The big chill: intraoperative diagnosis and treatment of unsuspected preoperative hypothermia.
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Biomedical subjects
Publications and source records attributed to C T Wallace.
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The large numbers of medical graduates seeking residency training in anesthesiology have created a logistical problem for many programs. This difficulty and the recurrent phenomenon of the misplaced physician have prompted a search for better selection criteria and more efficient evaluation systems. The literature does not provide a concise description of the ideal resident candidate, but it does contain several approaches taken by a few individual teaching centers to improve applicant review procedures. Computer-assisted resident candidate selection (CARCS) is a three-phase system of preinterview screening, interview evaluation, and final ranking. Based on faculty criteria, the entire process uses data management technology that provides automatic calculation of selection parameters, sorting on any data field or combination thereof, and maintenance of a concise information profile for each candidate. CARCS allows equitable consideration of all who apply, with significant cost savings to both program and applicants. This paper reviews traditional methods of selecting anesthesiology residents, describes the CARCS system, and previews the future of resident candidate selection.
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Analysis of learning style, a relatively new technique in the field of education, is being used in grade school and college, as well as in graduate and postgraduate training programs. The trend in the health professions to emphasize continuing education has created a need for individual practitioners to understand the principles of self-education. Analysis of learning style is useful in this regard. It also provides a basis for teaching task-specific cognitive skills to those in residency training. In this article we review the conceptual evolution of learning style analysis, especially its use in the health professions, and describe the Kolb Learning Style Inventory (LSI), which we use to study 205 anesthesia personnel.
The anesthetic management of pediatric patients for plastic surgical procedures requires close cooperation and understanding between the surgeon and anesthesiologist. Success depends upon avoidance of psychological trauma, establishment and maintenance of a secure airway, and adequate access to the vascular system.
Learning style analysis is being used at many educational levels to individualize the instructional process. The Kolb Learning Style Inventory (LSI) in particular has been employed to determine the learning preferences of medical students and physicians in family practice, internal medicine, and anesthesiology. This investigation was undertaken to discover whether there exists a characteristic learning profile for surgery as a specialty. The Kolb LSI was administered to 39 surgical personnel. Kolb's Converger was the preferred learning style type of the study group (46%). Accommodator (26%) and Assimilator (20%) were next, followed by Diverger (8%). These results suggest that there is an identifiable surgical learning style that can provide a referential basis for teaching and counseling during residency training.
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At the Medical University of South Carolina during the past five years, 62 patients have had intracranial aneurysm surgery, with an overall mortality of 4.8%. Anesthesia was given by me to 14 of these patients. Preoperatively these patients were placed on bedrest, steroid prophylaxis, and sedative and antihypertensive medication to reduce th possibility of recurrent subarrachnoid hemorrhage. Halothane-nitrous oxide-oxygen endotracheal anesthesia with controlled ventilation was used, with careful monitoring of EKG, direct arterial pressure, arterial blood gases, body temperature, and urinary output. Adjuncts for control of bleeding and intracranial pressure were osmotic diuresis, cerebrospinal fluid drainage, minimal head-up tilt, and controlled hypotension using trimethaphan (Arfonad). There were no operative deaths, although one patient died postoperatively. Three patients had neurologic deficitys. These data indicate that controlled hypotension is a safe technic which, when properly used, can reduce the risk of anesthesia for intracranial aneurysm surgery.
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