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  • Error in Presentation of Author’s Name
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-23

    In the Original Investigation titled “Management of Stage I Squamous Cell Carcinoma of the Anal Canal,”1 published online October 18, 2017, as well as in the March 2018 print issue, there was an error in the presentation of an author’s name. In the byline, “S.” should have appeared after Dr Tran Cao’s first name. In the Author Affiliations, Dr Tran Cao’s surname should have appeared as “Tran Cao.” This article was corrected online.

    更新日期:2018-05-23
  • Considerations When Calculating Data Completeness
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-23
    Wendy C. King, Steven H. Belle, Anita P. Courcoulas

    To the Editor We agree with Higa and Himpens1 that obtaining long-term data following metabolic/bariatric surgery is a challenge and that appropriate analytical methods need to be used to account for missing data, although they are not a substitute for complete follow-up. However, we disagree with their characterization of 7-year data completeness in the Longitudinal Assessment of Bariatric Surgery (LABS) study.2 Higa and Himpens stated, “data at 7 years were available for 1300 of the eligible 2277 patients (57%), not the 82.9% rate as reported.”1 They determined their percentage by dividing the number of nonpregnant participants with 7-year weight data (n = 1300) by the number of participants at study entry (n = 2348) minus the number who died prior to year 7 (n = 71). However, as the article indicates, the study ended before 700 participants were due for the 7-year assessment.2 Thus, it is inappropriate to include them in the denominator when calculating 7-year data completeness. Furthermore, because weights of pregnant women were excluded from the report, pregnant women (n = 9 at year 7) should not be counted in the denominator either.

    更新日期:2018-05-23
  • Unusual Scrotal Swelling
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-23
    Sante Capitano, Daniele Castellani
    更新日期:2018-05-23
  • The Problem of the Indeterminate Thyroid NoduleA Genomic Sequencing Classifier and Clinical Judgment
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-23
    Peter Angelos

    Despite the value of cytologic evaluation of thyroid nodules in reducing the frequency of surgery for benign cases, the challenge of indeterminate nodules, with their 5% to 30% risk of becoming cancerous, remains.1,2 Patients with indeterminate thyroid nodules have typically been recommended for surgery even though most nodules proved to be benign.3 In recent years, a commercially available gene expression classifier (GEC) test with high sensitivity and negative predictive value has been shown to reduce the number of thyroidectomies performed for benign disease.4

    更新日期:2018-05-23
  • Performance of a Genomic Sequencing Classifier for the Preoperative Diagnosis of Cytologically Indeterminate Thyroid Nodules
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-23
    Kepal N. Patel, Trevor E. Angell, Joshua Babiarz, Neil M. Barth, Thomas Blevins, Quan-Yang Duh, Ronald A. Ghossein, R. Mack Harrell, Jing Huang, Giulia C. Kennedy, Su Yeon Kim, Richard T. Kloos, Virginia A. LiVolsi, Gregory W. Randolph, Peter M. Sadow, Michael H. Shanik, Julie A. Sosa, S. Thomas Traweek, P. Sean Walsh, Duncan Whitney, Michael W. Yeh, Paul W. Ladenson
    更新日期:2018-05-23
  • Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-23
    Shahid Shafi, Ashley W. Collinsworth, Laurel A. Copeland, Gerald O. Ogola, Taoran Qiu, Maria Kouznetsova, I-Chia Liao, Natalie Mears, An T. Pham, George J. Wan, Andrew L. Masica
    更新日期:2018-05-23
  • JAMA Surgery
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01

    Mission Statement: To promote the art and science of surgery by publishing relevant peer-reviewed research to assist the surgeon in optimizing patient care. JAMA Surgery will also serve as a forum for the discussion of issues pertinent to surgery, such as the education and training of the surgical workforce, quality improvement, and the ethics and economics of health care delivery. JAMA Network is a consortium of peer-reviewed print and online medical publications that includes JAMA®, JAMA Surgery, and other specialty journals. JAMA Surgery does not hold itself responsible for statements made by any contributor. All articles published, including opinion articles, represent the views of the authors and do not reflect the policy of the Journal, the American Medical Association, or the institution with which the author is affiliated, unless otherwise indicated.

    更新日期:2018-05-16
  • JAMA Surgery Peer Reviewers in 2017
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01

    Oliver Aalami Fizan Abdullah David B. Adams Brij Bhushan Agarwal Suresh Agarwal Rajesh Aggarwal Syed Ahmad Gretchen M. Ahrendt Nita Ahuja Waddah B. Al-Refaie Hasan B. Alam Daniel Albo Adam M. Ali Maria D. Allo Thomas A. Aloia

    更新日期:2018-05-16
  • Error in Results Section
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01

    In the Original Investigation titled “Evaluation of Early Allograft Function Using the Liver Graft Assessment Following Transplantation Risk Score Model,”1 published online December 20, 2017, there was an error in the presentation of data in the first sentence of the second paragraph of the Results section. The sentence should read “The most frequent underlying cause of liver disease was hepatitis C (38.5%), with diabetes, hypertension, and coronary artery disease in 25.9%, 29.6%, and 7.0% of patients, respectively.” This article has been corrected online.

    更新日期:2018-05-16
  • Cultural Sensitivity in Deployed US Medical Personnel—Reply
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Peter A. Learn, Eric A. Elster

    In Reply We appreciate Jindal’s comments on the importance of cultural competency in the delivery of humanitarian surgical care. Cultural competency has gained increasing recognition not only as an essential component of effective global health engagement but also as a key to improving health care disparities domestically.1,2 Considering the number of factors that can increase the cultural distance between the deployed military surgeon and local populations and the volume of contact we demonstrated,3 focused training seems a reasonable prerequisite to deployment, although how best to integrate such training amidst mission-essential requirements will remain a challenge. For an organization that has already prioritized cultural competency in special operations forces training,4 this is certainly an achievable task if it is valued appropriately.

    更新日期:2018-05-16
  • Cultural Sensitivity in Deployed US Medical Personnel
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Rahul M. Jindal

    To the Editor I read with interest the Research Letter by Weeks et al1 in which surgeons from the US military have delivered humanitarian surgical care to local national civilians in war zones. The authors raise the important issue of preparing US surgeons for deployment. Cultural sensitivity is critical in these endeavors, in particular for deployed medical personnel.2 There are many different potential culture clashes that deployed troops can experience in a religious and conservative country.3 It has been well documented that some US troops’ misunderstanding of Iraqi culture when they first entered into the region led to failure of “winning hearts and minds.”4

    更新日期:2018-05-16
  • Myocardial Infarction After Vascular Surgery—Reply
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Yen-Yi Juo, Boback Ziaeian, Peyman Benharash

    In Reply We read with great interest the letter by Polok et al regarding our article1 and appreciate their insightful comments, which highlight several challenges in the use of retrospective databases for quality monitoring. However, several key factors deserve further consideration. The initial question prompting our study was whether recent innovations in research and technology translated into actual improvements in patient outcomes from 2005 to 2014. To objectively answer this question, we used the largest longitudinally collected and validated surgical database in the United States, the American College of Surgeons National Surgical Quality Improvement Program.2 However, as surgical practice has evolved over time, so too have methods of data collection. For example, our study covered trends from 2005 to 2014, during which time the definition of postoperative myocardial infarction was modified twice.3 In our study,1 definitions for events were standardized per National Surgical Quality Improvement Program registry definitions and protocols, which is itself constantly evolving to optimize modeling and adjust for complex patient and procedural risk profiles.4 We acknowledge the challenges in maintaining consistency of myocardial infarction definition across the study period. Yet this point leads to one of our highlighted findings: the Myocardial Infarction and Cardiac Arrest calculator, initially developed and validated prior to the most recent revision of the myocardial infarction definition,5 was found to consistently underestimate myocardial infarction risk.1 We agree with Polok et al that higher-quality cohort data with uniform characterization of patient characteristics and adjudication of postoperative events would be ideal for developing and validating future risk assessment tools.

    更新日期:2018-05-16
  • Myocardial Infarction After Vascular SurgeryA Systematic Troponin Surveillance and a Uniform Definition Is Needed
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Kamil Polok, Jakub Fronczek, Wojciech Szczeklik

    To the Editor The article by Juo et al1 addresses the important issue of temporal trends in perioperative myocardial infarction after high-risk vascular surgery. We congratulate the authors on their contribution; however, we have some reservations concerning the methods of this study. Definitions of myocardial infarction used in the database are out of date in light of recent developments in perioperative cardiac monitoring. The diagnostic threshold for myocardial infarction in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) cohort was defined as new elevation in troponin values greater than 3 times the upper level of the reference range. Furthermore, troponin levels were not measured routinely but only when the clinicians suspected ischemia. The problem with this approach is that 65% of perioperative myocardial infarctions are asymptomatic.2

    更新日期:2018-05-16
  • Surgeon Practice Patterns of Arthroscopic Partial Meniscectomy for Degenerative Disease in the United StatesA Measure of Low-Value Care
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Philip F. Stahel, Peiqi Wang, Susan Hutfless, Eric McCarty, Philip S. Mehler, Greg Michael Osgood, Martin A. Makary
    更新日期:2018-05-16
  • Failures of Sacral Neuromodulation for Incontinence
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Bilal Chughtai, Dominique Thomas, Tianyi Sun, Art Sedrakyan
    更新日期:2018-05-16
  • Abdominal Trauma Related to a Bicycle Accident
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Alban Zarzavadjian Le Bian, Philippe Wind
    更新日期:2018-05-16
  • A Large Abdominal Mass in a Young Man
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Yu Xi Terence Law, Lui Shiong Lee
    更新日期:2018-05-16
  • Near-Infrared Sentinel Lymph Node Identification in Non–Small Cell Lung Cancer
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Christopher S. Digesu, Kathleen D. Weiss, Yolonda L. Colson
    更新日期:2018-05-16
  • Venous Thromboembolism Prevention in Emergency General SurgeryA Review
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Patrick B. Murphy, Kelly N. Vogt, Brandyn D. Lau, Jonathan Aboagye, Neil G. Parry, Michael B. Streiff, Elliott R. Haut
    更新日期:2018-05-16
  • From Preoperative Assessment to Preoperative Optimization of Frailty
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Liane S. Feldman, Franco Carli

    Frailty is a multidimensional syndrome of decreased physiologic reserve that describes an older person’s vulnerability to health stressors. Frail patients have higher rates of morbidity, mortality, and hospital readmission and take longer to recover.1,2 Failure to rescue (FTR), defined as death after a complication, is an endorsed quality measure. While rescue requires both timely recognition and appropriate treatment of complications, patient-level factors are also important. Because frailty is distinct from age and comorbidities, standard risk adjustment may not be adequate.

    更新日期:2018-05-16
  • Standardized Handoffs in the Intensive Care UnitHope or Hype for Improving Critical Care?
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Amalia Cochran

    Transitions in patient care do not occur without negative consequences. We have known for more than 20 years that a cross-covering physician dramatically increases the risk of preventable adverse events.1 The 2003 implementation of duty hour restrictions increased the number of handoffs required for care of inpatients; these changes also led many to question whether duty hour restrictions were a benefit or detriment to patient safety, with both medicine and surgery residents indicating that patient harm commonly resulted from handoffs.2 No place is there more potential for patient harm resulting from handoffs than the intensive care unit (ICU), owing to patients’ severity of illness and the resulting complexity of this patient population.

    更新日期:2018-05-16
  • Personalized Surgical Care for Older Adults
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Gerard M. Doherty

    McDonald et al1 described a coordinated approach to elective perioperative care for older adults. The Perioperative Optimization of Senior Health (POSH) initiative is a collaborative quality improvement program to avert avoidable complications in older adults. While I admire their work, I question the substantiveness of their evidence supporting the association of POSH with quality improvement.

    更新日期:2018-05-16
  • The Value of Established Relationships Between Primary Care Clinicians and Specialists
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Larry R. Kaiser, Verdi J. DiSesa

    The article by Funk and colleagues1 in this issue of JAMA Surgery uses a network analysis to assess informal physician integration that arises from the shared care of multiple patients over time. They hypothesized that higher levels of informal integration would produce price-standardized total episode and component payments that were lower than those observed in health systems with lower indices. Their analysis supported the inference that deeper informal integration is associated with lower spending, specifically when related to readmissions and postacute care services, and that this difference might explain the limited efficacy of formal integration as mandated in accountable care organizations or patient-centered medical homes.

    更新日期:2018-05-16
  • Determinants of Failure in Hepatic Transplant
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Jorge D. Reyes

    One of the most enduring truisms in transplantation of all organs was written by Starzl almost 60 years ago: “The provision of a viable and minimally damaged homograft is undoubtedly the most important single factor in the determinant of success.”1 Presently, there are far more patients in need of transplant than there are organs available, and the use of expanded criteria donors has become an important source of organs for an ever-increasing acuity of patients. Consequently, the specter of graft failure and the ability to assess and predict outcomes to better intervene with management strategies has become the frontier in transplantation.

    更新日期:2018-05-16
  • The Reality of Long-term Follow-up of Bariatric/Metabolic Surgery Patients—A Conundrum
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Kelvin D. Higa, Jacques Himpens

    The frustration in advocating for universal policies and mandating insurance coverage for the treatment of patients with adiposity-based chronic disease (ie, morbid obesity) is fueled by the lack of high-quality long-term data. Are weight loss and remission of metabolic syndrome durable? Are there subsequent disease states or concerns brought on by our current interventions? The Longitudinal Assessment of Bariatric Surgery (LABS) consortium, funded by the National Institute of Diabetes and Digestive and Kidney Diseases with the assistance of the National Institutes of Health Office of Research on Women’s Health, represents the third installment of a large, extensive database with reported 82.9% of study participant follow-up at 7 years.1 Outcomes are consistent with other population-based studies, such as the Swedish Obese Subjects trial2 and Utah Obesity Study.3

    更新日期:2018-05-16
  • Nonuniversity-Based Surgeons Coming Up Anything but Short in Solutions to the Future Surgeon Shortage
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Kathryn J. Balinger, Lillian S. Kao

    Defining the optimal training paradigm for current and future general surgeons is of the utmost importance. Meaningful solutions are required for both the predicted national shortages in general surgeons and rural surgeons1 and the perceived decrease in the operative readiness of graduating surgical residents.2 In 2012, Polk et al3 reported on the recommendations of a diverse group of stakeholders who had convened to address the general surgery workforce issue. They recommended that training programs incorporate hospital experiences that entail a wider breadth of general surgery, such as those at community hospitals, which often do not have a university affiliation. However, there is a lack of data comparing surgical outcomes of graduates of nonuniversity-based residency (NUBR) with university-based residency programs. A matched analysis by Sellers et al4 addresses this knowledge gap.

    更新日期:2018-05-16
  • Choosing Successful Residents
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    David A. Harris, Stanley W. Ashley, Jennifer L. Irani

    The medical profession often looks outside itself for methods of improvement. As outlined by Gardner and Dunkin in this issue of JAMA Surgery,1 we can again turn to industry for clues on how to select general surgery residents who will be successful. The article adds to the literature in 2 distinct ways. First, the authors convincingly show the utility of situational judgment tests, a tool used heavily in industry, in conjunction with US Medical Licensing Examination Step 1 scores in predicting future success in residency at all 5 postgraduate levels. Second, the authors offer a framework for establishing situational judgment tests in diverse program settings.

    更新日期:2018-05-16
  • Association of Frailty With Failure to Rescue After Low-Risk and High-Risk Inpatient Surgery
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Rupen Shah, Kristopher Attwood, Shipra Arya, Daniel E. Hall, Jason M. Johanning, Emmanuel Gabriel, Anthony Visioni, Steven Nurkin, Moshim Kukar, Steven Hochwald, Nader N. Massarweh
    更新日期:2018-05-16
  • Association Between Real-time Electronic Injury Surveillance Applications and Clinical Documentation and Data Acquisition in a South African Trauma Center
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Eiman Zargaran, Richard Spence, Lauren Adolph, Andrew Nicol, Nadine Schuurman, Pradeep Navsaria, Damon Ramsey, S. Morad Hameed
    更新日期:2018-05-16
  • Patient Preferences for Surgery or Antibiotics for the Treatment of Acute Appendicitis
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Alexis L. Hanson, Ross D. Crosby, Marc D. Basson
    更新日期:2018-05-16
  • Effect of Standardized Handoff Curriculum on Improved Clinician Preparedness in the Intensive Care UnitA Stepped-Wedge Cluster Randomized Clinical Trial
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Brodie Parent, Lacey N. LaGrone, Mohamed T. Albirair, Peter T. Serina, Jonathan M. Keller, Joseph Cuschieri, Erin J. Addison, Lapio Choe, Genecelle B. Delossantos, Cameron E. Gaskill, Sarah D. Moon, Jestine T. MacDonald, Matthew J. Stolzberg, Erik G. Van Eaton, Jennifer M. Zech, Patricia A. Kritek
    更新日期:2018-05-16
  • Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older AdultsThe Perioperative Optimization of Senior Health (POSH) Initiative
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Shelley R. McDonald, Mitchell T. Heflin, Heather E. Whitson, Thomas O. Dalton, Michael E. Lidsky, Phillip Liu, Cornelia M. Poer, Richard Sloane, Julie K. Thacker, Heidi K. White, Mamata Yanamadala, Sandhya A. Lagoo-Deenadayalan
    更新日期:2018-05-16
  • Association of Informal Clinical Integration of Physicians With Cardiac Surgery Payments
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Russell J. Funk, Jason Owen-Smith, Samuel A. Kaufman, Brahmajee K. Nallamothu, John M. Hollingsworth
    更新日期:2018-05-16
  • Evaluation of Early Allograft Function Using the Liver Graft Assessment Following Transplantation Risk Score Model
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Vatche G. Agopian, Michael P. Harlander-Locke, Daniela Markovic, Wethit Dumronggittigule, Victor Xia, Fady M. Kaldas, Ali Zarrinpar, Hasan Yersiz, Douglas G. Farmer, Jonathan R. Hiatt, Ronald W. Busuttil
    更新日期:2018-05-16
  • Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Anita P. Courcoulas, Wendy C. King, Steven H. Belle, Paul Berk, David R. Flum, Luis Garcia, William Gourash, Mary Horlick, James E. Mitchell, Alfons Pomp, Walter J. Pories, Jonathan Q. Purnell, Ashima Singh, Konstantinos Spaniolas, Richard Thirlby, Bruce M. Wolfe, Susan Z. Yanovski
    更新日期:2018-05-16
  • Association of Surgical Practice Patterns and Clinical Outcomes With Surgeon Training in University- or Nonuniversity-Based Residency Program
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Morgan M. Sellers, Luke J. Keele, Catherine E. Sharoky, Christopher Wirtalla, Elizabeth A. Bailey, Rachel R. Kelz
    更新日期:2018-05-16
  • 更新日期:2018-05-16
  • JAMA Surgery—The Year in Review, 2017
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Melina R. Kibbe
    更新日期:2018-05-16
  • The Problem of Burnout Among Surgeons
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01
    Marco G. Patti, Francisco Schlottmann, Michael G. Sarr

    Today the world of medicine in general, and of surgery in particular, is faced with a problem that is severely affecting both trainees and practicing physicians: burnout. In 1974, the American psychologist Herbert Freudenberger coined the term burnout to describe “the consequences of severe or prolonged stress and anxiety experienced by people working in the healing professions.”1(p160) Several years later, Maslach and Jackson defined burnout as “a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do people work of some kind.”2(p99) Burnout is often complicated by disruptive behaviors, such as depression, substance abuse, interpersonal conflicts, and even suicidal ideation. In a survey of 7905 surgeons performed in 2010 and funded by the American College of Surgeons, Shanafelt and colleagues3 found that 6.3% reported some element of suicidal ideation during the prior 12 months; only 26% of these surgeons sought psychiatric care, while the remainder were afraid to seek help, because they thought that it could affect their medical license. Unfortunately, the rate of burnout among surgeons is much greater than among the general population (53% vs 28%), and represents a major increase compared with several years ago, when it was closer to 40%.4 Based on the analysis by Maslach and Jackson,2 the following 3 aspects of burnout have emerged: emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment.

    更新日期:2018-05-16
  • Highlights
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-01

    Program directors are tasked with identifying which applicants are likely to thrive in and complete residency. Gardner and Dunkin examined how emotional intelligence tests, personality profiles, and situational judgment tests predict resident performance 1 year after testing. Results indicated that situational judgment tests predicted residency performance above and beyond what traditional cognitive measures contribute. Little evidence was found for emotional intelligence tests or personality profiles.

    更新日期:2018-05-16
  • 更新日期:2018-05-16
  • Accuracy of Pediatric Trauma Field TriageA Systematic Review
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-16
    Rogier van der Sluijs, Eveline A. J. van Rein, Joep G. J. Wijnand, Luke P. H. Leenen, Mark van Heijl
    更新日期:2018-05-16
  • Association of BRAF Mutations With Survival and Recurrence in Surgically Treated Patients With Metastatic Colorectal Liver Cancer
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-16
    Georgios Antonios Margonis, Stefan Buettner, Nikolaos Andreatos, Yuhree Kim, Doris Wagner, Kazunari Sasaki, Andrea Beer, Christoph Schwarz, Inger Marie Løes, Maria Smolle, Carsten Kamphues, Jin He, Timothy M. Pawlik, Klaus Kaczirek, George Poultsides, Per Eystein Lønning, John L. Cameron, Richard A. Burkhart, Armin Gerger, Federico N. Aucejo, Martin E. Kreis, Christopher L. Wolfgang, Matthew J. Weiss
    更新日期:2018-05-16
  • Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma—Reply
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Ashley N. Leberfinger, Donald R. Mackay, Dino J. Ravnic

    In Reply We thank Altundag and Fleury for their interest in our article.1 The pathogenesis of this rare disease entity is still under investigation. However, all cases with detailed implant history have been linked to textured implants. Altundag commented on the lack of detailed information about the clinicopathological characteristics of the patients’ breast cancers as well as the chemotherapy and radiation therapy they received. This was a systematic review of the literature, and therefore, we were limited to previously published data. The vast majority of articles did not list any information about the clinicopathological details of the primary breast cancer and treatment. If information was reported, it was very basic (ie, stated that the patient underwent chemotherapy). We agree with Altundag that some breast cancer subtypes, such as triple-negative or human epidermal growth factor receptor 2–positive breast cancer, are more immunogenic. However, to our knowledge, there are no widespread data to suggest that these patients are more likely to develop breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Additionally, a significant number of patients with BIA-ALCL had cosmetic surgery without any history of breast cancer. This accounted for 46% of patients in our review article.1

    更新日期:2018-05-09
  • Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Eduardo de Faria Castro Fleury

    To the Editor I read with great interest the systematic review by Leberfinger et al1 on breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). The authors analyze 95 patients with BIA-ALCL and suppose it is caused by a complex process involving many factors, including bacterial biofilm growth, textured implant surface, immune response, and genetics of the patient. They also state that none of the reported patients presented with anaplastic lymphoma kinase,1 which is typically found in 60% of patients with systemic ALCL. Leberfinger et al1 raise the possibility that the BIA-ALCL is related to an inflammatory process secondary to a reaction process to the breast implant. They also speculate that the literature establishes that chronic inflammation can lead to a lymphoma.

    更新日期:2018-05-09
  • Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Kadri Altundag

    To the Editor I want to congratulate Leberfinger et al1 for their systematic review including 95 patients with breast implant–associated anaplastic large cell lymphoma. The underlying mechanism is briefly described as chronic inflammation from indolent infections, leading to malignant transformation of T cells that are anaplastic lymphoma kinase negative and CD30 positive. However, the authors did not give detailed information about the clinicopathological characteristics of the chemotherapy schedules and radiotherapy that patients with breast cancer received, which might be risk factors for the development of breast implant–associated anaplastic large cell lymphoma. Some breast cancer subtypes, such as triple-negative or human epidermal growth factor receptor 2–positive breast cancer, are more immunogenic and tend to develop more breast implant–associated anaplastic large cell lymphoma.2

    更新日期:2018-05-09
  • Computed Tomography in a Patient With Blunt Trauma
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Alison L. Halpern, Clay Cothren Burlew
    更新日期:2018-05-09
  • Optimizing Bleeding Control Training for the PublicA National Imperative
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Eileen M. Bulger, Mark L. Gestring, Lenworth M. Jacobs

    The Stop-the-Bleed Program, launched by the White House in 2015, seeks to inform, educate, and empower civilians to serve as immediate responders to save lives by control of hemorrhage at the scene of injury. In response to this initiative, the American College of Surgeons Committee on Trauma partnered with the National Association of National Association of Emergency Medical Technicians to develop the Bleeding Control course, which is targeted at the lay public. This course has been widely adopted, with more than 16 000 registered instructors and estimates of 100 000 to 150 000 citizens trained in the first year.1 Understanding the optimal educational approach to maximize mastery and retention of these skills is critical as we continue to promote and evolve this program. We therefore applaud Goralnick et al2 for this excellent assessment of 3 training options for the skill of tourniquet placement. This is a well-designed randomized clinical trial with appropriate statistical analyses. The results overwhelmingly favor in-person training with the bleeding control course vs point-of-care instructions, either visual or audio. The educational level of the training cohorts does not reflect the country because 2017 US census data suggest 38% of adults have high school or less as their highest level of education, compared with only 21.7% in this study.3 However, education level was not associated with skill retention in this study.

    更新日期:2018-05-09
  • Sarcopenia—A New Frontier in the Management Care of Patients With Borderline Resectable Pancreatic Cancer
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Oonagh Griffin, Kevin C. Conlon

    Pancreatic cancer is the fourth most common cause of cancer-related mortality in Europe.1 Despite increased awareness, most patients continue to present with advanced disease. There has been minimal improvement in survival rates over the past 30 years, with overall 5-year survival remaining less than 8%.2 While these disappointing results are due to a multitude of host and treatment variables, it is apparent that, for a significant number of patients, poor nutritional and performance status are limiting factors to treatment choice, delivery, and tolerance.

    更新日期:2018-05-09
  • Effectiveness of Instructional Interventions for Hemorrhage Control Readiness for Laypersons in the Public Access and Tourniquet Training Study (PATTS)A Randomized Clinical Trial
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Eric Goralnick, Muhammad A. Chaudhary, Justin C. McCarty, Edward J. Caterson, Scott A. Goldberg, Juan P. Herrera-Escobar, Meghan McDonald, Stuart Lipsitz, Adil H. Haider
    更新日期:2018-05-09
  • Association Between Changes in Body Composition and Neoadjuvant Treatment for Pancreatic Cancer
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-09
    Marta Sandini, Manuel Patiňo, Cristina R. Ferrone, Carlos A. Alvarez-Pérez, Kim C. Honselmann, Salvatore Paiella, Matteo Catania, Luca Riva, Giorgia Tedesco, Raffaella Casolino, Alessandra Auriemma, Maria C. Salandini, Giulia Carrara, Giulia Cristel, Anna Damascelli, Davide Ippolito, Mirko D’Onofrio, Keith D. Lillemoe, Claudio Bassi, Marco Braga, Luca Gianotti, Dushyant Sahani, Carlos Fernández-del Castillo
    更新日期:2018-05-09
  • USPTF Prostate Cancer Screening Recommendations—A Step in the Right Direction
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-08
    Peter R. Carroll

    The United States Preventive Services Task Force (USPSTF) is the most widely regarded source for information on US cancer screening. In 2012, the USPSTF gave prostate cancer screening a grade “D” recommendation, essentially guiding physicians and patients to discourage prostate cancer early detection.1 This recommendation may have had an adverse effect on prostate cancer incidence rates across risk groups, including potentially lethal cancers, and was widely decried by specialty and advocacy groups.2 The grade D recommendation was based on what is now known to be an incorrect interpretation of the clinical evidence supporting screening at the time and legitimate concerns about cancer overdetection and overtreatment (the detection and treatment of indolent cancers that would not have been a problem if left undiagnosed and untreated).

    更新日期:2018-05-08
  • Factors Associated With Emergency Department Visits and Hospital Admissions After Invasive Outpatient Procedures in the Veterans Health Administration
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-02
    Hillary J. Mull, Ziad F. Gellad, Rajan T. Gupta, Javier A. Valle, Danil V. Makarov, Tyler Silverman, Westyn Branch-Elliman
    更新日期:2018-05-02
  • Burnout and Depression Among General Surgery ResidentsImage Is Everything—It Alters Perception
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-02
    Julie Ann Freischlag

    In this issue of JAMA Surgery, Williford et al1 report that general surgery residents in North Carolina demonstrated signs and symptoms of burnout (75%) and depression (40%). This finding is probably not different in other states and other general surgery programs. This is not news for many of us, because burnout and depression have been identified as problems with surgeons since 2009.2 The unique finding in this study is that the perception by general surgery residents and faculty members was significantly better than what was found to be true. Why would that be? We are great clinicians; why can we not see this in each other?

    更新日期:2018-05-02
  • Association of Hospital Participation in a Regional Trauma Quality Improvement Collaborative With Patient Outcomes
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-02
    Mark R. Hemmila, Anne H. Cain-Nielsen, Jill L. Jakubus, Judy N. Mikhail, Justin B. Dimick
    更新日期:2018-05-02
  • Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-02
    Michael L. Williford, Sara Scarlet, Michael O. Meyers, Daniel J. Luckett, Jason P. Fine, Claudia E. Goettler, John M. Green, Thomas V. Clancy, Amy N. Hildreth, Samantha E. Meltzer-Brody, Timothy M. Farrell
    更新日期:2018-05-02
  • Future Directions for Breast Reconstruction on the 20th Anniversary of the Women’s Health and Cancer Rights Act
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-02
    Anaeze C. Offodile, Clara Nan-hi Lee

    Shortly after the Women's Health and Cancer Rights Act passed in 1998, evidence arose about variable rates of breast reconstruction in the United States. That evidence showed that whether or not a woman had breast reconstruction depended a great deal on where she lived, what kind of health insurance she had, how much money she made, and her race/ethnicity.1 Twenty years later, practice variations in breast reconstruction persist. Surgeons, patients, and policymakers have responded with various initiatives to increase the use of reconstruction, such as awareness campaigns and laws that require surgeons to discuss the procedure. Although these efforts are reasonable, the issue of who should have breast reconstruction is not so simple. Rather, the effectiveness of breast reconstruction has not been fully established, and evidence of its overuse exists.

    更新日期:2018-05-02
  • Addressing Continued Disparities in Access to Breast Reconstruction on the 20th Anniversary of the Women’s Health and Cancer Rights Act
    JAMA Surg. (IF 7.956) Pub Date : 2018-05-02
    Nicholas L. Berlin, Edwin G. Wilkins, Amy K. Alderman

    Approximately 12% of women in the United States will develop invasive breast cancer during their lifetime. Despite the growing use of breast conservation as primary therapy for breast cancer, mastectomy remains a common treatment option. Furthermore, as our understanding of genetic risk for breast cancer has improved, prophylactic mastectomy is increasingly performed to prevent this malignancy in women who belong to certain high-risk groups.1 For patients undergoing mastectomy, the repercussions for body image, psychosocial well-being, and quality of life can be distressing.2 Years of research documenting the health-related quality of life and psychosocial benefits of breast reconstruction after mastectomy empowered health advocacy groups to lobby for the Women’s Health and Cancer Rights Act (WHCRA). Enacted in 1998, the WHCRA mandates all-payer health insurance coverage of all stages of breast reconstruction, including procedures on the contralateral breast for symmetry.

    更新日期:2018-05-02
  • Limitations of the National Cancer Data Base to Evaluate Early-Stage Anal Cancer Treatment Outcomes—Reply
    JAMA Surg. (IF 7.956) Pub Date : 2018-04-25
    Christy Y. Chai, Hop S. Tran Cao, Nader N. Massarweh

    In Reply We appreciate the opportunity to respond to the comments provided by the authors of these 2 letters regarding our article.1 The overall message of the letter from Leeds and Fang seems to be that there are important limitations to consider when using the National Cancer Data Base (NCDB) for research and when interpreting the findings from such studies. Regarding the letter from Renehan et al, the main issue seems to be that contemporary European guidelines contraindicate local excision as a management strategy for squamous cell carcinoma of the anal canal (SCCAC), and they too cite additional limitations associated with the use of NCDB data.

    更新日期:2018-04-25
  • Limitations of the National Cancer Data Base to Evaluate Early-Stage Anal Cancer Treatment Outcomes
    JAMA Surg. (IF 7.956) Pub Date : 2018-04-25
    Andrew G. Renehan, Rebecca Muirhead, David Sebag-Montefiore

    To the Editor Using the National Cancer Data Base, Chai et al1 analyzed arguably the largest cohort of early-stage (T1N0) squamous cell carcinoma of the anal canal in the literature and concluded that local excision may be a treatment option in these patients. We strongly urge caution regarding this interpretation and remind the readership that the European Society for Medical Oncology–European Society of Surgical Oncology–European Society for Radiotherapy and Oncology guidelines2 consider this approach to be contraindicated.

    更新日期:2018-04-25
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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