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Lena M. Napolitano - One of the best experts on this subject based on the ideXlab platform.
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hepcidin and anemia in Surgical Critical Care a prospective cohort study
Critical Care Medicine, 2018Co-Authors: Jill R Cherrybukowiec, Milo Engoren, Arek J Wiktor, Krishnan Raghavendran, Lena M. NapolitanoAbstract:OBJECTIVE Because anemia of inflammation is common in ICU patients and hepcidin is the key regulator of iron homeostasis, we examined time-dependent changes in hepcidin, erythropoietin, iron, and inflammatory markers in Surgical ICU patients with anemia. DESIGN Prospective single-center clinical noninterventional study. SETTING Surgical ICUs; U.S. university hospital. PATIENTS One hundred Surgical adult ICU patients. MEASUREMENTS AND MAIN RESULTS Time-dependent changes in serum hepcidin, hematologic, and erythropoietic studies were performed on ICU admission and at serial time-points through day 28, and correlated with hematologic and iron parameters and inflammatory response. Median serum hepcidin levels were significantly increased at ICU admission and decreased over time (144-36 ng/mL; p < 0.0001). Despite increased reticulocyte counts (1.3-2.9%), mean serum erythropoietin levels remained low (29-44 mU/mL) and hemoglobin did not significantly change. Hepcidin was positively correlated with RBC transfusion, C-reactive protein, interleukin-6, ferritin, and negatively correlated with iron, total iron binding capacity, transferrin, and reticulocyte response. Hepcidin did not correlate with tumor necrosis factor-α serum concentrations. Regression analyses confirmed that ferritin, C-reactive protein, and reticulocyte number were predictive of same-day hepcidin; hepcidin and C-reactive protein were predictive of same-day reticulocyte count. CONCLUSIONS Hepcidin serum concentrations are markedly increased on ICU admission, and decrease significantly over the course of the ICU stay (28 d). Decreased hepcidin concentrations are associated with increased reticulocyte response and decreased inflammatory response reflected by decreased interleukin-6 and C-reactive protein concentrations, but not with anemia resolution.
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general surgery resident rotations in Surgical Critical Care trauma and burns what is optimal for residency training
American Journal of Surgery, 2016Co-Authors: Lena M. Napolitano, Gregory J Jurkovich, Karen J Brasel, Thomas W Biester, Jo Buyske, Mark A Malangoni, Frank R Lewis, Roxie M Albrecht, Eileen M Bulger, Martin A CroceAbstract:Abstract Background There are no specific Accreditation Council for Graduate Medical Education General Surgery Residency Program Requirements for rotations in Surgical Critical Care (SCC), trauma, and burn. We sought to determine the experience of general surgery residents in SCC, trauma, and burn rotations. Methods Data analysis of Surgical rotations of American Board of Surgery general surgery resident applicants (n = 7,299) for the last 8 years (2006 to 2013, inclusive) was performed through electronic applications to the American Board of Surgery Qualifying Examination. Duration (months) spent in SCC, trauma, and burn rotations, and postgraduate year (PGY) level were examined. Results The total months in SCC, trauma and burn rotations was mean 10.2 and median 10.0 (SD 3.9 months), representing approximately 16.7% (10 of 60 months) of a general surgery resident's training. However, there was great variability (range 0 to 29 months). SCC rotation duration was mean 3.1 and median 3.0 months (SD 2, min to max: 0 to 15), trauma rotation duration was mean 6.3 and median 6.0 months (SD 3.5, min to max: 0 to 24), and burn rotation duration was mean 0.8 and median 1.0 months (SD 1.0, min to max: 0 to 6). Of the total mean 10.2 months duration, the longest exposure was 2 months as PGY-1, 3.4 months as PGY-2, 1.9 months as PGY-3, 2.2 months as PGY-4 and 1.1 months as PGY-5. PGY-5 residents spent a mean of 1 month in SCC, trauma, and burn rotations. PGY-4/5 residents spent the majority of this total time in trauma rotations, whereas junior residents (PGY-1 to 3) in SCC and trauma rotations. Conclusions There is significant variability in total duration of SCC, trauma, and burn rotations and PGY level in US general surgery residency programs, which may result in significant variability in the fund of knowledge and clinical experience of the trainee completing general surgery residency training. As acute Care surgery programs have begun to integrate emergency general surgery with SCC, trauma, and burn rotations, it is an ideal time to determine the optimal curriculum and duration of these important rotations for general surgery residency training.
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challenging issues in Surgical Critical Care trauma and acute Care surgery a report from the Critical Care committee of the american association for the surgery of trauma
Journal of Trauma-injury Infection and Critical Care, 2010Co-Authors: Lena M. Napolitano, Gerard J Fulda, Kimberly A Davis, Dennis W Ashley, Randall S Friese, Charles W Van Way, Wayne J Meredith, Timothy Fabian, Gregory J Jurkovich, Andrew PeitzmanAbstract:Critical Care workforce analyses estimate a 35% shortage of intensivists by 2020 as a result of the aging population and the growing demand for greater utilization of intensivists. Surgical Critical Care in the U.S. is particularly challenged by a significant shortfall of Surgical intensivists, with only 2586 surgeons currently certified in Surgical Critical Care by the American Board of Surgery, and even fewer surgeons (1204) recertified in Surgical Critical Care as of 2009. Surgical Critical Care fellows (160 in 2009) represent only 7.6% of all Critical Care trainees (2109 in 2009), with the largest number of Critical Care fellowship positions in internal medicine (1472, 69.8%). Traditional trauma fellowships have now transitioned into Surgical Critical Care or Acute Care Surgery (trauma, Surgical Critical Care, emergency surgery) fellowships. Since adult Critical Care services are a large, expensive part of U.S. healthCare and workforce shortages continue to impact our healthCare system, recommendations for regionalization of Critical Care services in the U.S. is considered. The Critical Care Committee of the AAST has compiled national data regarding these important issues that face us in Surgical Critical Care, trauma and acute Care surgery, and discuss potential solutions for these issues.
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structure of Surgical Critical Care and trauma fellowships
Critical Care Medicine, 2006Co-Authors: Samuel A Tisherman, Peter B Angood, Philip S Barie, Lena M. NapolitanoAbstract:Introduction: Surgical Critical Care (SCC) and trauma fellowships have developed in a variety of formats. Although SCC fellowships must meet specific requirements for accreditation by the Accreditation Council for Graduate Medical Education, trauma fellowships do not. As the American Board of Surgery is considering combining SCC, trauma, and emergency surgery into “acute Care surgery” fellowship training, a better understanding of current program structures is needed. Methods: The Education Committee of the Surgery Section of the Society of Critical Care Medicine sent surveys by e-mail to all SCC program directors. The survey included questions regarding the content of the fellowship, specifically, subspecialty rotations, trauma content, and operative experience. If they offered a trauma fellowship, the survey queried its structure also. Results: A total of 39 of 82 surveys were returned. About one third of the programs have only SCC fellowships, one third combine SCC/trauma in 1-yr programs, and the remainder combine SCC/trauma in 2 yrs. Of the programs, 79% provided operative experience: 15% on a separate rotation and 39% on call during intensive Care unit coverage. About half of the operative experiences were related to trauma and one quarter to emergency general surgery. The great majority of rotations were in general Surgical or trauma intensive Care units. Conclusion: SCC programs already include meaningful trauma and emergency general surgery operative experience. Surgical subspecialty intensive Care unit and operative rotations may contribute to optimal training of the “acute Care surgeon.”
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Current status of blood component therapy in Surgical Critical Care.
Current opinion in critical care, 2004Co-Authors: Lena M. NapolitanoAbstract:PURPOSE OF REVIEW The use of blood component therapy, with transfusion of red cells, plasma, and platelets, is common in Critical Care. New evidence has emerged documenting the risks associated and lack of efficacy or improvement in clinical outcome with blood transfusion for the treatment of anemia in Critically ill patients who are hemodynamically stable. RECENT FINDINGS The safety of a restrictive transfusion strategy (transfuse only if hemoglobin < 7 g/dL) was reported in 1999. Despite compelling evidence from this prospective randomized clinical trial, clinicians have not substantially changed practice regarding blood transfusion in Critical Care. The recently published CRIT trial reported that the mean pre-transfusion hemoglobin was 8.6 g/dL in this large multicenter trial that examined transfusion practices in Critical Care in the US. Furthermore, only 19% of hospitals had an institutional blood transfusion protocol. The Surviving Sepsis Campaign guidelines have also recommended blood transfusion only when hemoglobin falls to 7.0 g/dL, following resolution of tissue hypoperfusion and in the absence of significant coronary artery disease or acute hemorrhage. We have an increased understanding of the pathophysiology of the anemia associated with Critical Care, related to the inflammatory response, downregulation of erythropoietin, and lack of iron availability due to macrophage sequestration. Clinical trials are underway to confirm the efficacy of recombinant erythropoietin in the treatment of Critically ill patients with anemia. SUMMARY Current data regarding blood transfusion thresholds and risks of blood transfusion have not as yet significantly altered practice patterns. Efforts to reduce blood transfusion rates in Critically ill patients are required. These strategies will require education, unit and institutional protocols, and reduction of phlebotomy for diagnostic laboratory testing in the intensive Care unit. Further investigations regarding anemia in Critical Care and new treatment and prevention strategies are required.
Samuel A Tisherman - One of the best experts on this subject based on the ideXlab platform.
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Surgical Critical Care training for emergency physicians curriculum recommendations
Journal of The American College of Surgeons, 2013Co-Authors: Samuel A Tisherman, Hasan B Alam, Fred A Luchette, William C Chiu, Evie G Marcolini, Lillian L Emlet, Michael D Grossman, Julie MayglothlingAbstract:Received March 16, 2013; Revised May 28, 2013; Accepted May 2 From the Departments of Critical Care Medicine (Tisherman, Surgery (Tisherman), and Emergency Medicine (Emlet), University burgh, Pittsburgh, PA, Department of Surgery, University of M Ann Arbor, MI (Alam), Department of Surgery, University of M Baltimore, MD (Chiu), Department of Acute Care Surgery, So Hospital/Northshore LIJ Trauma Network, Bay Shore, NY (Gro Department of Surgery, Loyola University, Maywood, IL (Lu Departments of Emergency Medicine and Neurology, Yale U New Haven, CT (Marcolini), and Departments of Surgery and Em Medicine, Virginia Commonwealth University, Richmon (Mayglothling). Correspondence address: Samuel A Tisherman, MD, FACS, Department of Critical Care Medicine, University of Pittsburg 1215, Lillian S Kaufmann Bldg, 3471 Fifth Ave, Pittsburgh, PA email: tishermansa@upmc.edu
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Surgical Critical Care and emergency surgery clinical questions and answers
2012Co-Authors: Forrest O Moore, Peter Rhee, Samuel A Tisherman, Gerard J FuldaAbstract:Surgical Critical Care And Emergency Surgery: Clinical Questions And Answers - Libros de Medicina - Medicina intensiva - 69,00
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structure of Surgical Critical Care and trauma fellowships
Critical Care Medicine, 2006Co-Authors: Samuel A Tisherman, Peter B Angood, Philip S Barie, Lena M. NapolitanoAbstract:Introduction: Surgical Critical Care (SCC) and trauma fellowships have developed in a variety of formats. Although SCC fellowships must meet specific requirements for accreditation by the Accreditation Council for Graduate Medical Education, trauma fellowships do not. As the American Board of Surgery is considering combining SCC, trauma, and emergency surgery into “acute Care surgery” fellowship training, a better understanding of current program structures is needed. Methods: The Education Committee of the Surgery Section of the Society of Critical Care Medicine sent surveys by e-mail to all SCC program directors. The survey included questions regarding the content of the fellowship, specifically, subspecialty rotations, trauma content, and operative experience. If they offered a trauma fellowship, the survey queried its structure also. Results: A total of 39 of 82 surveys were returned. About one third of the programs have only SCC fellowships, one third combine SCC/trauma in 1-yr programs, and the remainder combine SCC/trauma in 2 yrs. Of the programs, 79% provided operative experience: 15% on a separate rotation and 39% on call during intensive Care unit coverage. About half of the operative experiences were related to trauma and one quarter to emergency general surgery. The great majority of rotations were in general Surgical or trauma intensive Care units. Conclusion: SCC programs already include meaningful trauma and emergency general surgery operative experience. Surgical subspecialty intensive Care unit and operative rotations may contribute to optimal training of the “acute Care surgeon.”
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Critical Care medicine education of surgeons recommendations from the Surgical section of the society of Critical Care medicine
Critical Care Medicine, 2000Co-Authors: Michael E Ivy, Marc J Shapiro, Samuel A Tisherman, Peter B Angood, Orlando C Kirton, Mathilda HorstAbstract:Perspective: The role of surgeons in Critical Care medicine has a long and esteemed past. The presence of surgeons in intensive Care units provides specific insights and perspectives to the Care of Surgical patients sometimes not fully appreciated by the nonSurgical practitioners caring for the same patients. The training and education of surgeons is becoming more complex, fragmented, and lengthy. The knowledge base and skill set required to manage Critically ill or injured Surgical patients is also becoming more extensive but has the potential of becoming lost in the process of providing the overall educational program for Surgical trainees. Simultaneously, nonSurgical specialties are continuing to train individuals with special skills in Critical Care medicine and the concept of “hospitalists” is becoming more accepted by institutions across the United States. The certification exams in Critical Care medicine remain under the aegis of the individual medical specialty boards, and there is still not a unified examination process in Critical Care. Surgeons, in particular, have tremendous pressures these days to spend more clinical time in the operating room, and the task of consistently conducting high quality research is also becoming arduous. Perspective: This list of reasons could continue but are simply examples for why surgeons need to spend focused attention on how best to train and educate upcoming Surgical trainees in regards to the principles of Critical Care medicine. The Critically ill or injured patients need this focused attention and the specialty of Surgical Critical Care medicine needs this attention. The Surgical Section of the Society of Critical Care Medicine has developed this position statement in the hopes that ongoing discussion and refinement of this particular aspect of surgery will continue on several levels.
Tracey L Yap - One of the best experts on this subject based on the ideXlab platform.
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hospital acquired pressure injury prediction in Surgical Critical Care patients
BMC Medical Informatics and Decision Making, 2021Co-Authors: Jenny Alderden, Jonathan Dimas, Mollie R Cummins, Kathryn P Drake, Andrew Wilson, Tracey L YapAbstract:Hospital-acquired pressure injuries (HAPrIs) are areas of damage to the skin occurring among 5–10% of Surgical intensive Care unit (ICU) patients. HAPrIs are mostly preventable; however, prevention may require measures not feasible for every patient because of the cost or intensity of nursing Care. Therefore, recommended standards of practice include HAPrI risk assessment at routine intervals. However, no HAPrI risk-prediction tools demonstrate adequate predictive validity in the ICU population. The purpose of the current study was to develop and compare models predicting HAPrIs among Surgical ICU patients using electronic health record (EHR) data. In this retrospective cohort study, we obtained data for patients admitted to the Surgical ICU or cardiovascular Surgical ICU between 2014 and 2018 via query of our institution's EHR. We developed predictive models utilizing three sets of variables: (1) variables obtained during routine Care + the Braden Scale (a pressure-injury risk-assessment scale); (2) routine Care only; and (3) a parsimonious set of five routine-Care variables chosen based on availability from an EHR and data warehouse perspective. Aiming to select the best model for predicting HAPrIs, we split each data set into standard 80:20 train:test sets and applied five classification algorithms. We performed this process on each of the three data sets, evaluating model performance based on continuous performance on the receiver operating characteristic curve and the F1 score. Among 5,101 patients included in analysis, 333 (6.5%) developed a HAPrI. F1 scores of the five classification algorithms proved to be a valuable evaluation metric for model performance considering the class imbalance. Models developed with the parsimonious data set had comparable F1 scores to those developed with the larger set of predictor variables. Results from this study show the feasibility of using EHR data for accurately predicting HAPrIs and that good performance can be found with a small group of easily accessible predictor variables. Future study is needed to test the models in an external sample.
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risk factors for hospital acquired pressure injury in Surgical Critical Care patients
American Journal of Critical Care, 2020Co-Authors: Jenny Alderden, Linda J Cowan, Jonathan Dimas, Danli Chen, Yue Zhang, Mollie R Cummins, Tracey L YapAbstract:BACKGROUND Hospital-acquired pressure injuries disproportionately affect Critical Care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries. OBJECTIVE To identify factors associated with hospital-acquired pressure injuries among Surgical Critical Care patients. The specific aim was to analyze data obtained from routine nursing skin assessments alongside other potential risk factors identified in the literature. METHODS This retrospective cohort study included 5101 Surgical Critical Care patients at a level I trauma center and academic medical center. Multivariate logistic regression using the least absolute shrinkage and selection operator method identified important predictors with parsimonious representation. Use of specialty pressure redistribution beds was included in the model as a known predictive factor because specialty beds are a common preventive intervention. RESULTS Independent risk factors identified by logistic regression were skin irritation (rash or diffuse, nonlocalized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P < .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P < .001), and duration of intensive Care unit stay before the hospital-acquired pressure injury developed (odds ratio, 1.003; 95% CI, 1.003-1.004; P < .001). CONCLUSIONS The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.
Kimberly A Davis - One of the best experts on this subject based on the ideXlab platform.
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international rotations a valuable source to supplement operative experience for acute Care surgery trauma and Surgical Critical Care fellows
Journal of Trauma-injury Infection and Critical Care, 2017Co-Authors: Paula Ferrada, Michel B Aboutanos, David A Spain, Kimberly A Davis, Rao R Ivatury, John J Fildes, Thomas M ScaleaAbstract:BACKGROUND Acute-Care surgery (ACS), trauma, and Surgical Critical Care (SCC) fellowships graduate fellows deemed qualified to perform complex cases immediately upon graduation. We hypothesize international fellow rotations can be a resource to supplement operative case exposure. METHODS A survey was sent to all program directors (PDs) of ACS and SCC fellowships via e-mail. Data were captured and analyzed using the REDCap (Research Electronic Data Capture) tool. RESULTS The survey was sent to 113 PDs, with a response rate of 42%. Most fellows performed less than 150 operative cases (59.5%). The majority of PDs thought the operative exposure either could be improved or was not enough to ensure expertise in trauma and emergent general surgery. Only a minority of the PDs found their case load exceptional (can be improved: 43%, not enough: 30% exceptional: 27%). Most PDs thought an international experience could supplement the breadth of cases, provide research opportunities, and improve understanding of trauma systems (70%). Ten sites offered international rotations (70%). Most fellowships would be willing to provide reciprocity to the host institution (90%). CONCLUSIONS The majority of PDs for ACS, trauma, and SCC programs perceive a need for increased quality and quantity of operative cases. The majority recognize international fellow rotations as a valuable tool to supplement fellows' education.
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acute Care surgery fellowship graduates practice patterns the additional training is an asset
Journal of Trauma-injury Infection and Critical Care, 2017Co-Authors: Clay Cothren Burlew, Kimberly A Davis, Christopher J Dente, John J Fildes, Thomas J Esposito, Gregory J JurkovichAbstract:BACKGROUND Over the past decade, the American Association for the Surgery of Trauma Acute Care Surgery (ACS) fellowship program has matured to 20 verified programs. As part of an ongoing curricular evaluation, we queried the current practice patterns of the graduates of ACS fellowship programs regarding their view on their ACS training. We hypothesized that the majority of ACS fellowship graduates would be practicing ACS in academic Level I trauma centers and that fellowship training was pivotal in their Career. METHODS Graduates of American Association for the Surgery of Trauma-certified ACS fellowships completed an online survey that included practice demographics, specific categories of cases delineated by the current ACS curriculum, and perceived impact of training. RESULTS Surveys were submitted by 56 of 77 graduates for a completion rate of 73%. The majority of respondents were male (68%) aged 40 years or younger (80%). All but four completed ACS fellowship training in last 5 years (93%), and 83% completed fellowship in the last 3 years. Regarding their current practice, broadly defined ACS predominated (96%) with 2% practicing only trauma surgery and 2% only general surgery. Practice settings were 64% urban, 29% suburban, and 7% rural locations, with 84% of graduates practicing in a hospital-based group. The practitioner's hospital was identified as university/university-affiliated in 53%, community in 38%, and military in 9%, with 91% identified as a teaching hospital; trauma designation was identified as Level I (55%), Level II (39%), and other (6%). The graduates' average current practice mix is 10% elective general surgery, 29% emergency general surgery, 32% trauma, 25% Surgical Critical Care, and 4% other (burn, bariatric, vascular, and thoracic). Only 16% of graduates do not perform elective cases. Case specifics demonstrated 92% of graduates perform vascular cases, 88% perform thoracic cases, and 70% perform complex hepatobiliary. Practice elements that were satisfiers included (1) scope of practice, (2) case mix, (3) percentage emergency general surgery, (4) lifestyle, (5) case complexity (with 3 and 4 tied). Graduates agreed the ACS fellowship training prepared them well for practice and was worth the time invested (both 82%), increased their marketability and self-confidence (80%), and prepared them well for academics (71%) and administration (63%). Of those surveyed, 93% would encourage others to do an ACS fellowship. CONCLUSION Although 93% of graduates practice in urban/suburban areas, there was a mixture of university, university-affiliated, and community institutions and an almost even division of Levels I and II designation. Graduates demonstrate ongoing use of their acquired advanced operative training, particularly in vascular and thoracic surgery. The majority of ACS fellowship graduates were practicing ACS and felt fellowship training was valuable in their Career path and that they would recommend it to others.
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Surgical Critical Care for the patient with sepsis and multiple organ dysfunction
Anesthesiology Clinics, 2016Co-Authors: Gary J Kaml, Kimberly A DavisAbstract:Sepsis and multiple organ dysfunction syndrome (MODS) is common in the Surgical intensive Care unit. Sepsis involves infection and the patient's immune response. Timely recognition of sepsis and swift application of evidence-based interventions is Critical to the success of therapy. This article reviews the nature of the septic process, existing definitions of sepsis, and current evidence-based treatment strategies for sepsis and MODS. An improved understanding of the process of sepsis and its relation to MODS has resulted in clinical definitions and scoring systems that allow for the quantification of disease severity and guidelines for treatment.
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challenging issues in Surgical Critical Care trauma and acute Care surgery a report from the Critical Care committee of the american association for the surgery of trauma
Journal of Trauma-injury Infection and Critical Care, 2010Co-Authors: Lena M. Napolitano, Gerard J Fulda, Kimberly A Davis, Dennis W Ashley, Randall S Friese, Charles W Van Way, Wayne J Meredith, Timothy Fabian, Gregory J Jurkovich, Andrew PeitzmanAbstract:Critical Care workforce analyses estimate a 35% shortage of intensivists by 2020 as a result of the aging population and the growing demand for greater utilization of intensivists. Surgical Critical Care in the U.S. is particularly challenged by a significant shortfall of Surgical intensivists, with only 2586 surgeons currently certified in Surgical Critical Care by the American Board of Surgery, and even fewer surgeons (1204) recertified in Surgical Critical Care as of 2009. Surgical Critical Care fellows (160 in 2009) represent only 7.6% of all Critical Care trainees (2109 in 2009), with the largest number of Critical Care fellowship positions in internal medicine (1472, 69.8%). Traditional trauma fellowships have now transitioned into Surgical Critical Care or Acute Care Surgery (trauma, Surgical Critical Care, emergency surgery) fellowships. Since adult Critical Care services are a large, expensive part of U.S. healthCare and workforce shortages continue to impact our healthCare system, recommendations for regionalization of Critical Care services in the U.S. is considered. The Critical Care Committee of the AAST has compiled national data regarding these important issues that face us in Surgical Critical Care, trauma and acute Care surgery, and discuss potential solutions for these issues.
Peter B Angood - One of the best experts on this subject based on the ideXlab platform.
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structure of Surgical Critical Care and trauma fellowships
Critical Care Medicine, 2006Co-Authors: Samuel A Tisherman, Peter B Angood, Philip S Barie, Lena M. NapolitanoAbstract:Introduction: Surgical Critical Care (SCC) and trauma fellowships have developed in a variety of formats. Although SCC fellowships must meet specific requirements for accreditation by the Accreditation Council for Graduate Medical Education, trauma fellowships do not. As the American Board of Surgery is considering combining SCC, trauma, and emergency surgery into “acute Care surgery” fellowship training, a better understanding of current program structures is needed. Methods: The Education Committee of the Surgery Section of the Society of Critical Care Medicine sent surveys by e-mail to all SCC program directors. The survey included questions regarding the content of the fellowship, specifically, subspecialty rotations, trauma content, and operative experience. If they offered a trauma fellowship, the survey queried its structure also. Results: A total of 39 of 82 surveys were returned. About one third of the programs have only SCC fellowships, one third combine SCC/trauma in 1-yr programs, and the remainder combine SCC/trauma in 2 yrs. Of the programs, 79% provided operative experience: 15% on a separate rotation and 39% on call during intensive Care unit coverage. About half of the operative experiences were related to trauma and one quarter to emergency general surgery. The great majority of rotations were in general Surgical or trauma intensive Care units. Conclusion: SCC programs already include meaningful trauma and emergency general surgery operative experience. Surgical subspecialty intensive Care unit and operative rotations may contribute to optimal training of the “acute Care surgeon.”
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Critical Care medicine education of surgeons recommendations from the Surgical section of the society of Critical Care medicine
Critical Care Medicine, 2000Co-Authors: Michael E Ivy, Marc J Shapiro, Samuel A Tisherman, Peter B Angood, Orlando C Kirton, Mathilda HorstAbstract:Perspective: The role of surgeons in Critical Care medicine has a long and esteemed past. The presence of surgeons in intensive Care units provides specific insights and perspectives to the Care of Surgical patients sometimes not fully appreciated by the nonSurgical practitioners caring for the same patients. The training and education of surgeons is becoming more complex, fragmented, and lengthy. The knowledge base and skill set required to manage Critically ill or injured Surgical patients is also becoming more extensive but has the potential of becoming lost in the process of providing the overall educational program for Surgical trainees. Simultaneously, nonSurgical specialties are continuing to train individuals with special skills in Critical Care medicine and the concept of “hospitalists” is becoming more accepted by institutions across the United States. The certification exams in Critical Care medicine remain under the aegis of the individual medical specialty boards, and there is still not a unified examination process in Critical Care. Surgeons, in particular, have tremendous pressures these days to spend more clinical time in the operating room, and the task of consistently conducting high quality research is also becoming arduous. Perspective: This list of reasons could continue but are simply examples for why surgeons need to spend focused attention on how best to train and educate upcoming Surgical trainees in regards to the principles of Critical Care medicine. The Critically ill or injured patients need this focused attention and the specialty of Surgical Critical Care medicine needs this attention. The Surgical Section of the Society of Critical Care Medicine has developed this position statement in the hopes that ongoing discussion and refinement of this particular aspect of surgery will continue on several levels.