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Abstract: Background: Work hour restrictions and new educational standards pose substantial challenges for modern residency programs. We present results from an institutional effort to improve resident education using a competency-based conference program. Methods: The conference program is a weekly 3-hour mandatory block of protected time including a formal lecture series and a modular series tailored to resident level. A comprehensive survey was administered to all general surgery residents before (2005) and after (2006) implementation of the new conference program and included specific items related to the 6 competencies. Results: Scores for 16 competency-related items all showed statistically significant improvement. We also found improvements in residents'' perceptions of the faculty. Overall, the new conference program was rated positively by 98% of residents. Conclusions: Implementation of a structured conference program resulted in significant improvement in residents'' evaluation of their education in the 6 competencies and improved their perceptions of the faculty. [Copyright &y& Elsevier]

Quality indicators will likely be used in comprehensive surgical quality assessment and improvement programs. Quality indicators are the actions equated with good quality of care. As a case example, bariatric surgery quality indicators were developed using evidence in the literature combined with formal expert opinion validation. Qualitative analysis was performed to identify the critical thematic issues surrounding development of these surgical quality indicators. Researchers identified five major thematic categories during the development process. These included feasibility in medical records (availability, ease of abstraction, and cost), the number of indicators developed (optimal number), the lack of evidence in the literature (weight on expert opinion), structural versus process indicators, and linkage to outcomes (need to demonstrate that adherence to indicators is associated with better outcomes). This project, using bariatric surgery as an example, uncovered important issues that need to be addressed when developing quality assessment and quality improvement programs for evaluating surgical quality. As quality indicators will likely be developed and used increasingly, future projects in this regard will benefit from these lessons. [ABSTRACT FROM AUTHOR]

PURPOSE: A comprehensive analysis was performed for five histologic types of appendiceal tumors to compare incidence, clinicopathologic features, survival, and appropriateness of surgery. METHODS: All patients diagnosed with mucinous adenocarcinoma (n = 951), adenocarcinoma (n = 646), carcinoid (n = 435), goblet (n = 369), and signet-ring cell (n = 113) in the Surveillance, Epidemiology, and End Results database (1973–2001) were analyzed. Evaluation of incidence, stage, and five-year relative survival were determined for each histology. The appropriateness of the operative procedure (i.e., appendectomy vs. colectomy) was examined by tumor type and size. RESULTS: Tumor incidence, patient demographics, survival outcomes, and appropriateness of surgery varied significantly among the different appendiceal tumor histologies. The most common appendiceal tumors were mucinous. With regard to patient demographics, carcinoids presented at an earlier mean age of 41 years and 71 percent were female (P > 0.001 for both). Overall five-year survival was highest for carcinoid (83 percent) and lowest for signet ring (18 percent). Although current guidelines specify that a right hemicolectomy (rather than an appendectomy) be performed for all noncarcinoid tumors and carcinoid tumors <2 cm, we found that 30 percent of noncarcinoids underwent appendectomy. Similarly, 28 percent of carcinoids <2 cm underwent appendectomy, which is a lesser resection than is indicated. CONCLUSIONS: This study provides a population-based analysis of epidemiology, tumor characteristics, survival, and quality of care for appendiceal carcinomas. This characterization provides a novel description of the presentation and outcomes for malignancies of the appendix and highlights that a substantial number of patients with appendiceal tumors may not be receiving appropriate surgical resection. [ABSTRACT FROM AUTHOR]

Negative appendectomy rate varies significantly depending on patient age and sex. However, the impact of computed tomography (CT) scans on the diagnosis of appendicitis is unknown. The goal of this study was to examine the negative appendectomy rate using a statewide database and analyze the association of receipt of CT scan. Using the California Inpatient File, all patients undergoing appendectomy in 1999-2000 were identified (n = 75,452). Demographic and clinical data were analyzed, including procedure approach (open vs laparoscopic) and appendicitis type (negative, simple, abscess, peritonitis). Patients with CT scans performed were identified to compare the negative appendectomy rate. For the entire cohort, appendicitis type was 59 per cent simple, 10 per cent with abscess, 18.7 per cent with peritonitis, and 9.3 per cent negative. Males had a lower rate of negative appendicitis than females (6.0% vs 13.4%, P < 0.0001). The use of CT scans was associated with an overall lower negative appendectomy rate for females, especially in the < 5 years and > 45 years age categories. Use of CT scans in males does not appear to be efficacious, as the negative appendectomy rates were similar across all age categories. In conclusion, use of CT was associated with lower rate of negative appendectomy, depending on patient age and sex. [ABSTRACT FROM AUTHOR]

Background: The use of beta blockers in surgical patients has been suggested to decrease perioperative cardiac events. However, the overall risk reduction, on the basis of solely aggregate data from randomized studies, is unknown. The objective is to evaluate the effect of perioperative beta blockade in noncardiac surgery for protection against mortality or cardiac events. Methods: We performed a formal meta-analysis. The Medline database was searched for articles published from 1966-2004 by using the terms perioperative, beta blocker, surgery, and noncardiac. Inclusion criteria were randomized controlled trials evaluating perioperative beta blockade in noncardiac surgery. Studies were evaluated independently by 2 researchers. Cochrane Collaboration Software (Review Manager 4.2) was used to calculate relative risk (RR), risk difference (RD), and 95% confidence interval (CI). Six distinct postoperative adverse events were analyzed. Results: Eligible studies included 6 randomized controlled trials evaluating perioperative beta blockade in patients undergoing noncardiac surgery. These studies evaluated a total of 632 patients: 354 received perioperative beta blockade and 278 did not. Results for the 6 postoperative outcomes are shown.The 2 largest effects were a decrease in long-term cardiac mortality from 12% to 2% and a decrease in myocardial ischemia from 33% to 15%. All outcomes except perioperative overall mortality had improvements (P < .02), which favor the use of perioperative beta blockade. Conclusions: This report highlights for the first time the aggregated risk reduction from all published randomized controlled trials, and shows the protection of perioperative beta blockade against both short-term complications and mortality. [Copyright &y& Elsevier]