Journal of the American College of Surgeons
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Multicenter Study
Rural General Surgery: A 38-year Experience with a Regional Network Established by an Integrated Health System in the Midwestern United States.
General surgeon (GS) workforce shortages are predicted to worsen, particularly in rural areas. We report on a sustainable model for delivery of GS services within a large rural region that includes an integrated health system. ⋯ Successful recruitment of rural GSs depends on competitive salary, reasonable call and leave schedules, administrative support, and adequate case variety and volume. Case volume is enhanced by cooperative relationships with CAHs, health system assistance in performing appropriate procedures locally, co-management of complex cases, and development of outreach surgical locations. In addition to the recruitment principles mentioned, rural GS retention is optimized by connectivity with the main campus medical center.
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Multicenter Study
Sex-Specific Differences in Colon Cancer When Quality Measures Are Adhered To: Results from International, Prospective, Multicenter Clinical Trials.
There is no consensus on the relationship between patient sex and the location, stage, and oncologic outcome of colon cancer (CC). We hypothesized that there is a sex-specific difference in the biology and management of CC. ⋯ This is the first prospective study to demonstrate sex-specific differences in location and T stage of CC when surgical and pathologic management adhered to strict quality standards. The predominance of right-sided CC in females suggests that flexible sigmoidoscopy may be inadequate for screening and surveillance. Interestingly, earlier stage and right-sided location did not confer a DFS or OS advantage for women. Additional studies are needed to determine why females have a higher propensity for right-sided lesions and a potential difference in CC biology.
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Multicenter Study Comparative Study
Selective Nonoperative Management of Abdominal Gunshot Wounds from Heresy to Adoption: A Multicenter Study of the Research Consortium of New England Centers for Trauma (ReCoNECT).
Selective nonoperative management (SNOM) of abdominal gunshot wounds is being practiced in certain trauma centers, but its broader acceptance in the surgical community is unknown. We hypothesized that SNOM has been adopted in New England as an acceptable method of abdominal gunshot wound management. ⋯ Selective nonoperative management of abdominal gunshot wounds, despite being a heresy only a few years ago, has now been established as an acceptable method of management in Level I and II trauma centers in New England.
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Although there is increasing literature about burnout and attrition among surgeons, little is known about personal and professional well-being of surgical trainees. ⋯ Surgical trainee well-being is critical to optimal patient care, career development, and burnout reduction. Surgical residents attend to their own preventive health maintenance, finances, sleep, and stress reduction with variable success. Residency programs should make modest programmatic accommodations to allow trainees to tend to various aspects of their personal well-being.
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Multicenter Study
Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study.
An intraoperative adverse event (iAE) is often directly attributable to the surgeon's technical error and/or suboptimal intraoperative judgment. We aimed to examine the psychological impact of iAEs on surgeons as well as the surgeons' attitude about iAE reporting. ⋯ Intraoperative AEs occur often, have a significant negative impact on surgeons' well-being, and barriers to transparency are fear of litigation and absence of a well-defined reporting system. Efforts should be made to support surgeons and standardize reporting when iAEs occur.