A graduating surgical resident is an expert clinician and scientist. The Accreditation Council of Graduate Medical Education (ACGME) endorses the surgeon-scientist in its requirement for scholarly activity, emphasizing a "scholarly approach to patient care…grounded in the principles of evidence based medicine…[and expanding] the knowledge base through dissemination." 1,p35 This dissemination occurs through publication in peer-reviewed forums, and bibliometric profiling with citation metrics, such as the Hirsch index (h-index), measures an individual's research output. 2 Academic rank is correlated with h-index, 3,4 and gender disparities exist in publication productivity among surgery faculty. 5,6 This study aimed to characterize the publication productivity of graduating general surgery residents and to assess factors associated with a chief resident's academic research output.Methods | For this cross-sectional study, the names of residents graduating in 2020 from general surgery programs listed by the Electronic Residency Application Service were gathered from program websites. An author search for the number of publications and h-index for each resident in Scopus, and all publications were included irrespective of year published. This study was approved by the Regional Health Command-Pacific Institutional Review Board. Informed consent was waived because the research involved no more than minimal risk to the individuals included in the analysis. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.A negative binomial regression model was used to evaluate the associations of sex, program academic status (as defined by the American Medical Association Residency and Fellowship Database), region (as defined by the US Census Bureau), graduating class size, mandatory research time, and program-level American Board of Surgery Qualifying Exam and Certifying Exam (CE) 5-year first-time pass rates with a resident's number of publications and h-index. A logistic regression model was generated to compare individuals who did and did not have at least 1 published research article. K-means clustering was attempted but did not reveal any useful results. Statistical analyses were performed using R, version 3.6.1 (R Project for Statistical Computing). A 2-sided P < .05 was considered statistically significant.
BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta (REBOA), a minimally invasive alternative to resuscitative thoracotomy, has been associated with significant ischemia reperfusion injury (IRI). Resuscitation strategies using adenosine, lidocaine, and magnesium (ALM) have been shown to mitigate similar inflammatory responses in hemorrhagic and septic shock models. This study examined the effects of ALM on REBOA-associated IRI using a porcine model. METHODS:Animals underwent a 20% controlled hemorrhage followed by 30 minutes of supraceliac balloon occlusion. They were assigned to one of four groups: control (n = 5), 4-hour ALM infusion starting at occlusion, 2-hour (n = 5) and 4-hour (n = 5) interventional ALM infusions starting at reperfusion. Adenosine, lidocaine, and magnesium cohorts received a posthemorrhage ALM bolus followed by their respective ALM infusion. Primary outcomes for the study assessed physiologic and hemodynamic parameters. RESULTS:Adenosine, lidocaine, and magnesium infusion after reperfusion cohorts demonstrated a significant improvement in lactate, base deficit, and pH in the first hour following systemic reperfusion. At study endpoint, continuous ALM infusion initiated after reperfusion over 4 hours resulted in an overall improved lactate clearance when compared with the 2-hour and control cohorts. No differences in hemodynamic parameters were noted between ALM cohorts and controls. CONCLUSION: Adenosine, lidocaine, and magnesium may prove beneficial in mitigating the inflammatory response seen from REBOA-associated IRI as evidenced by physiologic improvements early during resuscitation. Despite this, further refinement should be sought to optimize treatment strategies.
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