American Surgeon最新文献_第8页

Evaluating the Factors Influencing Residency Match for Surgical Specialty Applicants and Programs: Challenges and Future Directions. 评估影响外科专科申请者和项目住院实习匹配的因素：挑战与未来方向。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-06-20 DOI: 10.1177/00031348241262427

Heli Patel, D-Dre Wright, Nickolas Hernandez, Alaina Werling, Emelia Watts, William S Havron, Adel Elkbuli

{"title":"Evaluating the Factors Influencing Residency Match for Surgical Specialty Applicants and Programs: Challenges and Future Directions.","authors":"Heli Patel, D-Dre Wright, Nickolas Hernandez, Alaina Werling, Emelia Watts, William S Havron, Adel Elkbuli","doi":"10.1177/00031348241262427","DOIUrl":"10.1177/00031348241262427","url":null,"abstract":"IntroductionWe aim to evaluate the impact of recent changes in the residency matching process on surgical specialties' applicants and programs to offer recommendations on residency selection and matching processes.MethodsWe utilized five databases while employing a Boolean query to search for studies from 2015 to March 2024. The search selection focused on factors and recent changes influencing residency match results across surgical specialties, including USMLE Step 1 pass/fail, research productivity, interview structure, and preference and geographic signaling.ResultsThe shift of the USMLE Step 1 to a pass/fail scoring system revealed a consensus among surgical program directors (PDs) and applicants not in favor of the change due to the emphasis on additional application elements. Research productivity was identified as a significant factor, especially in neurosurgery (with an average of 18.3 publications per applicant) and vascular surgery (8.3 publications), indicating a positive correlation between the number of publications and match outcomes. The adoption of virtual interviews has been well-received by both applicants and PDs, leading to an increase in the number of interviews offered and applicants. The implementation of preference and geographic signaling mechanisms has improved interview rates for applicants who utilize them.ConclusionThe transition to a pass/fail USMLE Step 1 has raised concerns among surgical specialties, necessitating a greater focus on Step 2 scores and research productivity. Virtual interviews and signaling have improved the accessibility and reach of the residency application process, however, the full impact of these changes on the perception of applicant-program fit remains unclear.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"386-392"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431178","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}

引用次数: 0

Oncocytic Adrenal Neoplasms: Clinical Profiles and Long-Term Outcomes. 肿瘤性肾上腺肿瘤：临床概况和长期疗效。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-10-21 DOI: 10.1177/00031348241292727

Alaa Sada, Josiane Joseph, Reem Alsibai, Elizabeth B Habermann, Trenton R Foster, Melanie L Lyden, Benzon M Dy, Irina Bancos, Travis J McKenzie

{"title":"Oncocytic Adrenal Neoplasms: Clinical Profiles and Long-Term Outcomes.","authors":"Alaa Sada, Josiane Joseph, Reem Alsibai, Elizabeth B Habermann, Trenton R Foster, Melanie L Lyden, Benzon M Dy, Irina Bancos, Travis J McKenzie","doi":"10.1177/00031348241292727","DOIUrl":"10.1177/00031348241292727","url":null,"abstract":"Background: Oncocytic adrenal neoplasms, defined by ≥90 % of oncocytic cells, are rare. The significance of oncocytic changes within an adrenal neoplasm remains unclear.Methods: A retrospective study of adults who underwent adrenalectomy at a large center identified pure oncocytic neoplasms on final pathology (1997-2022). Neoplasms were categorized based on Lin-Weiss-Bisceglia system as malignant, benign, or of uncertain malignant potential. Analysis was performed using Fisher exact, Kruskal-Wallis tests, and Kaplan-Meier analysis.Results: Among a total of 33 patients, 24% had benign, 36% malignant, and 39% neoplasm of uncertain malignant potential. None of the benign neoplasms recurred, while 50% of the malignant neoplasms recurred (median of 40 months). Two of 13 neoplasms initially thought to be of uncertain malignant potential recurred as distant metastatic adrenocortical carcinoma at 11 and 25 months, over a median follow-up duration of 31 months. Ki67% was available for 20 patients: median (IQR) Ki67% was 5 (1, 5) for benign, 10 (6, 15) for malignant, and 6.5 (5, 10) for neoplasms of uncertain behavior, P = 0.05. Recurred neoplasms had higher Ki67% at initial resection compared to cases that did not recur.Conclusion: While oncocytic adrenal neoplasms are rare, a significant proportion are malignant or have malignant potential. Judicious follow-up is required for oncocytic adrenal neoplasms of uncertain malignant potential, as they can recur as metastatic adrenocortical carcinoma. Ki67% should always be obtained in cases of malignancy or uncertain malignant potential as it can predict recurrence. Larger studies are needed to evaluate the appropriate follow-up protocols for these neoplasms.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"381-385"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456239","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}

引用次数: 0

The Impact of Non-trauma Factors on Trauma Patient Mortality and Hospital Resource Utilization: Population-Based Retrospective Review. 非创伤因素对创伤患者死亡率和医院资源利用率的影响：基于人群的回顾性研究。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-12 DOI: 10.1177/00031348241300368

Mariel Javier, Ilko Luque, Jaclyn Kliewer, Nicole Yordan Lopez, David Ritchie, Beatriz Cobo Dominguez, Orlando Morejon

{"title":"The Impact of Non-trauma Factors on Trauma Patient Mortality and Hospital Resource Utilization: Population-Based Retrospective Review.","authors":"Mariel Javier, Ilko Luque, Jaclyn Kliewer, Nicole Yordan Lopez, David Ritchie, Beatriz Cobo Dominguez, Orlando Morejon","doi":"10.1177/00031348241300368","DOIUrl":"10.1177/00031348241300368","url":null,"abstract":"BackgroundThe death of trauma patients with low injury severity scores (ISS) may not be fully explained by the severity of their injuries. Our objective was to evaluate preexisting conditions (PECs) that may contribute to the mortality rate of and hospital resources consumed by patients with low ISS.MethodsTrauma patients with ISS <9 were selected from the National Trauma Database Bank [NTDB] [2019-21]. Bivariate and multivariate analysis identified the risk factors associated with mortality, adjusting for secondary PECs, mechanism of injury, AIS body region, vital signs, and blood transfusion. A t test was used to compare PEC status with intensive care unit (ICU) and hospital length of stay (LOS) for significant differences (P < .05).Results1,689,392 patients suffered mild injuries [59.1% male, mean age 45.2, 8579 expired (0.5%)]. Mortality was associated with the presence of several risk factors, especially advanced directive [OR = 9.13, P < .001], cirrhosis [OR = 8.55, P < .001], disseminated cancer [OR = 8.53, P < .001], congestive heart failure (CHF) [OR = 6.62, P < .001], chronic renal failure (CRF) [OR = 6.16, P < .001], chemotherapy for cancer [OR = 5.64, P < .001], peripheral arterial disease (PAD) [OR = 5.32, P < .001], myocardial infarction (MI) [OR = 4.96, P < .001], dementia [OR = 4.62, P < .001], and functionally dependent health [OR = 4.57, P < .001]. In addition, there was a relationship between the presence of several PECs and increased ICU and hospital LOS, especially cirrhosis, CRF, CHF, and PAD.DiscussionNontraumatic factors and preexisting conditions are associated with increased mortality and hospital resource consumption in trauma patients with a low ISS. They should be considered during clinical decision-making for these patients, who may otherwise masquerade as part of a low-risk population.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"365-373"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612381","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}

引用次数: 0

Impact of Gastrointestinal Bleeding on Prognosis and Associated Risk Factors in Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis. 胃肠道出血对胃肠道间质瘤预后的影响及相关风险因素：系统回顾与元分析》。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-12-14 DOI: 10.1177/00031348241307402

Shuchen Bai, Yefei Sun, Hao Xu

{"title":"Impact of Gastrointestinal Bleeding on Prognosis and Associated Risk Factors in Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis.","authors":"Shuchen Bai, Yefei Sun, Hao Xu","doi":"10.1177/00031348241307402","DOIUrl":"10.1177/00031348241307402","url":null,"abstract":"BackgroundGastrointestinal stromal tumors (GISTs) are common mesenchymal tumors of the digestive tract. The impact of gastrointestinal bleeding on the prognosis of GISTs remains controversial. This study aims to evaluate the prognostic significance of gastrointestinal bleeding in GIST patients and analyze associated risk factors.MethodsA systematic review and meta-analysis were conducted according to the PRISMA guidelines. PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane Library databases were searched for relevant studies published up until December 31, 2023. The pooled hazard ratio (HR) with a 95% confidence interval (CI) was used to estimate the relationship between gastrointestinal bleeding and prognosis. Subgroup analyses were performed based on bleeding location and other risk factors.ResultsTwelve studies involving 3475 patients were included. Gastrointestinal bleeding significantly affected the prognosis of GIST patients, including recurrence-free survival (RFS) (HR = 1.57, 95% CI: 0.98-2.52, P < .01) and overall survival (OS) (HR = 3.04, 95% CI: 1.33-6.97, P < .01). Patients with gastric GIST bleeding had significantly worse prognoses (HR = 4.37, 95% CI: 2.36-8.11, P < .01), while small intestinal bleeding showed no significant difference. The bleeding risk was lower in the small intestine compared to the stomach (HR = .63, 95% CI: 0.48-0.83, P < .01). Age under 65, male gender, tumor size ≥5 cm, and mitotic index ≥5 HPF were identified as high-risk factors for GIST bleeding.ConclusionsGastrointestinal bleeding significantly impacts the prognosis of GIST patients, particularly in those with gastric bleeding.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"434-443"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823770","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}

引用次数: 0

The Effect of the Adoption of the National Accreditation Program for Rectal Cancer Process on Compliance Standards at a Single Institution. 采用直肠癌国家评审计划对一家机构遵守标准的影响。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-10-14 DOI: 10.1177/00031348241292730

Garrett W Peters, Gregory Thomas, Jacob A Applegarth, Joanna Wasvary, Forrest Bohler, Rose E Callahan, Shelli Bergeron, Harry J Wasvary

{"title":"The Effect of the Adoption of the National Accreditation Program for Rectal Cancer Process on Compliance Standards at a Single Institution.","authors":"Garrett W Peters, Gregory Thomas, Jacob A Applegarth, Joanna Wasvary, Forrest Bohler, Rose E Callahan, Shelli Bergeron, Harry J Wasvary","doi":"10.1177/00031348241292730","DOIUrl":"10.1177/00031348241292730","url":null,"abstract":"Background: The National Accreditation Program for Rectal Cancer (NAPRC) was developed to enhance the quality of rectal cancer care in the United States. This project compared NAPRC compliance at a single tertiary care academic hospital before and after the institution adopted these standards in 2019. Methods: Rectal cancer patients from 2016 to 2023 who met NAPRC eligibility criteria were retrospectively reviewed for compliance with pre-selected patient care standards. Patients diagnosed prior to August 1, 2019 (pre-NAPRC) were compared with those diagnosed afterward (post-NAPRC) to determine whether compliance with these standards differed following the institution's adoption of new guidelines. Results: This study included 353 patients, 146 pre-NAPRC and 207 post-NAPRC. The post-NAPRC group demonstrated significantly higher compliance with pretreatment standards compared to the pre-NAPRC group, including attaining magnetic resonance imaging (MRI) (P = .015), computed tomography (CT) (P < .001), and a carcinoembryonic antigen (CEA) level (P < .001). Postoperative standards were more frequently met in the post-NAPRC group regarding the photographing of surgical specimens (P < .001). No significant differences were observed in confirming a tissue diagnosis, starting treatment within a 60-day timeframe, or completing surgical pathology reports. Prior to initiation of the NAPRC process, the institution had achieved accreditation-level compliance in 2 of the 7 standards. Within 2 years of adopting NAPRC standards, complete compliance was met in 6 of the 7 measures. Conclusions: A single institution's adoption of NAPRC standards improved compliance with multiple rectal cancer care standards, achieving near-complete accreditation level compliance within 2 years.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"345-350"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456240","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}

引用次数: 0

Establishment of a Predictive Model for Seroma Formation After TAPP Repair for Unilateral Indirect Inguinal Hernia in Males. 建立男性单侧间接腹股沟疝 TAPP 修复术后血清肿形成的预测模型

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-11 DOI: 10.1177/00031348241300369

Xue-Feng Peng, Miao Yu, Deng-Chao Wang

{"title":"Establishment of a Predictive Model for Seroma Formation After TAPP Repair for Unilateral Indirect Inguinal Hernia in Males.","authors":"Xue-Feng Peng, Miao Yu, Deng-Chao Wang","doi":"10.1177/00031348241300369","DOIUrl":"10.1177/00031348241300369","url":null,"abstract":"BackgroundInguinal hernia repair, particularly using TAPP, is common in males, and acclaimed for minimal invasiveness but often complicated by seromas, significantly affecting recovery and health care costs.MethodsThis retrospective study analyzed data from 266 male patients with unilateral indirect inguinal hernia who underwent transabdominal preperitoneal (TAPP) repair. We divided the patients into a training set (n = 188) and a validation set (n = 78). We employed logistic regression to identify independent risk factors for post-TAPP seroma and developed a nomogram to predict the occurrence of seromas. The model's accuracy was evaluated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit test, calibration curves, and decision curve analysis (DCA).ResultsPostoperatively, 20.3% of patients developed a seroma. Multivariate logistic regression analysis highlighted several independent risk factors for seroma formation: the use of anticoagulants, an internal ring defect ≥5 cm, scrotal hernia, incarcerated hernia, and transected hernia sac (P < 0.05). The ROC curves for the training and validation sets demonstrated areas under the curve of 0.893 (95% CI: 0.845-0.942) and 0.864 (95% CI: 0.765-0.963), respectively, indicating good model fits (P > 0.05). DCA confirmed significant clinical applicability of the model.ConclusionThe findings suggest that the use of anticoagulants, an internal ring defect ≥5 cm, scrotal hernia, incarcerated hernia, and transected hernia sac are significant independent risk factors for seroma formation after TAPP repair. Clinical consideration of these factors and proactive preventive measures are essential. Although many of these factors are non-modifiable, understanding them is crucial for preoperative risk assessment and patient management.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"351-360"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612333","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}

引用次数: 0

Resection of Mediastinal Lymph Node Metastasis From HCC Using ICG Fluorescence Imaging and Repeat Resection of Its Solitary Recurrence. 利用ICG荧光成像切除肝癌纵隔淋巴结转移灶并再次切除其单发复发灶

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-11 DOI: 10.1177/00031348241300366

Takaomi Ozawa, Nobuyuki Takemura, Kyoji Ito, Fuminori Mihara, Fuyuki Inagaki, Satoshi Nagasaka, Kazuhiko Yamada, Norihiro Kokudo

引用次数: 0

The Surgeon's Role in Disaster and Counterterrorism Medicine. 外科医生在灾难和反恐医学中的作用。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-12-01 DOI: 10.1177/00031348241303995

Derrick Tin, Joshua E Lane, John Floyd

引用次数: 0

Expression of Concern. 表达关心。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2025-01-10 DOI: 10.1177/00031348241305412

引用次数: 0

Evaluation of New Mental Health Diagnoses After Pediatric Traumatic Injuries at a Level 1 Pediatric Trauma Center. 一级儿科创伤中心对儿科创伤后新心理健康诊断的评估。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-12 DOI: 10.1177/00031348241300358

Marshall W Wallace, Stephanie E Iantorno, Zachary J Moore, Bryan Tate Colton, Brooks Keeshin, Robert A Swendiman, Katie W Russell

{"title":"Evaluation of New Mental Health Diagnoses After Pediatric Traumatic Injuries at a Level 1 Pediatric Trauma Center.","authors":"Marshall W Wallace, Stephanie E Iantorno, Zachary J Moore, Bryan Tate Colton, Brooks Keeshin, Robert A Swendiman, Katie W Russell","doi":"10.1177/00031348241300358","DOIUrl":"10.1177/00031348241300358","url":null,"abstract":"BackgroundTraumatic injury is associated with significant mental health morbidity. To evaluate the need for implementation of active-post injury mental health screening at a Level 1 Pediatric Trauma center, we aimed to characterize all new mental health diagnoses after injury and evaluated for patient or injury factors that may aid in targeting of future screening.MethodsA single-center retrospective analysis of trauma patients aged 6-18 years presenting in 2022 was performed. Our primary outcome was a new DSM-5 mental health diagnosis documented after traumatic injury. Patients with and without a new mental health diagnosis were compared by age, sex, race, ethnicity, injury type/mechanism, injury severity score (ISS), intensive care unit (ICU) admission, and length of stay (LOS).Results492 patients were included. Their median (IQR) age was 13.5 (10.4, 15.4) years. The median (IQR) follow-up interval was 157 (9, 429) days. There were 24 (4.9%) children with a new mental health diagnosis: 12 (50%) with trauma-related stress disorders, with the remaining having diagnoses such as depressive or anxiety disorders. Patients with a new mental health diagnosis had longer LOS (3.0 [1.8, 7.5] vs 2.0 [1.0, 3.3] days, P = 0.02) and were more likely to have sustained penetrating injury (P = 0.01). There were no differences in demographics, rates of preexisting mental health diagnosis or area deprivation index (P > 0.05).DiscussionThere were fewer new mental health diagnoses in our cohort than expected, likely underestimating the acute need. Comprehensive post-injury screening is imperative to sufficiently identify and intervene upon mental health morbidity after pediatric trauma.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"374-380"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612337","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}

引用次数: 0