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Publisher: Elsevier   (Total: 3175 journals)

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Showing 1 - 200 of 3175 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 28, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 33, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 376, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 235, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 28, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 10)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 6)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 42, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 54, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 14, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 7)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 1, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 375, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 333, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 429, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 50, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 42, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 189, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 61, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 165, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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Journal Cover American Journal of Surgery
  [SJR: 1.286]   [H-I: 125]   [37 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9610
   Published by Elsevier Homepage  [3175 journals]
  • Intelligent cooperation: A framework of pedagogic practice in the
           operating room
    • Authors: Gary Sutkin; Eliza B. Littleton; Steven L. Kanter
      Pages: 535 - 541
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Gary Sutkin, Eliza B. Littleton, Steven L. Kanter
      Background Surgeons who work with trainees must address their learning needs without compromising patient safety. Methods We used a constructivist grounded theory approach to examine videos of five teaching surgeries. Attending surgeons were interviewed afterward while watching cued videos of their cases. Codes were iteratively refined into major themes, and then constructed into a larger framework. Results We present a novel framework, Intelligent Cooperation, which accounts for the highly adaptive, iterative features of surgical teaching in the operating room. Specifically, we define Intelligent Cooperation as a sequence of coordinated exchanges between attending and trainee that accomplishes small surgical steps while simultaneously uncovering the trainee's learning needs. Conclusions Intelligent Cooperation requires the attending to accurately determine learning needs, perform real-time needs assessment, provide critical scaffolding, and work with the learner to accomplish the next step in the surgery. This is achieved through intense, coordinated verbal and physical cooperation.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.06.034
       
  • Variation in markup of general surgical procedures by hospital market
           concentration
    • Authors: Marcelo Cerullo; Sophia Y. Chen; Mary Dillhoff; Carl R. Schmidt; Joseph K. Canner; Timothy M. Pawlik
      Pages: 549 - 556
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Marcelo Cerullo, Sophia Y. Chen, Mary Dillhoff, Carl R. Schmidt, Joseph K. Canner, Timothy M. Pawlik
      Background Increasing hospital market concentration (with concomitantly decreasing hospital market competition) may be associated with rising hospital prices. Hospital markup – the relative increase in price over costs – has been associated with greater hospital market concentration. Methods Patients undergoing a cardiothoracic or gastrointestinal procedure in the 2008–2011 Nationwide Inpatient Sample (NIS) were identified and linked to Hospital Market Structure Files. The association between market concentration, hospital markup and hospital for-profit status was assessed using mixed-effects log-linear models. Results A weighted total of 1,181,936 patients were identified. In highly concentrated markets, private for-profit status was associated with an 80.8% higher markup compared to public/private not-for-profit status (95%CI: +69.5% - +96.9%; p < 0.001). However, private for-profit status in highly concentrated markets was associated with only a 62.9% higher markup compared to public/private not-for-profit status in unconcentrated markets (95%CI: +45.4% - +81.1%; p < 0.001). Conclusion Hospital for-profit status modified the association between hospitals' market concentration and markup. Government and private not-for-profit hospitals employed lower markups in more concentrated markets, whereas private for-profit hospitals employed higher markups in more concentrated markets.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.10.028
       
  • Tattooing improves the detection of small lymph nodes and increases the
           number of retrieved lymph nodes in patients with rectal cancer who receive
           preoperative chemoradiotherapy: A randomized controlled clinical trial
    • Authors: Kazutake Okada; Sotaro Sadahiro; Takashi Ogimi; Hiroshi Miyakita; Gota Saito; Akira Tanaka; Toshiyuki Suzuki
      Pages: 563 - 569
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Kazutake Okada, Sotaro Sadahiro, Takashi Ogimi, Hiroshi Miyakita, Gota Saito, Akira Tanaka, Toshiyuki Suzuki
      Background In rectal cancer who received chemoradiotherapy, the number of Lymph nodes (LNs) required remains unclear. We conducted a randomized controlled trial to determine whether preoperative tattooing increases the number of LNs and enhances the detection rate of metastatic LNs. Methods Eighty patients with rectal cancer who received chemoradiotherapy were randomly assigned to receive no tattooing (C group) or to receive tattooing (T group). Results The number of LNs was significantly higher in the T group (13.3 ± 7.4, mean ± SD) than in the C group (8.8 ± 5.9, p < 0.001), however, the number of positive LNs did not differ (0.5 ± 1.3 vs. 0.5 ± 1.1, p = 0.882). The long-axis diameter of LNs was significantly smaller in the T group than in the C group (3.4 ± 1.8 vs. 3.9 ± 2.3 mm, p < 0.001), however, the long-axis diameter of positive LNs did not differ. Conclusions Tattooing increased the number of retrieved LNs by 51%, however, there was no increase in the number of positive LNs.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.06.030
       
  • Pain control with continuous infusion preperitoneal wound catheters versus
           continuous epidural analgesia in colon and rectal surgery: A randomized
           controlled trial
    • Authors: Nicolas J. Mouawad; Stefan W. Leichtle; Christodoulos Kaoutzanis; Kathleen Welch; Suzanne Winter; Richard Lampman; Matt McCord; Kimberly A. Hoskins; Robert K. Cleary
      Pages: 570 - 576
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Nicolas J. Mouawad, Stefan W. Leichtle, Christodoulos Kaoutzanis, Kathleen Welch, Suzanne Winter, Richard Lampman, Matt McCord, Kimberly A. Hoskins, Robert K. Cleary
      Objective To compare continuous infusion preperitoneal wound catheters (CPA) versus continuous epidural analgesia (CEA) after elective colorectal surgery. Methods An open-label equivalence trial randomizing patients to CPA or CEA. Primary outcomes were postoperative pain as determined by numeric pain scores and supplemental narcotic analgesia requirements. Secondary outcomes included incidence of complications and patient health status measured with the SF-36 Health Survey (Acute Form). Results 98 patients were randomized [CPA (N = 50, 51.0%); CEA (N = 48, 49.0%)]. 90 patients were included [ CPA 46 (51.1%); CEA 44 (48.9%)]. Pain scores were significantly higher in the CPA group in the PACU (p = 0.04) and on the day of surgery (p < 0.01) as well as supplemental narcotic requirements on POD 0 (p = 0.02). No significant differences were noted in postoperative complications between groups, aggregate SF-36 scores and SF-36 subscale scores. Conclusions Continuous epidural analgesia provided superior pain control following colorectal surgery in the PACU and on the day of surgery. The secondary endpoints of return of bowel function, length of stay, and adjusted SF-36 were not affected by choice of peri-operative pain control.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.06.031
       
  • Outcomes after laparoscopic or robotic colectomy and open colectomy when
           compared by operative duration for the procedure
    • Authors: Sunu Philip; Nancy Jackson; Vijay Mittal
      Pages: 577 - 580
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Sunu Philip, Nancy Jackson, Vijay Mittal
      Laparoscopic colectomy is associated with important early postoperative advantages. These procedures can however increase total operative duration. Our hypothesis is that increased operative duration is associated with post-operative complications that may outweigh the benefits of a minimally invasive approach. We analyzed data from the Michigan Surgical Quality Collaborative (MSQC)R. This is a statewide database of patients who have undergone colon or rectal resections. Colorectal procedures were divided into four groups by surgical approach: open, laparoscopic, robotic and laparoscopic and robotic procedures converted to open. The sample was divided into three groups by operative duration: less than 2 h, between 2 and 4 h and greater than 4 h and compared by selected preoperative variables and outcomes. Small but significant differences in perioperative outcomes were noted in colectomies with a >4 h operative duration. However, laparoscopic procedures exceeding 4 h were not associated with significant differences perioperative outcomes.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.04.020
       
  • Disparities in incidence of early- and late-onset colorectal cancer
           between Hispanics and Whites: A 10-year SEER database study
    • Authors: Jenna Koblinski; Jana Jandova; Valentine Nfonsam
      Pages: 581 - 585
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Jenna Koblinski, Jana Jandova, Valentine Nfonsam
      Background Racial disparities in incidence of colorectal cancer (CRC) exist. In Hispanics, CRC was the second most commonly diagnosed cancer in 2012. Methods We abstracted the national estimates for Hispanics/Whites with CRC using the SEER database between 2000 and 2010. Trends in incidence, mortality, gender and stage of disease were analyzed for early-onset (age<50; EO - young) and late-onset (age>50; LO - old) cases. Results The overall incidence of CRC increased by 48% in Hispanics. 38% increase in incidence of LO CRC and 80% increase in incidence of EO CRC was seen in this ethnic group. Hispanics and Whites showed higher percentage of distant tumors for both age groups. There was no deviation in overall trend between males and females. Conclusions Although there is an overall decrease in incidence of CRC in Whites increase was seen in Hispanics. While incidence of EO CRC is increasing in both races, LO CRC incidence is increasing in Hispanics not in Whites. This data suggest that disparities in incidence of EO and LO CRC exist between Hispanics and Whites.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.03.035
       
  • Post-operative management of perforated appendicitis: Can clinical
           pathways improve outcomes'
    • Authors: Robert R. Gerard; Barrett A. Kielhorn; Brent Petersen; Andrew J. Mullard; Laurence E. McCahill
      Pages: 593 - 598
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Robert R. Gerard, Barrett A. Kielhorn, Brent Petersen, Andrew J. Mullard, Laurence E. McCahill
      Background We sought to decrease organ space infection (OSI) following appendectomy for perforated acute appendicitis (PAA) by minimizing variation in clinical management. Objective A postoperative treatment pathway was developed and four recommendations were implemented: 1) clear documentation of post-operative diagnosis, 2) patients with unknown perforation status to be treated as perforated pending definitive diagnosis, 3) antibiotic therapy to be continued post operatively for 4–7 days after SIRS resolution, and 4) judicious use of abdominal computed tomography (CT) scanning prior to post-operative day 5. Patient demographics and potential clinical predictors of OSI were captured. The primary end point was development of OSI within 30 days of discharge. Secondary endpoints included length of stay (LOS), readmission rate, other complications and secondary procedures performed. Results A total of 1246 appendectomies were performed and we excluded patients <18 years (n = 205), interval appendectomies (n = 51) or appendectomies for other diagnosis (n = 37). Among the remaining 953 patients, 133 (14.0%) were perforated and 21 of these (15.8%) developed OSI. Comparing pre (n = 91) to post (n = 42) protocol patients, we saw similar rates of OSI (16.5 vs 14.3%, p = 0.75) with a peak in OSI development immediately prior to protocol implementation which dropped to baseline levels 1 year later based on CUSUM analysis. Readmission rates fell by 49.7% (14.3 vs 7.1%, p = 0.39) without increase in LOS (5.3 vs 5.7 days, p = 0.55) comparing patients pre and post protocol, although these results did not reach clinical significance. Conclusions The implementation of and compliance with a post-operative protocol status post appendectomy for PAA demonstrated a trend towards diminishing readmission rates and decreased utilization of CT imaging, but did not affect OSI rates. Additional approaches to diminishing OSI following management of perforated appendicitis need to be evaluated.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.06.003
       
  • Preoperative predictor of extensive resection for acute appendicitis
    • Authors: Fumitaka Saida; Shokei Matsumoto; Mitsuhide Kitano
      Pages: 599 - 602
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Fumitaka Saida, Shokei Matsumoto, Mitsuhide Kitano
      Background Appendectomy has been the preferred treatment of acute appendicitis. However, extensive resection (ER) such as an ileocecal resection is sometimes needed. We analyzed the predictive factors of ER. Methods This was a retrospective study of 927 patients with acute appendicitis in 7 years. The data collected, including demographic characteristics, laboratory tests, computed tomography (CT) findings and days from onset. Results ER was performed in 40 patients (4.3%). Age, days from onset, C-reactive protein (CRP), and the presence of several CT findings were significantly higher in the ER group than others (p < 0.01). In a multivariate analysis, four variables (appendiceal mass, non-visualization of appendix, delayed admission, and CRP) retained statistical significance as predictors of ER (p < 0.01). Conclusions We demonstrated that the four factors are clinically useful for predicting preoperatively whether or not ER is required. These may help in management decisions, including surgical procedure and anesthesia.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.06.033
       
  • Laparotomy and intraoperative enteroscopy for obscure gastrointestinal
           bleeding before and after the era of video capsule endoscopy and deep
           enteroscopy: A tertiary center experience
    • Authors: Wuttiporn Manatsathit; Usah Khrucharoen; Dennis M. Jensen; O. Joe Hines; Thomas Kovacs; Gordon Ohning; Rome Jutabha; Kevin Ghassemi; Gareth S. Dulai; Gustavo Machicado
      Pages: 603 - 609
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Wuttiporn Manatsathit, Usah Khrucharoen, Dennis M. Jensen, O. Joe Hines, Thomas Kovacs, Gordon Ohning, Rome Jutabha, Kevin Ghassemi, Gareth S. Dulai, Gustavo Machicado
      Background To evaluate roles of intraoperative endoscopy (IOE) in management of severe obscure GI bleeding (OGIB) before vs. after introduction of video capsule endoscopy (VCE) and deep enteroscopy (DE). Methods We retrospectively reviewed prospectively collected data of patients undergoing IOE for severe OGIB in a tertiary referral center. Results 52 patients had laparotomy/IOE for OGIB, 11 pre and 41 post VCE/DE eras. In the pre VCE/DE era, 36.4% (4/11) had preoperative presumptive diagnoses while in the post VCE/DE era presumptive diagnoses were made in 48.8% (20/41) (p = 0.18). Preoperative evaluation led to correct diagnoses in 18.2% (2/11) in the pre and 51.2% (21/41) in the post VCE/DE era (p = 0.09). Vascular lesions and ulcers were the most common diagnoses, but rebleeding was common. No rebleeding was found among patients with tumors, Meckel's diverticulum, and aortoenteric fistula. Conclusions Presumptive diagnoses in the post VCE/DE era were usually accurate. If VCE or DE are negative, the probability of negative IOE is high. Patients with tumors and Meckel's diverticulum were the best candidates for IOE.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.05.018
       
  • Delineating the burden of chronic post-operative pain in patients
           undergoing open repair of complex ventral hernias
    • Authors: Colin G. DeLong; Justin A. Doble; Amber L. Schilling; Eric M. Pauli; David I. Soybel
      Pages: 610 - 617
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Colin G. DeLong, Justin A. Doble, Amber L. Schilling, Eric M. Pauli, David I. Soybel
      Background After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care. Methods Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR. Results In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41.8%). Among 41 patients who initiated additional unsolicited complaints of pain, an actionable diagnosis was found in only 3 patients. Risk factors for such complaints included pre-operative pain and the use of synthetic mesh. Conclusions Even in the absence of an actionable diagnosis, significant resources are utilized in evaluation and management of unsolicited complaints of pain in the first year after cVHR.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2018.01.030
       
  • The correlation between fundamental characteristics and first-time
           performance in laparoscopic tasks
    • Authors: Cuan M. Harrington; Richard Bresler; Donncha Ryan; Patrick Dicker; Oscar Traynor; Dara O. Kavanagh
      Pages: 618 - 624
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Cuan M. Harrington, Richard Bresler, Donncha Ryan, Patrick Dicker, Oscar Traynor, Dara O. Kavanagh
      Background The ability of characteristics to predict first time performance in laparoscopic tasks is not well described. Videogame experience predicts positive performance in laparoscopic experiences but its mechanism and confounding-association with aptitude remains to be elucidated. This study sought to evaluate for innate predictors of laparoscopic performance in surgically naive individuals with minimal videogame exposure. Methods Participants with no prior laparoscopic exposure and minimal videogaming experience were recruited consecutively from preclinical years at a medical university. Participants completed four visuospatial, one psychomotor aptitude test and an electronic survey, followed by four laparoscopic tasks on a validated Virtual Reality simulator (LAP Mentor™). Results Twenty eligible individuals participated with a mean age of 20.8 (±3.8) years. Significant intra-aptitude performance correlations were present amongst 75% of the visuospatial tests. These visuospatial aptitudes correlated significantly with multiple laparoscopic task metrics: number of movements of a dominant instrument (rs ≥ −0.46), accuracy rate of clip placement (rs ≥ 0.50) and time taken (rs ≥ −0.47) (p < 0.05). Musical Instrument experience predicted higher average speed of instruments (rs ≥ 0.47) (p < 0.05). Participant's revised competitive index level predicted lower proficiency in laparoscopic metrics including: pathlength, economy and number of movements of dominant instrument (rs ≥ 0.46) (p < 0.05). Conclusion Multiple visuospatial aptitudes and innate competitive level influenced baseline laparoscopic performances across several tasks in surgically naïve individuals.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.04.015
       
  • The Parkland grading scale for cholecystitis
    • Authors: Tarik D. Madni; David E. Leshikar; Christian T. Minshall; Paul A. Nakonezny; Canon C. Cornelius; Jonathan B. Imran; Audra T. Clark; Brian H. Williams; Alexander L. Eastman; Joseph P. Minei; Herb A. Phelan; Michael W. Cripps
      Pages: 625 - 630
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Tarik D. Madni, David E. Leshikar, Christian T. Minshall, Paul A. Nakonezny, Canon C. Cornelius, Jonathan B. Imran, Audra T. Clark, Brian H. Williams, Alexander L. Eastman, Joseph P. Minei, Herb A. Phelan, Michael W. Cripps
      Background Gallbladders (GBs) with severe inflammation have longer operative times and an increased risk for complications. We propose a grading system using intraoperative images to better stratify GB inflammation. Methods After reviewing the intraoperative images of GBs obtained during several hundred laparoscopic cholecystectomies, we developed a five-tiered grading system based on anatomy and inflammatory changes. Fifty intraoperative photographs were taken prior to dissection and then distributed to 11 surgeons who rated each GB's severity per the grading system. The two-way random effects Intraclass Correlation Coefficient (ICC) was used to assess the reliability among the raters. Results The ICC among the raters of GB severity was 0.804 (95% CI: 0.733 to 0.867; p = 0.0001). Nineteen GB images had greater than 82% agreement and 16 were clustered around GBs with severe inflammation (grades 3–5). Conclusion This study proposes a simple, reliable grading system that characterizes GB complexity based on inflammation and anatomy.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.05.017
       
  • A novel laparoscopic transcystic approach using an ultrathin
           choledochoscope and holmium laser lithotripsy in the management of
           cholecystocholedocholithiasis: An appraisal of their safety and efficacy
    • Authors: Hong-tian Xia; Yang Liu; Hao Jiang; Tao Yang; Bin Liang; Jian-Ping Zeng; Jia-Hong Dong
      Pages: 631 - 635
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Hong-tian Xia, Yang Liu, Hao Jiang, Tao Yang, Bin Liang, Jian-Ping Zeng, Jia-Hong Dong
      Background Although laparoscopic transcystic common bile duct exploration (LTCBDE) is the preferred approach for CBD stone clearance, the success rate can vary between 55% and 85%. This study evaluated if ultrathin choledochoscope and holmium laser lithotripsy could improve the success rate of LTCBDE. Methods Records of 126 patients (average age, 46.1 ± 13.8 years) with cholecystocholedocholithiasis treated with laparoscopic cholecystectomy (LC) and LTCBDE were retrospectively reviewed. Results LC+LTCBDE was performed successfully in 118 of 126 patients, with a surgical success rate of 93.7%. An ultrathin choledochoscope was used in 75 (63.5%) patients, and holmium lithotripsy was performed in 38 (32.2%) patients. The stone clearance rate was 99.2% (117/118). No significant complications occurred. One hundred (84.7%) patients had excellent and 13 (11%) had good outcomes for an overall success rate (excellent plus good) of 95.7%. Conclusion Ultrathin choledochoscope and holmium laser lithotripsy can improve the surgical outcomes of LC+LTCBDE with minimal complications.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.05.020
       
  • Temporal artery biopsy in the diagnosis of giant cell arteritis: Bigger is
           not always better
    • Authors: Marios Papadakis; Sarantos Kaptanis; Aikaterini Kokkori-Steinbrecher; Nikolaos Floros; Frauke Schuster; Gunnar Hübner
      Pages: 647 - 650
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Marios Papadakis, Sarantos Kaptanis, Aikaterini Kokkori-Steinbrecher, Nikolaos Floros, Frauke Schuster, Gunnar Hübner
      Objective Accurate early giant cell arteritis (GCA) diagnosis can be established through temporal artery biopsy (TAB). We herein investigate the relationship between specimen length and positive TAB result in a tertiary-care hospital in Germany during a 8-year period. Secondarily, we studied the relationships of specific epidemiological and laboratory parameters with positive TABs. Method We retrospectively reviewed the medical records of all patients with suspected GCA, who underwent TAB in our institution. Results The total sample consisted of 116 patients with a mean age of 76.1 (SD 7.7) years. Mean specimen length post-fixation was 0.94 cm (SD 0.49). The TAB(+) group consisted of 64 patients (55.2%). The specimen length was comparable in the two groups (0.96 cm vs 0.91 cm, p = 0.581). Twenty six TAB(+) patients (41%) had a post-fixation specimen longer than 1 cm, comparable with the respective percentage in the TAB(−) group (42%, p = 1). All laboratory tests performed were statistically significantly different in the two groups. Conclusion We conclude that TAB length is not associated with the TAB diagnostic yield in patients with clinical suspicion of GCA.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.08.020
       
  • The role of preoperative blood parameters to predict the risk of surgical
           site infection
    • Authors: Edin Mujagic; Walter R. Marti; Michael Coslovsky; Jasmin Zeindler; Sebastian Staubli; Regula Marti; Robert Mechera; Savas D. Soysal; Lorenz Gürke; Walter P. Weber
      Pages: 651 - 657
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Edin Mujagic, Walter R. Marti, Michael Coslovsky, Jasmin Zeindler, Sebastian Staubli, Regula Marti, Robert Mechera, Savas D. Soysal, Lorenz Gürke, Walter P. Weber
      Background Routine preoperative blood work is not recommended but selected biochemical markers may predict the risk of surgical site infection (SSI). This study examines the association between preoperative biochemical markers and the risk of SSI. Methods This observational cohort study, nested in a randomized controlled trial, was conducted at two tertiary referral centers in Switzerland. Results 122 (5.8%) of 2093 patients experienced SSI. Preoperative increasing levels of albumin (OR 0.93), CRP (OR 1.34), hemoglobin (OR 0.87) and eGFR (OR 0.90) were significantly associated with the odds of SSI. The same accounts for categorized parameters. The highest area under the curve from ROC curves was 0.62 for albumin. Positive predictive values ranged from 6.4% to 9.5% and negative predictive values from 94.8% to 95.7%. The association of CRP, mildly and moderately decreased eGFR and hemoglobin with the odds of SSI remained significant on multivariate analysis. Conclusions Our results do not support generally delaying elective surgery based on preoperative blood results. However, it may be considered in situations with potentially severe sequelae of SSI.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.08.021
       
  • Morbid obesity and functional status as predictors of surgical
           complication after renal transplantation
    • Authors: Tara M. Veasey; James N. Fleming; Sara E. Strout; Ryan Miller; Nicole A. Pilch; Holly B. Meadows; Caitlin R. Mardis; Benjamin A. Mardis; Sunil Shenvi; John McGillicuddy; Kenneth D. Chavin; Prabhakar Baliga; David J. Taber
      Pages: 663 - 668
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Tara M. Veasey, James N. Fleming, Sara E. Strout, Ryan Miller, Nicole A. Pilch, Holly B. Meadows, Caitlin R. Mardis, Benjamin A. Mardis, Sunil Shenvi, John McGillicuddy, Kenneth D. Chavin, Prabhakar Baliga, David J. Taber
      Background This study evaluated the impact of body mass index (BMI) and patient functional status on the risk for surgical complications after kidney transplant. Methods This retrospective cohort study of adult kidney transplant recipients grouped patients by baseline Karnofsky status (low function ≤ 70%) and further stratified by morbid obesity (BMI ≥ 35 kg/m2) to assess surgical complication risk. Results 736 patients were included with surgical complications occurring in 25%. Logistic regression analysis with interaction terms demonstrated that morbid obesity and low functional status conditionally impact risk with an OR of 2.8 [95% CI (1.1–7.3)]. Within the functional status cohort, BMI ≥35 kg/m2 was associated with increased risk of surgical complication, superficial wound infection, and DGF. Independent predictors for surgical complications included diabetes and morbid obesity with low functional status. There was no significant difference in graft loss or death across the cohorts. Conclusions While neither morbid obesity nor poor functional status alone predicts increased complications, the combined presence is associated with significant increase in risk for surgical complications after renal transplantation.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.05.009
       
  • Boarding ICU patients: Are our rounding practices subpar'
    • Authors: Andrew M. Nunn; Justin S. Hatchimonji; Daniel N. Holena; Mark J. Seamon; Brian P. Smith; Lewis J. Kaplan; Niels D. Martin; Patrick M. Reilly; C. William Schwab; Jose L. Pascual
      Pages: 669 - 674
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Andrew M. Nunn, Justin S. Hatchimonji, Daniel N. Holena, Mark J. Seamon, Brian P. Smith, Lewis J. Kaplan, Niels D. Martin, Patrick M. Reilly, C. William Schwab, Jose L. Pascual
      Introduction Surgical Intensive Care Unit (SICU) patients “boarding” in ICUs other than the designated home unit have been shown to suffer increased rates of complications. We hypothesized that ICU rounding practices are different when SICU patients are housed in home vs. boarding ICUs. Material and methods SICU rounds were observed at an academic quaternary medical center. Individual patient rounding time and order seen on rounds along with patient data and demographics were recorded. Multivariable regression analysis was used for comparison between patients. Results Non-boarders were older, observed on a later post ICU admission day and were more likely to be mechanically ventilated. Boarded patients were often seen at the end of rounds and for less time. Not being a boarder, age, APACHE II score on admission, vasopressor use, and positive pressure ventilation all predicted increased rounding time. Conclusions Surgical ICU patients boarding in non-preferred units are often seen at the end of rounds, result in a greater reliance upon telephone communication, and receive less bedside attention from ICU provider teams.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.04.019
       
  • Disparities in compliance with the Oncotype DX breast cancer test in the
           United States: A National Cancer Data Base assessment
    • Authors: Zachary Kozick; Ammar Hashmi; James Dove; Marie Hunsinger; Tania Arora; Jeffrey Wild; Mohsen Shabahang; Joseph Blansfield
      Pages: 686 - 692
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Zachary Kozick, Ammar Hashmi, James Dove, Marie Hunsinger, Tania Arora, Jeffrey Wild, Mohsen Shabahang, Joseph Blansfield
      Background Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations were followed based on respective risk. Methods We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base. Results A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test. Non-testing rose with age. White patients were more likely to be tested (56%) versus black patients (46%, p < 0.0001). Testing was highest at academic facilities (40%). Privately insured patients were more likely to get the test compared to uninsured (45 versus 34%, p < 0.0001). Those in the highest income quartile were more likely to be tested (p < 0.001). Conclusions ODX is under-utilized, with racial and socio-economic factors influencing testing. Further studies are necessary to identify ways to remove disparities and increase testing when appropriate.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.05.008
       
  • Stratifying SLN incidence in intermediate thickness melanoma patients
    • Authors: James M. Chang; Heidi E. Kosiorek; Amylou C. Dueck; Stanley P.L. Leong; John T. Vetto; Richard L. White; Eli Avisar; Vernon K. Sondak; Jane L. Messina; Jonathan S. Zager; Carlos Garberoglio; Mohammed Kashani-Sabet; Barbara A. Pockaj
      Pages: 699 - 706
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): James M. Chang, Heidi E. Kosiorek, Amylou C. Dueck, Stanley P.L. Leong, John T. Vetto, Richard L. White, Eli Avisar, Vernon K. Sondak, Jane L. Messina, Jonathan S. Zager, Carlos Garberoglio, Mohammed Kashani-Sabet, Barbara A. Pockaj
      Background Guidelines for melanoma recommend sentinel lymph node biopsy (SLNB) in patients with melanomas ≥1 mm thickness. Recent single institution studies have found tumors <1.5 mm a low-risk group for positive SLNB. Methods A retrospective review of the Sentinel Lymph Node Working Group multicenter database identified patients with intermediate thickness melanoma (1.01–4.00 mm) who had SLNB, and assessed predictors for positive SLNB. Results 3460 patients were analyzed, 584 (17%) had a positive SLNB. Univariate factors associated with a positive SLNB included age <60 (p < .001), tumor on the trunk/lower extremity (p < .001), Breslow depth ≥2 mm (p < .001), ulceration (p < .001), mitotic rate ≥1/mm2 (p = .01), and microsatellitosis (p < .001). Multivariate analysis revealed age, location, and Breslow depth as significant predictors. Patients ≥75 with lesions 1.01–1.49 mm on the head/neck/upper extremity and 1.5–1.99 mm without high-risk features had <5% risk of SLN positivity. Conclusions Intermediate thickness melanoma has significant heterogeneity of SLNB positivity. Low-risk subgroups can be found among older patients in the absence of high-risk features.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.12.009
       
  • Postoperative opioid prescribing: Getting it RIGHTT
    • Authors: Brian K. Yorkgitis; Gabriel A. Brat
      Pages: 707 - 711
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Brian K. Yorkgitis, Gabriel A. Brat
      Background Prescription opioid medications account for a large number of fatal and non-fatal overdoses. Many opioid prescription medications after surgery go unused, with the potential for diversion and misuse. As surgeons become increasingly aware of their role in opioid misuse, better tools are needed to guide behavior. Data sources There has recently been a plethora of research into opioid prescribing after surgery. A review of this literature was performed using a search for manuscripts written in the English language. Our goal was to develop an easily recalled approach to postoperative opioid prescribing. Results Based on an extensive review of recent literature, we developed the acronym RIGHTT: Risk for adverse event, Insight into pain, Going over pain plan, Halting opioids, Tossing unused opioids and Trouble identification. It is important that surgeons recognize the potential for opioid misuse in their patients. Strategies have been developed to decrease the risk of prescribing opioids. RIGHTT provides a simple acronym for surgeons to integrate best-practice strategies into their management of post-surgical opioids.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2018.02.001
       
  • Management of colonoscopic perforations: A systematic review
    • Authors: Alexander T. Hawkins; Kenneth W. Sharp; Molly M. Ford; Roberta L. Muldoon; M. Benjamin Hopkins; Timothy M. Geiger
      Pages: 712 - 718
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Alexander T. Hawkins, Kenneth W. Sharp, Molly M. Ford, Roberta L. Muldoon, M. Benjamin Hopkins, Timothy M. Geiger
      Background Perforation during colonoscopy is a rare but well recognized complication with significant morbidity and mortality. We aim to systematically review the currently available literature concerning care and outcomes of colonic perforation. An algorithm is created to guide the practitioner in management of this challenging clinical scenario. Data sources A systematic review of the literature based on PRISMA-P guidelines was performed. We evaluate 31 articles focusing on findings over the past 10 years. Conclusion Colonoscopic perforation is a rare event and published management techniques are marked by their heterogeneity. Reliable conclusions are limited by the nature of the data available – mainly single institution, retrospective studies. Consensus conclusions include a higher rate of perforation from therapeutic colonoscopy when compared to diagnostic colonoscopy and the sigmoid as the most common site of perforation. Mortality appears driven by pre-existing conditions. Treatment must be tailored according to the patient's comorbidities and clinical status as well as the specific conditions during the colonoscopy that led to the perforation.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.08.012
       
  • Component separation technique for giant incisional hernia: A systematic
           review
    • Authors: Bram Cornette; Dirk De Bacquer; Frederik Berrevoet
      Pages: 719 - 726
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Bram Cornette, Dirk De Bacquer, Frederik Berrevoet
      The component separation technique (CST) has gained popularity among general surgeons in the management of giant abdominal hernia. A systematic review of the MedLine and EMBASE databases was performed. 36 observational cohort studies were included for data-analysis and divided in 4 main groups: Open Anterior Approach (OAA), Transversus Abdominis Release (TAR), Laparoscopic Anterior Approach (LAA) and Perforator Preserving Approach (PPA). Surgical Site Occurrences (SSO) occurred in 21.4%, 23.7%, 20.3% and 16.0% respectively. Incidence of recurrence was 11.9% (OAA), 5.25% (TAR), 7.02% (LAA) and 6.47% (PPA) with a significant difference in the advantage of TAR over OAA (p < 0.001). Limitations in this systematic review were a lack of randomized trials, a heterogenous population and non-standardized methods for measuring outcomes, all making it difficult to postulate conclusions about CST and its modifications. Based on pooled results of 36 studies, the prevalence of SSO is comparable between the techniques with an average of one in five and the prevalence of recurrences is highest when using the Open Anterior Approach at 11.9%.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.07.032
       
  • Tropism of liver epithelial cells toward hepatocellular carcinoma
           
    • Authors: Kuo-Shyang Jeng; Chi-Juei Jeng; Wen-Juei Jeng; I-Shyan Sheen; Shih-Yun Li; Ssu-Jung Lu; Chiung-Fang Chang
      Pages: 735 - 743
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Kuo-Shyang Jeng, Chi-Juei Jeng, Wen-Juei Jeng, I-Shyan Sheen, Shih-Yun Li, Ssu-Jung Lu, Chiung-Fang Chang
      Background Rat liver epithelial (RLE) cells could inhibit the proliferation and invasiveness of hepatoma cells in vitro. This study is to understand the tropism and the effect of RLE cells on mouse hepatoma cells both in vitro and in vivo. Methods RLE cells were isolated from new-born rats and characterized their stem cell markers. Co-culture and HCC mouse model was established to detect therapeutic effect of RLE cells. Results RLE cells (including Thy-1+ RLE cells, Thy-1- RLE cells, RLE cells) displayed a selective tropism toward ML-1 hepatoma cells both in vitro and in vivo. They altered the gene expression of some cancer stem cell markers in the liver tumor. Conclusion Liver epithelial cells have a selective tropism toward HCC in vitro and in vivo. They could alter the gene expression of cancer stem cells.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.11.041
       
  • Surgical registrars' perceptions of surgical training and capacity in
           Zambia: Results from three COSECSA affiliated training hospitals
    • Authors: Derek M. Freitas; James Munthali; Joseph Musowoya; Hebah Ismail; Allyson Herbst; Laston Chikoya; Shubhada Dhage; Mary Ann Hopkins
      Pages: 744 - 751
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Derek M. Freitas, James Munthali, Joseph Musowoya, Hebah Ismail, Allyson Herbst, Laston Chikoya, Shubhada Dhage, Mary Ann Hopkins
      Background Surgery is a vital component of a comprehensive health system, but there are often personnel limitations in resource constrained areas. Zambia provides post graduate surgical training through two systems to help address this shortage. However, no studies have analyzed surgical trainees' perceptions of these programs. Methods Surgical registrars at COSECSA affiliated hospitals in Zambia were surveyed about their programs. Responses were analyzed to identify key strengths and challenges across several categories including: operative training, clinical training, educational experiences, and career plans. Results Registrars report having significant independence and receiving broad and high quality operative training. They note specific challenges including limitations in specialty training, resources, and infrastructure. Conclusions Zambian training programs have the potential to increase number of surgeons in Zambia by a significant amount in the coming years. These programs have many strengths but also face challenges in their goal to expand surgical access in the country.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.07.023
       
  • Social media in the mentorship and networking of physicians: Important
           role for women in surgical specialties
    • Authors: Jessica G.Y. Luc; Nikki L. Stamp; Mara B. Antonoff
      Pages: 752 - 760
      Abstract: Publication date: April 2018
      Source:The American Journal of Surgery, Volume 215, Issue 4
      Author(s): Jessica G.Y. Luc, Nikki L. Stamp, Mara B. Antonoff
      Background Social media may be a useful supplement to physician and trainee interactions; however, its role in enhancing mentorship has not been described. Methods A 35-item survey investigating trainee and physician social media use was distributed. Responses were analyzed using descriptive statistics. Results 282 respondents completed the survey, among whom 136 (48.2%) reported careers in surgical specialties. Women in surgical specialties were more likely to describe the specialty as being dominated by the opposite sex (p < 0.001) and to be mentored by the opposite sex though wish to be mentored by individuals of the same sex (p < 0.001). Respondents in surgical specialties were also more likely to report using social media to build a network of same-sex mentorship (p = 0.031). Conclusions Social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2018.02.011
       
  • Role of supportive services in facilitating employment for cancer patients
    • Authors: Karen L. Kwong
      Abstract: Publication date: Available online 28 March 2018
      Source:The American Journal of Surgery
      Author(s): Karen L. Kwong


      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.11.066
       
  • Modified Blumgart anastomosis with the “complete packing method”
           reduces the incidence of pancreatic fistula and complications after
           resection of the head of the pancreas
    • Authors: Toru Kojima; Takefumi Niguma; Nobuyuki Watanabe; Taizo Sakata; Tetsushige Mimura
      Abstract: Publication date: Available online 26 March 2018
      Source:The American Journal of Surgery
      Author(s): Toru Kojima, Takefumi Niguma, Nobuyuki Watanabe, Taizo Sakata, Tetsushige Mimura
      Background Postoperative pancreatic fistula (POPF) and its complications remain problems. This study evaluated combination treatment with modified Blumgart anastomosis and an original infection control method (complete packing method) following pancreatic head resection. Methods This study included 374 consecutive patients who underwent pancreatic head resection: 103 patients underwent Cattell-Warren anastomosis (CWA); 170 patients underwent modified Kakita anastomosis (KA); and 101 patients underwent modified Blumgart anastomosis with the complete packing method (BAC). The outcomes of the KA and BAC groups were compared statistically. Results The POPF rate was significantly lower in the BAC group than in the KA group (28.8% vs 2.97%; p < 0.01). The overall postoperative complication rate, including SSI and postoperative hemorrhage, was significantly lower in the BAC group. Conclusions The combination of modified Blumgart anastomosis and the complete packing method is a simple and useful method for reducing the incidence of POPF and postoperative complications.

      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2018.03.024
       
  • Comments on “Tele-mentored emergency trauma surgery: A feasibility study
           using live-tissue models”
    • Authors: Camilo Rosales
      Abstract: Publication date: Available online 22 March 2018
      Source:The American Journal of Surgery
      Author(s): Camilo Rosales


      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2018.03.021
       
  • Discussion of: “Pre-surgical chemotherapy for breast cancer may be
           associated with improved outcome”
    • Authors: Kristen Massimino
      Abstract: Publication date: Available online 20 March 2018
      Source:The American Journal of Surgery
      Author(s): Kristen Massimino


      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.11.072
       
  • Discussion of: Routine shave margins are not necessary in early stage
           breast cancer treated with breast conserving surgery
    • Authors: Nathalie Johnson
      Abstract: Publication date: Available online 20 March 2018
      Source:The American Journal of Surgery
      Author(s): Nathalie Johnson


      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2018.03.018
       
  • Does the implementation of a pediatric appendicitis pathway promoting
           ultrasound work outside of a children's hospital'
    • Authors: Kenneth W. Gow
      Abstract: Publication date: Available online 16 March 2018
      Source:The American Journal of Surgery
      Author(s): Kenneth W. Gow


      PubDate: 2018-04-15T15:02:48Z
      DOI: 10.1016/j.amjsurg.2017.11.071
       
  • Medical Student Perceptions of a Mistreatment Program During the Surgery
           Clerkship
    • Authors: Brittany N. Hasty; Sarah E. Miller; Sylvia Bereknyei Merrell; Dana T. Lin; Edward S. Shipper; James N. Lau
      Abstract: Publication date: Available online 4 January 2018
      Source:The American Journal of Surgery
      Author(s): Brittany N. Hasty, Sarah E. Miller, Sylvia Bereknyei Merrell, Dana T. Lin, Edward S. Shipper, James N. Lau
      Background Medical student mistreatment remains a concern, particularly in the surgery clerkship. This is a single academic institution’s report of medical student perceptions of a mistreatment program embedded in the surgery clerkship. Methods Students who completed the surgery clerkship and the mistreatment program volunteered to be interviewed individually or in focus groups. The interviews were transcribed and qualitatively analyzed. Results Twenty-four medical students were interviewed and nine transcripts were obtained. Codes were identified independently then nested into four codes: Student Growth, Faculty Champion and Team, Student Perspectives on Surgical Culture, and Program Methods. Rank orders were then calculated for each major code. Conclusion Our mistreatment program has shown that providing students with an opportunity to define mistreatment, a safe environment for them to debrief, and staff to support and advocate for them, empowers them with the knowledge and skillset to confront what is too often considered part of the hidden curriculum.

      PubDate: 2018-01-04T18:14:19Z
      DOI: 10.1016/j.amjsurg.2018.01.001
       
 
 
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