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Showing 1201 - 1400 of 2281 Journals sorted alphabetically
J. of Earth Science     Hybrid Journal   (Followers: 6, SJR: 0.299, h-index: 11)
J. of Earth System Science     Open Access   (Followers: 24, SJR: 0.466, h-index: 27)
J. of East Asian Linguistics     Hybrid Journal   (Followers: 5, SJR: 0.669, h-index: 15)
J. of Echocardiography     Hybrid Journal   (Followers: 3, SJR: 0.136, h-index: 3)
J. of Economic Growth     Hybrid Journal   (Followers: 25, SJR: 5.251, h-index: 54)
J. of Economic Interaction and Coordination     Hybrid Journal   (SJR: 0.231, h-index: 11)
J. of Economics     Hybrid Journal   (Followers: 9, SJR: 0.463, h-index: 20)
J. of Economics and Finance     Hybrid Journal   (Followers: 7, SJR: 0.238, h-index: 15)
J. of Educational Change     Hybrid Journal   (Followers: 7, SJR: 0.694, h-index: 14)
J. of Elasticity     Hybrid Journal   (Followers: 4, SJR: 0.821, h-index: 38)
J. of Electroceramics     Hybrid Journal   (SJR: 0.566, h-index: 49)
J. of Electronic Materials     Hybrid Journal   (Followers: 2, SJR: 0.752, h-index: 68)
J. of Electronic Testing     Hybrid Journal   (Followers: 2, SJR: 0.241, h-index: 24)
J. of Electronics (China)     Hybrid Journal   (Followers: 3, SJR: 0.127, h-index: 7)
J. of Elementary Science Education     Hybrid Journal   (Followers: 8)
J. of Engineering Mathematics     Hybrid Journal   (SJR: 0.707, h-index: 32)
J. of Engineering Physics and Thermophysics     Hybrid Journal   (SJR: 0.132, h-index: 8)
J. of Engineering Research     Open Access  
J. of Engineering Thermophysics     Hybrid Journal   (SJR: 0.294, h-index: 7)
J. of Environmental Studies and Sciences     Partially Free   (Followers: 2)
J. of Ethology     Hybrid Journal   (Followers: 2, SJR: 0.484, h-index: 21)
J. of Evolution Equations     Hybrid Journal   (SJR: 1.312, h-index: 22)
J. of Evolutionary Biochemistry and Physiology     Hybrid Journal   (SJR: 0.127, h-index: 9)
J. of Evolutionary Economics     Hybrid Journal   (Followers: 8, SJR: 0.878, h-index: 42)
J. of Experimental and Theoretical Physics     Hybrid Journal   (Followers: 2, SJR: 0.565, h-index: 34)
J. of Experimental Criminology     Hybrid Journal   (Followers: 26, SJR: 1.587, h-index: 22)
J. of Failure Analysis and Prevention     Hybrid Journal   (Followers: 1, SJR: 0.256, h-index: 12)
J. of Family and Economic Issues     Hybrid Journal   (Followers: 6, SJR: 0.532, h-index: 27)
J. of Family Violence     Hybrid Journal   (Followers: 15, SJR: 0.552, h-index: 45)
J. of Financial Services Research     Hybrid Journal   (Followers: 16, SJR: 1.196, h-index: 29)
J. of Fixed Point Theory and Applications     Hybrid Journal   (SJR: 0.467, h-index: 10)
J. of Fluorescence     Hybrid Journal   (Followers: 4, SJR: 0.553, h-index: 47)
J. of Food Measurement and Characterization     Hybrid Journal   (SJR: 0.104, h-index: 1)
J. of Food Science and Technology     Hybrid Journal   (Followers: 5, SJR: 0.839, h-index: 21)
J. of Forest Research     Hybrid Journal   (Followers: 3, SJR: 0.578, h-index: 22)
J. of Forestry Research     Hybrid Journal   (Followers: 6, SJR: 0.271, h-index: 10)
J. of Fourier Analysis and Applications     Hybrid Journal   (Followers: 1, SJR: 1.248, h-index: 36)
J. of Friction and Wear     Hybrid Journal   (Followers: 6, SJR: 0.263, h-index: 6)
J. of Fusion Energy     Hybrid Journal   (Followers: 3, SJR: 0.389, h-index: 16)
J. of Gambling Studies     Hybrid Journal   (Followers: 3, SJR: 1.122, h-index: 50)
J. of Gastroenterology     Hybrid Journal   (Followers: 13, SJR: 1.724, h-index: 73)
J. of Gastrointestinal Cancer     Hybrid Journal   (Followers: 3, SJR: 0.371, h-index: 36)
J. of Gastrointestinal Surgery     Hybrid Journal   (Followers: 5, SJR: 1.632, h-index: 87)
J. of General Internal Medicine     Hybrid Journal   (Followers: 12, SJR: 2.379, h-index: 115)
J. of General Plant Pathology     Hybrid Journal   (SJR: 0.357, h-index: 17)
J. of Genetic Counseling     Hybrid Journal   (Followers: 4, SJR: 0.535, h-index: 32)
J. of Genetics     Open Access   (Followers: 4, SJR: 0.42, h-index: 24)
J. of Geodesy     Hybrid Journal   (Followers: 8, SJR: 4.049, h-index: 48)
J. of Geographical Sciences     Hybrid Journal   (Followers: 1, SJR: 0.58, h-index: 14)
J. of Geographical Systems     Hybrid Journal   (Followers: 2, SJR: 0.839, h-index: 32)
J. of Geometric Analysis     Hybrid Journal   (SJR: 1.496, h-index: 23)
J. of Geometry     Hybrid Journal   (Followers: 1, SJR: 0.349, h-index: 13)
J. of Global Optimization     Hybrid Journal   (Followers: 3, SJR: 0.919, h-index: 51)
J. of Global Policy and Governance     Hybrid Journal   (Followers: 8)
J. of Grid Computing     Hybrid Journal   (SJR: 0.727, h-index: 32)
J. of Hand and Microsurgery     Hybrid Journal   (Followers: 1)
J. of Happiness Studies     Hybrid Journal   (Followers: 14, SJR: 0.785, h-index: 30)
J. of Hematopathology     Hybrid Journal   (Followers: 3, SJR: 0.194, h-index: 11)
J. of Heuristics     Hybrid Journal   (Followers: 5, SJR: 1.718, h-index: 43)
J. of High Energy Physics     Hybrid Journal   (Followers: 4, SJR: 1.027, h-index: 139)
J. of Homotopy and Related Structures     Hybrid Journal   (SJR: 0.102, h-index: 1)
J. of Housing and the Built Environment     Hybrid Journal   (Followers: 6, SJR: 0.553, h-index: 21)
J. of Huazhong University of Science and Technology [Medical Sciences]     Hybrid Journal   (SJR: 0.317, h-index: 15)
J. of Ichthyology     Hybrid Journal   (Followers: 4, SJR: 0.28, h-index: 7)
J. of Immigrant and Minority Health     Hybrid Journal   (Followers: 8, SJR: 0.573, h-index: 29)
J. of Inclusion Phenomena and Macrocyclic Chemistry     Hybrid Journal   (Followers: 1, SJR: 0.459, h-index: 41)
J. of Indian Philosophy     Hybrid Journal   (Followers: 10, SJR: 0.179, h-index: 7)
J. of Indian Prosthodontic Society     Open Access   (SJR: 0.165, h-index: 5)
J. of Industrial Microbiology and Biotechnology     Hybrid Journal   (Followers: 10, SJR: 1.064, h-index: 68)
J. of Industry, Competition and Trade     Hybrid Journal   (Followers: 7, SJR: 0.411, h-index: 11)
J. of Infection and Chemotherapy     Hybrid Journal   (Followers: 1, SJR: 0.65, h-index: 39)
J. of Infrared, Millimeter and Terahertz Waves     Hybrid Journal   (Followers: 1, SJR: 0.902, h-index: 31)
J. of Inherited Metabolic Disease     Hybrid Journal   (Followers: 2, SJR: 1.182, h-index: 66)
J. of Inorganic and Organometallic Polymers and Materials     Partially Free   (Followers: 6, SJR: 0.316, h-index: 27)
J. of Insect Behavior     Hybrid Journal   (Followers: 8, SJR: 0.537, h-index: 36)
J. of Insect Conservation     Hybrid Journal   (Followers: 9, SJR: 0.775, h-index: 36)
J. of Intelligent and Robotic Systems     Hybrid Journal   (Followers: 2, SJR: 0.501, h-index: 36)
J. of Intelligent Information Systems     Hybrid Journal   (Followers: 1, SJR: 0.427, h-index: 39)
J. of Intelligent Manufacturing     Hybrid Journal   (Followers: 4, SJR: 1.095, h-index: 44)
J. of Interventional Cardiac Electrophysiology     Hybrid Journal   (SJR: 1.073, h-index: 38)
J. of Intl. Entrepreneurship     Hybrid Journal   (Followers: 8, SJR: 0.489, h-index: 16)
J. of Intl. Migration and Integration / Revue de l integration et de la migration internationale     Hybrid Journal   (Followers: 12, SJR: 0.385, h-index: 9)
J. of Labor Research     Hybrid Journal   (Followers: 14, SJR: 0.228, h-index: 21)
J. of Logic, Language and Information     Hybrid Journal   (Followers: 5, SJR: 0.63, h-index: 20)
J. of Low Temperature Physics     Hybrid Journal   (Followers: 1, SJR: 0.773, h-index: 48)
J. of Machinery Manufacture and Reliability     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 4)
J. of Mammalian Evolution     Hybrid Journal   (Followers: 5, SJR: 1.845, h-index: 32)
J. of Mammary Gland Biology and Neoplasia     Hybrid Journal   (Followers: 1, SJR: 3.22, h-index: 73)
J. of Management and Governance     Hybrid Journal   (Followers: 12, SJR: 0.383, h-index: 26)
J. of Management Control     Hybrid Journal   (Followers: 4, SJR: 0.134, h-index: 4)
J. of Marine Science and Application     Hybrid Journal   (Followers: 3, SJR: 0.343, h-index: 8)
J. of Marine Science and Technology     Hybrid Journal   (Followers: 3, SJR: 0.317, h-index: 22)
J. of Maritime Archaeology     Hybrid Journal   (Followers: 21, SJR: 0.19, h-index: 5)
J. of Market-Focused Management     Hybrid Journal   (Followers: 2)
J. of Material Cycles and Waste Management     Hybrid Journal   (Followers: 3, SJR: 0.392, h-index: 16)
J. of Materials Engineering and Performance     Hybrid Journal   (Followers: 24, SJR: 0.666, h-index: 31)
J. of Materials Science     Hybrid Journal   (Followers: 18, SJR: 1.006, h-index: 101)
J. of Materials Science : Materials in Electronics     Hybrid Journal   (Followers: 3, SJR: 0.697, h-index: 48)
J. of Materials Science : Materials in Medicine     Hybrid Journal   (Followers: 4, SJR: 0.926, h-index: 77)
J. of Mathematical Biology     Hybrid Journal   (Followers: 13, SJR: 1.183, h-index: 61)
J. of Mathematical Chemistry     Hybrid Journal   (Followers: 5, SJR: 0.407, h-index: 41)
J. of Mathematical Fluid Mechanics     Hybrid Journal   (Followers: 5, SJR: 1.709, h-index: 17)
J. of Mathematical Imaging and Vision     Hybrid Journal   (Followers: 3, SJR: 1.25, h-index: 44)
J. of Mathematical Modelling and Algorithms     Hybrid Journal   (Followers: 2, SJR: 0.358, h-index: 19)
J. of Mathematical Sciences     Hybrid Journal   (SJR: 0.32, h-index: 20)
J. of Mathematics Teacher Education     Hybrid Journal   (Followers: 13, SJR: 1.042, h-index: 14)
J. of Maxillofacial and Oral Surgery     Hybrid Journal   (Followers: 1)
J. of Mechanical Science and Technology     Hybrid Journal   (Followers: 4, SJR: 0.589, h-index: 20)
J. of Medical and Biological Engineering     Hybrid Journal   (SJR: 0.434, h-index: 13)
J. of Medical Humanities     Hybrid Journal   (Followers: 18, SJR: 0.251, h-index: 13)
J. of Medical Systems     Hybrid Journal   (Followers: 2, SJR: 0.604, h-index: 32)
J. of Medical Toxicology     Hybrid Journal   (Followers: 6, SJR: 0.765, h-index: 21)
J. of Medical Ultrasonics     Hybrid Journal   (Followers: 2, SJR: 0.209, h-index: 11)
J. of Medicine and the Person     Hybrid Journal  
J. of Membrane Biology     Hybrid Journal   (Followers: 1, SJR: 0.971, h-index: 75)
J. of Micro-Bio Robotics     Hybrid Journal  
J. of Microbiology     Hybrid Journal   (Followers: 7, SJR: 0.641, h-index: 35)
J. of Mining Science     Hybrid Journal   (Followers: 5, SJR: 0.296, h-index: 11)
J. of Molecular Evolution     Hybrid Journal   (Followers: 11, SJR: 1.07, h-index: 99)
J. of Molecular Histology     Hybrid Journal   (Followers: 2, SJR: 0.791, h-index: 43)
J. of Molecular Medicine     Hybrid Journal   (Followers: 15, SJR: 2.452, h-index: 100)
J. of Molecular Modeling     Hybrid Journal   (Followers: 4, SJR: 0.55, h-index: 42)
J. of Molecular Neuroscience     Partially Free   (Followers: 8, SJR: 1.242, h-index: 61)
J. of Mountain Science     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 11)
J. of Muscle Research and Cell Motility     Hybrid Journal   (SJR: 1.052, h-index: 51)
J. of Nanoparticle Research     Hybrid Journal   (Followers: 2, SJR: 0.777, h-index: 66)
J. of Natural Medicines     Hybrid Journal   (SJR: 0.586, h-index: 22)
J. of Near-Death Studies     Hybrid Journal   (Followers: 2)
J. of Nephrology     Hybrid Journal   (Followers: 5, SJR: 0.857, h-index: 48)
J. of Network and Systems Management     Hybrid Journal   (SJR: 0.331, h-index: 23)
J. of Neural Transmission     Hybrid Journal   (Followers: 2, SJR: 1.302, h-index: 77)
J. of Neuro-Oncology     Hybrid Journal   (Followers: 3, SJR: 1.342, h-index: 80)
J. of Neuroimmune Pharmacology     Hybrid Journal   (Followers: 1, SJR: 1.239, h-index: 36)
J. of Neurology     Hybrid Journal   (Followers: 13, SJR: 1.406, h-index: 91)
J. of NeuroVirology     Hybrid Journal   (Followers: 1, SJR: 1.367, h-index: 63)
J. of Nondestructive Evaluation     Hybrid Journal   (Followers: 7, SJR: 0.452, h-index: 22)
J. of Nonlinear Science     Hybrid Journal   (Followers: 1, SJR: 1.772, h-index: 36)
J. of Nonverbal Behavior     Hybrid Journal   (Followers: 3, SJR: 1.122, h-index: 38)
J. of Nuclear Cardiology     Hybrid Journal   (SJR: 1.456, h-index: 60)
J. of Nutrition, Health and Aging     Hybrid Journal   (Followers: 17, SJR: 0.886, h-index: 50)
J. of Obstetrics and Gynecology of India     Hybrid Journal   (Followers: 7, SJR: 0.174, h-index: 3)
J. of Occupational Rehabilitation     Hybrid Journal   (Followers: 11, SJR: 1.166, h-index: 43)
J. of Ocean Engineering and Marine Energy     Hybrid Journal   (Followers: 1)
J. of Ocean University of China (English Edition)     Hybrid Journal   (SJR: 0.144, h-index: 8)
J. of Oceanography     Hybrid Journal   (Followers: 7, SJR: 1.031, h-index: 46)
J. of Ocular Biology, Diseases, and Informatics     Hybrid Journal   (SJR: 0.228, h-index: 8)
J. of Optical and Fiber Communications Reports     Hybrid Journal   (Followers: 2, SJR: 0.831, h-index: 2)
J. of Optics     Hybrid Journal   (Followers: 4)
J. of Optimization Theory and Applications     Hybrid Journal   (Followers: 2, SJR: 0.928, h-index: 55)
J. of Ornithology     Hybrid Journal   (Followers: 20)
J. of Orofacial Orthopedics / Fortschritte der Kieferorthop√§die     Hybrid Journal   (SJR: 0.667, h-index: 27)
J. of Orthopaedic Science     Hybrid Journal   (Followers: 5, SJR: 0.684, h-index: 42)
J. of Paleolimnology     Hybrid Journal   (Followers: 5, SJR: 1.284, h-index: 58)
J. of Parasitic Diseases     Hybrid Journal   (Followers: 2, SJR: 0.272, h-index: 5)
J. of Pediatric Neuropsychology     Hybrid Journal  
J. of Pest Science     Hybrid Journal   (Followers: 2, SJR: 1.002, h-index: 21)
J. of Pharmaceutical Health Care and Sciences     Open Access  
J. of Pharmaceutical Innovation     Hybrid Journal   (Followers: 7, SJR: 0.617, h-index: 14)
J. of Pharmaceutical Investigation     Hybrid Journal   (Followers: 1, SJR: 0.16, h-index: 2)
J. of Pharmacokinetics and Pharmacodynamics     Hybrid Journal   (Followers: 22, SJR: 0.567, h-index: 41)
J. of Phase Equilibria and Diffusion     Hybrid Journal   (Followers: 19, SJR: 0.367, h-index: 31)
J. of Philosophical Logic     Hybrid Journal   (Followers: 7, SJR: 0.94, h-index: 20)
J. of Physiology and Biochemistry     Hybrid Journal   (Followers: 3, SJR: 0.741, h-index: 30)
J. of Plant Biochemistry and Biotechnology     Hybrid Journal   (Followers: 5, SJR: 0.257, h-index: 17)
J. of Plant Biology     Hybrid Journal   (Followers: 9, SJR: 0.52, h-index: 16)
J. of Plant Growth Regulation     Hybrid Journal   (Followers: 1, SJR: 0.761, h-index: 47)
J. of Plant Research     Hybrid Journal   (Followers: 4, SJR: 1.055, h-index: 43)
J. of Police and Criminal Psychology     Hybrid Journal   (Followers: 414, SJR: 0.328, h-index: 10)
J. of Polymer Research     Hybrid Journal   (Followers: 6, SJR: 0.649, h-index: 27)
J. of Polymers and the Environment     Hybrid Journal   (Followers: 1, SJR: 0.618, h-index: 39)
J. of Population Ageing     Hybrid Journal   (Followers: 4, SJR: 0.357, h-index: 3)
J. of Population Economics     Hybrid Journal   (Followers: 16, SJR: 2.455, h-index: 42)
J. of Population Research     Hybrid Journal   (Followers: 1, SJR: 0.404, h-index: 10)
J. of Porous Materials     Hybrid Journal   (Followers: 3, SJR: 0.523, h-index: 34)
J. of Primary Prevention     Hybrid Journal   (Followers: 6, SJR: 0.816, h-index: 30)
J. of Productivity Analysis     Hybrid Journal   (Followers: 2, SJR: 0.825, h-index: 48)
J. of Pseudo-Differential Operators and Applications     Hybrid Journal   (SJR: 1.275, h-index: 5)
J. of Psycholinguistic Research     Hybrid Journal   (Followers: 9, SJR: 0.445, h-index: 37)
J. of Psychology and Judaism     Hybrid Journal   (Followers: 2)
J. of Psychopathology and Behavioral Assessment     Hybrid Journal   (Followers: 1, SJR: 0.949, h-index: 39)
J. of Psychosocial Rehabilitation and Mental Health     Hybrid Journal   (Followers: 2)
J. of Public Health     Hybrid Journal   (Followers: 23, SJR: 0.262, h-index: 17)
J. of Quantitative Criminology     Hybrid Journal   (Followers: 6, SJR: 2.481, h-index: 44)
J. of Racial and Ethnic Health Disparities     Hybrid Journal   (Followers: 1)
J. of Radiation Oncology     Hybrid Journal   (Followers: 1)
J. of Radioanalytical and Nuclear Chemistry     Hybrid Journal   (Followers: 5, SJR: 0.515, h-index: 44)
J. of Radiosurgery     Hybrid Journal   (Followers: 2)
J. of Rational-Emotive & Cognitive-Behavior Therapy     Hybrid Journal   (Followers: 1, SJR: 0.394, h-index: 19)
J. of Real-Time Image Processing     Hybrid Journal   (Followers: 6, SJR: 0.356, h-index: 16)
J. of Regulatory Economics     Hybrid Journal   (Followers: 7, SJR: 1.081, h-index: 35)
J. of Religion and Health     Hybrid Journal   (Followers: 10, SJR: 0.483, h-index: 18)
J. of Religious Education     Hybrid Journal   (Followers: 3)
J. of Risk and Uncertainty     Hybrid Journal   (Followers: 19, SJR: 2.34, h-index: 46)
J. of Robotic Surgery     Hybrid Journal   (SJR: 0.227, h-index: 11)
J. of Russian Laser Research     Hybrid Journal   (SJR: 0.326, h-index: 18)
J. of Scheduling     Hybrid Journal   (Followers: 2, SJR: 1.417, h-index: 38)
J. of Science Education and Technology     Hybrid Journal   (Followers: 16, SJR: 0.754, h-index: 30)
J. of Science Teacher Education     Hybrid Journal   (Followers: 17, SJR: 1.128, h-index: 22)
J. of Scientific Computing     Hybrid Journal   (Followers: 18, SJR: 1.771, h-index: 42)
J. of Seismology     Hybrid Journal   (Followers: 8, SJR: 0.855, h-index: 34)

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Journal Cover European Surgery
  [SJR: 0.166]   [H-I: 13]   [4 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1682-4016 - ISSN (Online) 1682-8631
   Published by Springer-Verlag Homepage  [2281 journals]
  • Leadership in the 21st century
    • Abstract: Summary Background Leadership is considered important in academic health care systems and the demands on individual leaders are growing. Most often, leadership styles are self-taught by observation and practice. In the past, leadership was primarily defined by the tripod: research, patient care, and education. Beside the three traditional, tasks there is a business-oriented trend in health care, demanding an extreme diversity of abilities, e. g., skills in financial management, communication skills, conflict solving skills, networking, and rewarding skills. Integrating all these aspects to define the profile of a future chairperson has not been possible in the field of academic medicine. Methods A literature search for leadership in academic medicine was performed. In addition, the contributions to the conference “Chair4Medicine” were evaluated. Results Despite growing requirements for a leadership position, one essential property stayed the same over the years: a leader has to educate the next generation of surgeons and be a good motivator and inspiring teacher. Concerning education, surgery is facing a dilemma, displayed by a continuing decrease of applicants in surgical disciplines over the last years. Ten to 15 years ago, the number of applications for a surgical residency position was larger than the positions available. Today, this situation is clearly reversed, as indicated by a noticeable deficit in recruits. The decision to become a surgeon has become more and more unpopular. Reasons for this development are manifold, but often-mentioned causes are a lack of work–life balance, and a chaotic and non-inspiring training process combined with non-attractive leadership styles. Conclusions There is a need for defining objective criteria to identify a future chair in an academic medical center. If the ongoing trend of decreased applications in general surgery continues, we will face a lack of top-motivated surgeons in the close future. More than ever, leadership styles and centers have to rethink their way of teaching and define a new way of being “attractive” for young surgical residents to guarantee the succession of the next generation. Educational opportunities, a clearly structured curriculum, and a productive environment are assumed crucial prerequisites for the next generation. Objective guidelines and instruments for the improvement of education should be developed and implemented.
      PubDate: 2016-06-01
  • Young surgery: results of the survey among residents in Austria in 2015
    • Abstract: Summary Background The lack of doctors and the introduction of European Working Time Directive have influenced surgical training. Therefore, surgical training requires constant evaluation and development. Methods The Professional Association of Austrian surgeons (BÖC) and the Austrian Society of Surgery (ÖGC) carried out a survey via online survey software (Corporate Headquarters: QuestionPro Inc., San Francisco, USA). Results The survey was sent to 268 residents. Of these, 106 completed it. The response rate was thus 40.76 %. According to 73 % of the residents, there was no training structure or a rotation system at their training site. Only 38 % of the participants were satisfied with their surgical training. Conclusions The survey commissioned by the BÖC and the ÖGC showed that 73 % of residents in general surgery receive no structured surgical training.
      PubDate: 2016-06-01
  • Surgical residency in the United States–a personal European
    • Abstract: Summary Background Surgical education requires three things: dedication, mentorship, and exposure. This is true today as it was in 1878 when Dr. William Stewart Halsted travelled through Europe and returned to the United States (U.S.) to lay the ground stone for what would be the modern U.S. residency model. Methods This article is intended to help understand the evolution and current state of the U.S. residency model and is written through the lens of the first author who has trained in both systems. We hope to outline some key differences that we deem particularly interesting. Results Concrete lessons we can learn from the U.S. system are to abolish favoritism, enroll residents in formal training programs with a set start and finish date, consider implementing midlevel practitioners and establishing a steeper hierarchy within the residency itself. Conclusions The U.S. model, despite all its own inherent issues, has managed to balance the three ingredients of surgical education: dedication, mentorship, and exposure. Contrarily, in many European countries medical school is followed by years of uncertainty. With demographical and societal changes this deficiency has led to many potential young surgeons turning towards other specialties and industries.
      PubDate: 2016-06-01
  • Laparoscopic splenectomy for second-line treatment of immune
    • Abstract: Summary Background Splenectomy is a well-established second-line treatment for immune thrombocytopenia but novel medical therapies have changed the management of this disease. The objective of this study is to analyze the current results of splenectomy as a second-line treatment. Methods Retrospective analysis of 53 consecutive patients with chronic immune thrombocytopenia submitted to splenectomy from January 2007 through December 2014. Several parameters were analyzed including postoperative morbidity and outcomes after surgery. Results Fifty-two (98%) patients underwent successful laparoscopic splenectomy without conversion to open procedure, with a mean operative time of 103.6 ± 38.1 minutes. The median postoperative length of stay was 3 days (range 1–36 days). There were 3 (5.7%) major postoperative complications resulting in 2 (3.8%) reoperations. No splenectomy-related mortalities occurred. Fifty (94.3%) patients presented a response 1 month after surgery (45 complete responses and 5 responses). In the follow-up (mean 24.8 ± 16.9 months) 37 (75.5%) patients had a complete and sustained response after laparoscopic splenectomy and an additional 11 (22.4%) presented platelet counts above 30×109/L (the majority of these patients eventually reaching normal platelet counts). No additional therapies were needed in 39 (79.6%) patients after surgery. Conclusions In our experience, laparoscopic splenectomy is an effective second-line treatment for Immune Thrombocytopenia with short and long-term response rates of 94% and 91%, respectively. Major postoperative complications occurred in 6%. Future research should aim to discover new methods to properly select patients to different second-line treatments.
      PubDate: 2016-05-19
  • Eine kurze Geschichte der Chirurgie in Österreich
    • PubDate: 2016-05-13
  • Leadership and training
    • Abstract: Summary Against the background of substantial changes in the field of healthcare in Austria, the specialization in surgery must be reconsidered starting from modified points of view. However, in this context, the new training regulations are not the only standard: the training officers must show leadership skills by paying attention to the modified framework conditions and by promoting a new corporate culture related to training with innovating concepts. The challenge of the threatening quality loss in surgery can only be addressed in this way.
      PubDate: 2016-05-12
  • Doing your Doctor of Philosophy degree abroad
    • Abstract: Summary Background The Doctor of Philosophy degree, PhD or DPhil, derives from the Latin Doctor Philosophiae (for DPhil) or Philosophiae Doctor (for PhD) and has been awarded by universities around the world. Methods Going through a DPhil at Oxford University. Results Doing a DPhil abroad exposes you to a new research environment and helps to enhance your personal development. Conclusions Studying for a DPhil in a foreign country will satisfy your intellectual curiosity, pep up your curriculum vitae, gain you language skills and enhance your career chances significantly.
      PubDate: 2016-05-12
  • Surgical training under altered conditions
    • PubDate: 2016-05-12
  • Education in surgery: motivation counts
    • PubDate: 2016-05-11
  • What is needed for surgical training'
    • Abstract: Summary Surgical fields are renowned for being an interesting and attractive vocation on the one hand, but on the other they are afflicted with a notorious workload, poor work–life balance and a long training duration. This results in a noticeable scarcity of job applicants and trainees within the surgical fields per se. In order to tackle these circumstances, various surgical associations have formed task forces destined to cater for the needs and modern day challenges of young and aspiring surgeons. The CAJC (“Chirurgische Arbeitsgemeinschaft junger Chirurgen”/“surgical Working Group for Young Surgeons”) was created by the German Society for General and Visceral Surgery (DGAV) and is currently composed of approximately 120 members. Multiple workshops and joint discussions culminated in comprehensive and detailed recommendations on how precisely surgical training can be markedly improved in our hospitals. These suggestions were published on the website of the DGAV and parts of this essay “Weiterbildung to go”/“Training to go” are incorporated in this report.
      PubDate: 2016-05-11
  • Anatomic Variations of Biliary Ducts: Magnetic Resonance
           Cholangiopancreatography Findings of 1041 Consecutive Patients
    • Abstract: Background It is important for surgical purposes to know the biliary tract anatomy and its variations in detail. The aim of the study was to evaluate the frequency of anatomical variations of the biliary tract at hepatic bifurcation level and also at cystic duct level using magnetic resonance cholangiopancreatography (MRCP). Methods A total of 1041 patients (between 16 and 102 years of age, 600 women 441 men with mean age of 60.6) were included in the study. The MRCP imaging was carried out with a 1.5 Tesla magnetic resonance imaging (MRI) device by using heavily T2-weighted sequences. Results Among the 1041 patients included in the study, 424 (40.7 %) showed anatomical variations at different levels of the biliary tree, and 12 of these patients (1.15 %) had two anatomical variations. Typical anatomy was present in 57.2 % of the females and 62.1 % males. The highest incidence of variation at the level of bifurcation was trifurcation with 133 patients (12.8 %) and at the level of cystic duct was the medial cystic duct insertion with 56 patients (5.37 %). Conclusions Trifurcation and medial cystic duct insertion seem to be more frequent in females compared to males. It is necessary to have the knowledge of these variations to avoid possible complications and also help to achieve the most effective result. MRCP is a helpful and noninvasive technique of diagnosing bile duct variations; a preoperative description of these variations may prevent various surgical complications, and we recommend a routine preoperative MRCP especially before laparoscopic cholecystectomy, liver resection surgery and liver transplant surgery.
      PubDate: 2016-05-10
  • Missed injuries in patients with abdominal gunshot trauma: risk factors
           and mortality rates
    • Abstract: Introduction The aim of this study was to investigate the incidence, risk factors, and mortality rates of injuries missed during laparotomy in patients with high-kinetic energy gunshot trauma. Methods The retrospective study included 20 patients who underwent relaparotomy due to high-kinetic energy gunshot trauma at our hospital between 2010 and 2015. Mechanism of injury, time between initial laparotomy and relaparotomy, the method of incision used for laparotomy during the initial laparotomy, the organs detected with missed injury, and the mortality rates were recorded. Results All the patients were male, with a mean age of 24.90 ± 5.2 years. Missed injuries were markedly more common in the patients who underwent incomplete incision during the initial laparotomy (p < 0.05). Mortality occurred in 11 (55 %) patients. In these patients, time between laparotomy and relaparotomy was longer and the Injury Severity Score (ISS) was significantly higher compared to other patients (p < 0.05). Discussion A complete midline incision allowing optimal exposure should be performed in patients with penetrating abdominal trauma caused by high-kinetic energy gunshot. A systematic surgical exploration should be performed, including meticulous inspection of all the intraabdominal and retroperitoneal organs. Conclusion Damage control surgery (DCS) should be performed in patients with severe trauma and hemodynamic instability. Proper administration of DCS may lead to reduced incidence of missed injuries and thus may decrease the mortality rates.
      PubDate: 2016-05-03
  • Treatment of Boerhaave’s Syndrome: Specialized Esophago-Gastric Unit
           Experience on Twelve Patients
    • Abstract: Background Boerhaave’s syndrome is a rare condition of spontaneous esophageal rupture with high mortality. Treatment is a challenging issue, diagnosis is difficult and early surgery is the most important prognostic factor. Methods This article presents a case series of 12 patients treated in our specialized unit between 2005 and 2013. Medical records and imaging reports from the specialized upper gastrointestinal surgery unit at a university hospital were reviewed. Results The median age was 59 years (37–83), the male/female ratio was 11/1 and half of the patients did not have any sign of pleural effusion at chest x‑ray. The diagnosis was made in 66 % of cases (8/12) by computed tomography. Nine patients were referred, and treatment delay was greater than 24 h in six patients. Ten patients were operated, and two were treated conservatively. A transabdominal approach was performed in five patients, with esophageal suture with gastric fundus patch being the most common procedure (5/10). Two patients underwent simple esophageal suture. One patient had mediastinal and pleural drainage with no other intervention. Two patients required bipolar esophageal exclusion. Three patients underwent reoperation for empyema, and one required esophagectomy. Mortality was 25 % (3/12): two operated patients and one who had been treated conservatively. The median intensive care unit stay was 15 days (5–61), and the median hospital stay was 33 days (5–97). Conclusions When combined with mediastinal debridement and pleural drainage, primary transhiatal esophageal repair for Boerhaave’s syndrome is associated with acceptable morbidity and mortality, regardless of treatment delay. Conservative treatment should be reserved for carefully selected patients.
      PubDate: 2016-05-03
  • Packing of the thoracic cavity – Damage control surgery
           for severe intra thoracic haemorrhage
    • Abstract: Background Severe, uncontrollable intra thoracic haemorrhage is a life threatening situation for the patient in extremis and a challenge for the surgeon. Due to bleeding several serious pathophysiological changes occur in the organism. In addition to the threat of exsanguination itself, a “lethal triad” of acidosis, hypothermia and coagulopathy drive the patient into a hazardous situation. Methods In our prospective single centre study we present 19 patients with major bleeding aged 17 to 74 years (mean 48.36 years.). Results After successful packing the bleeding control was 100 % and no reoperation for bleeding was needed. There were two patients after trauma where the operation procedure came too late for successful packing. We observed a 5-day-mortality rate of 15.8 % (3 out of 19) and a 30-day-mortality rate of 31.2 % (5 out of 16). The overall mortality rate was 42.1 % (8 out of 19). Conclusions Damage control surgery (DCS) can save patients in extremis in spite of their serious condition. Thoracic packing as a DC procedure in patients with uncontrollable haemorrhage has only been published in a small series of patients or case reports over the last 30 years. In almost all case reports and publications, only patients with traumatic thoracic haemorrhage were treated by thoracic packing.
      PubDate: 2016-05-01
  • Comprehensive surgical care: less recognized factors in successfull
           operative treatment
    • PubDate: 2016-05-01
  • Use of an anatomical self-gripping Progrip™ laparoscopic mesh in
           TAPP hernia repair. Possible standard' Preliminary results of
           a prospective study
    • Abstract: Background By common perspective, it is generally considered that laparoscopic inguinal hernia repairs (LIHR) are comparable to conventional operative methods, as an equivalent treatment methodology in the management of inguinal hernias. The results of current studies, however, favour an LIHR in comparison to an open mesh repair (OMR) in selected patient populations. The advantages of LIHR lie in the clearer view of the spermatic cord contents it offers, and, as a result, it is a safer method in the preservation of testicular function, with fewer incidences of acute and chronic pain, and a significantly better quality of life postoperatively in comparison to OMR. One of the last unexplained questions regarding LIHR techniques (especially concerning the transabdominal preperitoneal inguinal hernia repair (TAPP) operation) was with regards to the fixation of the mesh. The goal of this study, based on single-centre prospective collection of data from the Internet-based multicentre Herniamed® register, is to demonstrate the safety and efficacy of the use of Parietex™ ProGrip™ Laparoscopic mesh in standardized LIHR with the TAPP technique. Methods Data analysis encompassed all patients who underwent inguinal hernia surgery within the period from May 1, 2013 to December 31, 2014, who fulfilled the inclusion criteria. There were two surgeons with experience in this particular technique contributing on the surgeries. Data were entered and subsequently analysed on the Herniamed® platform. All patients were managed in compliance with a standard protocol and were then re-evaluated 1 and 12 months postoperatively with a standardized questionnaire. Patients with a fixed scrotal hernia or an American Society of Anesthesiologists (ASA) stage IV were excluded from the study. Results In total, 95 patients were listed in the prospective, completely processed documentation on the Herniamed® platform. In total, 156 hernias were operated on. From the demographic point of view, there were 85 men (89.47 %) and 10 women (10.53 %). Representation of females in the group was around one-tenth: 10/95 (10.53 %), while these were mostly bilateral hernias. The average operation time was 64 min, while time taken for bilateral hernias was 67 min. Majority of operated hernias, i. e. 143 hernias (91.67 %) had hernia openings of moderate and large sizes (types 2 and 3, >1.5 cm and <4 cm); medial hernias were predominant on both sides. During the surgery, no complications were demonstrated; postoperative complications were evaluated as significant in relation to previous surgical procedures (major) and as less significant (minor), which did not influence the duration of hospitalization, and these were managed conservatively on an outpatient basis. Postoperative pain of moderate degree (4–6 Visual analogue scale [VAS]) lasting over 3 months in the groin was reported in one case (1.05 %). At the 1‑year assessment, mild discomfort was reported in the groin in 2 from 57 patients (3.51 %), which had no effect on any patient’s usual activity and did not require any therapy (1–3 VAS). After 1 year, there was no patient with chronic postherniorrhaphy inguinal pain (CPIP) reported. There was no recurrence of inguinal hernia confirmed in the followed-up group. Conclusion The legitimacy of the use of the self-fixation mesh was demonstrated in an experiment, in open inguinal hernia repair, laparoscopic totally extraperitoneal hernioplasty (TEP) technique and in TAPP technique. Our study demonstrates that LIHR using the TAPP technique with implantation of a new Parietex™ ProGrip™ laparoscopic self-fixation mesh is a fast, effective and reliable method in experienced hands, which combines the advantages of laparoscopic approach with simple and practical implantation of self-fixation mesh, which, according to our results, reduces the occurrence of CPIP and the recurrence rate.
      PubDate: 2016-05-01
  • Emergency management of penetrating cardiac injuries without a heart
    • Abstract: Background In penetrating chest injury, trauma to the heart does not occur frequently. However, an unstable patient must be operated on immediately. Methods A small group of patients, who were admitted to the hospital with thoracic injury and consequently became unstable during CT examination, is presented. Results In total, five patients were transferred immediately to the operating room. Penetrating heart injury was found. All patients were successfully treated and dismissed from hospital. Conclusion A general surgeon must be able to manage penetrating heart injury in unstable patients.
      PubDate: 2016-05-01
  • Acute Superior Mesenteric Artery Occlusion – Combined Treatment
    • Abstract: Background Acute occlusion of the proximal superior mesenteric artery is still a life-threatening disease. Different surgical and endovascular treatment strategies exist. Methods The technical and clinical outcome of first line endovascular treatment of proximal superior mesenteric artery occlusion in an academic teaching hospital was evaluated. Endovascular treatment included angioplasty, stent, lysis and/or aspiration and was performed on 38 patients (median age 78 years, range 44 to 88 years). These represent the study population. They presented with abdominal pain or other peritoneal signs. Technical success was defined as revascularization of the superior mesenteric artery with residual stenosis of not more than 30 % and reperfusion of the entire bowel. Clinical success was staged into initial cure, need for second line operation and resection of bowel or death of the patient. Results Complete endovascular technical success was reached in 37 of 38 patients. Laparotomy and additional bowel resection was necessary only in a minority of patients. Mortality after 30 days was 45 %. Conclusion Endovascular treatment of acute occlusion of the proximal superior mesenteric artery continues to be the promising first line treatment option with a high potential for primary technical success and clinical benefit.
      PubDate: 2016-05-01
  • Perspectives of surgery in the third millennium
           in all continents from an interdisciplinary point of view
    • Abstract: There are ten simple questions concerning the philosophy and future discussed in this editorial, in which reflects the main topic of the Jubilee World Congress of ICS, organized for the 80th anniversary of the founding of this oldest world surgical organization in Prague and in Pilsen in September 2015 (see Tab. 1).
      PubDate: 2016-04-27
  • Solid organ transplantation—where we are and how far can we possibly
    • Abstract: Background Solid organ transplants, e. g., kidney, pancreas, and liver, are well-established transplant methods at the Institute for Clinical and Experimental Medicine (IKEM), Czech Republic. Looking at the waiting lists, results, and also population in detail, some patients still suffer. Methods For the described reasons we have introduced some novel transplant methods since the second half of 2011. Kidney patients stay on dialysis; few get the best treatment method, which is live-donor kidney transplantation. Therefore, the live-donor program has been reorganized, kidney paired donation program introduced, miniinvasive donor nephrectomy used in all cases. Some liver patients suffer as well, especially small adults and children, also fulminant liver failure cases and those with multivisceral thrombosis. For these groups of patients we have introduced split-liver transplantation, ABO incompatible (AB0i) liver transplantation, live-donor liver transplantation, auxiliary liver transplantation, and also small bowel/multivisceral transplantation. Results Thanks to the changes, the number of live-donor kidney transplants has increased, the number of liver transplants doubled, many fulminant liver patients survived thanks to AB0i and auxiliary transplantation, and pediatric liver cases waiting time dropped dramatically. The small bowel transplant program started successfully with two multivisceral cases. Conclusion The novel methods and some program changes led to more transplants and also better outcomes. There is still room for further expansion and developments; there are for sure more transplant methods to be introduced. Also, the number of some transplants, e.g., live-donor kidney, still remains low.
      PubDate: 2016-04-27
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