Journal of the American College of Surgeons
-
Randomized Controlled Trial Comparative Study Pragmatic Clinical Trial
Program Director Perceptions of Surgical Resident Training and Patient Care under Flexible Duty Hour Requirements.
The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial was a national, cluster-randomized, pragmatic, noninferiority trial of 117 general surgery programs, comparing standard ACGME resident duty hour requirements ("Standard Policy") to flexible, less-restrictive policies ("Flexible Policy"). Participating program directors (PDs) were surveyed to assess their perceptions of patient care, resident education, and resident well-being during the study period. ⋯ Program directors involved in the FIRST trial perceived improvements in patient safety, continuity of care, and multiple aspects of resident education and well-being with flexible duty hours.
-
Venous thromboembolism (VTE) can be a devastating postoperative complication, with about one-third of VTEs occurring post-discharge. We previously retrospectively evaluated the Caprini VTE risk assessment model (RAM) in postoperative lung and esophageal cancer patients, demonstrating that "high risk" patients were more likely to have a postoperative VTE. In this study, we sought to implement the RAM protocol in thoracic surgical patients to evaluate adherence, safety, and VTE outcomes. ⋯ Implementation of a VTE risk assessment protocol with extended course prophylaxis in high risk patients is safe and feasible for providers and thoracic surgical patients at a large safety net institution with a diverse patient population. Follow-up studies are needed to assess efficacy of the RAM in this surgical population.
-
Comparative Study
Operative vs Nonoperative Management of Pediatric Blunt Pancreatic Trauma: Evaluation of the National Trauma Data Bank.
Traumatic pancreatic injury is associated with significant morbidity and mortality. We evaluated the differences in outcomes among children with blunt pancreatic injuries managed operatively and nonoperatively. ⋯ Overall, children managed nonoperatively have equivalent or better outcomes when compared with operative and delayed operative management in regard to death, overall complications, LOS, ICU LOS, and ICU use.
-
When a nipple margin of a nipple-sparing mastectomy (NSM) contains malignancy, current practice includes removal of the nipple or nipple areola complex (NAC). We evaluated rates and trends of positive nipple margins, subsequent management, and oncologic outcomes. ⋯ Early results suggest that excision of the nipple with retention of the areola is a safe approach for management of a positive nipple margin after NSM. With experience, low rates of positive nipple margins are possible in therapeutic NSM. Overall risk of nipple/NAC recurrence after NSM remains extremely low.
-
Thyroid cancer patients frequently have favorable outcomes. However, a small subset develops aggressive disease refractory to traditional treatments. Therefore, we sought to characterize oncogenic mutations in thyroid cancers to identify novel therapeutic targets that may benefit patients with advanced, refractory disease. ⋯ This analysis revealed that several previously unreported oncogenic gene mutations exist in thyroid cancers and may be targets for the development of future therapies. Further investigation into the role of these genes is warranted.