Mary E Klingensmith, Thomas H Cogbill, Frederick Luchette, Thomas Biester, Kelli Samonte, Andrew Jones, Frank R Lewis, Mark A Malangoni
OBJECTIVES: Surgery residency serves 2 purposes-prepare graduates for general surgery (GS) practice or postresidency surgical fellowship, leading to specialty surgical practice (SS). This study was undertaken to elucidate factors influencing career choice for these 2 groups. METHODS: All US allopathic surgery residency graduates from 2009 to 2013 (n = 5512) were surveyed by the American Board of Surgery regarding confidence, autonomy, and reasons for career selection between GS and SS...
September 2015: Annals of Surgery
Samer G Mattar, Adnan A Alseidi, Daniel B Jones, D Rohan Jeyarajah, Lee L Swanstrom, Ralph W Aye, Steven D Wexner, José M Martinez, Sharona B Ross, Michael M Awad, Morris E Franklin, Maurice E Arregui, Bruce D Schirmer, Rebecca M Minter
OBJECTIVE: To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America. METHODS: A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program directors. Respondents spanned minimally invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic specialties. There were 46 quantitative questions distributed across 5 domains and 1 or more reflective qualitative questions/domains...
September 2013: Annals of Surgery
Elise H Lawson, Rachel Louie, David S Zingmond, Robert H Brook, Bruce L Hall, Lein Han, Michael Rapp, Clifford Y Ko
OBJECTIVES: To compare the recording of 30-day postoperative complications between a national clinical registry and Medicare inpatient claims data and to determine whether the addition of outpatient claims data improves concordance with the clinical registry. BACKGROUND: Policymakers are increasingly discussing use of postoperative complication rates for value-based purchasing. There is debate regarding the optimal data source for such measures. METHODS: Patient records (2005-2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient and outpatient claims data sets...
December 2012: Annals of Surgery
Sophie Rym Hamada, Nathalie Delhaye, Sebastien Kerever, Anatole Harrois, Jacques Duranteau
BACKGROUND: The initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real "added value" of chest X-rays (CXRs) and pelvic X-rays (PXR), particularly in haemodynamically stable trauma patients. The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients...
December 2016: Annals of Intensive Care
R Gentry Wilkerson, Michael B Stone
OBJECTIVES: Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. METHODS: MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma...
January 2010: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
A W Kirkpatrick, M Sirois, K B Laupland, D Liu, K Rowan, C G Ball, S M Hameed, R Brown, R Simons, S A Dulchavsky, D R Hamiilton, S Nicolaou
BACKGROUND: Thoracic ultrasound (EFAST) has shown promise in inferring the presence of post-traumatic pneumothoraces (PTXs) and may have a particular value in identifying occult pneumothoraces (OPTXs) missed by the AP supine chest radiograph (CXR). However, the diagnostic utility of hand-held US has not been previously evaluated in this role. METHODS: Thoracic US examinations were performed during the initial resuscitation of injured patients at a provincial trauma referral center...
August 2004: Journal of Trauma
Oscar D Guillamondegui, John P Pryor, Vincente H Gracias, Rajan Gupta, Patrick M Reilly, C William Schwab
BACKGROUND: An anteroposterior pelvic radiograph (PXR) continues to be recommended by Advanced Trauma Life Support protocol as an early diagnostic adjunct in the resuscitation of blunt trauma patients. At the same time, computed tomographic (CT) scanning has become a practice standard for diagnosis of most abdominal and pelvic injury. The objective of this study was to determine the necessity of obtaining an early PXR in stable trauma patients who will undergo CT scanning during the initial resuscitation...
December 2002: Journal of Trauma
Nik Goyert, Gareth Eeson, Daniel J Kagedan, Ramy Behman, Madeline Lemke, Julie Hallet, Nicole Mittmann, Calvin Law, Paul J Karanicolas, Natalie G Coburn
OBJECTIVE: To determine the cost-effectiveness of perioperative administration of pasireotide for reduction of pancreatic fistula (PF). SUMMARY: PF is a major complication following pancreaticoduodenectomy (PD), associated with significant morbidity and healthcare-related costs. Pasireotide is a novel multireceptor ligand somatostatin analogue, which has been demonstrated to reduce the incidence of PF following pancreas resection; however, the drug cost is significant...
January 2017: Annals of Surgery
Peter J Allen, Mithat Gönen, Murray F Brennan, Adjoa A Bucknor, Lindsay M Robinson, Marisa M Pappas, Kate E Carlucci, Michael I D'Angelica, Ronald P DeMatteo, T Peter Kingham, Yuman Fong, William R Jarnagin
BACKGROUND: Postoperative pancreatic fistula is a major contributor to complications and death associated with pancreatic resection. Pasireotide, a somatostatin analogue that has a longer half-life than octreotide and a broader binding profile, decreases pancreatic exocrine secretions and may prevent postoperative pancreatic fistula. METHODS: We conducted a single-center, randomized, double-blind trial of perioperative subcutaneous pasireotide in patients undergoing either pancreaticoduodenectomy or distal pancreatectomy...
May 22, 2014: New England Journal of Medicine
Paul S Myles, Julian A Smith, Andrew Forbes, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D James Cooper, Silvana Marasco, John McNeil, Jean S Bussières, Shay McGuinness, Kelly Byrne, Matthew T V Chan, Giovanni Landoni, Sophie Wallace
BACKGROUND: Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. METHODS: In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo...
January 12, 2017: New England Journal of Medicine
Maureen V Hill, Michelle L McMahon, Ryland S Stucke, Richard J Barth
OBJECTIVE: To examine opioid prescribing patterns after general surgery procedures and to estimate an ideal number of pills to prescribe. BACKGROUND: Diversion of prescription opioids is a major contributor to the rising mortality from opioid overdoses. Data to inform surgeons on the optimal dose of opioids to prescribe after common general surgical procedures is lacking. METHODS: We evaluated 642 patients undergoing 5 outpatient procedures: partial mastectomy (PM), partial mastectomy with sentinel lymph node biopsy (PM SLNB), laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), and open inguinal hernia repair (IH)...
April 2017: Annals of Surgery
Peter Szasz, Esther M Bonrath, Marisa Louridas, Andras B Fecso, Brett Howe, Adam Fehr, Michael Ott, Lloyd A Mack, Kenneth A Harris, Teodor P Grantcharov
OBJECTIVES: The objectives of this study were to (1) create a technical and nontechnical performance standard for the laparoscopic cholecystectomy, (2) assess the classification accuracy and (3) credibility of these standards, (4) determine a trainees' ability to meet both standards concurrently, and (5) delineate factors that predict standard acquisition. BACKGROUND: Scores on performance assessments are difficult to interpret in the absence of established standards...
July 2017: Annals of Surgery
Alexa B Kimball, Martin M Okun, David A Williams, Alice B Gottlieb, Kim A Papp, Christos C Zouboulis, April W Armstrong, Francisco Kerdel, Michael H Gold, Seth B Forman, Neil J Korman, Evangelos J Giamarellos-Bourboulis, Jeffrey J Crowley, Charles Lynde, Ziad Reguiai, Errol-Prospero Prens, Eihab Alwawi, Nael M Mostafa, Brett Pinsky, Murali Sundaram, Yihua Gu, Dawn M Carlson, Gregor B E Jemec
BACKGROUND: Hidradenitis suppurativa is a painful, chronic inflammatory skin disease with few options for effective treatment. In a phase 2 trial, adalimumab, an antibody against tumor necrosis factor α, showed efficacy against hidradenitis suppurativa. METHODS: PIONEER I and II were similarly designed, phase 3 multicenter trials of adalimumab for hidradenitis suppurativa, with two double-blind, placebo-controlled periods. In period 1, patients were randomly assigned in a 1:1 ratio to 40 mg of adalimumab weekly or matching placebo for 12 weeks...
August 4, 2016: New England Journal of Medicine
J R Ingram, P N Woo, S L Chua, A D Ormerod, N Desai, A C Kai, K Hood, T Burton, F Kerdel, S E Garner, V Piguet
More than 50 interventions have been used to treat hidradenitis suppurativa (HS), and so therapy decisions can be challenging. Our objective was to summarize and appraise randomized controlled trial (RCT) evidence for HS interventions in adults. Searches were conducted in Medline, Embase, CENTRAL, LILACS, five trials registers and abstracts from eight dermatology conferences until 13 August 2015. Two review authors independently assessed study eligibility, extracted data and assessed methodological quality...
May 2016: British Journal of Dermatology
Ali Mehdizadeh, Paul G Hazen, Falk G Bechara, Nora Zwingerman, Marzyeh Moazenzadeh, Morteza Bashash, R Gary Sibbald, Afsaneh Alavi
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates. OBJECTIVE: This study provides a comprehensive systematic review of surgical approaches in the management of HS. METHODS: A systematic literature search and meta-analysis of proportions were performed on the included studies...
November 2015: Journal of the American Academy of Dermatology
F William Danby, Paul G Hazen, Jurr Boer
When the prevention of new lesions fails and when medical therapy of established and growing lesions is ineffective, surgery is the accepted method of dealing with hidradenitis suppurativa/acne inversa. The rationale and preferred techniques of mini-unroofing using a biopsy punch, deroofing using scissors, electrosurgery or laser, and classical wide excision and closure are discussed. The situation in which incision and drainage is considered for temporary pain relief would be best considered an opportunity for deroofing, as illustrated in the accompanying online videos...
November 2015: Journal of the American Academy of Dermatology
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