Early and late complications of bariatric operation.

Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient\u27s anatomy, which can lead to complications at any time during the course of a patient\u27s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes of an acute surgical abdomen-acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease-for these are still among the most common etiologies of abdominal pathology in these patients

Front line surgery : a practical approach

https://jdc.jefferson.edu/jeffersonfacultybooks/1027/thumbnail.jp

Anatomy of Guns, Mike The Gun Guy Weisser, and the Physics of Gun Injury

Discover how guns work and the impact of gun shots on the body with trauma surgeon Dr. Alec Beekley of Thomas Jefferson University Hospitals. This is an interactive session intended to introduce professionals and advocates, whom may never have interacted with a gun before, to different types of firearms, and a basic understanding of ballistics. ----- Dr. Alec C. Beekley is a Distinguished Graduate of the United States Military Academy. He earned his medical degree at Case Western Reserve University School of Medicine in Cleveland, Ohio, and completed his residency at Madigan Army Medical Center in Tacoma, Washington. Following residency, he spent 14 years on Active Duty in the U.S. Army where he deployed on 3 separate occasions to Operation Enduring Freedom and Operation Iraqi Freedom. On his last deployment with the 28th Combat Support Hospital, he served as the director of the Deployed Combat Casualty Research Team. Dr. Beekley has authored or contributed to several articles and books on combat casualty care. He performed the initial published clinical study on tourniquet use in Operation Iraqi Freedom. After separating from the Army, Dr. Beekley took a position as a general surgeon in the Trauma and Acute Care Surgery Division and Bariatric Surgery Division at Thomas Jefferson University, and is now a Professor in the Department of Surgery

Current US Military Operations and Implications for Military Surgical Training

BACKGROUND: Since 2001, US military surgeons have deployed frequently, with many surgeons deploying within 1 year of graduating residency. The purpose of this study was to evaluate readiness of recent graduates to manage combat-related injuries and to make recommendations for improvements in training military surgeons. STUDY DESIGN: We reviewed casualties treated at the 31st Combat Support Hospital in Baghdad from December 2003 to November 2004.We identified 3,426 wounded patients; of these, 2,648 (77.3%) required an operative procedure. There were 2,788 patients (81.4%) who sustained penetrating injuries. The most common procedures performed were debridement of wounds (39%), skeletal fixation (14.7%), and exploratory laparotomy (11.4%). Common procedures were compared with 15 case logs from the ACGME database for our institution from 2005 to 2009. RESULTS: Graduating residents averaged 973 cases during residency (range 867 to 1,293, median 921). This included experience with most procedures encountered except nephrectomy (1.5 procedures per resident [PPR]), craniotomy (1.1 PPRs), inferior vena cava injury (1.1 PPRs), bladder repair (0.87 PPR), and duodenal injury (0.6 PPR). Residents had minimal experience with skeletal fixation and external genital trauma. CONCLUSIONS: Recent surgical residency graduates are prepared for deployment in support of US military operations for the majority of injuries encountered. However, familiarization with procedures that fall outside the traditional general surgical curriculum would improve their ability to treat these injuries. To enhance experience with rare injuries, cadaver studies and animal models may serve as training tools before deployment

Ambroise Paré (1510 to 1590): a surgeon centuries ahead of his time.

In their extensive writings, Hippocrates and Celsus counseled physicians to be knowledgeable in both the medical and surgical management of patient recovery. However, their words fell by the wayside because cutting of the body was forbidden by the Roman Catholic Church. Furthermore, the contemporaneous Arabic medical teachings emphasized tradition and authority over observation and personal experience. This created an ever-growing rift between the schools of surgical and pharmacologic medicine with both groups denying their involvement in the other domain. Surgeons had been plagued by postoperative complications including infection, malnutrition, and muscular wasting for centuries. Surgeons were forced to re-examine how diet and exercise affected outcomes before the advent of microbiology and advances in pharmacology. All of this changed when Ambroise Paré, a 16th century surgeon, revolutionized the medical world with his astute observations of postoperative diet and exercise

Applying “Expectancy Theory” to Surgical Residency Training

Expectancy Theory is a well known theory in work motivation literature. It was first proposed by Victor Vroom in 1964 after studying the motivations behind individuals’ decision making. Expectancy Theory holds that a person’s choice to behave in a certain way reflects the belief that chosen actions will result in desired outcomes. Expectancy Theory is parsed of three components: Expectancy (E), Instrumentality (I) and Valence (V). Expectancy (E) is the belief that performance goals will be met if appropriate efforts are applied. Instrumentality (I) denotes an expectation that rewards will follow if defined performance outcomes are met. Valence (V) refers to the value an individual places on the reward being given. Expectancy Theory involves an interaction between these components, summing in a Motivational Force (MF). Namely, E x I x V = MF. Thus, as viewed by Expectancy Theory, MF will be affected by changes in performance expectations, recognition of goal achievements, and valuations of declared rewards. Interestingly, the traditional work-place organizational structure is in many ways analogous to contemporary surgical residency training in theUnited States. Examples include varied work assignments in the workplace being similar to varied clinical rotation assignments during residency; promotions offered in the workplace likened to training year advancement in residency; and the work-place hierarchy (e.g. employee to manager) akin to the hospital hierarchy (e.g. intern to department head). Many other similarities exist as well. These analogies between work-place organizational structure and surgical residency are significant as we propose the application of Expectancy Theory to surgical residency training. What follows are opportunities for greater insight into surgical resident MF, as well as the potential to enhance surgical residency training and performance. Learning Objectives: 1. To understand Expectancy Theory and its relevance to adult learning 2. To understand the application of Expectancy Theory to surgical residency education 3. To understand factors affecting motivation in adult learners 4. To understand Expectancy Theory, and Motivational Force in enhancing surgical resident trainin

Utility of the STOP-BANG Questionnaire for Identifying Obstructive Sleep Apnea in Patients Undergoing Bariatric Surgery

Introduction Patients undergoing bariatric surgery are at high risk for obstructive sleep apnea (OSA). OSA has been associated with an increased risk of perioperative complications, but is under-recognized and underdiagnosed in the bariatric population. It is currently recommended that all patients considering bariatric surgery for obesity should be evaluated for OSA. In the general pre-surgical population, the STOP-BANG questionnaire is a validated screening tool for identifying OSA. We hypothesize that in bariatric patients the STOP-BANG questionnaire plus other clinical variables can predict OSA