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Kinds of Surgeons Terms modified by Surgeons Selected AbstractsTHE SURGEON AND THE ANAESTHETIST: PROVIDING PATIENT CARE AS A PERIOPERATIVE TEAMANZ JOURNAL OF SURGERY, Issue 7 2008FANZCA, FFPMANZCA, Stephan A. Schug MD No abstract is available for this article. [source] CT32 WHEN TO CALL THE SURGEONANZ JOURNAL OF SURGERY, Issue 2007D. P. Shaw Not infrequently, a patient status has changed and the surgeon is not informed. This not only leads to frustration but potentially bad outcomes. Devising a protocol for when to call the surgeon is fraught with difficulties. Frequently they are so complicated that individuals were unable to remember them thus the protocols are not applied. High turnover of junior staff means that large protocol books are not read. The below three rules are designed to fulfil the role of protocols. They are compulsory flags for when the surgeon is to be called. They are not guides to management nor comments on adequacy of management. Their intent is to flag a change in status of the patient. The compulsory nature of the flags reduces the decision making and stress for the resident staff as to whether or not they should be calling the boss. The surgeon is to be called when 1The patient is to receive blood or blood products 2The inotropes dose is doubled from admission 3A vasoconstrictor is started [source] OPPORTUNITIES FOR YOUNG SURGEONS TO PUBLISHANZ JOURNAL OF SURGERY, Issue 1-2 2008John C. Hall No abstract is available for this article. [source] RURAL SURGERY AND RURAL SURGEONS: MEETING THE NEEDANZ JOURNAL OF SURGERY, Issue 11 2007John C. Graham FRACS No abstract is available for this article. [source] CUMULATIVE SUM TECHNIQUES FOR SURGEONS: A BRIEF REVIEWANZ JOURNAL OF SURGERY, Issue 7 2007Cheng-Hon Yap There has been increasing awareness of the need for monitoring the quality of health care, particularly in the area of surgery. The Cumulative Summation (Cusum) techniques have emerged as a popular tool for performance monitoring in surgery. They allow one to judge whether a given variation in performance is probably due to chance or greater than could be expected from random variation and thus a cause for concern. The Cusum techniques are simple to carry out and can be applied to any surgical process with a binary outcome. Four parameters need to be set in advance: acceptable outcome rate, unacceptable outcome rate, Type I and Type II error rates. In this article, we review the history, statistical methods and potential applications for the Cusum techniques in the field of surgery and illustrate the two common forms of charting (cumulative failure and Cusum charting) by using unadjusted outcome data from the Geelong Hospital and St Vincent's Hospital cardiac surgery databases. [source] THE BRITISH ASSOCIATION OF UROLOGICAL SURGEONSBJU INTERNATIONAL, Issue 2009Article first published online: 19 MAY 200 No abstract is available for this article. [source] Relevance of Cosmeceuticals to the Dermatologic SurgeonDERMATOLOGIC SURGERY, Issue 2005Harold J. Brody MD Background. The dermatologic surgeon is the dermatologist with special expertise in the surgical care of the health and beauty of the skin. Objectives, Methods, Results. There is no better arena for the use of topical regimens to preserve skin quality than in the time interval devoted to before and after care with respect to surgical procedures. Conclusion. Many of these regimens can be tailor devised with topical drugs and cosmeceuticals together in proper balance in the patient's best interest for affordable health care. HAROLD J. BRODY, MD, HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] The effect of preoperative weight loss and body mass index on postoperative outcome in patients with esophagogastric carcinomaDISEASES OF THE ESOPHAGUS, Issue 7 2009J. Skipworth SUMMARY Studies have shown that weight loss is associated with adverse outcomes in all treatment modalities for esophagogastric carcinoma. Because of the increased prevalence of obesity and the effectiveness of perioperative nutrition, a number of patients are now obese or have normal body mass index (BMI) at the time of treatment. We investigated the relationship between weight loss, BMI, and outcome of surgery for patients with esophagogastric carcinoma. Data were collected over a 38-month period for all patients diagnosed with operable esophagogastric cancer at two UK centers. All patients underwent resection by a single Consultant Upper Gastrointestinal Surgeon and the use of perioperative jejunal feeding was universal. Ninety-three patients (57 male) underwent esophagogastric resection; 48 had no preoperative weight loss (34 with a BMI > 25 and 14 with a BMI < 25). Forty-five patients had preoperative weight loss (20 with BMI > 25 and 25 with BMI < 25). There was no significant difference in complication rates, median hospital stay, or mortality between the four groups. A significantly higher number of patients displaying preoperative weight loss were found to have stage III disease, but difference in survival of up to 3 years did not reach statistical significance on multivariate analysis. Preoperative weight loss and low BMI did not significantly influence the complication rate, perioperative mortality rate, length of hospital stay, or short-term prognosis. We conclude that preoperative weight loss can not be reliably used as an independent predictor of poor outcome in patients undergoing surgery for esophagogastric carcinoma. However, patients with preoperative weight loss and low BMI are more likely to have advanced disease. [source] Genomics and the Cardiac SurgeonJOURNAL OF CARDIAC SURGERY, Issue 1 2007Miriam Kelley Bullard M.D. Now, some gene polymorphisms may predict perioperative trouble more precisely than a 10% ejection fraction. Gene chips will soon permit designer therapy and a micro-array "signature" will soon become fundamental to pre-operative risk stratification. It is time for the cardiac surgical community to come aboard. [source] Predictors of Mastectomy in a Certified Breast Center , The Surgeon is an Independent Risk FactorTHE BREAST JOURNAL, Issue 4 2008Roland Reitsamer MD Abstract:, The current study examined predictors of mastectomy in a certified breast center with the main impact on the factor surgeon. A total of 663 patients were analyzed for their mastectomy rates. Included were patients with T1 and T2 tumors, who had their surgery performed by one of three specialized breast surgeons with a workload of at least 50 new breast cancer cases per year. On multivariate analysis central tumor localization, positive lymph node status, nonunifocality, large tumor size, and the surgeon were independent predictors of mastectomy. Surgeon A had a mastectomy rate of 30.5% (50/164), surgeon B 26.9% (43/160) respectively, and surgeon C had a mastectomy rate of 15.8% (27/171), p = 0.005. Patients, who had surgery performed by surgeon A or surgeon B were 2.34 [95% confidence interval (CI): 1.38,3.97, p < 0.005] respectively 1.96 (95% CI: 1.14,3.36, p = 0.01) times as likely to have a mastectomy than patients who had surgery performed by surgeon C. Even in a certified breast center with specialized breast surgeons the surgeon is an independent risk factor of mastectomy, as the tumor criteria are given at the time of diagnosis. [source] MammoSite Balloon Brachytherapy: Errors, Pitfalls, and Technical Issues for a Practicing SurgeonTHE BREAST JOURNAL, Issue 2006Jan Forszpaniak MD Abstract: This article describes the technical aspects of insertion of the MammoSite radiation therapy system for patients with T1,2 disease. Practicing breast surgeons should be aware of the errors and pitfalls, the importance of cosmetic issues, and patient selection procedures., [source] What Defines a Transplant Surgeon?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010A Needs Assessment for Curricular Development in Transplant Surgery Fellowship Training This study compares the perceptions of transplant surgery program directors (PDs) and recent fellowship graduates (RFs) regarding the adequacy of training and relevancy to practice of specific curricular content items in fellowship training. Surveys were sent to all American Society of Transplant Surgery approved fellowship PDs and all RFs in practice <5 years. For operative procedures, the RFs considered the overall training to be less adequate than the PDs (p = 0.0117), while both groups considered the procedures listed to be relevant to practice (p = 0.8281). Regarding nonoperative patient care items, although RFs tended to rank many individual items lower, both groups generally agreed that the training was both adequate and relevant. For nonpatient care related items (i.e. transplant-related ethics, economics, research, etc.), both groups scored them low regarding their adequacy of training although RFs scored them significantly lower than PDs (p = 0.0006). Regarding their relevance to practice, while both groups considered these items relevant, RFs generally considered them more relevant than PDs. Therefore, although there is consensus on many items, significant differences exist between PDs and RFs regarding their perceptions of the adequacy of training and the relevance to practice of specific curriculum items in transplant surgery fellowship training. [source] Coppola: A Pediatric Surgeon in IRAQACADEMIC EMERGENCY MEDICINE, Issue 9 2010William G. Fernandez MD No abstract is available for this article. [source] Indenture of Apprenticeship as a Surgeon, Apothecary and Man Midwife, 1841AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2005Rosalind WINSPEAR Archivist No abstract is available for this article. [source] John Browne (1642,1702): Anatomist and plagiaristCLINICAL ANATOMY, Issue 1 2010Marios Loukas Abstract In contrast to many other physicians of his age, John Browne (1642,1702), an English anatomist and surgeon, managed to strike a balance in his career that spanned relative obscurity, prestige, and notoriety. Among his more prestigious credits, Browne was Surgeon in Ordinary to King Charles II and William III. He also had numerous publications to his name, some of which are credited as great innovations. His career, however, was tempered by his most important book, which has been critiqued by his contemporaries as well as modern historians as plagiarism. Although Browne undeniably copied the works of others and published them under his name, he was not alone in this practice. Various forms of intellectual thievery were common in Browne's day, and there were many perpetrators. The life of this overlooked figure in the history of anatomy and the stigma attached to him will be examined. Clin. Anat. 23:1,7, 2010. © 2009 Wiley-Liss, Inc. [source] I PREVENT Bacterial Resistance.DERMATOLOGIC SURGERY, Issue 10 2009An Update on the Use of Antibiotics in Dermatologic Surgery BACKGROUND AND OBJECTIVES Prophylaxis may be given to prevent a surgical wound infection, infective endocarditis (IE), or infection of a prosthetic joint, but its use before cutaneous surgery is controversial. Our aim was to review the current literature and provide a mnemonic to assist providers in appropriately prescribing prophylactic antibiotics. METHODS AND MATERIALS We reviewed the current literature, including the new guidelines provided by the American Heart Association (AHA). RESULTS The new AHA guidelines recommend prophylaxis for patients with high risk of an adverse outcome from IE instead of high risk of developing IE. The American Academy of Orthopedic Surgeons and the American Dental Association also provide guidelines. Given the paucity of conclusive studies, prophylaxis against a surgical wound infection is based more on clinical judgment. CONCLUSION The mnemonic we propose, "I PREVENT," represents: Immunosuppressed patients; patients with a Prosthetic valve; some patients with a joint Replacement; a history of infective Endocarditis; a Valvulopathy in cardiac transplant recipients; Endocrine disorders such as uncontrolled diabetes mellitus; Neonatal disorders including unrepaired cyanotic heart disorders (CHDs), repaired CHD with prosthetic material, or repaired CHD with residual defects; and the Tetrad of antibiotics: amoxicillin, cephalexin, clindamycin, and ciprofloxacin. [source] Hydrogen Peroxide and Wound Healing: A Theoretical and Practical Review for Hair Transplant SurgeonsDERMATOLOGIC SURGERY, Issue 6 2008SARA WASSERBAUER MD BACKGROUND In most hair restoration practices, hydrogen peroxide has been routinely used to remove blood during and after hair transplant surgery. In other specialties, hydrogen peroxide is also used in these ways: wound cleaning, prevention of infection, hemostasis, and removal of debris. Despite its widespread use, there are still concerns and controversy about the potential toxic effect of hydrogen peroxide. OBJECTIVE The objective was to review all available literature including in vivo and in vitro effects of hydrogen peroxide, as well as general wound healing research. MATERIAL AND METHODS Literature up to and including the past three decades was investigated. RESULTS Two pilot studies were found, and there are not enough data examining the real impact of using hydrogen peroxide in hair transplant surgery. In other specialties, H2O2 appears to have positive effects, such as stimulation of vascular endothelial growth factor, induction of fibroblast proliferation, and collagen, or negative effects, such as cytotoxicity, inhibition of keratinocyte migration, disruption of scarless fetal wound repair, and apoptosis. CONCLUSIONS There are not enough data in hair restoration surgery about the use of hydrogen peroxide, and it is unknown and unclear what the optimum dilution should be. Positive and negative effects were found in other specialties. Further studies are recommended. [source] Frequency of Use of Suturing and Repair Techniques Preferred by Dermatologic SurgeonsDERMATOLOGIC SURGERY, Issue 5 2006BETH ADAMS MD BACKGROUND There are many closure techniques and suture types available to cutaneous surgeons. Evidence-based data are not available regarding the frequency of use of these techniques by experienced practitioners. OBJECTIVE To quantify, by anatomic site, the frequency of use of common closure techniques and suture types by cutaneous surgeons. METHOD A prospective survey of the members of the Association of Academic Dermatologic Surgeons that used length-calibrated visual-analog scales to elicit the frequency of use of specific suture techniques. RESULTS A response rate of 60% (61/101) indicated reliability of the received data. Epidermal layers were closed most often, in descending order, by simple interrupted sutures (38,50%), simple running sutures (37,42%), and vertical mattress sutures (3,8%), with subcuticular sutures used more often on the trunk and extremities (28%). The most commonly used superficial sutures were nylon (51%) and polypropylene (44%), and the most common absorbable suture was polyglactin 910 (73%). Bilayered closures, undermining, and electrocoagulation were used, on average, in 90% or more sutured repairs. The median diameters (defined as longest extent along any axis) of most final wound defects were 1.1 to 2.0 cm (56%) or 2.1 to 3.0 cm (37%). Fifty-four percent of wounds were repaired by primary closure, 20% with local flaps, and 10% with skin grafting, with the remaining 15% left to heal by second intent (10%) or referred for repair (5%). Experience-related differences were detected in defect size and closure technique: defects less than 2 cm in diameter were seen by less experienced surgeons, and defects greater than 2 cm by more experienced surgeons (Wilcoxon's rank-sum test: p=.02). But more experienced surgeons were less likely to use bilayered closures (r=,0.28, p=.036) and undermining (r=,0.28, p=.035). CONCLUSIONS There is widespread consensus among cutaneous surgeons regarding optimal suture selection and closure technique by anatomic location. More experienced surgeons tend to repair larger defects but, possibly because of their increased confidence and skill, rely on less complicated repairs. [source] Incidence of and Risk Factors for Medical Malpractice Lawsuits among Mohs SurgeonsDERMATOLOGIC SURGERY, Issue 1 2006CLIFFORD S. PERLIS MD BACKGROUND Despite rising medical malpractice costs, little is known about the factors associated with claims filed against Mohs surgeons. OBJECTIVE We sought to define the scope of medical malpractice claims filed against Mohs surgeons and to identify salient factors associated with the filing and disposition of those claims. METHODS A comprehensive survey was mailed to 599 physicians with US addresses listed in the 2003 directory of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. RESULTS Of the 300 completed surveys returned, 33 (11%) reported ever having been sued. Physicians who practiced Mohs surgery for a longer period of time were more likely to have been sued for malpractice. Physicians reported the wrong site and functional outcome as the most frequent causes of malpractice lawsuits. [source] Recipient Area Hair Direction and Angle in Hair TransplantingDERMATOLOGIC SURGERY, Issue 6 2004Walter P. Unger MD Background. A variety of recommendations for creating "natural" hair directions and angles in hair transplanting have been described. Objective. A method of accomplishing that goal is outlined. Methods. Hair direction and angle are determined by multiple partings of the hair during the course of making recipient sites. Incisions are made to mimic such directions and angles. The direction is usually somewhat coronal and the use of grafts containing more than one follicular unit is particularly advantageous in producing a denser appearance. Results. If the above technique is employed, one does not accelerate the rate at which existing hair in the recipient area is lost and the hair flows in a natural easy to manage fashion. Conclusion. Surgeons should nearly always mimic the scalp hair directions and angles seen in nature. [source] Antibiotic Prophylaxis Guideline Awareness and Antibiotic Prophylaxis Use Among New York State Dermatologic SurgeonsDERMATOLOGIC SURGERY, Issue 9 2002Noah Scheinfeld JD background. Use of antibiotic prophylaxis in dermatologic surgery patients remains controversial and several sets of guidelines exist. objective. We investigated dermatologic surgeon's awareness of the American Heart Association (AHA) 1997 antibiotic prophylaxis guidelines, their use of prophylactic antibiotics, and their practices as compared with the Haas and Grekin's 1995 antibiotic prophylaxis guidelines. methods. We mailed postage-paid questionnaires regarding AHA guideline awareness and antibiotic prophylaxis use to the 235 New York State members of the American Society for Dermatologic Surgery (ASDS). We received 87 replies. results. Most participants recognize AHA guidelines and claim to follow them. We reiterate previous studies' findings. Most dermatologic surgeons use antibiotics appropriately. However, antibiotics are occasionally overused or dosed outside the guidelines. Many participants prescribe antibiotics based on a patient's other physicians' recommendations. Notably, erythromycin is sometimes used, an antibiotic the AHA no longer recommends. conclusion. Dermatologic surgeons commonly use antibiotic prophylaxis to prevent bacterial endocarditis. Based on previous studies, though, the risk of endocarditis following cutaneous surgery is low and thus the use of antibiotic prophylaxis is controversial. Although this practice is appropriate for high-risk patients when skin is contaminated, it is not recommended for noneroded, noninfected skin. We report that dermatologists may be aware of the guidelines, but only seem to partially follow them. Further studies are still needed to establish optimal guidelines. [source] The Importance of Core Surgical Training for Dermatologists and Dermatologic SurgeonsDERMATOLOGIC SURGERY, Issue 2 2002Robert L. Hewitt MD No abstract is available for this article. [source] Electrosurgery, Pacemakers and ICDs: A Survey of Precautions and Complications Experienced by Cutaneous SurgeonsDERMATOLOGIC SURGERY, Issue 4 2001Hazem M. El-Gamal MD Background. Minimal information is available in the literature regarding the precautions implemented or complications experienced by cutaneous surgeons when electrosurgery is used in patients with pacemakers or implantable cardioverter-defibrillators (ICDs). The literature pertinent to dermatologists is primarily based on experiences of other surgical specialties and a generally recommended thorough perioperative evaluation. Objective. To determine what precautions are currently taken by cutaneous surgeons in patients with pacemakers or ICDs, and what types of complications have occurred due to electrosurgery in a dermatologic setting. Methods. In the winter of 2000, a survey was mailed to 419 U.S.-based members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). Results. A total of 166 (40%) surveys were returned. Routine precautions included utilizing short bursts of less than 5 seconds (71%), use of minimal power (61%), and avoiding use around the pacemaker or ICD (57%). The types of interference reported were skipped beats (eight patients), reprogramming of a pacemaker (six patients), firing of an ICD (four patients), asystole (three patients), bradycardia (two patients), depleted battery life of a pacemaker (one patient), and an unspecified tachyarrhythmia (one patient). Overall there was a low rate of complications (0.8 cases/100 years of surgical practice), with no reported significant morbidity or mortality. Bipolar forceps were utilized by 19% of respondents and were not associated with any incidences of interference. Conclusions. Significant interference to pacemakers or ICDs rarely results from office-based electrosurgery. No clear community practice standards regarding precautions was evident from this survey. The use of bipolar forceps or true electrocautery are the better options when electrosurgey is required. These two modalities may necessitate fewer perioperative precautions than generally recommended, without compromising patient safety. [source] A Call for Dermatologic Surgeons to Take the Board Examination in Dermatologic Cosmetic Surgery from the American Board of Cosmetic SurgeryDERMATOLOGIC SURGERY, Issue 4 2000James B. Bridenstine MD No abstract is available for this article. [source] International survey on esophageal cancer: part II staging and neoadjuvant therapyDISEASES OF THE ESOPHAGUS, Issue 3 2009J. Boone SUMMARY The outcome of esophagectomy could be improved by optimal diagnostic strategies leading to adequate preoperative patient selection. Neoadjuvant therapy could improve outcome by increasing the number of radical resections and by controlling metastatic disease. The purposes of this study were to gain insight into the current worldwide practice of staging modalities and neoadjuvant therapy in esophageal cancer, and to detect intercontinental differences. Surgeons with particular interest in esophageal surgery, including members of the International Society for Diseases of the Esophagus, the European Society of Esophagology , Group d'Etude Européen des Maladies de l'Oesophage, and the OESO, were invited to participate in an online questionnaire. Questions were asked regarding staging modalities, neoadjuvant therapy, and response evaluation applied in esophageal cancer patients. Of 567 invited surgeons, 269 participated resulting in a response rate of 47%. The responders currently performing esophagectomies (n= 250; 44%) represented 41 countries across the six continents. Esophagogastroscopy with biopsy and computed tomography (CT) scanning were routinely performed by 98% of responders for diagnosing and staging esophageal cancer, while endoscopic ultrasound (EUS) and barium esophagography were routinely applied by 58% and 51%, respectively. Neoadjuvant therapy is routinely administered by 33% and occasionally by 63% of responders. Of the responders that administer identical neoadjuvant regimens to esophageal adenocarcinoma (AC) and squamous cell carcinoma, 54% favor chemoradiotherapy. For AC, chemotherapy is preferred by 31% of the responders that administer neoadjuvant therapy, whereas for squamous cell carcinoma, the majority of responders (38%) prefer chemoradiotherapy. Response to neoadjuvant therapy is predominantly assessed by CT scanning of the chest and abdomen (86%). Barium esophagography, EUS, and combined CT/PET scan are requested for response monitoring in equal frequency (25%). Substantial differences in applied staging modalities and neoadjuvant regimens were detected between surgeons from different continents. In conclusion, currently the most commonly applied diagnostic modalities for staging and restaging esophageal cancer are CT scanning of the chest and abdomen, gastroscopy, barium esophagography and EUS. Neoadjuvant therapy is routinely applied by one third of the responders. Intercontinental differences have been detected in the diagnostic modalities applied in esophageal cancer staging and in the administration of neoadjuvant therapy. The results of this survey provide baseline data for future research and for the development of international guidelines. [source] The impact of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) on esophageal cancer staging: a survey of thoracic surgeons and gastroenterologistsDISEASES OF THE ESOPHAGUS, Issue 6 2008J. T. Maple SUMMARY., Accurate staging of esophageal cancer is critical to achieving optimal treatment outcomes. End-oscopic ultrasound with fine needle aspiration (EUS-FNA) has emerged as a valuable tool for locoregional staging. However, it is unclear how different physician specialties perceive the benefit of EUS-FNA for esophageal cancer staging, and thus utilize this modality in clinical practice. A survey regarding utilization of EUS-FNA in esophageal cancer was distributed to 211 thoracic surgeons and 251 EUS-capable gastroenterologists. Seventy-six thoracic surgeons (36%) and 78 gastroenterologists (31%) responded to the survey. Most surgeons (75%) use EUS to stage potentially resectable esophageal cancer 75% of the time. Surgeons using EUS less often are less likely to have access to high-quality EUS services than their peers. Fewer surgeons believe EUS is the most accurate test for T and N-staging (84% and 71%, respectively) as compared with gastroenterologists (97% and 96%, P < 0.01 for both). Most endosonographers (68%) decide whether to dilate a malignant esophageal stricture to complete the staging exam on a case-by-case basis. Surgeons disagree as to whether involvement of celiac lymph nodes should preclude esophagectomy in distal esophageal cancer. While most thoracic surgeons have embraced EUS-FNA as the most accurate locoregional staging modality in esophageal cancer, this attitude is not fully reflected in utilization patterns due to a lack of quality EUS services in some centers. Controversial areas that warrant further study include dilation of malignant strictures to facilitate EUS staging, and the implication of involved celiac lymph nodes on management. [source] Farrier services at veterinary teaching hospitals in the USAEQUINE VETERINARY EDUCATION, Issue 10 2010C. A. Kirker-Head Summary Horse health is best served when farriers and veterinarians collaborate in the care of their patients. Veterinary Teaching Hospitals (VTHs) provide an environment that can nurture that collaboration. While VTH veterinary services are well known, VTH farrier activities are undocumented. To characterise farrier services at VTHs in the USA, 27 VTH Diplomates of the American College of Veterinary Surgeons and/or VTH farriers completed a multiple choice questionnaire characterising VTH farrier details, training, certification, remuneration method, and clinical, teaching and research responsibilities; and farrier service prevalence, facilities and financial viability. Questionnaire response rate was 81%. Eighteen of 22 (82%) responding VTHs had in-house farrier services. Twenty-one of 22 (95%) VTH farriers were male. Farriers' ages ranged from <30 years (n = 1, 5%) to >50 years (n = 7, 32%). At 11 (61%) VTHs the farriers were paid by the client and at 7 (39%) by the VTH. Five farriers (23%) received a VTH salary. Eighteen of 22 (82%) farriers had a professional certification. At 5 (28%) VTHs the farrier service made a profit and operational costs were met at 13 (72%). Fifteen (83%) farrier services provided professional education in clinical settings and 13 (72%) in lecture settings. Nine (41%) VTH farriers participated in research activities. In the USA, VTH farrier services vary considerably in both nature and extent. The farriers' potential contributions to VTH operations are often recognised but not consistently exploited. VTH farriers are a valuable resource who can contribute effectively toward VTH patient care, veterinary education and research. [source] The creation of an international audit and database of equine colic surgery: Survey of attitudes of surgeonsEQUINE VETERINARY JOURNAL, Issue 4 2008T. S. MAIR Summary Reasons for performing study: Currently, there is a lack of available evidence-based data concerning the optimum treatments for horses affected by different types of colic and this precludes the application of clinical audit in this area. In order to accumulate such data, a large-scale, multicentre database of the outcomes of colic surgery is proposed. The attitudes of surgeons is an important consideration in determining the feasibility of developing this database. Objectives: To assess attitudes and opinions of equine surgeons concerning clinical audit and to assess the perceived advantages and problems of setting up a large-scale international audit/database of colic surgery. Methods: Interviews were conducted with 30 equine surgeons (large animal/equine surgeons who are diplomates of either the American College of Veterinary Surgeons or the European College of Veterinary Surgeons). Questionnaires were sent by e-mail to 98 equine surgeons. Results: Face to face interviews were conducted (n = 30) and 43/98 completed questionnaires received (44%). The results of the 2 techniques were very similar. There was generally a high level of interest in the development of a large scale database of colic surgery, but perceived problems included time to collect and submit data, and confidentiality issues. A minority of surgeons reported that they were undertaking any form of specific monitoring of the results of colic surgery within their hospitals. Conclusions: There is a good level of interest among equine surgeons to develop a large scale database of colic surgery and most would be willing to contribute data from their own hospitals provided that data collection is quick and easy, and that confidentiality is maintained. Potential relevance: A large scale audit and database would provide relevant information to equine surgeons concerning the current success and complication rates of colic surgery. Such evidence-based data could be used in clinical audits within individual equine hospitals. The data would also be useful to identify trends within the discipline and could highlight areas that would benefit from active research. [source] End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative studyEQUINE VETERINARY JOURNAL, Issue 4 2005D. I. RENDLE Summary Reasons for performing study: Small intestinal resection and anastomosis is a relatively common procedure in equine surgical practice. This study was designed to test objectively the subjective opinions of surgeons at the Liphook Equine Hospital that an end-to-end jejuno-ileal anastomosis (JIA) is an effective and clinically justifiable procedure, contrary to conventional recommendations. Hypothesis: An end-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end jejunojejunal anastomosis (JJA). Methods: A retrospective observational study was performed on a population of 100 horses that had undergone small intestinal resection and end-to-end anastomosis. Two groups were identified; Group 1 (n = 30) had undergone an end-to-end JIA and Group 2 (n = 70) an end-to-end JJA. The 2 populations were tested for pre- and intraoperative comparability and for their equivalence of outcomes. Results: The 2 populations were comparable in terms of their distributions of preoperative parameters and type of lesion present. The observations used as outcome parameters (incidence risk of post operative colic, incidence risk of post operative ileus, duration of post operative ileus, rates of functioning original anastomoses at the time of discharge and at 12 months, survival rates at 6 months and 12 months) were equivalent between the 2 groups. Conclusion: End-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end JJA. Potential relevance: Surgeons faced with strangulating obstructions involving the jejuno-ileal junction in which there remains an accessible length of viable terminal ileum may reasonably perform an end-to-end JIA. This has the potentially significant advantage over a jejunocaecal anastomosis of preserving more anatomical and physiological normality to the intestinal tract. The study was, however, relatively small for an equivalence study and greater confidence would be gained with higher numbers. [source] Increased GFAP and S100, but not NSE serum levels after subarachnoid haemorrhage are associated with clinical severityEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2006P. E. Vos Assessment of initial disease severity after subarachnoid haemorrhage (SAH) remains difficult. The objective of the study is to identify biochemical markers of brain damage in peripheral blood after SAH. Hospital admission S100,, glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE) serum levels were analysed in 67 patients with SAH. Disease severity was determined by using the World Federation of Neurological Surgeons (WFNS) scale and the Fisher CT (computerized tomography) grading scale. Mean astroglial serum concentrations taken at hospital admission were increased (S100, 2.8-fold and GFAP 1.8-fold) compared with the upper limit of normal laboratory reference values (P95). The mean NSE concentration was within normal limits. S100, (P < 0.001) and GFAP (P =0.011) but not NSE levels were higher in patients who were in coma at the time of hospital admission compared with patients who were not. Similarly S100, and GFAP but not NSE serum levels increased with higher WFNS scores, raised intracranial pressure and higher CT Fisher grade scores. Concerning the location of the aneurysm, S100, and GFAP serum levels were within normal limits after a perimesencephalic type of haemorrhage and significantly increased after aneurysmal type SAH. Increased glial (S100, and GFAP) but not neuronal (NSE) protein serum concentrations are found after SAH, associated to the clinical severity of the initial injury. [source] | |||||||||||||||||||||||||||||||||||||||||||