Strategies to Improve the Rural Surgical Workforce.

The rural surgical workforce is in crisis, resulting in significant health care access issues for the 60 million rural Americans. Rural surgeons encounter unique barriers to providing care for patients that are different than their urban counterparts. Rural hospitals are failing at an alarming rate.

Quality and Value in Rural Cancer Care.

Nearly 60 million people reside in rural America with only 10% of US general surgeons providing for their surgical care. Rural cancer care has been maligned in the literature due to a lack of understanding of local resource limitations and to the difficulties involved in documenting the quality of local cancer care in small and rural communities. A majority of US cancer patients are diagnosed and treated in community cancer programs, many of which are Commission on Cancer accredited and deliver care that is of high quality and value.

Rural Standards and the Quality Equation.

The article describes the barriers rural surgeons face when attempting to measure, analyze, and benchmark the quality and value of the care they provide for their patients. Examples of suboptimal care are presented as well as special geographic and resource-related circumstances for many of these disparities of care. The article includes in-depth descriptions of the American College of Surgeons (ACS) Optimal Resources for Surgical Quality and Safety Program and the ACS Rural Hospital Surgical Verification and Quality Improvement Program.

When rural is no longer rural: Demand for subspecialty trained surgeons increases with increasing population of a non-metropolitan area.

Background: Surgery in larger, non-metropolitan, communities may be distinct from rural practice. Understanding these differences may help guide training. We hypothesize that increasing community size is associated with a desire for subspecialty surgeons.

A rare case of iron-deficiency anemia rapidly progressing to a life-threatening event.

Giant colonic diverticula are extremely rare; however, they should be considered in a patient with a history or susceptibility to diverticular disease because of the nonspecific presentation and life-threatening complications. Giant colonic diverticula often are overlooked because of their nonspecific gastrointestinal (GI) symptoms, leading to complications of obstruction, perforation, abscess formation, and sepsis. A rare and unusual presentation of a giant colonic diverticulum is the development of a bezoar.

Small bowel necrosis in association with jejunal tube feeding.

Early recognition and appropriate treatment of bowel ischemia is imperative to reduce morbidity and mortality in any situation, including in conjunction with enteral tube feeding. GI intolerance can manifest as increased nasogastric tube output, unexplained abdominal pain/distension, and pneumatosis intestinalis in critically ill patients who are on tube feedings and may be experiencing periods of splanchnic hypotension. Recommendations are to immediately cease tube feedings when these signs and symptoms are recognized, and total parenteral nutrition should be considered.