Risk-adjusted 30- to 90-day outcome data for selected types of operations done by specific surgeons and hospitals are now being publicly posted online by England's National Health Service. According to the site, "Any hospital or consultant [attending surgeon in the UK] identified as an outlier will be investigated and action taken to improve data quality and/or patient care." After cardiac surgery outcomes data were made public in New York, some interesting unexpected ...

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Contrary to what you may have heard, pain is not the fifth vital sign. It's not a sign at all. Vital signs are the following: heart rate, blood pressure, respiratory rate, temperature. What do those four signs have in common? They can be measured. A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers ...

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An orthopedist asked me if I could explain why a couple of papers of his did not generate any feedback. He wasn't even sure that anyone had read them. He enclosed PDFs for me. Not being an orthopedist, I cannot comment on their validity. But I think I can explain why the papers have not created much interest. Are you familiar with the term, "impact factor"?

A journal's impact factor is an ...

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Several months ago, a post called, "Everything's my fault: How a surgeon says I'm sorry," appeared here on KevinMD.com. It was written by a plastic surgeon who feels that no matter goes wrong with a patient, surgeons should never blame anyone else. She gave some examples such as the lab losing a specimen, a chest x-ray that was ordered and not done, a patient eating something when he was not to ...

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In case you haven't noticed, a hot new topic in education is "grit." In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness. A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs ...

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You may find this story hard to believe, but it's true. A 75-year-old non-smoking man with no serious medical problems and a relatively low-risk family history (father, a life-long smoker, died of a stroke at age 76) has been undergoing routine physical examinations by his primary care physician in Florida every 6 months for several years. The visits include a full battery of laboratory studies, nearly all of which have been completely ...

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The other day Atul Gawande tweeted the following:

I am not against checklists. When I was a surgical chairman, I implemented and used one in both the operating room and the ICU. They do not add costs and ...

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It is so nice to be right. To summarize what I wrote almost 4 years ago, based on my experience, patients and families will accept the theoretical risk of a future cancer if it means they'll get an accurate diagnosis. A recent study validates that opinion. MedPage Today reports that before receiving any recommendation for CT scanning, 742 parents of children who presented with head injuries ...

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Live tweeting from conferences has become very popular, but I'm not sure why. The biggest problem is this: Lucid communication of a point made by a speaker using more than 140 characters at a time is difficult to capture in a tweet. The tweets tend to be filled with obscure abbreviations and references to previous tweets that may seem quite clear to the tweeter but not the tweetee. Some also post ...

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Google Glass has a long way to go in the OR The Royal London Hospital and the Barts and The London School of Medicine and Dentistry presented the first live-streamed surgical procedure in the UK. The operation was an extended right hemicolectomy with resection of a metastatic liver lesion. Here is what I thought about the event. The case started about 30 minutes late, which is similar to what would have happened in any ...

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