Competence in palliative and end of life care - general surgery and family medicine residencies

Background: Palliative care and end of life care is being emphasized ever more in everyday practice of medicine. Many of the specialty boards either recommend or require education in these aspects of care of patients during residency. The specific strengths and weakness of a given residency might help tailor a curriculum that is relevant and addresses the perceived strengths and weakness of the residents in that specialty. Objective: The aim of this study was to compare general surgery residents&#8217; self-perceived attitudes, confidence, and concerns, as it relates to effectively practicing palliative and end of life care, to family medicine residents. Material and methods: The Attitudes Toward Death and Palliative Medicine Comfort and Confidence Surveys were used to assess self-perceived competence with palliative medicine. Surgery and family medicine residents in a major University medical center were surveyed. Data was analyzed with t-tests for independent measures. Statistical significance was set at p < .05. Results: University of Florida surgery residents assessed their attitudes about dealing with dying patients as significantly more positive (t = 2.25, df = 38, p = 0.03) and their level of confidence in providing palliative care as significantly higher (t = 2.60, df = 30, p = 0.01) than family medicine residents. Surgery residents expressed similar concerns about end-of-life issues (t = 0.14, df = 38, p = 0.89) as family medicine residents. Conclusions: Both similarities and differences existed in the self-perceptions of surgery and family medicine residents about palliation and end of life issues. Recognizing the importance of palliation as a competency, curriculum can be tailored to meet the specific needs of a residency program as well as the establishment of specific benchmarks that all training programs must achieve. Adv. Pall. Med. 2010; 9, 1: 3&#8211;8Background: Palliative care and end of life care is being emphasized ever more in everyday practice of medicine. Many of the specialty boards either recommend or require education in these aspects of care of patients during residency. The specific strengths and weakness of a given residency might help tailor a curriculum that is relevant and addresses the perceived strengths and weakness of the residents in that specialty. Objective: The aim of this study was to compare general surgery residents&#8217; self-perceived attitudes, confidence, and concerns, as it relates to effectively practicing palliative and end of life care, to family medicine residents. Material and methods: The Attitudes Toward Death and Palliative Medicine Comfort and Confidence Surveys were used to assess self-perceived competence with palliative medicine. Surgery and family medicine residents in a major University medical center were surveyed. Data was analyzed with t-tests for independent measures. Statistical significance was set at p < .05. Results: University of Florida surgery residents assessed their attitudes about dealing with dying patients as significantly more positive (t = 2.25, df = 38, p = 0.03) and their level of confidence in providing palliative care as significantly higher (t = 2.60, df = 30, p = 0.01) than family medicine residents. Surgery residents expressed similar concerns about end-of-life issues (t = 0.14, df = 38, p = 0.89) as family medicine residents. Conclusions: Both similarities and differences existed in the self-perceptions of surgery and family medicine residents about palliation and end of life issues. Recognizing the importance of palliation as a competency, curriculum can be tailored to meet the specific needs of a residency program as well as the establishment of specific benchmarks that all training programs must achieve. Adv. Pall. Med. 2010; 9, 1: 3-

Thoracoschisis: case report and review of the literature

Introduction: Thoracoschisis is a rare congenital malformation characterized by herniation of intraabdominal contents through a thoracic wall defect. There have been six previously reported cases. We describe our novel approach incorporating closure of the chest wall defect with temporary abdominal wall expansion utilizing a silastic pouch.Case report: A male child born at 29 weeks’ gestation was transferred to our institution for the management of a right anterior chest wall defect with herniation of intraabdominal contents through this defect. The patient was taken to the operating room for reduction of the herniated viscera from the right chest wall defect into the abdomen utilizing a spring-loaded silastic pouch to cover the abdominal viscera.Discussion: The cause of thoracoschisis is unclear. Multiple mechanisms have been proposed for the development of thoracoschisis, including amnionic rupture, vascular injury, and embryologic maldevelopment. In previously reported cases, a majority of patients had associated limb abnormalities. It has been proposed that this association between extremity agenesis/deformity  and chest wall defects is related to the limb–body wall complex. In addition, most of the cases reported also had an accompanying diaphragmatic defect, allowing the abdominal viscera to enter the chest and then herniate through the thoracic defect.Conclusion: Overall, thoracoschisis is a very rare congenital abnormality characterized by a chest wall defect with herniation of intra-abdominal organs through this defect. Previously, only six cases have been reported, most of which had an associated limb anomaly or diaphragmatic hernia.Keywords: gastroschisis, limb–body wall complex, thoracoabdominal schisis, thoracoschisi

The use of sleep aids among Emergency Medicine residents: a web based survey

BACKGROUND: Sleepiness is a significant problem among residents due to chronic sleep deprivation. Recent studies have highlighted medical errors due to resident sleep deprivation. We hypothesized residents routinely use pharmacologic sleep aids to manage their sleep deprivation and reduce sleepiness. METHODS: A web-based survey of US allopathic Emergency Medicine (EM) residents was conducted during September 2004. All EM residency program directors were asked to invite their residents to participate. E-mail with reminders was used to solicit participation. Direct questions about use of alcohol and medications to facilitate sleep, and questions requesting details of sleep aids were included. RESULTS: Of 3,971 EM residents, 602 (16%) replied to the survey. Respondents were 71% male, 78% white, and mean (SD) age was 30 (4) years, which is similar to the entire EM resident population reported by the ACGME. There were 32% 1st year, 32% 2nd year, 28% 3rd year, and 8% 4th year residents. The Epworth Sleepiness Scale (ESS) showed 38% of residents were excessively sleepy (ESS 11–16) and 7% were severely sleepy (ESS>16). 46% (95 CI 42%–50%) regularly used alcohol, antihistamines, sleep adjuncts, benzodiazepines, or muscle relaxants to help them fall or stay asleep. Study limitations include low response and self-report. CONCLUSION: Even with a low response rate, sleep aid use among EM residents may be common. How this affects performance, well-being, and health remains unknown