American journal of surgery最新文献

{"title":"Professional identity formation for all physicians on the surgery clerkship","authors":"Daniel L. Dent","doi":"10.1016/j.amjsurg.2024.115971","DOIUrl":"10.1016/j.amjsurg.2024.115971","url":null,"abstract":"<div><div>No abstract is necessary for an invited commentary.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115971"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339491","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":"Empowered or abandoned: Immediate information without explanation.","authors":"Ashley B Simpson, Amanda L Amin","doi":"10.1016/j.amjsurg.2024.115985","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115985","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"115985"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339487","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":"Does surgeon-performed intraoperative wire localization allow for lower margin positivity rates compared to radiologist-performed preoperative localization in early breast cancer?","authors":"Reeta Asmai, Tess Huy, Jennifer L Baker, Hong-Ho Yang, Carlie K Thompson, Nimmi S Kapoor","doi":"10.1016/j.amjsurg.2024.115986","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115986","url":null,"abstract":"<p><strong>Background: </strong>This study compares positive margin rates in breast conserving surgery (BCS) for early breast cancer using two localization techniques: surgeon-performed intraoperative ultrasound-guided wire localization (IOWL) versus radiologist-performed preoperative wire localization (POWL).</p><p><strong>Methods: </strong>Patients with unifocal breast cancer undergoing BCS with follow-up at a single institution were retrospectively identified. Factors associated with positive margins were identified.</p><p><strong>Results: </strong>177 patients underwent IOWL (N ​= ​85) or POWL (N ​= ​92). There was a significantly lower rate of positive margins for IOWL vs. POWL (7.1 ​% vs. 23.9 ​%, p ​= ​0.002) and a corresponding lower rate of re-excision for IOWL vs. POWL (5.9 ​% vs. 18.5 ​%, p ​= ​0.011). Presence of DCIS was associated with positive margins (p ​= ​0.015). After adjusting for presence of DCIS, tumor size, and volume of tissue removed, the positive margin rate was significantly lower in the IOWL group compared to the POWL group (aOR 0.34, 95 ​% CI 0.13-0.93).</p><p><strong>Conclusions: </strong>In this study, adjusted analysis favored IOWL in achieving negative tumor margins. Prospective studies are needed to further explore the impact of IOWL on quality, cost-effectiveness, and patient experience.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"115986"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339486","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":"Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)","authors":"Vibhu Jain ,&nbsp;Santhosh Irrinki ,&nbsp;Siddhant Khare ,&nbsp;Kailash Chand Kurdia ,&nbsp;Sathish Subbiah Nagaraj ,&nbsp;Yashwant Raj Sakaray ,&nbsp;Ajay Savlania ,&nbsp;Cherring Tandup ,&nbsp;Prerna Verma ,&nbsp;Lileshwar Kaman","doi":"10.1016/j.amjsurg.2024.115975","DOIUrl":"10.1016/j.amjsurg.2024.115975","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy.</div></div><div><h3>Study design</h3><div>Prospective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 ​h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo).</div></div><div><h3>Results</h3><div>Fifty patients were randomized into ERAS(n ​= ​25) and conventional care(n ​= ​25) groups. Ninety-two percent of patients were young males, 58 ​% had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 ​%). ERAS group had a reduced median LOH(days) (6 versus 8, p ​= ​0.007), early recovery of bowel function(p ​= ​0.010) and shorter times for nasogastric tube(p ​= ​0.001), urinary catheter(p ​= ​0.007) and drain(p ​= ​0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p ​= ​0.009)].</div></div><div><h3>Conclusion</h3><div>ERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115975"},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320387","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":"To speak or not to speak: Factors influencing medical students’ speech and silence in the operating room","authors":"Margaret Brommelsiek ,&nbsp;Kashif Javid ,&nbsp;Tariq Said ,&nbsp;Gary Sutkin","doi":"10.1016/j.amjsurg.2024.115976","DOIUrl":"10.1016/j.amjsurg.2024.115976","url":null,"abstract":"<div><h3>Purpose</h3><div>The surgical clerkship provides medical students with valuable hands-on experience. This study examined why medical students speak or remain silent in the OR to improve progression from novice to engaged surgical team member.</div></div><div><h3>Methods</h3><div>Using Constructivist Grounded Theory 37 interviews were conducted concerning expectations and behaviors that encourage or discourage students from speaking during their clerkship. Transcripts were coded, analyzed, and triangulated to develop a conceptual model.</div></div><div><h3>Results</h3><div>Students’ decision to speak or remain silent was based on their perception of the OR as a safe learning space. Our findings suggest that better preparation, awareness of critical moments, and informal communication with team members encouraged student speech.</div></div><div><h3>Conclusions</h3><div>Medical students remain conflicted about their speaking in the OR and their evaluation. Key to improving students’ psychological safety is establishment of interpersonal relationships, awareness of OR mood, and assignment of case-related tasks to assist with OR assimilation and improved learning.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115976"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322587","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":"Leveraging an EHR tool to improve provider adherence to the modified brain injury guidelines","authors":"Aricia Shen,&nbsp;Dana Lemke,&nbsp;Matthew Bloom,&nbsp;Marcel Maya,&nbsp;Rodrigo Alban,&nbsp;Daniel R. Margulies,&nbsp;Galinos Barmparas","doi":"10.1016/j.amjsurg.2024.115982","DOIUrl":"10.1016/j.amjsurg.2024.115982","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim was to leverage electronic health record (EHR) smartphrases to improve compliance with the modified Brain Injury Guidelines (mBIG).</div></div><div><h3>Methods</h3><div>Smartphrases were developed for the trauma team and radiology and implemented December 2022. Traumatic brain injury (TBI) patients meeting mBIG inclusion from 03/2021- 07/2023 were reviewed. Smartphrase usage and clinical compliance with mBIG (measured by percent reduction of repeat head imaging, ICU admissions, and neurosurgery consults) were compared pre- and post-intervention.</div></div><div><h3>Results</h3><div>268 cases were examined. Post-intervention, mBIG1 patients had significantly fewer neurosurgery consults (82.4 ​% vs. 50.0 ​%, OR ​= ​0.21, p ​= ​0.03), while mBIG2 patients had significantly fewer repeat head CTs (91.0 ​% vs. 66.7 ​%, OR ​= ​0.2, p ​= ​0.01), ICU admissions (66.7 ​% vs. 38.5 ​%, OR ​= ​0.31, p ​= ​0.02) and neurosurgery consults (93.9 ​% vs. 56.4 ​%, OR ​= ​0.08, p ​&lt; ​0.01).</div></div><div><h3>Conclusion</h3><div>Standardized smartphrases can streamline workflow and significantly improve trauma team compliance with best practice guidelines for TBI and reduce unnecessary imaging, consults, and costly ICU admissions.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115982"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315927","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":"Predicting nosocomial pneumonia risk in level-1 trauma patients: An external validation study using the trauma quality improvement program","authors":"Tim Kobes ,&nbsp;Ander Dorken-Gallastegi ,&nbsp;Anne-Sophie C. Romijn ,&nbsp;Luke PH. Leenen ,&nbsp;Karlijn JP. van Wessem ,&nbsp;Falco Hietbrink ,&nbsp;Rolf HH. Groenwold ,&nbsp;Mark CPM. van Baal ,&nbsp;Marilyn Heng","doi":"10.1016/j.amjsurg.2024.115983","DOIUrl":"10.1016/j.amjsurg.2024.115983","url":null,"abstract":"<div><h3>Background</h3><div>Early identification of patients at risk of nosocomial pneumonia enables the opportunity for preventative measures, which may improve survival and reduce costs. Therefore, this study aimed to externally validate an existing prediction model (issued by Croce et al.) to predict nosocomial pneumonia in patients admitted to US level-1 trauma centers.</div></div><div><h3>Methods</h3><div>A retrospective cohort study including patients admitted to level-1 trauma centers and registered in the TQIP, a US nationwide trauma registry, admitted between 2013–2015 and 2017–2019. The main outcome was total nosocomial pneumonia for the first period and ventilator-associated pneumonia (VAP) for the second. Model discrimination and calibration were assessed before and after recalibration.</div></div><div><h3>Results</h3><div>The study comprised 902,231 trauma patients (N_2013–2015 ​= ​180,601; N_2017–2019 ​= ​721,630), with a median age of 52 in both periods, 64–65 ​% male, and approximately 90 ​% sustaining blunt traumatic injury. The median Injury Severity Scores were 13 (2013–2015) versus 9 (2017–2019); median Glasgow Coma Scale scores were 15. Nosocomial pneumonia incidence was 4.4 ​%, VAP incidence was 0.7 ​%. The original model demonstrated good to excellent discrimination for both periods (c-statistic_2013–2015 0.84, 95%CI 0.83–0.84; c-statistic_2017–2019 0.92, 95%CI 0.91–0.92). After recalibration, discriminatory capacity and calibration for the lower predicted probabilities improved.</div></div><div><h3>Conclusions</h3><div>The Croce model can identify patients admitted to US level-1 trauma centers at risk of total nosocomial pneumonia and VAP. Implementing (modified) Croce models in route trauma clinical practice could guide judicious use of preventative measures and prescription of additional non-invasive preventative measures (e.g., increased monitoring, pulmonary physiotherapy) to decrease the occurrence of nosocomial pneumonia in at-risk patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115983"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387354","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":"Helping patients navigate the immediate release of medical records: MedEd, a novel patient engagement technology.","authors":"Bridget Foy, Abigail Ludwigson, Nicole M Mott, Monica Adams, Madeline G Higgins, Sudheer Vemuru, Dulcy Wolverton, Jeniann Yi, Sharon Sams, Chen-Tan Lin, Randy Miles, Nancy Taft, Erin Baurle, Ethan Cumbler, Sarah Tevis","doi":"10.1016/j.amjsurg.2024.115977","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115977","url":null,"abstract":"<p><strong>Background: </strong>Through online health portals, patients receive complex medical reports without interpretation from their healthcare provider. This study evaluated the usability of MedEd, a patient engagement tool providing definitions of medical terminology in breast pathology and radiology reports.</p><p><strong>Methods: </strong>Individuals who underwent a normal screening mammogram were invited to complete semi-structured interviews where they downloaded MedEd and discussed their download experience. Acceptability, appropriateness, and feasibility of MedEd were evaluated.</p><p><strong>Results: </strong>143 individuals were invited to participate, and 14 semi-structured interviews were completed. Participants reported ease of downloading and navigating MedEd with concerns about privacy and others' abilities to download. Participants demonstrated high acceptability (mean 4.48/5, SD 0.95), appropriateness (mean 4.66/5, SD 0.83), and feasibility (mean 4.48/5, SD 1.04) scores.</p><p><strong>Conclusion: </strong>Participants expressed excitement for future use of MedEd and provided suggestions for improvements. Next steps include evaluating comprehension of real breast reports while using MedEd and expanding patient access.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"115977"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339488","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":"A thorough evaluation for primary hyperparathyroidism: More than a stone's throw away","authors":"Rebecca L. Green ,&nbsp;Rajiv Raghavan ,&nbsp;Laura M. Douglass ,&nbsp;Jennifer Sykes ,&nbsp;Patricia Dunham ,&nbsp;Terry P. Gao ,&nbsp;Lindsay Talemal ,&nbsp;George A. Taylor ,&nbsp;Lindsay E. Kuo","doi":"10.1016/j.amjsurg.2024.115978","DOIUrl":"10.1016/j.amjsurg.2024.115978","url":null,"abstract":"<div><h3>Background</h3><div>Primary hyperparathyroidism (PHPT) is a treatable cause of nephrolithiasis. However, PHPT is not consistently evaluated in nephrolithiasis patients. Symptoms of parathyroid disease were explored in relation to evaluation of PHPT in nephrolithiasis patients.</div></div><div><h3>Methods</h3><div>Patients with nephrolithiasis on imaging between 2017 and 2021 were identified. Measurement of serum calcium levels after nephrolithiasis diagnosis was determined. Patients with hypercalcemia (<span><math><mrow><mo>≥</mo></mrow></math></span> 10.2 ​mg/dL) were identified. Characteristics associated with parathyroid hormone (PTH) evaluation and specialist referral were assessed.</div></div><div><h3>Results</h3><div>Of 2264 nephrolithiasis patients with calcium levels measured, 383 (17.1 ​%) had hypercalcemia. Of those, 107 (27.9 ​%) had PTH levels drawn. PTH was more often assessed in patients with higher median calcium levels, recurrent nephrolithiasis, depression, and osteopenia/osteoporosis. PTH was elevated (&gt;64 ​pg/mL) or non-suppressed (40–64 ​pg/mL) in 68 (63.6 ​%) patients. Of those, 31 (45.6 ​%) were referred to a parathyroid specialist. Referred patients had higher PTH and calcium levels than those without referral, and higher rates of osteopenia/osteoporosis.</div></div><div><h3>Conclusions</h3><div>PTH evaluation in hypercalcemic nephrolithiasis patients was low. The majority of patients evaluated had elevated or non-suppressed PTH levels, but only a fraction were referred to a specialist.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115978"},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315926","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":"Less is more: Streamlining management of isolated traumatic subarachnoid hemorrhage in the modified brain injury guidelines","authors":"Brandon A. Bellen ,&nbsp;Janet S. Lee ,&nbsp;Emily Johnson ,&nbsp;Nathan Schmoekel ,&nbsp;Robert McIntyre Jr. ,&nbsp;Michael Cripps ,&nbsp;John McVicker ,&nbsp;Thomas Schroeppel","doi":"10.1016/j.amjsurg.2024.115973","DOIUrl":"10.1016/j.amjsurg.2024.115973","url":null,"abstract":"<div><h3>Background</h3><div>Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) are managed according to the modified Brain Injury Guidelines (mBIG) class. The current study aimed to describe patients with iTSAH and analyze their clinical outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on trauma patients with iTSAH. Exclusion criteria were Glasgow Coma Scale (GCS) ​&lt; ​13 and pre-injury antiplatelet/anticoagulant use.</div></div><div><h3>Results</h3><div>276 patients were identified over the 8-year study period. The median number of head CT scans was 2. Neurosurgery consultation was obtained in 80.4 ​% of patients. A total of 19 (8.6 ​%) patients had radiographic progression. Six (2.2 ​%) patients had neurologic deterioration. No patients required operative intervention or readmission. No deaths were related to iTSAH.</div></div><div><h3>Conclusions</h3><div>There were no patients with iTSAH that required neurosurgical consultation despite a subset of patients having radiographic or neurologic progression. These patients may not require repeat head CT scan or neurosurgical consult, necessitating a change of SAH definitions in the mBIG.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115973"},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322588","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}