Mittwoch, 23. Mai 2012

Sind wir menschlich oder sind wir Chirurgen?

Are We Human or Are We Surgeon?
Nicholas P. W. Coe, MD
Arch Surg. 2012;147(5):414-415. doi:10.1001/archsurg.2012.46
This wide-ranging study by Sullivan et al1 examined questions of social and mentoring interaction between residents and faculty and how that played into residents' satisfaction with their training programs. The instrument was administered after the grueling 5-hour American Board of Surgery In-Training Examination at a time when, at least in the Northeast, it is dark and cold and everyone is sunlight deprived. These factors certainly raise questions regarding interpretation of the results, yet such concerns should not diminish the importance of this study, which emphasizes an aspect of our responsibilities to residents that has received far too little attention to date.
In the past, faculty—especially surgeons—were placed or placed themselves on a pedestal. This has become less common today, but this study shows that we still have a ways to go. If we are indeed human and not just surgeons, is there a better way to let residents understand this so that they do not in turn become haughty and aloof? Many faculty members have a host of diverse interests, including skills in the humanities as well as music of all types, painting, photography, or writing; some have boats; some love to fix cars; and there are a multitude of other pastimes that occupy their leisure time. However, we as a faculty rarely display these interests for residents to see. If residents saw us as human rather than as austere, distant, and unattainable figures, would they want to socialize more, would they then seek us out as mentors more readily, would they be happier in the environment we have created, and would they themselves ultimately become more human? I don't know the answer because, for the most part, we have not shown that other side of our panoply of talents to our charges.
Regrettably, the authors1 found far too many residents feeling isolated and unhappy with their choice of surgery training program. It is most troubling to learn that this applies especially to the most vulnerable of our charges, the junior residents. It is also worrisome that female residents apparently feel the same way, perhaps, as pointed out, explaining the higher attrition rate in these 2 groups. Today, half our residents are female, but the composition of our faculty does not yet reflect that balance. Showing our human side might help reduce feelings of alienation, but this particular concern may only be solved when more women join our ranks and we are seen as welcoming to all residents.
This study is a wake-up call to pay attention to a too-often-neglected aspect of our responsibility to all the residents who have placed themselves in our charge.

Leberverletzungen - operative versus non-operative Versorgung


Successful Nonoperative Management of the Most Severe Blunt Liver Injuries
Gwendolyn M. van der Wilden et al
Arch Surg. 2012;147(5):423-428. doi:10.1001/archsurg.2012.147

Hypothesis  Grade 4 and grade 5 blunt liver injuries can be safely treated by nonoperative management (NOM).
Design  Retrospective case series.
Setting  Eleven level I and level II trauma centers in New England.
Patients  Three hundred ninety-three adult patients with grade 4 or grade 5 blunt liver injury who were admitted between January 1, 2000, and January 31, 2010.
Main Outcome Measure  Failure of NOM (f-NOM), defined as the need for a delayed operation.
Results  One hundred thirty-one patients (33.3%) were operated on immediately, typically because of hemodynamic instability. Among 262 patients (66.7%) who were offered a trial of NOM, treatment failed in 23 patients (8.8%) (attributed to the liver in 17, with recurrent liver bleeding in 7 patients and biliary peritonitis in 10 patients). Multivariate analysis identified the following 2 independent predictors of f-NOM: systolic blood pressure on admission of 100 mm Hg or less and the presence of other abdominal organ injury. Failure of NOM was observed in 23% of patients with both independent predictors and in 4% of those with neither of the 2 independent predictors. No patients in the f-NOM group experienced life-threatening events because of f-NOM, and mortality was similar between patients with successful NOM (5.4%) and patients with f-NOM (8.7%) (P = .52). Among patients with successful NOM, liver-specific complications developed in 10.0% and were managed definitively without major sequelae.
Conclusions  Nonoperative management was offered safely in two-thirds of grade 4 and grade 5 blunt liver injuries, with a 91.3% success rate. Only 6.5% of patients with NOM required a delayed operation because of liver-specific issues, and none experienced life-threatening complications because of the delay.

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Montag, 21. Mai 2012

Lob der Erfahrung...

Der Patient war blass und nicht ganz bei sich. Er sprach undeutlich und konnte nicht mehr gut sehen. Während die Assistenzärzte in der Notaufnahme des Hamburger Krankenhauses noch über den Fall grübelten, stand auf einmal der Chefarzt in der Tür. Ein Blick und ein paar Fragen reichten ihm. »Morbus Moschcowitz«, lautete seine Diagnose. Im Routinebetrieb wäre diese extrem seltene Blutgefäßerkrankung vielleicht erst nach Monaten festgestellt worden. Der erfahrene Chef hatte die Zeichen sofort erkannt. Mehr

Sonntag, 20. Mai 2012

Abstieg in Dortmund...

Arbeitslosigkeit, Armut, Drogen und Gewalt: Die Dortmunder Nordstadt hat alle Probleme, die ein Viertel auch nur haben kann. Mitten in der Stadt, die als „Herzkammer der Sozialdemokratie“ gilt, bekommt die SPD die sozialen Schwierigkeiten nicht in den Griff. Mehr