American journal of surgery最新文献

{"title":"Who's on the healthcare team? Nurse navigators in the era of information transparency.","authors":"Elizabeth A O'Brien, Abigail Ludwigson, Madeline G Higgins, Sarah Tevis","doi":"10.1016/j.amjsurg.2024.116070","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116070","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116070"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612276","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":"Artificial intelligence based assessment of minimally invasive surgical skills using standardised objective metrics - A narrative review.","authors":"D Kankanamge, C Wijeweera, Z Ong, T Preda, T Carney, M Wilson, V Preda","doi":"10.1016/j.amjsurg.2024.116074","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116074","url":null,"abstract":"<p><strong>Introduction: </strong>Many studies display significant heterogeneity in the reliability of artificial intelligence (AI) assessment of minimally invasive surgical (MIS) skills. Our objective is to investigate whether AI systems utilising standardised objective metrics (SOMs) as the basis of skill assessment can provide a clearer understanding of the current state of such technology.</p><p><strong>Methods: </strong>We systematically searched Medline, Embase, Scopus, CENTRAL and Web of Science from March 2023 to September 2023. Results were compiled as a narrative review.</p><p><strong>Results: </strong>Twenty-four citations were analysed. Overall accuracy of AI systems in predicting overall SOM score of a procedure ranged from 63 ​% to 100 ​%. The most frequently used SOM by AI algorithms were Objective Structured Assessment of Technical Skills (OSATS) (8/24) and Global Evaluative Assessment of Robotic Skills (GEARS) (8/24).</p><p><strong>Conclusions: </strong>Stratifying for AI studies which employed SOMs to assess surgical skill did not reduce heterogeneity of reported reliability. Our study identifies key issues within the current literature, which, once addressed, could allow more meaningful comparisons between studies.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"116074"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674702","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":"Analysis of the incidence and outcomes of breast cancer in women with schizophrenia.","authors":"Jennifer Den, Nicole Nelson, V Suzanne Klimberg","doi":"10.1016/j.amjsurg.2024.116050","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116050","url":null,"abstract":"<p><strong>Objective: </strong>Breast cancer (BC) is the leading cause of female cancer death in the world and the second leading cause of female cancer death in the U.S, Mortality from breast cancer is even higher in individuals with schizophrenia. The aim of our project was to evaluate the incidence of breast cancer in women with schizophrenia and to compare outcomes between breast cancer patients who were or were not on antipsychotics prior to diagnosis.</p><p><strong>Methods: </strong>This retrospective study used data from the TriNetX database. Women ≥18 years old diagnosed with schizophrenia were identified. The incidence of primary BC diagnosis between January 2011 and December 2023 was evaluated and stratified by ethnicity. We then conducted a retrospective cohort study to compare outcomes of women ≥18 years who did or did not use antipsychotics one year before BC diagnosis. Patients' propensity score was matched based on age, obesity, tobacco use, socioeconomic status, cancer stage, chemoradiation, axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and hormone therapy use. Outcomes of interest were 5-year overall survival, recurrence, chemotherapy need, and lymphedema.</p><p><strong>Results: </strong>1,398,475 women ≥18 years old with schizophrenia were identified. Breast cancer incidence in these patients was 0.53 ​% in 2011 and 0.53 ​% in 2022, with a peak in 2017 (1.29 ​%). Non-Hispanic patients were diagnosed with BC approximately 1.3 times more than Hispanic patients. The outcomes study included 183,062 matched patients, with 91,531 per cohort. 5-year survival with the Kaplan-Meier analysis was significantly greater in women not on antipsychotics (72 ​%) compared to those on antipsychotics (60 ​%), log-rank test p-value <0.0001. The risk of local recurrence (13.4 ​% versus 22.6 ​%, p-value <0.0001), chemotherapy need (41.2 ​% versus 48.4 ​%, p-value <0.0001), and lymphedema (7.7 ​% versus 11.5 ​%, p-value <0.0001) were also significantly lower in women who did not take antipsychotics.</p><p><strong>Conclusion: </strong>Breast cancer incidence in patients with schizophrenia identified through TriNetX has not experienced a significant uptrend or downtrend over the past decade. Non-Hispanic patients with schizophrenia have a higher incidence of BC than Hispanic patients. Matched breast cancer patients on antipsychotics at least one year prior to diagnosis had higher mortality, recurrence, chemotherapy need, and risk of lymphedema.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116050"},"PeriodicalIF":2.7,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638558","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":"Parental leave policies are failing female physicians.","authors":"Nastassia Pham, Catherine H Davis","doi":"10.1016/j.amjsurg.2024.116066","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116066","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116066"},"PeriodicalIF":2.7,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643255","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":"Effects of the COVID-19 pandemic on the providers of oncological abdominal surgery services– a scoping review","authors":"Murielle Madi ,&nbsp;Marcus Heise ,&nbsp;Lisa Rieder ,&nbsp;Elke Mattern ,&nbsp;Ulrich Ronellenfitsch ,&nbsp;Anke Steckelberg","doi":"10.1016/j.amjsurg.2024.116068","DOIUrl":"10.1016/j.amjsurg.2024.116068","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic, led to significant global health challenges. Medical services worldwide had to reconfigure to manage the surge in COVID-19 cases, including oncological abdominal surgery (OAS). This study investigates the impact of the pandemic on the OAS workforce and aims to enhance future healthcare preparedness to potential pandemics.</div></div><div><h3>Methods</h3><div>This scoping review followed the methodologies from Arksey &amp; O'Malley and the Joanna Briggs Institute. The search included the databases MEDLINE, CINAHL, Cochrane Library, and Web of Science, with backward citation tracking using Google Scholar™. The results were reported narratively and divided in categories and sub-categories. The reporting followed the PRISMA-ScR guidelines.</div></div><div><h3>Results</h3><div>Fifteen studies were included in this scoping review. Seven studies were conducted in the United Kingdom and eight in the European Union. Key findings include treatment plan alterations such as postponing or cancelling surgeries, referring patients to alternative treatments, and changes in surgical techniques. Organizational challenges included patient and healthcare professionals’ reallocation, resource shortages, and cold site availability. Measures to handle COVID-19 included adherence to guidelines, patient prioritization, and nursing roles. Testing and contamination prevention involved routine testing and the use of protective equipment. Communication shifted to virtual formats, with the introduction of telemedicine and video conferences. The pandemic induced significant psychological stress among surgical teams and highlighted lessons for future pandemics.</div></div><div><h3>Discussion and conclusion</h3><div>The COVID-19 pandemic required substantial adjustments in oncological surgery. Keeping up with rapidly changing recommendations was challenging, yet provided valuable lessons for future healthcare management and crisis response. Future pandemic preparedness strategies should include innovative solutions that unburden healthcare professionals.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116068"},"PeriodicalIF":2.7,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612288","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":"Beyond Grit and Resilience: An AWS series on surgical culture change.","authors":"Fatima Qamar, Alexandra E Hernandez, Lisa K Cannada, Caitlin McMullen","doi":"10.1016/j.amjsurg.2024.116065","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116065","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116065"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612237","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":"Stent strategies: Endothelial progenitor cell coated stents vs sirolimus eluting stents in a pairwise meta-analysis","authors":"Srishti Kohli ,&nbsp;Daksh Kohli ,&nbsp;Raghav Gupta","doi":"10.1016/j.amjsurg.2024.116055","DOIUrl":"10.1016/j.amjsurg.2024.116055","url":null,"abstract":"<div><h3>Background</h3><div>Endothelial progenitor cells (EPCs) capturing stents were developed to enhance endothelial repair and reduce the risk of stent thrombosis, addressing limitations of Sirolimus-Eluting Stents (SES). This study aims to compare the safety and efficacy of EPC stents versus SES in patients undergoing percutaneous coronary intervention (PCI).</div></div><div><h3>Methods</h3><div>We performed a meta-analysis following PRISMA guidelines in patients undergoing PCI treated with Sirolimus eluting stent (SES) vs the use of EPC stents and recognized 8 clinical trials with patients undergoing PCI and reporting outcomes such as Target Lesion Failure (TLF), stent thrombosis, and revascularisation. Relative risks were calculated using a random effects model and heterogeneity was assessed with I^2 statistics.</div></div><div><h3>Results</h3><div>The EPC group showed higher incidence of TLF (RR ​= ​1.28), MI(RR ​= ​1.10), and cardiac death (RR ​= ​1.19) compared to SES, though these differences were not statistically significant. Revascularisation rates were significantly higher in EPC group with TVR (RR ​= ​1.60) and TLR(RR ​= ​2.20) while stent thrombosis was lower (RR ​= ​0.93).</div></div><div><h3>Conclusion</h3><div>The results of this EPC study reveals that while EPC stents show promise in revascularisation and lowering stent thrombosis, they are also associated with higher incidence of adverse events. The utility of EPC, especially vast reendothelialization, may have niche applications but their full potential can be realized with more rigorous trials as a clear advantage over SES remains lacking.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116055"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602873","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":"Making surgical education intuitive: A surgical robotics primer for pre-clinical medical students","authors":"Sarah E. Adkins ,&nbsp;Dylan T. Vance ,&nbsp;Katelyn Sanner Dixon ,&nbsp;Jalee Birney ,&nbsp;Joshua Lawton ,&nbsp;Tyler Elmendorf ,&nbsp;Benjamin Stone ,&nbsp;German Berbel ,&nbsp;Lyndsey J. Kilgore","doi":"10.1016/j.amjsurg.2024.116057","DOIUrl":"10.1016/j.amjsurg.2024.116057","url":null,"abstract":"<div><h3>Background</h3><div>As robotic surgeries increase nationwide, residency programs are implementing commensurate curriculum. Medical student exposure and comfort with these surgeries, however, is lagging. This program sought to improve student interest and confidence through additional robotic exposure.</div></div><div><h3>Methods</h3><div>A two-part educational program was implemented at an academic institution. Part-one included a surgeon-led lecture and part-two a hands-on robotics primer where students were exposed to 3-D anatomy and instrumentation via robotic console. Data was collected via RedCap and analyzed for significance (p ​&lt; ​0.05).</div></div><div><h3>Results</h3><div>Thirty-two students participated in part one, ten of which were selected for part two. The majority (82 ​%) reported being interested or very interested in pursuing additional robotic experiences and 40 ​% reported improved confidence in actively assisting in a robotics case (p ​&lt; ​0.005).</div></div><div><h3>Conclusion</h3><div>Conducting robotic exposure events improves medical students' confidence and interest in seeking future robotic surgery experiences. As robotic surgery expands, medical students have shown to benefit from earlier exposure.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116057"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612284","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":"Access to results of patient reported outcome surveys did not improve longitudinal patient reported outcomes in breast cancer patients in a randomized controlled trial","authors":"Madeline G. Higgins ,&nbsp;Sudheer Vemuru ,&nbsp;Laura Helmkamp ,&nbsp;Monica Adams ,&nbsp;Kathryn Colborn ,&nbsp;Hannah Parris ,&nbsp;Victoria Huynh ,&nbsp;Nicole Christian ,&nbsp;Gretchen Ahrendt ,&nbsp;Clara Lee ,&nbsp;Simon Kim ,&nbsp;Dan Matlock ,&nbsp;Ethan Cumbler ,&nbsp;Sarah Tevis","doi":"10.1016/j.amjsurg.2024.116054","DOIUrl":"10.1016/j.amjsurg.2024.116054","url":null,"abstract":"<div><h3>Background</h3><div>We assessed the impact of breast cancer (BC) patients receiving their own patient-reported outcome (PRO) results on future PROs.</div></div><div><h3>Methods</h3><div>Newly diagnosed female BC patients completed validated measures of satisfaction with breasts (SB), and psychosocial (PsyW), physical (PhW), and sexual wellbeing (SW) longitudinally during treatment. Patients were randomized to receive their PRO scores (Intervention) or not (Control). The primary outcome was difference in PRO scores from baseline to 1-year post-surgery. T- and chi²-tests compared baseline characteristics between groups. Linear mixed models assessed differences in PRO changes over time.</div></div><div><h3>Results</h3><div>131 patients (70 intervention, 61 control) completed baseline and 1-year modules; groups were well-balanced. At 1-year, the intervention group had less improvement in PsyW compared to controls with a <em>t</em>-test (mean difference: 1.2 vs 8.3, p ​= ​0.04); this difference did not remain in mixed models (intervention group effect estimate (SE) 1.7 (2.1) vs control group 7.0 (2.2), p ​= ​0.08). Changes in SB, PhW, and SW did not differ.</div></div><div><h3>Conclusions</h3><div>Access to individual PRO scores throughout treatment did not improve BC patients’ future PROs.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116054"},"PeriodicalIF":2.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577839","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":"Risk of financial catastrophe for breast cancer patients in Nigeria: A retrospective analysis","authors":"Norah N. Zaza ,&nbsp;Matt Caputo ,&nbsp;Frances I. Uwechue ,&nbsp;Sophia Okeke ,&nbsp;Toluwanimi Aduloju ,&nbsp;Zainab Adegbite ,&nbsp;Chinenye Iwuji ,&nbsp;Chukwumere Nwogu ,&nbsp;Bindiya Sadarangani ,&nbsp;Kristina Diaz ,&nbsp;Egide Abahuje ,&nbsp;Juliet S. Lumati","doi":"10.1016/j.amjsurg.2024.116053","DOIUrl":"10.1016/j.amjsurg.2024.116053","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer imposes significant financial burden on patients in low and middle-income countries like Nigeria, where breast cancer (BC) is the most common cancer and has the highest mortality. This study aims to investigate the financial burden of BC care at Lakeshore Cancer Center (LCC) in Nigeria and identify risk factors for financial catastrophe (FC).</div></div><div><h3>Methods</h3><div>LCC was queried for uninsured patients diagnosed with breast cancers between 2013 and 2023, linked to cost data through chart abstraction of billing data and adjusted to 2023 USD. All costs were out-of-pocket costs (OOP) as all patients were uninsured. Risk for financial catastrophe was defined as OOP exceeding 20 ​% of Nigeria's 2023 per capita GDP ($467). Total OOP and risk for financial catastrophe were measured with descriptive statistics and stratified by clinical characteristics.</div></div><div><h3>Results</h3><div>352 BC patients (99 ​% female, median age 47, 41 ​% stage 4, 28 ​% stage 3) were included. 260 (74 ​%) patients risked financial catastrophe, despite only 30 ​% completing treatment. Patients with HER2+/HR ​+ ​disease exhibited the highest treatment costs. Among patients that underwent multiple treatment modalities (n ​= ​130), the average OOP was $17992 with 100 ​% risking financial catastrophe. The highest contributors to the cohort's total costs were chemotherapy (29 ​%), immunotherapy (18 ​%), and other drugs (12 ​%). Surgery contributed 7 ​%.</div></div><div><h3>Discussion</h3><div>Less than one-third of BC patients completed treatment, and the majority faced financial catastrophe, especially those with HER2+/HR ​+ ​disease and patients who underwent multiple treatment modalities or immunotherapy. Targeted efforts are essential to ensure equitable access to quality cancer care while minimizing risk of financial catastrophe.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116053"},"PeriodicalIF":2.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593145","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}