American Chapter Research Articles

Guidelines for hospital privileges in vascular surgery

This is a report by an ad hoc committee to the Joint Council of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery (North American Chapter) concerning guidelines that hospitals may use or modify when judging individual applicants for hospital and operating room privileges in vascular surgery. The committee recognizes that the completion of training and obtaining a board certificate is testimony to the qualification but not necessarily the competence of an individual to practice vascular surgery. This report identifies three categories of applicant for privileges in vascular surgery; the surgeon who just completed training, the surgeon who completed training after 1984, and the surgeon who completed training before 1984. In addition, the committee recognizes the importance of periodic vascular surgery privileges renewal for established surgeons. Several pathways are defined for use by hospital privilege committees to evaluate the competence of an individual to be granted privileges in general vascular surgery. The ad hoc committee also has outlined a program for evaluation of established surgeons for renewing privileges in vascular surgery using a mechanism of case outcome audit. Finally, a review mechanism, potential corrective actions, and an appeals mechanism are also suggested. This report represents optimal criteria that may require modification by individual hospitals to meet local community needs and standards. It is the hope of the ad hoc committee that this report will help hospitals and practicing physicians improve the quality of care and treatment outcome in patients with vascular disease.

Suggested standards for reports dealing with cerebrovascular disease. Subcommittee on Reporting Standards for Cerebrovascular Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery.

The evaluation of clinical reports on vascular disease is often made difficult by variations in descriptive terms, clinical classification, and outcome criteria. In 1983 the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery created the Ad Hoc Committee on Reporting Standards to address these problems and recommend solutions. Some general problems were addressed in the initial report dealing with lower extremity ischemia. This article concerns clinical standards for reports dealing with cerebrovascular disease, suggests a scheme for clinical classification, and recommends standardized reporting practices for grading risk factors, angiographic and other diagnostic findings, and the results and complications of therapeutic intervention.

Suggested standards for reports dealing with cerebrovascular disease

The evaluation of clinical reports on vascular disease is often made difficult by variations in descriptive terms, clinical classification, and outcome criteria. In 1983 the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery created the Ad Hoc Committee on Reporting Standards to address these problems and recommend solutions. Some general problems were addressed in the initial report dealing with lower extremity ischemia. This article concerns clinical standards for reports dealing with cerebrovascular disease, suggests a scheme for clinical classification, and recommends standardized reporting practices for grading risk factors, angiographic and other diagnostic findings, and the results and complications of therapeutic intervention.

Vascular surgery in the United States. Report of the Joint Society for Vascular Surgery—International Society for Cardiovascular Surgery Committee on Vascular Surgical Manpower

The Joint Committee on Vascular Surgical Manpower was established in 1985 by the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. It was charged to provide recommendations regarding vascular surgical manpower requirements for the next 15 years. Analysis of National Center for Health Statistics vascular operative rate data and 1690 questionnaire responses from vascular surgeons documented that vascular surgeons performed 235,400 (41%) of the total of 571,000 vascular operations undertaken in 1985. Vascular surgeons performed 87% of 30,000 aortoiliofemoral reconstructions, 77% of 72,000 peripheral vessel bypasses, 75% of 33,000 abdominal aortic aneurysm repairs, 59% of 55,000 angioaccess procedures, and 50% of 107,000 carotid endarterectomies. However, lack of accurate data on caseloads of surgeons who were not vascular specialists precludes precise prediction of manpower requirements for vascular surgery. It is important that surgical leaders and policy makers define the types of vascular surgical procedures that may be undertaken by vascular and other surgeons. Ongoing analyses must include such determinations to establish accurate data for the prediction of future manpower needs for vascular surgery. Furthermore, future manpower studies should be linked to outcome studies to assess not only numbers of surgeons and operations but quality of care as well.

: Papers from the Fourth and Fifth Annual Meetings, Gypsy Lore Society, North American Chapter . Joanne Grumet.

: Papers from the Fourth and Fifth Annual Meetings, Gypsy Lore Society, North American Chapter . Joanne Grumet.

Suggested standards for reports dealing with lower extremity ischemia

Reports in the vascular surgery literature are often difficult to assess and compare with each other because of poorly defined terms, imprecise categorization, lack of indices for gauging the severity of the disease or the presence of risk factors capable of affecting outcome, and varying criteria for success or failure—in essence, a lack of standardized reporting practices. The joint councils of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery have appointed an ad hoc committee to deal with this problem. This report represents the recommendations of the first of its several subcommittees, that is, the one dealing with reports on lower extremity ischemia. Certain terms are defined and criteria offered for uniformly gauging the severity of disease, the findings of diagnostic studies, the types of therapeutic interventions, and the outcome of such treatments. Although future modifications may further improve on this effort, it is hoped that this committee's recommendations will help establish reporting standards for articles dealing with lower extremity ischemia.

Another year of progress

This past year has been another year of progress for AANA and, in these pages, I will review the accomplishments of this year, touch briefly on our past history, and make some suggestions as to our future. As many of you know, the first ar throscopy course was held at the University of Pennsylvania in 1973. At that time, the faculty consisted of Doctors John Joyce, Michael Harty, Bob Jackson, and Ward Casscells. In the 1974 course, again at the University of Pennsylvania, the faculty was slightly larger and, in addition to the 1973 faculty were Doctors Lanny Johnson, Bob Friberger, and Masaki Watanabe. It was at this meeting, largely due to the efforts of John Joyce, that the International Arthroscopy Association was founded. Dr. Watanabe was elected President, Bob Jackson, VicePresident, Ward Casscells, Secretary, and Dick O'Connor, Treasurer. In 1975, the first Academysponsored course was given in Boston with Jack McGinty as Chairman. Later in 1975, the International Arthroscopy Association (IAA) met in Copenhagen in conjunct ion with SICOT. At this meeting, many of the conferees were Japanese. At subsequent meetings, it became obvious that the majority of active members were from North America, as was the financial support. As a result, AANA was founded in 1982. John Joyce, past president of the North American Chapter, as it was called at that time, made three important suggestions in his presidential address in 1980.

Introduction to symposium on transvenous vena cava interruption.

This Symposium comprises papers presented at the combined breakfast meeting of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery, North American Chapter, on June 18, 1983, as part of the yearly scientific program. The invited speakers were asked to deal with selected subjects of immediate clinical importance. The emphasis in the presentations, therefore, was not so much on originality and completeness as on practical applicability of information.

Introduction to symposium on transvenous vena cava interruption

This Symposium comprises papers presented at the combined breakfast meeting of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery, North American Chapter, on June 18, 1983, as part of the yearly scientific program. The invited speakers were asked to deal with selected subjects of immediate clinical importance. The emphasis in the presentations, therefore, was not so much on originality and completeness as on practical applicability of information.

The New Style of 'Sweeney Agonistes'

When, in the late eighteenth century, the neo-classical system of genres began to break down, formal satire ceased to attract major literary talents. But the satiric impulse itself did not of course disappear. Satire became an incidental element: it no longer prescribed its own form. Much of the best Victorian satirical writing is found in prose fiction (an obvious instance would be the American chapters in Martin Chuzzlewit). In the present century only Wyndham Lewis could be called a thoroughgoing satirist; and he too uses the novel as the vehicle for his satiric vision. T. S. Eliot's earliest

International Surgical Meetings: Mutual Benefits From Joint Planning

The biennial meeting of the International Cardiovascular Society was held in Athens, Sept 6-10, 1981. The society was founded 30 years ago and membership has increased, with strong European, Japanese, Latin American, and North American chapters, and members at large in Australasia, Africa, and the Middle East. The North American chapter holds its annual meetings jointly with the Society of Vascular Surgery. Membership is structured to include qualified surgeons who are leading practitioners in the community as well as those with a strong academic background. A similar distribution of membership is found in the other chapters, and the programs every two years are enhanced by significant contributions by the European and Japanese surgeons, and by members from other countries. Programs are selected from abstracts of clinical experience with selected panels of internationally recognized members, with a balance between vascular and cardiac subjects. This society is the largest and most significant

Controversies in Carotid Surgery

During the past 30 years, carotid endarterectomy for the management of cerebrovascular insufficiency has become one of the most commonly performed operations in the United States. Much knowledge has been gained, many new techniques have been developed, and much progress has been made. As with any developing field, controversies still exist in some areas of carotid surgery. The symposium that follows was presented as a panel discussion at the annual joint meeting of the Society for Vascular Surgery and the North American Chapter of the International Cardiovascular Society that was held in Dallas in June 1981. The panel devoted itself to a discussion of several important controversies in carotid surgery, in an effort to enable practicing vascular surgeons to consider all aspects of these problems and render the best possible patient care. In the first article, Anthony Imparato, MD, and his colleagues, of New York University, discuss the problem of

The time in which we dwell.

There is a wonderful saying—attributed to the Quakers, I believe—that one should not speak unless he can improve on silence. With this self-admonition, I should like to discuss three topics: (1) the international aspects of cardiovascular surgery and of our Society in particular; (2) the North American Chapter, its resources and its responsibilities; and (3) our possible role, as cardiovascular specialists, for modifying the impending federal domination of health care services in the United States. The International Scene Because newcomers to any discipline usually give insufficient credit to the past and because we Americans tend to be less well informed about others than others may be about us, let me present a small sample of the debt we all owe to past and present international pioneers. My apologies for many obvious omissions. Arteriography, as you know, was largely a European development beginning with cerebral visualization by Moniz 1 in 1927,

A Time for Action

In his presidential address before the 23rd scientific meeting of the International Cardiovascular Society in Boston last June, Allan D. Callow, MD, was mindful of the Quaker adage that one should not speak unless he can improve on silence. In his discourse, to be published inArchives of Surgery,1he first paid tribute to the foreign scientists who have contributed substantially to advancement in his field of interest. Second, he gave a brief history of the Society he represents, enumerated its weaknesses, and offered suggestions for its improvement and for that of the North American Chapter. For the latter, he announced the objectives and responsibilities to be concerned with the improvement of training programs in cardiovascular surgery and the pursuit of excellence in patient care. He implied that the training programs may be found wanting. He took into account the fact that, after long experience in the area of

Editorial: Certification in vascular surgery.

In June 1973, the Society for Vascular Surgery and the North American Chapter of the International Cardiovascular Society (ICVS) held their annual meetings back to back, as is their custom. The members will, we are sure, all agree that the most significant event emerging from the Toronto meeting was acceptance of the concept of vascular surgery as a formal specialty. A recent previous president of the ICVS's North American Chapter, Dr. Jack Cannon, had in his presidential address drawn attention to the tragedies that are the common results of vascular operations performed by surgeons with incomplete training and overabundant enthusiasm. In the previous year Dr. E. J. Wylie in his presidential address to the same society made the firm recommendation that formal vascular training programs and their products be given recognition and that the better of them be used as standards for the formation of new ones. Almost simultaneously the

Transapical left ventricular bypass.

To the Editor.—Good people often reinvent a procedure that has already been invented, when there is a need for it and when the times are ripe for it. This is true for the procedure described by Dr. John C. Norman,1and also described by Drs. J. Kent Trinkle and Lester R. Bryant.2To the best of our knowledge, Dr. William Chardack and coworkers3were the first to describe the method of transapical left ventricular bypass.4He also presented it before the North American Chapter of the International Cardiovascular Society in 1966. He proved that a left ventricle decompressed with a special kind of double lumen cannula could be more easily defibrillated. Not having seen his article, two men in our department, Drs. Alex Kralios and Clifford S. Kwan-Gett, independently reinvented the method. Their aim was to apply it in patients dying from cardiogenic shock, particularly

Vascular surgery: a quest for excellence.

The International Cardiovascular Society was founded 18 years ago to bring together investigators, teachers, and practitioners from medical and surgical disciplines with a common interest in vascular disease. From a review of the membership roster and the contributions to this and previous programs, it is apparent that our North American chapter has become increasingly surgically oriented. In these exciting years we have, in fact, participated in the birth of two surgical specialties, vascular surgery and cardiac surgery. We are now being asked by the government to propose means for strengthening the delivery of the products of these specialties. Many of you began service last year as professional consultants in a nationwide, federally sponsored and financed study which is to provide guidelines for the future conduct of these disciplines. Your responsibility is to design and to develop programs for the care of patients with cardiovascular disease that would assure the availability

Insurance Rate Making in Louisiana

Herbert S. Denenberg, Ph.D., LL.M., C.L.U., C.P.C.U., is Associate Professor of Insurance at the Wharton School of Finance and Commerce and Associate Director of the Staff of the Wisconsin Insurance Laws Revision project. In September of 1967, he was appointed Special Counsel and Research Director of the Insurance Advisory Panel of the President's Commission on Civil Disorders. He is second vice-president of the American Risk and Insurance Association and vice-president and scientific secretary of the American Chapter of the International Association of Insurance Law. He is author or co-author of Risk and Insurance and Life Insurance And/ Or Mutual Funds and articles on insurance, law and regulation.

The role of plastics and engineering in vascular surgery.

AS A charter member of the North American Chapter of the International Cardiovascular Society, it has been my privilege to serve through the 14 years of our existence on committees or as an officer, culminating in my term as president. During this brief span, our membership has grown not only in numbers, but also in scientific quality. Most of the major advances in diagnostic and therapeutic techniques in peripheral and cardiovascular disease have been made by those who number themselves as members in our chapters throughout the world. All of us, as physicians, have strived to provide new and better care for those suffering from cardiac and vascular disease. In reviewing these past years, it can be noted that increasingly we have come to depend upon an association with basic scientists and engineers in order to develop new materials and devices to further our ends. Since those developments have taken

Acute Injuries of the Head: Their Diagnosis, Treatment, Complications and Sequels

As the Foreword states, this istheBritish text on head injuries. The American reader can smile tolerantly when he reads tyre for tire or lorrie for truck, he may envy the free rehabilitation service available to the British patient, but he will have to have hisBritish Pharmacopoeiaat the ready to deal with the recommended drugs, even in the American chapter. This is now clearly a book of many authors, and as such it suffers from uneven quality. The chapters on posttraumatic epilepsy, radiology, and rehabilitation can be singled out for special praise. The historical introduction is an interminable and ofttimes inappropriate hurdle to be jumped before the book begins, The latest facts and concepts about the reticular formation are beautifully expounded but their application to the head-injured patient seems not to concern the researcher-author. A great pity! The roast beef of this British repast is the central four chapters dealing with the diagnosis and