American journal of surgery最新文献_第10页

Mediation analysis identifies causal factors that lead to increased rates of kidney transplant failure in patients with peripheral vascular disease 中介分析确定了导致周围血管疾病患者肾移植失败率增加的原因因素。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-07 DOI: 10.1016/j.amjsurg.2025.116190

Johnathan Torikashvili , Melissa A. Kendall , Tyler Zander , Rajavi Parikh , Paul C. Kuo , Emily A. Grimsley

{"title":"Mediation analysis identifies causal factors that lead to increased rates of kidney transplant failure in patients with peripheral vascular disease","authors":"Johnathan Torikashvili , Melissa A. Kendall , Tyler Zander , Rajavi Parikh , Paul C. Kuo , Emily A. Grimsley","doi":"10.1016/j.amjsurg.2025.116190","DOIUrl":"10.1016/j.amjsurg.2025.116190","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to identify causal mediators of one-year kidney transplant failure in patients with peripheral vascular disease.</div></div><div><h3>Methods</h3><div>Standard Transplant Analysis and Research database was queried for adults who underwent kidney transplantation from 1987 to 2021. Multi-organ transplant, prior transplant, and living donor kidneys were excluded. Causal mediation analysis with 2000 percentile bootstrapping interactions identified mediators of one-year kidney transplant failure.</div></div><div><h3>Results</h3><div>212,259 patients were included: 16,215 with and 196,044 without peripheral vascular disease. Causal mediators of one-year kidney transplant failure are Kidney Donor Profile Index (proportionate mediation [PM] 17 %, p < 0.01, E-value = 1.20), pre-transplant dialysis (PM 19 %, p < 0.001, E-value = 1.17), recipient total serum albumin (PM 2 %, p = 0.003, E-value = 1.05), and donor hypertension (PM 1 %, p = 0.017, E-value = 1.04).</div></div><div><h3>Conclusions</h3><div>Several causal mediators increase rates of one-year kidney transplant failure in patients with peripheral vascular disease. Understanding these mediators can improve pre-transplant assessments and post-transplant outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116190"},"PeriodicalIF":2.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982504","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}

引用次数: 0

Medicare advantage and equity in surgical access and quality: A growing program with potentially growing problems. 医疗保险在手术准入和质量方面的优势和公平性：一个不断发展的项目，潜在的问题也越来越多。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-06 DOI: 10.1016/j.amjsurg.2025.116189

Mark Pedersen, Jillian Timperley, Bonnie Simpson Mason, Waddah Al-Refaie

引用次数: 0

Outpatient surgical institutions in the rural United States: Trends from 2010 to 2020 美国农村门诊外科机构：2010 - 2020年趋势

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-06 DOI: 10.1016/j.amjsurg.2025.116188

Vineeth Amba , Shawn Izadi , Tarun Ramesh , Hao Yu

{"title":"Outpatient surgical institutions in the rural United States: Trends from 2010 to 2020","authors":"Vineeth Amba , Shawn Izadi , Tarun Ramesh , Hao Yu","doi":"10.1016/j.amjsurg.2025.116188","DOIUrl":"10.1016/j.amjsurg.2025.116188","url":null,"abstract":"<div><h3>Background</h3><div>The volume and proportion of surgeries occurring in outpatient settings has increased. However, the growth and distribution of outpatient surgical institutions, namely ambulatory surgery centers (ASCs) and hospital-based outpatient surgical departments (HOPDs), remains understudied in rural areas.</div></div><div><h3>Methods</h3><div>We used descriptive statistics and a multivariate logistic regression to assess the growth and distribution of ASCs and HOPDs in rural areas from 2010 to 2020, leveraging the Area Health Resources Files and American Community Survey.</div></div><div><h3>Results</h3><div>From 2010 to 2020, the number of ASCs in rural counties decreased by 4.9 % (410 vs. 390), and rural HOPDs decreased by 14.3 % (1400 vs. 1200). Completely rural counties were over five times likelier to lack both ASCs and HOPDs (AOR = 5.32; 95 % CI = [4.82–5.89]); p < 0.001).</div></div><div><h3>Conclusions</h3><div>Outpatient surgical institution access in rural America declined. Policymakers should protect rural HOPDs, promote the creation of ASCs in rural communities, and incentivize surgeons to enter rural practice.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116188"},"PeriodicalIF":2.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998774","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}

引用次数: 0

The canaries in the coal mine: Medical and surgical trainees. 煤矿中的金丝雀：医学和外科实习生。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-06 DOI: 10.1016/j.amjsurg.2024.116173

M Tariq, K E Kopecky

引用次数: 0

A study of internal structure validity for the American board of surgery in training examination 美国外科委员会培训考试内部结构效度研究。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-03 DOI: 10.1016/j.amjsurg.2025.116184

Taylor M. Carter , Ting Sun , Andrew Jones , Brigitte K. Smith

{"title":"A study of internal structure validity for the American board of surgery in training examination","authors":"Taylor M. Carter , Ting Sun , Andrew Jones , Brigitte K. Smith","doi":"10.1016/j.amjsurg.2025.116184","DOIUrl":"10.1016/j.amjsurg.2025.116184","url":null,"abstract":"<div><h3>Background</h3><div>As principles of competency-based medical education are implemented into graduate medical education [GME] programs, it is imperative that the assessments employed are reliable and valid. Internal structure is a core component of validity evidence that has been under studied. In this study, we examined elements of the internal structure for the American Board of Surgery In-Training Examination [ABSITE].</div></div><div><h3>Methods</h3><div>This national retrospective cohort study utilized performance data for general surgery residents from 2018 to 2023 to determine aspects of the internal structure for the ABSITE. The item difficulty, item discrimination, internal consistency, and dimensionality of the exam were calculated.</div></div><div><h3>Results</h3><div>55,986 unique test results were obtained in the study. The ABSITE exhibits strong reliability, (Cronbach's alpha >0.9), and appropriate item difficulty (0.66) and item discrimination index (>0.2) for a formative examination. Results of the exploratory factor analysis reveals that the ABSITE is unidimensional.</div></div><div><h3>Conclusions</h3><div>The ABSITE is a unidimensional examination with strong reliability. Furthermore, the item difficulty and item discrimination levels of the exam are appropriate for a formative test. Future studies utilizing consensus methods could be employed to determine what specific construct is measured by the ABSITE.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116184"},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998769","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}

引用次数: 0

Read one, write one, dictate one 读一本，写一本，口述一本。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-03 DOI: 10.1016/j.amjsurg.2025.116179

Natalie M. Liu, Michael J. Campbell, Claire E. Graves

引用次数: 0

The scalpel or the scope? Balancing Prudence and Practicality for endoscopic submucosal dissection in early colorectal cancer 手术刀还是瞄准镜？早期结直肠癌内镜下粘膜下清扫术的审慎性与实用性的平衡。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-02 DOI: 10.1016/j.amjsurg.2024.116171

Bhuwan Giri

引用次数: 0

Development and dissemination of a series of surgical skills and procedures video tutorials using a novel, low-cost, and sustainable simulation kit (GlobalSurgBox) 利用新颖、低成本和可持续的模拟工具包（GlobalSurgBox），开发和传播一系列外科技能和程序视频教程。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-01 DOI: 10.1016/j.amjsurg.2024.116002

Mayte Bryce-Alberti , Rachel E. Wittenberg , Michael J. Kirsch , Daniel Bollinger , Kiana Winslow , Matthew T. Hey , Raisa Rauf , Barnabas Alayande , Geoffrey A. Anderson , Yihan Lin

{"title":"Development and dissemination of a series of surgical skills and procedures video tutorials using a novel, low-cost, and sustainable simulation kit (GlobalSurgBox)","authors":"Mayte Bryce-Alberti , Rachel E. Wittenberg , Michael J. Kirsch , Daniel Bollinger , Kiana Winslow , Matthew T. Hey , Raisa Rauf , Barnabas Alayande , Geoffrey A. Anderson , Yihan Lin","doi":"10.1016/j.amjsurg.2024.116002","DOIUrl":"10.1016/j.amjsurg.2024.116002","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator.</div></div><div><h3>Methods</h3><div>We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS).</div></div><div><h3>Results</h3><div>Videos ranged from surgical techniques to complex procedures. We uploaded these to <em>Youtube</em> and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ± 1.05 and GQS of 3.06 ± 0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty.</div></div><div><h3>Conclusions</h3><div>This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116002"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387352","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}

引用次数: 0

High risk populations for unplanned healthcare utilization following ostomy construction 造口术后意外使用医疗服务的高风险人群

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-01 DOI: 10.1016/j.amjsurg.2024.115799

Hannah Ficarino Sheffer , Madi Bruce , Chandler McLeod , Joshua Richman , Karin Hardiman , Daniel Chu , Smita Bhatia , Robert Hollis

{"title":"High risk populations for unplanned healthcare utilization following ostomy construction","authors":"Hannah Ficarino Sheffer , Madi Bruce , Chandler McLeod , Joshua Richman , Karin Hardiman , Daniel Chu , Smita Bhatia , Robert Hollis","doi":"10.1016/j.amjsurg.2024.115799","DOIUrl":"10.1016/j.amjsurg.2024.115799","url":null,"abstract":"<div><h3>Background</h3><div>Patients with a new ostomy have high rates of unplanned healthcare utilization (UPHU). We used machine learning to assess which factors contributed the most to UPHU after ostomy construction.</div></div><div><h3>Methods</h3><div>We retrospectively studied new ostomy patients between 2018 and 2021 at a single institution. The primary outcome was UPHU within 60 days of discharge. Factors that contributed the most to UPHU were assessed using a classification tree machine learning method.</div></div><div><h3>Results</h3><div>Among 318 patients, 30.8 % of patients had an UPHU event. The classification tree identified diabetes mellitus as the most important factor associated with UPHU: 56 % of diabetics had UPHU. Smoking history was the next most important factor: 77 % of diabetics who smoked had UPHU. Patients who had diabetes, smoked, and had chronic kidney disease had the highest UPHU rate at 86 %.</div></div><div><h3>Discussion</h3><div>Unplanned healthcare utilization after ostomy construction is highest among patients with diabetes, smoking history, and chronic kidney disease.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 115799"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413959","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}

引用次数: 0

The association of genetic testing timing and mutation type on breast cancer management in patients with breast cancer-related mutations 基因检测时间和突变类型对乳腺癌相关突变患者乳腺癌治疗的影响。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-01 DOI: 10.1016/j.amjsurg.2024.116005

Ebunoluwa J. Olunuga , Samantha M. Thomas , Koumani W. Ntowe , Juliet C. Dalton , Ton Wang , Akiko Chiba , Jennifer K. Plichta

{"title":"The association of genetic testing timing and mutation type on breast cancer management in patients with breast cancer-related mutations","authors":"Ebunoluwa J. Olunuga , Samantha M. Thomas , Koumani W. Ntowe , Juliet C. Dalton , Ton Wang , Akiko Chiba , Jennifer K. Plichta","doi":"10.1016/j.amjsurg.2024.116005","DOIUrl":"10.1016/j.amjsurg.2024.116005","url":null,"abstract":"<div><h3>Background</h3><div>We aim to characterize breast management for patients with genetic mutations and concurrent breast cancer (BC) or prior BC treatment.</div></div><div><h3>Methods</h3><div>Adults with a BC-related mutation and prior/concurrent BC diagnosis were identified. Groups were stratified by mutation type [<em>BRCA1/2</em>, high penetrance mutation (HPM), moderate penetrance mutation (MPM)] and timing of genetic testing (concurrent with BC versus after BC treatment). Outcomes were compared.</div></div><div><h3>Results</h3><div>Among 338 patients included, 63 % had <em>BRCA1/2</em> mutations, 9 % HPM, and 28 % MPM. Approximately 38 % had testing concurrent with a BC diagnosis and 62 % after BC treatment. Patients with concurrent testing favored bilateral mastectomy (57 %) versus 26 % lumpectomy, and 16 % unilateral mastectomy, which varied by mutation type. Patients previously treated preferred surveillance (92 % vs. 8 % additional surgery), regardless of mutation type.</div></div><div><h3>Conclusion</h3><div>The timing of a significant BC-related genetic test result and mutation type may be associated with management decisions among patients with breast cancer.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116005"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405916","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}

引用次数: 0