American journal of surgery最新文献

{"title":"Invited commentary for “How well do faculty do in providing general surgery EPA feedback?”","authors":"","doi":"10.1016/j.amjsurg.2024.115910","DOIUrl":"10.1016/j.amjsurg.2024.115910","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002961024004628/pdfft?md5=ec2da676485fce1c212516cfedac840b&pid=1-s2.0-S0002961024004628-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046125","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":"The “6th R” of sustainability: Repurposing operating room waste for community benefit","authors":"","doi":"10.1016/j.amjsurg.2024.115930","DOIUrl":"10.1016/j.amjsurg.2024.115930","url":null,"abstract":"<div><h3>Background</h3><p>Operating rooms contribute greatly to hospital waste and greenhouse gas production. Efforts to “green the operating room” have focused on the 5R's of sustainability: reduce, reuse, recycle, rethink, and research. We propose a “6th R” —repurposing— as simple yet effective means of addressing operating room waste.</p></div><div><h3>Methods</h3><p>Clean, non-reusable surgical supplies were collected from a satellite facility of a children's hospital during a six-week pilot program. Materials were catalogued and repurposed throughout the community. The potential financial benefits were estimated based upon the value of repurposed goods and savings from reduced waste disposal.</p></div><div><h3>Results</h3><p>Over 960 items were collected during the 6-week pilot. Materials ranging from plastic trays to surgical towels were donated to organizations throughout the community. Approximate retail value of repurposed items was over $1200. When extrapolated to the entire hospital system, these repurposing efforts could account for over $50,000 in donations and $1300 in operational savings over a calendar year.</p></div><div><h3>Conclusions</h3><p>Repurposing unused surgical items provide environmental, societal, and financial benefits, all while promoting more sustainable healthcare systems.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002961024004823/pdfft?md5=3aba372fb060a277f0919fc54f23db84&pid=1-s2.0-S0002961024004823-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083225","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":"Disparities in timely surgery among Asian American women with breast cancer.","authors":"Yuan-Hsin Chen, Ya-Wen Chen, David C Chang, Tawakalitu O Oseni","doi":"10.1016/j.amjsurg.2024.115928","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115928","url":null,"abstract":"<p><strong>Background: </strong>We investigated the likelihood of timely surgery for breast cancer patients among diverse Asian subgroups.</p><p><strong>Methods: </strong>We analyzed the National Cancer Database from 2010 to 2019 and included White and Asian women diagnosed with stage I-III breast cancer. Patients with multiple cancers, patients who received chemotherapy, and those diagnosed and treated at different hospitals were excluded. The primary outcome was timely surgery within 8 weeks of diagnosis. Race was the primary independent variable. Asian Americans were stratified by geography.</p><p><strong>Results: </strong>A total of 716,701 women were analyzed, with 3.5% Asians. Delayed surgery was experienced by 13.2% of women. Adjusted analysis indicated no difference in receiving timely surgery between all Asians and Whites. However, Southeast Asians were less likely to undergo timely surgery compared to Whites (OR 0.75, 95% CI 0.67-0.84).</p><p><strong>Conclusions: </strong>Variations among Asian ethnicities emphasize the need to explore treatment patterns to address disparities in breast cancer care.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139050","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":"How well do faculty do in providing general surgery EPA feedback?","authors":"","doi":"10.1016/j.amjsurg.2024.115902","DOIUrl":"10.1016/j.amjsurg.2024.115902","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;Entrustable Professional Activities (EPAs) provide a framework for competency-based assessment in surgery. EPA descriptions include observable behaviors by trainees at progressive levels of autonomy. The American Board of Surgery (ABS) required all General Surgery (GS) residency programs to implement assessment of 18 EPAs at the beginning of academic year 2023–2024. Microassessments provide formative self-reflection by the resident and feedback by faculty upon completion of the EPA. These frequent assessments culminate in a resident performance profile utilized by the trainee for formative growth and the clinical competency committee for summative feedback. Assessor free text comments are an opportunity to provide meaningful, constructive feedback to residents. Our aim was to analyze comments provided by faculty to residents in terms of their alignment with EPA descriptors and provision of actionable feedback.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A total of 540 ​GS EPA assessments for inguinal hernia, gallbladder disease, appendicitis, trauma, and surgical consultation were evaluated from 6/2021-12/2022. We assessed free text EPA comments from faculty compared to EPA behavior descriptions for alignment with the selected EPA level of entrustment. The comments were judged on a binary scale of “Align” vs “Not Align” by two independent evaluators, with a third evaluator to address discordance. Comments were then evaluated for resident behavioral descriptions, suggestions for improvement, and positive or negative feedback.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Approximately 77 ​% of EPA microassessments had alignment between level of autonomy and free text feedback. A common example of feedback discordant with level of autonomy was rating a trainee at an intraoperative level 4 (independent practice) with comments such as “required some guidance with retrocecal case and upsizing port.” Based on behavior descriptions this would be a level 3 (indirect supervision). Approximately 88 ​% of feedback contained positive comments with minimal negative feedback (e.g., “this did not go well.”). Actionable feedback including “work on optimization of retracting hand” or “continue to work clamp/tie technique and square off each knot” was present in 28.3 ​% of feedback.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;The majority of faculty provide feedback that is aligned with the behavioral anchors of the EPAs assessed, but frequently did not provide actionable feedback to the resident regarding how to advance to the next level of entrustment. EPA entrustment behaviors provide a framework for the development of practice-ready behaviors, and if assessors anchor their feedback in the behaviors for a given entrustment level and project how a resident could proceed to the next level, they can provide a clear trajectory for skill development. Faculty development should focus on improving the frequency of actionable free text feedback, outlining how residents c","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144971","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":"From the Editor – in – Chief: Papers from the Society of Black Academic Surgeons","authors":"","doi":"10.1016/j.amjsurg.2024.115915","DOIUrl":"10.1016/j.amjsurg.2024.115915","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046124","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":"Underrepresented in medicine (URiM) residents: A scoping review on prevalence trends & improving recruitment","authors":"","doi":"10.1016/j.amjsurg.2024.115924","DOIUrl":"10.1016/j.amjsurg.2024.115924","url":null,"abstract":"<div><h3>Background</h3><p>Disparities exist in underrepresented in medicine (URiM) resident representation. This review examines recent trends in resident diversity, URiM recruitment strategies, and identifies research gaps in equity, diversity, and inclusion (EDI) for URiM residents.</p></div><div><h3>Methods</h3><p>MEDLINE, EMBASE, Web of Science, and ERIC databases were searched for studies published from 2017 to 2022 on URiM resident prevalence and recruitment initiatives.</p></div><div><h3>Results</h3><p>3634 abstracts were reviewed, and 52 articles were included. 35 (67 ​%) studies reported on prevalence of URiM residents, demonstrating URiM resident composition is lower than residency applicant demographics, particularly in surgery. Seventeen (33 ​%) studies reported on URiM recruitment interventions, such as visiting clerkship programs, holistic review, and targeted outreach, and demonstrated success in increasing recruitment of URiM candidates to programs.</p></div><div><h3>Conclusions</h3><p>URiM residents remain disproportionately underrepresented, and markedly so among surgical residency programs. Further research should focus on implementing EDI interventions in surgery and assess URiM resident attrition post-matriculation.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002961024004768/pdfft?md5=abb732e56ad1578ec02b1fa5440206c8&pid=1-s2.0-S0002961024004768-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142086961","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":"Primary thyroid lymphoma: A multi-center retrospective review","authors":"","doi":"10.1016/j.amjsurg.2024.115927","DOIUrl":"10.1016/j.amjsurg.2024.115927","url":null,"abstract":"<div><h3>Background</h3><p>Primary thyroid lymphoma (PTL) is rare and diagnosis is challenging.</p></div><div><h3>Methods</h3><p>We conducted a multicenter retrospective study of patients with PTL from 1990 to 2023 to determine method of diagnosis, treatment, and outcomes.</p></div><div><h3>Results</h3><p>The study cohort included 31 patients with PTL; all had thyroid enlargement; 21 (68 ​%) had compressive symptoms, 11 (35 ​%) had hypothyroidism and 3 had (10 ​%) B symptoms. Diagnosis was established from incisional biopsy in 8 (26 ​%), needle biopsy in 4 (13 ​%), excisional lymph node biopsy in 1 (3 ​%), and thyroidectomy specimens in 18 (58 ​%). 15 (48 ​%) patients had Hashimoto thyroiditis. Treatment included chemotherapy in 19 (61 ​%); surgery alone in 7 (23 ​%); and radiation alone or with surgery in 5 (16 ​%) patients. One (3 ​%) patient recurred, and 4 (13 ​%) patients died after a median 4.2 years.</p></div><div><h3>Conclusion</h3><p>Diagnosis of PTL was made in only 13 ​% of patients preoperatively. There may be opportunity for needle biopsy to facilitate earlier diagnosis and treatment.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142097669","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":"A machine learning-based prediction model for delayed clinically important postoperative nausea and vomiting in high-risk patients undergoing laparoscopic gastrointestinal surgery","authors":"","doi":"10.1016/j.amjsurg.2024.115912","DOIUrl":"10.1016/j.amjsurg.2024.115912","url":null,"abstract":"<div><h3>Background</h3><p>Delayed clinically important postoperative nausea and vomiting (CIPONV) could lead to significant consequences following surgery. We aimed to develop a prediction model for it using machine learning algorithms utilizing perioperative data from patients undergoing laparoscopic gastrointestinal surgery.</p></div><div><h3>Methods</h3><p>All 1154 patients in the FDP-PONV trial were enrolled. The optimal features for model development were selected by least absolute shrinkage and selection operator and stepwise regression from 81 perioperative variables. The machine learning algorithm with the best area under the receiver operating characteristic curve (ROCAUC) was determined and assessed. The interpretation of the prediction model was performed by the SHapley Additive Explanations library.</p></div><div><h3>Results</h3><p>Six important predictors were identified. The random forest model showed the best performance in predicting delayed CIPONV, achieving an ROCAUC of 0.737 in the validation cohort.</p></div><div><h3>Conclusion</h3><p>This study developed an interpretable model predicting personalized risk for delayed CIPONV, aiding high-risk patient identification and prevention strategies.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002961024004641/pdfft?md5=d0a527ddb5319445771bba1fd6ab07d7&pid=1-s2.0-S0002961024004641-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049230","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":"Comparison of conventional resection to D3 lymphadenectomy in right-sided colon cancer: A retrospective cohort study","authors":"","doi":"10.1016/j.amjsurg.2024.115911","DOIUrl":"10.1016/j.amjsurg.2024.115911","url":null,"abstract":"<div><h3>Background</h3><p>Lymphadenectomy during right hemicolectomy for colon cancer varies between the U.S. and Japan.</p></div><div><h3>Methods</h3><p>Patients undergoing right hemicolectomy for non-metastatic right-sided colon cancer between 2010 and 2019 ​at U.S. and Japanese institutions were compared. Outcomes included survival, pathologic findings, and postoperative complications.</p></div><div><h3>Results</h3><p>319 American patients (57 ​% female, mean age 70 years) underwent conventional resection and 308 Japanese patients (52 ​% female, mean age 70 years) underwent extended dissection. The conventional group underwent more laparotomies (26.6 ​% vs. 8.4 ​%, p ​&lt; ​0.001), had more poorly differentiated histology (31.7 ​% vs. 11.0 ​%, <em>p</em> ​&lt; ​0.01), lower lymph node yield (<em>M</em> ​= ​27 ​± ​11 vs. <em>M</em> ​= ​32 ​± ​14, p ​&lt; ​0.001), and more 30-day readmissions (31 vs. 5, p ​&lt; ​0.001). Adjusting for demographics, pathology, perioperative outcomes, and adjuvant chemotherapy, extended lymphadenectomy improved disease-free survival (HR 0.50; 95 ​% CI, 0.31–0.80; p ​= ​0.004), but not overall survival (HR 0.98; 95 ​% CI, 0.95–1.02; p ​= ​0.14).</p></div><div><h3>Conclusions</h3><p>Extended lymphadenectomy for right sided-colon cancer improves disease-free, but not overall, survival among Japanese patients.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142041342","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":"Pediatric surgical border health: Supply may not be meeting demand in South Texas communities.","authors":"Toluwani Akinpelu, Aaron I Dadzie, Victoria M Jacobsen, Valentine S Alia, Nikhil R Shah, Edward M Diaz, Daniel Bolton","doi":"10.1016/j.amjsurg.2024.115908","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115908","url":null,"abstract":"<p><strong>Introduction: </strong>The Rio Grande Valley (RGV) has historically high incidence of congenital defects (CDs) necessitating intervention by pediatric surgical specialties. We examined mortality in this region and related workforce patterns.</p><p><strong>Methods: </strong>Mortality data related to CDs (2007-2021) and surgical workforce trends/projections (2024-2032) were collected using multiple databases: National Vital Statistics System, Texas Department of State Health Services, Texas Medical Board, Center for Disease Control.</p><p><strong>Results: </strong>Nationally, RGV counties rank as high as 5th in CD mortality rates. Between 2020 and 2024, 3 of 4 studied pediatric surgical specialties experienced stagnant/decreasing workforces ranging from 0 to 66 ​%. Furthermore, the RGV is projected to have some of the most marked state-wide disparities in surgical providers over the next 8 years.</p><p><strong>Conclusion: </strong>High infant mortality rates along with ongoing and future shortages of surgical specialists is concerning. These results may inform allocation of public health resources and workforce distribution to improve outcomes.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142091399","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}