bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Self-administered Acupressure for Family Caregivers of Advanced Cancer Patients With Insomnia
Authors: Lee Kwo-Chen , Chao Yann-Fen C. , Lin Yun-Ping , Wang Hsiao-Chiao
Published: August 2020

Background

Sleep disturbances are common among family caregivers (FCs) of patients with advanced cancer. Self-administered acupressure can combat insomnia, but no study has been conducted to evaluate its efficacy in caregivers of patients with advanced cancer.

Objective

The aim of this study is to investigate whether self-administered acupressure improves sleep quality for FCs of patients with advanced cancer.

Methods

Family caregivers of patients with advanced cancer who reported sleep disturbance (Pittsburgh Sleep Quality Index scores >5 in recent months) were recruited. The experimental group self-administered acupressure at the Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Shenmen (HT7) points over a 12-week period, whereas the comparison group received sleep hygiene education. Sleep quality was assessed subjectively at 4, 8, and 12 weeks after the intervention using the Pittsburgh Sleep Quality Index and objectively using actigraphy measurements. Improvements in sleep quality were analyzed using a generalized estimating equation.

Results

Compared with the control group, the experimental group demonstrated significantly lower sleep latency (Wald χ
2 = 11.49, P = .001) and significantly better sleep efficiency (Wald χ
2 = 5.24, P = .02) according to actigraphy measurements, but Pittsburgh Sleep Quality Index scores did not differ significantly between the groups.

Conclusions

Self-administered acupressure did not demonstrate favorable effects on subjective sleep quality, but did reduce sleep latency and improve sleep efficiency, according to actigraphy measurements. Self-administered acupressure may help relaxation and sedation and promote sleep in FCs.

Implications for Practice

Healthcare providers may consider advising FCs to apply this self-administered acupressure to improve their sleep latency and sleep efficiency.
Effects of a Mind Map–Based Life Review Program on Anxiety and Depressive Symptoms on Cancer Patients Undergoing Chemotherapy
Authors: Chen Ying , Zheng Jianwei , Xiao Huimin , Lin Xiaoyan , Zhang Xiaoling
Published: August 2020

Background

Cancer patients undergoing chemotherapy often experience psychological distress. The mind map–based life review program (MBLRP) offers the potential to reduce patients’ negative emotions. However, its effects remain unknown.

Objective

The objective of this study is to determine the effects of the MBLRP on anxiety and depressive symptoms in cancer patients undergoing chemotherapy.

Methods

A randomized controlled trial with repeated measures was adopted. Eighty-four cancer patients undergoing chemotherapy were recruited from a general hospital in Fujian, China. Participants were randomly assigned to an experimental group (n = 40) or a control group (n = 44). The participants in the experimental group received the MBLRP plus routine care. The participants in the control group received routine care. Outcomes were measured at baseline, on the second day, and at 4 weeks after the MBLRP.

Results

In terms of anxiety, multivariate test statistics showed significant differences in within-group (F = 11.343, P < .001), between-group (F = 8.873, P = .004), and interaction effects (group × time) (F = 19.595, P < .001). For the depressive symptoms, the results showed that the within-group effect (F = 12.385, P < .001), group effect (F = 18.000, P < .001), and group × time effect (F = 26.544, P < .001) were statistically significant, favoring the MBLRP experimental group.

Conclusions

The MBLRP has the potential to reduce anxiety and depressive symptoms in cancer patients undergoing chemotherapy. Further research is needed within larger more representative samples.

Implications for Practice

The MBLRP is a nurse-led, nonpharmacological program that could be recommended for cancer patients undergoing chemotherapy and integrated into clinical practice.
An Integrative Review of Community Theories Applied to Palliative Care Nursing
Authors: Cross Lisa A.
Published: August 2020

The purpose of this integrative review was to appraise the qualitative and quantitative literature for community-level health behavior theory application to palliative care nursing to identify their use and future research implications. To date, there has not been an integrative review of the nursing studies that have used community-level health behavior theory to guide palliative care nursing research. Despite the availability of high-quality care, there continues to be underuse of resources. An integrative review on community-level theory application may provide a more holistic understanding of previous interventions to frame future interventions and research needs. The review was guided by the 5-step framework of Whittemore and Knafl. Relevant literature was searched and appraised. Seven different community-level health behavior theories were found with applications to palliative care nursing, and 16 studies using these theories were identified for discussion. Community-Based Participatory Research was the most used theory. Community-level health behavior theories such as Community-Based Participatory Research have helped build partnerships and activate community resources such as capacity, engagement, and diversity through culturally sensitive training interventions. Further research using these theories in palliative care nursing can realize positive outcomes, particularly in low-income rural areas.
What Mattered Then, Now, and Always
Authors: Bennett C. Robert , Shive Nadia , Coats Heather
Published: August 2020

Developing solid communication-based partnerships through obtaining illness narratives allows for an understanding of patients' social resources, values, and beliefs and allows an opportunity to provide person-centered care. This study aimed to elicit cocreated illness narratives from persons of color who have serious illness. Twenty patients receiving care for serious illness were interviewed at a large academic medical center. The interviews focused on how illness affected patients' lives and were followed by formation of illness narratives. From the persons living with serious illness, 3 main themes emerged: (1) time, (2) life changes, and (3) family. Participants described how illness did influence their lifestyles and identities but did not define their personhood. Family influence had a lasting effect on participants' values and beliefs, and family presence was viewed as valuable in their current lives. Narratives from persons of color with serious illness can provide an intimate account informing nurses' understanding of patients' illness experiences and may enhance communication between nurses and patients.
Death in Sauna Associated With a Transdermal Fentanyl Patch
Authors: Kriikku Pirkko , Ojanperä Ilkka , Lunetta Philippe
Published: August 2020

We present a case of an accidental fatal fentanyl overdose caused by increased uptake of the drug from a transdermal patch while experiencing the heat of a sauna.

The transdermal patch administers fentanyl at a relatively constant rate through the skin. However, in the subcutaneous tissue, blood circulation greatly influences the rate of this drug's systemic intake. In the present case, an elderly woman with multiple health conditions was prescribed fentanyl patches but was unaware of the risks associated with external heat sources when one wears the patch. She was found dead in the sauna with a postmortem femoral blood concentration of fentanyl that was elevated (15 μg/L). The cause of death was determined to be fatal poisoning by fentanyl with the contributing factor of external heat from the sauna.

Risks associated with transdermal administration of a potent opioid-like fentanyl are widely described in the scientific literature and described in the manufacturer's summary of product characteristics. Physicians and pharmacists should take particular care to ensure that patients understand these risks.
Fatal Hemoperitoneum Due to Isolated Splenic Peliosis
Authors: Podduturi Varsha , Blessing Melissa M.
Published: August 2020

Isolated splenic peliosis is an exceedingly rare condition of unclear etiology characterized by blood filled cyst-like cavities in the primary mononuclear phagocytic organ. People with splenic peliosis are typically asymptomatic. However, splenic peliosis may present as an incidental mass on imaging mimicking a neoplasm during life, or present as sudden death after hemoperitoenum when ruptured, mimicking traumatic injury. Awareness of this condition is important to forensic pathologists so as to provide an accurate cause and manner of death.
Liquid Nitrogen Applied at Point of Sale
Authors: Pinilla Escobar Victoria A. , Granger Caroline J. , Hogan Anthony R. , Thorson Chad M. , Perez Eduardo A. , Sola Juan E. , Brady Ann-Christina
Published: August 2020

The August 30, 2018, US Food and Drug Administration advisory warned consumers to avoid eating, drinking, or handling food products prepared with liquid nitrogen (LN) (US FDA. Safety Alerts & Advisories: FDA Advises Consumers to Avoid Eating, Drinking, or Handling Food Products Prepared with Liquid Nitrogen at the Point of Sale. US Food and Drug Administration). We report on the case of a pediatric patient sustaining gastric perforation after ingestion of LN applied to food at the point of sale in the United States. “Dragon's Breath” is a popular snack of cereal puffs coated in LN giving the allusion of breathing smoke on ingestion. Instructions provided by vendors include avoidance of touching or drinking the liquid in the bottom of the cup. We report on a case of a 9-year-old girl presenting with peritonitis and gross pneumoperitoneum after consumption of Dragon's Breath with injury conferred secondary to LN ingestion. Intraoperative finding of a large perforation along the lesser curvature of the stomach was repaired primarily with an omental overlay. Her postoperative course was complicated by pneumonia and a surgical site infection. She was discharged 13 days after admission. A review of the literature of previous case reports of LN ingestion by intentional or accidental means is provided. This case report and review of the literature bring awareness of the dangers posed to pediatric patients exposed to LN applied at the point of sale.
Physical Medicine and Rehabilitation Residency Quality Improvement and Research Curriculum
Authors: Grover Prateek , Volshteyn Oksana , Carr David B.
Published: August 2020

Physical medicine and rehabilitation residency programs do not demonstrate a uniform level of training and mentorship for resident scholarly activities related in part to variable utilization of standardized curricula. The aim of this study was to design, develop, implement, and evaluate a structured Quality Improvement and Research Curriculum for a physical medicine and rehabilitation residency program in academic year 2015 using standardized methodology. A combination of five-phase project-lifecycle and six-step medical-curriculum development methodologies was used to integrate existing resources into five institutional domains: (1) Patient Safety and Quality Improvement Program; (2) Research Mentorship Program; (3) Rehab in Review; (4) Publication and Presentation Resources, and (5) Research and QI Lecture Series. Dedicated resident-faculty teams were created for individual domains and for the overall curriculum. Written materials developed included scope documents, reporting forms, and tracking tables. A dedicated webpage on the department website served as an accessible resource. A bimonthly Updates newsletter highlighted ongoing resident achievements. Program and resident outcome metrics were evaluated at the mid and end of academic year 2015. Excellent resident and good faculty participation in the curriculum was observed. Resident publication and presentation productivity improved. Time was the biggest barrier to success. Key factors for success included phased implementation, dedicated teams, scope clarity, accessible resources, personnel support, resident champions, and faculty mentorship.
Association of Implementation and Social Network Factors With Patient Safety Culture in Medical Homes: A Coincidence Analysis
Authors: Dy Sydney M. , Acton Ryan M. , Yuan Christina T. , Hsu Yea-Jen , Lai Alden Yuanhong , Marsteller Jill , Ye Faye C. , McGee Nancy , Kharrazi Hadi , Mahabare Darshan , Kim Julia , Gurses Ayse P. , Bittle Mark , Scholle Sarah Hudson
Published: August 2020

Objectives

The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture.

Methods

This was a cross-case analysis study in 25 diverse U.S. PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs’ characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture.

Results

The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health.

Conclusions

Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors.
Influence of a Preadmission Procedure-Specific Consent Document on Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement: A Randomized Controlled Trial
Authors: Power Fiachra Richard , McClean Aine , Cashman James
Published: August 2020

Objectives

Consent is a legal and ethical requirement for undertaking surgical procedures; however, the literature suggests that there continues to be poor recall among patients of the surgical risks discussed during the consent process. The aim of this study was to evaluate whether the addition of a preadmission procedure-specific consent document would improve patient recall of surgical risks at 4 weeks after total hip replacement in patients consented with a procedure-specific consent form.

Methods

A prospective randomized controlled trial allocated seventy adult patients who were undergoing a primary total hip replacement to either receive (intervention group) or not receive (control group) a preadmission procedure-specific consent document. All patients were also consented with a procedure-specific consent form on the morning of surgery and were contacted 4 weeks later to assess recall of surgical risks.

Results

There was a very poor recall rate seen in both the intervention group (16%) and the control group (13%), with no statistically significant difference between them (P = 0.49). A large number (30%) of patients could not recall a single risk. A subgroup analysis excluding these “consent nonresponders” did show a significantly increased recall rate in the intervention group (24.5% versus 18.25%, P = 0.02).

Conclusions

Patient recall of potential complications of total hip replacement was poor despite the intervention. Although not effective overall, the use of a preadmission procedure-specific consent document did improve recall of potential complications of surgery in a subset of patients. The phenomenon of consent nonresponders is worth exploring in future research.
To What Extent Is the World Health Organization’s Medication Safety Challenge Being Addressed in English Hospital Organizations? A Descriptive Study
Authors: Garfield Sara , Teo Vivien , Chan Li , Vujanovic Biljana , Aftab Ansa , Coleman Bridget , Puaar Seetal , Sen Green Namrita , Franklin Bryony Dean
Published: August 2020

Objectives

Our study aimed to explore to what extent the priority areas and domains of the World Health Organization (WHO)‘s third Global Patient Safety Challenge were being addressed in a sample of hospital organizations.

Methods

A qualitative approach was taken using a combination of focus groups, semistructured interviews, and documentary analysis in 4 UK teaching hospital organizations. A purposive sampling strategy was adopted with the aim of recruiting health care professionals who would be likely to have knowledge of medication safety interventions that were being carried out at the hospital organizations. Medication safety group meeting notes from 2017 to 2019 were reviewed at the hospital organizations to identify interventions recently implemented, those currently being implemented, and plans for the future. A content analysis was undertaken using the WHO’s third Global Patient Safety Challenge priority areas and domains as deductive themes.

Results

All the domains and priority areas of the WHO Medication Safety Challenge were being addressed at all 4 sites. However, a greater number of interventions focused on “health care professionals” and “systems and practices of medication management” than on “patients and the public.” In terms of the priority areas, the main focus was on “high-risk situations,” particularly high-risk medicines, with fewer interventions in the areas of “transitions of care” and “polypharmacy.”

Conclusions

More work may be needed to address patient and public involvement in medication safety and the priority areas of transitions of care and polypharmacy. Comparative global studies would help build an international picture and allow shared learning.
Master’s Programs in Patient Safety and Health Care Quality Worldwide
Authors: Tekian Ara , Infante Alexander F. , Valenta Annette L.
Published: August 2020

Objectives

As we approach the 20th anniversary of the Institute of Medicine’s report To Err Is Human: Building a Safer Health System, it is important to assess the progress we have made with respect to patient safety thus far. This study reviews all the existing master’s-level degree programs worldwide and assesses them to determine trends and disagreements.

Methods

Web-based searches were performed using phrases such as “masters,” “education,” “patient safety,” and “healthcare quality.” Communication with programs representatives was used to obtain pertinent data not represented on the programs’ webpages.

Results

Twenty-five programs exist worldwide, 17 of which within North America. These programs are predominantly taught in a part-time format, with many providing an online setting for learning and requiring various forms of scholarship.

Conclusions

Programs varied widely in credit hour structure and duration, as well as primary competencies. This highlights the need for the development of program standards to ensure the quality of such programs, as have been developed in other professional fields. Information pertaining to these programs including similarities, differences, trends, and characteristics is detailed in this section. The existence and development of these programs are paramount to future progression in health care, to prevent future errors by studying previous ones, thus improving health care.
Role of Imaging in Bronchoscopic Lung Volume Reduction Using Endobronchial Valve
Authors: Dass Chandra , Goldbach Alyssa , Dako Farouk , Kumaran Maruti , Steiner Robert , Criner Gerard J.
Published: August 2020

Chronic obstructive pulmonary disease (COPD) is becoming one of the leading causes of mortality and morbidity throughout the world. The National Emphysema Treatment Trial demonstrated that lung volume reduction surgery can improve pulmonary function, exercise capacity, and quality of life in select subgroups of patients with COPD. In recent years, few bronchoscopic lung volume reduction (BLVR) procedures have undergone clinical trials with the goal of establishing an effective and safe alternative approach for reducing hyperinflation in patients with severe emphysema who are symptomatic despite optimal medical management, but are poor surgical candidates. Of these BLVR procedures, only deployment of 1-way endobronchial valves (EBVs) has the largest pool of scientific data available to date to support its clinical utility. Two EBV systems have been food and drug administration-approved within the last year to meet the clinical demands of this select group of patients with COPD. On the basis of the results of multiple randomized clinical trials, the recommendations of the original 2016 Expert Panel Report on BLVR usage criteria of EBV have been updated in 2019. The outcome of EBV therapy is maximized in certain image-based COPD phenotypes. Imaging plays a major role in patient selection, target lobe identification, and in the management of postprocedural adverse events. With the expected widespread use of EBV therapy in the coming years, knowledge and familiarity of the Role of Imaging in BLVR using EBVs is essential for radiologists attempting to make meaningful contribution toward improving clinical outcomes.
Outcome Measures Reported in Published Clinical Research Studies in Craniosynostosis: A Systematic Review
Authors: Pidgeon Thomas E. , Al Omran Yasser , Farwana Reem , Phan Kevin , Al-Dulaimy Bakir , Radhakrishnan Anand , Kurar Langhit , Szczap Aleksandra , Sujan Mark-Alexander
Published: August 2020

Context:

The fair comparison of treatment interventions for craniosynostosis across different studies is expected to be impaired by incomplete reporting and the use of inconsistent outcomes.

Objective:

This review assessed the outcomes currently reported in studies of craniosynostosis, and whether these outcomes are formally defined and prespecified in the study methods.

Data Sources, Search Terms, and Study Selection:

Studies were sourced via an electronic, multi-database literature search for “craniosynostosis.” All primary, interventional research studies published from 2011 to 2015 were reviewed.

Data Extraction:

Two independent researchers assessed each study for inclusion and performed the data extraction. For each study, data were extracted on the individual outcomes reported, and whether these outcomes were defined and prespecified in the methods.

Data Synthesis and Results:

Of 1027 studies screened, 240 were included and proceeded to data extraction. These studies included 18,365 patients.

2192 separate outcomes were reported. Of these, 851 outcomes (38.8%) were clearly defined, 1394 (63.6%) were prespecified in the study methods.

“Clinical and functional” was the most commonly reported outcome theme (900 outcomes, 41.1%), and “patient-reported” outcomes the least (7 outcomes, 0.3%).

“Duration of surgery” was the most commonly reported single outcome (reported 80 times). “Cranial index” was the most variably defined outcome (18 different definitions used).

Conclusion:

The outcomes reported following treatment interventions for craniosynostosis are incompletely and variably defined. Improving definitions for these outcomes may aid comparison of different management strategies and improve craniosynostosis care. Suboptimal prespecification of these outcomes in the study methods implied that outcome reporting bias cannot be excluded.
Acute Kidney Injury After Esophageal Cancer Surgery
Authors: Murphy Conor F. , Dunne Talulla , Elliott Jessie A. , Kamarajah Sivesh K. , Leighton James , Evans Richard P. T. , Bundred James , King Sinead , Ravi Narayanasamy , Donohoe Claire L. , Griffin S. Michael , Griffiths Ewen A. , Phillips Alexander W. , Reynolds John V.
Published: August 2020

Objective:

To determine the incidence, risk factors, and consequences of AKI in patients undergoing surgery for esophageal cancer

Summary of Background Data:

Esophageal cancer surgery is an exemplar of major operative trauma, with well-defined risks of respiratory, cardiac, anastomotic, and septic complications. However, there is a paucity of literature regarding AKI.

Methods:

consecutive patients undergoing curative-intent surgery for esophageal cancer from 2011 to 2017 in 3 high-volume centers were studied. AKI was defined according to the AKI Network criteria. AKI occurred if, within 48 hours postoperatively, serum creatinine rose by 50% or by 0.3 mg/dL (26.5 μmol/L) from preoperative baseline. Complications were recorded prospectively. Multivariable logistic regression determined factors independently predictive of AKI.

Results:

A total of 1135 patients (24.7%:75.3% female:male, with a mean age of 64, a baseline BMI of 27 kg m−2, and dyslipidemia in 10.2%), underwent esophageal cancer surgery, 85% having an open thoracotomy. Overall in-hospital mortality was 2.1%. Postoperative AKI was observed in 208 (18.3%) patients, with AKI Network 1, 2, and 3 in 173 (15.2%), 28 (2.5%), and 7 (0.6%), respectively. Of these, 70.3% experienced improved renal function within 48 hours. Preoperative factors independently predictive of AKI were age [P = 0.027, odds ratio (OR) 1.02 (1.00–1.04)], male sex [P = 0.015, OR 1.77 (1.10–2.81)], BMI at diagnosis [P < 0.001, OR 1.10 (1.07–1.14)], and dyslipidemia [P = 0.002, OR 2.14 (1.34–3.44)]. Postoperatively, AKI was associated with atrial fibrillation (P = 0.013) and pneumonia (P = 0.005). Postoperative AKI did not impact survival outcomes.

Conclusion:

AKI is common but mostly self-limiting after esophageal cancer surgery. It is associated with age, male sex, increased BMI, dyslipidemia, and postoperative morbidity.
Patterns of National Institutes of Health Grant Funding to Surgical Research and Scholarly Productivity in the United States
Authors: Mesquita-Neto Jose Wilson , Dailey William , Macedo Francis I. , Merchant Nipun B.
Published: August 2020

Objective:

The aim of this study was to assess the contemporary trends in National Institutes of Health (NIH) grants awarded to surgical investigators, including potential disparities.

Background:

The NIH remains the primary public funding source for surgical research in the United States; however, the patterns for grants and grantees are poorly understood.

Methods:

NIH RePORTER was queried for new grants (R01, -03, -21) awarded to Departments of Surgery (DoS). Principal investigators’ (PIs) data were extracted from publicly available information from their institutions’ websites and/or professional social media accounts.

Results:

The NIH awarded 1101 new grants (total: $389,006,782; median: $313,030) between 2008 and 2018. Funding to DoS has doubled in the last 10 years ($22,983,500–2008 to $49,446,076–2018). Midwest/Southeast institutions and surgical oncologists accounted for majority of the grants (31.9% and 24.5%, respectively). Only 24.7% of the projects were led by female PIs, who were predominantly nonphysician PhD scientists (52% vs 37.7% PhD-only male PIs; P = 0.002). During this time, there was a significant increase from 12.4% to 31.7% in grants awarded to PIs with >15 years of experience. These grants were associated with 8215 publications; however, only 13.2% were published in high-impact journals (impact factor ≥10). 4.4% of the grants resulted in patents, and these were associated with higher award amounts ($345,801 vs $311,350; P = 0.030). On multivariate analysis, combined MD/PhD degree [odds ratio (OR) 5.98; 95% confidence interval (CI) 2.18–16.39; P < 0.001] was associated with improved odds of patent creation; conversely, practicing surgeon PIs affected patent creation negatively (OR 0.31; 95% CI 0.11–0.85; P = 0.024).

Conclusion:

In the last decade, a greater proportion of NIH grants in DoS were awarded to more experienced investigators. Disparities exist among grantees, and female investigators are underrepresented, especially among practicing surgeons.
Predictors of Survival After Liver Transplantation in Patients With the Highest Acuity (MELD ≥40)
Authors: Evans Michael D. , Diaz Jessica , Adamusiak Anna M. , Pruett Timothy L. , Kirchner Varvara A. , Kandaswamy Raja , Humphreville Vanessa R. , Leventhal Thomas M. , Grosland Jeffrey O. , Vock David M. , Matas Arthur J. , Chinnakotla Srinath
Published: August 2020

Objective:

To identify factors that accurately predict 1-year survival for liver transplant recipients with a MELD score ≥40.

Background:

Although transplant is beneficial for patients with the highest acuity (MELD ≥40), mortality in this group is high. Predicting which patients are likely to survive for >1 year would be medically and economically helpful.

Methods:

The Scientific Registry of Transplant Recipients database was reviewed to identify adult liver transplant recipients from 2002 through 2016 with MELD score ≥40 at transplant. The relationships between 44 recipient and donor factors and 1-year patient survival were examined using random survival forests methods. Variable importance measures were used to identify the factors with the strongest influence on survival, and partial dependence plots were used to determine the dependence of survival on the target variable while adjusting for all other variables.

Results:

We identified 5309 liver transplants that met our criteria. The overall 1-year survival of high-acuity patients improved from 69% in 2001 to 87% in 2016. The strongest predictors of death within 1 year of transplant were patient on mechanical ventilator before transplantation, prior liver transplant, older recipient age, older donor age, donation after cardiac death, and longer cold ischemia.

Conclusions:

Liver transplant outcomes continue to improve even for patients with high medical acuity. Applying ensemble learning methods to recipient and donor factors available before transplant can predict survival probabilities for future transplant cases. This information can be used to facilitate donor/recipient matching and to improve informed consent.
Perioperative Broad-spectrum Antibiotics are Associated With Decreased Surgical Site Infections Compared to 1st–3rd Generation Cephalosporins After Open Pancreaticoduodenectomy in Patients With Jaundice or a Biliary Stent
Authors: Kone Lyonell B. , Torres Carolina , Banulescu Mihaela , Maker Vijay K. , Maker Ajay V.
Published: August 2020

Objective:

Compare the effectiveness of 1st-3rd generation cephalosporins (1st-3rdCE) to broad-spectrum antibiotics in decreasing surgical site infections (SSI) after pancreatectomy.

Summary of Background Data:

SSI is one of the most common complications after pancreatic surgery. Various antibiotic regimens are utilized nationwide with no clear guidelines for pancreatectomy. As we await results of a recently initiated prospective trial, this study retrospectively evaluates over 15,000 patients using the same administrative data abstraction tools as in the trial.

Methods:

All relevant clinical variables were collected from the 2016–2018 targeted-pancreatectomy database from the American College of Surgeon National Surgical Quality Improvement Program. Preoperative antibiotics were initially collected as first-generation cephalosporin, second or third-generation cephalosporin, and broad-spectrum antibiotics (Broad-abx).

Results:

Of the 15,182 patients who completed a pancreatic surgery between 2016 and 2018, 6114 (40%) received a first-generation cephalosporin, 4097 (27%) received a second or third-generation cephalosporin, and 4971 (33%) received Broad-abx. On multivariate analysis, Broad-abx was associated with a decrease in all-type SSI compared to 1st-3rdCE (odds ratio = 0.73–0.77, P < 0.001) after open pancreaticoduodenectomy (PD). There was no difference in SSI between antibiotic-types after distal pancreatectomy. Subgroup multivariate analysis of open PD revealed decrease in all-type SSI with Broad-abx amongst patients with jaundice and/or biliary stent only, regardless of wound protector use (odds ratio = 0.69–0.70, P < 0.001). Propensity score matching of open PD patients with jaundice and/or biliary stent confirmed a decrease in all-type SSI (19% vs 24%, P = 0.001), and organ-space SSI (12% vs 16%, P < 0.001).

Conclusion:

Broad-abx are associated with decreased SSI after open PD and may be preferred specifically for patients with preoperative biliary stent and/ or jaundice.
National Variation in Elective Colon Resection for Diverticular Disease
Authors: Hawkins Alexander T. , Samuels Lauren R. , Rothman Russell L. , Geiger Timothy M. , Penson David F. , Resnick Matthew J.
Published: August 2020

Objective:

This study aims to characterize the extent of geographic variation in elective sigmoid resection for diverticulitis and to identify factors associated with observed variation.

Introduction:

National guidelines for treatment of recurrent diverticulitis fail to offer strong recommendations for or against surgical intervention. We hypothesize that healthcare market factors will be significantly associated with geographic variation in colon resection for diverticulitis, a discretionary surgical intervention.

Methods:

We used Center for Medicare Services 100% inpatient Limited Data Set (LDS) files from January 2013 through September 2015 to calculate an observed to expected standardized colon resection ratio for each hospital referral region (HRR). We then analyzed patient, hospital-, and market-level factors associated with variation of colectomy. For each HRR, a Herfindahl-Hirschman index, a measure of market competition, was calculated.

Results:

A total of 19,557 Medicare patients underwent an elective colon resection for diverticulitis at 2462 hospitals over the study period. Standardized colon resection ratios ranged from 0 in the Tuscaloosa HRR to 3.7 in the Royal Oak, MI HRR. Few patient factors were associated with variation, but a number of hospital factors (size, area, profit status, and critical access designation) all were associated with variation. In an analysis of market factors, increased surgeon density, and decreased market competition were associated with higher predicted rates of colon resection.

Conclusion:

We observed pronounced variation (excess of 3-fold) in standardized colon resection ratios for recurrent diverticulitis. Surgeon density and hospital level factors were strongly associated with this variation and may be the main drivers of colonic resection for diverticular disease. Further investigation and stronger national guidelines are needed to optimize patient selection for colectomy.
Locoregional Residual Esophageal Cancer after Neo-adjuvant Chemoradiotherapy and Surgery Regarding Anatomic Site and Radiation Target Fields
Authors: Faiz Zohra , Kats-Ugurlu Gursah , Mui Véronique E. M. , Karrenbeld Arend , Burgerhof Hans G. M. , Plukker John T. M. , Muijs Christel T.
Published: August 2020

Objective:

Neoadjuvant chemoradiotherapy followed by surgery establishes a considerable pathologic complete response (pCR) in EC. The aim was to determine site of residual tumor and its prognostic impact.

Summary Background Data:

High rates of residual tumor in the adventitial region even inside the radiation fields will influence current decision-making.

Methods:

We evaluated resection specimens with marked target fields from 151 consecutive EC patients treated with carboplatin/paclitaxel and 41.4Gy between 2009 and 2018.

Results:

In radically resected (R0) specimens 19.8% (27/136) had a pCR (ypT0N0) and 14% nearly no response (tumor regression grade: tumor regression grade 4–5). Residual tumor commonly extended in or restricted to the adventitia (43.1%; 47/109), whereas 7.3% was in the mucosa (ypT1a), 16.5% in the submucosa (ypT1b) and 6.4% only in lymph nodes (ypT0N+). Macroscopic residues in R0-specimens of partial responders (tumor regression grade 2-3: N = 90) were found in- and outside the gross tumor volume (GTV) in 33.3% and 8.9%, and only microscopic in- and outside the clinical target volume in 58.9% and 1.1%, respectively. Residual nodal disease was observed proximally and distally to the clinical target volume in 2 and 5 patients, respectively. Disease Free Survival decreased significantly if macroscopic tumor was outside the GTV and in ypT2-4aN+.

Conclusions:

After neoadjuvant chemoradiotherapy, pCR and ypT1aN0 were seen in a limited number of R0 resected specimens (19.8% and 7.3%, respectively), whereas 6.4% had only nodal disease (yT0N+). Disease Free Survival decreased significantly if macroscopic residue was outside the GTV and in responders with only nodal disease. Therefore, we should be cautious in applying wait and see strategies.
Ten-year Evaluation of a Large Retrospective Cohort Treated by Sacral Nerve Modulation for Fecal Incontinence
Authors: Desprez Charlotte , Damon Henri , Meurette Guillaume , Mege Diane , Faucheron Jean-Luc , Brochard Charlène , Lambrescak Elsa , Gourcerol Guillaume , Mion Francois , Wyart Vincent , Sielezneff Igor , Siproudhis Laurent , Etienney Isabelle , Ajamie Nadine , Lehur Paul-Antoine , Duflot Thomas , Bridoux Valérie , Leroi Anne-Marie ,   Club NEMO
Published: August 2020

Objective:

The aim of this study was to assess the effectiveness of sacral nerve modulation (SNM) in a large cohort of patients implanted for at least 10 years, quantify adverse event rates, and identify predictive factors of long-term success.

Summary Background Data:

Few studies have evaluated the long-term success of SNM.

Methods:

Data collected prospectively from patients implanted for fecal incontinence (FI) in 7 French centers between January 1998 and December 2008 were retrospectively analyzed. Patient FI severity scores were assessed before and 10 years after implantation. The main evaluation criterion was the success of SNM defined by the continuation of the treatment without additional therapies. The secondary evaluation criteria were the rate of device revisions and explantations. Preoperative predictors of success at 10 years were sought.

Results:

Of the 360 patients (27 males, mean age: 59 ± 12 years) implanted for FI, 162 (45%) had a favorable outcome 10 years post-implantation, 115 (31.9%) failed, and 83 (23.1%) were lost to follow-up. The favorable outcome derived from the time-to-event Kaplan-Meier curve at 10 years was 0.64 (95% CI 0.58–0.69). FI severity scores were significantly better 10 years post-implantation compared to preimplantation (7.4 ± 4.3 vs 14.0 ± 3.2; P < 0.0001). During the 10-year follow-up, 233 patients (64.7%) had a surgical revision and 94 (26.1%) were explanted. A history of surgery for FI and sex (male) were associated with an increased risk of an unfavorable outcome.

Conclusions:

Long-term efficacy was maintained in approximately half of the FI patients treated by SNM at least 10 years post-implantation.
Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team
Authors: Doussot Alexandre , Ciceron Floriane , Cerutti Emilie , Salomon du Mont Lucie , Thines Laurent , Capellier Gilles , Pretalli Jean-Baptiste , Evrard Philippe , Vettoretti Lucie , Garbuio Patrick , Brunel Anne-Sophie , Pili-Floury Sebastien , Lakkis Zaher
Published: August 2020

Objective:

The aim of this study was to define whether rapidly reallocating health care workers not experienced with PP for performing PP in ICU is feasible and safe.

Summary Background Data:

In the setting of severe acute respiratory distress syndrome (ARDS), the use of prone and supine positioning procedures (PP) has been associated with improved oxygenation resulting in decreased mortality. Nevertheless, applying PP is time consuming for ICU staffs that are at risk of mental of physical exhaustion, especially with the constant surge of admitted COVID-19 patients with severe ARDS.

Methods:

This prospective cohort study conducted at a single regional university hospital between March 27 and April 15, 2020. Among 117 patients admitted to ICU, 67 patients (57.3%) presented with proven SARS-CoV-2 infection with severe ARDS requiring PP. After accelerated simulation training, 109 volunteers including surgeons, physicians, nurses and physiotherapists, multiple dedicated teams performed daily multiple PP following a systematic checklist. Patient demographics and PP data were collected. Patient safety and health care workers safety were assessed.

Results:

Among 117 patients admitted to ICU, 67 patients (57.3%) required PP. Overall, 53 (79%) were male, with a median age of 68.5 years and median body mass index of 29.3 kg/m2. A total of 384 PP were performed. Overall, complication occurred in 34 PP (8.8%) and led to PP cancelation in 4 patients (1%). Regarding health care workers safety, four health care workers presented with potential COVID-19 related symptoms and none was positive.

Conclusions:

To overcome the surge of critically ill COVID-19 patients, reallocating health care workers to targeted medical tasks beyond their respective expertise such as PP was safe.
Does Surgical Intensity Correlate With Opioid Prescribing?
Authors: Cho Hoyune E. , Hu Hsou-Mei , Gunaseelan Vidhya , Chen Jung-Sheng , Englesbe Michael J. , Chung Kevin C. , Waljee Jennifer F.
Published: August 2020

Objective:

To examine the relationship between aspects of surgical intensity and postoperative opioid prescribing.

Summary of Background Data:

Despite the emergence of postoperative prescribing guidelines, recommendations are lacking for many procedures. identifying a framework based on surgical intensity to guide prescribing for those procedures in which guidelines may not exist could inform postoperative prescribing.

Methods:

We used clustering analysis with 4 factors of surgical intensity (intrinsic cardiac risk, pain score, median operative time, and work relative value units) to devise a classification system for common surgical procedures. We used IBM MarketScan Research Database (2010–2017) to examine the correlation between this framework with initial opioid prescribing and rates of refill for each cluster of procedures.

Results:

We examined 2,407,210 patients who underwent 128 commonly performed surgeries. Cluster analysis revealed 5 ordinal clusters by intensity: low, mid-low, mid, mid-high, and high. We found that as the cluster-order increased, the median amount of opioid prescribed increased: 150 oral morphine equivalents (OME) for low-intensity, 225 OME for mid-intensity, and 300 OME for high-intensity surgeries. Rates of refill increased as surgical intensity also increased, from 17.4% for low, 26.4% for mid, and 48.9% for high-intensity procedures. The odds of refill also increased as cluster-order increased; relative to low-intensity procedures, high-intensity procedures were associated with 4.37 times greater odds of refill.

Conclusion:

Surgical intensity is correlated with initial opioid prescribing and rates of refill. Aspects of surgical intensity could serve as a guide for procedures in which guidelines based on patient-reported outcomes are not available.
Surgeons’ Coaching Techniques in the Surgical Coaching for Operative Performance Enhancement (SCOPE) Program
Authors: Pradarelli Jason C. , Yule Steven , Panda Nikhil , Lowery Kurt W. , Lagoo Janaka , Gee Denise W. , Ashley Stanley W. , Waters Peter M. , Gawande Atul A. , Smink Douglas S.
Published: August 2020

Objective:

To evaluate coaching techniques used by practicing surgeons who underwent dedicated coach training in a peer surgical coaching program.

Background:

Surgical coaching is a developing strategy for improving surgeons’ intraoperative performance. How to cultivate effective coaching skills among practicing surgeons is uncertain.

Methods:

Through the Surgical Coaching for Operative Performance Enhancement (SCOPE) program, 46 surgeons within 4 US academic medical centers were assigned 1:1 into coach/coachee pairs. All attended a 3-hour Surgical Coaching Workshop—developed using evidence from the fields of surgery and education—then received weekly reminders. We analyzed workshop evaluations and audio transcripts of postoperative debriefs between coach/coachee pairs, co-coding themes based on established principles of effective coaching: (i) self-identified goals, (ii) collaborative analysis, (iii) constructive feedback, and (iv) action planning. Coaching principles were cross-referenced with intraoperative performance topics: technical, nontechnical, and teaching skills.

Results:

For the 8 postoperative debriefs analyzed, mean duration was 24.4 min (range 7–47 minutes). Overall, 326 coaching examples were identified, demonstrating application of all 4 core principles of coaching. Constructive feedback (17.6 examples per debrief) and collaborative analysis (16.3) were utilized more frequently than goal-setting (3.9) and action planning (3.0). Debriefs focused more often on nontechnical skills (60%) than technical skills (32%) or teaching-specific skills (8%). Among surgeons who completed the workshop evaluation (82% completion rate), 90% rated the Surgical Coaching Workshop “good” or “excellent.”

Conclusions:

Short-course coach trainings can help practicing surgeons use effective coaching techniques to guide their peers’ performance improvement in a way that aligns with surgical culture.
Efficacy of Intragastric Balloon Placement and Botulinum Toxin Injection in Bariatric Endoscopy
Authors: Kanlioz Murat , Ekici Uğur , Tatli Faik , Karatas Turgay
Published: August 2020

Background:

To evaluate the results obtained from the combination of intragastric botulinum toxin A (IGBTA), intragastric balloon (IGB), and IGBTA(+)IGB in the treatment of obesity.

Materials and Methods:

Three separate treatment groups were set up. IGBTA, IGB, and IGBTA(+)IGB were administered to Group 1, 2, and 3, respectively. The body mass indexes (BMI) of patients were measured before and 6 months after the treatment. The intragroup and intergroup treatment results have been evaluated. P<0.05 was considered significant.

Results:

The mean BMI decreased by 1.6 kg/m2 in 40 patients who received IGBTA in group 1 (P<0.001), 3.95 kg/m2 in 42 patients who received IGB in group 2 (P<0.001), and 4.9 kg/m2 in 39 patients who received IGBTA and IGB in group 3 (P<0.001) after 6 months of treatment. The intolerance because of the application was the highest in group 3, followed by group 2.

Conclusion:

The treatment was most successful in group 3 followed by group 2 and group 1, respectively. The authors recommend the group 3 treatment, provided that nausea, vomiting, and flatulence have a high index of probability in such a treatment. However, when deciding between group 1 and group 2 treatments, the authors recommend opting for group 2 treatment that shows to be more efficient.