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J Stewart Humphrey

Publications and source records attributed to J Stewart Humphrey.

3 recordsLinked to original sources
PubMed2006

Effect of the Veterans Affairs Medical System on plastic surgery residency training.

BACKGROUND: Teaching hospitals within the Veterans Affairs Health System perform the majority of complex and high-risk surgical procedures in the veteran patient population. Residency positions in the Veterans Affairs Medical System are usually part of a rotational educational system within a university-based residency, and plastic surgeons in training are a major work force and health care provider. The purpose of this study was to evaluate the current effect of the Veterans Affairs Medical System on plastic surgery residency training. METHODS: A 6-year (January of 1998 to December of 2003) review was performed of procedures completed at the Durham Veterans Affairs Medical Center, Section of Plastic Surgery. Procedures were divided into the following categories: extremities and trunk; breast and cosmetic; head and neck, including excision of skin lesions; hand surgery; craniomaxillofacial surgery; and other. Only procedures performed in the main operating room were reviewed and analyzed. In addition, a detailed review was performed of major head and neck reconstructions with free tissue transfer. RESULTS: A total of 1655 operative procedures were performed in 1290 patients. The ratio of men to women was 6:1 (1112 men and 178 women). Patients ranged in age from 26 to 97 years (average age, 62.7 years). Procedures in the extremities and trunk (n = 193, 11.7 percent), breast and cosmetic (n = 228, 13.8 percent), hand surgery (n = 155, 9.4 percent), and other (n = 275, 16.6 percent) categories were comparably distributed. Although the head and neck category accounted for the highest number of procedures (n = 766, 46.3 percent), the majority of these procedures were simple excisions of skin tumors (n = 612). There were significantly fewer major craniomaxillofacial cases (n = 38, 2.3 percent). CONCLUSIONS: Data from the retrospective analysis reveal that a broad spectrum of plastic surgical procedures is performed within the Veterans Affairs Health System, serving as a tremendous resource for resident training. The fact that approximately 260 procedures per year are performed demonstrates an active service. Craniomaxillofacial surgery is currently underrepresented compared with other categories at the authors' particular institution. By their definition, nonspecific plastic surgical procedures ("other") account for 275 (16.6 percent) of all 1655 procedures performed. This demonstrates that plastic surgery "overlaps" with other specialties, such as dermatology. The Veterans Affairs Health System will continue to play a significant role in the future training of plastic surgeons. Now, more than ever, a strong Veterans Affairs surgical service, including plastic surgery and its modern techniques, will be needed.

Adult↗
PubMed2005

Sural flap delay procedure: a preliminary report.

Over the last decade, the sural flap has been popularized as a suitable alternative to free-tissue transfer for soft-tissue coverage of the lower extremity. However, flap failure rates may be increased especially if patients have certain risk factors, such as age over 40 years, peripheral artery disease, venous insufficiency, diabetes mellitus, and others. This article describes a sural flap delay procedure to avoid flap necrosis in this potentially "high-risk" patient population.

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PubMed2000

Does gender bias exist in the medical management of heart failure?

INTRODUCTION: The purpose of this study was to ascertain the presence of gender bias in the medical management of heart failure, and to assess its association with the specialty of the caregiver physician. METHODS: In 309 patients with documented left ventricular systolic dysfunction (ejection fraction <45%) and at least one hospitalization for heart failure, we assessed the frequency of use of effective medical therapy for heart failure among male (n=187) and female (n=122) patients at the time of hospital discharge. We constructed multivariate models relating patient gender and caregiver specialty to utilization of each class of medications (angiotensin-converting enzyme inhibitors, effective vasodilator therapy (i.e., angiotensin-converting enzyme inhibitors or hydralazine-nitrate therapy), diuretics, digoxin), and combination therapy (i.e., vasodilator plus diuretic plus digoxin). RESULTS: In crude analyses, we did not find any difference in utilization of medications between male and female patients. Multivariate analyses involving adjustment for age, race, coronary artery disease, ejection fraction, and other relevant variables, revealed higher utilization of combination therapy by cardiologists in male versus female patients (adjusted odds ratios=2.07; 95%CI=1.09-3.95), and higher utilization of digoxin therapy by non-cardiologists in female versus male patients (adjusted odds ratio=5.5; 95%CI=1.4-22.2). No gender or caregiver specialty differences were seen in models relating to the other classes of medications. CONCLUSIONS: Our findings suggest the presence of gender bias in the medical management of heart failure, and identify an interesting interaction between caregiver specialty and gender bias.

Aged↗