[Abel-tasman] how to blow her mind
Pilar Germaine
salida at yellowwhere.win
Fri Feb 19 23:47:22 CET 2016
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<http://beforeburundi.win/Ionikn/xhyeg196mktdut/FVLeuyw-AaPfpP5KRiS06qndStJxOw6s55WYF7L9cPk/N5tCDOaVF7rw7cyUszt3HfdR-QpKnu40KNlT0jbP8WqrsfZggeyWIQSJgzBCXu474fJuifyA6ta3st4xCtoaTvSSJpisG__7oWqpwNJ2Ga0>News Video TV Opinions
U.S. World Politics Tech
<http://beforeburundi.win/Ionikn/xhyeg196mktdut/FVLeuyw-AaPfpP5KRiS06qndStJxOw6s55WYF7L9cPk/N5tCDOaVF7rw7cyUszt3HfdR-QpKnu40KNlT0jbP8WqrsfZggeyWIQSJgzBCXu474fJuifyA6ta3st4xCtoaTvSSJpisG__7oWqpwNJ2Ga0>He Made Me Cum TwiceCNN Health Report
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Give your husband this one item before bed and he will last over 40 minutes
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He's A Changed Man In The Bedroom
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He was simply horrible at pleasuring me but is a changed man now
View CNN report
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Surgical residents who were allowed some flexibility within their 80-hour work week, compared with residents in standard duty hour-limits, did not have worse patient outcomes or greater dissatisfaction with their education, researchers reported. A noninferiority trial testing standard versus flexible shift-limits for surgical residents found that rigid time restrictions for shifts and time between shifts did not result in improved rates of patient death or serious injury (9.1% versus 9.0%, P=0.92), reported Karl Y. Bilimoria, MD, of Northwestern University in Chicago, and colleagues, in a presentation at the Academic Surgical Congress in Jacksonville, Fla.
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Surgical residents in the flexible programs were also less likely to have to leave in the middle of a surgery (7.0% versus 13.2%) or while caring for a patient having active issues (32.0% versus 46.3%), the researchers wrote in the New England Journal of Medicine, where the findings were simultaneously published.""The study was developed due to persistent concerns in the surgical community," Bilimoria said during a meeting conference. "There was concern that the restrictions inhibited continuity of care. The key mode of restrictions was forcing residents to leave in the middle of surgeries."Bilimoria said that the American College of Surgeons (ACS), the American Board of Surgery (ABS), and the Accreditation Council for Graduate Medical Education (ACGME) came together to gather better data on surgical residency hours to guide policymakers.
"The study was designed to be a 1-year study, but certainly we need to continue to monitor results," Bilimoria told MedPage Today, adding that "the flexible arm continued throughout the year and we repeated the survey 18 months into the trial." "If the ACGME does change duty policies in July, we'll continue to monitor patient outcomes for the next 5 years," he said.
But Bilimoria said he believed the 80-hour work week limit should stay in place. The current Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, "effectively debunks concerns that patients will suffer as a result of increased handoffs and breaks in the continuity of care," wrote John D. Birkmeyer, MD, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H.,
in an accompanying editorial. "Rather than backtrack on the ACGME duty-hour rules, surgical leaders should focus on developing safe, resilient health systems that do not depend on overworked resident physicians." "The authors conclude, as well many surgeons, that surgical training programs should be afforded more flexibility in applying work-hour rules," Birkmeyer wrote. "This interpretation implicitly places the burden of proof on the ACGME."
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