PubMed · 10847059
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S W Pepicello. Clarifications, please.. https://doi.org/10.1111/j.1744-6198.2000.tb01169.x
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BACKGROUND: After more than a decade of growth for laparoscopic cholecystectomy and decline in open cholecystectomy, the impact on the training of resident's in other open biliary operations can be analyzed quantitatively. METHODS: The national operative statistics for residents' operations from 1988 to 2001 (data in the public domain) were analyzed by regression analysis to establish trends and to calculate the rate of change. For laparoscopic biliary operations, the changes in laparoscopic and open operations over time and the number of operations per trainee each year were used to measure the growth of a laparoscopic operation and to predict future trends. A survey of attitude, management algorithm, and self-confidence for coping with unexpected events in laparoscopic cholecystectomy also was conducted for senior residents and recent graduates. RESULTS: In 2001, open cholecystectomy decreased to 28%, open common duct exploration to 27%, sphincteroplasty to 20%, of 1988 (baseline year) levels. Cholecystostomy and choledochoenteric bypass decreased to 70% and 75%, respectively. The decline began before the era of laparoscopic cholecystectomy, but accelerated after its introduction. Many of the recent graduates surveyed in one program indicated a preference for a nonsurgical, mainly endoscopic, approach for all bile duct conditions, but also for the assistance of senior surgeons in the operative management of unexpected events. CONCLUSION: The popularity of noninvasive therapy in biliary surgery significantly reduced the resident's exposure to open biliary surgery, adversely affecting their confidence in the management of unexpected events encountered during laparoscopic operations. Supplemental and remedial education measures must be instituted in training programs.
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OBJECTIVE: To assess Israeli women gynecologists toward their own health, their health related behaviors and to assess attitude towards and the use of hormone replacement therapy (HRT). METHODS: Ninety five actively employed hospital and community women gynecologist completed a questionnaire on attitude towards self-health, way of life, smoking habits, and regular breast, blood, pap smear examinations and HRT. RESULTS: Mean BMI was 25.3 Kg/m(2)+/-4.2, 61% considered themselves above average weight, and only 39% estimated their weight as appropriate. Fifty six percent were on active weight-loss diets, and 35% were current smokers. Blood tests, pap smears and breast evaluations were regularly done by 73.4, 91.5, and 64.1%, respectively. Overall, 74% of the gynecologists had a positive opinion about HRT; 70% of the menopausal subgroup had ever used HRT, and 93.3% of the perimenopausal subgroup intended to use it. The main reason for starting HRT was climacteric symptoms, and for stopping or avoiding HRT were equally bleeding, fear of cancer and adverse reactions towards HRT. By far the oral HRT mode was the most popular and 90% of users expressed satisfaction with treatment. CONCLUSIONS: Israeli women gynecologists are aware and maintain carefully their health, excluding cigarette smoking. The high rate of use and awareness of HRT among this group is encouraging considering that gynecologist serves as role model for the public and maintains the main source of HRT in the community.