11-01 00:00:00
abstract：BACKGROUND:Cancer of unknown primary (CUP) origin is a very aggressive disease with a poor prognosis. Most of the literature reports of CUP are generated from tertiary cancer centers. METHODS:A retrospective chart review of all patients with a diagnosis of CUP was performed between January 1995 and January 2005. Age, ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.08.039
更新日期：2007-12-01 00:00:00
abstract：:A seven day old dehydrated male infant was found to have acute ischemia of the leg due to acute thrombotic occlusion of an external iliac, common and superficial femoral, and popliteal arteries. Early thrombectomy and arterioplasty resulted in complete remission of ischemia. Our success with direct vascular surgery pr...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(75)90254-8
更新日期：1975-03-01 00:00:00
abstract：BACKGROUND:Colonic inertia (CI) is a disturbance of colonic motility characterized by severe constipation and abdominal pain. This study was conducted to assess the results of total abdominal colectomy (TAC) in the management of CI. METHODS:A retrospective chart review of 55 patients who underwent TAC for CI was condu...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00820-0
更新日期：2001-12-01 00:00:00
abstract：BACKGROUND:Despite conventional neuromonitoring, the recurrent laryngeal nerve (RLN) is still at risk for damage during thyroid surgery. The feasibility of continuous RLN monitoring by vagal nerve (VN) stimulation with a new anchor electrode should be shown, and electromyographic signal alterations of stressed RLN were...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.04.036
更新日期：2010-04-01 00:00:00
abstract：:Intragastric illumination using a flexible light source is described as a technical aid in the management of gastric bleeding. The flexible light source can be recommended for illumination of the proximal intragastric area to facilitate surgical control of bleeding from Mallory-Weiss lacerations, ulcers, varices, and ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90173-8
更新日期：1977-06-01 00:00:00
abstract：BACKGROUND:Although the immunologic benefits of laparoscopic surgery have been established, effects from hand-assisted (HA) surgery have not been investigated thoroughly. We hypothesized that the HA approach maintains the immunologic advantage of laparoscopic surgery compared with the open (O) approach. METHODS:Six O,...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2010.09.026
更新日期：2011-07-01 00:00:00
abstract：:Three hundred patients who underwent upper abdominal operations were studied. One hundred fifty patients were treated by insertion of a nasogastric tube, and 150 patients were treated without it. The incidence of postoperative pneumonia was 10 times higher in the patients treated with a nasogastric tube. Pneumonia was...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章
doi：10.1016/0002-9610(80)90395-5
更新日期：1980-06-01 00:00:00
abstract：:Although few trauma patients sustain fatal pulmonary embolism, a large population is at risk from nonfatal embolism due to unrecognized deep vein thrombosis (DVT). Thirty-eight of 39 immobilized trauma patients at bed rest for 10 days or longer had venographic study of their lower extremities to evaluate for the prese...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(89)90182-7
更新日期：1989-12-01 00:00:00
abstract：:Aortoesophageal fistula secondary to a thoracic aortic aneurysm is usually a fatal disease with few survivors reported previously. We encountered 2 consecutive patients who were treated successfully with esophagectomy and in situ aorta reconstruction using cryopreserved homograft that was wrapped completely with oment...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.09.011
更新日期：2006-07-01 00:00:00
abstract：:Appendicitis in preschool children is not uncommon. A duration of greater than 40 hours usually implied perforation. The most common findings were abdominal pain, tenderness, temperature elevation and vomiting. In the presence of perforation or abscess formation, appendectomy followed by copious wound irrigation, absc...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90265-2
更新日期：1980-02-01 00:00:00
abstract：BACKGROUND:The appropriate management of gallstones in patients undergoing renal transplantation is controversial. Screening for gallstones and subsequent prophylactic cholecystectomy has been recommended by some authors for kidney transplant candidates. Our program does not practice routine pretransplant screening for...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(98)00009-9
更新日期：1998-04-01 00:00:00
abstract：:A hundred consecutive patients who underwent cholecystectomy and exploration of the common bile duct were studied. The traditional indications for exploration resulted in a yield of 55 percent positive explorations. There were nine patients with retained stones, three of whom died. The high mortality rate of patients ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90410-6
更新日期：1985-12-01 00:00:00
abstract：BACKGROUND:The results and advantages of laparoscopic cholecystectomy in the geriatric population have received minimal attention. Several early reports related high conversion rates complications and mortality. This case series review is focused on the results of laparoscopic cholecystectomy in the geriatric populatio...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2003.11.031
更新日期：2004-06-01 00:00:00
abstract：BACKGROUND:The aims of this study were to compare the effectiveness of percutaneous drainage between pyogenic hepatic abscesses with and those without biliary communication and to evaluate the role of endoscopic biliary stent placement in the treatment of communicating abscesses. METHODS:Sixty-one patients with hepati...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00869-8
更新日期：2002-02-01 00:00:00
abstract：:Lower esophageal sphincter (LES) effects produced by the mammalian tachykinins were evaluated in anesthetized dogs. The distribution and content of substance P (SP) and neurokinin A (NKA) in the region of the canine gastroesophageal junction was also studied. SP and NKA stimulated a linear dose-dependent contraction o...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(91)90379-r
更新日期：1991-01-01 00:00:00
abstract：INTRODUCTION:The aim of this study was to assess the malignancy rate in patients with Hürthle cell metaplasia (HCM) on fine-needle aspiration biopsy (FNAB). METHODS:The pathology results of patients with benign colloid (BC) and HCM on FNAB were compared using a prospective database. RESULTS:One hundred fifty-three (6...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2011.09.019
更新日期：2012-03-01 00:00:00
abstract：:Although common in Japan, early gastric cancer is rarely seen in Western countries and generally accounts for only 7 to 10 percent of all gastric malignancies. Eleven patients with early gastric cancer seen over a 10 year period have been reviewed for clinical and pathologic features, method of diagnosis, treatment, a...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(87)90268-6
更新日期：1987-11-01 00:00:00
abstract：:Gut glutamine utilization after massive small bowel resection was studied to gain further insight into the alterations and adaptations in intestinal glutamine metabolism that occur during the development of post-resectional hyperplasia. After resection of the middle 60% of the small intestine in the rat, gut glutamine...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80603-8
更新日期：1990-01-01 00:00:00
abstract：BACKGROUND:The objective of this study was to compare middle authorships between male and female general surgeons in the United States. METHODS:A stratified random sample of American College of Surgeons general surgery fellows was identified. Relevant author demographic, affiliation, and publication metrics were colle...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.04.025
更新日期：2020-12-01 00:00:00
abstract：BACKGROUND:The role of sentinel lymph node status (SLNS) in thick melanoma is evolving. The purpose of this study was to determine the prognostic value of SLNS in thick melanoma. METHODS:A retrospective analysis of 120 prospectively collected clinically node-negative thick melanomas over 5 years was performed. Patient...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2013.12.022
更新日期：2014-05-01 00:00:00
abstract：BACKGROUND:Sustained intraabdominal pressures of 14 to 20 mm Hg have significant pathophysiological consequences, but there is currently no satisfactory low-morbidity procedure appropriate for intervention early in the disease process of abdominal compartment syndrome (ACS). The anatomical principles of abdominal wall ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(03)00171-5
更新日期：2003-08-01 00:00:00
abstract：:Mentoring has been recognized as a critical aspect of the professional and/or personal development of the student, resident or faculty member. This career development resource discusses strategies for building effective mentoring relationships and outlines some of the challenges to contemporary mentoring. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2013.08.001
更新日期：2013-11-01 00:00:00
abstract：INTRODUCTION:The few series of synchronous lung cancers have included small cell and carcinoid tumors. We wished to determine the prognosis for patients with synchronous non-small cell lung cancer (NSCLC). METHODS:A database of 3034 lung cancer patients was reviewed for synchronous NSCLC. Survival was determined by Ka...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/S0002-9610(96)00019-0
更新日期：1996-05-01 00:00:00
