The impact of the implementation of work hour requirements on residents' career satisfaction, attitudes and emotions

BACKGROUND: To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes. METHODS: A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004. Only the latter included work-hour related questions. RESULTS: The response rates were 56% for the 2002 and 72% for the 2004 surveys respectively. Although career satisfaction remained unchanged, numerous changes occurred in both emotions and attitudes. Compared to those residents who did not violate work-hour requirements, those who did were significantly more negative in attitudes and emotions. CONCLUSION: With the implementation of the ACGME work hour limitations, the training experience became more negative for those residents who violated the work hour limits and had a small positive impact on those who did not violate them. Graduate medical education leaders must innovate to make the experiences for selected residents improved and still maintain compliance with the work hour requirements

COX-2 selective inhibition reverses the trophic properties of gastrin in colorectal cancer

Gastrin is a gastrointestinal peptide that possesses potent trophic properties on both normal and neoplastic cells of gastrointestinal origin. Previous studies have indicated that chronic hypergastrinaemia increases the risk of colorectal cancer and cancer growth and that interruption of the effects of gastrin could be a potential target in the treatment of colorectal cancer. Here we demonstrate that gastrin leads to a dose-dependent increase in colon cancer cell proliferation and tumour growth in vitro and in vivo, and that this increment is progressively reversed by pretreatment with the cyclo-oxygenase-2 inhibitor NS-398. Gastrin was able to induce cyclo-oxygenase-2 protein expression, as well as the synthesis of prostaglandin E2, the major product of cyclo-oxygenase. Moreover, gastrin leads to approximately a two-fold induction of cyclo-oxygenase-2 promoter activity in transiently transfected cells. The results of these studies demonstrate that cyclo-oxygenase-2 appears to represent one of the downstream targets of gastrin and that selective cyclo-oxygenase-2 inhibition is capable of reversing the trophic properties of gastrin and presumably might prevent the growth of colorectal cancer induced by hypergastrinaemia

Early-life gut dysbiosis linked to juvenile mortality in ostriches

Imbalances in the gut microbial community (dysbiosis) of vertebrates have been associated with several gastrointestinal and autoimmune diseases. However, it is unclear which taxa are associated with gut dysbiosis, and if particular gut regions or specific time periods during ontogeny are more susceptible. We also know very little of this process in non-model organisms, despite an increasing realization of the general importance of gut microbiota for health

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present — ‘D’, either elevated blood glucose levels or a family history of diabetes mellitus; ‘K’, the presence of high urinary or blood ketoacids; and ‘A’, a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology, pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children

American Surgical Association Presidential Forum A Lifetime of Surgical Education: Can We Do better?

Surgical education has traditionally focused on the surgical clerkship during medical school and general surgery residency. Over the past 20 years, however, there has been a tremendous evolution in this very important mission of academic surgery. The most dramatic of these changes affecting resident training began with the implementation of residency work-hour restrictions in 2003. Changes in assessment of competency of the surgical trainee, challenges in providing resident autonomy in the era of reporting surgical outcomes and RVU-based compensation, and the increased emphasis on fellowship training, including integrated training programs or early specialization, have dramatically affected the training of surgical residents. Undergraduate medical education in surgery has been affected as medical schools have shortened the time spent on surgical rotations, while students are being asked to make decisions regarding choice of specialty earlier to consider new integrated specialty tracks. On a positive note, after selection of surgical specialty, many schools have an increased emphasis on preparation for residency training with “surgical boot camps.” Maintenance of certification of trained specialists has added to the administrative burden of surgeons already at risk for burnout. Finally, questions as to how to introduce new technology, or to retrain or retool practicing surgeons, have yet to be answered. Thus, one can safely conclude that the changes in surgical education are now extending throughout the lifetime of a surgeon. Despite these extensive changes and challenges existing at all levels, surgical education has only been the focus of the American Surgical Association (ASA) Presidential Forum twice over the past 20 years. In 2004,1 with a report that preceded the presentation of the ASA “Blue Ribbon” panel,2 and in 2012, with a review of the issues in general surgery resident training.3 It is the purpose of this panel to provide an overview of surgical education from medical school until the late stages of a surgeon's practice. To lead the discussions, we have called on leading experts and innovators in surgical education from both the United States and the United Kingdom, and also members of the leadership of the American Board of Surgery (ABS)