Journal of the American College of Surgeons
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Although surgical repair is universally recognized as the gold standard for treatment of paraesophageal hernia (PEH), the optimal surgical approach is still the subject of debate. To determine which surgical technique is safest, we compared the outcomes of laparoscopic (lap), open transabdominal (TA), and open transthoracic (TT) PEH repair using the NSQIP database. ⋯ In the absence of published data indicating improved long-term outcomes after open TA or TT approach, our findings support the use of laparoscopy, whenever technically feasible, because it yields improved short-term outcomes.
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We designed MRI-guided quadrantectomy using 2-dimensional images reconstructed from MRI to enable virtual simulation of breast-conserving surgery. This study evaluated the efficacy of our approach, which involved projection of the 2-dimensional reconstruction images directly onto the breast to guide planned resection compared with the conventional approach with preoperative localization with hooked wires, for patients with ductal carcinoma in situ (DCIS) detected by mammographic calcifications. ⋯ Compared with a conventional approach using hooked wires, our MRI-guided quadrantectomy might be useful for patients with DCIS and DCIS with T1mic detected by mammographic calcifications, due to the superior ability to detect DCIS on MRI compared with mammography.
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Whether high-ratio resuscitation (HRR) provides patients with survival advantage remains controversial. We hypothesized a direct correlation between HRR infusion rates in the first 180 minutes of resuscitation and survival. ⋯ This is the first study to examine effects of MIRs on survival. Further studies on the effects of narrow time-interval analysis for blood product resuscitation are warranted.
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The national pass rate for the American Board of Surgery Certifying Examination has decreased in the past 5 years. An individual's ability to pass might be as dependent on his or her handling of the psychology of the examination-the "examanship" -because it is about clinical knowledge and judgment. To assess this, we implemented the Advanced Certifying Examination Simulation (ACES) program. The ACES was created as a novel method to simulate the stress of the Certifying Examination and focuses on the examanship of the test. ⋯ The ACES program provides feedback on the qualities of examanship: controlling anxiety, expressing a positive attitude, and maintaining a strong and confident voice. By providing a structured, simulated venue where residents can safely gain experience, we believe that ACES might lead to increased first-time passage rates on the American Board of Surgery Certifying Examination.