Cellular and molecular imaging of the arteries in the age of precision medicine
Cellular and molecular imaging techniques use cell-specific or process-specific imaging probes to identify and assess biological activity. MRI and combined PET–CT are the current main techniques. PET–CT has been used to identify metastases for many years.
Cost-effective surgery for better outcomes
Health services worldwide are under fiscal pressure and this is particularly so in countries, such as the UK, where the government (alias the National Health Service) bears the greatest burden, compared with those that have higher individual- and insurance-based funding. Surgical procedures make a substantial contribution to healthcare expenditure and represent easy targets for hollow-minded, bargain-basement shoppers looking for a quick deal.
!Centralize Pancreatic Surgery Now
Considering the Ability of General Surgeons to Add Value to Pediatric Surgery
In this issue of JAMA Surgery, Akhtar-Danesh et al1 report a population-based study of Canadian children undergoing laparoscopic cholecystectomy from 2008 to 2015. The researchers found that children cared for by high-volume general surgeons experienced fewer complications and lower costs. This study introduces the novel concept that high-volume adult general surgeons might add value to the surgical management of pediatric biliary disease by decreasing postoperative morbidity and health care costs.
The Impact of Surgeons: Pathologists Dialog on Lymph Node Evaluation of Colorectal Cancer Patients
A durable improvement in LN evaluation was
realized through a multi-pronged change initiative aimed at
both surgeons and pathologists.
Cancer surgery in the genomic era
Although the majority of patients with cancer do not have a constitutive genetic defect, ultimately all malignancy represents an abnormality at the level of chromosomal DNA and its transcription. Not surprisingly, when BJS put to vote of its readers (via Twitter) the subject matter of this special issue, the majority chose cancer care in the genomic era.
Reducing Length of Stay Using a Robotic-assisted Approach for Retromuscular Ventral Hernia Repair: A Comparative Analysis From the Americas Hernia Society Quality Collaborative
Using real-world evidence, a robotic-assisted approach to RVHR offers the clinical benefit of reduced postoperative LOS. Ongoing monitoring of this technique should be employed through continuous quality improvement to determine the long-term effect on hernia recurrence, complications, patient satisfaction, and overall cost.
Importance of surgeon-performed ultrasound in the preoperative nodal assessment of patients with potential thyroid malignancy
A comprehensive cervical ultrasound evaluation is essential in the operative planning of patients with thyroid disease. Reliance on radiographic reports alone may result in incomplete operative management as pathologic lymph nodes are often not palpable and evaluation of the lateral neck is not routine. This study examined the role of surgeon-performed ultrasound in the evaluation of patients who underwent lateral neck dissection for thyroid cancer.
Do Calcifications Seen on Mammography After Neoadjuvant Chemotherapy for Breast Cancer Always Need to Be Excised?
This study aimed to determine the relationship between mammographic calcifications and magnetic resonance imaging (MRI) tumoral enhancement before and after neoadjuvant chemotherapy (NAC) and to assess the impact of these findings on surgical management.
For the patient—Evolution in the management of vascular trauma
There has been an evolution in the diagnosis and management of vascular trauma over the past 100 years. The primary stimulus to these changes has been the increased volume of patients with cervical, truncal, and peripheral vascular injuries during military conflicts and in civilian life. Patients with “hard” signs of a vascular injury are taken to surgery emergently with a few exceptions to be described
Value of social media in advancing surgical research
Some say surgical research is an oxymoron, maybe because they do not know how much surgeons long for high-quality clinical investigation when they have to make decisions on how to treat their patients. Unfortunately, hard evidence obtained by rigorous surgical research is not always available, and, when it is, not all surgeons have equal access to it.
Stopping the Bleeding Is Not Enough
Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis
Uncompliaim of this randomized trial was to compare the outcome of a non‐antibiotic management strategy with that of acated appendicitis may resolve spontaneously or require treatment with antibiotics or appendicectomy. The ntibiotic therapy in uncomplicated appendicitis
Mesh sutured repairs of contaminated incisional hernias
Association of Overlapping Surgery With Patient Outcomes in a Large Series of Neurosurgical Cases JAMA SURGERY NOV 2017
Rescuing the Clinical Breast Examination: Advances in Classifying Technique and Assessing Physician Competency
חוק הצינון: וירוס שיהרוג את רפואת הקהילה בישראל
הרופאים יפסיקו לבצע פעולות שאינן מתוגמלות כראוי, ויפנו את המבוטח לבתי החולים שכורעים תחת העומס
Clostridium difficile disease: Diagnosis, pathogenesis, and treatment update
Clostridium difficile infections are the leading cause of health care–associated infectious diarrhea, posing a significant risk for both medical and surgical patients. Because of the significant morbidity and mortality associated with C difficile infections, knowledge of the epidemiology of C difficile in combination with a high index of suspicion and susceptible patient populations (including surgical, postcolectomy, and inflammatory bowel disease patients) is warranted.
Robotic Surgery: no clinical benefit over laparoscopy
Robotic technology in surgery: Past, present, and future
t has been nearly 20 years since the first appearance of robotics in the operating room. In that time, much progress has been made in integrating robotic technologies with surgical instrumentation, as evidenced by the many thousands of successful robot-assisted cases. However, to build on past success and to fully leverage the potential of surgical robotics in the future, it is essential to maximize a shared understanding and communication among surgeons, engineers, entrepreneurs, and healthcare administrators. This article provides an introduction to medical robotic technologies, develops a possible taxonomy, reviews the evolution of a surgical robot, and discusses future prospects for innovation. Robotic surgery has demonstrated some clear benefits.
Clonidine restores vascular endothelial growth factor expression and improves tissue repair following severe trauma The American Journal of Surgery June 2017
We hypothesized that clonidine and propranolol would increase VEGF and VEGF-receptor expression and promote lung healing following severe trauma and chronic stress.
Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies The American Journal Of Surgery , July 2017
Background: The study aims to evaluate the methodological quality of publications relating to predicting the need of conversion from laparoscopic to open cholecystectomy and to describe identified prognostic factors.
JAMA Surg. 2017 Sep. Association of a Surgical Task During Training With Team Skill Acquisition Among Surgical Residents: The Missing Piece in Multidisciplinary Team Training.
Importance The human patient simulators that are currently used in multidisciplinary operating room team training scenarios cannot simulate surgical tasks because they lack a realistic surgical anatomy. Thus, they eliminate the surgeon’s primary task in the operating room...
Comparison of Wound Complications After Immediate, Delayed, and Secondary Breast Reconstruction Procedures. JAMA Surg. 2017 Sep
IMPORTANCE: Few data are available concerning surgical site infection (SSI) and noninfectious wound complications (NIWCs) after delayed(DR) and secondary reconstruction (SR) compared with immediate reconstruction (IR) procedures in the breast.
Striving for Clarity About the Best Approach to Thyroid Cancer Screening and Treatment: Is the Pendulum Swinging Too Far?: JAMA Surg. 2017 Aug
The US Preventive Services Task Force (USPSTF) recommends against screening for thyroid cancer in asymptomatic adults, giving the practice a grade of D.1 That is, the Task Force discourages use of screening with palpation or ultrasonography with a moderate degree of certainty that such screening has no net benefit or that the harm outweighs any benefits...
Cutting-edge Efforts in Surgical Patient Safety
Optimizing patient safety is a universally laudable goal. However, despite increased patient, health care professional, payer, and media attention, progress has been slow and difficult. On Sunday, October 4, 2015, the Surgical Outcomes Club convened a patient safety panel at its 11th Annual Scientific Session in Chicago, Illinois...