Measuring service-specific performance and educational value within a general surgery residency: the power of a prospective, anonymous, Web-based rotation evaluation system in the optimization of resident satisfaction.

BACKGROUND: We used a Web-based evaluation system to institute specific changes to various clinical teaching services in our integrated residency in an effort to optimize the overall quality of the educational experience and measured the resident satisfaction in these rotations. METHODS: Residents rated 8 categories of experience on a scale of 1 to 5 (maximum summation score, 40 points). Data were analyzed by t-test for equality of means. A probability value of less than.05 was considered significant. RESULTS: Compliance with completion of the evaluations was 100%. The Chronbach's alpha reliability coefficient of the tool was 0.826. Tukey's estimate of power to achieve additivity was 1.5. Six under-performing services were re-engineered with prominent effects on 7 postgraduate year (PGY) rotations. On 2 general surgery services at 1 hospital, the workload was redistributed, and a dedicated team teaching time was instituted (PGY-3 [a]: before, 22 points/after, 31 points; P =.003; PGY-3 [b]: before, 25 points/after, 31 points; P =.004; PGY-1: before, 24 points/after, 29 points; P =.07). A general surgery service at another hospital redistributed coverage of the attending surgeons to create a nonteaching service (PGY-1: before, 22 points/-after, 27 points; P =.01). The transplantation service (PGY-3) was examined, and the role of the point was redefined (before, 24 points/after, 31 points; P =.01). One vascular service (PGY-2) redistributed cases and workload (before, 27 points/after, 22 points; P =.07). The vascular PGY-2 position was eliminated and replaced by a mid-level practitioner. The cardiothoracic service (PGY-1) rotation was converted into a preceptorship (before, 23 points/after, 30 points; P =.015). CONCLUSIONS: A web-based clinical rotation evaluation provides a means for the assessment of the impact of programmatic changes while preserving resident anonymity and maintaining accountability.

Congenital pulmonary lymphangiectasia: a case report of thoracic duct agenesis.

We present a 17-year-old Caucasian male with congenital pulmonary lymphangiectasia and an absent thoracic duct. This patient is unique as he did not present with the disorder until age 9.5 years. Since his initial presentation he has had recurrent chylothoraces and has been treated symptomatically. We discuss the possible implications of his disorder as well as some of the limited treatment that is available.

Beyond requirements: residency management through the Internet.

HYPOTHESIS: An Internet application could collect information to satisfy documentation required by the Residency Review Committee. Beyond replacing a difficult and inefficient paper system, it would collect, process, and distribute information to administration, faculty, and residents. DESIGN: Descriptive study. SETTING: An integrated residency of 18 services at a university teaching hospital with 4 affiliated institutions. PARTICIPANTS: Residency administrators, faculty, and residents. INTERVENTIONS: The application included a procedure recorder, resident evaluation of faculty and rotations, goals and objectives (stratified by service and resident level), and matching faculty evaluation of residents with these goals as competencies. Policies, schedules, research opportunities, clinical site information, and curriculum support were created. MAIN OUTCOME MEASURES: Degree of compliance with Residency Review Committee standards, number of deficiencies corrected, and quantity and quality of information available to administration, faculty, and residents. RESULTS: The Internet system increased resident compliance for faculty and rotation evaluations from 20% and 34%, respectively, to 100%, which was maintained for 22 months. These evaluations can be displayed individually, in summary grids, and as postgraduate year-specific averages. Faculty evaluations of residents can be reviewed throughout the system. The defined category report for procedures, which had deficiencies in the preceding 6 years, had none for the last 2 years. The Internet application provides Accreditation Council for Graduate Medical Education-validated operative logs to regulatory agencies. CONCLUSIONS: A Web-based system can satisfy requirements and provide processed data that are of better quality and more complete than our paper system. We are now able to use scarce time and personnel to nurture developing surgical residents instead of shuffling paper.

[Evaluation and administration of home care towards a new management]. / La valutazione e la gestione dell'assistenza domiciliare verso un nuovo management.

PURPOSE: The aim of the present contribution is to always provide a more complete and flexible direction. MATERIALS AND METHODS: With the purpose of evaluating the activity of the CAD in a typical area of about 100,000 inhabitants, 400 case history statistics were elaborated, a number corresponding to all the patients assumed by the CAD in thr Guidonia (RM) district. In these details, the distribution of pathology of the men and women assisted, were analysed as well as the specialist consultation requested by both males and females. They have, however, examined the analytic guide of the district's activity; the distribution of patients admitted to the hospital in the last two years before the CAD had taken charge, has been compared with those that occurred successively. DISCUSSION AND CONCLUSIONS: The prevalent pathology are those of neurological nature, followed by cardiovascular, oncological, diabetic and orthopedic pathology, the last of which is more frequent in women. They are all pathology that can be prevented and/or delayed with suitable programmes of prevention and rehabilitation. The specialists most requested are the heart specialist and neurologist. It emerges from the guide analysis, that while the CAD activity is growing, the programmed assistance with the doctor in charge doesn't keep the same pace. This contribution wants therefore to offer an idea for battering the CAD services in spite of the scarce human resources and economical assests.

Vanadium salts induce cytogenetic effects in in vivo treated mice.

Three vanadium salts, vanadyl sulfate (SVO5), sodium orthovanadate (Na3VO4) and ammonium metavanadate (NH4VO3), were tested for induction of genotoxic effects in bone marrow of mice following intragastric treatment. Micronucleus (MN) induction in polychromatic erythrocytes (PCEs), structural (sCA) and numerical (nCA) chromosome aberrations in bone marrow cells were evaluated. The micronucleus test, performed at different harvesting times (0-72 h), was found to be positive for all compounds tested. In contrast, except for vanadyl sulfate, no difference was found between controls and treated animals in the sCA test performed 24 and 36 h after treatment. At the same sampling intervals, second metaphases (M II) were positively scored for nCA induction for all three vanadium salts. In addition, the frequency of hypoploid and hyperploid cells was shown to be statistically different from the control value. Polyploid cells were also induced by all compounds, but their frequency was not statistically significant. The positive results obtained by nCA analysis support the finding of a significant presence of types of micronuclei that are probably aneuploidy-related. This finding was further supported by the successful classification of such micronuclei on the basis of shape and size according to Tinwell and Ashby (1991) during microscope analysis.

New data on the pharmacokinetics of adriamycin and its major metabolite, adriamycinol.

Twenty-two days after administration by intravenous bolus, of 50 mg of adriamycin to several patients we found concentrations of adriamycin and adriamycinol of the order of 100 pcg/ml. In theory, however, with a terminal half-life of 30 h, the plasma levels of adriamycin and adriamycinol should be close to 0.1 pcg/ml. Further pharmacokinetic investigation was therefore necessary. We have retained for this study nine male patients, aged between 53 and 69 years who received 25 to 50 mg of adriamycin by slow intravenous injection. The HPLC method permitted the detection of 50 pcg/ml of adriamycin and adriamycinol, with the possibility of monitoring their elimination during 120 h (and in one case during 160 h). The terminal half-lives of elimination estimated in 8 patients were respectively 110 +/- 52 h for adriamycin and 92 h 50 min +/- 43 h for adriamycinol. Surface ratios under adriamycinol curves against calculated adriamycin was 1.10 +/- 0.26. Plasma levels found during the To in certain patients correspond to the end of the drug elimination of the previous treatment. It is difficult with a half-life to 110 h to predict the effects of residual concentrations of adriamycin and adriamycinol.