Surgery
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In a decade, the US military reduced deaths from uncontrolled bleeding on the battlefield by 67%. This success, coupled with an increased incidence of mass shootings in the US, has led to multiple initiatives intent on translating hemorrhage-control readiness to the civilian sector. However, the best method to achieve widespread population-level hemorrhage-control readiness for civilians has not yet been elucidated. This study evaluates the implementation of American College of Surgeons Bleeding Control training at a National Football League stadium as a prospective model for general mass gathering site implementation. ⋯ Achieving initial hemorrhage-control readiness and maintenance at a mass gathering site through American College of Surgeons Bleeding Control training is feasible but requires significant commitment from training staff, site leadership, and financial resources.
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Comparative Study
A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals.
Postoperative opioid prescribing is often excessive, but the differences in opioid prescribing between teaching hospitals and nonteaching hospitals is not well understood. Given the workload of surgical training and frequent turnover of prescribers on surgical services, we hypothesized that postoperative opioid prescribing would be higher among teaching compared with nonteaching hospitals. ⋯ In Michigan, surgical patients discharged from teaching hospitals received significantly larger postoperative opioid prescriptions and had higher rates of high-risk prescribing compared with nonteaching hospitals. All hospitals, and particularly teaching institutions, should ensure that adequate resources are devoted to facilitating safe postoperative opioid prescribing.
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The impact of the resection margin on survival outcomes in patients with hepatocellular carcinoma remains to be determined. This study aimed to examine the association between the width of resection margin and the presence of microvascular invasion in hepatitis B virus-related hepatocellular carcinoma. ⋯ The presence of microvascular invasion was associated with a worse prognosis after resection. A wide resection margin resulted in better long-term prognoses versus a narrow resection margin among patients with hepatitis B virus-related hepatocellular carcinoma with microvascular invasion.
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The surgical safety checklist is an evidence-based global initiative designed to reduce perioperative morbidity and mortality. However, the expounded benefits of the surgical safety checklist have not been realized in naturalistic settings. This may be related to the quality of surgical safety checklists being performed in operating rooms. ⋯ These results highlight that compliance data are insufficient for monitoring surgical safety checklist quality. Our study suggests that surgical safety checklist quality may be enhanced through better calibration of the surgical safety checklist with existing procedures and staff expectations through a bottom-up implementation strategy.
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Although the presence of women and minorities is increasing in academic surgery, inclusion at the highest levels appears to continue to lag in many aspects of leadership and participation. Participation in medical societies is an opportunity in career development but may also propagate disparities. We investigated the presence of women and minorities within one subspecialty society, the American Association of Endocrine Surgeons, to better understand the presence of these groups in the leadership of this society. ⋯ Diversity in the American Association of Endocrine Surgeons has improved for all groups of diversity that were explored except African American members. Women and Asians are not consistently well represented throughout the organizational leadership, and Hispanic/Latin/South American and African American members are underrepresented. Opportunity exists to improve the diversity opportunities in this organization.