Abstract：
BACKGROUND:Endoscopic retrograde cholangiopancreatography is a challenging procedure performed by surgeons and gastroenterologists. We employed cognitive task analysis to identify steps and decision points for this procedure. METHODS:Standardized interviews were conducted with expert gastroenterologists (7) and surgeons (4) from 4 institutions. A procedural step and cognitive decision point protocol was created from audio-taped transcriptions and was refined by 5 additional surgeons. RESULTS:Conceptual elements, sequential actions, and decision points were iterated for 5 tasks: patient preparation, duodenal intubation, selective cannulation, imaging interpretation with related therapeutic intervention, and complication management. A total of 180 steps were identified. Gastroenterologists identified 34 steps not identified by surgeons, and surgeons identified 20 steps not identified by gastroenterologists. CONCLUSION:The findings suggest that for complex procedures performed by diverse practitioners, more experts may help delineate distinctive emphases differentiated by training background and type of practice.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Canopy E,Evans M,Boehler M,Roberts N,Sanfey H,Mellinger Jdoi
10.1016/j.amjsurg.2015.05.006subject
Has Abstractpub_date
2015-10-01 00:00:00pages
710-4issue
4eissn
0002-9610issn
1879-1883pii
S0002-9610(15)00356-6journal_volume
210pub_type
杂志文章abstract：:Surgeons have a history of almost 100 years of being in the forefront of efforts to standardize medical care and improve patients' health outcomes. Recently, increases in the "for-profit" sector have made it more difficult for patients to receive quality medical care. In this new era, surgeons need to stay involved in...
journal_title：American journal of surgery
pub_type： 社论
doi：10.1016/s0002-9610(97)00101-3
更新日期：1997-09-01 00:00:00
abstract：:The correlation between serum amylase and pancreatic amylase secretion was studied in two patients. Both patients underwent sphincterotomy, and the pancreatic duct was cannulated with a polyethylene tube. The tube was left in place for 15 to 21 days. The rate of amylase secretion over 7 days was studied in response to...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90178-7
更新日期：1982-05-01 00:00:00
abstract：BACKGROUND:Human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) infections are transmitted by blood exposure. Surgeons have been concerned about the risks of blood exposure in the operating room as a potential source of occupational infections from these viruses. The actual risk and frequency of...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/j.amjsurg.2005.05.021
更新日期：2005-08-01 00:00:00
abstract：BACKGROUND:Splenectomy is generally a second-line therapy in patients with immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AHA) refractory to medical therapy. Our objective was to evaluate outcomes after splenectomy for these disorders. METHODS:A retrospective review of the medical records of pa...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2012.05.030
更新日期：2012-12-01 00:00:00
abstract：:The difficulties created by an unsuccessful initial operation can usually be avoided by choosing experienced surgeons, identifying four glands, and selectively excising grossly abnormal parathyroid tissue. Patients with multiple endocrine adenomatosis or familial hyperparathyroidism should have a subtotal parathyroide...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90412-3
更新日期：1982-10-01 00:00:00
abstract：:Sixty-nine patients with pancreatic pseudocysts were reviewed. Chronic alcohol abuse was associated with pancreatitis in 78 percent of the patients. Presenting signs and symptoms were nonspecific. Ultrasonographic and computerized axial tomographic scans were most commonly used to established the diagnosis. Twenty pat...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90407-6
更新日期：1985-12-01 00:00:00
abstract：BACKGROUND:The increased utilization of expanded criteria kidney donors has necessitated the reevaluation of multiple donor risk factors to insure the best outcome from this valuable resource. Reports of decreased graft survival in recipients of kidneys from donors with > or =20% glomerular sclerosis (GS) have led many...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(00)00502-x
更新日期：2000-12-01 00:00:00
abstract：BACKGROUND:For locally advanced Siewert type II and III tumors we have performed total gastrectomy including resection of the distal 2/3 of the esophagus, through separate abdominal and right chest incisions (THX-ABD). The procedure involves wide lymphadenectomy in the abdomen/chest and a Roux-en-Y jejunostomy to the l...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2018.11.049
更新日期：2019-08-01 00:00:00
abstract：BACKGROUND:To improve surgical training standards, it is necessary to first define the elements of high-quality training and methods for measuring them. METHODS:Semistructured interviews were conducted with attending (n = 10) and resident (n = 10) general surgeons. An interview topic guide was used to elicit end users...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2013.07.044
更新日期：2014-04-01 00:00:00
abstract：:Between 1971 and 1976, ninety-three patients with a clinical diagnosis of pseudocyst confirmed by ultrasonography were identified from a group of 923 patients admitted for pancreatic disease. Uncertainties in diagnosis and/or rapid progression of underlying pancreatitis led to urgent laparotomy and drainage in eleven ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90024-2
更新日期：1979-01-01 00:00:00
abstract：:Fixation of polypropylene (Marlex) mesh in the epigastrium and at the iliac crest can be ineffective because of insufficient local fascia; however, two techniques have been described to obtain firm and durable attachment of polypropylene grafts at these sites. Perichondral slips at the costal margin permit very satisf...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(85)80194-x
更新日期：1985-06-01 00:00:00
abstract：:Trauma patients in rural areas usually have no access to regional trauma systems or designated trauma centers. Efforts to provide quality trauma care in small hospitals may seriously overextend local capabilities. The urban trauma center retains an important role in trauma care even when the initial care must be provi...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80767-6
更新日期：1990-12-01 00:00:00
abstract：BACKGROUND:Prognosis in peritoneal carcinomatosis from gastric cancer has improved with cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy. The aim of this study was to identify predictive factors for incomplete CS. METHODS:Forty-five patients undergoing laparotomy for gastric cancer with periton...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2012.06.009
更新日期：2013-06-01 00:00:00
abstract：BACKGROUND:Chronic pain is a severe complication of mesh-based inguinal hernia repair. Its perceived risk varies widely in the literature. The current objectives are to review the incidence, severity, and consequences of chronic pain and its etiologies. DATA SOURCES:A multi-database systematic search was conducted for...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/j.amjsurg.2007.02.012
更新日期：2007-09-01 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
abstract：:One hundred seven patients with pseudocyst managed during the past decade were reviewed. The mortality rate of 11.2 percent compares favorably with the rates in other recent series. Twenty-two percent of the patients were managed conservatively, and 76 underwent exploration. None of the nonoperative patients died from...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(81)90052-0
更新日期：1981-05-01 00:00:00
abstract：:Urinary tract infection continues to be a major source of morbidity for surgical patients, and treating these infections continues to be a difficult problem in clinical surgical practice. The majority of these infections are due to urinary catheters. One strategy that has been advanced to prevent the morbidity associa...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/s0002-9610(03)00120-x
更新日期：2003-07-01 00:00:00
abstract：:Part II of this two-part article (See The American Journal of Surgery 1992; 164: 85-9) reviews the current definition of the role of immunosuppressive therapy in inflammatory bowel disease (IBD) and the use of antibiotics in IBD, as well as summarizes the uses of the new agents on the horizon for the treatment of IBD....
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/s0002-9610(05)80381-2
更新日期：1992-08-01 00:00:00
abstract：:The value of bacteriologic findings in patients with acute appendicitis was studied. Routine urinary culture specimens were taken preoperatively from 194 children (mean age 11 +/- 3 years) undergoing emergency appendectomy. Bacteria were found in culture specimens of urine from 26 of 156 patients with acute appendicit...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(88)80731-1
更新日期：1988-02-01 00:00:00
abstract：:Conventional wisdom dictates that autogenous tissue interposition be used in contaminated wounds when direct vascular repair is not feasible. Although there are few reports of successful use of PTFE grafts in grossly contaminated wounds, doubt still exists regarding the use of any prosthetic material in such wounds fo...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(84)90227-7
更新日期：1984-08-01 00:00:00
abstract：:One hundred seventeen patients with threatened limb loss were evaluated. Seventy-three of these patients underwent vascular reconstruction. Diabetics had a significantly higher incidence of ischemic ulceration and gangrene when compared with nondiabetics. Nondiabetics typically presented with rest pain. The outcome of...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(88)80534-8
更新日期：1988-12-01 00:00:00
abstract：:We studied 48 patients with laryngeal or hypopharyngeal primary tumors with DNA flow cytometry. Twenty-four of the tumors were glottic, 18 were supraglottic, and 6 were from the pyriform sinus. Patients were followed for a minimum of 12 months, with a mean follow-up of 23 months. Twenty-three of the 48 primary tumors ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(86)90311-9
更新日期：1986-10-01 00:00:00
abstract：BACKGROUND:Interest in surgery has declined for two decades. This study aimed to evaluate the impact of one's interest in surgery on career choice. METHODS:Students who completed the surgical clerkship (2016-2017) were invited to complete surveys assessing rotation experience, learning style, burnout, and grit. Studen...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2019.09.040
更新日期：2020-02-01 00:00:00
abstract：BACKGROUND:Reconstruction of the portal vein with autologous veins requires extra incisions. Prosthetic material is associated with an increased risk of infection. We therefore created an animal model of portal vein reconstruction using the peritoneum. METHODS:A 2.5 x 2.5 cm piece of the peritoneum was resected from L...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00552-9
更新日期：2001-03-01 00:00:00
abstract：OBJECTIVE:We aimed to identify potential variables predictive of a resident achieving faculty future entrustment as a way to enhance attending surgeons' planning of teaching in the operating room leading to improved resident operative autonomy in practice. METHODS:We reviewed 273 resident performance evaluations from ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2021.01.020
更新日期：2021-01-19 00:00:00
abstract：:Diabetic foot wounds affect an estimated 15% of all patients with diabetes. These wounds are typically multifactorial in origin. Neuropathy of the foot and impaired wound healing are frequently associated with peripheral arterial occlusive disease. These factors combine to contribute to the development of foot ulcers....
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/S0002-9610(03)00302-7
更新日期：2004-05-01 00:00:00
abstract：BACKGROUND:The purpose of this study was to determine the indications and outcome of surgery in patients with Hashimoto's thyroiditis (HT). METHODS:All patients who underwent thyroidectomy from 1990 to 2009 with pathologically confirmed HT were identified. Patients whose principle diagnosis was HT were evaluated for s...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2010.08.021
更新日期：2011-03-01 00:00:00
abstract：BACKGROUND:The biofragmentable anastomosis ring (BAR) was introduced by Hardy in 1985 as a simple alternative to sutured or stapled intestinal anastomosis. METHODS:The aim of this study was to analyze complications related to the use of the BAR in elective intraperitoneal intestinal anastomosis to identify technical a...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2006.01.005
更新日期：2006-04-01 00:00:00
abstract：BACKGROUND:We hypothesize that medical centers that prioritize altruism can also deliver superior quality care. METHODS:Data were obtained from California's Office of Statewide Health Planning and Development, Medicare Hospital Compare, and the Joint Commission US Census Bureau's American Community Survey. Outcomes we...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2014.10.016
更新日期：2015-03-01 00:00:00
abstract：:Knowledge of venous, capillary, and arterial blood flow in microgravity is required to modify hemostatic techniques for control of bleeding in traumatic injuries or surgical procedures in space. To simulate human arterial, venous, and capillary bleeding, fresh whole bovine blood was injected by two operators at calcul...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80368-x
更新日期：1992-08-01 00:00:00
