PubMed Health⌕ Search

Biomedical subjects

E Hoover

Publications and source records attributed to E Hoover.

14 recordsLinked to original sources
PubMed2002

Maintaining outcomes in a surgical residency while complying with resident working hour regulations.

BACKGROUND: Regulatory requirements for resident working hours were designed to improve patient care. Compliance challenges a training program to meet procedural and clinical requirements. This is a retrospective study of a 5-year experience in addressing the challenges and studying the impact of compliance on resident caseload and board performance. METHODS: Our surgical program adopted strict start/stop working hours for clinical contact. Program leadership modified the program to establish procedural and performance criteria. Procedures were prioritized and assignments were changed to maximize clinical and procedural experience while reducing redundancy of experience. Procedural activity was monitored frequently. Compliance with working hour regulations was monitored and behavior modified where necessary. A web based computer program was developed to improve measurement of compliance and provide feedback. Outcome measures included both the number of procedures as reported by the ACGME and performance on the American Board of Surgery, Qualifying Examination. RESULTS: Working hour compliance is greater than 95%. First time pass rate on the Qualifying examination is 90% (45/50). There is no significant difference in the procedural activity. CONCLUSION: Complying with working hour regulations improves the quality of a resident's life and can be achieved while maintaining procedural experience and guaranteeing academic development.

General Surgery↗
PubMed1992

The Surgical Infection Society's policy on human immunodeficiency virus and hepatitis B and C infection. The Ad Hoc Committee on Acquired Immunodeficiency Syndrome and Hepatitis.

The Ad Hoc Committee on Acquired Immunodeficiency Syndrome and Hepatitis of The Surgical Infection Society has outlined its policy regarding three deadly blood-borne viral infections. The risk of transmission of these microbes, the role of preoperative testing, the problem of the human immunodeficiency virus-infected surgeon, and conduct in the operating room are discussed.

General Surgery↗
PubMed1992

Utility of an oral examination in a surgical clerkship.

To evaluate the utility of the oral examination in a surgical clerkship, we designed a prospective and randomized study to relate the subjective impressions of experienced examiners with an objective measure of cognitive knowledge. The examiners were asked to score the student's performance as honors, high satisfactory, satisfactory, or unsatisfactory, according to their subjective impression of the student's ability. Student performance was grouped according to oral examination performance. The cognitive performance in the honors group was significantly better than that of the other groups (Student's t-test, p = 0.05). There was a significant difference in cognitive performance for oral examination groups throughout the rotations (analysis of variance, p = 0.000; Kruskal Wallis, p = 0.05). The oral examination is useful to identify a high level of cognitive achievement but cannot discriminate between groups of median to low competence. It should be used for educational feedback, career counseling, residency recommendations, and professional development.

Achievement↗
PubMed1992

A complication of the Greenfield filter: fracture and distal migration of two struts--a case report.

This is a case report of a 41-year-old woman who required surgical removal of a Greenfield filter 7 months after placement. The filter developed several complications. Two struts were noted to be completely separated from the filter and lodged in the infrarenal vena cava. The filter had migrated to a resting position in the right renal, vein with two struts perforating the renal vein and inferior vena caval junction. The perforating struts were intraperitoneal and were found to impinge on the right ureter with seromuscular involvement of the second portion of the duodenum. No free perforation was noted at the time of exploration.

Adult↗
PubMed1992

Experience as a surgeon determines resident knowledge.

BACKGROUND: This is a prospective study that compares operative experience with performance on the American Board of Surgery Inservice Training Examination (ABSITE) to establish the primacy of procedural experience in the graduate training environment. METHODS: Operative experience was determined from a computerized log of surgical procedures. The Report D of the 1991 ABSITE was used to assign each test item to specific operative procedures and to determine the frequency of the correct response (Fcr) for each item. The fraction of operative procedures (Fs) was determined for each category of surgical procedures (Fs = Number of procedures as surgeon/Total number of procedures). The Fcr was compared to the Fs by use of the Pearson correlation coefficient with significance at 95% confidence. RESULTS: Forty-two residents reported doing 8357 surgical procedures as surgeon in 12 months. Report D contained 209 test items. Of these, 162 items could be assigned to 26 categories of surgical procedures. The Fcr correlated directly with the Fs (p = 0.002, r = 0.605). CONCLUSIONS: A significant correlation exists between the experience of surgical residents as surgeon and their performance on the ABSITE:

Clinical Competence↗
PubMed1991

Proliferative pancreatic cysts: pathogenesis and treatment options.

Proliferative pancreatic cysts are subdivided into microcystic and mucinous cystadenomas. These rare, slow-growing, multilocular lesions usually remain localized for long periods of time, therefore frequently becoming rather sizeable before becoming symptomatic. Patients present with intermittent abdominal or back pain, nausea and vomiting, early satiety, and a palpable mass without a history of trauma or alcoholism. Computed tomographic scanning is the most useful laboratory test. The lesions are more often found in women, with the microcystic adenomas usually located in the head of the pancreas and the mucinous lesions in the pancreatic body or tail. At surgery, if it is at all possible, the lesions should be completely removed, even if it means performance of a Whipple procedure. This is particularly important for mucinous cysts because of their potential for malignant degeneration. Internal drainage or marsupialization procedures should not be done in these patients. The long-term results are excellent if the entire lesion is removed.

Cystadenoma↗
PubMed1989

Use of naloxone in septic shock.

Experimental and clinical evidence show that endogenous opiates (endorphins) contribute to the pathophysiology of circulatory shock. The authors evaluated the effectiveness and safety of continuous infusion of naloxone in five septic patients with prolonged hypotension unresponsive to volume replacement and dopamine infusion. Naloxone (2 mg bolus) was intravenously administered and continued at 0.25 mg/hr for 24 to 48 hours. All five patients had significant increase in mean arterial pressure of between 20 and 30 mmHg (P less than 0.0012). Cardiac index, systemic vascular resistance, and pulmonary arterial pressure were not significantly altered; however, there was a significant difference in pulmonary capillary wedge pressure (P less than 0.034) and urinary output (P less than 0.0273). Subjects did not experience side effects with naloxone. We conclude that continuous infusion of naloxone can reverse endorphin-mediated hypotension in septic shock patients.

Aged↗
PubMed1988

Is routine triple endoscopy cost-effective in head and neck cancer?

The multicentric occurrence of tumors of the upper aerodigestive tract has been well described, with an incidence ranging from 5 to 16 percent. Detection of a synchronous primary tumor at the time of initial work-up is crucial both for management and final outcome. However, there is a diversity of opinions regarding the extent of the work-up to search for a second primary tumor. Some investigators consider routine panendoscopy to be essential for every patient with a head and neck primary tumor. Routine esophagoscopy and bronchoscopy with bronchial washings in the absence of specific symptoms appear to have minimal benefit and high cost. In our study of 140 consecutive patients with primary squamous cell carcinoma of the head and neck seen over a period of 3 years, detailed history, thorough head and neck examination, routine chest radiograph, and barium swallow when indicated were sufficient to identify 18 patients (13 percent) with a second primary tumor in the upper aerodigestive tract. The synchronous tumors of eight patients were in the head and neck area, seven patients had carcinoma of the lung, and three patients had a second primary in the esophagus. Two patients had three synchronous primaries. Follow-up of these patients ranged from 1 to 4 years. Panendoscopy with cytologic washings was performed routinely. We questioned the cost-effectiveness of routine triscopy in every patient with head and neck cancer.

Adult↗
PubMed1988

Exposure of the internal carotid artery near the skull base: the posterolateral anatomic approach.

Internal carotid injuries in zone III near the base of the skull are technically the most challenging of the carotid injuries. Diagnostic angiography is important to evaluate the exact site and extent of injury and the presence or absence of prograde flow in the injured segment. Vascular repair in this area is highly dependent on the adequacy of surgical exposure. Previous approaches have emphasized displacement of the mandible either by subluxation or mandibulotomy. Problems related to mandibulotomy, such as intraoral contamination, infection, and nonunion, are potential complications of this approach to the high carotid artery. In addition, it does not give adequate exposure of the internal carotid artery at the critical area, near the base of the skull. Experience gained from the extended radical neck dissection exposing the internal carotid artery up to the skull base has demonstrated that a posterolateral anatomic approach can provide superior exposure of the high carotid artery with lower morbidity and shortened operative time. This surgical approach involves cutting the sternomastoid muscle close to the mastoid and dissecting all the tissues away from the surface of the mastoid. Dividing the posterior belly of the digastric and styloid group of muscles assists in exposure of the internal carotid artery. Rarely, dissection of the facial nerve and removal of the tail of parotid add additional access to this area. This article describes the stepwise anatomic approach to the internal carotid artery near the base of the skull.

Adult↗
PubMed1983

Aortico-right ventricular shunt following aortic valve replacement.

A 58-year-old man developed cardiac decompensation following aortic valve replacement as a result of an aortico-right ventricular fistula. Serial hemodynamic and electrocardiographic changes are presented. Attention is drawn to this rare complication as a cause of hemodynamic deterioration following aortic valve surgery.

Aortic Diseases↗