Can general surgeons perform colonoscopy safely?

The purpose of the current study was to review the safety of colonoscopy performed by nonfellowship-trained general surgeons. To address this issue, we reviewed more than 1,000 consecutive diagnostic and therapeutic colonoscopies and recorded the complications. This was a multi-institutional study involving seven general surgeons, none of whom had had formal fellowship endoscopic training. Perforation was confirmed by laparotomy, bleeding was defined as that requiring hospitalization and/or transfusion, and cardiopulmonary arrest was self-explanatory. There was one perforation in the diagnostic group and none in the therapeutic group, for a rate of 0.10% overall and 0.12% in diagnostic colonoscopy. There were no instances of bleeding or cardiac arrest. This complication rate of 1 per 1,025 colonoscopic procedures by general surgeons compares favorably with that previously reported by other specialties (p less than 0.001). We conclude that postgraduate endoscopy fellowship is not necessary for general surgeons to become safe colonoscopists.

Pitfalls in the role of standardized preadmission laboratory screening for ambulatory surgery.

We conducted a one-year retrospective analysis to determine the effect of a standardized preadmission screening (PAS) program on the cancellation rate of ambulatory surgery. Patients were divided into two groups. Group One patients had selective PAS lab work based on history and physical examination. Group Two patients underwent a standardized PAS consisting of history, physical examination, biochemical profile, complete blood count, and urinalysis. Patients in both groups received a prothrombin/partial thromboplastin time (PT/PTT) if one anticoagulation therapy, an electrocardiogram (EKG) with age greater than 40 years, and a chest X ray with age greater than 50 years. We found that the frequency of surgery cancellation before and after instituting a standardized PAS remained the same (6.9% vs 6.4%); furthermore, only 38.5 per cent of the cancellations in Group One and 16.4 per cent in Group Two were due to laboratory, EKG, or chest X-ray results. The rest were due to intercurrent illness, scheduling conflicts, and other uncontrollable factors. A closer analysis of Group Two shows that of 4,058 standardized preadmission screens performed, 4,015 (99%) were normal; only 43 (1%) had abnormal results that led to cancellation of ambulatory surgery. Similarly, 99.93 per cent of all EKGs and 99.97 per cent of all chest X-rays performed in both groups were normal, having no influence on operational performance or patient management. We suggest that selective use of laboratory and diagnostic studies, in conjunction with a thorough history and physical examination, is as effective as a standardized PAS in identifying patients at risk for ambulatory surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Behaviorism: Are reports of its death exaggerated?

Despite reports that behaviorism is dead or dying, examination of the data indicates otherwise. The opinions of psychology historians, the number of professional associations devoted to behaviorism, and the increasing number of behavioral publications all support the conclusion that behaviorism is vital and growing.

Hearing test for a profoundly retarded human subject.

A profoundly retarded 28-yr.-old female was trained to avoid an aversive but harmless shock to the foot by withdrawing the foot upon presentation of a visual cue. She was later unable to learn to avoid the shock consistently upon presentation of an auditory cue, confirming the ward staff's contention that she had a hearing disability. The audiometric technique using negative reinforcement bridges the problems of (1) difficulty in finding positive reinforcers for patients of low functioning and (2) satiation which may result from the continued use of positive reinforcers. The use of aversive stimuli raises ethical concerns. The growing trend in research is that aversive stimuli are permissible for individuals for whom positive techniques have not been effective and when used by trained professionals under careful review.