In minimally invasive surgery, technology, in a way, replaces surgeons' eyes, allowing them to see inside a patient despite only making tiny incisions. For some surgical specialties, this technology takes the form of a camera. For others, such as vascular and cardiovascular surgery, less invasive approaches have created a unique need for high-end angiographic imaging, fostering a new concept known as the hybrid OR.
The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.
A gifted artist in his early 60s, the patient was a liver transplant candidate who learned he had hepatitis B some 20 years earlier. Despite the worsening fatigue that accompanied his liver failure, he threw himself into preparing for his transplant. He read everything he could about the procedure and the postoperative care, drilled doctors with endless questions and continued to drag himself to the gym each day in the hopes of being better prepared to withstand the rigors of the operation.
An excerpt from Surviving the Emergency Room . by Ron Clark, MD With regard to emergency trauma care, a few minutes can mean the difference between life and death. This first hour of definitive medical care is called the “golden hour.” It is usually this first hour where the patient’s medical fate is sealed.
Closing The Complex Open Abdomen: Rethinking The Management of Acute And Chronic Giant Ventral Hernias: The Cook County ExperienceFebruary 9, 2011 5:22 am | by Andrew Dennis, DO, FACOS | Comments
Managing giant ventral hernias after traumatic injury and operation has become a dilemma plaguing trauma surgeons in recent years. The post-traumatic open abdomen presents either in the acute phase, days-to-weeks post-injury, or in the delayed chronic phase, years after the application of a skin graft directly over bowel or over an absorbable mesh.
It is estimated that it takes an average of 17 years for evidence to be put into practice (Balas & Boren 2000). Implementation of evidence-based practice (EBP) should be the goal for all perioperative professionals. However, where evidence is scant, we must rely on all practices that constitute EBP.
At a recent medical conference in Miami, I sat spellbound as Dr. Stephen Ferrara, a commander in the Navy, delivered a keynote address describing his work in a mobile hospital in Afghanistan. Dr. Ferrara is an interventional radiologist, a doctor who uses medical images — CT scans, ultrasounds and the like — to treat abscesses, biopsy hard-to-reach masses, check blood flow and cauterize bleeds.
One morning during my training, I noticed that the belly of a patient in the I.C.U. had grown rounder and tighter overnight. The patient had gone through a difficult liver transplant a day earlier and was bleeding, it seemed, into his abdomen. I was the newest member of the transplant team, but even so, I knew what had to be done right away: We had to take this man back to the operating room.
It was in my second year of medical school that I learned one of the most important lessons of my career: That it can be hard to distinguish truth from a perfectly good answer. Certainty was what I craved the most back then, poised as I was on the threshold of my medical career. But my first patient would cure me of certainty forever.
WakeMed Health & Hospitals is an 870-bed private, not-for-profit healthcare system based in Raleigh, N.C. Its system includes two full-service hospitals, two stand-alone emergency departments, Children’s Emergency Department, Children’s Hospital, Rehab Hospital, Heart Center as well as multiple outpatient centers and rehabilitation facilities.
Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy — and, frankly, a certain amount of discomfort — to a fourth-year medical student’s account of his grandmother’s recent hospitalization at a well regarded inpatient facility in New York City.
January 31, 2011 The answer to that question is a surprisingly resounding “No!” The medical software industry is far from supporting the iPad on a meaningful scale. Buyers would think that vendors eager to grow market share would quickly adopt new, flashy technologies, but software vendors are surprisingly slow to react.
This past week while spending time with nonmedical friends, I found myself referring to what health care experts have been touting as the system’s best hope for the future. My friends, eager to learn more and always game for any clarification of the health care system, leaned in to hear me expound on accountable care organizations, or A.