RESUMEN
The purpose of this paper is to assess career satisfaction of surgeons in the era of managed care. The method of this assessment is by membership survey of the Southeastern Surgical Congress and the Western Surgical Association. Members were queried about their demographic characteristics, some aspects of the business of their practices, their attitudes toward retirement, their perception of the effectiveness of organized medicine as a socioeconomic advocate, and a comparison of each surgeon's career satisfaction before and during the era of managed care. Three hundred seventy-three usable surveys were returned, computerized, and analyzed statistically. Summaries of categorical variables are presented as percentages for various groupings of the categorical set. Results reveal a broad-based career disaffection in all areas queried, most notably in the business of surgical practice, attitude toward retirement and retirement alternatives, and the advocacy role of organized medicine for their issues. There is an almost unanimous desire for the American College of Surgeons to become their aggressive socioeconomic advocate. The data support a conclusion that surgeons perceive they are not represented in a realistic manner with the insurance companies and the government when their core issues are decided.
Asunto(s)
Cirugía General/economía , Satisfacción en el Trabajo , Programas Controlados de Atención en Salud/economía , Actitud del Personal de Salud , Selección de Profesión , Cirugía General/organización & administración , Humanos , Programas Controlados de Atención en Salud/organización & administración , Autonomía Profesional , Estados UnidosRESUMEN
This report concerns two cases and a review of the literature on the subject of symmetrical peripheral gangrene. Symmetrical peripheral gangrene is defined as symmetrical distal ischemic damage in two or more sites in the absence of major vascular occlusive disease. It occurs in patients who are septic and have disseminated intravascular coagulation and in nonseptic patients who have cardiogenic or hypovolemic shock. The syndrome is devastating and rare, and controlled studies of its etiology and management are lacking. Recommendations are presented for its prevention and treatment. Cooperative multicenter studies may be necessary to obtain valid data about its prevention and management.
Asunto(s)
Gangrena/etiología , Anciano , Anciano de 80 o más Años , Gangrena/cirugía , Humanos , Pierna/patología , Masculino , Complicaciones Posoperatorias/etiología , Factores de Riesgo , SíndromeRESUMEN
A 15-year-old boy developed traumatic cholecystitis from a BB shot that lodged in his gallbladder. This is an unusual cause of gallbladder disease, and we review the literature.