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Ma AC, Hu J, Zheng E, Levine JS, Schwaitzberg SD, Guo WA. The Changing Faces of Leadership in Surgery: Study on Presidents of Major Surgical Organizations. J Surg Res 2024; 295:340-349. [PMID: 38061239 DOI: 10.1016/j.jss.2023.11.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION To gain an understanding of the changing faces of leadership in surgery, we examined trends in the demographics, additional degrees pursued, and scientific publication characteristics of the past presidents of three major surgery organizations. METHODS We queried the BoardCertifiedDocs and Web of Science databases for the demographics, as well as the quantity and quality of publications, of the past presidents of the Association for Academic Surgery, Society of University Surgeons, and American College of Surgeons from 1970 to 2020. Data were analyzed by decade to identify any trends. RESULTS We identified a total of 140 presidents from the organizations. The proportion of female presidents significantly increased from the 1990s to the 2010s (10% versus 33%, P < 0.05). The percentage of non-White presidents increased from the 1970s to the 2010s (3.33% versus 21.2%, P = 0.024). The percentage of presidents with additional degrees also increased from the 1970s to the 2010s (10.0% versus 48.8%, P = 0.039). During this same time period, the most common area of expertise of presidents shifted from cardiothoracic surgery to surgical oncology. The ratio of presidents' postinduction to preinduction publications was significantly increased among all three organizations in the 2010s compared to the 1970s (P < 0.05). Co-cluster analysis revealed a research topic change from the 1970s to the 2010s. CONCLUSIONS The faces of surgical leadership have changed in terms of gender equality, racial diversity, surgical subspecialty, and additional degrees held. Such a transformation mirrors evolving diversity, equity, and inclusion initiatives, and it further highlights the adaptability of surgical leadership to the ever-changing landscape of surgery.
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Affiliation(s)
- Alison C Ma
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Jinwei Hu
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Erika Zheng
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Jordan S Levine
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Steven D Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Weidun Alan Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
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Kelly WH, Narvaez JRF, Hu J, Zhao JY, Pugh J, Panesar M, Guo WA. Triumph over adversity: Unlocking optimal trauma outcomes during healthcare ransomware attacks. Injury 2023; 54:111046. [PMID: 37826882 DOI: 10.1016/j.injury.2023.111046] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Affiliation(s)
- William H Kelly
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - J Reinier F Narvaez
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Jinwei Hu
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; Department of Biomedical Informatics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Jane Y Zhao
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; Department of Biomedical Informatics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Jennifer Pugh
- Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Mandip Panesar
- Department of Biomedical Informatics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Weidun Alan Guo
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States.
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F Narvaez JR, Cooper C, Brewer JJ, Schwaitzberg SD, Guo WA. Do We "Do No Harm" in the Management of Acute Cholecystitis in COVID-19 Patients? Am Surg 2020; 86:748-750. [PMID: 32683947 DOI: 10.1177/0003134820939881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- J Reinier F Narvaez
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Clairice Cooper
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Jeffrey J Brewer
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Steven D Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
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Ernst M, Sherman A, Danforth T, Guo WA. Lower urinary tract injury: is urology consultation necessary? Int Urol Nephrol 2019; 52:489-494. [PMID: 31677053 DOI: 10.1007/s11255-019-02326-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/25/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE There is a paucity of data regarding urology involvement in the management of lower urinary tract injuries (LUTI). We seek to analyze the incidence and epidemiology of LUTI with special attention to trends in urology consultation. METHODS A retrospective review was conducted of patients presenting to our Level I trauma center with LUTI from 2002 to 2016. Demographics, mechanism of injury, associated injuries, injury severity score (ISS), American Association for the Surgery of Trauma (AAST) injury scales, and clinical hospital course were analyzed. RESULTS A total of 140 patients (0.47% of all trauma patients) were identified with LUTI, with 72.1% of these presenting with blunt trauma. Bladder injuries were more common than urethral injuries (79% vs. 14%) with 6% of patients having both. In-hospital mortality was 9.2% (13/140). Among patients with LUTI, 115 patients (82%) received urology consultation. There was no significant difference in sex, age, or LOS (hospital and ICU) between the groups. The consult group had a lower mean ISS (21.7 vs 27.9, p = 0.034), but a higher mean AAST bladder injury scale (2.57 vs 2.00, p = 0.016), than the non-consult group. There was a statistically significant difference in the diagnosis methods between the two groups (χ2 test of independence, p = 0.002). CONCLUSION Urology service is important in the management of LUTI with high AAST injury scale. While further study is needed to look at degree of urology service involvement in the management of LUTI, we recommend a consultation for severe LUTI or when the management of injuries is out of the comfort zone of the trauma surgeons. Whether consultation is obtained or not, there is room for improvement in appropriate work up of lower urinary tract injury.
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Affiliation(s)
- Michael Ernst
- Department of Urology, University at Buffalo, C/o Wendy Scales, 100 High Street, Buffalo, NY, 14203, USA.
| | - Amanda Sherman
- Department of Urology, University at Buffalo, C/o Wendy Scales, 100 High Street, Buffalo, NY, 14203, USA
| | - Teresa Danforth
- Department of Urology, University at Buffalo, C/o Wendy Scales, 100 High Street, Buffalo, NY, 14203, USA
| | - Weidun Alan Guo
- Department of Surgery, University at Buffalo, 462 Grider St - ECMC, Buffalo, NY, 14215, USA
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Zhao JY, Kessler EG, Yu J, Jalal K, Cooper CA, Brewer JJ, Schwaitzberg SD, Guo WA. Impact of Trauma Hospital Ransomware Attack on Surgical Residency Training. J Surg Res 2018; 232:389-397. [PMID: 30463746 DOI: 10.1016/j.jss.2018.06.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/01/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A recent ransomware attack led to the shutdown of the electronic health information system (HIS) at our trauma center for 2 mo. We investigated its impact on residency training during the downtime. MATERIAL AND METHODS General and orthopedic surgical residents who rotated at the hospital were invited to participate in a survey regarding their patient care and residency training experiences during the downtime. Attending surgeons from both the specialties were invited to participate in a semistructured interview regarding their attitude toward residency training during the downtime. RESULTS Twenty-nine residents responded to the survey with a response rate of 78.4%. Residents acknowledged significant increases in face-to-face communication and decreases in use of online educational resources during the downtime (P < 0.01). Residents were significantly stressed by the dearth of online resources (P < 0.0001) and by paper-based orders and outpatient clinic (P < 0.05). A multivariate analysis demonstrated an inverse relationship between postgraduate year and stress from paper orders (P = 0.003). Attending surgeon's interviews revealed that they recognized residents' unpreparedness and strove harder to teach more effectively. CONCLUSIONS Our study demonstrated that an unexpected shutdown of the hospital HIS imposed significant stress upon surgical residents providing trauma patient care and made attending surgeons take greater efforts to be more effective teachers. Residents who are digital natives lack adaptability to handle a paper-based workflow. With cyber security threats increasing in health care, preparedness should be included in the graduate medical education curriculum.
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Affiliation(s)
- Jane Y Zhao
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Evan G Kessler
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York
| | - Jihnhee Yu
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York
| | - Kabir Jalal
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York
| | - Clairice A Cooper
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Jeffrey J Brewer
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Steven D Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Weidun Alan Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.
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Abstract
In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one's competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team-building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work-life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.
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Affiliation(s)
- Anthony D Turner
- Department of Surgery, SUNY-Buffalo, Buffalo, NY, USA.,Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Stanislaw P Stawicki
- Department of Research and Innovation, St Luke's University Health Network, Bethlehem, PA, USA
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Vargas-Pinto S, Lesh CD, Kayler LK, Guo WA. Cecal volvulus with necrosis following deceased-donor renal transplantation. Trauma Surg Acute Care Open 2018; 2:e000123. [PMID: 29766114 PMCID: PMC5887773 DOI: 10.1136/tsaco-2017-000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/22/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Susana Vargas-Pinto
- Department of Surgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Caitlyn D Lesh
- Department of Surgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Liise K Kayler
- Department of Surgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Weidun Alan Guo
- Department of Surgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Strollo BP, Bennett GJ, Chopko MS, Guo WA. Timing of venous thromboembolism chemoprophylaxis after traumatic brain injury. J Crit Care 2018; 43:75-80. [DOI: 10.1016/j.jcrc.2017.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
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Cho EE, Bevilacqua E, Brewer J, Hassett J, Guo WA. Variation in the Practice of Central Venous Catheter and Chest Tube Insertions among Surgery Residents. J Emerg Trauma Shock 2018; 11:47-52. [PMID: 29628669 PMCID: PMC5852917 DOI: 10.4103/jets.jets_124_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives Central venous catheter (CVC) and chest tube (CT) insertions are common bedside procedures frequently performed by surgery residents. Despite published guidelines, variability in the practice exists. We sought to characterize the surgery residents' practice patterns surrounding these two bedside procedures. Materials and Methods Over the last 1½ months of the academic year in 2012 and 2013, surgery residents across the US were surveyed online. Participants reported levels of agreement for 15 questions in a 5-point Likert scale format. Results A total of 219 residents completed the survey. Majority of residents agreed that they received appropriate education and training. Over half of the respondents reported that they did not have attending staff physician's supervision during the procedures. Junior residents felt less confident in performing CVC or CT insertions. Those younger than 29 years old and of female sex were also less confident in performing CT insertion. Although almost all residents reported using maximal sterile barrier precautions, 7% reported not securing their gowns and another 7% reported inadequate draping of patients. About ⅓ reported no hand cleansing before the procedures. Those from community programs compared to university programs less frequently used antibiotics. Sixty-five percent of residents reported routine use of ultrasound for CVC insertion. Conclusion Surgery residents do not strictly adhere to the guidelines for CVC and CT insertions, and there is substantial variation in the practice of the procedures, which may contribute to complications associated with these procedures. This survey opens new areas for in-service education, feedback, and practices for these procedures to reduce the risk of complications, especially the infectious one.
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Affiliation(s)
- Edward Eun Cho
- Department of Surgery, SUNY, Buffalo, New York 14215, USA
| | | | - Jeffrey Brewer
- Department of Surgery, SUNY, Buffalo, New York 14215, USA
| | - James Hassett
- Department of Surgery, SUNY, Buffalo, New York 14215, USA
| | - Weidun Alan Guo
- Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, SUNY, Buffalo, New York 14215, USA
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Abstract
OBJECTIVES Traumatic cardiac arrest (TCA) represents a unique problem, and poses difficult challenges in the care of trauma patients. Although the literature has suggested that attempted resuscitation from TCA in trauma is futile and consumptive of medical and human resources, studies have recently demonstrated that the outcome of TCA is comparable cardiac arrest secondary to non-traumatic events. The objective of this study was to determine the incidence, predictors, and outcomes following TCA. METHODS We retrospectively reviewed 124 adult patients with TCA over a period of 5 years (July 2010 to June 2014). Cardiopulmonary resuscitation (CPR) occurred either in the field, en route, or in the emergency department at our Level I Trauma Center. Patients' demographics, clinical data, CPR-related variables, and outcomes were extracted from both the electronic and paper medical records. RESULTS The median age of the group was 37 (IQR 38), and the median ISS was 37 (IQR 50). The most common cardiac rhythm observed was pulseless electrical activity (PEA, 55%). While 31.4% of patients achieved a return of spontaneous circulation (ROSC), only 7.3% survived with a complete neurological recovery (CNR). In blunt injury patients, the mortality rate after CPR was higher in motor-vehicle-related injuries than falls from heights (93.1 vs 72.3%, OR 5.06, 95% CI 0.95-27.0, p < 0.05). In penetrating injuries, the mortality rate after CPR was higher in patients with trauma to the torsos than those suffering injuries to the head, neck, face, and extremities combined (100 vs 81.3%, OR 0.049, 95% CI 0.0024-1.008, p < 0.001). Two variables predicted failure of CPR were prolonged time interval hospital transport (OR 0.42, 95% CI 0.22-0.80, p < 0.01) and high injury severity score (OR 0.97, 95% CI 0.94-1.00, p < 0.05). However, CPR duration/location (out-of-hospital or in-hospital), head injury, and day/night shifts in ED were not associated with the above outcome. When comparing age groups, the mortality was significantly higher in patients < 65 years than those ≥ 65 years (OR 0.2619, 95% CI 0.09485-0.9703, p = 0.0182). CONCLUSION Although survival after CPR among trauma patients continues to have dismal outcomes, advanced cardiac life support should be initiated regardless of the initial EKG rhythm. Ultimately, both a rapid response time and transport to the ED are of the utmost importance to survival.
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Affiliation(s)
- Katie L Konesky
- Department of Surgery, SUNY, ECMC, D.K. Miller Building, 462 Grider St, Buffalo, NY, 14215, USA
| | - Weidun Alan Guo
- Department of Surgery, SUNY, ECMC, D.K. Miller Building, 462 Grider St, Buffalo, NY, 14215, USA.
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Garg M, Peck GL, Arquilla B, Miller AC, Soghoian SE, Anderson Iii HL, Bloem C, Firstenberg MS, Galwankar SC, Guo WA, Izurieta R, Krebs E, Hansoti B, Nanda S, Nwachuku CO, Nwomeh B, Paladino L, Papadimos TJ, Sharpe RP, Swaroop M, Stawicki SP. A Comprehensive Framework for International Medical Programs: A 2017 consensus statement from the American College of Academic International Medicine. Int J Crit Illn Inj Sci 2017; 7:188-200. [PMID: 29291171 PMCID: PMC5737060 DOI: 10.4103/ijciis.ijciis_65_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The American College of Academic International Medicine (ACAIM) represents a group of clinicians who seek to promote clinical, educational, and scientific collaboration in the area of Academic International Medicine (AIM) to address health care disparities and improve patient care and outcomes globally. Significant health care delivery and quality gaps persist between high-income countries (HICs) and low-and-middle-income countries (LMICs). International Medical Programs (IMPs) are an important mechanism for addressing these inequalities. IMPs are international partnerships that primarily use education and training-based interventions to build sustainable clinical capacity. Within this overall context, a comprehensive framework for IMPs (CFIMPs) is needed to assist HICs and LMICs navigate the development of IMPs. The aim of this consensus statement is to highlight best practices and engage the global community in ACAIM's mission. Through this work, we highlight key aspects of IMPs including: (1) the structure; (2) core principles for successful and ethical development; (3) information technology; (4) medical education and training; (5) research and scientific investigation; and (6) program durability. The ultimate goal of current initiatives is to create a foundation upon which ACAIM and other organizations can begin to formalize a truly global network of clinical education/training and care delivery sites, with long-term sustainability as the primary pillar of international inter-institutional collaborations.
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Affiliation(s)
- Manish Garg
- Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Gregory L Peck
- Rutgers: Robert Wood Johnson Medical School, New Brunswick, United States of America
| | - Bonnie Arquilla
- Suny Downstate Medical Center, Brooklyn, United States of America
| | - Andrew C Miller
- East Carolina University, Greenville, NC, United States of America
| | | | | | - Christina Bloem
- Suny Downstate Medical Center, Brooklyn, United States of America
| | | | - Sagar C Galwankar
- University of Florida College of Medicine, Jacksonville, United States of America
| | - Weidun Alan Guo
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Ricardo Izurieta
- University of South Florida, Tampa, FL, United States of America
| | - Elizabeth Krebs
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - Bhakti Hansoti
- Johns Hopkins Medicine, Baltimore, MD, United States of America
| | - Sudip Nanda
- St. Luke's University Health Network, Bethlehem, PA, United States of America
| | - Chinenye O Nwachuku
- St. Luke's University Health Network, Bethlehem, PA, United States of America
| | - Benedict Nwomeh
- Nationwide Children's Hospital, Columbus, United States of America
| | - Lorenzo Paladino
- Suny Downstate Medical Center, Brooklyn, United States of America
| | - Thomas J Papadimos
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Richard P Sharpe
- Warren Hospital, St. Luke's University Health Network, Phillipsburg, NJ, United States of America
| | - Mamta Swaroop
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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Schmidt LE, Cooper CA, Guo WA. Factors influencing US medical students' decision to pursue surgery. J Surg Res 2016; 203:64-74. [PMID: 27338536 DOI: 10.1016/j.jss.2016.03.054] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/09/2016] [Accepted: 03/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. METHODS Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. RESULTS We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). CONCLUSIONS This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career.
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Knight PH, Maheshwari N, Hussain J, Scholl M, Hughes M, Papadimos TJ, Guo WA, Cipolla J, Stawicki SP, Latchana N. Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention. Int J Crit Illn Inj Sci 2016; 5:256-64. [PMID: 26807395 PMCID: PMC4705572 DOI: 10.4103/2229-5151.170840] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intrahospital transportation of critically ill patients is associated with significant complications. In order to reduce overall risk to the patient, such transports should well organized, efficient, and accompanied by the proper monitoring, equipment, and personnel. Protocols and guidelines for patient transfers should be utilized universally across all healthcare facilities. Care delivered during transport and at the site of diagnostic testing or procedure should be equivalent to the level of care provided in the originating environment. Here we review the most common problems encountered during transport in the hospital setting, including various associated adverse outcomes. Our objective is to make medical practitioners, nurses, and ancillary health care personnel more aware of the potential for various complications that may occur during patient movement from the intensive care unit to other locations within a healthcare facility, focusing on risk reduction and preventive strategies.
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Affiliation(s)
- Patrick H Knight
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Neelabh Maheshwari
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Jafar Hussain
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Michael Scholl
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Michael Hughes
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Weidun Alan Guo
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, The State University of New York (SUNY)-University at Buffalo, Buffalo, New York, USA
| | - James Cipolla
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Nicholas Latchana
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Fontenot AM, Malizia RA, Chopko MS, Flynn WJ, Lukan JK, Wiles CE, Guo WA. Revisiting endotracheal self-extubation in the surgical and trauma intensive care unit: Are they all fine? J Crit Care 2015; 30:1222-6. [PMID: 26271687 DOI: 10.1016/j.jcrc.2015.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/13/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Endotracheal self-extubation (ESE) is a serious health care concern. We designed this study to test our hypothesis that not all patients with ESE are successful in spontaneous breathing and reintubation has negative impact on outcomes. METHODS Data on all 39 patients of ESE in our surgical and trauma intensive care unit (ICU) in 2012 were prospectively collected and retrospectively analyzed. RESULTS There were 42 episodes of ESE in 39 of 939 intubated patients (frequency, 4.0%), with 54% of events requiring reintubation. Pre-ESE positive end-expiratory pressure was higher and Pao2/fraction of inspired oxygen ratio was lower, and the post-ESE respiration rate was higher in the reintubated group. On univariate analysis, weaning and spontaneous breathing trial before ESE were favorable predictors for nonreintubation. Multivariate regression analysis demonstrated that agitation before ESE was an independent predictor of reintubation. The need for reintubation was associated with increased risk of pulmonary infectious complications, ventilator days, the need for tracheostomy, and ICU and hospital LOS. The financial costs for ventilator days and ICU rooms were significantly higher in patients with reintubation. CONCLUSION Not all patients were fine after ESE. We have not decreased the frequency of ESE or improved outcomes if the patients were reintubated. The need for reintubation was not only associated with a high pulmonary complication rate but also prolonged duration on mechanical ventilation and hospital/ICU stay and increased the hospital costs.
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Affiliation(s)
- Ashleigh M Fontenot
- Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY
| | - Robert A Malizia
- Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY
| | - Michael S Chopko
- Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY
| | - William J Flynn
- Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY
| | - James K Lukan
- Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY
| | - Charles E Wiles
- Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY
| | - Weidun Alan Guo
- Division of Acute Care Surgery, Department of Surgery, SUNY-Buffalo, Buffalo, NY.
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Carter JW, Falco MH, Chopko MS, Flynn WJ, Wiles Iii CE, Guo WA. Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury 2015; 46:817-21. [PMID: 25498329 DOI: 10.1016/j.injury.2014.11.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 10/27/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Focused Assessment with Sonography in Trauma examination (FAST) is currently taught and recommended in the ATLS(®), often as an addendum to the primary survey for patients with blunt abdominal trauma. Although it is non-invasive and rapidly performed at bedside, the utility of FAST in blunt abdominal trauma has been questioned. We designed this study to examine our hypothesis that FAST is not an efficacious screening tool for identifying intra-abdominal injuries. METHODS We performed a retrospective chart review of all patients with confirmatory diagnosis of blunt abdominal injuries with CT and/or laparotomy for a period of 1.5 years (from 7/2009 to 11/2010). FAST was performed by ED residents and considered positive when free intra-abdominal fluid was visualized. Abdominal CT, or exploratory laparotomy findings were used as confirmation of intra-abdominal injury. RESULTS A total of 1671 blunt trauma patients were admitted to and evaluated in the Emergency Department during a 1½ year period and 146 patients were confirmed intra-abdominal injuries by CT and/or laparotomy. Intraoperative findings include injuries to the liver, spleen, kidneys, and bowels. In 114 hemodynamically stable patients, FAST was positive in 25 patients, with a sensitivity of 22%. In 32 hemodynamically unstable patients, FAST was positive in 9 patients, with a sensitivity of 28%. A free peritoneal fluid and splenic injury are associated with a positive FAST on univariate analysis, and are the independent predictors for a positive FAST on multiple logistic regression. CONCLUSION FAST has a very low sensitivity in detecting blunt intraabdominal injury. In hemodynamically stable patients, a negative FAST without a CT may result in missed intra-abdominal injuries. In hemodynamically unstable blunt trauma patients, with clear physical findings on examination, the decision for exploratory laparotomy should not be distracted by a negative FAST.
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Affiliation(s)
- Jeffrey W Carter
- Department of Surgery, University at Buffalo, State University of New York, United States
| | - Mark H Falco
- Department of Surgery, University at Buffalo, State University of New York, United States
| | - Michael S Chopko
- Department of Surgery, University at Buffalo, State University of New York, United States
| | - William J Flynn
- Department of Surgery, University at Buffalo, State University of New York, United States
| | - Charles E Wiles Iii
- Department of Surgery, University at Buffalo, State University of New York, United States
| | - Weidun Alan Guo
- Department of Surgery, University at Buffalo, State University of New York, United States.
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Guo WA. The search for a magic bullet to fight multiple organ failure secondary to ischemia/reperfusion injury and abdominal compartment syndrome. J Surg Res 2013; 184:792-3. [DOI: 10.1016/j.jss.2012.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 06/08/2012] [Accepted: 06/14/2012] [Indexed: 11/26/2022]
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Guo WA, Knight PR, Raghavendran K. The receptor for advanced glycation end products and acute lung injury/acute respiratory distress syndrome. Intensive Care Med 2012; 38:1588-98. [DOI: 10.1007/s00134-012-2624-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/04/2012] [Indexed: 01/10/2023]
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Scott DJ, Rege RV, Bergen PC, Guo WA, Laycock R, Tesfay ST, Valentine RJ, Jones DB. Measuring operative performance after laparoscopic skills training: edited videotape versus direct observation. J Laparoendosc Adv Surg Tech A 2000; 10:183-90. [PMID: 10997840 DOI: 10.1089/109264200421559] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Global assessment by direct observation has been validated for evaluating operative performance of surgery residents after formal skills training but is time-consuming. The purpose of this study was to compare global assessment performed from edited videotape with scores from direct observation. MATERIALS AND METHODS Junior surgery residents (N = 22) were randomized to 2 weeks of formal videotrainer skills training or a control group. Laparoscopic cholecystectomy was performed at the beginning and end of the rotation, and global assessment scores were compared for the training and control groups. Laparoscopic videotapes were edited: initial (2 minutes), cystic duct/artery (6 minutes), and fossa dissection (2 minutes). Two independent raters performed both direct observation and videotape assessments, and scores were compared for each rater and for interrater reliability using a Spearman correlation. RESULTS Correlation coefficients for videotape versus direct observation for five global assessment criteria were <0.33 for both raters (NS for all values). The correlation coefficient for interrater reliability for the overall score was 0.57 (P = 0.01) for direct observation v 0.28 (NS) for videotape. The trained group had significantly better overall performance than the control group according to the assessment by direct observation (P = 0.02) but not by videotape assessment (NS). CONCLUSIONS Direct observation demonstrated improved overall performance of junior residents after formal skills training on a videotrainer. Global assessment from an edited 10-minute videotape did not correlate with direct observation and had poor interrater reliability. Efficient and valid methods of evaluating operative performance await development.
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Affiliation(s)
- D J Scott
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, USA
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