Bariatric surgery patient perceptions and willingness to consent to resident participation.

Background: Many bariatric surgery programs are located at teaching hospitals, where they are integral to the training of surgical residents.

Objectives: The purpose of this study was to examine preexisting bariatric patient perceptions and willingness to allow resident participation in their surgery.

Setting: Madigan Army Medical Center, Tacoma, Washington, USA.

The weekend effect: does time of admission impact management and outcomes of small bowel obstruction?

Aims: To determine whether day and time of admission influences the practice patterns of the admitting general surgeon and subsequent outcomes for patients diagnosed with small bowel obstruction.

Methods: A retrospective database review was carried out, covering patients admitted with the presumed diagnosis of partial small bowel obstruction from 2004-2011.

Results: A total of 404 patients met the inclusion criteria.

The hidden war: humanitarian surgery in a combat zone.

Background: Humanitarian surgical care (HSC) provided during wartime plays a substantial role in military operations, but has not been described or quantified beyond individual experiences.

Methods: Prospective survey was conducted of all military members deployed to Iraq or Afghanistan between 2002 and 2011.

Results: There were 266 responses.

Tranexamic acid corrects fibrinolysis in the presence of acidemia in a swine model of severe ischemic reperfusion.

Background: Tranexamic acid (TXA) is an antifibrinolytic with anti-inflammatory properties associated with improved outcomes when administered to trauma patients at risk for bleeding; however, its efficacy is unknown in acidemia. We evaluated the efficacy of TXA on hyperfibrinolysis using an established porcine traumatic hemorrhage ischemic shock model.

Methods: Ten Yorkshire swine underwent a controlled hemorrhage followed by supraceliac aortic cross-clamping.

Effects of histone deacetylase inhibition on 24-hour survival and end-organ injury in a porcine trauma model: a prospective, randomized trial.

Background: Valproic acid (VPA) is a histone deacetylase inhibitor that has been shown to improve early resuscitation from hemorrhagic shock. We sought to examine whether there is a sustained benefit of VPA in a survival model of severe injury.

Methods: Yorkshire swine (n = 36) were randomized to three groups as follows: (a) control, (b) VPA (single dose), and (c) VPA (two doses at 12 hours apart).

The effects of tranexamic acid and prothrombin complex concentrate on the coagulopathy of trauma: an in vitro analysis of the impact of severe acidosis.

Background: Bleeding is the most frequent cause of preventable death after severe injury. Our purposes were to study the efficacy of tranexamic acid (TXA) and prothrombin complex concentrate (PCC) on a traumatic coagulopathy with a severe native metabolic acidosis and compare the efficacy of PCC versus fresh frozen plasma (FFP) to reverse a dilutional coagulopathy.

Methods: In vitro effects of TXA and PCC were assessed with standard laboratory analysis (prothrombin time [PT]/international normalized ratio [INR]) and rotational thromboelastometry in a porcine hemorrhage with ischemia-reperfusion (H/I) model.

Optimum cystic duct closure: a comparative study using metallic clips, ENSEAL, and ENDOLOOP in swine.

Background: Metal clips are commonly used to secure the cystic duct during cholecystectomy, although use of an ENDOLOOP (Ethicon Endo-Surgery, Blue Ash, OH) is often touted as a more secure closure when postoperative endoscopic retrograde cholangiopancreatography (ERCP) is anticipated. The objective of this study was to test the strength of 3 different cystic duct closure methods in a model simulating postoperative biliary insufflation.

Methods: The extrahepatic biliary system, including common bile duct, gallbladder, and cystic duct, was harvested en bloc from 22 swine postmortem.

Examining the relevance of the physician's clinical assessment and the reliance on computed tomography in diagnosing acute appendicitis.

Background: The aim of this study was to examine the relevance of clinical assessment in diagnosing appendicitis in the current medical environment, in which routine use of computed tomography (CT) has become the norm.

Methods: A retrospective review was conducted, analyzing patient demographics, Alvarado clinical assessment scoring, and radiologic and pathologic results.

Results: A total of 664 patients were identified.

Operating room efficiency improvement after implementation of a postoperative team assessment.

Introduction: Operating room time is highly resource intensive, and delays can be a source of lost revenue and surgeon frustration. Methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization. The purpose of this study was to determine the root cause of operating room delays in a standardized manner to help improve overall operating room efficiency.

Initial operative time and metastatic disease recurrence.

Colon cancer metastases are a major source of morbidity and mortality for patients following oncologic resection. The purpose of this study was to identify whether operative time as a surrogate for resident involvement increased the risk of future liver metastases. We performed a retrospective review of patients undergoing curative colon resection from 2001 to 2010 at two military residency training hospitals.

Training surgeons and the informed consent process: routine disclosure of trainee participation and its effect on patient willingness and consent rates.

Objectives: To examine patient perceptions and willingness to participate in resident education and to assess the effect on patient willingness and consent rates.

Design: Anonymous questionnaire designed to capture demographics, overall opinions of teaching programs, and willingness to consent to various scenarios of trainee participation. Descriptive and univariate analyses were performed.