American Surgeon最新文献

{"title":"Discrepancies in the Reporting of Hiatal Hernia Size: A Review.","authors":"Timothy Nehila, Theo Sher, Samer Ganam, Joseph Sujka, Christopher DuCoin","doi":"10.1177/00031348251329465","DOIUrl":"https://doi.org/10.1177/00031348251329465","url":null,"abstract":"<p><p>BackgroundIn the current literature there is a paucity of both standardized diagnostic criteria and accurate methods for determining hernia size. The aim of this review is to describe the most common methods for reporting hiatal hernia size.MethodsLiterature search using PubMed and Embase databases was performed. After exclusion and screening, 67 articles were analyzed and data were collected on hernia type and subtype, diagnostic method, size reporting method, and the author's definition of hernia size (measurement protocol).ResultsAuthors publishing on hiatal hernia size employed 8 different methods for diagnosing hiatal hernias and reported data using 7 distinct measurement types. Within individual diagnostic methods there was a further lack of standardization of measurement protocols.ConclusionOur review underscores the critical need for standardized reporting methods in the assessment and reporting of hiatal hernia size. Moving forward, collaboration is essential to establish and adopt standardized guidelines for reporting hiatal hernia size, ultimately improving patient care and outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329465"},"PeriodicalIF":1.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Care: The Role of Hospital-Based Violence Intervention Programs.","authors":"Vanessa Arientyl, Christine Castater, Lucy Hart, Randi N Smith","doi":"10.1177/00031348251329464","DOIUrl":"https://doi.org/10.1177/00031348251329464","url":null,"abstract":"<p><p>Limited access along the continuum of trauma care, at any point, may lead to significant health disparities. Trauma care begins with prevention and pre-hospital services and extends to inpatient care, post-hospital rehabilitation, and recovery. If looking at violent injuries, specifically, there are clear opportunities for hospital systems, trauma centers, and individual providers to promote awareness, provide education, engage with communities, embody trauma-informed care, and mitigate violence. These include community-focused initiatives like Stop the Bleed and hospital-based violence intervention programs. Failure to provide access to care poses a significant risk of increased incidence of violent injury and poor health. Therefore, policymakers and health care professionals alike should prioritize access to care and violence prevention to reduce the incidence of trauma and promote health, safety, and well-being for all communities.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329464"},"PeriodicalIF":1.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Planned Stoma Before Neoadjuvant Chemoradiation in Patients With Endoscopically Obstructing Colorectal Cancer.","authors":"Zhan-Xiang Hai, Jun-Nan Zhao, Xu-Rui Liu, Shu-Pei Qu, Quan Lv, Chun-Yi Wang","doi":"10.1177/00031348251329482","DOIUrl":"https://doi.org/10.1177/00031348251329482","url":null,"abstract":"<p><p>PurposeIn order to investigate whether colorectal cancer (CRC) patients with endoscopic obstruction benefited from a planned stoma before neoadjuvant chemoradiation (nCRT).MethodsPatients who were diagnosed with CRC with endoscopic obstruction at a single clinical center from January 2017 to April 2022 were retrospectively collected. Baseline characteristics and short-term and long-term outcomes were compared between the stoma group and the no stoma group. Statistical analysis was performed using SPSS (version 22.0) software.ResultsA total of 51 CRC patients with endoscopic obstruction were included in this study. Eleven (21.6%) patients received a planned stoma before nCRT, and 40 (78.4%) patients were treated with immediate nCRT. The mean time from diagnosis to nCRT was 30.6 days for the stoma group and 11.9 days for the no stoma group. There was a significant delay in the initiation of nCRT in the stoma group (<i>P</i> < 0.05). In terms of complications, there was a statistical difference between the stoma group and the no stoma group (<i>P</i> < 0.05). Planned stoma before nCRT did not affect survival for patients with endoscopically obstructing CRC (<i>P</i> > 0.05).ConclusionA planned stoma caused delay in nCRT; the no stoma group was more likely to develop perforation or obstruction of the tumor during nCRT. A comprehensive assessment might be needed to determine whether a planned stoma was necessary in CRC patients with endoscopic obstruction.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329482"},"PeriodicalIF":1.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the Maternal Health Crisis in Rural Georgia: Challenges, Disparities, and Pathways to Improvement.","authors":"Myah M Griffin, Natalie D Hernandez, Anahit Mehranian, Deidre V R Wright, Kiwita Phillips, Raimot Olanrewaju, Cheryl G Franklin","doi":"10.1177/00031348251329477","DOIUrl":"https://doi.org/10.1177/00031348251329477","url":null,"abstract":"<p><p>The maternal health crisis in the United States, marked by alarming maternal mortality rates, necessitates a multidisciplinary response, including from surgical specialties. Despite a decline in maternal mortality rates in 2022, disparities remain, with Black women experiencing significantly higher risks of complications. In Georgia, the maternal mortality rate is notably elevated, particularly in rural areas lacking access to obstetric care. Effective initiatives, such as utilizing informative research to establish impactful community health programs and obstetrical rural residency tracks to address the rural obstetrical provider shortage, aim to bridge these gaps. By equipping local health care providers with advanced skills and utilizing telehealth, surgeons can enhance maternal care accessibility in rural communities. This collaborative approach is vital for improving maternal health outcomes and addressing systemic barriers, ultimately fostering health equity for all women.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329477"},"PeriodicalIF":1.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Environmental Determinants of Health on Access to Surgical Care.","authors":"Temisan Blagogee, Jenaye Burrows, Darren Gopaul, Shaneeta Johnson","doi":"10.1177/00031348251323708","DOIUrl":"https://doi.org/10.1177/00031348251323708","url":null,"abstract":"<p><p>Environmental determinants significantly impact the health of individuals and populations contributing to increased rates of traumatic injuries, higher cancer incidence, and disruptions in access to healthcare systems and surgical services. Additionally, the healthcare industry contributes significantly to climate change, negatively impacting the earth's environment in both developed and developing nations. Natural disasters such as hurricanes and wildfires cause destruction of hospitals, clinics, pharmacies, and even supply chain facilities, hindering patient access to surgical care. These impacts were recently evidenced by the recent hurricanes Helene and Milton, which struck the Southeast US, hindering access and delivery of surgical care. Damage to infrastructure caused by hurricanes can compromise emergency response efforts, limiting access to essential services, and interrupting healthcare delivery. The increase in traumatic injuries because of natural disasters, coupled with damage to infrastructure, places an additional strain on healthcare systems' ability to provide essential and critical care. While the direct immediate effects of natural disasters and other environmental determinants can be substantial, a decrease in regular and consistent access to healthcare can lead to a long-term decline in community health. Continuous evaluation of cultural and environmental factors that impact the health care system's capacity to provide care is necessary to inform interventions to improve the health system's ability to adapt to provide continued access to care and serve the surgical community.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323708"},"PeriodicalIF":1.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Galen's Surgical Legacy: Treating the Children in Ancient Rome.","authors":"Michele Augusto Riva, Francesco Petrella, Maria Emilia Paladino","doi":"10.1177/00031348251329486","DOIUrl":"https://doi.org/10.1177/00031348251329486","url":null,"abstract":"<p><p>Galen of Pergamon (128-216 AD) is one of the most renowned physicians of antiquity, known for his extensive contributions to various medical disciplines. His early career included treating traumatic injuries, which developed his knowledge of human anatomy and surgical techniques. The aim of this work is to analyze the contributions of Galen to the history of pediatric surgery. Galen's work in pediatric surgery is notable for its detailed case reports and methods, such as using healing poultices. He emphasized the necessity of surgery only when required, criticizing colleagues who endangered patient safety. Galen's writings also provide unique insights into the health of children in Imperial Rome, offering information not easily found in other sources. His meticulous approach to patient care and willingness to adapt treatments based on age and condition highlight his advanced medical understanding. In conclusion, Galen's impact on surgery extended into the Middle Ages and beyond, making his works essential for anyone interested in the history of surgery and particularly in the history of pediatric surgical practices.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329486"},"PeriodicalIF":1.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Large Language Models in the Diagnosis of Acute Cholecystitis: Assessing Accuracy and Guidelines Compliance.","authors":"Marta Goglia, Arianna Cicolani, Francesco Maria Carrano, Niccolò Petrucciani, Francesco D'Angelo, Marco Pace, Lucio Chiarini, Gianfranco Silecchia, Paolo Aurello","doi":"10.1177/00031348251323719","DOIUrl":"https://doi.org/10.1177/00031348251323719","url":null,"abstract":"<p><p>BackgroundLarge language models (LLMs) are advanced tools capable of understanding and generating human-like text. This study evaluated the accuracy of several commercial LLMs in addressing clinical questions related to diagnosis and management of acute cholecystitis, as outlined in the Tokyo Guidelines 2018 (TG18). We assessed their congruence with the expert panel discussions presented in the guidelines.MethodsWe evaluated ChatGPT4.0, Gemini Advanced, and GPTo1-preview on ten clinical questions. Eight derived from TG18, and two were formulated by the authors. Two authors independently rated the accuracy of each LLM's responses on a four-point scale: (1) accurate and comprehensive, (2) accurate but not comprehensive, (3) partially accurate, partially inaccurate, and (4) entirely inaccurate. A third author resolved any scoring discrepancies. Then, we comparatively analyzed the performance of ChatGPT4.0 against newer large language models (LLMs), specifically Gemini Advanced and GPTo1-preview, on the same set of questions to delineate their respective strengths and limitations.ResultsChatGPT4.0 provided consistent responses for 90% of the questions. It delivered \"accurate and comprehensive\" answers for 4/10 (40%) questions and \"accurate but not comprehensive\" answers for 5/10 (50%). One response (10%) was rated as \"partially accurate, partially inaccurate.\" Gemini Advanced demonstrated higher accuracy on some questions but yielded a similar percentage of \"partially accurate, partially inaccurate\" responses. Notably, neither model produced \"entirely inaccurate\" answers.DiscussionLLMs, such as ChatGPT and Gemini Advanced, demonstrate potential in accurately addressing clinical questions regarding acute cholecystitis. With awareness of their limitations, their careful implementation, and ongoing refinement, LLMs could serve as valuable resources for physician education and patient information, potentially improving clinical decision-making in the future.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323719"},"PeriodicalIF":1.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"South Asian Immigration to the US: From Collective Farms to High-Tech Cities Through H-1B Visas.","authors":"Don K Nakayama","doi":"10.1177/00031348251323856","DOIUrl":"https://doi.org/10.1177/00031348251323856","url":null,"abstract":"<p><p>With origins in the conscripted labor system of nineteenth century European colonies, the South Asian diaspora began in the early twentieth. Migrants faced racial hostility, their foreignness identifiable by skin color, physiognomy, languages unintelligible to Anglophone ears, and customs and religions that confirmed them as heathens in a Christian country. More threatening was their capacity for hard work at substandard wages. Driven out of the Pacific Northwest by mob violence, Sikhs from Punjab brought the intensive farming practices of their native Indus Valley to the agricultural districts of California. Prohibited by statute from owning land, they formed farming collectives to pool their modest plots and capital into larger acreages that were competitive with the industrial farms of the Central and Imperial Valleys. Prejudice and economic competition drove laws and policies that prohibited Asian naturalization (Barred Zone Act, 1917). In 1924, the Johnson-Reed Act set quotas that barred migration from India. Unable to establish second generations, by the 1940s Sikh agricultural settlements were threatened with extinction. Anti-Asian policies unwound in the last half of the twentieth century. Prohibitions against Asian immigration were lifted in 1965. Preferred were those trained in science, technology, and medicine. In 1990 the H-1B visa system added workers in the nascent fields of information technology and computer science, fields where the Indian educational system was robust. After a half-century of immigration policies that favored the highly schooled in science and technology, South Asian communities were created that were intellectually, financially, and socially accomplished, transforming American society.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323856"},"PeriodicalIF":1.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: Estimated Blood Volume (EBV)-Based Dosing as an Alternative to BW-Based Dosing.","authors":"Jana K Elsawwah, Zoltan H Nemeth","doi":"10.1177/00031348251323715","DOIUrl":"https://doi.org/10.1177/00031348251323715","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323715"},"PeriodicalIF":1.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ileocecectomy as an Acceptable Alternative to Right Hemicolectomy in Trauma: A Propensity Score Matched TQIP Analysis.","authors":"Devanshi D Patel, Andrew M Fleming, Andrew J Kerwin, Cory Evans, Emily K Lenart, Dina M Filiberto, Saskya Byerly","doi":"10.1177/00031348251323699","DOIUrl":"https://doi.org/10.1177/00031348251323699","url":null,"abstract":"<p><strong>Background: </strong>Ileocecectomy (IC) as an alternative to right hemicolectomy (RH) for traumatic indication is controversial with limited comparison data. We sought to compare IC vs RH for traumatic injury and hypothesized there was no difference in outcomes.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Program database was queried from 2017 to 2022 with IC and RH patients evaluated using propensity score matching (PSM) in a 1:3 ratio. Presenting factors and outcomes were analyzed.</p><p><strong>Results: </strong>After PSM, 558 RH and 186 IC patients had no difference in age, penetrating mechanism, time to OR and injury severity score. RH patients were more likely to have unplanned ICU admission (8.6% vs 3.8%, <i>P</i> = 0.03) and organ space infection (7.5% vs 3.2%, <i>P</i> = 0.04) but similar rates of acute kidney injury (<i>P</i> = 0.5), unplanned OR (<i>P</i> > 0.9) and mortality (<i>P</i> = 0.08) compared to IC patients.</p><p><strong>Conclusions: </strong>Traumatic colon injury managed by ileocecectomy had similar outcomes compared to right hemicolectomy and should be considered an acceptable alternative when anatomically feasible.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323699"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}