Abstract：
BACKGROUND:Surgery is an environment in which being an expert requires the ability to manage the unexpected. This feature has necessitated a shift in surgical decision-making research. The present study explores the processes by which surgeons assess and respond to nonroutine challenges in the operating room. METHODS:We used a grounded theory methodology supported on intraoperative observations and postoperative interviews with 7 faculty surgeons from various specialties. A total of 32 cases were purposively sampled to compile a dataset of challenging situations. RESULTS:Thematic data analysis yielded 3 main themes that were linked in a cyclic model: assessing the situation, the reconciliation cycle, and implementing the planned course of action. These elements were connected through 2 points of transition (ie, active and confirmatory reconciliation), during which time the surgeons continue to act although they may change the course of their action. CONCLUSIONS:The proposed model builds on existing theories of naturalistic decision making from other high-stakes environments. This model elaborates on a theoretic language that accounts for the unique aspects of surgery, making it useful for teaching in the operating room.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Cristancho SM,Vanstone M,Lingard L,LeBel ME,Ott Mdoi
10.1016/j.amjsurg.2012.10.005subject
Has Abstractpub_date
2013-02-01 00:00:00pages
156-62issue
2eissn
0002-9610issn
1879-1883pii
S0002-9610(12)00577-6journal_volume
205pub_type
杂志文章abstract：:A technique for carotid endarterectomy done under general anesthesia features the routine use of a straight shunt, precise removal of all plaque and shreds of media, and routine completion angiography done as a means of quality control. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80274-0
更新日期：1990-02-01 00:00:00
abstract：BACKGROUND:Academic institutions have increasingly focused on educating physicians and surgeons in concepts of value-based care, including quality improvement (QI). The extent to which QI curricular competencies are addressed in specialty surgical residency training is unclear. METHODS:A survey instrument was develope...
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abstract：BACKGROUND:The use of biologic markers to aid in individualizing wound treatment may help improve outcomes. A biologic marker that has been demonstrated to be predictive of healing in both chronic and acute wounds is wound tissue bacterial level. The objective of this study was to determine whether tissue bacterial lev...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2010.09.009
更新日期：2011-08-01 00:00:00
abstract：:Fine-needle aspiration (FNA) biopsy of a thyroid nodule was performed in 797 patients. Ninety-six patients had resection of the thyroid nodule performed subsequent to a one-time FNA biopsy. The surgical pathology of these 96 cases demonstrated a 5.8% false-negative rate and a 9.9% false-positive rate. As a consequence...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80330-7
更新日期：1993-10-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
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更新日期：2009-07-01 00:00:00
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journal_title：American journal of surgery
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journal_title：American journal of surgery
pub_type： 杂志文章
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journal_title：American journal of surgery
pub_type： 杂志文章
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journal_title：American journal of surgery
pub_type： 杂志文章,评审
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更新日期：2009-01-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(76)90416-5
更新日期：1976-01-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
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更新日期：1981-12-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(78)90305-7
更新日期：1978-09-01 00:00:00
abstract：BACKGROUND:We conducted a national survey of general surgeons to address the association between surgeon characteristics and the tendency to recommend surgery. METHODS:We used a web-based survey with 25 hypothetical clinical scenarios with clinical equipoise regarding the decision to operate. The respondent-level tend...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2013.08.018
更新日期：2013-12-01 00:00:00
abstract：BACKGROUND:Laparoscopic splenectomy (LS) has been used to treat a variety of splenic disorders. However, there have been few direct comparisons of this approach with open splenectomy (OS). METHODS:Results and outcomes were compared retrospectively in 46 consecutive patients treated by laparoscopic (n = 26) or open spl...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(96)00241-3
更新日期：1996-11-01 00:00:00
abstract：:Forty-six infants and children with primary malignant liver tumors were studied. Thirty-three had hepatoblastomas, 9 hepatocellular carcinomas, and 4 had sarcomas. Thirty-eight patients underwent liver biopsy or excision of the tumor. Nineteen patients were treated between 1952 and 1971 (mean survival 5.5 months) and ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90381-1
更新日期：1983-08-01 00:00:00
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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
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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:During the reproductive years, women have a 4-fold higher prevalence of gallstones than men, making gallbladder disease a critically important topic in women's health. Among age-matched women and men hospitalized for cholecystitis, gender based differences in demographics, management, and economic and clinic...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2013.07.011
更新日期：2013-11-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
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更新日期：1979-08-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
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更新日期：1984-12-01 00:00:00
abstract：:Quercetin exhibits antitumor activity. We investigated the effect of quercetin on the in vitro and in vivo growth of two squamous cell carcinoma cell lines and a normal human lung fibroblast-like cell line. The in vivo effect was evaluated using implantable cell growth chambers implanted subcutaneously in immunocompet...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(89)90132-3
更新日期：1989-10-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2014.11.014
更新日期：2015-07-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90571-2
更新日期：1982-11-01 00:00:00
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journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(97)00006-8
更新日期：1997-03-01 00:00:00
abstract：:Reports in the surgical literature are conflicting as to whether appendectomy "in passing" during laparotomy for trauma or for some other disease state does or does not significantly increase patient morbidity or mortality. A chart survey of all appendectomies (342 for acute appendicitis and 146 as incidental procedur...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：1983-06-01 00:00:00
abstract：BACKGROUND:The aim of this study is to establish a relationship between critical ischemia of the lower limb and kidney dysfunction. MATERIALS AND METHODS:At rest, urine samples were collected from three groups: group A, 16 patients with critical ischemia; group B, 22 patients with stable intermittent claudication; and...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(02)01406-x
更新日期：2003-04-01 00:00:00
abstract：BACKGROUND:Appropriate therapy for women over 70 years of age with breast cancer is currently a highly debated topic. The aim of this study was to determine whether a subset of patients could be identified in which lumpectomy alone, followed by tamoxifen, would offer adequate local, regional, and long-term control of d...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00474-8
更新日期：2000-09-01 00:00:00
abstract：:Cardiac decompensation is clearly the major complication of aortic reconstructive surgery that leads to morbidity. Major changes in intravascular volume, third spacing, and increased systemic vascular resistance are extremely stressful to the diseased heart. Hemodynamic monitoring is readily available to provide an ac...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90367-7
更新日期：1983-08-01 00:00:00
abstract：:The superiority of the minimally invasive approach to adrenal resections has been well documented for benign pathology. With technical advances and increased experience, surgeons have successfully performed laparoscopic adrenalectomies for metastatic and primary malignancies of the adrenal gland. The technique of lapa...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/j.amjsurg.2005.01.021
更新日期：2005-04-01 00:00:00
