Effects of a Brief Web-Based "Social Norms"-Intervention on Alcohol, Tobacco and Cannabis Use Among German University Students: Results of a Cluster-Controlled Trial Conducted at Eight Universities.

Background and Aim: "Social norms" (SN)-interventions are aimed at changing existing misperceptions regarding peer substance use by providing feedback on actual norms, thereby affecting personal substance use. It is unknown whether SN-intervention effects previously demonstrated in US students can be replicated in German students. The aim of the INSIST-study was to examine the effects of a web-based SN-intervention on substance use. Design: Cluster-controlled trial. Setting: Eight Universities in Germany. Participants and Measurements: Students were recruited at four intervention vs. four delayed intervention control Universities. 4,463 students completed baseline, 1,255 students (59% female) completed both baseline and 5-months follow-up web-based surveys on personal and perceived peer substance use. Intervention participants received feedback contrasting personal and perceived peer use with previously assessed use and perceptions of same-sex, same-university peers. Intervention effects were assessed via multivariable mixed logistic regression models. Findings: Relative to controls, reception of SN-feedback was associated with higher odds for decreased alcohol use (OR: 1.91, 95% CI 1.42-2.56). This effect was most pronounced in students overestimating peer use at baseline and under or accurately estimating it at follow-up (OR: 6.28, 95% CI 2.00-19.8). The OR was 1.33 (95% CI 0.67-2.65) for decreased cannabis use in students at intervention Universities and was statistically significant at 1.70 (95% CI 1.13-2.55) when contrasting unchanged and decreased with increased use. Regarding tobacco use and episodes of drunkenness, no intervention effects were found. Conclusions: This study was the first cluster-controlled trial suggesting beneficial effects of web-based SN-intervention on alcohol and cannabis use in a large sample of German University students. Clinical Trial Registration: The trial registration number of the INSIST-study is DRKS00007635 at the "German Clinical Trials Register."

Outcomes and outcome measures used in evaluation of communication training in oncology - a systematic literature review, an expert workshop, and recommendations for future research.

BACKGROUND: Communication between health care provider and patients in oncology presents challenges. Communication skills training have been frequently developed to address those. Given the complexity of communication training, the choice of outcomes and outcome measures to assess its effectiveness is important. The aim of this paper is to 1) perform a systematic review on outcomes and outcome measures used in evaluations of communication training, 2) discuss specific challenges and 3) provide recommendations for the selection of outcomes in future studies. METHODS: To identify studies and reviews reporting on the evaluation of communication training for health care professionals in oncology, we searched seven databases (Ovid MEDLINE, CENTRAL, CINAHL, EMBASE, PsychINFO, PsychARTICLES and Web of Science). We extracted outcomes assessed and the respective assessment methods. We held a two-day workshop with experts (n = 16) in communication theory, development and evaluation of generic or cancer-specific communication training and/or outcome measure development to identify and address challenges in the evaluation of communication training in oncology. After the workshop, participants contributed to the development of recommendations addressing those challenges. RESULTS: Out of 2181 references, we included 96 publications (33 RCTs, 2 RCT protocols, 4 controlled trials, 36 uncontrolled studies, 21 reviews) in the review. Most frequently used outcomes were participants' training evaluation, their communication confidence, observed communication skills and patients' overall satisfaction and anxiety. Outcomes were assessed using questionnaires for participants (57.3%), patients (36.0%) and observations of real (34.7%) and simulated (30.7%) patient encounters. Outcomes and outcome measures varied widely across studies. Experts agreed that outcomes need to be precisely defined and linked with explicit learning objectives of the training. Furthermore, outcomes should be assessed as broadly as possible on different levels (health care professional, patient and interaction level). CONCLUSIONS: Measuring the effects of training programmes aimed at improving health care professionals' communication skills presents considerable challenges. Outcomes as well as outcome measures differ widely across studies. We recommended to link outcome assessment to specific learning objectives and to assess outcomes as broadly as possible.

[Tobacco Use and Utilization of Medical Services in Adolescence: An Analysis of the KiGGS Data]. / Tabakkonsum und Inanspruchnahme medizinischer Leistungen im Jugendalter ­ Eine Analyse der KIGGS Daten.

OBJECTIVE: In Germany, there is a lack of information on the correlation between tobacco use by adolescents and their utilization of medical care. The aim of this article is to identify possible early consequences of adolescent smoking. METHODS: We conducted a re-analysis of cross-sectional data of the baseline wave (2003-2006) of the German Health Survey for Children and Adolescents (KiGGS). To examine the association between current smoking status and utilization of medical care during the 12 months before the interview, prevalence of selected diseases was calculated, and stratified by smoking status. Besides, the proportion of adolescents who consulted a physician at least once and the total number of medical consultations were estimated. For the inpatient setting, information about the number of nights spent in a hospital was analyzed. In a multiple logistic regression, the association of smoking behavior with utilization of outpatient medical care was assessed, further adjusting for sociodemographic variables and comorbidities. RESULTS: The study population included 3 679 adolescents aged between 14 and 17 years. 49.1% were female and 31.7% were current smokers. Among smokers, there was an increased prevalence of cystitis (+87.0%) and bronchitis (+50.0%). Tobacco users consulted a general practitioner more frequently than non-smokers (+30.8%). As far as medical specialists are concerned, there were more consultations with psychiatrists (+171.4%) and psychologists (+94.4%), but there was no increase in the total number of visits. Additionally, smoking adolescents were more frequently hospitalized (+26.5%) and the stays were of longer duration (+19.7%). There was a statistically significant association between current tobacco use and a greater utilization of medical care (OR=1.20; 95%-CI: 1.02-1.40). CONCLUSIONS: Tobacco use among adolescents was associated with increased prevalence of certain diseases and a greater utilization of medical care. Nevertheless, whether there is a causal connection is still debatable. The KiGGS cohort study will provide opportunities to further clarify the observed association.

Inducible disruption of the c-myb gene allows allogeneic bone marrow transplantation without irradiation.

Allogeneic bone marrow (BM) transplantation enables the in vivo functional assessment of hematopoietic cells. As pre-conditioning, ionizing radiation is commonly applied to induce BM depletion, however, it exerts adverse effects on the animal and can limit experimental outcome. Here, we provide an alternative method that harnesses conditional gene deletion to ablate c-myb and thereby deplete BM cells, hence allowing BM substitution without other pre-conditioning. The protocol results in a high level of blood chimerism after allogeneic BM transplantation, whereas immune cells in peripheral tissues such as resident macrophages are not replaced. Further, mice featuring a low chimerism after initial transplantation can undergo a second induction cycle for efficient deletion of residual BM cells without the necessity to re-apply donor cells. In summary, we present an effective c-myb-dependent genetic technique to generate BM chimeras in the absence of irradiation or other methods for pre-conditioning.

Personal and perceived peer use and attitudes towards the use of nonmedical prescription stimulants to improve academic performance among university students in seven European countries.

BACKGROUND: Overestimations of non-prescribed stimulant use of peers are well documented in the USA and have also been identified as predictive of personal stimulant consumption. This study aimed to examine whether overestimations of peer use and approval of the use are associated with personal use and attitude towards the use of non-prescribed stimulants among European university students. METHOD: The EU funded 'Social Norms Intervention for the prevention of Polydrug usE (SNIPE)' study was conducted in seven European countries. In a web-based questionnaire, 4482 students were asked about their personal use and their attitude towards non-prescribed stimulant use, as well as the perceived peer use and peer attitude. RESULTS: 59% of students thought that the majority of their peers used non-prescribed stimulants more frequently than themselves, and only 4% thought that the use of the majority was lower than their personal use. The perception that the majority of peers had used non-prescribed stimulants at least once was significantly associated with higher odds for personal use of non-prescribed stimulants (OR: 3.30, 95% CI: 2.32-4.71). In addition, the perception that the majority of peers approved of the non-prescribed use of stimulants was associated with a 4.03 (95% CI: 3.35-4.84) times higher likelihood for personal approval. DISCUSSION: European university students generally perceived the non-prescribed use of stimulants of peers to be higher than their personal use. This perception, as well as a perception of higher approval in the peer group, was associated with a higher likelihood of personal non-prescribed stimulant medication use and approval.

Asymmetric brain edema after cardiac transplantation: cerebroautoregulatory failure and relative hyperperfusion.

Asymmetric brain edema is a rare neurologic complication after cardiovascular surgery. We describe the clinical and imaging features of an asymmetric brain edema syndrome in a 52-year-old man following cardiac transplantation who presented with facial myoclonus and left hemiparesis in the postoperative period. To our knowledge, this is the first case report of asymmetric brain edema syndrome after cardiac transplant and the second following cardiac surgery. Arterial bypass cannula malposition in the ascending aorta or brachiocephalic artery with subsequent cerebral hypoperfusion and subsequent hyperperfusion appears to be the most likely physiologic cause.

Illicit substance use among university students from seven European countries: a comparison of personal and perceived peer use and attitudes towards illicit substance use.

OBJECTIVE: To compare European students' personal use and approval of illicit substance use with their perceptions of peer behaviours and attitudes, and investigate whether perceptions of peer norms are associated with personal use of illicit substances and attitudes. METHOD: This study used baseline data from the Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project involving 4482 students from seven European countries in 2012. Students completed an online survey which included questions on personal and perceived peer illicit substance use and personal and perceived peer attitude towards illicit substances. RESULTS: 8.3% of students reported having used illicit substances at least once in their life. 49.7% of students perceived that the majority of their peers have used illicit substances more frequently than themselves. The perception was significantly associated with higher odds for personal illicit substance use (OR: 1.97, 95% CI: 1.53-2.54). The perception that the majority of peers approve illicit substance use was significantly associated with higher odds for personal approval of illicit substance use (OR: 3.47, 95% CI: 2.73-4.41). CONCLUSION: Students commonly perceived that their peers used illicit subtances more often than themselves. We found an association between the perceived peer norms/attitudes and reported individual behaviour/attitudes.

What is normal intra-abdominal pressure?

The causes and effects of increased intra-abdominal pressure and abdominal compartment syndrome have been well documented. However, there have been no large series to determine normal intra-abdominal pressure in hospitalized patients. The purpose of this study was to determine normal intra-abdominal pressure in randomly selected hospitalized patients and to identify factors that predict variation in normal intra-abdominal pressure. A total of 77 patients were prospectively enrolled between September 1998 and July 1999. Data obtained included patient demographics (i.e., age, gender, height, weight, and body mass index), reason for hospitalization and bladder catheterization, previous and current surgical status, comorbidities, and intra-abdominal pressures. Intra-abdominal pressure readings were obtained through an indwelling transurethral bladder (Foley) catheter. Data were analyzed by analysis of variance and multiple regression analysis. There were 36 females and 41 males with a mean age of 67.7 years. Average weight, height, and body mass index were 79.6 kg, 1.70 m, and 27.6 kg/m2, respectively. Mean intraabdominal pressure was 6.5 mm Hg (range 0.2-16.2 mm Hg). Body mass index was positively related to intra-abdominal pressure (P < 0.0004). Gender, age, and medical and surgical histories did not significantly affect intra-abdominal pressure. However, using multiple regression analysis, a relationship between intra-abdominal pressure, body mass index, and abdominal surgery was discovered. Intra-abdominal pressure is related to a patient's body mass index and influenced by recent abdominal surgery. Thus, the normal intra-abdominal pressure can be estimated in hospitalized patients by using the derived equation. Knowledge of the expected intra-abdominal pressure can then by used in recognizing when an abnormally high intra-abdominal pressure or abdominal compartment syndrome exists.

Thoracic epidural versus patient-controlled analgesia in elective bowel resections.

BACKGROUND: This study was undertaken to determine if thoracic epidural analgesia is of practical benefit after bowel resection. METHODS: Patients were prospectively randomized to receive either a thoracic epidural or patient-controlled analgesia for pain control after bowel resection. A standardized postoperative protocol was instituted after surgery. RESULTS: Pain scores were significantly lower in the epidural group. Return of bowel function, and interval to discharge was not different between groups. Cost and complication rates were significantly higher in the epidural group. CONCLUSIONS: Although pain scores were significantly lower in the epidural group, this did not translate into a quicker return of bowel function or earlier discharge of the patient. Furthermore, the epidural group had a significantly higher complication rate and cost. Therefore, while thoracic epidural analgesia provides superior pain control, it does not offer a significant advantage over patient-controlled analgesia in return of bowel function after bowel resection.

Family presence during trauma resuscitation: a survey of AAST and ENA members. American Association for the Surgery of Trauma. Emergency Nurses Association.

BACKGROUND: The Emergency Nurses Association (ENA) has formally resolved that family presence (FP) during resuscitation and invasive procedures (TR) is the right of the patient and is beneficial for both patients and family members. Furthermore, FP during TR has been implemented at several trauma centers. Because this policy is controversial, a survey was conducted to assess the opinions of members of the American Association for the Surgery of Trauma (AAST) and ENA in regard to FP. METHODS: A survey instrument regarding FP during TR was mailed to the AAST membership (n = 813) and a random sampling (10%) of ENA members (n = 2,988). Questions regarding membership (AAST vs. ENA), age, gender, years in practice, trauma experience, the patient's right to FP during the primary survey, secondary survey, and invasive procedures, the potential effects of FP on trauma team function, and medicolegal implications were included in the survey. Qualitative and quantitative variables were analyzed by analysis of variance and chi2 analysis, respectively. Responses to questions by using a Likert Scale for degree of agreement were analyzed by using the Kruskal-Wallis test. RESULTS: A total of 1,629 (AAST, n = 368; ENA, n = 1,261) surveys were returned (43.4% response). There were 44 surveys returned as undeliverable (1.2%). The members of the AAST were older, more likely to be male, had been in practice longer, and had greater trauma experience when compared with ENA members (p < 0.001). More AAST than ENA members (97.8% vs. 80.2%) believed that FP during all phases of TR was inappropriate (p < 0.001). Fewer AAST members believed that FP was a patient right when compared with ENA members (p < 0.0001). The AAST members were more likely to believe FP interfered with patient care and increased the stress of trauma team members (p < 0.0001). The majority of AAST and ENA members had experience with FP during TR (55.3 vs. 67.8%; p < 0.001). However, the impressions of their experiences were widely disparate, with 63.6% of ENA and only 17.5% of AAST members, indicating that the experience was beneficial (p < 0.001). CONCLUSION: Attitudes toward FP during TR are significantly different between AAST and ENA members. Because of these differences in opinion, implementation of an FP policy may create conflicts between trauma team members and may interfere with the effectiveness of the trauma team.

Limited utility of routine drug screening in trauma patients.

BACKGROUND: Routine toxicology screening of seriously injured patients has become the standard of care in most trauma centers. However, the benefit of drug screening in acute trauma is unproven. We reviewed the impact of positive drug screening results on patient care within the first 3 days of treatment. METHODS: We retrospectively reviewed the charts of seriously injured patients admitted to an American College of Surgeons-certified level I trauma center over a 5-year period. Modifications of therapeutic regimens based on positive toxicology results were noted. Using current financial data, charges for toxicology were calculated. RESULTS: Between January 1, 1990, and December 31, 1995, 2,678 trauma patients had drug screening. Of these, 414 (15%) had detectable quantities of the following intoxicants: opiates, barbiturates, amphetamines, phencyclidine hydrochloride (PCP), cocaine, marijuana, or benzodiazepines. Review of all 401 available charts failed to identify any cases in which treatment was altered by a positive toxicology result. Hospital costs related to routine screening were $138,587, while charges to patients amounted to $538,278. CONCLUSIONS: Routine toxicology does not alter or improve the immediate care of the injured patient. Routine drug screening is expensive, and benefits were not easily documented. The policy of routine toxicology screening in trauma centers should be reevaluated.

Seroma formation after breast cancer surgery: incidence and predicting factors.

The pathophysiology of seroma formation has yet to be determined. Therefore, the present study was undertaken to calculate the incidence of postoperative seromas after definitive breast cancer operations utilizing electrocautery dissection. Additionally, we attempted to identify risk factors associated with seroma development and to examine seroma formation in relation to operative procedure. A retrospective review of 252 breast cancer operations was undertaken. Patients were subdivided by operative procedure: modified radical mastectomy (MRM; n = 148), breast preservation with axillary node dissection (n = 64), or MRM with immediate reconstruction (n = 40). Electrocautery was used in development of skin flaps. Seromas developed in 39 of the 252 operations for an incidence of 15.5 per cent. Seroma formation was significantly lower in those patients receiving MRM with immediate reconstruction than in those receiving MRM (2.5% vs 19.6%; P = 0.009) and tended to be lower than for patients receiving breast preservation with axillary node dissection (14.06%; P = 0.052). Neoadjuvant chemotherapy was performed in 18 patients, of whom 6 developed seromas (P = 0.030). The incidence of postoperative seromas was low despite the use of electrocautery. An association of postoperative seromas with neoadjuvant chemotherapy was noted. Additionally, it appears that immediate reconstruction may reduce the incidence of postoperative seromas, presumably by filling the dead space in the chest wall.

Factors influencing a woman's choice to undergo breast-conserving surgery versus modified radical mastectomy.

BACKGROUND: The use of breast-conserving surgery (BCS) rather than modified radical mastectomy (MRM) for the treatment of breast carcinoma is an option for the majority of women (75%) with early stage breast cancer, but only 20% to 50% choose to undergo this procedure nationwide. The objective of this study was to identify factors influencing a woman's choice between BCS and MRM, and specifically, the surgeon's influence on this choice. METHODS: A total of 134 women eligible for BCS were sent a survey. Data obtained included demographics, influential factors in treatment choice, and satisfaction with preoperative discussion and postoperative results. RESULTS: Ninety-six women completed the questionnaire. Mean patient age was 62 years. Most women surveyed felt their treatment options were satisfactorily explained to them. BCS, MRM with reconstruction (MRM-R), and MRM without reconstruction (MRM-NR) were performed in 45%, 15%, and 40% of patients, respectively. Overall, the most influential factor was the fear of cancer. Women choosing BCS indicated that the surgeon, cosmetic result, and psychological aspects were more influential in their decision than in women undergoing MRM-NR (P <0.02). Fear of cancer was the most important factor affecting the choice to undergo MRM-NR. In comparing MRM-R with MRM-NR, there was a similar fear of cancer; however, MRM-R had much greater concern with cosmesis (P = 0.0002). CONCLUSION: The surgeon's input is important in a woman's choice to undergo BCS or MRM-R. However, it appears that if a woman wants to have MRM-NR, even when she is a candidate for BCS, the surgeon's input is overshadowed by the patient's fear of cancer.

Debt and other influences on career choices among surgical and primary care residents in a community-based hospital system.

BACKGROUND: To evaluate debt and other factors that help formulate the career paths of future surgical and primary care physicians, a survey was undertaken. METHODS: Surgical specialty (SS) and primary care (PC) residents were surveyed regarding demographics, factors influencing choice of specialty, methods of financing education, debt characteristics, and outlooks regarding future earnings and practice characteristics. RESULTS: The clinical years of medical school and personalities of specialists and residents were important factors in career choices for both PC and SS. The length of residency, desirable lifestyle, and working hours were all more important to PC residents. Surgeons found intellectual challenge and procedure-based practice of greater importance. Although not highly regarded by either group, scholarship obligation and student loans had a significantly greater impact on specialty choice and practice plans for PC residents. At the completion of training, 55% of SS and 28% of PC residents anticipate owing more than $100,000. Debt was especially significant in specialty choice and practice plans for PC residents with debt over $100,000. CONCLUSION: Surgical residents are less concerned about personal sacrifices in their quest to become surgeons. It appears state funded scholarships are successful in attracting students to primary care. Both SS and PC residents have significant debt, although, SS residents have greater financial debt than primary care residents. However, the anticipation of indebtedness was a more significant factor in determination of career path for PC.

Serial pHi measurement as a predictor of mortality, organ failure, and hospital stay in surgical patients.

Intestinal ischemia is a common condition in critically ill patients and has been postulated to play a role in the development of organ failure and death. This has resulted in the recent interest in monitoring gastric intramucosal pH (pHi) in critically ill patients to provide earlier evidence of inadequate resuscitation, cardiogenic dysfunction, or sepsis. Several reports have indicated that low pHi values obtained during the initial 24 to 48 hours of intensive care unit (ICU) admission were associated with the development of organ failure and death. The purpose of this study was to assess the predictive value of serial pHi measurements obtained throughout the entire ICU admission. A retrospective analysis of critically ill trauma, burn, and surgical patients who had frequent pHi determinations during ICU treatment was performed. When stratified by pHi values, there were no significant differences in length of stay, organ dysfunction, or mortality. Our findings suggest that serial pHi determinations obtained beyond the early critical care period are less reliable predictors of poor outcome.

Is resuscitation after traumatic suicide attempt a futile effort? A five-year review at a level I trauma center.

A retrospective analysis of all traumatic suicide attempts at a Level I regional trauma center between 1990 and 1994 was performed. Data were obtained from the trauma registry, charts, computer data, and telephone interviews. Age, gender, mechanism of injury, and prior mental status were noted. Repeat suicide attempts/ideation, postinjury employment status, and subsequent deaths were recorded. Nontraumatic attempts and successful suicides not transported to the hospital were excluded. Ninety-one patients (71 males and 20 females) with attempted suicide were identified. Average patient age was 33.6 years. Method of attempted suicide and deaths by that method were: firearms (n = 55 attempts/36 deaths), sharp instrumentation (n = 22 attempts/0 deaths), and others. Mortality by firearms and all other mechanisms were 65.0 per cent and 8.3 per cent, respectively. Fifty-two patients survived to be discharged from the hospital. Follow-up data were available for 38 patients with a mean follow-up interval of 53.6 months. Three subsequent deaths were confirmed. The mortality from the index attempt was 42.9 per cent. Mortality by firearms was significantly higher than by all other mechanisms. Patients with chronic mental illness had a significantly higher incidence of subsequent suicide attempts/ideation and unemployment. Confirmed mortality at follow-up was only eight per cent (mean, 53.6 months), and all were patients with chronic mental illness.

Institutional learning curve of surgeon-performed trauma ultrasound.

BACKGROUND: Sonography has become the primary mode for the initial evaluation of abdominal injury in many trauma centers. However, the rate at which nonradiologists become proficient in this technique remains controversial. OBJECTIVE: To assess the learning curve for this technique in a single institution. DESIGN: Retrospective review of sonographic examinations for trauma performed by senior surgical residents during a 24-month period at an American College of Surgeons-verified level I trauma center. SETTING: University-affiliated private hospital. PATIENTS AND METHODS: Before the initiation of a program of surgeon-performed trauma ultrasound, senior surgical residents (postgraduate years 4 and 5) received 11.5 hours of hands-on and didactic instruction in the focused ultrasound examination for trauma. This examination then became a standard component of the evaluation of injured patients. Subsequent groups of senior residents received 8 hours of instruction at the onset of new academic years, 6 and 18 months, respectively, after the initial course. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were then calculated for each 6-month period after the introduction of trauma sonography. RESULTS: During the 24-month study period, 902 sonographic examinations were performed. No statistically significant differences were noted in sensitivity, specificity, accuracy, positive predictive value, or negative predictive value for any 6-month period of study when compared with the other 6-month periods or with the values calculated for the entire study period. CONCLUSIONS: Senior surgical residents are capable of performing the focused ultrasound examination for trauma with a high level of skill after a concise introductory course. A learning curve was not apparent in our series. Criteria for being permitted to perform trauma sonography that include the requirement of a large number of examinations or extensive proctoring should be reassessed.

A comparison of sonographic examinations for trauma performed by surgeons and radiologists.

BACKGROUND: It has been demonstrated that surgeons and surgery residents, trained in the focused abdominal sonographic examination, are able to accurately and reliably evaluate trauma patients. Despite this, radiologists have objected to surgeon-performed sonography for several reasons. We set out to compare the accuracy of sonographic examinations performed by surgery residents and radiologists. METHODS: A retrospective review of medical records of all trauma patients who received focused ultrasound examinations from January 1, 1995, through June 30, 1996, at one of two American College of Surgeons-verified Level I trauma centers in the same city was undertaken. Ultrasound examinations were performed by surgery residents at trauma center A (TCA) and by radiologists or radiology residents at trauma center B (TCB). Findings for each patient were compared with the results of computed tomography, diagnostic peritoneal lavage, operative exploration, or observation. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for each group of patients. Comparison of patient charges for the trauma ultrasound examinations at each of the trauma centers was also made. RESULTS: Patient populations at the two centers were similar except that the mean Injury Severity Score at TCB was higher than at TCA (11.74 vs. 9.6). Sensitivity, specificity, accuracy, or negative predictive value were not significantly different between the two cohorts. A significantly lower positive predictive value for examinations performed by surgery residents was noted and attributed to a lower threshold of the surgery residents to confirm their findings by computed tomography. Billing data revealed that the average charge for trauma sonography by radiologists (TCB) was $406.30. At TCA, trauma sonography did not generate a specific charge; however, a $20.00 sum was added to the trauma activation fee to cover ultrasound machine maintenance and supplies. CONCLUSION: Focused ultrasound examination in the trauma suite can be as safely and accurately performed by surgery residents as by radiologists and radiology residents and should be a routine part of the initial trauma evaluation process.

Endoscopic saphenous vein harvest in infrainguinal bypass surgery.

BACKGROUND: Autologous greater saphenous vein is considered to be the optimal material for peripheral arterial reconstruction and coronary artery revascularization. We describe a new endoscopic technique of saphenous vein harvest in infrainguinal arterial bypass surgery. METHODS: A retrospective analysis of 64 infrainguinal bypass procedures was performed comparing the standard open technique of saphenous vein harvesting with a new less invasive endoscopic technique. RESULTS: There were no differences in age, gender, indications for surgery, or proximal or distal anastomosis between the two groups. There were also no significant differences in early wound complications, early patency, and transfusion requirements. In the endoscopic group, length of operation was longer (189 versus 158 minutes; P <0.005), length of stay was shorter (5.2 versus 8.1 days; P <0.05), and postoperative day of discharge was also less (3.3 versus 5.5 days; P <0.01). CONCLUSIONS: Our findings indicate that endoscopic saphenectomy is technically feasible, leads to earlier discharge from the hospital, and leads to increased operative time. Most importantly, the procedure can be performed safely without subjecting the patient to increased risk.