Surgery

Expertise in surgery is essential to ensure the best outcomes across various phases of surgical care. Expertise is multidimensional and is both domain- and context-specific. It encompasses a broad range of knowledge, skills, and professional attributes. General expertise is characterized by pattern recognition, rapid and effective decision-making, fluency of actions, and efficiency in performance. Adaptive expertise involves complex decision-making and exceptional performance within the context of unexpected findings, unusual circumstances, complex systems, and the rapidly changing surgical environment...

BACKGROUND: Perioperative efficiency has been studied, although little is known about patient and personnel factors associated with a timely operating room start. We hypothesize that patient, personnel factors, and induction-order decisions are associated with anesthesia induction time. METHODS: An institutional database was used to identify the anesthesia induction time of adults undergoing first-start, elective operations from January 2014 to May 2017 at an academic quaternary care center...

BACKGROUND: Vessel ligation with a knot is one of the most fundamental tasks surgeons must master. We developed a simulator designed to enable novices to acquire and refine gentle knot tying capabilities. METHODS: A bench-top, knot-tying simulator with computer-acquired assessment was tested on expert surgeons and surgery residents at an academic medical center during the years 2016 to 2018. Each participant tied a total of 8 knots in different settings (superficial versus deep) and techniques (1-handed versus 2 hands)...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: The evidence is conflicting regarding the effect of delays from the time of diagnosis to surgery on the survival in patients with hepatocellular carcinoma. We sought to investigate the impact of time to surgery on overall survival for patients who underwent curative resection for primary hepatocellular carcinoma. METHODS: We performed a retrospective review of all patients who underwent liver resection for primary hepatocellular carcinoma between the years 2000 and 2015...

BACKGROUND: Hypertension with hyperaldosteronism could be associated with stroke attributable to endothelial injury. Whether the detrimental effect of aldosterone on stroke among primary aldosteronism patients could be mitigated by administration of mineralocorticoid receptor antagonist or by reduction of aldosterone level via adrenalectomy is still inconclusive. METHODS: Primary aldosteronism and essential hypertensive patients were enrolled in the Taiwan National Health Insurance from 1997 to 2009...

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BACKGROUND: The use of lightweight mesh for inguinal hernia repair has been suggested to be preferable compared with heavyweight mesh. Nevertheless, surgeons do not use lightweight mesh routinely, possibly owing to the higher price and lack of confidence in evaluation of previous evidence. The aim of this systematic review and meta-analysis is to update the available randomized controlled trials and provide a recommendation on the use of lightweight mesh or heavyweight mesh in open inguinal hernia repair...

No abstract text is available yet for this article.

BACKGROUND: Incidental adrenal masses are those that are found on imaging performed for any nonadrenal evaluation. Published guidelines define accepted follow-up criteria for incidental adrenal masses; however, adherence to these guidelines and barriers to appropriate follow-up are not well understood. We aimed to describe practice patterns for the discovery, evaluation, and follow-up of incidental adrenal masses. METHODS: Medical records of patients with an incidental adrenal mass underwent retrospective review at a tertiary referral and level-1 trauma center, as well as regional ambulatory care locations...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Primary hyperparathyroidism is associated with an increased cardiovascular mortality, but mechanisms underlying this association are unclear. The goal of this study was to evaluate coronary artery calcifications via the coronary calcification score in primary hyperparathyroidism patients, to compare with control subjects, and to identify risk factors for high to intermediate risk coronary calcification scores (coronary calcification score >100). METHOD: Cross-sectional study of primary hyperparathyroidism patients without a history of coronary artery disease, diabetes, or severe, chronic kidney disease...

INTRODUCTION: The incidence of severe perioperative renal dysfunction in high-acuity patients has not been well-explored at the national level. The present study aimed to evaluate the trends in the incidence of perioperative acute kidney injury and renal replacement therapy as well as associated mortality among patients undergoing an emergency general surgery operation. METHODS: This was a retrospective cohort study using the National Inpatient Sample to identify all adult patients (>18 y) without chronic kidney disease who underwent an emergency general surgery procedure from 2008 to 2016...

No abstract text is available yet for this article.

Workplace-based assessments are used by raters to evaluate observed performance of trainees in actual clinical practice. These types of assessments are of growing interest, especially because observed performance is prioritized within the larger competency-based medical educational movement. Implementation of workplace-based assessments has, however, been challenging. This article describes the motivations and implications for workplace-based assessments that leverage smartphone technology. It does so in reference to an app called SIMPL (System for Improving and Measuring Procedural Learning) in order to highlight some of the challenges and benefits one might encounter during implementation of similar systems...

BACKGROUND: Earlier studies have demonstrated poor concordance between patients' advance care preferences and those endorsed by their surrogate health care decision makers in a medical setting. This study aimed to determine concordance in the perioperative setting among high-risk patients and to identify areas for improvement. METHODS: This was a prospective cohort study set in a preoperative clinic for high-risk patients. Patients (>55 y) and their surrogates (dyads) were eligible for participation...

No abstract text is available yet for this article.

No abstract text is available yet for this article.