The Role of a Community Surgeon in the Care of Hepatopancreatobiliary Patients: Short-Term Outcomes and Learning Curve.

Background Owing to the well-established volume-outcome relationship, hepatopancreatobiliary (HPB) surgery is commonly regionalized to academic, teaching hospitals. However, regionalization is associated with decreased access for some populations in need, as well as geographic and financial barriers for patients. If high surgeon and institutional volumes can be achieved, the community, non-teaching HPB surgical practice could help alleviate some issues associated with regionalization.

Surgical management of adrenal metastases.

In the presence of a history of cancer, adrenal masses are commonly, but not exclusively, metastases. Depending upon the status of the patient's ongoing cancer therapy, overall tumor burden, and performance score, adrenalectomy is a viable treatment option. Herein we review the prevalence, diagnostic evaluation, and selection for surgical treatment of adrenal metastases.

Family engagement regarding the critically ill patient.

The Institute of Medicine strongly recommends a health care system that supports family members. Nowhere is the need for family-centered care greater than with critically ill patients. Simplistically, family-centered care is primarily about communication.

Physician attitudes regarding advance directives for high-risk surgical patients: a qualitative analysis.

Background: Advance directive (AD) use is uncommon in surgical patients, yet the exact reasons for this are unknown. Our aim was to identify and describe beliefs held by surgeons regarding ADs. A qualitative exploration of physicians' opinions of ADs for surgical patients was designed.

Structured teaching versus experiential learning of palliative care for surgical residents.

Background: Previous end-of-life and palliative care curricula for surgical residents have shown improved learner confidence, but have not measured cognitive knowledge or skill acquisition.

Methods: A nonrandomized trial evaluated a structured palliative care curriculum for 7 postgraduate year 2 surgical residents (intervention group) compared with 6 postgraduate year 5 surgical residents (comparison group). Outcomes were measured using an 18-item knowledge test, a 20-minute objective structured clinical examination simulating an intensive care unit family conference, and a survey measuring self-confidence.

Injury severity and quality of life: whose perspective is important?

Background: Ambiguity exists regarding factors that predict postinjury quality of life (QOL). We hypothesized that patient-perceived injury severity, not Injury Severity Score (ISS), would be correlated with QOL in a model that included severity of post-traumatic stress disorder (PTSD) symptoms.

Methods: Four hundred twenty-six trauma patients admitted to a Level I trauma center completed a questionnaire during inpatient stay and 6 months after injury.

Surgical "buy-in": the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy.

Objective: There is a general consensus by intensivists and nonsurgical providers that surgeons hesitate to withdraw life-sustaining therapy on their operative patients despite a patient's or surrogate's request to do so. The objective of this study was to examine the culture and practice of surgeons to assess attitudes and concerns regarding advance directives for their patients who have high-risk surgical procedures.

Design: A qualitative investigation using one-on-one, in-person interviews with open-ended questions about the use of advance directives during perioperative planning.

Cost-effectiveness of prolonged thromboprophylaxis after cancer surgery.

Background: Consensus guidelines recommend prolonged thromboprophylaxis for up to 4 weeks after major abdominopelvic cancer operations. Several factors impede widespread adoption of these guidelines. These include lack of awareness, cost, increased bleeding complications, increased incidence of heparin-induced thrombocytopenia, and poor patient compliance.

Emergency contraception and physicians' rights of conscience: a review of current legal standards in Wisconsin.

Recent legislation in Wisconsin mandating provision of emergency contraception to victims of sexual assault may create a conflict of conscience for some health care professionals. Although disputes exist over the exact mechanism of action of emergency contraception, those professionals who espouse a particularly strict stance may be reluctant to dispense the medication for fear that it could prevent a fertilized embryo from implanting in the uterus. While no objection of conscience clause was written into the new law, Wisconsin law has a long tradition of recognizing rights of conscience in matters of religious conflict.

Roman Catholic doctrine guiding end-of-life care: a summary of the recent discourse.

Recent statements emanating from high-level church authorities have reignited discussion over the traditional Roman Catholic doctrine guiding end-of-life care. Although these statements concerned the specific issue of artificial nutrition and hydration for patients in a persistent vegetative state, they contain principles that might be applied to other life-prolonging interventions. This paper examines the origins of the Catholic moral tradition that guides end-of-life care.

Developing guidelines that identify patients who would benefit from palliative care services in the surgical intensive care unit.

Objective: The convergence of end-of-life care and surgical practice often occurs in the surgical intensive care unit (SICU). Because many patients who encounter difficult end-of-life issues in the SICU do not receive palliative care services, there is a need to educate surgeons on how to better identify those patients.

Design: A group of 29 national and local experts were identified based on qualifications as surgical intensivists, palliative care specialists, or members of the American College of Surgeons Surgical Palliative Care Task Force.

Core competencies in palliative care for surgeons: interpersonal and communication skills.

Surgeons are an important part of the multidisciplinary approach to the care of terminally ill and dying patients. Some surgical residencies have recognized the need to incorporate palliative care-related topics into graduate surgical education. One core competency of utmost importance to palliative care is the effective use of interpersonal and communication skills.