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The authors discuss the history and evolution of management of traumatic wounds to the colon and rectum, summarizing early management parallel with the history of armed conflict followed by the increase in research and management interest by civilian centers in the post-Vietnam era. They explore the strong opinions of the early thought-leaders such as DeBakey and Ogilvie, detailing factors that may have impacted their views. The current literature on optimal management of both colon and rectal trauma is reviewed, including the contentious debate over which patients may benefit from diversion. Current organ injury staging and clinical practice guidelines are also reviewed, as well as lessons learned by the U.S. military in recent conflicts in Iraq and Afghanistan. Understanding of the evolution of colon and rectal trauma management, as well as the current literature, will help surgeons in their decision-making and management of these challenging injuries.
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Dr Aldred Scott Warthin discovered a "cancerous" family in the early 1900s, mapped its kindred, and studied their diseases to the extent possible in his day. His seminal article was published in 1913. Dr Henry Lynch took Warthin's studies and began using more modern techniques to characterize this so-called "Family G," beginning in the 1960s. Somehow in this process, Warthin's observations became "Lynch syndrome." We need a better name for this condition, and propose "Warthin-Lynch syndrome" to also honor its primary discoverer.
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Neoplasias Colorrectales Hereditarias sin Poliposis/historia , Terminología como Asunto , Historia del Siglo XX , Humanos , SíndromeRESUMEN
This paper describes a model humanitarian mission to Guyana; it illustrates the value of excellent ongoing care in collaboration with local physicians and surgeons, cooperation with local government and medical officials, and frequent periodic follow-up missions (always to the same hospital, working with the same staff). This effort has largely avoided the so-called "Seven Sins of Humanitarian Medicine".
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Altruismo , Misiones Médicas , Países en Desarrollo , Guyana , Humanos , Fallo Renal Crónico/terapia , Trasplante de Riñón , Diálisis Renal/economíaRESUMEN
PURPOSE: To investigate the association between poor performance on National Board of Medical Examiners clinical subject examinations across six core clerkships and performance on the United States Medical Licensing Examination Step 3 examination. METHOD: In 2012, the authors studied matriculants from the Uniformed Services University of the Health Sciences with available Step 3 scores and subject exam scores on all six clerkships (Classes of 2007-2011, N = 654). Poor performance on subject exams was defined as scoring one standard deviation (SD) or more below the mean using the national norms of the corresponding test year. The association between poor performance on the subject exams and the probability of passing or failing Step 3 was tested using contingency table analyses and logistic regression modeling. RESULTS: Students performing poorly on one subject exam were significantly more likely to fail Step 3 (OR 14.23 [95% CI 1.7-119.3]) compared with students with no subject exam scores that were 1 SD below the mean. Poor performance on more than one subject exam further increased the chances of failing (OR 33.41 [95% CI 4.4-254.2]). This latter group represented 27% of the entire cohort, yet contained 70% of the students who failed Step 3. CONCLUSIONS: These findings suggest that individual schools could benefit from a review of subject exam performance to develop and validate their own criteria for identifying students at risk for failing Step 3.
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Prácticas Clínicas , Educación de Pregrado en Medicina/normas , Evaluación Educacional , Licencia Médica , Intervalos de Confianza , Femenino , Humanos , Modelos Logísticos , Masculino , Evaluación de Necesidades , Oportunidad Relativa , Estados Unidos , Adulto JovenRESUMEN
PURPOSE: The United States is experiencing an accelerating physician shortage, especially within primary care. Medical educators are actively seeking ways to predict student specialty match and workforce requirements. Previous studies investigating specialty match have focused on factors known at the time of matriculation. This study examined whether third-year clerkship performance could be used to predict specialty match later in medical school. METHOD: The authors evaluated the clerkship performance of 802 students graduating from the Uniformed Services University between 2007 and 2011. They examined the relationship of students' clerkship grades and National Board of Medical Examiners' clinical subject examination scores to specialty match. In addition, the authors combined student performance in family medicine, internal medicine, and pediatrics to create composite variables and assessed their associations with the match. RESULTS: Among 802 students, 339 (42.4%) students matched to primary care specialties. There was a positive association between higher family medicine (Odds ratio [OR] 1.65, 95% confidence interval [CI] 1.05, 2.59), general surgery (OR 1.91, 95% CI 1.22, 2.99), internal medicine (OR 2.17, 95% CI 1.35, 3.49), and pediatrics (OR 2.59, 95% CI 1.52, 4.43) clerkship grades and students matching into family medicine, general surgery, internal medicine, and pediatrics, respectively. Only family medicine showed a weak correlation between higher National Board of Medical Examiners' scores and specialty match. CONCLUSIONS: Higher clerkship performance in four of six Uniformed Services University third-year clerkships is associated with matching into the corresponding specialty. Clerkship performance provides a potential tool for educators in counseling students and predicting future specialty match.
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Selección de Profesión , Prácticas Clínicas , Adulto , Competencia Clínica , Evaluación Educacional , Femenino , Humanos , Masculino , Atención Primaria de SaludRESUMEN
The purpose of this report is to record some of the recent accomplishments of the Surgery Interest Group (SIG) at the Uniformed Services University of the Health Sciences, and to provide a framework for others to follow, with the goal of encouraging students to become interested in the exciting field of surgery. We will outline some of the events that our SIG planned and carried out in order to provide a quality experience to its members.
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Educación de Pregrado en Medicina , Cirugía General/educación , Personal Militar , Estudiantes de Medicina , Selección de Profesión , Humanos , Facultades de Medicina , Estados UnidosRESUMEN
In the spirit of international exchanges of knowledge with colleagues from all over the world, who are interested in the care and treatment of vascular trauma, we offer selected historical reflections from the western world on vascular trauma. Whereas there are a number of key individuals and a variety of events that are important to us in our writing, we know essentially nothing about what is written by other cultures and, particularly, the Chinese. It is well recognized around the world that Chinese surgeons are among the first to be highly successful in re-plantation of severed extremities, repairing both injured arteries and veins. Also, we recognize that there are contributions in other parts of the world, which are not well known to us collectively. Contributions from the Arabic speaking part of the world come to mind because there is periodic brief reference. We offer our perspective hoping that there will be one or more Chinese surgeons who will offer us the benefit of sharing their perspective on important historical contributions to the managing of vascular trauma outside of the western world, and, particularly, the English speaking literature. Once again, we encourage our colleagues in the Arabic speaking world to provide us with their perspective of the development and management of vascular trauma.
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Lesiones del Sistema Vascular/historia , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Historia Medieval , Humanos , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/cirugíaRESUMEN
The need for humanitarian assistance throughout the world is almost unlimited. Surgeons who go on humanitarian missions are definitely engaged in a noble cause. However, not infrequently, despite the best of intentions, errors are made in attempting to help others. The following are seven areas of concern: 1. Leaving a mess behind. 2. Failing to match technology to local needs and abilities. 3. Failing of non-governmental organizations (NGO's) to cooperate and help each other, and and accept help from military organizations. 4. Failing to have a follow-up plan. 5. Allowing politics, training, or other distracting goals to trump service, while representing the mission as "service". 6. Going where we are not wanted, or needed and/or being poor guests. 7. Doing the right thing for the wrong reason. The goal of this report is to discuss these potential problems, with ideas presented about how we might do humanitarian missions more effectively.
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Altruismo , Cirugía General/normas , Misiones Médicas/normas , Humanos , Relaciones Interinstitucionales , Personal Militar , Organizaciones , PolíticaAsunto(s)
Colectomía/métodos , Colon/lesiones , Colostomía/métodos , Medicina Militar/normas , Infección de la Herida Quirúrgica/epidemiología , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/mortalidad , Traumatismos Abdominales/cirugía , Adulto , Anastomosis Quirúrgica , Traumatismos por Explosión/diagnóstico , Traumatismos por Explosión/mortalidad , Traumatismos por Explosión/cirugía , Colectomía/estadística & datos numéricos , Colostomía/estadística & datos numéricos , Tratamiento de Urgencia/normas , Hospitales Militares , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Laparotomía , Masculino , Medicina Militar/tendencias , Personal Militar , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/mortalidad , Traumatismo Múltiple/cirugía , Pautas de la Práctica en Medicina , Pronóstico , Medición de Riesgo , Muestreo , Análisis de Supervivencia , Resultado del Tratamiento , GuerraRESUMEN
This report details the life and contributions of William Ray Rumel, an early cardiovascular surgeon known for his innovations, particularly the "Rumel tourniquet," and the ability to repair the diseased mitral valve without replacing it.
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Cirugía General/historia , Instrumentos Quirúrgicos/historia , Torniquetes/historia , Historia del Siglo XX , Retratos como Asunto , Estados UnidosAsunto(s)
Eficiencia Organizacional , Liderazgo , Medicina Militar , Personal Militar , Cultura Organizacional , Humanos , Estados UnidosRESUMEN
The current dogma about the treatment of penetrating colon injuries is reviewed, both from the civilian and the military perspective. This discussion is still evolving, and the time-honored methods of diversion, including colostomy and ileostomy, are still appropriate for the most severe and devastating sorts of wounds, especially in the military context. For the vast majority of penetrating wounds, primary repair works well and should be practiced. For the few patients who have primary repair that fails and leaks, mortality rates are high. The art of surgery involves knowing when to divert and when to repair.