Length of intraabdominal measurement of bowel (LIMB).

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric surgeries. The steep associated learning curve is dependent on the training facility, laparoscopic experience, and overall procedural volume. William Beaumont Army Medical Center (WBAMC) has been accredited as a bariatric center of excellence and trains resident surgeons in the performance of RYGB.

Recurrent pancreatitis due to intraductal papillary mucinous neoplasm in a young adult.

A young adult male presented with recurrent pancreatitis and a 2.2 cm mixed duct intraductal papillary mucinous neoplasm (IPMN) located in the pancreatic body. Our patient presented at age 21 with his second hospitalization for acute pancreatitis within a year.

Do Relatives With Greater Reproductive Potential Get Help First?: A Test of the Inclusive Fitness Explanation of Kin Altruism.

According to inclusive fitness theory, people are more willing to help those they are genetically related to because relatives share a kin altruism gene and are able to pass it along. We tested this theory by examining the effect of reproductive potential on altruism. Participants read hypothetical scenarios and chose between cousins (Studies 1 and 2) and cousins and friends (Study 3) to help with mundane chores or a life-or-death rescue.

Prospective randomized double-blind controlled trial of continuous local anesthetic infusion to reduce narcotic use in laparoscopic sleeve gastrectomy.

Background: In an era of cost containment and outcome-based medicine, bariatric surgeons are attempting to decrease perioperative morbidity and streamline care. One way of accomplishing this is by decreasing opioid use and hospital stay. Several studies of nonbariatric open procedures have shown that continuous infusion catheters (CIC) are beneficial.

Efficacy and process of cognitive bibliotherapy for the treatment of depression in jail and prison inmates.

The purpose of this two-study project was to determine the effects of cognitive bibliotherapy for the treatment of depressive symptoms in jail and prison inmates. Participants in both samples were randomly assigned to either a treatment group that received the 4-week bibliotherapy program or a delayed-treatment control group. In the jail sample, which served as a pilot study for the more detailed prison study, the treatment group showed greater improvement on the A.

The future of gerontological social work: a case for structural lag.

The US population is aging. Traditional perspectives have emphasized that a substantial increase in the number of gerontological social workers is needed to care for this population. However, published evidence demonstrates that, along with population growth, economic and social factors must be taken into account before predicting future gerontological social work demand.

[Good effect of plasmapheresis in fat embolism syndrome following bilateral fracture of tibia].

Fat embolism syndrome is a life-threatening condition, and early diagnosis and supportive treatment is important. In this case report plasmapheresis seemed to be of great importance.

Patient attitudes to surgeons' attire in an outpatient clinic setting: substance over style.

Background: It is believed that patients prefer that surgeons convey a professional appearance with traditional business attire and white laboratory coat. We performed a prospective study to assess patient opinions regarding traditional attire versus the wearing surgical scrubs in the outpatient setting.

Methods: During a 5-month period, surgeons alternated wearing traditional clothing and surgical scrubs.

Relationship between varying Roux limb lengths and weight loss in gastric bypass.

Background: The optimal Roux limb length for gastric bypass is unknown. Therefore, the effect of Roux limb length on weight loss and nutritional deficiency after a Roux-en-Y gastric bypass procedure was studied.

Methods: From September 2000 to February 2004, 165 Roux-en-Y gastric bypass surgeries were performed at William Beaumont Army Medical Center.

Prevalence of teaching sentinel lymph node biopsy for breast cancer in general surgery residency programs.

Purpose: Sentinel lymphadenectomy (SLNB) for the evaluation of clinically negative lymph nodes in women with invasive breast cancer is rapidly gaining acceptance within the surgical community. The purpose of this study was to document the prevalence of teaching SLNB to residents in general surgery training programs in the United States.

Methods: The Fellowship and Residency Electronic Interactive Database (FREIDA) was searched for a listing of all general surgery residency programs.

A new method of continuous venovenous rewarming.

Purpose: Hypothermia is a significant problem in medicine and is part of a deadly triad, including hypothermia, acidosis, and coagulopathy. Multiple methods of rewarming are used to treat moderate hypothermia. The purpose of this study was to compare the effectiveness of continuous venovenous rewarming (CVVR) using the FMS 2000 (Belmont Instrument Corp.

The use of simvastatin for the prevention of gallstones in the lithogenic prairie dog model.

Background: Surgery for morbid obesity is rapidly increasing. Patients undergoing bariatric surgery are prone to gallstone development during the rapid weight loss. These patients are often given medications such as ursodeoxycholic acid to prevent gallstone formation; however, these medications are often poorly tolerated by patients, who subsequently discontinue them.

Emergency nursing: historical, current, and future roles.

Building upon a historical context, the current and future roles of the clinical emergency nurse are reviewed. For several reasons, emergency nurse availability is expected to be insufficient to meet staffing demands in the near future. Emergency physicians can partner with emergency nurses and hospital administrators to pursue the following strategies for addressing the nursing shortage: (1) improve the workplace environment by improving nurse-to-patient ratios and avoiding the boarding of admitted patients in the emergency department (ED); (2) refocus the emergency nurse job description to patients and their families; (3) promote mutually supportive relationships and comradeship between emergency nurses and physicians; (4) create an environment that allows unique solutions to staff scheduling and accommodates shiftwork; (5) increase nursing wages, and recognize special contributions of emergency nurses with financial reward; (6) identify and promote the personnel of the hospital ED as members of an elite unit; (7) develop preceptorships and internships for nurses new to emergency nursing and invest in clinical specialists or nurse-mentors to assist in "on-the-job" instruction of nurses with previous experience; and (8) invest in nursing education.

Emergency nursing: historical, current, and future roles.

Building upon a historical context, the current and future roles of the clinical emergency nurse are reviewed. For several reasons, emergency nurse availability is expected to be insufficient to meet staffing demands in the near future. Emergency physicians can partner with emergency nurses and hospital administrators to pursue the following strategies for addressing the nursing shortage: 1) improve the workplace environment by improving nurse-to-patient ratios and avoiding the boarding of admitted patients in the emergency department (ED); 2) refocus the emergency nurse job description to patients and their families; 3) promote mutually supportive relationships and comradeship between emergency nurses and physicians; 4) create an environment that allows unique solutions to staff scheduling and accommodates shiftwork; 5) increase nursing wages, and recognize special contributions of emergency nurses with financial reward; 6) identify and promote the personnel of the hospital ED as members of an elite unit; 7) develop preceptorships and internships for nurses new to emergency nursing and invest in clinical specialists or nurse-mentors to assist in "on-the-job" instruction of nurses with previous experience; and 8) invest in nursing education.

Implementation of sentinel lymph node biopsy for breast cancer by surgeons in the Department of Defense.

Background: Sentinel lymph node biopsy (SLNB) for the evaluation of women with invasive breast cancer is rapidly gaining acceptance. The purpose of this study was to assess how surgeons in the Department of Defense (DOD) are incorporating SLNB into practice.

Methods: Surgeons at all DOD hospitals were telephonically surveyed regarding their current practices with SLNB.

Selective use of single-photon emission computed tomography myocardial perfusion imaging in a chest pain center.

Emergency department chest pain centers (CPCs) vary in their approach to patients with chest pain and nonischemic electrocardiograms (ECG). Although single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been evaluated in this setting, both acutely at rest and after stress, we questioned its application in all patients. We prospectively evaluated the utility of selective SPECT imaging in a CPC (i.

Ultrasound-guided Kopans' needle location and removal of a retained foreign body.

Penetrating injury with retained foreign body is a common problem. Location of the foreign body and surgical excision may be difficult. Ultrasound can be a sensitive and cost-effective tool in both the detection and surgical removal of retained foreign bodies in soft tissue.

Care and outcome of out-of-hospital deliveries.

Objectives: To identify interventions by paramedics in out-of-hospital deliveries and predictors of neonatal outcome.

Methods: A prospective case series of consecutive out-of-hospital deliveries at Yale-New Haven Hospital from January 1991 to January 1994. Data describing out-of-hospital interventions, demographics, maternal risk factors, and neonatal outcomes were collected from out-of-hospital, emergency department (ED), and hospital records.

Biliary dyskinesia: a study of more than 200 patients and review of the literature.

The diagnosis and treatment of biliary dyskinesia, defined as symptoms of biliary colic in the absence of gallstones, remains controversial and has been the subject of several previous retrospective reviews. The diagnosis and treatment of biliary dyskinesia based on the CCK-HIDA scan, and the outcome with cholecystectomy for billary dyskinesia, are reviewed. We add more than 200 cases of cholecystectomy for biliary dyskinesia, and compare our results with those of previous reports.

Emergency department patients with assault injuries: previous injury and assault convictions.

Study Objective: To compare the incidence of previous assault injury and assault conviction of patients presenting to the ED with assault injuries and the incidence of assault injury and conviction in nonassaulted control patients.

Methods: We conducted a retrospective, medical record-based case-control study of ED patients with assault injuries and matched controls presenting with medical and surgical problems unrelated to assault. The setting was the ED of a 900-bed teaching hospital and Level I trauma center in an urban area.

Paramedic field instructors: an approach to training the newest paramedics while maintaining the interest of the most successful senior paramedics.

A unique approach to providing orientation and supervised field experience for newly graduated paramedics and for the continuing education and recognition of experienced, skilled, operational paramedics is described. A group of 30 paramedic field instructors (PFI) was selected following application, development of criteria for selection, and interviews. This program had a positive effect in both realms during its first year of operation in the emergency medical services system in which it was implemented.

Computerized hospital on-line resources allocation link (CHORAL): a mechanism to monitor and establish policy for hospital ambulance diversions.

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources.

The effect of base station contact on ambulance destination.

Concern has been raised that a single medical control base station serving a metropolitan area may preferentially divert ambulance patients to the base station hospital. Such concern may discourage the development of regional medical control systems. During the first six months of 1988, a retrospective cross-sectional analysis was made of all advanced life support (ALS) ambulance transports and all contacts to the single base station, known as Medical Resource Hospital (MRH).