Characterization of resident surgeon participation during carotid endarterectomy and impact on perioperative outcomes

IntroductionThe impact of resident surgeon participation during vascular procedures on postoperative outcomes is incompletely understood. We characterized resident physician participation during carotid endarterectomy (CEA) procedures within the 2005-2009 American College of Surgeons National Surgical Quality Improvement Participant Use Datafile and evaluated associations with procedural characteristics and perioperative adverse events.MethodsCEAs were identified using primary current procedural terminology codes; those performed simultaneously with other major procedures or unknown resident participation status were excluded. Group-wise comparisons based on resident participation status were performed using χ2 or Fisher's exact test for categorical variables and t tests or nonparametric methods for continuous variables. Associations with perioperative adverse events (major = stroke, death, myocardial infarction, or cardiac arrest; minor = peripheral nerve injury, bleeding requiring transfusion, surgical site infection, or wound disruption) were assessed using multivariable logistic regression models adjusting for other known risk factors.ResultsA total of 25,280 CEA procedures were analyzed, of which residents participated in 13,705 (54.2%), while residents were absent in 11,575 (45.8%). Among CEAs with resident physician participation, resident level was categorized as junior (postgraduate year [PGY] 1-2) in 21.9%, senior (PGY 3-5) in 52.7%, and fellow (PGY ≥6) in 25.3%. Major adverse event rates with and without resident participation were 1.9% versus 2.1%, and minor adverse event rates with and without resident participation were 0.9% versus 1.0%, respectively. In multivariable models, resident physician participation was not associated with perioperative risk for major adverse events (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.75-1.08) or minor adverse events (OR, 0.93; 95% CI, 0.72-1.21).ConclusionsResident surgeon participation during CEA is not associated with risk of adverse perioperative events

Advanced Trauma Life Support®. ABCDE from a radiological point of view

Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support® (ATLS®) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS®, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS® is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious attention to defining the indications and limitations pertaining to diagnostic imaging

A model for evaluating the environmental and functional benefits of "innovative" roudabauts

This study looks at the singling out of a multi-parameter criterion for choosing conventional or innovative roundabout layouts, by taking functional, environmental and economic aspects into consideration. The performances of three conventional roundabouts (with different lane number at entries and through the ring), turbo-roundabouts and roundabouts with right-turn bypass lane on all the arms (flower roundabouts) have been compared in terms of vehicle delays and pollutant (carbon dioxide, nitrogen oxides, particle pollution (PM10 and PM2.5)) emissions. By means of closed-form capacity models and with the help of COPERT IV software, several traffic simulations have been carried out, referred to yearly peak flow values Qmax and ranging between 1300 and 3300veh/h, starting from a typical annual traffic demand curve in urban areas. The estimation of cumulative vehicle delays and annual pollutant emissions, together with construction and maintenance costs has allowed working out overall costs for each roundabout under consideration, depending on the traffic demand. Thus, the proposed model allows finding the most cost-effective geometric solution as to overall costs for a comprehensive case record of traffic values

Reducing air pollutants through road innovative intersections

Road pollutant emissions are correlated mainly to infrastructural capacity and to traffic intensity and typology. With the aim to improve road intersections performances in the last years was designed many new geometric layouts, like \u201cturbo roundabouts\u201d and \u201cflower roundabouts\u201d. The main objective of this paper is carried out a comparative analysis between conventional and innovative roundabouts in terms of CO, CO2, NO and PM2,5 vehicular emissions, evaluated by means of COPERT Software which is developed as a European tool for the calculation of emissions from the road transport sector

Febbre Bottonosa in Italia: Solo da Rickettsia Conorii?

Over the last few years we have monitored accurately the dynamics of Rickettsial diseases in Sicily. In this way we can affirm that in Sicily, as well as in other European countries, there exist several types of Rickettsia. As a matter of fact, we succeeded in isolating, both from patients and from ticks, different strains such as R. Conorii, R. Israeli and R. Massilia