Abstract:
BACKGROUND:In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. METHODS:Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. RESULTS:A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. CONCLUSIONS:The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training programs. The increasing level of responsibility and simultaneous care of multiple specialty patients through the VA hospital systems offers a crucial experience for those pursuing a career in general surgery.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Poteet S,Tarpley M,Tarpley JL,Pearson ASdoi
10.1016/j.amjsurg.2011.06.015subject
Has Abstractpub_date
2011-11-01 00:00:00pages
507-10issue
5eissn
0002-9610issn
1879-1883pii
S0002-9610(11)00411-9journal_volume
202pub_type
杂志文章abstract:BACKGROUND:Retractions of scientific articles represent attempts to correct the literature. Our goal was to examine retracted surgical papers. METHODS:NCBI PubMed database was queried using the search terms "surgery," "surg," or "surgical" and "retracted" or "retraction." Article details were recorded. RESULTS:There ...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/j.amjsurg.2017.11.033
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Local custom, rather than evidence-based medicine, dictates how a surgeon closes abdominal wounds. Closures might be more secure if grounded on statistical data. MATERIALS AND METHODS:A meta-analysis of 12,249 patients with abdominal wound closures was made. Infections, hernias, and dehiscences were compare...
journal_title:American journal of surgery
pub_type: 杂志文章,meta分析
doi:10.1016/s0002-9610(98)00277-3
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:The Affordable Care Act (ACA) dramatically changed the healthcare system in the United States. This study aims to analyze the impact of the ACA on general surgery clinic visits and resultant procedures. METHODS:A retrospective review was conducted on new patients who presented to the elective general surger...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.11.004
更新日期:2019-06-01 00:00:00
abstract::The salient clinical and pathological features of verrucous carcinoma, as first described by Ackerman in 1948, are reviewed. Two case reports are presented. The first concerns a personal experience with a patient who had five surgical procedures for multifocal oral verrucous carcinoma and remains alive and well 28 yea...
journal_title:American journal of surgery
pub_type: 传,历史文章,杂志文章
doi:10.1016/s0002-9610(98)00232-3
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:There is disagreement regarding the preferred injection site for breast sentinel lymph node mapping. METHODS:The concordance of blue staining and radioactivity in the sentinel nodes of 730 consecutive patients was analyzed based on injection of mapping agents into the same or separate intradermal and subare...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.06.018
更新日期:2004-10-01 00:00:00
abstract::Mean fasting preoperative pancreatic polypeptide levels in a group of 18 patients with duodenal ulcer disease were 462 +/- 88 pg/ml, with 13 patients having markedly elevated levels (mean 600 +/- 106 pg/ml) and 5 patients having normal or minimally elevated levels (mean 112 +/- 32 pg/ml). Mean fasting postoperative pa...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(86)90040-1
更新日期:1986-06-01 00:00:00
abstract::Cholecystostomy in patients with noninflammatory disease of the biliary tract has rarely been evaluated. Our experience with 124 patients suggests that, in addition to being helpful in inflammatory conditions, cholecystostomy is helpful in performing cholangiography, in removing stones and in decompressing an otherwis...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(81)90192-6
更新日期:1981-03-01 00:00:00
abstract:BACKGROUND:Skin-sparing mastectomy represents a new surgical approach that allows a mastectomy while preserving the natural skin envelope of the breast. It facilitates immediate breast reconstruction using an implant or myocutaneous flap, resulting in excellent cosmesis. DATA SOURCES:A PubMed database literature searc...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/j.amjsurg.2004.02.004
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Patients with the best performance status have the best prognosis after resection for pancreatic adenocarcinoma. This study was undertaken to determine the impact of performance status on survival after pancreatectomy for adenocarcinoma. METHODS:Patients with a Karnofsky Performance Score (KPS) status (KPS)...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.amjsurg.2012.01.016
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:After enthusiasm for total pancreatectomy for pancreatic adenocarcinoma peaked in the 1970s, a failure to improve outcomes in the 1980s led to fewer reports of this procedure. METHODS:We retrieved records from 252 Whipple and 47 total pancreatectomies for pancreatic cancer performed at U.S. Department of Ve...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80126-6
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Laparoscopic adrenalectomy is now the standard for pheochromocytoma. We report two decades of institutional experience with pheochromocytoma adrenalectomy. METHODS:A retrospective review was undertaken of pheochromocytoma adrenalectomy patients between 1997 and 2017. Clinical variables and postoperative com...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.03.016
更新日期:2019-05-01 00:00:00
abstract::The role of preoperative localization tests in patients undergoing initial neck exploration for hyperparathyroidism (HPT) is controversial. The use of parathyroid ultrasonography (US) in 46 patients (7 men, 39 women; mean age: 60 years) who underwent initial neck exploration for hypercalcemia and who had the diagnosis...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80900-6
更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:This study was designed to compare short-term laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) outcomes in gastric cancer. METHODS:Seventy patients who underwent total gastrectomy via LTG or OTG were included. All cases were matched for stage, age, and sex by means of statistically gen...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2012.11.011
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Colorectal liver metastases with hepatic vein (HV) involvement may require combined resection of the liver and HV. However, the short- and long-term outcomes of such a procedure remain unclear. METHODS:We reviewed 16 cases of liver resection with major HV resection and reconstruction. RESULTS:The patients ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.08.040
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine tumor that may spread via lymphatics and can therefore be staged with sentinel lymph node biopsy (SLNB). MCC is radiosensitive and chemosensitive, although the role of adjuvant therapy is still unclear. We examined the impact of different treatments o...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.06.013
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Over the past 15 years of war, eligible U.S. military members donated organs overseas in Germany. Our hypothesis was that outcomes at a military treatment facility were comparable to a civilian cohort. METHODS:Military donors were matched 1:3 with a donor cohort from the U.S. United Network for Organ Sharin...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2017.01.024
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Rectopexy is one of the accepted treatment options for full-thickness rectal prolapse, but the details of the technique remain controversial. This unit has adopted a laparoscopic approach as an alternative to open surgery, and has used three techniques: mesh, suture, and resection. This retrospective study c...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(01)00672-9
更新日期:2001-08-01 00:00:00
abstract:BACKGROUND:Laparoscopic rectal cancer surgery involving rectal division with intracorporeal stapling devices is technically difficult. This study aimed to identify risk factors for anastomotic leakage associated with laparoscopic anterior resection for rectal cancer. METHODS:We studied 363 patients who underwent lapar...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.11.014
更新日期:2011-09-01 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:This study aimed to assess the transferability of basic laparoscopic skills between a virtual reality simulator (MIST-VR) and a video trainer box (D-Box). METHODS:Forty-six medical students were randomized into 2 groups, training on MIST-VR or D-Box. After training with one modality, a crossover assessment ...
journal_title:American journal of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.amjsurg.2009.05.016
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:The American Association of Endocrine Surgeons initiated a fellowship match in 2007. The profile of applicants who successfully match into an endocrine surgery (ES) fellowship has not previously been characterized. METHODS:An institutional review board-approved, web-based survey was distributed to recent an...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.03.013
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Research has shown that pulsed electromagnetic fields (EMFs) promote wound healing in experimental colonic anastomosis; however, the effects of static EMFs in this setting have not been investigated to date. METHODS:Fifty male Wistar rats were used. Ten served as controls for mechanical strength testing, an...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2006.01.024
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:Numerous protocols for laparoscopic skills training using simulator-based laboratories have proven effective. However, little is known about the availability and uniformity of such facilities. The purpose of this study was to evaluate the prevalence, utilization, and costs of skills laboratories currently in...
journal_title:American journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjsurg.2005.05.048
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:The use of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has increased in recent years. Limited data exists on the impact of NAC on biliary microbiome. METHODS:Patients who underwent pancreaticoduodenectomy (PD) for PDAC between 2014 and 2017 were reviewed. Patients were stratif...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.09.042
更新日期:2020-10-05 00:00:00
abstract:BACKGROUND:Mental skills training refers to the implementation of cognitive performance-enhancing strategies to promote optimal performance. We aimed to develop a surgery-specific mental skills curriculum (MSC) and obtain initial evidence of efficacy. METHODS:The developed MSC consisted of 8 proven performance-enhanci...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2016.06.027
更新日期:2017-02-01 00:00:00
abstract::A persistent perineal sinus may develop in patients undergoing proctocolectomy for inflammatory bowel disease. Healing may resist the traditional methods of wound management. Wide excision including coccygectomy, transposition of the vascularized gracilis muscle flap into the rigid cavity, and wound closure have led t...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(84)90290-3
更新日期:1984-07-01 00:00:00
abstract:BACKGROUND:A critical outcome analysis of a large, single-institution experience provides a better frame of reference for an assessment of the role of laparoscopic colectomy for colorectal pathology. METHODS:Review of a prospectively gathered database was performed of a consecutive series of laparoscopic colectomy pat...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.10.039
更新日期:2006-03-01 00:00:00
abstract::The popliteal artery entrapment syndrome is increasingly recognized as a cause of arterial insufficiency in the leg. Diagnosis is based on a clinical history of claudication, which may be atypical, physical examination, noninvasive exercise testing and angiography. Patients with normal ankle pulses and resting ankle/b...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90285-8
更新日期:1980-03-01 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::The first case of a carotid body chemodectoma that was diagnosed using dynamic radionuclide perfusion angiography and subsequently excised is presented. The value of this technic in the investigation of pulsatile tumors is emphasized. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(79)90043-6
更新日期:1979-05-01 00:00:00