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Gentry LE, Green JM, Mitchell CA, Andino LF, Rolf MK, Schaefer D, Nafziger ED. Split fertilizer nitrogen application with a cereal rye cover crop reduces tile nitrate loads in a corn-soybean rotation. J Environ Qual 2024; 53:90-100. [PMID: 37940131 DOI: 10.1002/jeq2.20530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Splitting fertilizer nitrogen (N) applications and using cover crops are management strategies to reduce nitrate in tile drainage water. We investigated split fertilizer N applications to corn (Zea mays L.) on crop yields and tile nitrate loss in both corn and soybean (Glycine max L.) in rotation from 2016 through 2019. We evaluated the inclusion of cover crops in a split-N treatment. Fertilizer N treatments included 100% in the fall; 50% in the fall + 25% at planting + 25% at side-dress; 100% as spring preplant; 75% as spring preplant (reduced N rate); 50% as spring preplant + 50% at side-dress; and 50% as spring preplant + 50% at side-dress with a cover crop. We did not find significant differences between split and single full rate N application treatments for corn yields or tile nitrate loss; however, the reduced N rate treatment significantly decreased corn yield by 10%. Cumulative tile nitrate losses (over four seasons) ranged from 115 kg ha-1 for all of the N in the fall to 65 kg ha-1 for 50% as spring preplant + 50% at side-dress with a cover crop, a decrease of 43%. Tile nitrate loss responded similarly to (corn) N treatments under both corn and soybean, with 64% of the loss under corn and 36% under soybean. Our results suggest that decreasing the fertilizer N rate may impact corn yield more than nitrate loss, while split fertilizer N application with a cover crop has potential to reduce tile nitrate loss without decreasing crop yield.
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Affiliation(s)
- Lowell E Gentry
- Department of Natural Resources and Environmental Sciences, University of Illinois, Illinois, Urbana, USA
| | - John M Green
- Department of Natural Resources and Environmental Sciences, University of Illinois, Illinois, Urbana, USA
| | - Corey A Mitchell
- Department of Natural Resources and Environmental Sciences, University of Illinois, Illinois, Urbana, USA
| | - Luis F Andino
- Department of Natural Resources and Environmental Sciences, University of Illinois, Illinois, Urbana, USA
| | - Michelle K Rolf
- Department of Natural Resources and Environmental Sciences, University of Illinois, Illinois, Urbana, USA
| | - D Schaefer
- Illinois Fertilizer and Chemical Association, Bloomington, Illinois, USA
| | - Emerson D Nafziger
- Department of Crop Sciences, University of Illinois, Illinois, Urbana, USA
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2
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Morris CJ, Nguyen KQ, Green JM. Comparison of lethal and non-lethal age-based growth estimation methodologies to assess an endemic bay population of Atlantic cod (Gadus morhua). J Nat Conserv 2022. [DOI: 10.1016/j.jnc.2022.126265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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3
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Ross SW, McCartt JC, Cunningham KW, Reinke CE, Thompson KJ, Green JM, Thomas BW, Jacobs DG, May AK, Christmas AB, Sing RF. Emergencies do not shut down during a pandemic: COVID pandemic impact on Acute Care Surgery volume and mortality at a level I trauma center. Am J Surg 2022; 224:1409-1416. [PMID: 36372581 PMCID: PMC9575313 DOI: 10.1016/j.amjsurg.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of the COVID-19 pandemic on volume and outcomes of Acute Care Surgery patients, and we hypothesized that inpatient mortality would increase due to COVID+ and resource constraints. METHODS An American College of Surgeons verified Level I Trauma Center's trauma and operative emergency general surgery (EGS) registries were queried for all patients from Jan. 2019 to Dec. 2020. April 1st, 2020, was the demarcation date for pre- and during COVID pandemic. Primary outcome was inpatient mortality. RESULTS There were 14,460 trauma and 3091 EGS patients, and month-over-month volumes of both remained similar (p > 0.05). Blunt trauma decreased by 7.4% and penetrating increased by 31%, with a concomitant 25% increase in initial operative management (p < 0.001). Despite this, trauma (3.7%) and EGS (2.9-3.0%) mortality rates remained stable which was confirmed on multivariate analysis; p > 0.05. COVID + mortality was 8.8% and 3.7% in trauma and EGS patients, respectively. CONCLUSION Acute Care Surgeons provided high quality care to trauma and EGS patients during the pandemic without allowing excess mortality despite many hardships and resource constraints.
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Affiliation(s)
- Samuel W. Ross
- Corresponding author. Atrium Health Carolinas Medical Center, Charlotte NC, 1000 Blythe Blvd, Suite 601 MEB, Charlotte, NC, 28203, USA
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Willis G, Robinson JN, Green JM, Dieffenbaugher ST, Madjarov JM, LeNoir BJ, Frederick JR, Sing RF, Cunningham KW. Atrial Cannulation During Resuscitative Clamshell Thoracotomy. Am Surg 2022:31348221101479. [PMID: 35575235 DOI: 10.1177/00031348221101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Resuscitative thoracotomy and clamshell thoracotomy are performed in the setting of traumatic arrest with the intent of controlling hemorrhage, relieving tamponade, and providing open chest cardiopulmonary resuscitation. Historically, return of spontaneous circulation rates for penetrating traumatic arrest as well as out of hospital survival have been reported as low as 40% and 10%. Vascular access can be challenging in patients who have undergone a traumatic arrest and can be a limiting step to effective resuscitation. Atrial cannulation is a well-established surgical technique in cardiac surgery. Herein, we present a case series detailing our application of this technique in the context of acute trauma resuscitation during clamshell thoracotomy for traumatic arrest in the emergency department. METHODS A retrospective case series of atrial cannulation during traumatic arrest was conducted in Charlotte, NC at Carolinas Medical Center an urban level 1 trauma center. RESULTS The mean rate of return of spontaneous circulation in our series, 60%, was greater than previously published upper limit of return of spontaneous circulation for penetrating causes of traumatic arrest. DISCUSSION Intravenous access can be difficult to establish in the hypovolemic and exsanguinating patient. Traditional methods of vascular access may be insufficient in the setting of central vascular injury. Atrial appendage cannulation during atrial cannulation is a quick and reliable technique to achieve vascular access that employs common methods from cardiac surgery to improve resuscitation of traumatic arrest.
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Affiliation(s)
- Grant Willis
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Jordan N Robinson
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - John M Green
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | | | | | | | | | - Ronald F Sing
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Kyle W Cunningham
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
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5
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Green JM, Dunbrack RL, Bates AE. Signals of resilience and change in tidepool fish communities on the Pacific coast of Vancouver Island, Canada. DIVERS DISTRIB 2021. [DOI: 10.1111/ddi.13387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- John M. Green
- Department of Biology Memorial University of Newfoundland St. John’s Canada
| | - Robert L. Dunbrack
- Department of Biology Memorial University of Newfoundland St. John’s Canada
| | - Amanda E. Bates
- Department of Ocean Sciences Memorial University of Newfoundland St. John's Canada
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6
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Riojas C, Cunningham KW, Green JM, Sachdev G, Ross SW, Lauer CW, Thomas BW. Attention to detail: A dedicated rib fracture consultation service leads to earlier operation and improved clinical outcomes. Am J Surg 2021; 223:410-416. [PMID: 33814108 DOI: 10.1016/j.amjsurg.2021.03.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical stabilization of rib fractures (SSRF) has been correlated with improved outcomes, including decreased length of stay (LOS). We hypothesized that an SSRF consultation service would increase the frequency of SSRF and improve outcomes. METHODS A prospective observational study was performed to compare outcomes before and after implementing an SSRF service. Primary outcome was time from admission to surgery; secondary outcomes included LOS, mortality and morphine milligram equivalents (MME) prescribed at discharge. RESULTS 1865 patients met consultation criteria and 128 patients underwent SSRF. Mortality decreased (6.3% vs. 3%) and patients were prescribed fewer MME at discharge (328 MME vs. 124 MME) following implementation. For the operative cohort, time from admission to surgery decreased by 1.72 days and ICU LOS decreased by 2.6 days. CONCLUSION Establishment of an SSRF service provides a mechanism to maximize capture and evaluation of operative candidates, provide earlier intervention, and improve patient outcomes. Additional study to determine which elements and techniques are most beneficial is warranted. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christina Riojas
- FH "Sammy" Ross Trauma Center, Department of Surgery, Carolinas Medical Center, NC.1000 Blythe Boulevard, Charlotte, NC, 28203, United States
| | - Kyle W Cunningham
- FH "Sammy" Ross Trauma Center, Department of Surgery, Carolinas Medical Center, NC.1000 Blythe Boulevard, Charlotte, NC, 28203, United States
| | - John M Green
- FH "Sammy" Ross Trauma Center, Department of Surgery, Carolinas Medical Center, NC.1000 Blythe Boulevard, Charlotte, NC, 28203, United States
| | - Gaurav Sachdev
- FH "Sammy" Ross Trauma Center, Department of Surgery, Carolinas Medical Center, NC.1000 Blythe Boulevard, Charlotte, NC, 28203, United States
| | - Samuel W Ross
- FH "Sammy" Ross Trauma Center, Department of Surgery, Carolinas Medical Center, NC.1000 Blythe Boulevard, Charlotte, NC, 28203, United States
| | - Cynthia W Lauer
- FH "Sammy" Ross Trauma Center, Department of Surgery, Carolinas Medical Center, NC.1000 Blythe Boulevard, Charlotte, NC, 28203, United States
| | - Bradley W Thomas
- FH "Sammy" Ross Trauma Center, Department of Surgery, Carolinas Medical Center, NC.1000 Blythe Boulevard, Charlotte, NC, 28203, United States.
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Watson MD, Elhage SA, Green JM, Sachdev G. Surgery Residents Spend Nearly 8 Months of Their 5-Year Training on the Electronic Health Record (EHR). J Surg Educ 2020; 77:e237-e244. [PMID: 32654998 DOI: 10.1016/j.jsurg.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Electronic health records (EHRs) are an integral part of the medical system and are used in all aspects of care. Despite multiple advantages of an EHR, concerns exist over the amount of time that residents spend on computers rather than in direct patient care. This study aims to quantify the time a general surgery resident spends on the EHR during their training. DESIGN/PARTICIPANTS Active usage time data from our institution's EHR were extracted for 34 unique general surgery residents from October 2014 to June 2019. Career time on the EHR was calculated and a "work month" was defined as a 4-week period of 80 hours per week. SETTING Carolinas Medical Center, Charlotte, NC. RESULTS Total career EHR usage for a general surgery resident was 2512 continuous hours, corresponding to 31.4 work weeks or 7.9 work months. In total, 7133 charts were opened with an average of 20.5 minutes on the EHR per patient chart. Career time spent on specific tasks included: chart review 10.6 work weeks, documentation 10.4 work weeks, and order entry 5.4 work weeks. The total number of orders entered were 57,739 and total number of documents created were 9222. EHR time in all aspects, patient charts opened, documents created, and number of orders entered decreased as postgraduate year increased. CONCLUSIONS This is the first study quantifying the total time a general surgery resident spends on the EHR during their clinical training. Total EHR time equated to nearly 8 work months. General surgery residents spend considerable time on the EHR and this underscores the importance of implementing methods to improve EHR efficiency and maximize time for clinical training.
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Affiliation(s)
- Michael D Watson
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Sharbel A Elhage
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Gaurav Sachdev
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
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Terhune KP, Choi JN, Green JM, Hildreth AN, Lipman JM, Aarons CB, Heyduk DA, Misra S, Anand RJ, Fise TF, Thorne CB, Edwards GC, Joshi ART, Clark CE, Nfonsam VN, Chahine A, Smink DS, Jarman BT, Harrington DT. Ad astra per aspera (Through Hardships to the Stars): Lessons Learned from the First National Virtual APDS Meeting, 2020. J Surg Educ 2020; 77:1465-1472. [PMID: 32646812 PMCID: PMC7336917 DOI: 10.1016/j.jsurg.2020.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE After COVID-19 rendered in-person meetings for national societies impossible in the spring of 2020, the leadership of the Association of Program Directors in Surgery (APDS) innovated via a virtual format in order to hold its national meeting. DESIGN APDS leadership pre-emptively considered factors that would be important to attendees including cost, value, time, professional commitments, education, sharing of relevant and current information, and networking. SETTING The meeting was conducted using a variety of virtual formats including a web portal for entry, pre-ecorded poster and oral presentations on the APDS website, interactive panels via a web conferencing platform, and livestreaming. PARTICIPANTS There were 298 registrants for the national meeting of the APDS, and 59 participants in the New Program Directors Workshop. The registrants and participants comprised medical students, residents, associate program directors, program directors, and others involved in surgical education nationally. RESULTS There was no significant difference detected for high levels of participant satisfaction between 2019 and 2020 for the following items: overall program rating, topics and content meeting stated objectives, relevant content to educational needs, educational format conducive to learning, and agreement that the program will improve competence, performance, communication skills, patient outcomes, or processes of care/healthcare system performance. CONCLUSIONS A virtual format for a national society meeting can provide education, engagement, and community, and the lessons learned by the APDS in the process can be used by other societies for utilization and further improvement.
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Affiliation(s)
- Kyla P Terhune
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Jennifer N Choi
- Department of Surgery Indiana University School of Medicine, Indianapolis, Indiana
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Amy N Hildreth
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Cary B Aarons
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donna A Heyduk
- Department of Surgery, Main Line Health Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Subhasis Misra
- HCA Healthcare/USF Morsani College of Medicine GME, Brandon Regional Hospital, Brandon, Florida
| | - Rahul J Anand
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Thomas F Fise
- Association of Program Directors in Surgery, Bethesda, Maryland
| | | | | | | | - Clarence E Clark
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Valentine N Nfonsam
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Alfred Chahine
- Department of Surgery, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David T Harrington
- Department of Surgery, Warren Alport School of Medicine, Brown University, Providence, Rhode Island
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9
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Elhage SA, Watson MD, Green JM, Sachdev G. Distractions During Patient Handoff: The Application-Based Messaging Volume on General Surgery Interns. J Surg Educ 2020; 77:e201-e208. [PMID: 32703741 DOI: 10.1016/j.jsurg.2020.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/18/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Mobile phone-based paging systems have become increasingly common for communication within hospitals. Surgical interns receive the most pages, and our aim is to objectively quantify and evaluate this burden to allow for targeted improvement. DESIGN We performed a retrospective review of our institutions mobile phone-based paging system data (Halo Health, Cincinnati, OH) from July 2019 to September 2019. SETTING Carolinas Medical Center, Charlotte, NC, USA. PARTICIPANTS Seven general surgery postgraduate year (PGY) 1 residents. RESULTS Forty-five thousand eight hundred and one messages met inclusion criteria, with 27,397 messages received and 18,404 sent. PGY 1 residents each received an average of 48 ± 41 messages per shift, with 8 ± 17 messages per day while off-duty. Night shifts averaged more messages than day shifts (80 ± 39 vs 38 ± 32, p < 0.0001), and had more shifts with high message volume (30% vs 11%, p = 0.0005). Evaluating the total number of messages received per minute of the day, the largest number of high-volume message intervals (21) occurred during patient handoff (1700-1900 hours). Most messages were sent by nursing staff (55.8%), followed by medical providers (38.2%). CONCLUSIONS PGY 1 residents receive a large number of pages using a messaging application, with many occurring at critical times. Residents received a higher volume of pages on night shifts, during patient handoff, and while off-duty. Since most pages are from nursing staff, targeted education and preventative actions may help decrease the volume of pages during these critical times.
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Affiliation(s)
- Sharbel A Elhage
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael D Watson
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Gaurav Sachdev
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
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Pace MT, Green JM, Killen LG, Swain JC, Chander H, Simpson JD, O'Neal EK. Minimalist style boot improves running but not walking economy in trained men. Ergonomics 2020; 63:1329-1335. [PMID: 32588761 DOI: 10.1080/00140139.2020.1778096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
This study examined movement economy under load with 1000 g minimalist (MIN) vs. 1600 g traditional (TRD) style boots. Fourteen trained, male participants completed a VO2peak test (46.6 ± 7.3 ml/kg/min) while wearing a 16 kg external load. Treadmill speeds for the running economy (RE) trials were determined by the slowest pace in which participants completed a full stage with a running gait pattern during the VO2peak test. Walking economy (WE) pace was 1.6 km/h slower than RE pace. During the second session, participants completed 5-min exercise bouts at WE and RE pace under load wearing MIN and TRD. There were no differences for any measured variables during WE trials. In contrast, RE (MIN = 2.95 ± 0.28 vs. TRD = 3.04 ± 0.30 L/min; p = .003: Cohen's d = 0.32), respiratory exchange ratio (p < .001), and perceptual measures (p < .05) were all improved while wearing MIN. Practitioner summary: In trained men, 1000 g/pair minimalist style boots (MIN) resulted in improvements of approximately 3% and 5% for running economy and respiratory exchange ratio versus 1600 g/pair traditional boots while wearing a 16 kg kit. Perceptual responses, including comfort, also favoured MIN. These effects were not found at walking pace. Abbreviations: MIN: minimalist style boots; TRD: traditional style boots; RE: running economy; WE: walking economy; ES: effect size; RER: respiratory exchange ratio; HR: heart rate.
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Affiliation(s)
- M T Pace
- Department of Kinesiology, University of North Alabama, Florence, AL, USA
| | - J M Green
- Department of Kinesiology, University of North Alabama, Florence, AL, USA
| | - L G Killen
- Department of Kinesiology, University of North Alabama, Florence, AL, USA
| | - J C Swain
- Department of Kinesiology, University of North Alabama, Florence, AL, USA
| | - H Chander
- Department of Kinesiology, Mississippi State University, MS, USA
| | - J D Simpson
- Department of Movement Sciences and Health, University of West Florida, Pensacola, FL, USA
| | - E K O'Neal
- Department of Kinesiology, University of North Alabama, Florence, AL, USA
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Maloney SR, Peterson S, Kao AM, Sherrill WC, Green JM, Sachdev G. Surgery Resident Time Consumed by the Electronic Health Record. J Surg Educ 2020; 77:1056-1062. [PMID: 32305335 DOI: 10.1016/j.jsurg.2020.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/25/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Time spent on the Electronic Health Record (EHR) influences surgical residents' clinical availability. Objective data assessing EHR usage among surgical residents are lacking and necessary. DESIGN/PARTICIPANTS Active EHR usage data for 70 surgical residents were collected from April 2015 through April 2016. Active EHR usage was defined as more than 15 keystrokes, or 3 mouse clicks, or 1700 "mouse miles" per minute. Usage data of different specialties, interns (PGY 1), juniors (PGY 2, 3), and seniors (PGY 4, 5) were compared. SETTING Carolinas Medical Center, Charlotte, NC. RESULTS Interns spent more time than juniors on total EHR activities per day (134.5 vs 105.5 minutes, p < 0.001) and juniors spent more time per day than seniors (105.5 vs 78.7 minutes, p < 0.001). Among different EHR activities per patient, interns spent greater time than juniors on chart review (8.1 vs 6.2 minutes, p < 0.001), documentation (9.0 vs 6.5 minutes, p < 0.001), and orders (3.6 vs 3.0 minutes, p < 0.001). Juniors spent the same time as seniors on chart review (6.2 vs 6.5 minutes, p = 0.2). Juniors spent more time than seniors on documentation (6.5 vs 5.2 minutes, p < 0.001) and orders (3.0 vs 2.7 minutes, p < 0.05). Comparing EHR activities per patient among different specialties, General Surgery residents spent more time than Orthopedic residents on total EHR time (19.9 vs 15.9 minutes, p < 0.001), chart review (6.8 vs 5.7 minutes, p < 0.001), documentation (6.3 vs 5.6 minutes, p < 0.001), and orders (3.6 vs 2.6 minutes, p < 0.001). General Surgery residents spent less time than OB/GYN residents on total EHR time (19.9 vs 22 minutes, p < 0.01), chart review (6.8 vs. 7.5 minutes, p < 0.05), and documentation (6.3 vs 7.6 minutes, p < 0.001), but more time on orders (3.6 vs 2.9 minutes, p < 0.001). CONCLUSIONS These are the first reported objective findings on surgical resident use of the EHR and may provide an opportunity for improvement in EHR training and usage.
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Affiliation(s)
- Sean R Maloney
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Sabrina Peterson
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Angela M Kao
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - William C Sherrill
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Gaurav Sachdev
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina.
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12
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Klima DA, Hanna EM, Christmas AB, Huynh TT, Etson KE, Fair BA, Green JM, Madjarov J, Sing RF. Endovascular Graft Repair for Blunt Traumatic Disruption of the Thoracic Aorta: Experience at a Nonuniversity Hospital. Am Surg 2020. [DOI: 10.1177/000313481307900620] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blunt thoracic aortic injury (BAI) represents the second leading cause of death from blunt trauma. Admission rates for BAI are extremely low because instant fatality occurs in nearly 75 per cent of patients. Management strategies have transitioned from the more invasive immediate thoracotomy to delayed endograft repair with strict hemodynamic management. In this study, we assess outcomes and complications of open versus endograft repair for BAI at a nonuniversity hospital. Retrospective chart review was conducted on 49 patients admitted to a Level I trauma center who incurred BAI from 2004 to 2011. Collected data points included demographics, mortality, complication rates, and intensive care unit and hospital length of stay (LOS). Twenty-one patients underwent open thoracotomy (OPEN), whereas 28 patients were managed with thoracic endovascular aortic repair (TEVAR). The overall 30-day mortality rate was significantly lower comparing TEVAR to OPEN (7.1 vs 50%, P = 0.028); seven deaths occurred in the OPEN group versus two with TEVAR. Overall complications, including mortality, acute respiratory distress syndrome, renal failure, pneumonia, pulmonary embolism, and cardiac arrest, were fewer after TEVAR (32.1 vs 81.0%, P < 0.001) despite similar injury severity. Survivor hospital LOS (26.0 ± 15.3 vs 27.7 ± 18.7 days, P = 0.79), intensive care unit LOS (13.5 ± 10.9 vs 12.7 ± 8.8 days, P = 0.94), and ventilator days (11.4 ± 13.4 vs 16.4 ± 14.5 days, P = 0.25) were similar. Early nonoperative management with TEVAR for BAIs is a feasible and effective management strategy. Improved patient outcomes over traditional open thoracotomy in the presence of similar injury severity can be seen after TEVAR in the nonuniversity hospital setting.
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Affiliation(s)
- David A. Klima
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Erin M. Hanna
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - A. Britton Christmas
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Toan T. Huynh
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kristina E. Etson
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Brett A. Fair
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John M. Green
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Jeko Madjarov
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Ronald F. Sing
- From the F.H. “Sammy” Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Ross SW, Lauer CW, Miles WS, Green JM, Christmas AB, May AK, Matthews BD. Maximizing the Calm before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19). J Am Coll Surg 2020; 230:1080-1091.e3. [PMID: 32240770 PMCID: PMC7128345 DOI: 10.1016/j.jamcollsurg.2020.03.019] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 01/16/2023]
Abstract
The novel coronavirus (COVID-19) was first diagnosed in Wuhan, China in December 2019 and has now spread throughout the world, being verified by the World Health Organization as a pandemic on March 11. This had led to the calling of a national emergency on March 13 in the US. Many hospitals, healthcare networks, and specifically, departments of surgery, are asking the same questions about how to cope and plan for surge capacity, personnel attrition, novel infrastructure utilization, and resource exhaustion. Herein, we present a tiered plan for surgical department planning based on incident command levels. This includes acute care surgeon deployment (given their critical care training and vertically integrated position in the hospital), recommended infrastructure and transfer utilization, triage principles, and faculty, resident, and advanced care practitioner deployment.
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Affiliation(s)
- Samuel Wade Ross
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC.
| | - Cynthia W Lauer
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - William S Miles
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - John M Green
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - A Britton Christmas
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Addison K May
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Brent D Matthews
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
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14
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Jarman BT, Borgert AJ, Kallies KJ, Joshi ART, Smink DS, Sarosi GA, Chang L, Green JM, Greenberg JA, Melcher ML, Nfonsam V, Whiting J. Underrepresented Minorities in General Surgery Residency: Analysis of Interviewed Applicants, Residents, and Core Teaching Faculty. J Am Coll Surg 2020; 231:54-58. [PMID: 32156654 DOI: 10.1016/j.jamcollsurg.2020.02.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) requires diversity in residency. The self-identified race/ethnicities of general surgery applicants, residents, and core teaching faculty were assessed to evaluate underrepresented minority (URM) representation in surgery residency programs and to determine the impact of URM faculty and residents on URM applicants' selection for interview or match. STUDY DESIGN Data from the 2018 application cycle were collated for 10 general surgery programs. Applicants without a self-identified race/ethnicity were excluded. URMs were defined as those identifying as black/African American, Hispanic/Latino/of Spanish origin, and American Indian/Alaskan Native/Native Hawaiian/Pacific Islander-Samoan. Statistical analyses included chi-square tests and a multivariate model. RESULTS Ten surgery residency programs received 9,143 applications from 3,067 unique applicants. Applications from white, Asian, Hispanic/Latino, black/African American, and American Indian applicants constituted 66%, 19%, 8%, 7% and 1%, respectively, of those applications selected to interview and 66%, 13%, 11%, 8%, and 2%, respectively, of applications resulting in a match. Among programs' 272 core faculty and 318 current residents, 10% and 21%, respectively, were identified as URMs. As faculty diversity increased, there was no difference in selection to interview for URM (odds ratio [OR] 0.83; 95% CI 0.54 to 1.28, per 10% increase in faculty diversity) or non-URM applicants (OR 0.68; 95% CI 0.57 to 0.81). Similarly, greater URM representation among current residents did not affect the likelihood of being selected for an interview for URM (OR 1.20; 95%CI 0.90 to 1.61) vs non-URM applicants (OR 1.28; 95% CI 1.13 to 1.45). Current resident and faculty URM representation was correlated (r = 0.8; p = 0.005). CONCLUSIONS Programs with a greater proportion of URM core faculty or residents did not select a greater proportion of URM applicants for interview. However, core faculty and resident racial diversity were correlated. Recruitment of racially/ethnically diverse trainees and faculty will require ongoing analysis to develop effective recruitment strategies.
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Affiliation(s)
- Benjamin T Jarman
- Department of General Surgery, Gundersen Health System, La Crosse, WI.
| | - Andrew J Borgert
- Department of Medical Research, Gundersen Health System, La Crosse, WI
| | - Kara J Kallies
- Department of Medical Research, Gundersen Health System, La Crosse, WI
| | - Amit R T Joshi
- Department of Surgery, Einstein Healthcare Network, Philadelphia, PA
| | - Douglas S Smink
- Department of Surgery, Brigham & Women's Hospital, Boston, MA
| | - George A Sarosi
- Department of Surgery, University of Florida, Gainesville, FL
| | - Lily Chang
- Department of General Surgery, Virginia Mason Medical Center, Seattle, WA
| | - John M Green
- Department of General Surgery, Carolinas HealthCare System, Charlotte, NC
| | - Jacob A Greenberg
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Marc L Melcher
- Department of Surgery, Stanford University, Stanford, CA
| | | | - James Whiting
- Department of Surgery, Maine Medical Center, Portland, ME
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15
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Jarman BT, Kallies KJ, Joshi ART, Smink DS, Sarosi GA, Chang L, Green JM, Greenberg JA, Melcher ML, Nfonsam V, Ramirez LD, Borgert AJ, Whiting J. Underrepresented Minorities are Underrepresented Among General Surgery Applicants Selected to Interview. J Surg Educ 2019; 76:e15-e23. [PMID: 31175064 DOI: 10.1016/j.jsurg.2019.05.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Diversity is an ill-defined entity in general surgery training. The Accreditation Council for Graduate Medical Education recently proposed new common program requirements including verbiage requiring diversity in residency. "Recruiting" for diversity can be challenging within the constraints of geographic preference, type of program, and applicant qualifications. In addition, the Match process adds further uncertainty. We sought to study the self-identified racial/ethnic distribution of general surgery applicants to better ascertain the characteristics of underrepresented minorities (URM) within the general surgery applicant pool. DESIGN Program-specific data from the Electronic Residency Application Service was collated for the 2018 medical student application cycle. Data were abstracted for all participating programs' applicants and those selected to interview. Applicants who did not enter a self-identified race/ethnicity were excluded from analysis. URM were defined as those identifying as Black/African American, Hispanic/Latino/of Spanish origin, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander-Samoan. Appropriate statistical analyses were accomplished. SETTING Ten general surgery residency programs-5 independent programs and 5 university programs. PARTICIPANTS Residency applicants to the participating general surgery residency programs. RESULTS Ten surgery residency programs received 10,312 applications from 3192 unique applicants. Seven hundred and seventy-eight applications did not include a self-identified race/ethnicity and were excluded from analysis. The racial/ethnic makeup of applicants in this study cohort was similar to that from 2017 to 2018 Electronic Residency Application Service data of 4262 total applicants to categorical general surgery. Programs received a median of 1085 (range: 485-1264) applications each and altogether selected 617 unique applicants for interviews. Overall, 2148 applicants graduated from US medical schools, and of those, 595 (28%) were offered interviews. The mean age of applicants was 28.8 ± 3.8 years and 1316 (41%) were female. Hispanic/Latino/of Spanish origin, Black, and American Indian/Alaskan Native/Hawaiian/Pacific Islander-Samoan applicants constituted 12%, 8%, and 1% of total applicants, but only 8%, 6%, and 1% of those selected for interview. Overall, 29% of applicants had United States Medical Licensing Examination (USMLE) Step 1 scores ≤220; 37 (6%) of those selected for interviews had a USMLE Step 1 score of ≤220. A higher proportion of URM applicants had USMLE scores ≤220 compared to White and Asian applicants. Non-white self-identification was a significant independent predictor of a lower likelihood of interview selection. Female gender, USMLE Step 1 score >220, and graduating from a US medical school were associated with an increased likelihood of being selected to interview. CONCLUSIONS URM applicants represented a disproportionately smaller percentage of applicants selected for interview. USMLE Step 1 scores were lower among the URM applicants. Training programs that use discreet USMLE cutoffs are likely excluding URM at a higher rate than their non-URM applicants. Attempts to recruit racially/ethnically diverse trainees should include program-level analysis to determine disparities and a focused strategy to interview applicants who might be overlooked by conventional screening tools.
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Affiliation(s)
- Benjamin T Jarman
- Gundersen Health System and Gundersen Medical Foundation, La Crosse, Wisconsin.
| | - Kara J Kallies
- Gundersen Health System and Gundersen Medical Foundation, La Crosse, Wisconsin
| | | | | | | | - Lily Chang
- Virginia Mason Medical Center, Seattle, Washington
| | - John M Green
- Carolinas Medical Center, Charlotte, North Carolina
| | | | | | | | - Luis D Ramirez
- Gundersen Health System and Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Andrew J Borgert
- Gundersen Health System and Gundersen Medical Foundation, La Crosse, Wisconsin
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Williford ML, Scarlet S, Meyers MO, Luckett DJ, Fine JP, Goettler CE, Green JM, Clancy TV, Hildreth AN, Meltzer-Brody SE, Farrell TM. Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training. JAMA Surg 2019; 153:705-711. [PMID: 29800976 DOI: 10.1001/jamasurg.2018.0974] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Prior studies demonstrate a high prevalence of burnout and depression among surgeons. Limited data exist regarding how these conditions are perceived by the surgical community. Objectives To measure prevalence of burnout and depression among general surgery trainees and to characterize how residents and attendings perceive these conditions. Design, Setting, and Participants This cross-sectional study used unique, anonymous surveys for residents and attendings that were administered via a web-based platform from November 1, 2016, through March 31, 2017. All residents and attendings in the 6 general surgery training programs in North Carolina were invited to participate. Main Outcomes and Measures The prevalence of burnout and depression among residents was assessed using validated tools. Burnout was defined by high emotional exhaustion or depersonalization on the Maslach Burnout Inventory. Depression was defined by a score of 10 or greater on the Patient Health Questionnaire-9. Linear and logistic regression models were used to assess predictive factors for burnout and depression. Residents' and attendings' perceptions of these conditions were analyzed for significant similarities and differences. Results In this study, a total of 92 residents and 55 attendings responded. Fifty-eight of 77 residents with complete responses (75%) met criteria for burnout, and 30 of 76 (39%) met criteria for depression. Of those with burnout, 28 of 58 (48%) were at elevated risk of depression (P = .03). Nine of 77 residents (12%) had suicidal ideation in the past 2 weeks. Most residents (40 of 76 [53%]) correctly estimated that more than 50% of residents had burnout, whereas only 13 of 56 attendings (23%) correctly estimated this prevalence (P < .001). Forty-two of 83 residents (51%) and 42 of 56 attendings (75%) underestimated the true prevalence of depression (P = .002). Sixty-six of 73 residents (90%) and 40 of 51 attendings (78%) identified the same top 3 barriers to seeking care for burnout: inability to take time off to seek treatment, avoidance or denial of the problem, and negative stigma toward those seeking care. Conclusions and Relevance The prevalence of burnout and depression was high among general surgery residents in this study. Attendings and residents underestimated the prevalence of these conditions but acknowledged common barriers to seeking care. Discrepancies in actual and perceived levels of burnout and depression may hinder wellness interventions. Increasing understanding of these perceptions offers an opportunity to develop practical solutions.
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Affiliation(s)
| | - Sara Scarlet
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Daniel J Luckett
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Claudia E Goettler
- Department of Surgery, East Carolina Brody School of Medicine, Greenville, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Thomas V Clancy
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Amy N Hildreth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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17
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Green JM. How to handle a negative review on social media. CDS Rev 2017; 110:18. [PMID: 29461726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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18
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Green JM. Are you a problem solver? CDS Rev 2016; 109:20. [PMID: 29714842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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19
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Green JM. An Innovative, No-cost, Evidence-Based Smartphone Platform for Resident Evaluation. J Surg Educ 2016; 73:e14-e18. [PMID: 27651056 DOI: 10.1016/j.jsurg.2016.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/03/2016] [Accepted: 07/28/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Timely performance evaluation and feedback are critical to resident development. However, formulating and delivering this information disrupts physician workflow, leading to low participation. This study was designed to determine if a locally developed smartphone platform would integrate regular evaluation into daily processes and thus increase faculty participation in timely resident evaluation. METHODS Formal, documented resident operative and patient interaction evaluations were compiled over an 8-month study period. The study was divided into two 4-month phases. No changes to the existing evaluation methods were made during Phase 1. Phase 2 began after a washout period of 2 weeks and coincided with the launch of a smartphone-based platform. The platform uses a combination of Likert scale questions and the Dreyfus model of skill acquisition to describe competence levels in technical and nontechnical skills. The instrument inflicts minimal effect on surgeon workflow, with the aim of integrating resident evaluation into daily processes. The number of different faculty members performing evaluations, resident level (postgraduate year), type of interaction or procedure, and competency data were compiled. All evaluations were tracked by the program director as they were automatically uploaded into a database. Faculty members were introduced to the new platform at the beginning of Phase 2, and previous methods of evaluation continued to be encouraged and were considered valid throughout both phases of the study. Data were analyzed using Fisher exact test for specific PGY level, and chi-square test was used for overall program analysis. Statistical significance was set at p < 0.05. RESULTS Total faculty engagement, that is, number of faculty members completing evaluations, increased from 13% (5/38) in Phase 1 to 53% (20/38) in Phase 2. During Phase 1, all evaluations consisted of online forms through the department's established system or e-mails to the program director. Evaluations were completed in 0.9% (15/1599) of cases residents completed in Phase 1 versus 12% (217/1812) of those in Phase 2. During Phase 2, evaluations were conducted exclusively using the new platform. This was done based on participant's choice. Total numbers of residents and core faculty members did not change between Phases 1 and 2. CONCLUSIONS A smartphone-based platform can be created with existing technology at no cost. It is adaptable and can be updated in real-time and can employ validated scales to build an evaluation portfolio for learners assessing technical and nontechnical skills. Furthermore, and perhaps most importantly, it can be designed to integrate into existing workflow patterns to increase faculty participation.
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Affiliation(s)
- John M Green
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina.
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20
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Green JM. Failure to follow protocol is difficult to swallow. CDS Rev 2016; 109:26. [PMID: 29693836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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21
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Green JM. Dispelling five dento-legal myths. CDS Rev 2016; 109:24. [PMID: 29694744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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22
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Green JM. Be prepared for medical emergencies. CDS Rev 2016; 109:14. [PMID: 27451535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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23
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Green JM. Avoid creating a tangled web(site). CDS Rev 2016; 109:30. [PMID: 26951023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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24
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Green JM. Why take X-rays? CDS Rev 2015; 108:22. [PMID: 26591242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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25
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Pritchett RC, Al-Nawaiseh AM, Pritchett KK, Nethery V, Bishop PA, Green JM. Sweat gland density and response during high-intensity exercise in athletes with spinal cord injuries. Biol Sport 2015; 32:249-54. [PMID: 26424929 PMCID: PMC4577563 DOI: 10.5604/20831862.1163370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/17/2014] [Accepted: 01/08/2015] [Indexed: 11/13/2022] Open
Abstract
Sweat production is crucial for thermoregulation. However, sweating can be problematic for individuals with spinal cord injuries (SCI), as they display a blunting of sudomotor and vasomotor responses below the level of the injury. Sweat gland density and eccrine gland metabolism in SCI are not well understood. Consequently, this study examined sweat lactate (S-LA) (reflective of sweat gland metabolism), active sweat gland density (SGD), and sweat output per gland (S/G) in 7 SCI athletes and 8 able-bodied (AB) controls matched for arm ergometry VO2peak. A sweat collection device was positioned on the upper scapular and medial calf of each subject just prior to the beginning of the trial, with iodine sweat gland density patches positioned on the upper scapular and medial calf. Participants were tested on a ramp protocol (7 min per stage, 20 W increase per stage) in a common exercise environment (21±1°C, 45-65% relative humidity). An independent t-test revealed lower (p<0.05) SGD (upper scapular) for SCI (22.3 ±14.8 glands · cm(-2)) vs. AB. (41.0 ± 8.1 glands · cm(-2)). However, there was no significant difference for S/G between groups. S-LA was significantly greater (p<0.05) during the second exercise stage for SCI (11.5±10.9 mmol · l(-1)) vs. AB (26.8±11.07 mmol · l(-1)). These findings suggest that SCI athletes had less active sweat glands compared to the AB group, but the sweat response was similar (SLA, S/G) between AB and SCI athletes. The results suggest similar interglandular metabolic activity irrespective of overall sweat rate.
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Affiliation(s)
- R C Pritchett
- Department of Nutrition, Exercise and Health Science, Central Washington University, Ellensburg, WA, USA
| | - A M Al-Nawaiseh
- Department of Sport Rehabilitation, Hashemite University, Zarqa, Jordan
| | - K K Pritchett
- Department of Nutrition, Exercise and Health Science, Central Washington University, Ellensburg, WA, USA
| | - V Nethery
- Department of Nutrition, Exercise and Health Science, Central Washington University, Ellensburg, WA, USA
| | - P A Bishop
- Department of Kinesiology, University of Alabama, Tuscaloosa, USA
| | - J M Green
- Department of Health, Physical Education and Recreation, University of North Alabama, Florence, USA
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Sola R, Avery MJ, Fischer PE, Christmas AB, Green JM, Heniford BT, Sing RF. Bariatric Complications for the Acute Care Surgeon: Perforated Marginal Ulcer After a Roux-en-Y Gastric Bypass. Am Surg 2015; 81:E269-E270. [PMID: 26140872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Richard Sola
- Carolinas Medical Center, Charlotte, North Carolina, USA
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Sola R, Avery MJ, Fischer PE, Christmas AB, Green JM, Heniford BT, Sing RF. Bariatric Complications for the Acute Care Surgeon: Perforated Marginal Ulcer after a Roux-en-Y Gastric Bypass. Am Surg 2015. [DOI: 10.1177/000313481508100701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Sola
- Carolinas Medical Center Charlotte, North Carolina
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28
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Huntington CR, Strayer M, Huynh T, Green JM. A Multidisciplinary Approach to Improving SCIP Compliance. Am Surg 2015; 81:687-692. [PMID: 26140888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Surgical Care Improvement Project (SCIP) is a national program aimed at reducing perioperative complications and is a quality benchmark metric for Centers for Medicare and Medicaid Services. This study evaluates whether a multidisciplinary program improved an institution's compliance with SCIP measures. Analysis of the facility's performance data identified three key areas of SCIP noncompliance: 1) timely discontinuation of perioperative antibiotics and urinary catheters, 2) initiation of venous thromboembolism prophylaxis, and 3) perioperative beta blocker administration. Multidisciplinary teams collaborated with providers and department chairs in reviewing and enable SCIP compliance. Anesthesia staff managed preoperative antibiotics. SCIP-compliant order sets, venous thromboembolism pop-up alerts, and progress note templates were added to the electronic medical record. Standardized education was provided to explain SCIP requirements, review noncompliant cases, and update teams on SCIP performance. Data were captured from January 2009 to March 2014. Ten SCIP fallouts were reported for general surgery specialties in January 2013, when the SCIP compliance project launched. Specifically, colon-related surgery achieved 100 per cent compliance. Six months after implementation, overall SCIP compliance at our institution improved by 65 per cent (from 90.7-98.6% compliance).
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Affiliation(s)
- Ciara R Huntington
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
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Abstract
The Surgical Care Improvement Project (SCIP) is a national program aimed at reducing perioperative complications and is a quality benchmark metric for Centers for Medicare and Medicaid Services. This study evaluates whether a multidisciplinary program improved an institution's compliance with SCIP measures. Analysis of the facility's performance data identified three key areas of SCIP noncompliance: 1) timely discontinuation of perioperative antibiotics and urinary catheters, 2) initiation of venous thromboembolism prophylaxis, and 3) perioperative beta blocker administration. Multidisciplinary teams collaborated with providers and department chairs in reviewing and enable SCIP compliance. Anesthesia staff managed preoperative antibiotics. SCIP-compliant order sets, venous thromboembolism pop-up alerts, and progress note templates were added to the electronic medical record. Standardized education was provided to explain SCIP requirements, review noncompliant cases, and update teams on SCIP performance. Data were captured from January 2009 to March 2014. Ten SCIP fallouts were reported for general surgery specialties in January 2013, when the SCIP compliance project launched. Specifically, colon-related surgery achieved 100 per cent compliance. Six months after implementation, overall SCIP compliance at our institution improved by 65 per cent (from 90.7–98.6% compliance).
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Affiliation(s)
| | - Melissa Strayer
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Toan Huynh
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John M. Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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30
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Zahn G, Hauck M, Pearson D, Green JM, Heffner AC. Major hemorrhage from hepatic laceration after cardiopulmonary resuscitation. Am J Emerg Med 2015; 33:991.e3-4. [DOI: 10.1016/j.ajem.2014.12.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022] Open
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31
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Green JM, Avery MJ, Sing RF. Safe Endovascular Retrieval of a Vena Cava Filter after Duodenal and Pancreatic Perforation and Associated Recurrent Pancreatitis. Am Surg 2015. [DOI: 10.1177/000313481508100501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John M. Green
- Carolinas Health Care System, Charlotte, North Carolina
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32
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Green JM. The post-op phone call is a good idea. CDS Rev 2015; 108:14. [PMID: 26058297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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33
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Green JM, Avery MJ, Sing RF. Safe endovascular retrieval of a vena cava filter after duodenal and pancreatic perforation and associated recurrent pancreatitis. Am Surg 2015; 81:E188-E189. [PMID: 25975304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- John M Green
- Carolinas Health Care System, Charlotte, North Carolina, USA
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34
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Wormer BA, Colavita PD, Yokeley WT, Bradley JF, Williams KB, Walters AL, Green JM, Heniford BT. Impact of Implementing an Electronic Health Record on Surgical Resident Work Flow, Duty Hours, and Operative Experience. Am Surg 2015. [DOI: 10.1177/000313481508100230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our objective was to assess the effect of implementing an electronic health record (EHR) on surgical resident work flow, duty hours, and operative experience at a large teaching hospital. In May 2012, an EHR was put into effect at our institution replacing paper documentation and orders. Resident time to complete patient documentation, average duty hours, and operative experience before EHR and afterward (at 1, 4, 6, 8, and 24 weeks) were surveyed. We obtained 100 per cent response rate from 15 surgical residents at all time intervals. The average time spent documenting before EHR was 9 ± 2 minutes per patient document and at Weeks 1, 4, 6, 8, and 24 after EHR implementation was 22 ± 10, 15 ± 7, 15 ± 7, 14 ± 8, and 12 ± 4 minutes, respectively. Repeated measures analysis of variance demonstrated a difference among the means ( P < 0.0001). Discharge summary and operative note remained significantly longer to complete at Week 24 compared with paper documentation ( P < 0.05). Average resident work hours and operative cases per week before EHR were 77 ± 5 hours and 12 ± 5 cases, respectively, which were similar at all time points after EHR implementation ( P > 0.05). At 24 weeks after EHR, 74 per cent of residents felt their risk of performing a medical error using electronic documentation and order entry was higher compared with paper charting and orders. Transition to EHR led to a significant doubling in resident time spent performing documentation for each patient. It improved over 6 months after implementation but never reached the pre-EHR baseline for operative notes and discharge summaries. Average resident work hours and case logs remained similar during this transition.
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Affiliation(s)
- Blair A. Wormer
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Paul D. Colavita
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - William T. Yokeley
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Joel F. Bradley
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | | | - Amanda L. Walters
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John M. Green
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B. Todd Heniford
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Wormer BA, Colavita PD, Yokeley WT, Bradley JF, Williams KB, Walters AL, Green JM, Heniford BT. Impact of implementing an electronic health record on surgical resident work flow, duty hours, and operative experience. Am Surg 2015; 81:172-177. [PMID: 25642880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Our objective was to assess the effect of implementing an electronic health record (EHR) on surgical resident work flow, duty hours, and operative experience at a large teaching hospital. In May 2012, an EHR was put into effect at our institution replacing paper documentation and orders. Resident time to complete patient documentation, average duty hours, and operative experience before EHR and afterward (at 1, 4, 6, 8, and 24 weeks) were surveyed. We obtained 100 per cent response rate from 15 surgical residents at all time intervals. The average time spent documenting before EHR was 9 ± 2 minutes per patient document and at Weeks 1, 4, 6, 8, and 24 after EHR implementation was 22 ± 10, 15 ± 7, 15 ± 7, 14 ± 8, and 12 ± 4 minutes, respectively. Repeated measures analysis of variance demonstrated a difference among the means (P < 0.0001). Discharge summary and operative note remained significantly longer to complete at Week 24 compared with paper documentation (P < 0.05). Average resident work hours and operative cases per week before EHR were 77 ± 5 hours and 12 ± 5 cases, respectively, which were similar at all time points after EHR implementation (P > 0.05). At 24 weeks after EHR, 74 per cent of residents felt their risk of performing a medical error using electronic documentation and order entry was higher compared with paper charting and orders. Transition to EHR led to a significant doubling in resident time spent performing documentation for each patient. It improved over 6 months after implementation but never reached the pre-EHR baseline for operative notes and discharge summaries. Average resident work hours and case logs remained similar during this transition.
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Affiliation(s)
- Blair A Wormer
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
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Green JM. To refund or not to refund? CDS Rev 2015; 108:32. [PMID: 26309950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Zhang Y, Carter SJ, Schumacker RE, Neggers YH, Curtner-Smith, MD, Richardson MT, Green JM, Bishop PA. Effect of caffeine ingestion on fluid balance during exercise in the heat and during recovery. S Afr J SM 2014. [DOI: 10.17159/2413-3108/2014/v26i2a395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background. The effect of ingestion of a common stimulant, caffeine, on fluid balance during exercise and recovery is not fully known. Objectives. To determine the effect of caffeine on fluid balance during exercise in the heat and during a 3-hour recovery period thereafter. Methods. In a randomised, controlled design, caffeine-naive participants (N=8) pedalled on a bike to achieve 2.5% baseline body mass loss in a hot environment in four separate conditions: with (C+) or without (C–) caffeine ingestion (6 mg/kg of body mass) prior to exercise, followed by (W+) or without (W–) 100% fluid replenishment (water) of the body mass loss during a 3-hour recovery period (yielding C+W+, C+W–, C–W+ and C–W–, respectively). Results. Mean (standard deviation) urine production was not different (p>0.05) regardless of rehydration status: 230 (162) mL (C+W–) v. 168 (77) mL (C–W–); and 713 (201) mL (C+W+) v. 634 (185) mL (C–W+). For the 3-hour recovery, caffeine ingestion caused higher hypohydration during rehydration conditions (p=0.02), but practically the mean difference in the loss of body mass was only 0.2 kg. Conclusion. In practical terms, there was no evidence that caffeine ingestion in moderation would impair fluid balance during prolonged exercise in the heat or during 3 hours of recovery.
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Ross SW, Oommen B, Kim M, Walters AL, Green JM, Heniford BT, Augenstein VA. A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair. Surg Endosc 2014; 28:3092-100. [PMID: 24902819 DOI: 10.1007/s00464-014-3586-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The purpose of this study was to analyze the effect of residents on patient outcomes in laparoscopic ventral hernia repair (LVHR).We hypothesized that increasing postgraduate year (PGY) level would correlate with better outcomes. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2011 for elective LVHR. Attending only cases were used as the control, and resident cases were stratified into junior (PGY 1-3), chief (4-5), and fellow (6+) cases. Standard statistical tests and multivariate regression controlling for age, body mass index, Charlson comorbidity index, smoking, functional status, and inpatient cases were performed for trainee involvement and PGY level. RESULTS There were 6,841 ventral hernia repairs that met inclusion criteria: 2,773 attending and 4,068 resident cases. There were 1,644 junior, 1,983 chief, and 441 fellow cases. Patients were similar between the attending and resident groups. The resident group had a higher rate of inpatient cases, general complications, longer operative time, and hospital length of stay. After controlling for confounders in multivariate analysis, only operative time was significantly different; resident cases were 17.7 min longer (CI 15.0-20.6; p < 0.001). There was no significant difference in the rate of wound or major complications, readmission, reoperation, or mortality between attending and resident cases. Demographics were not significantly different between the PGY level strata. On multivariate regression by PGY level with attending alone as the reference, only operative time was significantly different. Juniors (15.7 min, CI 12.2-19.2), chiefs (18.0 min, CI 14.7-21.3), and fellows (24.9 min, CI 19.1-30.7) had significantly longer cases than attending alone; all p < 0.001. CONCLUSION Trainee involvement during LVHR does not change the clinical outcomes for patients as compared to those performed by an attending only. Operative time is significantly longer with increasing PGY level, perhaps indicating the complexity of the operation or increasing trainee involvement as primary surgeon. However, patient care does not suffer, affirming the current surgical training curriculum is appropriate.
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Affiliation(s)
- Samuel W Ross
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA,
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Stawicki SP, Green JM, Martin ND, Green RH, Cipolla J, Seamon MJ, Eiferman DS, Evans DC, Hazelton JP, Cook CH, Steinberg SM. Results of a prospective, randomized, controlled study of the use of carboxymethylcellulose sodium hyaluronate adhesion barrier in trauma open abdomens. Surgery 2014; 156:419-30. [PMID: 24962185 DOI: 10.1016/j.surg.2014.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/09/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The open abdominal (OA) approach is a management strategy used in the most severely injured trauma patients. In addition to the morbidity and mortality, a major challenge is the gradual development of dense adhesions that make reoperations progressively more difficult. This randomized, prospective, proof-of-concept study was conducted to determine the effect of carboxymethylcellulose sodium hyaluronate adhesion barrier (CMHAB; Seprafilm, Genzyme Biosurgery, Bridgewater, NJ) on abdominal adhesions and wound characteristics in trauma open abdomens. METHODS A prospective, randomized, controlled study of wound and adhesion characteristics with or without CMHAB was conducted at 5 level I trauma centers. Consenting patients were randomized to either CMHAB or no adhesion barrier (NAB) groups. We evaluated patient demographics, injury characteristics/severity, reason for OA management, wound sizes (transverse/longitudinal), Zuhlke adhesion score, abdominal contamination score, hospital/intensive care durations of stay, morbidity, and mortality. RESULTS Thirty patients were enrolled (17 randomized to CMHAB; 13 randomized to NAB) with mean age of 40.3, Injury Severity Score of 30, Abbreviated Injury Score (AIS)-abdomen of 3.68, APACHE II score of 14.4, and 67% blunt trauma mechanism. The groups were well-matched with regard to age, sex, Injury Severity Score/abdominal AIS, penetrating/blunt injury rates, initial lactate/base deficit, mortality, OA indications, and contamination scores. There were no differences in nonabdominal or abdominal complications (ie, fistula, abscess, wound related) between the groups. Patients with CMHAB had shorter intensive care unit durations of stay (15 vs 22 days; P < .05). Intraoperative adhesion scores were not different during the first four operations but diverged significantly at the 5th operative intervention or after about 1 week of OA therapy. After the 5th operation, adhesion scores in the NAB group were 67% greater (approximately 1 Zuhlke point) than the CMHAB group. We did not note differences between wound sizes over time, closure types, or wound closure characteristics between CMHAB and NAB. CONCLUSION Although CMHAB did not eliminate adhesions in this proof-of-concept study, it limited their severity, particularly in abdomens left open >9 days or requiring ≥5 operations. There was no difference in wound sizes, overall or abdominal complications, or mortality between the groups. Further research is warranted to better delineate potential benefits of CMHAB, especially in the setting of reoperations in post-OA patients.
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Affiliation(s)
- Stanislaw P Stawicki
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH.
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Niels D Martin
- Thomas Jefferson University and the University of Pennsylvania, Philadelphia, PA
| | - Raymond H Green
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | | | - Mark J Seamon
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Daniel S Eiferman
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - David C Evans
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | | | - Charles H Cook
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Steven M Steinberg
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
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Green JM, Biehal N, Roberts C, Dixon J, Kay C, Parry E, Rothwell J, Roby A, Kapadia D, Scott S, Sinclair I. Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation. Br J Psychiatry 2014; 204:214-21. [PMID: 24357575 DOI: 10.1192/bjp.bp.113.131466] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children in care often have poor outcomes. There is a lack of evaluative research into intervention options. AIMS To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England. METHOD A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending. RESULTS The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour. CONCLUSIONS There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.
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Affiliation(s)
- J M Green
- J. M. Green, BA, MA, MBBS, DCH, FRCPsych, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; N. Biehal, BA, MA, PhD, Department of Social Policy and Social Work, University of York, York; C. Roberts, BSc, MSc, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, BA, MA, Social Policy Research Unit (SPRU), University of York, York; C. Kay, BSc, PhD, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; E. Parry, BA, MSc, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, BSc, PhD, A. Roby, BSc, MSc, ClinPsyD, D. Kapadia, BSc, MSc, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; S. Scott, MB BChir, FRCP, FRCPsych, Institute of Psychiatry, King's College London, London; I. Sinclair, BA, PhD, Social Policy Research Unit (SPRU), University of York, York, UK
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Fischer PE, Nunn AM, Wormer BA, Christmas AB, Gibeault LA, Green JM, Sing RF. Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries. Am J Surg 2013; 206:900-3. [DOI: 10.1016/j.amjsurg.2013.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/14/2013] [Accepted: 07/14/2013] [Indexed: 11/26/2022]
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Green JM. Poor supervision of dental assistants can be a dangerous liability. CDS Rev 2013; 106:18. [PMID: 24558727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Stefanidis D, Yonce TC, Green JM, Coker AP. Cadavers versus pigs: which are better for procedural training of surgery residents outside the OR? Surgery 2013; 154:34-7. [PMID: 23809483 DOI: 10.1016/j.surg.2013.05.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 05/01/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Our objective was to compare the value of porcine versus cadaveric models for procedural training of general surgery residents outside the operating room (OR). METHODS Two procedural workshops for general surgery residents based on the American College of Surgeons/Association of Program Directors in Surgery national skills curriculum were administered. During each workshop, 7 surgery faculty taught 16 residents level-appropriate operative procedures on 4 training models (2 cadaver torsos; 2 pigs). Participants compared the 2 models at the end of the workshops using a 10-point Likert scale and indicated their training model preference. Ratings were compared using a paired t test. RESULTS Among the 39 participants (9 faculty and 30 residents) who provided ratings, the porcine models were rated lower for anatomic relevance (6.8 ± 2.1 vs 9.1 ± 1.5; P < .01) but higher for tissue handling (8.4 ± 1.3 vs 7.2 ± 2.0; P < .01) and ability to dissect/identify planes (8.6 ± 1.2 vs 6.7 ± 2.4; P < .01) compared with the cadavers. There were no differences in perceived similarity to live patient surgery and overall value of the 2 models for training (7.2 ± 2.2 vs 6.9 ± 2.5 and 8.5 ± 1.6 vs 8.5 ± 1.5, respectively). There were no differences between resident and faculty ratings. Eight (20%) participants preferred the porcine model for training, 5 (13%) the cadaveric model, 16 (41%) both, and 10 (26%) indicated differences in preference based on operative procedure. Participants rated highly the overall quality and value of these procedural workshops for their learning (8.4 ± 1.1). CONCLUSION Based on resident and faculty evaluations, both porcine and cadaveric models are deemed necessary and valuable for procedural training outside the OR. Such skills workshops should be incorporated into the surgical curriculum.
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Green JM. A dentist's guide to the National Practitioner Data Bank. CDS Rev 2013; 106:14. [PMID: 24283022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Green JM. If you offer Botox, don't skimp on training. CDS Rev 2013; 106:16. [PMID: 23980341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Klima DA, Hanna EM, Christmas AB, Huynh TT, Etson KE, Fair BA, Green JM, Madjarov J, Sing RF. Endovascular graft repair for blunt traumatic disruption of the thoracic aorta: experience at a nonuniversity hospital. Am Surg 2013; 79:594-600. [PMID: 23711269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Blunt thoracic aortic injury (BAI) represents the second leading cause of death from blunt trauma. Admission rates for BAI are extremely low because instant fatality occurs in nearly 75 per cent of patients. Management strategies have transitioned from the more invasive immediate thoracotomy to delayed endograft repair with strict hemodynamic management. In this study, we assess outcomes and complications of open versus endograft repair for BAI at a nonuniversity hospital. Retrospective chart review was conducted on 49 patients admitted to a Level I trauma center who incurred BAI from 2004 to 2011. Collected data points included demographics, mortality, complication rates, and intensive care unit and hospital length of stay (LOS). Twenty-one patients underwent open thoracotomy (OPEN), whereas 28 patients were managed with thoracic endovascular aortic repair (TEVAR). The overall 30-day mortality rate was significantly lower comparing TEVAR to OPEN (7.1 vs 50%, P = 0.028); seven deaths occurred in the OPEN group versus two with TEVAR. Overall complications, including mortality, acute respiratory distress syndrome, renal failure, pneumonia, pulmonary embolism, and cardiac arrest, were fewer after TEVAR (32.1 vs 81.0%, P < 0.001) despite similar injury severity. Survivor hospital LOS (26.0 ± 15.3 vs 27.7 ± 18.7 days, P = 0.79), intensive care unit LOS (13.5 ± 10.9 vs 12.7 ± 8.8 days, P = 0.94), and ventilator days (11.4 ± 13.4 vs 16.4 ± 14.5 days, P = 0.25) were similar. Early nonoperative management with TEVAR for BAIs is a feasible and effective management strategy. Improved patient outcomes over traditional open thoracotomy in the presence of similar injury severity can be seen after TEVAR in the nonuniversity hospital setting.
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Affiliation(s)
- David A Klima
- F.H. Sammy Ross, Jr. Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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Green JM. Scandal is painful reminder to practice safely. CDS Rev 2013; 106:16. [PMID: 23829046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Green JM. To be or not to be an owner. CDS Rev 2013; 106:26-27. [PMID: 23691765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Green JM. Don't be numb; do the right thing. CDS Rev 2013; 106:28. [PMID: 23437594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Green JM. What is a dentist's duty? CDS Rev 2012; 105:16-17. [PMID: 23477045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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