Annals of surgery
-
Review
Industry Bias in Randomized Controlled Trials in General and Abdominal Surgery: An Empirical Study.
Industry sponsorship has been identified as a source of bias in several fields of medical science. To date, the influence of industry sponsorship in the field of general and abdominal surgery has not been evaluated. ⋯ Industry funding of surgical trials leads to exaggerated positive reporting of outcomes. This study emphasizes the necessity for declaration of funding source. Industry involvement in surgical research has to ensure scientific integrity and independence and has to be based on full transparency.
-
The aim of this study was to describe current understanding of the local and systemic immune responses to surgery and their impact on clinical outcomes, predictive biomarkers, and potential treatment strategies. ⋯ Local immune responses to surgery lead to systemic pro-inflammatory and immunosuppressive phases that are temporally related and proportionate in magnitude. Improved understanding of these mechanisms has implications for clinical study design and has led to the emergence of novel biomarkers such as Toll-like receptor expression. These can be used to stratify patient care pathways to maximize the benefit from current therapies or to select the right target at the right phase of illness for future drug development.
-
Comparative Study
Impaired Immune Response in Elderly Burn Patients: New Insights Into the Immune-senescence Phenotype.
Comparing the inflammatory and immunological trajectories in burned adults versus burned elderly patients to gain novel insights and better understanding why elderly have poor outcomes. ⋯ Elderly burned patients mount a delayed immune and dampened inflammatory response early after burn injury that changes to an augmented response at later time points. Late-onset sepsis and nonsurvivors had an immune exhaustion phenotype, which may represent one of the main mediators responsible for the striking mortality in elderly.
-
Comparative Study
Implementing and Evaluating a National Certification Technical Skills Examination: The Colorectal Objective Structured Assessment of Technical Skill.
To implement the Colorectal Objective Structured Assessment of Technical skill (COSATS) into American Board of Colon and Rectal Surgery (ABCRS) certification and build evidence of validity for the interpretation of the scores of this high stakes assessment tool. ⋯ COSATS is the first technical skill examination used in national surgical board certification. This study suggests that the current certification process may be failing to identify individuals who have demonstrated technical deficiencies on this standardized assessment tool.
-
To develop parsimonious prediction models for postoperative mortality, overall morbidity, and 6 complication clusters applicable to a broad range of surgical operations in adult patients. ⋯ Our results suggest that it will be possible to develop parsimonious models to predict 8 important postoperative outcomes for a broad surgical population, without the need for surgeon specialty-specific models or inclusion of laboratory variables.