The American College of Surgeons
About: This article is published in American Journal of Ophthalmology.The article was published on 1932-12-01. It has received 616 citations till now. The article focuses on the topics: Specialty.
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TL;DR: Assessment of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after general surgery education.
Abstract: Objective:To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America.Methods:A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program director
641 citations
TL;DR: A pressing need exists to improve the management of major depression for patients attending specialist cancer services, and 1130 of 1538 patients with depression and complete patient-reported treatment data were not receiving potentially effective treatment.
292 citations
TL;DR: These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and may be updated with pertinent scientific developments at a later time.
231 citations
TL;DR: In this article, the authors conducted a retrospective descriptive and analytic epidemiologic study of an inpatient database representing 20,659,684 traumatic injury discharges from US hospitals between 2000 and 2011.
Abstract: Background Trauma is a leading cause of death and disability in the United States (US). This analysis describes trends and annual changes in in-hospital trauma morbidity and mortality; evaluates changes in age and gender specific outcomes, diagnoses, causes of injury, injury severity and surgical procedures performed; and examines the role of teaching hospitals and Level 1 trauma centres in the care of severely injured patients. Methods We conducted a retrospective descriptive and analytic epidemiologic study of an inpatient database representing 20,659,684 traumatic injury discharges from US hospitals between 2000 and 2011. The main outcomes and measures were survey-adjusted counts, proportions, means, standard errors, and 95% confidence intervals. We plotted time series of yearly data with overlying loess smoothing, created tables of proportions of common injuries and surgical procedures, and conducted survey-adjusted logistic regression analysis for the effect of year on the odds of in-hospital death with control variables for age, gender, weekday vs. weekend admission, trauma-centre status, teaching-hospital status, injury severity and Charlson index score. Results The mean age of a person discharged from a US hospital with a trauma diagnosis increased from 54.08 (s.e.=0.71) in 2000 to 59.58 (s.e.=0.79) in 2011. Persons age 45-64 were the only age group to experience increasing rates of hospital discharges for trauma. The proportion of trauma discharges with a Charlson Comorbidity Index score greater than or equal to 3 nearly tripled from 0.048 (s.e.=0.0015) of all traumatic injury discharges in 2000 to 0.139 (s.e.=0.005) in 2011. The proportion of patients with traumatic injury classified as severe increased from 22% of all trauma discharges in 2000 (95% CI 21, 24) to 28% in 2011 (95% CI 26, 30). Level 1 trauma centres accounted for approximately 3.3% of hospitals. The proportion of severely injured trauma discharges from Level 1 trauma centres was 39.4% (95% CI 36.8, 42.1). Falls, followed by motor-vehicle crashes, were the most common causes of all injuries. The total cost of trauma-related inpatient care between 2001 and 2011 in the US was $240.7 billion (95% CI 231.0, 250.5). Annual total US inpatient trauma-related hospital costs increased each year between 2001 and 2011, more than doubling from $12.0 billion (95% CI 10.5, 13.4) in 2001 to 29.1 billion (95% CI 25.2, 32.9) in 2011. Conclusions Trauma, which has traditionally been viewed as a predicament of the young, is increasingly a disease of the old. The strain of managing the progressively complex and costly care associated with this shift rests with a small number of trauma centres. Optimal care of injured patients requires a reappraisal of the resources required to effectively provide it given a mounting burden.
182 citations
TL;DR: The authors examined the associations of insurance status with stage at diagnosis among women with breast cancer and found that individuals without medical insurance or with limited insurance are less likely to receive preventive services and to seek timely medical care.
Abstract: BACKGROUND
Individuals without medical insurance or with limited insurance are less likely than those with broader insurance coverage to receive preventive services and to seek timely medical care. The authors examined the associations of insurance status with stage at diagnosis among women with breast cancer.
METHODS
This study included women age ≥40 years who were diagnosed with invasive breast cancer from 1998 to 2003 and who were reported to the National Cancer Data Base. Multivariable logistic regression analyses were used to examine the associations of insurance status with more advanced-stage breast cancer at diagnosis while controlling for other patient characteristics.
RESULTS
Among the 533,715 women with breast cancer who were included in the current analysis, the proportions with advanced-stage (III/IV) cancer at diagnosis ranged from 8% among privately insured patients to 18% among uninsured patients and 19% among Medicaid patients; differences in the proportions of women with advanced-stage cancer were statistically significant (P < .0001). Regression analyses indicated that, compared with privately insured patients, uninsured patients and Medicaid patients had a greater likelihood of diagnosis at stage II (odds ratio [OR], ∼≈1.5) or at stages III/IV (OR, 2.4) versus stage I (P < .001). Black and Hispanic patients also were significantly more likely than white patients to be diagnosed at a more advanced stage (P < .001).
CONCLUSIONS
The results from this study provided strong evidence that patients without health insurance or with Medicaid coverage, as well as black and Hispanic patients, were more likely to present with advanced-stage breast cancer. These results are consistent with other reports that have documented less use of preventive services, including mammography, among uninsured women and delays in diagnosis and treatment for black and Hispanic women. Cancer 2007. © 2007 American Cancer Society.
180 citations
References
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TL;DR: Assessment of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after general surgery education.
Abstract: Objective:To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America.Methods:A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program director
641 citations
TL;DR: A pressing need exists to improve the management of major depression for patients attending specialist cancer services, and 1130 of 1538 patients with depression and complete patient-reported treatment data were not receiving potentially effective treatment.
292 citations
University of Ulsan1, Chungnam National University2, Korea University3, Chonnam National University4, Yonsei University5, Keimyung University6, Catholic University of Korea7, Soonchunhyang University8, Hallym University9, Kangwon National University10, Catholic University of Daegu11, Chonbuk National University12, Kyungpook National University13, Dongguk University14, Inje University15
TL;DR: An additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke.
Abstract: Background—The risks and benefits of long-term dual antiplatelet therapy remain unclear Methods and Results—This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011 Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531) The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization At 24 months, the primary end point occurred in 57 aspirin-alone group patients (24%) and 61 dual-therapy group patients (26%; hazard ratio, 094; 95% confidence interval, 066–135; P=075) The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent
267 citations
TL;DR: These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and may be updated with pertinent scientific developments at a later time.
231 citations
TL;DR: In this article, the authors conducted a retrospective descriptive and analytic epidemiologic study of an inpatient database representing 20,659,684 traumatic injury discharges from US hospitals between 2000 and 2011.
Abstract: Background Trauma is a leading cause of death and disability in the United States (US). This analysis describes trends and annual changes in in-hospital trauma morbidity and mortality; evaluates changes in age and gender specific outcomes, diagnoses, causes of injury, injury severity and surgical procedures performed; and examines the role of teaching hospitals and Level 1 trauma centres in the care of severely injured patients. Methods We conducted a retrospective descriptive and analytic epidemiologic study of an inpatient database representing 20,659,684 traumatic injury discharges from US hospitals between 2000 and 2011. The main outcomes and measures were survey-adjusted counts, proportions, means, standard errors, and 95% confidence intervals. We plotted time series of yearly data with overlying loess smoothing, created tables of proportions of common injuries and surgical procedures, and conducted survey-adjusted logistic regression analysis for the effect of year on the odds of in-hospital death with control variables for age, gender, weekday vs. weekend admission, trauma-centre status, teaching-hospital status, injury severity and Charlson index score. Results The mean age of a person discharged from a US hospital with a trauma diagnosis increased from 54.08 (s.e.=0.71) in 2000 to 59.58 (s.e.=0.79) in 2011. Persons age 45-64 were the only age group to experience increasing rates of hospital discharges for trauma. The proportion of trauma discharges with a Charlson Comorbidity Index score greater than or equal to 3 nearly tripled from 0.048 (s.e.=0.0015) of all traumatic injury discharges in 2000 to 0.139 (s.e.=0.005) in 2011. The proportion of patients with traumatic injury classified as severe increased from 22% of all trauma discharges in 2000 (95% CI 21, 24) to 28% in 2011 (95% CI 26, 30). Level 1 trauma centres accounted for approximately 3.3% of hospitals. The proportion of severely injured trauma discharges from Level 1 trauma centres was 39.4% (95% CI 36.8, 42.1). Falls, followed by motor-vehicle crashes, were the most common causes of all injuries. The total cost of trauma-related inpatient care between 2001 and 2011 in the US was $240.7 billion (95% CI 231.0, 250.5). Annual total US inpatient trauma-related hospital costs increased each year between 2001 and 2011, more than doubling from $12.0 billion (95% CI 10.5, 13.4) in 2001 to 29.1 billion (95% CI 25.2, 32.9) in 2011. Conclusions Trauma, which has traditionally been viewed as a predicament of the young, is increasingly a disease of the old. The strain of managing the progressively complex and costly care associated with this shift rests with a small number of trauma centres. Optimal care of injured patients requires a reappraisal of the resources required to effectively provide it given a mounting burden.
182 citations