American journal of surgery最新文献_第3页

The effect of social determinants of health on patient outcomes in acute trauma: A systematic review

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-05 DOI: 10.1016/j.amjsurg.2025.116284

Jaclyn N Portelli Tremont, Erik H. Ander, Szu-In Lim, Jared R. Gallaher, Trista Reid

{"title":"The effect of social determinants of health on patient outcomes in acute trauma: A systematic review","authors":"Jaclyn N Portelli Tremont, Erik H. Ander, Szu-In Lim, Jared R. Gallaher, Trista Reid","doi":"10.1016/j.amjsurg.2025.116284","DOIUrl":"10.1016/j.amjsurg.2025.116284","url":null,"abstract":"<div><h3>Introduction</h3><div>Social determinants of health (SDoH) may mediate disparities, but their effect on outcomes after trauma is not well known. The purpose of this review is to improve existing gaps of knowledge for a broad range of SDoH and trauma-related outcomes.</div></div><div><h3>Methods</h3><div>This was a systematic search to identify studies that evaluated the effect of race, insurance status, socioeconomic status (SES), health literacy, and community deprivation on inpatient mortality, morbidity, and post-discharge health care utilization in diverse trauma populations ≥16 years. Data were extracted on study design, patient and injury characteristics, outcomes, and covariates. Qualitative analysis was performed and reported results were stratified by exposure. An overall assessment of the strength of evidence for key clinically relevant comparisons was conducted.</div></div><div><h3>Results</h3><div>60 studies were included. Overall, race was not meaningfully predictive of mortality or morbidity, with evidence reporting inconsistent or small magnitude of effects. However, African American/Black race was consistently associated with decreased odds of discharge to rehabilitation. Compared to insured patients, uninsured patients may have greater mortality risk and be less likely to discharge to rehabilitation. Studies evaluating health literacy or community deprivation reported conflicting results.</div></div><div><h3>Conclusions</h3><div>Disparities related to race are most profound for post-discharge health care utilization, while insurance status may be a strong negative predictor of both mortality and discharge disposition. More research is needed on health literacy and community deprivation to better understand mechanisms of disparity after trauma. Interventions targeted at improving continuity of inpatient and outpatient care may be beneficial.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116284"},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609311","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

Sheltered yet unscreened: Exploring cancer screening rates and barriers in the unhoused (homeless) population

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-04 DOI: 10.1016/j.amjsurg.2025.116289

Talal Al-Assil , Claire Kalina , Madison C. Laird , Ryan C. Olivier , Nataly Dawood , Neya Suresh Kumar , Raven Riordan , Saad Shebrain , Cheryl Dickson , Gitonga Munene

{"title":"Sheltered yet unscreened: Exploring cancer screening rates and barriers in the unhoused (homeless) population","authors":"Talal Al-Assil , Claire Kalina , Madison C. Laird , Ryan C. Olivier , Nataly Dawood , Neya Suresh Kumar , Raven Riordan , Saad Shebrain , Cheryl Dickson , Gitonga Munene","doi":"10.1016/j.amjsurg.2025.116289","DOIUrl":"10.1016/j.amjsurg.2025.116289","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer related mortality amongst the homeless and unhoused has been reported to be significantly higher than the housed population. This study explores cancer screening uptake and barriers in a homeless community in Michigan.</div></div><div><h3>Methods</h3><div>Questionnaires were administered at two homeless shelters focusing on Hepatitis C (HCV), lung, breast, colon, and cervical cancer screenings.</div></div><div><h3>Results</h3><div>Amongst 143 participants, rates of screening uptake were lowest for breast cancer (44 %), followed by colorectal cancer (45 %), HCV (55 %), and cervical cancer (79 %). The three most common barriers to receiving screenings were lack of transportation (21.8 %), lack of access to or awareness of screenings (20.5 %), and low prioritization of health compared to other insecurities faced while being homeless (17.9 %).</div></div><div><h3>Conclusions</h3><div>Enhancing the unhoused/homeless community's access to cancer screenings is crucial. High willingness to undergo screenings suggests potential targeted interventions, such as providing transportation tokens and comprehensive educational resources, onsite screenings, and potentially employing social work navigators at shelters.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116289"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642280","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

From past to present: A comparison of interpersonal firearm violence between historically graded neighborhoods of Kansas City 从过去到现在：堪萨斯城历史上分级街区之间人际枪支暴力的比较

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-04 DOI: 10.1016/j.amjsurg.2025.116287

Terra M. Hill , Lauren T. Kerivan , Milind Phadnis , Christopher A. Guidry , Robert D. Winfield

{"title":"From past to present: A comparison of interpersonal firearm violence between historically graded neighborhoods of Kansas City","authors":"Terra M. Hill , Lauren T. Kerivan , Milind Phadnis , Christopher A. Guidry , Robert D. Winfield","doi":"10.1016/j.amjsurg.2025.116287","DOIUrl":"10.1016/j.amjsurg.2025.116287","url":null,"abstract":"<div><h3>Background</h3><div>Interpersonal firearm violence (IFV) has been connected to the structural racism of redlining. We explored the relationship between historic redlining and IFV with population-level factors.</div></div><div><h3>Methods</h3><div>A cross-sectional study of IFV within historically graded neighborhoods was performed, and incidence rate ratios (IRRs) between these neighborhoods and the rate of IFV were modeled with a Poisson regression model.</div></div><div><h3>Results</h3><div>Comparing redlined to non-redlined neighborhoods, the IRRs adjusted for income was 14.9 (p < 0.0001), adjusted for poverty was 14.4 (p < 0.0001), adjusted for uninsured was 15.6 (p < 0.0001), and adjusted for IFV-related mortality was 26.05 (p < 0.0001). After county adjustment, every one unit increase in logarithm of income decreases the IFV rate by 64.7 % (p < 0.0001), whereas every one percent increase of poverty and uninsured, increases the IFV rates by 4.1 % (p < 0.0001) and 3.05 % (p < 0.0002), respectively.</div></div><div><h3>Conclusion</h3><div>Historically redlined communities have higher rates of IFV in Kansas City, Kansas.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116287"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561742","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

Association of immediate symmetrizing oncoplastic surgery with patient-reported outcomes in patients with breast cancer – A retrospective cohort study

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-04 DOI: 10.1016/j.amjsurg.2025.116286

Martin Heidinger , Gilles Bilfeld , Nico Föge , Julie M. Loesch , Nadia Maggi , Rama Kiblawi , Ruth S. Eller , Marie Louise Frevert , Fabienne D. Schwab , Christian Kurzeder , Tibor A. Zwimpfer , Walter P. Weber

{"title":"Association of immediate symmetrizing oncoplastic surgery with patient-reported outcomes in patients with breast cancer – A retrospective cohort study","authors":"Martin Heidinger , Gilles Bilfeld , Nico Föge , Julie M. Loesch , Nadia Maggi , Rama Kiblawi , Ruth S. Eller , Marie Louise Frevert , Fabienne D. Schwab , Christian Kurzeder , Tibor A. Zwimpfer , Walter P. Weber","doi":"10.1016/j.amjsurg.2025.116286","DOIUrl":"10.1016/j.amjsurg.2025.116286","url":null,"abstract":"<div><h3>Introduction</h3><div>Oncoplastic breast surgery (OPS) with immediate symmetrization is commonly performed. However, its impact on patient-reported outcomes (PROs) remains uncertain.</div></div><div><h3>Methods</h3><div>Patients with stage 0-III breast cancer who underwent OPS (including oncoplastic breast conserving surgery, or nipple- or skin-sparing mastectomy) at a Swiss university hospital between 01/2013-12/2023 who completed a postoperative BREAST-Q questionnaire were identified from a prospectively maintained database. A generalized linear model was used to detect differences in PROs between those who underwent unilateral versus immediate symmetrizing surgery.</div></div><div><h3>Results</h3><div>Of 441 eligible patients, 333 (75.5 %) underwent unilateral OPS, while 108 (24.5 %) underwent bilateral OPS. Median time to PRO assessment was 35.1 months (Q1-Q3 13.4–49.5). No differences in PROs were identified between patients who underwent unilateral versus bilateral OPS. Short-term surgical morbidity was more common in patients who underwent symmetrizing surgery, which negatively impacted PROs.</div></div><div><h3>Conclusion</h3><div>The present study did not demonstrate any impact of immediate symmetrization on PROs.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116286"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577165","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

Enhancing healthcare outcomes through interprofessional collaboration: Challenges and future directions.

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-03 DOI: 10.1016/j.amjsurg.2025.116283

Nikita Nunes Espat, Sanjan Kumar, Heather X Rhodes-Lyons, Adel Elkbuli

引用次数: 0

Parathyroid autotransplantation: Nonsense or nuance?

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-28 DOI: 10.1016/j.amjsurg.2025.116279

Niranjna Swaminathan, C Corbin Frye

引用次数: 0

Individual- versus neighborhood-level social determinants of health-related factors and their associations with postoperative morbidity

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-27 DOI: 10.1016/j.amjsurg.2025.116280

Vaishnavi Krishnan , Stephanie M. Trautmann , Gwyneth A. Sullivan , Talib Chaudhry , Alison C. Coogan , Brian C. Gulack , Ami N. Shah

{"title":"Individual- versus neighborhood-level social determinants of health-related factors and their associations with postoperative morbidity","authors":"Vaishnavi Krishnan , Stephanie M. Trautmann , Gwyneth A. Sullivan , Talib Chaudhry , Alison C. Coogan , Brian C. Gulack , Ami N. Shah","doi":"10.1016/j.amjsurg.2025.116280","DOIUrl":"10.1016/j.amjsurg.2025.116280","url":null,"abstract":"<div><h3>Background</h3><div>Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are neighborhood-level measures of social determinants of health. This study compares individual-level Z codes with these neighborhood-level measures through spatial analysis and their associations with postoperative morbidity.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients at an urban hospital between 2015 and 2021. Spatial autocorrelation was assessed using Global Moran's I. A multivariable logistic regression model assessed their association with 30-day postoperative morbidity.</div></div><div><h3>Results</h3><div>There was no spatial autocorrelation for Z codes (Moran's I: 0.001, p = .96), but there was for ADI (Moran's I:0.013, p < .001) and SVI (Moran's I:0.007, p < .001). Z codes were associated with 90 % increased odds of morbidity [CI:1.39–2.58]. For every one-point increase in ADI, odds of morbidity increased by 7 % [CI:1.04–1.11], but SVI was not associated.</div></div><div><h3>Conclusions</h3><div>Both individual- and neighborhood-level factors were associated with increased postoperative morbidity. However, Z codes demonstrate greater predictive value than neighborhood-level measures.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116280"},"PeriodicalIF":2.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563477","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

Diversity equity and inclusions in an academic surgery department: Exploring the present and building a future.

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-27 DOI: 10.1016/j.amjsurg.2025.116261

Denzel R Woode, Beth Ann Reimel, Jacqueline Valdez Gonzalez, Jorge Reyes, Douglas E Wood, Elina Quiroga, Tam N Pham, Estell Williams

{"title":"Diversity equity and inclusions in an academic surgery department: Exploring the present and building a future.","authors":"Denzel R Woode, Beth Ann Reimel, Jacqueline Valdez Gonzalez, Jorge Reyes, Douglas E Wood, Elina Quiroga, Tam N Pham, Estell Williams","doi":"10.1016/j.amjsurg.2025.116261","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116261","url":null,"abstract":"<p><strong>Introduction: </strong>The University of Washington Department of Surgery (DoS) Diversity Council created a survey to understand our socio-demographics, identify gaps regarding Diversity, Equity and Inclusion (DEI) initiatives, and support efforts prioritizing DEI.</p><p><strong>Methods: </strong>An anonymous, voluntary online survey was administered over 5 weeks to DoS members. Quantitative and qualitative analysis were performed using SurveyMonkey and Dedoose, respectively.</p><p><strong>Results: </strong>Response rate was 59 % (300/507). Questions assessed demographics, beliefs, and priorities. 43 % of respondents agreed that the DoS addresses DEI effectively. While 99 % agreed that racism exists in society, 49 % agreed that it exists in the DoS. Key priorities included pipeline issues, recruitment, and retention of under-represented in Medicine (URM) faculty.</p><p><strong>Discussion: </strong>While heartened by our progress, our URM pipeline, recruitment, and retention remain a concern. Yet, we commit to promoting greater understanding around DEI, increasing URM in our pipeline, and improving our culture to increase retention and promotion of URM department-members.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116261"},"PeriodicalIF":2.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613042","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

From the Editor – In – Chief

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-26 DOI: 10.1016/j.amjsurg.2025.116278

Herbert Chen MD (Editor-in-Chief)

引用次数: 0

Learning how to suture: Should learners observe a demonstration of someone who is experienced or inexperienced to improve their own performance?

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-25 DOI: 10.1016/j.amjsurg.2025.116276

Portia Kalun , Ranil Sonnadara

{"title":"Learning how to suture: Should learners observe a demonstration of someone who is experienced or inexperienced to improve their own performance?","authors":"Portia Kalun , Ranil Sonnadara","doi":"10.1016/j.amjsurg.2025.116276","DOIUrl":"10.1016/j.amjsurg.2025.116276","url":null,"abstract":"<div><h3>Background</h3><div>We explored the influence of observing experienced or inexperienced demonstrators on a learner's own performance of a simple, interrupted suture.</div></div><div><h3>Methods</h3><div>Participants without suturing experience observed videos of an experienced or inexperienced demonstrator suturing, rated the performance, and then practiced the task; this was repeated twice more. Suturing performance was rated using a modified Objective Structured Assessment of Technical Skills (OSATS). We calculated participants' accuracy in rating the demonstrator's performances. Data were analyzed using mixed model analyses of variance (ANOVAs) and pairwise t-tests.</div></div><div><h3>Results</h3><div>Participants who observed the experienced demonstrator significantly improved their suturing performance. Participants who observed the inexperienced demonstrator became significantly more accurate at rating the demonstrator's performance.</div></div><div><h3>Conclusions</h3><div>Learners who are new to suturing can improve their suturing performance through observation of an experienced demonstrator and physical practice. While the experiment itself was conducted in-person, learners could engage in this method of learning remotely.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116276"},"PeriodicalIF":2.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548683","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