Preventing deep wound infection after coronary artery bypass grafting: a review.

The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined.

Building character: a model for reflective practice.

In 1950, Harrison and colleagues proposed that the physician's ultimate and sufficient destiny should be to "build an enduring edifice of character." Recent work in philosophy underscores the importance of character ethics (virtue ethics) as a complement to ethical systems based on duty (deontology) or results (consequentialism). Recent work in psychology suggests that virtues and character strengths can, to at least some extent, be analyzed and taught.