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Medical consultation rates for surgical cases vary
The use of inpatient medical consultations for hospitalized surgical patients was found to vary by hospital, but consultations didn’t appear to have much of an impact on risk-adjusted 30-day mortality rates, a study found.
Rates of medical consultations varied from 50% to 91% among 91,684 patients undergoing colectomy and from 36% to 90% among 339,319 patients undergoing total hip replacements, a retrospective study found.
The variation was most dramatic for patients undergoing colectomy who did not have complications, among whom rates of inpatient medical consultation ranged from 47% to 79% between hospitals, Dr. Lena M. Chen and her associates reported. For patients undergoing colectomy who did have complications, 90%-95% received medical consultations.
Similarly, variation in the use of medical consultation for patients getting total hip replacement was wider for those without complications (36%-87%), compared with patients with complications (89%-94%).
The results highlight the fact that there’s no consensus on when and how to best provide medical consultation for hospitalized surgical patients. "Wide variation in medical consultation use – particularly among patients without complications – suggests that understanding when medical consultations provide value will be important as hospitals seek to increase their efficiency under bundled payments," wrote Dr. Chen of the University of Michigan, Ann Arbor (JAMA Intern. Med. 2014 Aug. 4 [doi:10.1001/jamainternmed.2014.3376]).
She and her associates analyzed Medicare claims data and American Hospital Association data on patients aged 65-99 years who underwent colectomy at 930 hospitals or total hip replacement at 1,589 hospitals in 2007-2010. These are 2 of the top 10 procedures performed on Medicare patients, and total hip replacement is included in the Centers for Medicare & Medicaid Services bundled payment demonstration project, the authors noted.
At least one medical consultant saw 69% of patients undergoing colectomy and 63% of patients getting a total hip replacement. Among patients who got consultations, colectomy patients saw consultants a median of nine times, and hip replacement patients saw consultants a median of three times.
Colectomy patients most often saw general medicine consultants (50%), followed by cardiologists (28%), oncologists (25%), or gastroenterologists (22%). Among patients receiving total hip replacement, 53% had a general medicine consultation, and the most common specialist consultations were for physical medicine and rehabilitation (11%) or cardiology (8%).
Approximately a third of hip replacement patients were "comanaged" by surgeons and medical consultants, defined by records of a claim for evaluation and management by a medicine physician on at least 70% of inpatient days.
It seems logical to assume that extra care from nonsurgical physicians should improve outcomes for some surgical patients, but an exploratory analysis of the data found that risk-adjusted 30-day mortality rates were not significantly different between hospitals with the greatest or least use of medical consultations, Dr. Chen reported. The 30-day mortality rate for colectomy patients was 5% at hospitals in the lowest quintile of medical consultations and 6% at hospitals in the highest quintile. The results for total hip replacement were similar.
Greater use of medical consultation was associated with a significantly greater likelihood of having at least one postoperative complication, affecting 24% of colectomy patients at hospitals in the lowest quintile of consultations and 28% at hospitals in the highest quintile. The results for total hip replacement were similar.
The National Institute of Aging and a University of Michigan McCubed grant funded the study. Dr. Chen reported having no relevant financial disclosures. One of her coinvestigators owns stock in ArborMetrix, a company that analyzes hospital quality and cost efficiency.
On Twitter @sherryboschert
Dr. Chen’s findings that rates of medical consultation varied widely for surgical patients without complications complement a 2010 study by Dr. Gulshan Sharma and his associates that found 35% of patients hospitalized for a common surgical procedure were comanaged by medicine physicians (Arch. Intern. Med. 2010;170:363-8).
"I agree [with Dr. Chen] that understanding the ‘value’ of medical consultation is an important next step, especially in low-risk patients undergoing elective surgery," Dr. Sharma commented in an article accompanying Dr. Chen’s study (JAMA Intern. Med. 2014 Aug. 4 [doi:10.1001/jamainternmed.2014.1499]).
Comanagement may benefit patients by increasing the use of evidence-based treatments or reducing the time to surgery, postoperative complications, the need for ICU care, the length of stay, and readmission rates, among other possibilities. But there are possible downsides, too, including potential confusion among caregivers, more complicated decision making, lack of "ownership" of problems, or added costs, he noted.
Hospitals with the greatest use of medical consultation in Dr. Chen’s study had higher risk-adjusted rates of 30-day mortality and complications, compared with hospitals with the least use of medical consultation (though the difference in mortality was not statistically significant). "Is there a potential harm associated with medical consultation?" Dr. Sharma asked.
"There is no one fit for all" hospitals, he wrote. Institutional data on quality and cost should drive decisions on the routine use of medical consultation. The practice of mandating comanagement of all surgical patients "should be discouraged," Dr. Sharma said. "During preoperative evaluation, patients with comorbid conditions and those at significant risk of postoperative complications should be considered for medical comanagement."
Dr. Sharma is director of the division of pulmonary critical care and sleep medicine at the University of Texas Medical Branch, Galveston. He reported having no relevant financial disclosures.
Dr. Chen’s findings that rates of medical consultation varied widely for surgical patients without complications complement a 2010 study by Dr. Gulshan Sharma and his associates that found 35% of patients hospitalized for a common surgical procedure were comanaged by medicine physicians (Arch. Intern. Med. 2010;170:363-8).
"I agree [with Dr. Chen] that understanding the ‘value’ of medical consultation is an important next step, especially in low-risk patients undergoing elective surgery," Dr. Sharma commented in an article accompanying Dr. Chen’s study (JAMA Intern. Med. 2014 Aug. 4 [doi:10.1001/jamainternmed.2014.1499]).
Comanagement may benefit patients by increasing the use of evidence-based treatments or reducing the time to surgery, postoperative complications, the need for ICU care, the length of stay, and readmission rates, among other possibilities. But there are possible downsides, too, including potential confusion among caregivers, more complicated decision making, lack of "ownership" of problems, or added costs, he noted.
Hospitals with the greatest use of medical consultation in Dr. Chen’s study had higher risk-adjusted rates of 30-day mortality and complications, compared with hospitals with the least use of medical consultation (though the difference in mortality was not statistically significant). "Is there a potential harm associated with medical consultation?" Dr. Sharma asked.
"There is no one fit for all" hospitals, he wrote. Institutional data on quality and cost should drive decisions on the routine use of medical consultation. The practice of mandating comanagement of all surgical patients "should be discouraged," Dr. Sharma said. "During preoperative evaluation, patients with comorbid conditions and those at significant risk of postoperative complications should be considered for medical comanagement."
Dr. Sharma is director of the division of pulmonary critical care and sleep medicine at the University of Texas Medical Branch, Galveston. He reported having no relevant financial disclosures.
Dr. Chen’s findings that rates of medical consultation varied widely for surgical patients without complications complement a 2010 study by Dr. Gulshan Sharma and his associates that found 35% of patients hospitalized for a common surgical procedure were comanaged by medicine physicians (Arch. Intern. Med. 2010;170:363-8).
"I agree [with Dr. Chen] that understanding the ‘value’ of medical consultation is an important next step, especially in low-risk patients undergoing elective surgery," Dr. Sharma commented in an article accompanying Dr. Chen’s study (JAMA Intern. Med. 2014 Aug. 4 [doi:10.1001/jamainternmed.2014.1499]).
Comanagement may benefit patients by increasing the use of evidence-based treatments or reducing the time to surgery, postoperative complications, the need for ICU care, the length of stay, and readmission rates, among other possibilities. But there are possible downsides, too, including potential confusion among caregivers, more complicated decision making, lack of "ownership" of problems, or added costs, he noted.
Hospitals with the greatest use of medical consultation in Dr. Chen’s study had higher risk-adjusted rates of 30-day mortality and complications, compared with hospitals with the least use of medical consultation (though the difference in mortality was not statistically significant). "Is there a potential harm associated with medical consultation?" Dr. Sharma asked.
"There is no one fit for all" hospitals, he wrote. Institutional data on quality and cost should drive decisions on the routine use of medical consultation. The practice of mandating comanagement of all surgical patients "should be discouraged," Dr. Sharma said. "During preoperative evaluation, patients with comorbid conditions and those at significant risk of postoperative complications should be considered for medical comanagement."
Dr. Sharma is director of the division of pulmonary critical care and sleep medicine at the University of Texas Medical Branch, Galveston. He reported having no relevant financial disclosures.
The use of inpatient medical consultations for hospitalized surgical patients was found to vary by hospital, but consultations didn’t appear to have much of an impact on risk-adjusted 30-day mortality rates, a study found.
Rates of medical consultations varied from 50% to 91% among 91,684 patients undergoing colectomy and from 36% to 90% among 339,319 patients undergoing total hip replacements, a retrospective study found.
The variation was most dramatic for patients undergoing colectomy who did not have complications, among whom rates of inpatient medical consultation ranged from 47% to 79% between hospitals, Dr. Lena M. Chen and her associates reported. For patients undergoing colectomy who did have complications, 90%-95% received medical consultations.
Similarly, variation in the use of medical consultation for patients getting total hip replacement was wider for those without complications (36%-87%), compared with patients with complications (89%-94%).
The results highlight the fact that there’s no consensus on when and how to best provide medical consultation for hospitalized surgical patients. "Wide variation in medical consultation use – particularly among patients without complications – suggests that understanding when medical consultations provide value will be important as hospitals seek to increase their efficiency under bundled payments," wrote Dr. Chen of the University of Michigan, Ann Arbor (JAMA Intern. Med. 2014 Aug. 4 [doi:10.1001/jamainternmed.2014.3376]).
She and her associates analyzed Medicare claims data and American Hospital Association data on patients aged 65-99 years who underwent colectomy at 930 hospitals or total hip replacement at 1,589 hospitals in 2007-2010. These are 2 of the top 10 procedures performed on Medicare patients, and total hip replacement is included in the Centers for Medicare & Medicaid Services bundled payment demonstration project, the authors noted.
At least one medical consultant saw 69% of patients undergoing colectomy and 63% of patients getting a total hip replacement. Among patients who got consultations, colectomy patients saw consultants a median of nine times, and hip replacement patients saw consultants a median of three times.
Colectomy patients most often saw general medicine consultants (50%), followed by cardiologists (28%), oncologists (25%), or gastroenterologists (22%). Among patients receiving total hip replacement, 53% had a general medicine consultation, and the most common specialist consultations were for physical medicine and rehabilitation (11%) or cardiology (8%).
Approximately a third of hip replacement patients were "comanaged" by surgeons and medical consultants, defined by records of a claim for evaluation and management by a medicine physician on at least 70% of inpatient days.
It seems logical to assume that extra care from nonsurgical physicians should improve outcomes for some surgical patients, but an exploratory analysis of the data found that risk-adjusted 30-day mortality rates were not significantly different between hospitals with the greatest or least use of medical consultations, Dr. Chen reported. The 30-day mortality rate for colectomy patients was 5% at hospitals in the lowest quintile of medical consultations and 6% at hospitals in the highest quintile. The results for total hip replacement were similar.
Greater use of medical consultation was associated with a significantly greater likelihood of having at least one postoperative complication, affecting 24% of colectomy patients at hospitals in the lowest quintile of consultations and 28% at hospitals in the highest quintile. The results for total hip replacement were similar.
The National Institute of Aging and a University of Michigan McCubed grant funded the study. Dr. Chen reported having no relevant financial disclosures. One of her coinvestigators owns stock in ArborMetrix, a company that analyzes hospital quality and cost efficiency.
On Twitter @sherryboschert
The use of inpatient medical consultations for hospitalized surgical patients was found to vary by hospital, but consultations didn’t appear to have much of an impact on risk-adjusted 30-day mortality rates, a study found.
Rates of medical consultations varied from 50% to 91% among 91,684 patients undergoing colectomy and from 36% to 90% among 339,319 patients undergoing total hip replacements, a retrospective study found.
The variation was most dramatic for patients undergoing colectomy who did not have complications, among whom rates of inpatient medical consultation ranged from 47% to 79% between hospitals, Dr. Lena M. Chen and her associates reported. For patients undergoing colectomy who did have complications, 90%-95% received medical consultations.
Similarly, variation in the use of medical consultation for patients getting total hip replacement was wider for those without complications (36%-87%), compared with patients with complications (89%-94%).
The results highlight the fact that there’s no consensus on when and how to best provide medical consultation for hospitalized surgical patients. "Wide variation in medical consultation use – particularly among patients without complications – suggests that understanding when medical consultations provide value will be important as hospitals seek to increase their efficiency under bundled payments," wrote Dr. Chen of the University of Michigan, Ann Arbor (JAMA Intern. Med. 2014 Aug. 4 [doi:10.1001/jamainternmed.2014.3376]).
She and her associates analyzed Medicare claims data and American Hospital Association data on patients aged 65-99 years who underwent colectomy at 930 hospitals or total hip replacement at 1,589 hospitals in 2007-2010. These are 2 of the top 10 procedures performed on Medicare patients, and total hip replacement is included in the Centers for Medicare & Medicaid Services bundled payment demonstration project, the authors noted.
At least one medical consultant saw 69% of patients undergoing colectomy and 63% of patients getting a total hip replacement. Among patients who got consultations, colectomy patients saw consultants a median of nine times, and hip replacement patients saw consultants a median of three times.
Colectomy patients most often saw general medicine consultants (50%), followed by cardiologists (28%), oncologists (25%), or gastroenterologists (22%). Among patients receiving total hip replacement, 53% had a general medicine consultation, and the most common specialist consultations were for physical medicine and rehabilitation (11%) or cardiology (8%).
Approximately a third of hip replacement patients were "comanaged" by surgeons and medical consultants, defined by records of a claim for evaluation and management by a medicine physician on at least 70% of inpatient days.
It seems logical to assume that extra care from nonsurgical physicians should improve outcomes for some surgical patients, but an exploratory analysis of the data found that risk-adjusted 30-day mortality rates were not significantly different between hospitals with the greatest or least use of medical consultations, Dr. Chen reported. The 30-day mortality rate for colectomy patients was 5% at hospitals in the lowest quintile of medical consultations and 6% at hospitals in the highest quintile. The results for total hip replacement were similar.
Greater use of medical consultation was associated with a significantly greater likelihood of having at least one postoperative complication, affecting 24% of colectomy patients at hospitals in the lowest quintile of consultations and 28% at hospitals in the highest quintile. The results for total hip replacement were similar.
The National Institute of Aging and a University of Michigan McCubed grant funded the study. Dr. Chen reported having no relevant financial disclosures. One of her coinvestigators owns stock in ArborMetrix, a company that analyzes hospital quality and cost efficiency.
On Twitter @sherryboschert
FROM JAMA INTERNAL MEDICINE
Key clinical point: In the era of bundled payments for episodes of care, consider when and how medical consultation for surgical patients is helpful.
Major finding: Use of medical consultations ranged from 50%-91% for colectomies and 36%-90% for total hip replacements.
Data source: A retrospective study of Medicare data on 431,003 older adults undergoing colectomy or total hip replacement in 2007-2010.
Disclosures: Dr. Chen reported having no financial disclosures. One of her associates owns stock in ArborMetrix, a company that analyzes hospital quality and cost efficiency.
Feedback sought with patient education survey
The American College of Surgeons (ACS) Board of Governors Patient Education Workgroup, in conjunction with the Division of Education Patient Education Committee, is requesting feedback by Friday, August 29, on members’ surgical patient education practices, needs, and how the ACS might enhance surgical patient education programs. The ACS strives to keep surgeons current with the best practices in patient education and is continually developing materials to help members meet current standards and advance the quality of patient education. Please complete the survey at http://www2.e-surveymaker.com/nph-dsp?4752888053558067.
If you have questions, contact [email protected].
The American College of Surgeons (ACS) Board of Governors Patient Education Workgroup, in conjunction with the Division of Education Patient Education Committee, is requesting feedback by Friday, August 29, on members’ surgical patient education practices, needs, and how the ACS might enhance surgical patient education programs. The ACS strives to keep surgeons current with the best practices in patient education and is continually developing materials to help members meet current standards and advance the quality of patient education. Please complete the survey at http://www2.e-surveymaker.com/nph-dsp?4752888053558067.
If you have questions, contact [email protected].
The American College of Surgeons (ACS) Board of Governors Patient Education Workgroup, in conjunction with the Division of Education Patient Education Committee, is requesting feedback by Friday, August 29, on members’ surgical patient education practices, needs, and how the ACS might enhance surgical patient education programs. The ACS strives to keep surgeons current with the best practices in patient education and is continually developing materials to help members meet current standards and advance the quality of patient education. Please complete the survey at http://www2.e-surveymaker.com/nph-dsp?4752888053558067.
If you have questions, contact [email protected].
Many eyes are better
Peer review is the filter that determines what is published in the scientific literature and what is not allowed to see the light of day. It has been considered "the gatekeeper of science." In modern times, peer review has consisted of a journal editor sending a submitted article to a limited number of experts in the field who then judge its worth for publication. Many specialists see reviewing manuscripts as a service to their profession, put considerable effort into their analysis, and provide extensive comments on revisions needed to strengthen papers.
However, the value of this venerable process as it is presently constituted has been questioned by numerous critics. Because manuscripts are reviewed by a limited number of often rival scientists in a highly specialized field, the practice is prone to bias. Innovation may be stifled when reviewers reject outlier concepts that may be correct but that do not fit into the mainstream of thought. Critiques are often superficial as they are performed by otherwise busy individuals who receive no compensation for their efforts. Finally, journal editors are given undue power in the process. Not only do they make the final decision to publish or reject a manuscript, they are also responsible for selecting reviewers and are then free to ignore or accept their recommendations.
These criticisms of this time-honored system have led to a strong impetus for change. Coincident with the motivation for modifying this essential component of the publication process have been technological advancements that are facilitating new approaches. The Internet has provided a mechanism for making peer review a more open, inclusive process with any member of the scientific community who so desires having the opportunity to contribute to the evaluation of published work. A recent incident highlights how uninvited, but valuable, input from the wider scientific community can rapidly and effectively improve the accuracy of the literature.
On July 2, 2014, National Public Radio’s Morning Edition broadcast "Easy method for making stem cells was too good to be true" and a New York Times headline proclaimed "Stem cell research papers are retracted." In January 2014, Haruko Obokata of the RIKEN Centre for Developmental Biology in Japan published an innovative and considerably simpler method of producing stem cells than extracting them from embryos or making them from skin cells in a complicated and prolonged process (Nature 2014;505: 641-7). At the time of publication, the work was viewed by many to be potentially Nobel Prize-worthy research—that is, until the stem cell research community chimed in with its extensive and detailed post-publication peer review.
A number of research groups questioned Obokata’s conclusions. Some even attempted to replicate the experiments, but with no success. Soon the critics’ findings and opinions appeared on a variety of websites and blogs, including the Nature website. The RIKEN Centre took notice and appointed a committee to investigate the research. The committee found that Obokata had manipulated her data on at least two occasions and concluded that she had participated in research misconduct. Pressure mounted, which led to the recent voluntary retraction of the article by its authors.
This case represents an extreme outcome resulting from a failure of pre-publication vetting followed by a successful post-hoc peer review. But it demonstrates how the emerging and more comprehensive means of evaluating published research is rapidly working its way into the fabric of how science and the reporting of it operate. It would be ideal if this extensive vetting of potentially important research could be done prior to rather than after its release to the general public. Physics academicians have accomplished this by posting their research papers as pre-prints on-line for their colleagues to evaluate. Only after a successful conclusion of this process is a work deemed acceptable for entry into the physics literature. Submission of biomedical research to a similar process has a significant downside in that new, possibly harmful therapies, not yet peer-reviewed, could be adopted by practitioners and/or patients before their time. However, some modification of it will likely evolve and lead to a more accurate assessment of submitted work than the present process allows.
How publications are valued is also being modified thanks to the omnibus means of rapid communication allowed by an ever-expanding Internet. Bibliometrics, most notably the number of times an article is subsequently cited in print, has been the mainstay in determining the value of individual articles. The journal impact factor, which has historically been the main measure of a journal\'s standing compared to that of others in its field, is derived from the aggregate of citations for all articles over a period of time. With the advent of the Internet, a new set of alternative metrics (altmetrics) is now contributing to the evaluation of published work. While print citations take years to accumulate, article downloads, mentions on Facebook, number of tweets on Twitter, and numerous other altmetrics have the considerable advantage of immediacy and can be logged by any reader, not only those authors who decide to subsequently cite certain publications. Although these new metrics are unlikely to replace traditional citations in assigning value to individual articles, along with them, they will be helpful in determining what must be read to maintain currency in one’s specialty.
So, readers of the surgical literature feel your newly found power and exert it. You along with your colleagues around the globe can, and in fact have an obligation to, play a role in determining what is worth reading from an ever-expanding volume of new information. Many eyes will almost certainly be better than relying solely on the opinions of a chosen few.
Dr. Rikkers is Editor in Chief of ACS Surgery News.
Peer review is the filter that determines what is published in the scientific literature and what is not allowed to see the light of day. It has been considered "the gatekeeper of science." In modern times, peer review has consisted of a journal editor sending a submitted article to a limited number of experts in the field who then judge its worth for publication. Many specialists see reviewing manuscripts as a service to their profession, put considerable effort into their analysis, and provide extensive comments on revisions needed to strengthen papers.
However, the value of this venerable process as it is presently constituted has been questioned by numerous critics. Because manuscripts are reviewed by a limited number of often rival scientists in a highly specialized field, the practice is prone to bias. Innovation may be stifled when reviewers reject outlier concepts that may be correct but that do not fit into the mainstream of thought. Critiques are often superficial as they are performed by otherwise busy individuals who receive no compensation for their efforts. Finally, journal editors are given undue power in the process. Not only do they make the final decision to publish or reject a manuscript, they are also responsible for selecting reviewers and are then free to ignore or accept their recommendations.
These criticisms of this time-honored system have led to a strong impetus for change. Coincident with the motivation for modifying this essential component of the publication process have been technological advancements that are facilitating new approaches. The Internet has provided a mechanism for making peer review a more open, inclusive process with any member of the scientific community who so desires having the opportunity to contribute to the evaluation of published work. A recent incident highlights how uninvited, but valuable, input from the wider scientific community can rapidly and effectively improve the accuracy of the literature.
On July 2, 2014, National Public Radio’s Morning Edition broadcast "Easy method for making stem cells was too good to be true" and a New York Times headline proclaimed "Stem cell research papers are retracted." In January 2014, Haruko Obokata of the RIKEN Centre for Developmental Biology in Japan published an innovative and considerably simpler method of producing stem cells than extracting them from embryos or making them from skin cells in a complicated and prolonged process (Nature 2014;505: 641-7). At the time of publication, the work was viewed by many to be potentially Nobel Prize-worthy research—that is, until the stem cell research community chimed in with its extensive and detailed post-publication peer review.
A number of research groups questioned Obokata’s conclusions. Some even attempted to replicate the experiments, but with no success. Soon the critics’ findings and opinions appeared on a variety of websites and blogs, including the Nature website. The RIKEN Centre took notice and appointed a committee to investigate the research. The committee found that Obokata had manipulated her data on at least two occasions and concluded that she had participated in research misconduct. Pressure mounted, which led to the recent voluntary retraction of the article by its authors.
This case represents an extreme outcome resulting from a failure of pre-publication vetting followed by a successful post-hoc peer review. But it demonstrates how the emerging and more comprehensive means of evaluating published research is rapidly working its way into the fabric of how science and the reporting of it operate. It would be ideal if this extensive vetting of potentially important research could be done prior to rather than after its release to the general public. Physics academicians have accomplished this by posting their research papers as pre-prints on-line for their colleagues to evaluate. Only after a successful conclusion of this process is a work deemed acceptable for entry into the physics literature. Submission of biomedical research to a similar process has a significant downside in that new, possibly harmful therapies, not yet peer-reviewed, could be adopted by practitioners and/or patients before their time. However, some modification of it will likely evolve and lead to a more accurate assessment of submitted work than the present process allows.
How publications are valued is also being modified thanks to the omnibus means of rapid communication allowed by an ever-expanding Internet. Bibliometrics, most notably the number of times an article is subsequently cited in print, has been the mainstay in determining the value of individual articles. The journal impact factor, which has historically been the main measure of a journal\'s standing compared to that of others in its field, is derived from the aggregate of citations for all articles over a period of time. With the advent of the Internet, a new set of alternative metrics (altmetrics) is now contributing to the evaluation of published work. While print citations take years to accumulate, article downloads, mentions on Facebook, number of tweets on Twitter, and numerous other altmetrics have the considerable advantage of immediacy and can be logged by any reader, not only those authors who decide to subsequently cite certain publications. Although these new metrics are unlikely to replace traditional citations in assigning value to individual articles, along with them, they will be helpful in determining what must be read to maintain currency in one’s specialty.
So, readers of the surgical literature feel your newly found power and exert it. You along with your colleagues around the globe can, and in fact have an obligation to, play a role in determining what is worth reading from an ever-expanding volume of new information. Many eyes will almost certainly be better than relying solely on the opinions of a chosen few.
Dr. Rikkers is Editor in Chief of ACS Surgery News.
Peer review is the filter that determines what is published in the scientific literature and what is not allowed to see the light of day. It has been considered "the gatekeeper of science." In modern times, peer review has consisted of a journal editor sending a submitted article to a limited number of experts in the field who then judge its worth for publication. Many specialists see reviewing manuscripts as a service to their profession, put considerable effort into their analysis, and provide extensive comments on revisions needed to strengthen papers.
However, the value of this venerable process as it is presently constituted has been questioned by numerous critics. Because manuscripts are reviewed by a limited number of often rival scientists in a highly specialized field, the practice is prone to bias. Innovation may be stifled when reviewers reject outlier concepts that may be correct but that do not fit into the mainstream of thought. Critiques are often superficial as they are performed by otherwise busy individuals who receive no compensation for their efforts. Finally, journal editors are given undue power in the process. Not only do they make the final decision to publish or reject a manuscript, they are also responsible for selecting reviewers and are then free to ignore or accept their recommendations.
These criticisms of this time-honored system have led to a strong impetus for change. Coincident with the motivation for modifying this essential component of the publication process have been technological advancements that are facilitating new approaches. The Internet has provided a mechanism for making peer review a more open, inclusive process with any member of the scientific community who so desires having the opportunity to contribute to the evaluation of published work. A recent incident highlights how uninvited, but valuable, input from the wider scientific community can rapidly and effectively improve the accuracy of the literature.
On July 2, 2014, National Public Radio’s Morning Edition broadcast "Easy method for making stem cells was too good to be true" and a New York Times headline proclaimed "Stem cell research papers are retracted." In January 2014, Haruko Obokata of the RIKEN Centre for Developmental Biology in Japan published an innovative and considerably simpler method of producing stem cells than extracting them from embryos or making them from skin cells in a complicated and prolonged process (Nature 2014;505: 641-7). At the time of publication, the work was viewed by many to be potentially Nobel Prize-worthy research—that is, until the stem cell research community chimed in with its extensive and detailed post-publication peer review.
A number of research groups questioned Obokata’s conclusions. Some even attempted to replicate the experiments, but with no success. Soon the critics’ findings and opinions appeared on a variety of websites and blogs, including the Nature website. The RIKEN Centre took notice and appointed a committee to investigate the research. The committee found that Obokata had manipulated her data on at least two occasions and concluded that she had participated in research misconduct. Pressure mounted, which led to the recent voluntary retraction of the article by its authors.
This case represents an extreme outcome resulting from a failure of pre-publication vetting followed by a successful post-hoc peer review. But it demonstrates how the emerging and more comprehensive means of evaluating published research is rapidly working its way into the fabric of how science and the reporting of it operate. It would be ideal if this extensive vetting of potentially important research could be done prior to rather than after its release to the general public. Physics academicians have accomplished this by posting their research papers as pre-prints on-line for their colleagues to evaluate. Only after a successful conclusion of this process is a work deemed acceptable for entry into the physics literature. Submission of biomedical research to a similar process has a significant downside in that new, possibly harmful therapies, not yet peer-reviewed, could be adopted by practitioners and/or patients before their time. However, some modification of it will likely evolve and lead to a more accurate assessment of submitted work than the present process allows.
How publications are valued is also being modified thanks to the omnibus means of rapid communication allowed by an ever-expanding Internet. Bibliometrics, most notably the number of times an article is subsequently cited in print, has been the mainstay in determining the value of individual articles. The journal impact factor, which has historically been the main measure of a journal\'s standing compared to that of others in its field, is derived from the aggregate of citations for all articles over a period of time. With the advent of the Internet, a new set of alternative metrics (altmetrics) is now contributing to the evaluation of published work. While print citations take years to accumulate, article downloads, mentions on Facebook, number of tweets on Twitter, and numerous other altmetrics have the considerable advantage of immediacy and can be logged by any reader, not only those authors who decide to subsequently cite certain publications. Although these new metrics are unlikely to replace traditional citations in assigning value to individual articles, along with them, they will be helpful in determining what must be read to maintain currency in one’s specialty.
So, readers of the surgical literature feel your newly found power and exert it. You along with your colleagues around the globe can, and in fact have an obligation to, play a role in determining what is worth reading from an ever-expanding volume of new information. Many eyes will almost certainly be better than relying solely on the opinions of a chosen few.
Dr. Rikkers is Editor in Chief of ACS Surgery News.
ACS seeks to fill eight vacancies on Commission on Cancer
The American College of Surgeons (ACS) is seeking eight Fellows to fill vacancies on the Commission on Cancer (CoC). The initial term of appointment is for three years with eligibility for re-election to a second term. Members may hold office or serve as a vice-chair of a committee or subcommittee during their second term. New members will be recommended by the Nominating Committee, selected in October by the Executive Committee, and then brought before the full CoC membership for approval at the CoC’s Annual Meeting. The ACS Board of Regents will confirm the final list of new members, and the CoC will announce the new members in late October.
Surgeons who meet the criteria below and are interested in becoming a member of the CoC should contact Lynda Watt at [email protected] to receive an application. The completed application, curriculum vitae, and any letters of recommendation must be sent to Ms. Watt at the same address by Monday, September 1.
CoC member criteria include:
• Full ACS Fellowship status
• Staff appointment at a CoC-accredited cancer program and participation in cancer program activities
• Service as an effective State Chair or Cancer Liaison Physician
• Knowledge of the CoC’s goals and initiatives
• Representation of a surgical specialty, geographic area, or diverse group not currently represented on the CoC.
• Interest in contributing to and enhancing CoC programs and committee work
• Ability to serve as a member of at least one CoC committee.
• Attendance and participation in at least two in-person meetings annually
• Attendance and participation in committee conference calls.
Please contact Ms. Watt at [email protected] if you have any questions.
The American College of Surgeons (ACS) is seeking eight Fellows to fill vacancies on the Commission on Cancer (CoC). The initial term of appointment is for three years with eligibility for re-election to a second term. Members may hold office or serve as a vice-chair of a committee or subcommittee during their second term. New members will be recommended by the Nominating Committee, selected in October by the Executive Committee, and then brought before the full CoC membership for approval at the CoC’s Annual Meeting. The ACS Board of Regents will confirm the final list of new members, and the CoC will announce the new members in late October.
Surgeons who meet the criteria below and are interested in becoming a member of the CoC should contact Lynda Watt at [email protected] to receive an application. The completed application, curriculum vitae, and any letters of recommendation must be sent to Ms. Watt at the same address by Monday, September 1.
CoC member criteria include:
• Full ACS Fellowship status
• Staff appointment at a CoC-accredited cancer program and participation in cancer program activities
• Service as an effective State Chair or Cancer Liaison Physician
• Knowledge of the CoC’s goals and initiatives
• Representation of a surgical specialty, geographic area, or diverse group not currently represented on the CoC.
• Interest in contributing to and enhancing CoC programs and committee work
• Ability to serve as a member of at least one CoC committee.
• Attendance and participation in at least two in-person meetings annually
• Attendance and participation in committee conference calls.
Please contact Ms. Watt at [email protected] if you have any questions.
The American College of Surgeons (ACS) is seeking eight Fellows to fill vacancies on the Commission on Cancer (CoC). The initial term of appointment is for three years with eligibility for re-election to a second term. Members may hold office or serve as a vice-chair of a committee or subcommittee during their second term. New members will be recommended by the Nominating Committee, selected in October by the Executive Committee, and then brought before the full CoC membership for approval at the CoC’s Annual Meeting. The ACS Board of Regents will confirm the final list of new members, and the CoC will announce the new members in late October.
Surgeons who meet the criteria below and are interested in becoming a member of the CoC should contact Lynda Watt at [email protected] to receive an application. The completed application, curriculum vitae, and any letters of recommendation must be sent to Ms. Watt at the same address by Monday, September 1.
CoC member criteria include:
• Full ACS Fellowship status
• Staff appointment at a CoC-accredited cancer program and participation in cancer program activities
• Service as an effective State Chair or Cancer Liaison Physician
• Knowledge of the CoC’s goals and initiatives
• Representation of a surgical specialty, geographic area, or diverse group not currently represented on the CoC.
• Interest in contributing to and enhancing CoC programs and committee work
• Ability to serve as a member of at least one CoC committee.
• Attendance and participation in at least two in-person meetings annually
• Attendance and participation in committee conference calls.
Please contact Ms. Watt at [email protected] if you have any questions.
The Right Choice? Surgeons, patients, and ethical analysis
In July 2011, I first had the opportunity to write a column on ethics for ACS Surgery News. That article, "Responding to Family/Patient Requests," explored possible responses to the family members’ requests to "do everything" for a critically ill patient. The article was published under the tag line, "The Right Choice."
Since that first article, I have had the opportunity to write 12 additional columns on different ethical issues in the care of surgical patients. The issues have ranged from considerations of informed consent and disclosure of information to the challenges of innovative techniques and scarce resources. Each of these columns has continued to be under the heading "The Right Choice." As I considered what to write about this month, I reviewed my previous articles and I was struck by a worrisome possibility. In the challenging surgical cases presented, is the suggestion that I know "the right choice" actually wrong?
Medical ethics has increasingly become an important topic in medical schools and the clinical care of patients since the late 1970s. Although the medical and surgical care of patients has always had an ethical dimension, it has only been in the last several decades that the ethical issues have been separately identified and analyzed. As the acceptance of surgeons making decisions about what is "best" for their patients has shifted to increasing respect for the patient as an autonomous decision maker, we have seen the importance of understanding patient preferences increase.
At the same time, as medical and surgical care has improved, we now have more options to prolong patients’ lives even when the quality of those lives may be dramatically diminished. These factors have led to the increased consideration of ethical dimensions of decisions that we must help our patients make.
Although many authors have suggested ways to proceed with the ethical analysis of cases, few methods have been as widely adopted as that suggested by Albert Jonsen, Mark Siegler, and William Winslade in their influential book, "Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine," 7th edition (New York: Lange Clinical Science/McGraw Hill, 2010). These authors suggest that the analysis of a case should include attention to four sets of issues: medical indications, patient preferences, quality of life, and contextual features. By analyzing these issues for a difficult case, we are often able to see where the underlying principles of beneficence, nonmaleficence, respect for patient autonomy, and justice may be at odds.
For example, in the case that I discussed in the July 2011 issue, about the 80-year-old woman with extensive gangrenous bowel, a central concern was whether the surgical decision making should be altered by the family member’s request to "do everything you can." In this case, I suggested that requests from surrogate decision makers must be tempered by the realities of the case and the importance of not harming a patient by providing burdensome care that has minimal chance of success.
As I reread that prior article, I am struck by the fact that I suggest a way of thinking about the case and a series of considerations that are important. However, I am not comfortable saying that I have identified the single correct course of action. I believe that although ethical analysis of cases has tremendous value for doctors and patients, there is rarely one right answer. There may be several wrong answers, and there may be several acceptable answers, but there is rarely a single right choice. My goal in these columns that I wrote in the past and hope to write in the future is to raise awareness of the ethical dimensions of the case, to suggest important considerations, and perhaps even to identify some of the ethical principles that may be relevant. But I do not believe that I can identify "the right choice
In the very first edition of "Clinical Ethics" published in 1982, Jonsen, Siegler, and Winslade wrote in the preface, "We do not merely discuss or analyze the ethical problems; we offer counsel about decisions. Lest this be thought presumptuous, we do not consider our counsel the single and final answer. We offer it in the tradition of medical consultation: The consultant may bring to the practitioner’s view of the case not only broader information but another perspective."
I have tried to provide this type of information and perspective in the ACS Surgery News ethics columns and in view of the difficulty of determining the single right answer to many challenging cases, future columns will be found under the new heading, "The Right Choice?" By adding the critical question mark, I hope that readers will be reminded of the need for ongoing discussion of the challenging ethical questions that arise in the care of surgical patients.
Dr. Angelos is the Linda Kohler Anderson Professor of Surgery and Surgical Ethics; chief, endocrine surgery; and associate director, MacLean Center for Clinical Medical Ethics, at the University of Chicago.
In July 2011, I first had the opportunity to write a column on ethics for ACS Surgery News. That article, "Responding to Family/Patient Requests," explored possible responses to the family members’ requests to "do everything" for a critically ill patient. The article was published under the tag line, "The Right Choice."
Since that first article, I have had the opportunity to write 12 additional columns on different ethical issues in the care of surgical patients. The issues have ranged from considerations of informed consent and disclosure of information to the challenges of innovative techniques and scarce resources. Each of these columns has continued to be under the heading "The Right Choice." As I considered what to write about this month, I reviewed my previous articles and I was struck by a worrisome possibility. In the challenging surgical cases presented, is the suggestion that I know "the right choice" actually wrong?
Medical ethics has increasingly become an important topic in medical schools and the clinical care of patients since the late 1970s. Although the medical and surgical care of patients has always had an ethical dimension, it has only been in the last several decades that the ethical issues have been separately identified and analyzed. As the acceptance of surgeons making decisions about what is "best" for their patients has shifted to increasing respect for the patient as an autonomous decision maker, we have seen the importance of understanding patient preferences increase.
At the same time, as medical and surgical care has improved, we now have more options to prolong patients’ lives even when the quality of those lives may be dramatically diminished. These factors have led to the increased consideration of ethical dimensions of decisions that we must help our patients make.
Although many authors have suggested ways to proceed with the ethical analysis of cases, few methods have been as widely adopted as that suggested by Albert Jonsen, Mark Siegler, and William Winslade in their influential book, "Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine," 7th edition (New York: Lange Clinical Science/McGraw Hill, 2010). These authors suggest that the analysis of a case should include attention to four sets of issues: medical indications, patient preferences, quality of life, and contextual features. By analyzing these issues for a difficult case, we are often able to see where the underlying principles of beneficence, nonmaleficence, respect for patient autonomy, and justice may be at odds.
For example, in the case that I discussed in the July 2011 issue, about the 80-year-old woman with extensive gangrenous bowel, a central concern was whether the surgical decision making should be altered by the family member’s request to "do everything you can." In this case, I suggested that requests from surrogate decision makers must be tempered by the realities of the case and the importance of not harming a patient by providing burdensome care that has minimal chance of success.
As I reread that prior article, I am struck by the fact that I suggest a way of thinking about the case and a series of considerations that are important. However, I am not comfortable saying that I have identified the single correct course of action. I believe that although ethical analysis of cases has tremendous value for doctors and patients, there is rarely one right answer. There may be several wrong answers, and there may be several acceptable answers, but there is rarely a single right choice. My goal in these columns that I wrote in the past and hope to write in the future is to raise awareness of the ethical dimensions of the case, to suggest important considerations, and perhaps even to identify some of the ethical principles that may be relevant. But I do not believe that I can identify "the right choice
In the very first edition of "Clinical Ethics" published in 1982, Jonsen, Siegler, and Winslade wrote in the preface, "We do not merely discuss or analyze the ethical problems; we offer counsel about decisions. Lest this be thought presumptuous, we do not consider our counsel the single and final answer. We offer it in the tradition of medical consultation: The consultant may bring to the practitioner’s view of the case not only broader information but another perspective."
I have tried to provide this type of information and perspective in the ACS Surgery News ethics columns and in view of the difficulty of determining the single right answer to many challenging cases, future columns will be found under the new heading, "The Right Choice?" By adding the critical question mark, I hope that readers will be reminded of the need for ongoing discussion of the challenging ethical questions that arise in the care of surgical patients.
Dr. Angelos is the Linda Kohler Anderson Professor of Surgery and Surgical Ethics; chief, endocrine surgery; and associate director, MacLean Center for Clinical Medical Ethics, at the University of Chicago.
In July 2011, I first had the opportunity to write a column on ethics for ACS Surgery News. That article, "Responding to Family/Patient Requests," explored possible responses to the family members’ requests to "do everything" for a critically ill patient. The article was published under the tag line, "The Right Choice."
Since that first article, I have had the opportunity to write 12 additional columns on different ethical issues in the care of surgical patients. The issues have ranged from considerations of informed consent and disclosure of information to the challenges of innovative techniques and scarce resources. Each of these columns has continued to be under the heading "The Right Choice." As I considered what to write about this month, I reviewed my previous articles and I was struck by a worrisome possibility. In the challenging surgical cases presented, is the suggestion that I know "the right choice" actually wrong?
Medical ethics has increasingly become an important topic in medical schools and the clinical care of patients since the late 1970s. Although the medical and surgical care of patients has always had an ethical dimension, it has only been in the last several decades that the ethical issues have been separately identified and analyzed. As the acceptance of surgeons making decisions about what is "best" for their patients has shifted to increasing respect for the patient as an autonomous decision maker, we have seen the importance of understanding patient preferences increase.
At the same time, as medical and surgical care has improved, we now have more options to prolong patients’ lives even when the quality of those lives may be dramatically diminished. These factors have led to the increased consideration of ethical dimensions of decisions that we must help our patients make.
Although many authors have suggested ways to proceed with the ethical analysis of cases, few methods have been as widely adopted as that suggested by Albert Jonsen, Mark Siegler, and William Winslade in their influential book, "Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine," 7th edition (New York: Lange Clinical Science/McGraw Hill, 2010). These authors suggest that the analysis of a case should include attention to four sets of issues: medical indications, patient preferences, quality of life, and contextual features. By analyzing these issues for a difficult case, we are often able to see where the underlying principles of beneficence, nonmaleficence, respect for patient autonomy, and justice may be at odds.
For example, in the case that I discussed in the July 2011 issue, about the 80-year-old woman with extensive gangrenous bowel, a central concern was whether the surgical decision making should be altered by the family member’s request to "do everything you can." In this case, I suggested that requests from surrogate decision makers must be tempered by the realities of the case and the importance of not harming a patient by providing burdensome care that has minimal chance of success.
As I reread that prior article, I am struck by the fact that I suggest a way of thinking about the case and a series of considerations that are important. However, I am not comfortable saying that I have identified the single correct course of action. I believe that although ethical analysis of cases has tremendous value for doctors and patients, there is rarely one right answer. There may be several wrong answers, and there may be several acceptable answers, but there is rarely a single right choice. My goal in these columns that I wrote in the past and hope to write in the future is to raise awareness of the ethical dimensions of the case, to suggest important considerations, and perhaps even to identify some of the ethical principles that may be relevant. But I do not believe that I can identify "the right choice
In the very first edition of "Clinical Ethics" published in 1982, Jonsen, Siegler, and Winslade wrote in the preface, "We do not merely discuss or analyze the ethical problems; we offer counsel about decisions. Lest this be thought presumptuous, we do not consider our counsel the single and final answer. We offer it in the tradition of medical consultation: The consultant may bring to the practitioner’s view of the case not only broader information but another perspective."
I have tried to provide this type of information and perspective in the ACS Surgery News ethics columns and in view of the difficulty of determining the single right answer to many challenging cases, future columns will be found under the new heading, "The Right Choice?" By adding the critical question mark, I hope that readers will be reminded of the need for ongoing discussion of the challenging ethical questions that arise in the care of surgical patients.
Dr. Angelos is the Linda Kohler Anderson Professor of Surgery and Surgical Ethics; chief, endocrine surgery; and associate director, MacLean Center for Clinical Medical Ethics, at the University of Chicago.
ACS, Iowa health care leaders address rural surgery at IQ Forum
The American College of Surgeons (ACS) hosted the Surgical Health Care Quality Forum Iowa on June 27 in Des Moines. It was the 19th in a series of Inspiring Quality forums held across the U.S. since 2011.
At this forum, a panel of health care leaders shared insights regarding the unique health care issues that rural areas face today, including workforce shortages, quality education and training for the next generation of rural surgeons, and access to trauma care. Presenters discussed the 2001 start of Iowa’s trauma system and how it has helped to improve trauma patient outcomes. The forum also highlighted ACS programs and initiatives that support rural surgeons in the delivery of high-quality care, such as the creation of the ACS Advisory Council on Rural Surgery and the ACS rural listserv, a "hub" for 1,000 rural surgeons across the country to share information. More than 5 million e-mails have been exchanged on the listserv.
Ronald J. Weigel, MD, PhD, MBA, FACS, and Carol Scott-Conner, MD, PhD, MBA, FACS, co-hosted the event. Dr. Weigel is associate vice-president of the University of Iowa Health Alliance; and the EA Crowell Jr., Professor and Chair of Surgery, professor of surgery – surgical oncology and endocrine surgery, professor of biochemistry, anatomy and cell biology, University of Iowa Carver College of Medicine (UICCM), Iowa City. Dr. Scott-Conner is professor of surgery, division of oncology and endocrine surgery, at UICCM.
View a complete list of Iowa Forum participants at http://inspiringquality.facs.org/national-tour/iowa-2/, a full-program video, and photos from the event on the ACS Inspiring Quality website at http://inspiringquality.facs.org/national-tour/ohio/. For more information, e-mail [email protected].
The American College of Surgeons (ACS) hosted the Surgical Health Care Quality Forum Iowa on June 27 in Des Moines. It was the 19th in a series of Inspiring Quality forums held across the U.S. since 2011.
At this forum, a panel of health care leaders shared insights regarding the unique health care issues that rural areas face today, including workforce shortages, quality education and training for the next generation of rural surgeons, and access to trauma care. Presenters discussed the 2001 start of Iowa’s trauma system and how it has helped to improve trauma patient outcomes. The forum also highlighted ACS programs and initiatives that support rural surgeons in the delivery of high-quality care, such as the creation of the ACS Advisory Council on Rural Surgery and the ACS rural listserv, a "hub" for 1,000 rural surgeons across the country to share information. More than 5 million e-mails have been exchanged on the listserv.
Ronald J. Weigel, MD, PhD, MBA, FACS, and Carol Scott-Conner, MD, PhD, MBA, FACS, co-hosted the event. Dr. Weigel is associate vice-president of the University of Iowa Health Alliance; and the EA Crowell Jr., Professor and Chair of Surgery, professor of surgery – surgical oncology and endocrine surgery, professor of biochemistry, anatomy and cell biology, University of Iowa Carver College of Medicine (UICCM), Iowa City. Dr. Scott-Conner is professor of surgery, division of oncology and endocrine surgery, at UICCM.
View a complete list of Iowa Forum participants at http://inspiringquality.facs.org/national-tour/iowa-2/, a full-program video, and photos from the event on the ACS Inspiring Quality website at http://inspiringquality.facs.org/national-tour/ohio/. For more information, e-mail [email protected].
The American College of Surgeons (ACS) hosted the Surgical Health Care Quality Forum Iowa on June 27 in Des Moines. It was the 19th in a series of Inspiring Quality forums held across the U.S. since 2011.
At this forum, a panel of health care leaders shared insights regarding the unique health care issues that rural areas face today, including workforce shortages, quality education and training for the next generation of rural surgeons, and access to trauma care. Presenters discussed the 2001 start of Iowa’s trauma system and how it has helped to improve trauma patient outcomes. The forum also highlighted ACS programs and initiatives that support rural surgeons in the delivery of high-quality care, such as the creation of the ACS Advisory Council on Rural Surgery and the ACS rural listserv, a "hub" for 1,000 rural surgeons across the country to share information. More than 5 million e-mails have been exchanged on the listserv.
Ronald J. Weigel, MD, PhD, MBA, FACS, and Carol Scott-Conner, MD, PhD, MBA, FACS, co-hosted the event. Dr. Weigel is associate vice-president of the University of Iowa Health Alliance; and the EA Crowell Jr., Professor and Chair of Surgery, professor of surgery – surgical oncology and endocrine surgery, professor of biochemistry, anatomy and cell biology, University of Iowa Carver College of Medicine (UICCM), Iowa City. Dr. Scott-Conner is professor of surgery, division of oncology and endocrine surgery, at UICCM.
View a complete list of Iowa Forum participants at http://inspiringquality.facs.org/national-tour/iowa-2/, a full-program video, and photos from the event on the ACS Inspiring Quality website at http://inspiringquality.facs.org/national-tour/ohio/. For more information, e-mail [email protected].
COT resident competition deadline on November 15
The American College of Surgeons (ACS) Regional Committees on Trauma (RCOT) will accept papers for the 2015 Residents Trauma Papers Competition until November 15, 2014. The competition will take place during the Committee on Trauma (COT) Annual Meeting, March 12–14, in Chicago, IL.
The competition is open to general surgery residents, surgical specialty residents, and trauma fellows. The papers should describe original research in the area of trauma care and/or prevention, categorized as either basic laboratory research or clinical investigation. The RCOT Chair must submit the papers to the appropriate ACS RCOT Region Chief. Please contact Bridget Blackwood, ACS Trauma Programs, at 312-202-5380 or [email protected] for information regarding the names and addresses of RCOT Chairs.
The Eastern and Western States COTs, Region 7 COT, and the ACS are funding the competition.
The American College of Surgeons (ACS) Regional Committees on Trauma (RCOT) will accept papers for the 2015 Residents Trauma Papers Competition until November 15, 2014. The competition will take place during the Committee on Trauma (COT) Annual Meeting, March 12–14, in Chicago, IL.
The competition is open to general surgery residents, surgical specialty residents, and trauma fellows. The papers should describe original research in the area of trauma care and/or prevention, categorized as either basic laboratory research or clinical investigation. The RCOT Chair must submit the papers to the appropriate ACS RCOT Region Chief. Please contact Bridget Blackwood, ACS Trauma Programs, at 312-202-5380 or [email protected] for information regarding the names and addresses of RCOT Chairs.
The Eastern and Western States COTs, Region 7 COT, and the ACS are funding the competition.
The American College of Surgeons (ACS) Regional Committees on Trauma (RCOT) will accept papers for the 2015 Residents Trauma Papers Competition until November 15, 2014. The competition will take place during the Committee on Trauma (COT) Annual Meeting, March 12–14, in Chicago, IL.
The competition is open to general surgery residents, surgical specialty residents, and trauma fellows. The papers should describe original research in the area of trauma care and/or prevention, categorized as either basic laboratory research or clinical investigation. The RCOT Chair must submit the papers to the appropriate ACS RCOT Region Chief. Please contact Bridget Blackwood, ACS Trauma Programs, at 312-202-5380 or [email protected] for information regarding the names and addresses of RCOT Chairs.
The Eastern and Western States COTs, Region 7 COT, and the ACS are funding the competition.
ACS members’ accomplishments in the news
Gary E. Friedlaender, MD, FACS, is the 2014 recipient of the William W. Tipton, Jr., MD, Leadership Award from the American Academy of Orthopaedic Surgeons (AAOS). The Tipton Leadership Award recognizes one academy member each year who has demonstrated outstanding leadership qualities that have benefitted the orthopaedic community, patients, and/or the American public. The award honors the life of the late William W. Tipton, Jr., MD, FACS, an orthopaedic surgeon, educator, and former AAOS chief executive officer. Dr. Friedlaender, a preeminent orthopaedic oncology surgeon, researcher, and mentor to hundreds of young orthopaedic surgeons, received the award earlier this year at the 2014 AAOS annual meeting.
Faruk Koreishi, MD, FACS, of Buffalo, NY, was recently recognized by the Ross Eye Institute, Buffalo, as Community Ophthalmologist of the Year. The Ross Eye Institute provides diagnostic, treatment, and surgical services; serves as a research center for diseases of the eye; and provides education to medical personnel in Western New York. Dr. Koreishi received the award, which recognizes his leadership and community service, at the Vision Beyond Sight Foundation’s first annual "Eye Ball." Dr. Koreishi established his practice in Buffalo in 1975 and currently is with the Retina Consultants of Western New York. He is a clinical assistant professor at the State University of New York, Buffalo.
Dan Poenaru, MD, FACS, FRCSC, originally from Kingston, ON, and now practicing at MyungSung Christian Medical Center in Addis Ababa, Ethiopia, received the seventh annual Teasdale-Corti Humanitarian Award, sponsored by the Royal College of Physicians and Surgeons of Canada, in recognition of his longstanding commitment to providing surgical care to needy children throughout Eastern Africa. The prestigious award is given annually to a physician or surgeon who exceeds expectations by providing health care throughout the world while exhibiting altruism, courage, and integrity.
In 2003, Dr. Poenaru moved with his wife and two children to Kenya to pursue a humanitarian surgical practice with Africa Inland Mission and BethanyKids, two faith-based organizations. Since then, Dr. Poenaru has helped build a quality pediatric surgical unit that provides care and treatment to thousands of children each year, often in the middle of civil unrest and in refugee camps. Dr. Poenaru also established the first accredited pediatric surgery training program in Eastern Africa.
Gary E. Friedlaender, MD, FACS, is the 2014 recipient of the William W. Tipton, Jr., MD, Leadership Award from the American Academy of Orthopaedic Surgeons (AAOS). The Tipton Leadership Award recognizes one academy member each year who has demonstrated outstanding leadership qualities that have benefitted the orthopaedic community, patients, and/or the American public. The award honors the life of the late William W. Tipton, Jr., MD, FACS, an orthopaedic surgeon, educator, and former AAOS chief executive officer. Dr. Friedlaender, a preeminent orthopaedic oncology surgeon, researcher, and mentor to hundreds of young orthopaedic surgeons, received the award earlier this year at the 2014 AAOS annual meeting.
Faruk Koreishi, MD, FACS, of Buffalo, NY, was recently recognized by the Ross Eye Institute, Buffalo, as Community Ophthalmologist of the Year. The Ross Eye Institute provides diagnostic, treatment, and surgical services; serves as a research center for diseases of the eye; and provides education to medical personnel in Western New York. Dr. Koreishi received the award, which recognizes his leadership and community service, at the Vision Beyond Sight Foundation’s first annual "Eye Ball." Dr. Koreishi established his practice in Buffalo in 1975 and currently is with the Retina Consultants of Western New York. He is a clinical assistant professor at the State University of New York, Buffalo.
Dan Poenaru, MD, FACS, FRCSC, originally from Kingston, ON, and now practicing at MyungSung Christian Medical Center in Addis Ababa, Ethiopia, received the seventh annual Teasdale-Corti Humanitarian Award, sponsored by the Royal College of Physicians and Surgeons of Canada, in recognition of his longstanding commitment to providing surgical care to needy children throughout Eastern Africa. The prestigious award is given annually to a physician or surgeon who exceeds expectations by providing health care throughout the world while exhibiting altruism, courage, and integrity.
In 2003, Dr. Poenaru moved with his wife and two children to Kenya to pursue a humanitarian surgical practice with Africa Inland Mission and BethanyKids, two faith-based organizations. Since then, Dr. Poenaru has helped build a quality pediatric surgical unit that provides care and treatment to thousands of children each year, often in the middle of civil unrest and in refugee camps. Dr. Poenaru also established the first accredited pediatric surgery training program in Eastern Africa.
Gary E. Friedlaender, MD, FACS, is the 2014 recipient of the William W. Tipton, Jr., MD, Leadership Award from the American Academy of Orthopaedic Surgeons (AAOS). The Tipton Leadership Award recognizes one academy member each year who has demonstrated outstanding leadership qualities that have benefitted the orthopaedic community, patients, and/or the American public. The award honors the life of the late William W. Tipton, Jr., MD, FACS, an orthopaedic surgeon, educator, and former AAOS chief executive officer. Dr. Friedlaender, a preeminent orthopaedic oncology surgeon, researcher, and mentor to hundreds of young orthopaedic surgeons, received the award earlier this year at the 2014 AAOS annual meeting.
Faruk Koreishi, MD, FACS, of Buffalo, NY, was recently recognized by the Ross Eye Institute, Buffalo, as Community Ophthalmologist of the Year. The Ross Eye Institute provides diagnostic, treatment, and surgical services; serves as a research center for diseases of the eye; and provides education to medical personnel in Western New York. Dr. Koreishi received the award, which recognizes his leadership and community service, at the Vision Beyond Sight Foundation’s first annual "Eye Ball." Dr. Koreishi established his practice in Buffalo in 1975 and currently is with the Retina Consultants of Western New York. He is a clinical assistant professor at the State University of New York, Buffalo.
Dan Poenaru, MD, FACS, FRCSC, originally from Kingston, ON, and now practicing at MyungSung Christian Medical Center in Addis Ababa, Ethiopia, received the seventh annual Teasdale-Corti Humanitarian Award, sponsored by the Royal College of Physicians and Surgeons of Canada, in recognition of his longstanding commitment to providing surgical care to needy children throughout Eastern Africa. The prestigious award is given annually to a physician or surgeon who exceeds expectations by providing health care throughout the world while exhibiting altruism, courage, and integrity.
In 2003, Dr. Poenaru moved with his wife and two children to Kenya to pursue a humanitarian surgical practice with Africa Inland Mission and BethanyKids, two faith-based organizations. Since then, Dr. Poenaru has helped build a quality pediatric surgical unit that provides care and treatment to thousands of children each year, often in the middle of civil unrest and in refugee camps. Dr. Poenaru also established the first accredited pediatric surgery training program in Eastern Africa.
Register online for CSF 2014 by August 25 for discounted fee
The 2014 Canadian Surgery Forum (CSF 2014), September 17–21, at the Vancouver Convention Centre and Fairmont Waterfront Hotel, BC, will offer a broad range of scientific and educational sessions through interactive symposia, panel discussions, postgraduate courses, debates, plenary sessions, and "breakfast with the professor" roundtables. The forum, which provides extensive networking opportunities, is the largest surgical meeting in Canada. August 25 is the registration deadline for [www.canadiansurgeryforum.com] a discounted fee. Access the preliminary program at http://media.wix.com/ugd/990a75_79bacd50afd240ef8cf35c1abddb852f.pdf and download the meeting App at http://admin.myeventapps.com/cansurgery/downloads.
Major participating societies of the forum include the Canadian Association of General Surgeons, the Canadian Society of Colon and Rectal Surgeons, the Canadian Society of Surgical Oncology, and the Canadian Association of Thoracic Surgery. The American College of Surgeons is one of the forum’s participating societies. Other participants include the British Columbia Surgical Society, the Canadian Association of University Surgeons, the Canadian Hepato-Pancreato-Biliary Association, the Canadian Undergraduate Surgical Education Committee, the James IV Association of Surgeons, and the Trauma Association of Canada.
A theme of the event will be Healthy Docs Are Happy Docs: Promoting Health, Wellness, and Career Longevity for Today’s Surgical Professionals. Participants may book their flight online on the CSF 2014 official airline, Air Canada, at www.aircanada.com, using the code JMHG7UN1, to receive a 20 percent fare discount. Reserve a hotel room on the CSF website at www.candiansurgeryforum.com by August 25 to receive a group rate, or call the hotel at 604-691-1820.
The 2014 Canadian Surgery Forum (CSF 2014), September 17–21, at the Vancouver Convention Centre and Fairmont Waterfront Hotel, BC, will offer a broad range of scientific and educational sessions through interactive symposia, panel discussions, postgraduate courses, debates, plenary sessions, and "breakfast with the professor" roundtables. The forum, which provides extensive networking opportunities, is the largest surgical meeting in Canada. August 25 is the registration deadline for [www.canadiansurgeryforum.com] a discounted fee. Access the preliminary program at http://media.wix.com/ugd/990a75_79bacd50afd240ef8cf35c1abddb852f.pdf and download the meeting App at http://admin.myeventapps.com/cansurgery/downloads.
Major participating societies of the forum include the Canadian Association of General Surgeons, the Canadian Society of Colon and Rectal Surgeons, the Canadian Society of Surgical Oncology, and the Canadian Association of Thoracic Surgery. The American College of Surgeons is one of the forum’s participating societies. Other participants include the British Columbia Surgical Society, the Canadian Association of University Surgeons, the Canadian Hepato-Pancreato-Biliary Association, the Canadian Undergraduate Surgical Education Committee, the James IV Association of Surgeons, and the Trauma Association of Canada.
A theme of the event will be Healthy Docs Are Happy Docs: Promoting Health, Wellness, and Career Longevity for Today’s Surgical Professionals. Participants may book their flight online on the CSF 2014 official airline, Air Canada, at www.aircanada.com, using the code JMHG7UN1, to receive a 20 percent fare discount. Reserve a hotel room on the CSF website at www.candiansurgeryforum.com by August 25 to receive a group rate, or call the hotel at 604-691-1820.
The 2014 Canadian Surgery Forum (CSF 2014), September 17–21, at the Vancouver Convention Centre and Fairmont Waterfront Hotel, BC, will offer a broad range of scientific and educational sessions through interactive symposia, panel discussions, postgraduate courses, debates, plenary sessions, and "breakfast with the professor" roundtables. The forum, which provides extensive networking opportunities, is the largest surgical meeting in Canada. August 25 is the registration deadline for [www.canadiansurgeryforum.com] a discounted fee. Access the preliminary program at http://media.wix.com/ugd/990a75_79bacd50afd240ef8cf35c1abddb852f.pdf and download the meeting App at http://admin.myeventapps.com/cansurgery/downloads.
Major participating societies of the forum include the Canadian Association of General Surgeons, the Canadian Society of Colon and Rectal Surgeons, the Canadian Society of Surgical Oncology, and the Canadian Association of Thoracic Surgery. The American College of Surgeons is one of the forum’s participating societies. Other participants include the British Columbia Surgical Society, the Canadian Association of University Surgeons, the Canadian Hepato-Pancreato-Biliary Association, the Canadian Undergraduate Surgical Education Committee, the James IV Association of Surgeons, and the Trauma Association of Canada.
A theme of the event will be Healthy Docs Are Happy Docs: Promoting Health, Wellness, and Career Longevity for Today’s Surgical Professionals. Participants may book their flight online on the CSF 2014 official airline, Air Canada, at www.aircanada.com, using the code JMHG7UN1, to receive a 20 percent fare discount. Reserve a hotel room on the CSF website at www.candiansurgeryforum.com by August 25 to receive a group rate, or call the hotel at 604-691-1820.
Applications due for Resident Research Scholarships
The American College of Surgeons (ACS) is now accepting applications for six 2015 Resident Research Scholarships. Eligibility for these scholarships is limited to the research projects of residents in general surgery or a surgical specialty. The closing date for receipt of completed applications and all supporting documents is September 2, 2014.
These scholarships are supported through the generosity of Fellows, Chapters, and friends of the College, to encourage residents to pursue careers in academic surgery. General policies covering the granting of the ACS Resident Research Scholarships are as follows:
• The applicant must be a Resident Member of the College who has completed two postdoctoral years at an accredited surgical training program in the U.S. or Canada at the time the scholarship is awarded on July 1, 2015, and must be on track to complete formal surgical training in June 2017 or later. Scholarships do not support research after completion of the chief residency year.
• The scholarship is awarded for two years, and recipients must commit to conducting research over the entire two-year period of the scholarship—July 2015 through June 2017. Priority will be given to the projects of residents involved in full-time laboratory investigation. Study outside the U.S. or Canada is permissible. Renewal of the scholarship for the second year is required and is contingent upon the acceptance of a progress report and research study protocol for the second year, as submitted to the Scholarships Section of the College by May 1, 2016.
• Applications for these scholarships may be submitted even if comparable applications to other organizations have been made. If the recipient is offered a scholarship, fellowship, or research award from another organization, it is the responsibility of the recipient to contact the College’s Scholarships Administrator to request approval of the additional award. The Scholarships Committee reserves the right to review potentially overlapping awards and adjust its award accordingly.
• The scholarship is $30,000 per year; the total amount is to support the research of the recipient and is not to diminish or replace the scholar’s usual or expected compensation or benefits. No indirect costs are paid to the recipient or to the recipient’s institution.
• The scholar is expected to attend the ACS Clinical Congress in 2017 to present a report on the research as part of the Surgical Forum and to receive a certificate at the annual meeting of the Scholarships Committee.
• Approval of the application is required from the administration (dean or fiscal officer) of the candidate’s institution. Supporting letters from the head of the department of surgery or the surgical specialty and from the mentor who will be supervising the applicant’s research must be submitted. Only in exceptional circumstances will more than one scholarship be granted in a single year to applicants from the same institution.
Application forms may be obtained from the College’s website: www.facs.org, or upon request from the Scholarships Administrator at [email protected].
The American College of Surgeons (ACS) is now accepting applications for six 2015 Resident Research Scholarships. Eligibility for these scholarships is limited to the research projects of residents in general surgery or a surgical specialty. The closing date for receipt of completed applications and all supporting documents is September 2, 2014.
These scholarships are supported through the generosity of Fellows, Chapters, and friends of the College, to encourage residents to pursue careers in academic surgery. General policies covering the granting of the ACS Resident Research Scholarships are as follows:
• The applicant must be a Resident Member of the College who has completed two postdoctoral years at an accredited surgical training program in the U.S. or Canada at the time the scholarship is awarded on July 1, 2015, and must be on track to complete formal surgical training in June 2017 or later. Scholarships do not support research after completion of the chief residency year.
• The scholarship is awarded for two years, and recipients must commit to conducting research over the entire two-year period of the scholarship—July 2015 through June 2017. Priority will be given to the projects of residents involved in full-time laboratory investigation. Study outside the U.S. or Canada is permissible. Renewal of the scholarship for the second year is required and is contingent upon the acceptance of a progress report and research study protocol for the second year, as submitted to the Scholarships Section of the College by May 1, 2016.
• Applications for these scholarships may be submitted even if comparable applications to other organizations have been made. If the recipient is offered a scholarship, fellowship, or research award from another organization, it is the responsibility of the recipient to contact the College’s Scholarships Administrator to request approval of the additional award. The Scholarships Committee reserves the right to review potentially overlapping awards and adjust its award accordingly.
• The scholarship is $30,000 per year; the total amount is to support the research of the recipient and is not to diminish or replace the scholar’s usual or expected compensation or benefits. No indirect costs are paid to the recipient or to the recipient’s institution.
• The scholar is expected to attend the ACS Clinical Congress in 2017 to present a report on the research as part of the Surgical Forum and to receive a certificate at the annual meeting of the Scholarships Committee.
• Approval of the application is required from the administration (dean or fiscal officer) of the candidate’s institution. Supporting letters from the head of the department of surgery or the surgical specialty and from the mentor who will be supervising the applicant’s research must be submitted. Only in exceptional circumstances will more than one scholarship be granted in a single year to applicants from the same institution.
Application forms may be obtained from the College’s website: www.facs.org, or upon request from the Scholarships Administrator at [email protected].
The American College of Surgeons (ACS) is now accepting applications for six 2015 Resident Research Scholarships. Eligibility for these scholarships is limited to the research projects of residents in general surgery or a surgical specialty. The closing date for receipt of completed applications and all supporting documents is September 2, 2014.
These scholarships are supported through the generosity of Fellows, Chapters, and friends of the College, to encourage residents to pursue careers in academic surgery. General policies covering the granting of the ACS Resident Research Scholarships are as follows:
• The applicant must be a Resident Member of the College who has completed two postdoctoral years at an accredited surgical training program in the U.S. or Canada at the time the scholarship is awarded on July 1, 2015, and must be on track to complete formal surgical training in June 2017 or later. Scholarships do not support research after completion of the chief residency year.
• The scholarship is awarded for two years, and recipients must commit to conducting research over the entire two-year period of the scholarship—July 2015 through June 2017. Priority will be given to the projects of residents involved in full-time laboratory investigation. Study outside the U.S. or Canada is permissible. Renewal of the scholarship for the second year is required and is contingent upon the acceptance of a progress report and research study protocol for the second year, as submitted to the Scholarships Section of the College by May 1, 2016.
• Applications for these scholarships may be submitted even if comparable applications to other organizations have been made. If the recipient is offered a scholarship, fellowship, or research award from another organization, it is the responsibility of the recipient to contact the College’s Scholarships Administrator to request approval of the additional award. The Scholarships Committee reserves the right to review potentially overlapping awards and adjust its award accordingly.
• The scholarship is $30,000 per year; the total amount is to support the research of the recipient and is not to diminish or replace the scholar’s usual or expected compensation or benefits. No indirect costs are paid to the recipient or to the recipient’s institution.
• The scholar is expected to attend the ACS Clinical Congress in 2017 to present a report on the research as part of the Surgical Forum and to receive a certificate at the annual meeting of the Scholarships Committee.
• Approval of the application is required from the administration (dean or fiscal officer) of the candidate’s institution. Supporting letters from the head of the department of surgery or the surgical specialty and from the mentor who will be supervising the applicant’s research must be submitted. Only in exceptional circumstances will more than one scholarship be granted in a single year to applicants from the same institution.
Application forms may be obtained from the College’s website: www.facs.org, or upon request from the Scholarships Administrator at [email protected].