The bandwagon effect

Conclusion Although surgery has a glorious past that includes numerous seminal contributions to the medical sciences, at times progress has been and continues to be impeded by the bandwagon effect. Although many factors contribute to this phenomenon, the major obstacle that is sometimes in the pathway to truth is ourselves. The rigor of our clinical investigation has been less than it should be and our educational templates have overemphasized memorization of facts and creating clones of ourselves rather than fostering independent critical thinking by our students. Just as good basic science research is preceded by years of training in the laboratory, good clinical research will depend on well-prepared, educated, and meticulous clinical scientists. Recent initiatives, such as the “Clinical Trials” course sponsored by the American College of Surgeons and the Clinical Investigators Preparatory Program (CIPP) funded by the National Institutes of Health, are promising aids for the development of effective clinical scientists. Finally, we need to continually remind ourselves of the observation that “knowledge is always tentative and can only be made incrementally more certain with increasing data or evidence.” direct our energies toward forming the basis of a more complete knowledge. It is our challenge to make certain that the evidence generated in our clinical laboratories and published in our journals is reliable and that we and surgeons of the future can temper it with critical judgment as it is applied in the optimal care of our patients. Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002.     

The cushion effect

BACKGROUND: The pattern and severity of crash injury depends on a complex interaction of biomechanical factors such as deceleration velocity at impact (delta-V), seat-belt and airbag use, and type of impact. Human body characteristics such as height and weight may play an important role. We hypothesized that body mass index (BMI) will influence crash injury patterns. METHODS: The University of Michigan Program for Injury Research and Education database was queried. Three cohorts were analyzed, lean (BMI 30 kg/m2)RESULTS: There were 189 detailed crash cases, with 22 fatalities. There was an increased risk of fatal outcome associated with the obese cohort (adjusted odds ratio, 4.2 compared with lean; p = 0.04). Age, delta-V, seat-belt use, and type of impact were independent predictors of Injury Severity Score (ISS). After adjusting for other modifiers, being overweight was associated with decreased ISS (p = 0.03) and abdominal maximal Abbreviated Injury Scale (mAIS) score (p = 0.008) when compared with the lean cohort. However, the lower extremity mAIS score increased when overweight (p = 0.03) and obese cohorts (p = 0.001) were compared with the lean cohort. CONCLUSION: Although no difference in ISS was identified between the lean and obese cohorts, there was an increase in mortality with the obese cohort. The severity of lower extremity injuries increased with increasing BMI. The overweight cohort was associated with lower ISS and abdominal mAIS score compared with the lean cohort. This protection may be attributable to an increase in insulating tissue, or a "cushion effect," without a significant increase in mass and momentum.     

Hemodynamic effect of pericardiectomy

The method of integral rheography was used for the examination of 126 patients with different forms of pericarditis. The authors have established different nature of the blood circulation insufficiency (heart compression and myocardiodystrophy), which should be taken into consideration in choosing the methods of treatment.     

综合医院消毒效果监测

目的:了解我院消毒灭菌的质量,预防和控制院内感染的发生.方法:对我院重点科室的物体表面、医护人员手、消毒器械、使用中的消毒剂、压力蒸汽灭菌器进行抽样监测.结果:共采样624份,合格597份,合格率为95.7%.结论:我院消毒效果总体质量较好,但有个别科室的物体表面、医护人员的手合格率比较低.