Biomedical subjects

Patricia L Lewis

Publications and source records attributed to Patricia L Lewis.

4 recordsLinked to original sources

PubMed2006

Trauma nurse specialists' performance of advanced skills positively impacts surgical residency time constraints.

The Accreditation Council for Graduate Medical Education imposed 80-hour work week constraints on residency programs in July 2003. Certain programs were granted an additional 10 per cent for specific educational purposes, bringing restrictions to 88 hours per week. The increased demand for residents to leave the hospital has placed teaching institutions in exhaustive situations to provide comprehensive patient care. In response to the work hour constraints among residents and emergency room staff, a unique group of registered nurses, trauma nurse specialists (TNSs), were credentialed with advanced practice skill sets. Governed by practice guidelines and overseen by a medical director, TNSs perform invasive procedures that are normally the responsibility of the surgical resident. The purpose of this study was to evaluate work hours saved for surgery residents using credentialed nurses (TNSs). Procedure logs were maintained by the TNSs over a 6-month period, and surgical house staff (postgraduate year 1-3) over a 4-month period. A total of 423 procedures were recorded, reflecting time taken for attempted/completed procedures and complications. Resident procedures numbered 98; TNS procedures numbered 325. TNSs spent an average of 42 hours per month (10.6 hours per week) completing advanced procedures with no statistical difference in time or complications compared with surgical residents. By using the TNSs, work hours for surgery residents were saved while maintaining a safe and reliable work atmosphere for patients.

Education, Nursing↗

PubMed2004

Resident work hours: can we meet the ACGME requirements?

The Accreditation Council for Graduate Medical Education (ACGME) requires all programs to limit resident work hours to 80 hours per week with some programs allotted an extra 10 per cent for specific educational purposes. The purpose of this study was to evaluate data reflecting changes in resident schedules made in 2002-2003 to be compliant with ACGME requirements without compromising patient care or resident education. Surgery residents originally completed a work-hour survey in May 2002. The survey contained 14 daily time sheets. Residents were asked to document how their time was spent between 14 different categories delineating in-house and out-of-house hours. Changes were made to resident schedules in order to become compliant with the new regulations. After making changes in the schedule, two more surveys were completed and evaluated, once in May 2003 and again in November 2003. Final analyses compared results from May 2002 to November 2003. Surveys were distributed to 30 residents in May 2002. Twenty-two residents completed the survey with 16 surveys eligible for analysis following exclusion of abnormal rotations (i.e., research and vacation). Eighty-eight per cent of junior residents (PGY 1, 2, and 3), 50 per cent of senior residents (PGY 4-5), and 33 per cent of chief residents (PGY 6) worked more than 88 hours per week. In November 2003, surveys were sent to 32 residents. Twenty-four residents who were on our normal call schedule completed the survey. Fourteen per cent of junior residents, 33 per cent of senior residents, and 0 per cent of chief residents worked more than 88 hours per week. By making the changes described, we have substantially reduced the number of resident work-hours while maintaining our academic and patient care missions.

Accreditation↗

PubMed2002

Routine prophylactic vena cava filtration is not indicated after acute spinal cord injury.

BACKGROUND: Acute spinal cord injury (SCI) is a devastating problem, with over 10,000 new cases annually. Pulmonary embolism (PE) is a well-recognized risk in SCI patients, although no clear recommendations for prophylaxis exist. We therefore evaluated whether routine placement of prophylactic inferior vena cava filters is indicated in SCI patients. METHODS: The trauma registry of a regional trauma center was used to identify patients sustaining acute SCI resulting in tetraplegia or paraplegia after blunt or penetrating trauma for a 5-year period beginning in January 1995. Patients were analyzed for demographics, mechanism of injury, Injury Severity Score, associated long bone or pelvic fracture, severe closed-head injury, type of deep venous thrombosis (DVT) prophylaxis, level of SCI, and incidence of DVT and PE. DVT prophylaxis was performed in all patients with sequential compression devices (SCDs) when extremity fracture status permitted. Data are expressed as mean +/- SD and analyzed using Fisher's exact test. RESULTS: There were 8,269 admissions during the study period, with an overall incidence of DVT and PE of 11.8% and 0.9%, respectively. There were 111 (1.3%) patients who sustained SCI, with an incidence of DVT and PE of 9.0% and 1.8%, respectively, and no deaths. Of these 111 patients, 41.4% were paraplegics and 58.6% were tetraplegics, and 17.1% of patients had severe closed-head injury. Mean hospital length of stay was 23 +/- 20 days for SCI patients. Surveillance duplex ultrasound was performed an average of 2.3 +/- 2.1 times during each hospitalization. Mean Injury Severity Score was 30.0 +/- 12.2. The incidence of DVT and PE in those patients with SCDs alone was 7.1% and 2.3%; for SCDs plus subcutaneous heparin, the incidence was 11.1% and 2.8%; and for SCDs plus low-molecular-weight heparin, the incidence was 7.4% and 0%, respectively, with no statistical difference between groups. The incidence of DVT in SCI patients with long bone fractures was 37.5%, which was significantly greater than the total SCI population (p < 0.02). CONCLUSION: The incidence of DVT and PE in SCI patients was similar to that of the overall trauma population when appropriate DVT prophylaxis was used. Subgroup analysis demonstrated that SCI associated with long bone fracture significantly increases the incidence of DVT. On the basis of the low incidence of PE in the present study, routine placement of prophylactic caval filters does not appear warranted in all SCI patients. However, SCI patients with long bone fractures, patients with DVT formation despite prophylactic anticoagulation, or patients with contraindications to anticoagulation may be appropriate candidates for prophylactic caval filtration.

Acute Disease↗

PubMedDate not supplied

Is there declining interest in general surgery training?

PURPOSE: To monitor and report the quality of categorical first-year surgery residents matched to U.S. general surgery training programs from 1996 to 2001. METHODS: A survey was sent to 258 program directors of accredited general surgery training programs. In this survey, data were requested regarding United States Medical Licensing Exam (USMLE) Step 1 and 2 scores, matched residents' rank list position, Alpha Omega Alpha (AOA) status, number of applications received, and interviews granted pertaining to all National Residency Matching Program (NRMP) residents matched. In addition, the USMLE and NRMP were petitioned for national data regarding Step 1 and 2 scores in all entering surgery residents and first-time USMLE takers. RESULTS: Usable survey data were received on 1241 residents. The number for each year (and percent of total matched PGY-1 residents) was as follows: 1996-196 (20.0), 1997-206 (20.4), 1998-204 (19.9), 1999-212 (21.0), 2000-212 (20.7), and 2001-211 (21.7). The mean Step 1 scores increased over time (p < 0.001), and programs with 5 or more categorical spots had higher scores than those with 4 or less (p < 0.001). The depth required to fill the rank list increased over the study period (p < 0.05). National data received from the NRMP from 1994 to 2001 (mean of 916 residents at each year) showed a similar increase in USMLE Step 1 scores when compared with our survey. The proportion of AOA students matching into general surgery has decreased from 30% in 1996 to 15% in 2001 (p < 0.001). CONCLUSIONS: Over the 6 years of our study, USMLE Step 1 scores increased and the results of our survey are in agreement with the national data. However, the proportion of AOA students declined, implying the top 10% of the medical school class found general surgery training less attractive. Also, programs went deeper into their rank lists to fill, implying a shrinking pool of candidates.

Analysis of Variance↗