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American Journal of Surgery

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https://www.readbyqxmd.com/read/29157892/is-it-safe-to-discharge-geriatric-trauma-patients-with-anemia
#1
Adrian W Ong, Nick R Jaisingh, Susan Butler, Adam Sigal, Forrest B Fernandez
INTRODUCTION: The consequences of discharging anemic geriatric trauma patients are not well studied. We hypothesize that anemia at discharge is associated with adverse outcomes. METHODS: A 1-year retrospective review of patients ≥65 years was performed. Hemoglobin levels at admission (HbA), discharge (HbD) and the lowest inpatient level (HbL) were recorded. Severity of anemia was categorized as mild (Hb ≥ 10.0 g/dl), moderate (Hb < 10.0 and ≥ 8.5 g/dl) and severe (Hb < 8...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29157891/surgical-resection-improves-median-overall-survival-with-marginal-improvement-in-long-term-survival-when-compared-with-definitive-radiotherapy-in-merkel-cell-carcinoma-a-propensity-score-matched-analysis-of-the-national-cancer-database
#2
G Paul Wright, Matthew P Holtzman
BACKGROUND: Definitive radiotherapy has been suggested as a treatment alternative to surgical resection in Merkel cell carcinoma (MCC). METHODS: Patients with MCC were identified from the National Cancer Database. Propensity score matching accounting for age, Charlson-Deyo score, grade, and AJCC stage was used to match patients in 1:1 fashion by primary treatment (surgery vs. radiotherapy). RESULTS: There were 1227 patients in each group. Median overall survival was improved with surgical resection in stage I/II (76 vs...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29157890/surgical-clerkship-or-medical-clerkship-first-does-it-make-a-difference
#3
Andrew Adelsheimer, Russell S Berman, H Leon Pachter, Mark S Hochberg
INTRODUCTION: This study compares NBME surgical clerkship scores of students who completed their medicine clerkship before their surgical clerkship with the performance of those who had not previously completed their medical clerkship. METHODS: The study included 815 New York University School of Medicine students from the years 2014-2018 (571 students took medicine first, while 244 took surgery first). Performance on the surgical clerkship was assessed using the NBME SHELF examination...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29157889/the-effect-of-damage-control-laparotomy-on-major-abdominal-complications-a-matched-analysis
#4
Mitchell J George, Sasha D Adams, Michelle K McNutt, Joseph D Love, Rondel Albarado, Laura J Moore, Charles E Wade, Bryan A Cotton, John B Holcomb, John A Harvin
INTRODUCTION: Damage control laparotomy (DCL) for trauma is thought to be associated with increased abdominal complications. The purpose of this study is to determine the effect of DCL on abdominal complications by comparing two groups of trauma patients: DCL patients who were prospectively adjudicated to potentially being closed at the primary laparotomy (potential DEF or pDEF) and those who underwent definitive laparotomy (DEF). METHODS: The pDEF group was matched to DEF patients according to mechanism of injury, abdominal injury severity, operating room transfusions, and performance of a colon resection...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29157888/quality-measurement-affecting-surgical-practice-utility-versus-utopia
#5
REVIEW
Leonard R Henry, Urs W von Holzen, Michael J Minarich, Ashley N Hardy, Wilbur A Beachy, M Susan Franger, Roderich E Schwarz
The Triple Aim: improving healthcare quality, cost and patient experience has resulted in massive healthcare "quality" measurement. For many surgeons the origins, intent and strengths of this measurement barrage seems nebulous-though their shortcomings are noticeable. This article reviews the major organizations and programs (namely the Centers for Medicare and Medicaid Services) driving the somewhat burdensome healthcare quality climate. The success of this top-down approach is mixed, and far from convincing...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29153249/accurate-surgical-skills-evaluation-does-it-mandate-raters-have-a-medical-background
#6
Muhammad Zeb, Apram Jyot, Eduardo Abbott, Miguel Gomez, Mohamed Baloul, David Farley
BACKGROUND: Surgeons rarely have time to assess/rate trainee performance. From a 10 year-experience of implementing OSCE style assessments, we hypothesize that the accurate scoring of interns in selected tests is not affected by the rater's medical background. METHODS: A prospective collection of quantitative scoring data by both medical school graduates and college students was compared. Each rater underwent training and then watched three videos of actors performing in each of two OSCE stations and individually scored them...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29153247/early-versus-delayed-appendectomy-a-comparison-of-outcomes
#7
Kyle Seudeal, Hira Abidi, Saad Shebrain
BACKGROUND: The optimal timing for performing appendectomy in adults remains controversial. METHOD: A one-year retrospective review of adult patients with acute appendicitis who underwent appendectomy. The cohort was divided by time-to-intervention into two groups: patients who underwent appendectomy within 8 h (group 1), and those who had surgery after 8 h (group 2). Outcome measures including perioperative morbidity and mortality, post-operative length of stay, and the 30-day readmission rate were compared between the two groups...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29153979/individual-surgeon-practice-is-the-most-important-factor-influencing-diverting-loop-ileostomy-creation-for-patients-undergoing-sigmoid-colectomy-for-diverticulitis
#8
Cigdem Benlice, Conor P Delaney, David Liska, Jennifer Hrabe, Scott Steele, Emre Gorgun
BACKGROUND: To identify factors associated with diverting ileostomy creation (DLI) in patients undergoing sigmoid colectomy for diverticular disease in a high volume colorectal unit and to obtain information for better preoperative patient counseling. METHODS: Patients who underwent sigmoid colectomy with colorectal anastomosis with or without DLI for diverticulitis between 01/1994-12/2014 were identified. Preoperative characteristics, surgeon practice year, individual surgeon and postoperative outcomes were compared between patients with DLI or not...
November 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29157893/a-surgical-residency-preparatory-course-for-senior-medical-students-leads-to-earlier-independence-in-acgme-competencies
#9
Joshua A Wunder, Christopher P Brandt, Jeremy M Lipman
BACKGROUND: It is unknown whether surgery residency preparatory courses lead to earlier independent practice. METHODS: A four-week surgical residency preparatory course was offered to graduating medical students. Upon entering residency, participants reported supervised and unsupervised performance of patient management and procedural competencies. Those who participated in the course (Group A) were compared with graduates from our institution who did not participate but entered surgery residency (Group B) and with residents from other medical schools in the same program as Group A (Group C)...
November 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29153980/why-saying-what-you-mean-matters-an-analysis-of-trauma-team-communication
#10
Hee Soo Jung, Charles Warner-Hillard, Ryan Thompson, Krista Haines, Brooke Moungey, Anne LeGare, David Williamson Shaffer, Carla Pugh, Suresh Agarwal, Sarah Sullivan
BACKGROUND: We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork. METHODS: Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded for grammatical form and communicative intent. The rate of mixed mode communication (MMC) was calculated. MMC rates were compared to overall TEAM scores...
November 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29153250/mental-skills-training-effectively-minimizes-operative-performance-deterioration-under-stressful-conditions-results-of-a-randomized-controlled-study
#11
N E Anton, J Beane, A M Yurco, L D Howley, E Bean, E M Myers, D Stefanidis
BACKGROUND: Stress can negatively impact surgical performance, but mental skills may help. We hypothesized that a comprehensive mental skills curriculum (MSC) would minimize resident performance deterioration under stress. METHODS: Twenty-four residents were stratified then randomized to receive mental skills and FLS training (MSC group), or only FLS training (control group). Laparoscopic suturing skill was assessed on a live porcine model with and without external stressors...
November 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29153248/efficacy-of-proximal-colectomy-for-surgical-management-of-right-sided-first-colorectal-cancer-in-lynch-syndrome-mutation-carriers
#12
Molly J Hiatt, Murray Joseph Casey, Henry T Lynch, Carrie L Snyder, Mark Stacey, Ryan W Walters
BACKGROUND: This study analyzes the occurrence of colorectal cancer (CRC) in Lynch syndrome (LS) mutation carriers, interval until diagnosis of metachronous CRC, and survival after proximal colectomy (PC) compared with total (TC) and subtotal colectomy (STC) for right-sided first CRC in LS mutation carriers. METHODS: Sixty-four LS mutation carriers with right-sided first CRC treated with PC or TC + STC were confirmed by clinical records. Bivariate analyses were examined for significance and life tables were generated for risk of metachronous CRC and survival estimates following surgery...
November 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29128103/the-benefits-of-a-low-dose-complex-carbohydrate-citrulline-electrolyte-solution-for-preoperative-carbohydrate-loading-focus-on-glycemic-variability
#13
Barrett A Kielhorn, Anthony J Senagore, Theodor Asgeirsson
BACKGROUND: Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program. METHODS: Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016-March 2017...
November 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29128100/improving-the-feasibility-and-utility-of-optrust-a-tool-assessing-intraoperative-entrustment
#14
Vahagn C Nikolian, Danielle C Sutzko, Patrick E Georgoff, Niki Matusko, Anna Boniakowski, Kaustubh Prabhu, Joseph T Church, Julie Thompson-Burdine, Rebecca M Minter, Gurjit Sandhu
BACKGROUND: Changes in the surgical training landscape have sparked an interest in developing new educational models anchored on entrustment assessment. We sought to optimize the validated OpTrust entrustment assessment tool by comparing ratings from short-course video reviews to previously validated intraoperative assessments. METHODS: Entrustment assessment scores for video-based and 1-h (short-course) observations were compared to previously validated intraoperative assessment scores...
November 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29137722/why-teach-why-ase
#15
Christopher P Brandt
No abstract text is available yet for this article.
November 7, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29137720/improving-surgical-residents-communication-in-disclosing-complications-a-qualitative-analysis-of-simulated-physician-and-patient-surrogate-conversations
#16
Carolina Fernandez Branson, Jeffrey G Chipman
BACKGROUND: In this study, we explore surgical resident communication with simulated patient surrogates (SPs), in an Objective Structured Clinical Examination (OSCE). METHODS: We use discourse analysis (DA), a qualitative approach to analyzing language, to evaluate our residents' interactions with simulated patient surrogates. After identifying problematic communication patterns, we apply communication theory to discuss our findings and provide suggestions for improvement...
November 7, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29126594/seeing-the-forest-beyond-the-trees-predicting-survival-in-burn-patients-with-machine-learning
#17
Adrienne N Cobb, Witawat Daungjaiboon, Sarah A Brownlee, Anthony J Baldea, Arthur P Sanford, Michael M Mosier, Paul C Kuo
BACKGROUND: This study aims to identify predictors of survival for burn patients at the patient and hospital level using machine learning techniques. METHODS: The HCUP SID for California, Florida and New York were used to identify patients admitted with a burn diagnosis and merged with hospital data from the AHA Annual Survey. Random forest and stochastic gradient boosting (SGB) were used to identify predictors of survival at the patient and hospital level from the top performing model...
November 7, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29122236/commentary-on-the-article-a-prospective-study-of-a-vein-sparing-technique-for-the-management-of-varicose-vein-disease-by-m-zmudzinski-et%C3%A2-al
#18
LETTER
C Franceschi, A Bahnini, M Cappelli, R L Cuaranta, M Dadon, R Delfrate, S Ermini, S Gianesini, E Mendoza, F Passariello, A Puskas
No abstract text is available yet for this article.
November 7, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29137721/current-robotic-curricula-for-surgery-residents-a-need-for-additional-cognitive-and-psychomotor-focus
#19
Courtney A Green, Hueylan Chern, Patricia S O'Sullivan
BACKGROUND: Current robot surgery curricula developed by industry were designed for expert surgeons. We sought to identify the robotic curricula that currently exist in general surgery residencies and describe their components. METHODS: We identified 12 residency programs with robotic curricula. Using a structured coding form to identify themes including sequence, duration, emphasis and assessment, we generated a descriptive summary. RESULTS: Curricula followed a similar sequence: learners started with online modules and simulation exercises, followed by bedside experience during R2-R3 training years, and then operative opportunities on the console in the final years of training...
November 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29137723/the-promise-and-problems-of-non-physician-practitioners-in-general-surgery-education-results-of-a-multi-center-mixed-methods-study-of-faculty
#20
James E Coverdill, Jeff Scott Shelton, Adnan Alseidi, David C Borgstrom, Daniel L Dent, Russell Dumire, Jonathan Fryer, Thomas H Hartranft, Steven B Holsten, M Timothy Nelson, Mohsen M Shabahang, Stanley R Sherman, Paula M Termuhlen, Randy J Woods, John D Mellinger
BACKGROUND: Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems. METHODS: General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns...
November 5, 2017: American Journal of Surgery
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