Biomedical subjects

John D Mellinger

Publications and source records attributed to John D Mellinger.

5 recordsLinked to original sources

PubMed2006

How surgical faculty and residents assess the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions: results of a multi-institutional study.

BACKGROUND: This study examined how surgical residents and faculty assessed the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions. METHODS: Questionnaires were administered in 9 general-surgery programs during the summer of 2004; response rates were 63% for faculty and 58% for residents (N = 259). Questions probed patient care, the residency program, quality of life, and overall assessments of the duty-hour restrictions. Results include the means, mean deviations, percentage who agree or strongly agree with the hour restrictions, and significance tests. RESULTS: Although most support the restrictions, few maintain that they improved surgical training or patient care. Faculty and residents differed (P < or = .05) on 16 of 21 items. Every difference shows that residents view the restrictions more favorably than faculty. The sex of the resident shaped the magnitude of the gap for 11 of 21 items. CONCLUSIONS: Few believe that duty-hour restrictions improve patient care or resident training. Residents, especially female residents, view the restrictions more favorably than faculty.

Attitude of Health Personnel↗

PubMed2006

Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study.

PURPOSE: To examine whether duty-hour restrictions have been consequential for various aspects of the work of surgical faculty and if those consequences differ for faculty in academic and nonacademic general surgery residency programs. METHOD: Questionnaires were distributed in 2004 to 233 faculty members in five academic and four nonacademic U.S. residency programs in general surgery. Participation was restricted to those who had been faculty for at least one year. Ten items on the questionnaire probed faculty work experiences. Results include means, percentages, and t-tests on mean differences. Of the 146 faculty members (63%) who completed the questionnaire, 101 volunteered to be interviewed. Of these, 28 were randomly chosen for follow-up interviews that probed experiences and rationales underlying items on the questionnaire. Interview transcripts (187 single-spaced pages) were analyzed for main themes. RESULTS: Questionnaire respondents and interviewees associated duty-hour restrictions with lowered faculty expectations and standards for residents, little change in the supervision of residents, a loss of time for teaching, increased work and stress, and less satisfaction. No significant differences in these perceptions (p < or = .05) were found for faculty in academic and nonacademic programs. Main themes from the interviews included a shift of routine work from residents to faculty, a transfer of responsibility to faculty, more frequent skill gaps at night, a loss of time for research, and the challenges of controlling residents' hours. CONCLUSIONS: Duty-hour restrictions have been consequential for the work of surgical faculty. Faculty should not be overlooked in future studies of duty-hour restrictions.

Attitude of Health Personnel↗

PubMed2005

Single-stage reconstruction of perforated choledochal cyst: case report and review of the literature.

Choledochal cysts represent a rare disease in the Western world. We reviewed our recent experience with a case of perforated choledochal cyst, define the currently accepted treatment options, and review the literature of this unusual disease. An 11-month-old girl presented with abdominal pain and distention as well as non-bilious vomiting. Subsequent workup included endoscopic retrograde cholangiopancreatography revealing a perforated type I choledochal cyst. She underwent single-stage excision and reconstruction with a Roux-en-Y hepaticojejunostomy. Perforated choledochal cyst is a rare event, and prompt surgical intervention is warranted. Single-stage cystectomy and Roux-en-Y reconstruction is possible in select patients. A thorough understanding of the pathophysiology, management, and follow-up is required.

Biliary Tract Surgical Procedures↗

PubMed2004

Animate advanced laparoscopic courses improve resident operative performance.

BACKGROUND: The use of animate training laboratories have been touted as an important part of a surgical resident's training. This study determines if there was any benefit in resident performance and whether that benefit persisted. METHODS: Twelve senior surgical residents attended a course in advanced laparoscopy with didactic and laboratory components. The residents' skills were tested by having them perform a laparoscopic fundoplication before, immediately after, and 6 months after the course. The procedure was videotaped, and divided into stages that were timed and scored by a single, masked observer. RESULTS: Overall performance score was 35.7 +/- 2.5 for the pretest, improving to 16.5 +/- 1.2 (P <0.05) immediately after the course, and 23.7 +/- 5.1 (P <0.05) at 6 months. Significant improvements were seen with trocar insertion, crural closure, division of short gastric arteries, and fundoplication. CONCLUSIONS: The data presented demonstrate significant and persistent improvement in laparoscopic operative skills as a result of focused laboratory skill training.

Adult↗

PubMed2003

Upper gastrointestinal endoscopy: current status.

Esophagogastroduodenoscopy occupies a predominant position in the diagnostic evaluation and therapeutic management of foregut disease. The safety, anatomic refinement, and tissue sampling capabilities offered by endoscopic examination support its use as a premier diagnostic tool. An increasingly diverse and ingenious set of endoscopically delivered tools are available to expand the diagnostic capability, and extend the therapeutic application of esophagogastroduodenoscopy to a wide range of pathology, both benign and neoplastic. Comparative outcome data support the utility of therapeutic esophagogastroduodenoscopy in the management of upper gastrointestinal bleeding and the palliative management of foregut neoplasia. Endoscopically delivered therapies may have an increasing role in the management of gastroesophageal reflux disease in the future, and the development of endoluminal ultrasound has added a whole new dimension to endoscopic diagnostic and, potentially, therapeutic capability. This review highlights the current status of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal pathology.

Endoscopy, Digestive System↗