Journal of the American College of Surgeons
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Primary aldosteronism (PA) is the most common cause of secondary hypertension, yet screening remains startlingly infrequent. We describe (1) PA screening practices in a large, diverse health system, (2) the development of a computable phenotype for PA screening, and (3) the design and pilot deployment of an electronic health record (EHR)-based active choice nudge to recommend PA screening. ⋯ PA screening rates are low. This pilot study suggests an EHR-based nudge leveraging a precise computable phenotype can dramatically increase appropriate PA screening.
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Healthcare is responsible for 8.5% of US greenhouse gas emissions. This impact must be mitigated while maintaining clinical excellence. This study compares clinical outcomes, cost-efficiency, and climate impact of transumbilical laparoscopic-assisted appendectomy (TULAA) vs 3-port laparoscopic appendectomy (LA). ⋯ Although patient safety and excellent clinical outcomes must remain the top priority in healthcare, the current environmental crisis demands consideration of climate impact. When clinical noninferiority can be demonstrated, treatment options with fewer greenhouse gas emissions should be chosen.
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The success of parathyroidectomy in primary hyperparathyroidism depends on the intraoperative differentiation of diseased from normal glands. Deep learning can potentially be applied to digitalize this subjective interpretation process that relies heavily on surgeon expertise. In this study, we aimed to investigate whether diseased vs normal parathyroid glands have different near-infrared autofluorescence (NIRAF) signatures and whether related deep learning models can predict normal vs diseased parathyroid glands based on intraoperative in vivo images. ⋯ Normal and diseased parathyroid glands in primary hyperparathyroidism have different intraoperative NIRAF patterns that could be quantified with intensity and heterogeneity analyses. Visual deep learning models relying on these NIRAF signatures could be built to assist surgeons in differentiating normal from diseased parathyroid glands.
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Nonhealing wounds are particularly prevalent in older adults and in patients with multiple comorbidities, and they represent a significant medicoeconomic burden. Autologous split-thickness skin grafts (STSGs) are considered the gold standard for wound closure but suffer from high failure rates and complications. Autologous skin cell suspension (ASCS) technology is an autografting technique able to significantly minimize donor site morbidity. This retrospective, propensity-matched cohort study compared outcomes of wounds treated with ASCS vs STSG. ⋯ This study suggests that ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared with traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings.