Seminars in Vascular Surgery最新文献

{"title":"Assessment in the era of competency-based surgical education","authors":"Erica L. Mitchell","doi":"10.1053/j.semvascsurg.2025.04.006","DOIUrl":"10.1053/j.semvascsurg.2025.04.006","url":null,"abstract":"<div><div>Competency-based medical education (CBME) has emerged as a transformative approach to medical and surgical training. Competency-based assessments (CBAs) are assessments associated with a CBME curricula, and drive CBME curricula administration, implementation, and development. This review article provides an overview of CBME, the educational theory behind its underlying principles, and evolving implementation strategies in the United States. The key foundational concepts related to assessment in the era of CBME are discussed, beginning with an historical overview, followed by definitions and rationale for the adoption of differing CBA frameworks for surgical training, and terminating in the current state of CBAs for surgical training in the United States. Finally, the strengths and challenges of CBAs are discussed.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 122-131"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives in community training in vascular surgery","authors":"Kirran Bakhshi,&nbsp;Peter Kanuika,&nbsp;Ayman Ahmed,&nbsp;Javariah Asghar,&nbsp;Shameem Kunhammed,&nbsp;Tahlia L. Weis","doi":"10.1053/j.semvascsurg.2025.04.007","DOIUrl":"10.1053/j.semvascsurg.2025.04.007","url":null,"abstract":"<div><div>It has been established that there is a shortage of vascular surgeons nationwide. This is attributed partially to an imbalance between the number of vascular trainees, and consequently the number of newly graduated vascular surgeons entering the workforce, and the number of clinically active vascular surgeons approaching retirement age. Concurrently, a “silver tsunami” of an aging population in the United States, and increasing prevalence of morbid obesity, diabetes, and peripheral vascular disease portends a marked increase in the patient population in need of vascular care. This anticipated lack of appropriate vascular care may disproportionately affect specific populations. It is our aim to explore the role community training can serve in addressing this issue.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 198-201"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charcot neuroarthropathy: Surgical and conservative treatment approaches","authors":"Michael Hurst ,&nbsp;Laura Shin","doi":"10.1053/j.semvascsurg.2025.01.004","DOIUrl":"10.1053/j.semvascsurg.2025.01.004","url":null,"abstract":"<div><div>Charcot neuroarthropathy (CN) is an inflammatory condition affecting the joints of patients with peripheral neuropathy; its prevalence is as high as 7.5%. It is commonly seen in patients with diabetes and poses a significant public health burden. CN often leads to severe morbidity, with complications including ulcerations, infections, and lower extremity amputations, and a 5-year mortality rate of 29.0%. The etiology of this condition is a combination of inflammation, neurotrauma, and altered bone metabolism, necessitating early identification and accurate diagnosis through clinical evaluation and imaging studies. Conservative management, particularly total contact casting, plays a pivotal role in managing midfoot ulcers, demonstrating success in reducing plantar pressure and promoting ulcer healing. Surgical interventions are aimed to stabilize affected joints through techniques like arthrodesis and osteotomy and creating a plantigrade foot. Reconstructive options, including external and internal fixation, play a crucial role in the healing process. Postoperative management, including rehabilitation, is vital for successful outcomes, with surgical success rates varying based on procedures. CN is often misdiagnosed as gout, deep vein thrombosis, cellulitis, or infection, and diagnosis is often delayed in the acute care setting. Early diagnosis and intervention can significantly improve outcomes for these patients.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 74-84"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the go with Toe & Flow: Private Clinic Design and Flow","authors":"Ben Li ,&nbsp;Miguel Montero-Baker ,&nbsp;Brian D. Lepow","doi":"10.1053/j.semvascsurg.2025.01.011","DOIUrl":"10.1053/j.semvascsurg.2025.01.011","url":null,"abstract":"<div><div>Lower extremity amputation secondary to diabetes and/or peripheral artery disease is a significant health issue globally. Many amputation prevention programs exist in academic settings; however, given the increasing administrative burdens associated with large institutions, it can be challenging to develop and maintain such programs in the modern era. Private amputation prevention clinics may be a viable alternative, allowing for greater control over services provided and better ability to meet patient needs. HOPE Vascular and Podiatry (<span><span>https://hcic.io/</span><svg><path></path></svg></span>), a private amputation prevention clinic established in 2023 in Houston, Texas, has successfully integrated a clinical, research, and educational program focused on amputation prevention. Key aspects of this program include a multidisciplinary team consisting of vascular/podiatric surgeons, clinical/administrative staff, and interdisciplinary collaborators. Notable advantages include decentralization of care, improvements in clinician satisfaction, and fewer administrative barriers to providing high-quality care. By identifying and quantifying the need for amputation prevention care in the community, establishing a clear mission, building a minimum viable program, and growing responsibly, there is potential to establish private amputation prevention clinics that provide high-quality, accessible, and personalized care for patients with diabetes and/or peripheral artery disease to improve limb outcomes. In this article, we describe the design and flow of HOPE Vascular and Podiatry, including how the clinic was developed, its mission and values, and ongoing clinical, research, and educational activities. We also share logistical, financial, and operational considerations, and provide lessons learned on how to effectively develop, maintain, and run a successful private amputation prevention clinic.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 11-19"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic foot in primary and tertiary (DEFINITE) care: An efficacious, synergistic and cost-effective multidisciplinary team model for diabetic foot care in Singapore","authors":"Wen Zhe Leo ,&nbsp;Lixia Ge ,&nbsp;Sadhana Chandrasekar ,&nbsp;Elaine Tan ,&nbsp;Yi Bing Loh ,&nbsp;Xiaoli Zhu ,&nbsp;Huiling Liew ,&nbsp;Enming Yong ,&nbsp;Tiffany Chew ,&nbsp;Jeremy Hoe ,&nbsp;Chelsea Law ,&nbsp;Jaime Lin ,&nbsp;Jo Anne Lim ,&nbsp;Pravin Lingam ,&nbsp;Joseph Molina ,&nbsp;Gary Ang ,&nbsp;Yan Sun ,&nbsp;Zhiwen Joseph Lo ,&nbsp;DEFINITE (Diabetic Foot in Primary and Tertiary) Care Team","doi":"10.1053/j.semvascsurg.2025.01.007","DOIUrl":"10.1053/j.semvascsurg.2025.01.007","url":null,"abstract":"<div><div>Diabetic foot ulcers (DFUs) and lower extremity amputations (LEAs) threaten survival and quality of life (QoL) of patients, contributing to healthcare and economic burden. Guidelines advocate for a multidisciplinary team (MDT) approach, but limited literature exists on cost-effectiveness and collaboration with primary care. We present the outcomes of the Diabetic Foot in Primary and Tertiary (DEFINITE) Care program, an MDT initiative in Singapore across primary and tertiary care. Patients with DFU from June 2020 to 2022 were enrolled. Clinical outcomes encompassed one-year minor and major LEAs, mortality and LEA-free survival rates. Healthcare utilization outcomes included number of admissions, length of stay, and primary care and hospital visits. QoL and Patient Reported Outcome Measures (PROMs) were respectively assessed using the EuroQol Five-Dimensional Questionnaire and Diabetic Foot Ulcer Scale-Short Form. Results from DEFINITE were propensity-score matched against a retrospective cohort. Cost-effectiveness analysis was performed using Markov simulation. Subgroup analyses focused on at-risk populations, including patients without access to MDT clinics or podiatry, appointment defaulters, octogenarians, patients with end-stage renal failure and different primary care locations. Total of 2,798 patients, with a mean age of 65.7 years and majority males (61.4%), were included for analysis. DEFINITE Care patients had higher minor LEA and improved LEA-free survival rates, fewer and shorter hospital admissions, and enhanced QoL and PROMs. DEFINITE Care demonstrated greater cost-effectiveness when compared to traditional care. Outcomes varied among subgroups. DEFINITE Care is an efficacious and cost-effective MDT model which fosters collaboration between primary and tertiary care for diabetic limb salvage.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 20-31"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of flaps in preventing lower extremity amputations","authors":"John M. Felder,&nbsp;Emmanuel Nageeb,&nbsp;Ingrid Rocha,&nbsp;Ryan Qasawa,&nbsp;Syena Moltaji,&nbsp;Yuma Fuse","doi":"10.1053/j.semvascsurg.2025.01.013","DOIUrl":"10.1053/j.semvascsurg.2025.01.013","url":null,"abstract":"<div><div>The increasing prevalence of chronic limb-threatening ischemia and diabetes mellitus has led to a surge in lower extremity amputations, driven by the combination of peripheral arterial disease and extensive wounds. Although revascularization often addresses ischemia, severe wounds pose a significant risk of amputation. Flaps, which involve the transfer of vascularized tissue, can provide immediate closure of complex wounds, particularly those involving bone or tendon exposure, where skin grafts are insufficient. Flap reconstruction of wounds can prevent amputation in cases when revascularization alone would not, but these complex efforts require close collaboration between vascular and plastic surgeons. Despite their potential to prevent amputations, flaps are underused in vascular surgery due to limited availability and expertise, particularly in complex cases involving diabetes and peripheral vascular disease. There are also socioeconomic and reimbursement challenges that limit interest on the part of plastic surgeons. This article explores the principles, techniques, and challenges of flap reconstruction in lower extremity limb salvage, emphasizing the need for multidisciplinary care.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 64-73"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fundamentals of wound care for amputation prevention","authors":"Beatriz Moschiar Almeida ,&nbsp;Robyn Evans ,&nbsp;Ahmed Kayssi","doi":"10.1053/j.semvascsurg.2025.01.001","DOIUrl":"10.1053/j.semvascsurg.2025.01.001","url":null,"abstract":"<div><div>The initial skin breakdown and subsequent healing processes are complex and influenced by various parameters, including systemic factors, infectious bioburden, and perfusion. Vascular wounds comprise inadequate inflow (due to peripheral artery disease), microvascular damage (result of diabetes mellitus), or vasoconstriction. Normal healing of acute wounds occurs in a sequence of defined stages; however, if a dysregulated inflammatory state ensues, it is classified as chronic. Both chronic and vascular wounds carry an increased risk of amputation. Therefore, holistic wound care is crucial in preventing limb loss. This review outlines a systematic approach to wound assessment and examines the latest recommendations for managing vascular wounds, focusing on strategies for preventing amputations.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 54-63"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best practice offloading treatments for diabetic foot ulcer healing, remission, and better plans for the healing-remission transition","authors":"Peter A. Lazzarini ,&nbsp;Jaap J. van Netten","doi":"10.1053/j.semvascsurg.2025.01.012","DOIUrl":"10.1053/j.semvascsurg.2025.01.012","url":null,"abstract":"<div><div>Diabetes-related foot disease is arguably the world's least known major health problem and causes a disease burden larger than most well-known diseases, such as stroke and breast cancer. This burden is driven by people developing more severe stages of foot disease, such as foot ulcers and infections, and with that worsening quality of life. To reduce this burden, we need treatments that prevent more severe stages of foot disease and improve quality of life. Best practice offloading treatments have been found to be arguably the most effective existing treatments to heal and prevent diabetes-related foot ulcers and infections, but can worsen quality of life. Furthermore, high re-ulceration rates still occur with best practice offloading treatments after healing. This may be because of the gap in guideline recommendations on the transition from ulcer healing to ulcer remission when it comes to offloading treatments. In this paper, we review why we need offloading treatments and what are the best offloading treatments recommended by the latest international guidelines for healing and remission. Further, we propose plans for future best practice offloading treatments for the transition from healing-to-remission to help reduce re-ulceration rates and improve longer-term ulcer remission. These plans could be the catalyst for better transitioning patients from first ulcer presentation through healing and into long-term remission, and in turn delivering better quality of life, and lower diabetes-related foot disease burdens on patients, nations, and the globe in future.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 110-120"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic foot infections: Questions for an infectious disease consultant","authors":"Varidhi Nauriyal ,&nbsp;Karin Byers","doi":"10.1053/j.semvascsurg.2025.01.009","DOIUrl":"10.1053/j.semvascsurg.2025.01.009","url":null,"abstract":"<div><div>Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 85-93"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of physical therapy in managing peripheral artery disease and diabetes","authors":"Stephanie L. Woelfel ,&nbsp;Deborah M. Wendland","doi":"10.1053/j.semvascsurg.2025.01.006","DOIUrl":"10.1053/j.semvascsurg.2025.01.006","url":null,"abstract":"<div><div>Peripheral artery disease and diabetes mellitus impact millions of adults in the United States and their combined effects are severe, resulting in loss of limb and loss of life. A strong multidisciplinary team is required to comprehensively care for this complicated patient population. As movement specialists, physical therapists are essential members of this team. Many of these patients will benefit from an individualized exercise and mobility prescription for not only disease and wound management but also for safe return to activity once any associated wounds have closed. Specialized care and loading guidance are necessary, especially for the closed but still healing skin. The purpose of this review is to highlight the role of physical therapists as team members in caring for patients with vascular compromise and/or diabetes mellitus. Furthermore, the value added for patient care and outcomes will be emphasized.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 101-109"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}