显示样式:     当前期刊: JAMA Surgery    加入关注       排序: 导出
我的关注
我的收藏
您暂时未登录!
登录
  • JAMA Surgery
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01

    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.

    更新日期:2018-08-15
  • Error in Table 1
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01

    In the Original Investigation titled “Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System,”1 published online May 23, 2018, there was an error in Table 1. The percentage value for the ASA score in column 3 listed as 35.0 should be 19.8. This article was corrected online.

    更新日期:2018-08-15
  • Error in Table 2
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01

    In the Original Investigation titled “Association Between Preoperative Hemoglobin A1c Levels, Postoperative Hyperglycemia, and Readmissions Following Gastrointestinal Surgery,”1 published online July 26, 2017, there was an error in Table 2. The confidence interval for any preoperative complication among people with diabetes was written as “0.90 (0.82-0.99),” but the correct confidence interval is “1.03 (0.95-1.11).” This article was corrected online.

    更新日期:2018-08-15
  • Considerations When Calculating Data Completeness
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • Estimating Surgical Risk for Patients With Severe Comorbidities
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Scott K. Sherman, Elizabeth C. Poli, Muneera R. Kapadia, Kiran K. Turaga
    更新日期:2018-08-15
  • 更新日期:2018-08-15
  • Factors Associated With Emergency Department Visits and Hospital Admissions After Invasive Outpatient Procedures in the Veterans Health Administration
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Hillary J. Mull, Ziad F. Gellad, Rajan T. Gupta, Javier A. Valle, Danil V. Makarov, Tyler Silverman, Westyn Branch-Elliman
    更新日期:2018-08-15
  • Computed Tomography in a Patient With Blunt Trauma
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Alison L. Halpern, Clay Cothren Burlew
    更新日期:2018-08-15
  • 更新日期:2018-08-15
  • Practical Guide to Surgical Data Sets: Veterans Affairs Surgical Quality Improvement Program (VASQIP)
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Nader N. Massarweh, Amy H. Kaji, Kamal M. F. Itani

    Since the early 1990s, Veterans Affairs (VA) has been at the vanguard of national efforts to measure hospital-level performance and ensure quality care for veterans. In response to a congressional mandate that “the VA should report its surgical outcomes in comparison to the national average…with risk adjustment,” the initial VA National Surgical Quality Improvement Program (NSQIP) was created to accurately collect clinical data using standardized methodology and incorporating robust risk adjustment.1 Renamed the VA Surgical Quality Improvement Program (VASQIP) after merging the cardiac and noncardiac surgery components of NSQIP, this mandatory, VA-wide program has remained a model for national quality improvement (QI) efforts and was the template used to develop the private sector American College of Surgeons–NSQIP.

    更新日期:2018-08-15
  • 更新日期:2018-08-15
  • Practical Guide to Surgical Data Sets: National Surgical Quality Improvement Program (NSQIP) and Pediatric NSQIP
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Mehul V. Raval, Timothy M. Pawlik

    For more than 100 years, the American College of Surgeons (ACS) has set the standard for the delivery of high-quality medical and surgical care. Based on programs originally created at the Department of Veterans Affairs, the ACS developed and implemented the National Surgical Quality Improvement Program (NSQIP) in 2004.1 Since its inception, the NSQIP has spread to nearly 700 hospitals and captures more than 1 million incident cases annually.

    更新日期:2018-08-15
  • Evaluating Outcomes in Trauma After Medicaid Expansion Under The Affordable Care Act
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Joseph V. Sakran

    More than 8 years ago, President Obama signed the Patient Protection and Affordable Care Act into law. It is arguably one of the most important pieces of legislation of his administration.1 As a result of optional Medicaid expansion under the Affordable Care Act, millions of Americans in 32 participating states and the District of Columbia have gained access to affordable and high-quality health insurance.2 However, the remaining states have chosen not to participate in the Medicaid expansion, creating an organic opportunity to appropriately study outcomes between expansion states and nonexpansion states. Such an opportunity can prove fruitful for studying trauma in the United States, which still remains the leading cause of death and disability among individuals younger than 44 years.3

    更新日期:2018-08-15
  • Locally Advanced Rectal CancerIs It Time for a Paradigm Change?
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Alessandro Fichera

    The modern era of rectal cancer surgery started with the introduction of the concept of total mesorectal excision (TME) by Heald and Ryall.1 They reported an overall survival rate of 87% in patients who underwent a resection for a cure. The rationale behind TME has been further validated by the understanding of the importance of the circumferential resection margins and the quality of TME, both prognostic markers of recurrence and survival.2,3 To further improve these results, the use of neoadjuvant chemoradiation therapy has become the standard of care for stage 2 to 3 rectal cancer.4

    更新日期:2018-08-15
  • Making the Case for Importance of Health Literacy in the Surgical Population
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Jesse P. Wright, Kelvin Moses, Kamran Idrees

    Population health literacy has recently garnered attention within the medical community as new associations between health literacy and health care–related outcomes have been elucidated. Within the medical patient population, there is a clear correlation between low health literacy and poor patient outcomes.1,2 It has only been more recently that health literacy within the surgical patient population has been evaluated.3,4 However, there continue to be gaps in our knowledge on its impact in surgery, such as in ambulatory settings and quality of life (QoL).

    更新日期:2018-08-15
  • All Surgical Readmissions Are Not Created Equal
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Yanik J. Bababekov, Brooks V. Udelsman, David C. Chang

    Hospital readmissions are an important quality indicator1; however, Mull et al2 emphasize that, unlike for patients with an index admission for medical treatment, all-cause readmission is not an appropriate indicator of quality of care for postoperative patients. In a modified Delphi process, a multidisciplinary panel assessed diagnosis codes related to 30-day postoperative readmission in a Veterans Affairs population and found that one-third of postoperative readmissions are unlikely to reflect deficiencies in surgical quality. Their findings are similar to those reported by Marks and colleagues3 in a smaller pediatric population. As government and private payers implement pay-for-performance metrics, the current study cautions that not every surgical readmission reflects poor quality and not every readmission should be penalized.

    更新日期:2018-08-15
  • Regionalization, Readmissions, and Repercussions of Major Cancer Surgery
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Srinivas J. Ivatury, Sandra L. Wong

    Longstanding data noting the volume-outcomes relationship in high-risk surgical procedures has led to ongoing work to realize the implied benefits.1,2 Two main strategies are considered: regionalization to high-volume centers and translation of best practices from high-volume centers to improve care across settings. Resultant increased travel distances from regionalization—an inconvenience when arriving for surgery—presents complex problems for patients at discharge that are magnified if complications occur. As Zafar et al3 found in their work, the benefits of regionalization are tempered because readmissions to local (nonindex) hospitals after major cancer surgery are associated with significantly higher risks of mortality and morbidity. The unintended consequences of regionalization warrant consideration.

    更新日期:2018-08-15
  • Reducing Surgical Resident Attrition
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Christiana Shaw, George A. Sarosi

    Resident attrition remains high in general surgical training programs, in which approximately 1 in 5 residents will not complete training. This rate is higher than those of other surgical specialties and has remained constant since the 1990s.1,2 Attrition has not appreciably changed with Accreditation Council for Graduate Medical Education recommendations about duty hours, suggesting that attrition is not just about hours of training. Multiple studies during the past 25 years have examined factors potentially leading to attrition, such as age, sex, American Board of Surgery In-Service Training Examination scores, marital status, and program characteristics with inconsistent findings.

    更新日期:2018-08-15
  • Burnout and Depression Among General Surgery ResidentsImage Is Everything—It Alters Perception
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Manzilat Akande, Peter C. Minneci, Katherine J. Deans, Henry Xiang, Jennifer N. Cooper
    更新日期:2018-08-15
  • Association of Plane of Total Mesorectal Excision With Prognosis of Rectal CancerSecondary Analysis of the CAO/ARO/AIO-04 Phase 3 Randomized Clinical Trial
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Julia Kitz, Emmanouil Fokas, Tim Beissbarth, Philipp Ströbel, Christian Wittekind, Arndt Hartmann, Josef Rüschoff, Thomas Papadopoulos, Elisabeth Rösler, Peter Ortloff-Kittredge, Ulrich Kania, Hans Schlitt, Karl-Heinrich Link, Wolf Bechstein, Hans-Rudolf Raab, Ludger Staib, Christoph-Thomas Germer, Torsten Liersch, Rolf Sauer, Claus Rödel, Michael Ghadimi, Werner Hohenberger
    更新日期:2018-08-15
  • 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 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • Association of Hospital Participation in a Regional Trauma Quality Improvement Collaborative With Patient Outcomes
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Mark R. Hemmila, Anne H. Cain-Nielsen, Jill L. Jakubus, Judy N. Mikhail, Justin B. Dimick
    更新日期:2018-08-15
  • 更新日期:2018-08-15
  • Association of Postoperative Readmissions With Surgical Quality Using a Delphi Consensus Process to Identify Relevant Diagnosis Codes
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Hillary J. Mull, Laura A. Graham, Melanie S. Morris, Amy K. Rosen, Joshua S. Richman, Jeffery Whittle, Edith Burns, Todd H. Wagner, Laurel A. Copeland, Tyler Wahl, Caroline Jones, Robert H. Hollis, Kamal M. F. Itani, Mary T. Hawn
    更新日期:2018-08-15
  • Comparison of Rates and Outcomes of Readmission to Index vs Nonindex Hospitals After Major Cancer Surgery
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Syed Nabeel Zafar, Adil A. Shah, Hira Channa, Mustafa Raoof, Lori Wilson, Nabil Wasif
    更新日期:2018-08-15
  • Association of Expectations of Training With Attrition in General Surgery Residents
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Jonathan S. Abelson, Julie A. Sosa, Matthew M. Symer, Jialin Mao, Fabrizio Michelassi, Richard Bell, Art Sedrakyan, Heather L. Yeo
    更新日期:2018-08-15
  • Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • USPTF Prostate Cancer Screening Recommendations—A Step in the Right Direction
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    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:2018-08-15
  • Culturally Competent Science
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    David C. Chang, Diego B. López, George Molina

    Although social norms have eliminated many forms of overt discrimination, more subtle forms of bias persist. Unfortunately, the scientific community, and particularly those of us in the health sciences, may be unintentionally contributing to many of these biases. The study of population differences is important for the understanding of health outcomes. However, studies of population differences can be, and have been, negatively influenced by subjective value judgments. This has historically taken the form of the majority population being ascribed as having “normal” traits and being used to set norms for disease definitions and treatment standards. We hypothesize that this subtle “majority is normal” bias has resulted from a lack of broad-based participation in the scientific process. Although there have been great efforts to promote culturally competent care, less has been done to encourage culturally competent science. The former focuses on practicing physicians delivering culturally competent bedside care, such as accommodating language differences. The latter goes beyond this and involves physician-scientists striving to incorporate cultural competency into the scientific process that ultimately develops the knowledge base that underpins bedside care. This would involve incorporating cultural awareness in hypothesis generation, study design, and data interpretation and being open to the possibility that scientific findings from one population (eg, concepts of disease and harm and appropriateness of treatment) may not be generalizable to other populations. Our concerns are similar to those prompted by recent awareness regarding sex bias in clinical research, which has led to the unfounded extension of scientific findings in men to women and has resulted in harm to female patients.1 Culturally competent science requires that physician-scientists identify and understand their own biases and how those biases might influence the scientific process, and it necessitates the training and support of diverse physician-scientists.

    更新日期:2018-08-15
  • JAMA Surgery
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01

    Burnout is one of the major challenges facing physicians and is increasingly prevalent in the surgical community. Williford and colleagues analyzed the perceptions of burnout and depression among 147 surgical residents and faculty in North Carolina with validated survey metrics. Both cohorts underestimated the true prevalence of these conditions but identified the same barriers to seeking care. Invited Commentary Continuing Medical Education

    更新日期:2018-08-15
  • Association of Early vs Delayed Cholecystectomy for Mild Gallstone Pancreatitis With Perioperative Outcomes
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-15
    Emily D. Dubina, Christian de Virgilio, Eric R. Simms, Dennis Y. Kim, Ashkan Moazzez
    更新日期:2018-08-15
  • Interventions for Postsurgical Opioid PrescribingA Systematic Review
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-15
    Martha Wetzel, Jason Hockenberry, Mehul V. Raval
    更新日期:2018-08-15
  • A Learning Health System Approach to the Opioid CrisisNever Let a Good Crisis Go to Waste
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-15
    Elizabeth C. Wick, Niraj L. Sehgal

    The opioid crisis is in the national headlines almost daily. Many US states have enacted prescribing restrictions and stipulations to begin addressing the problem. While it is unclear how much of the excess supply of opioids in circulation stems from perioperative prescribing, significant variation in prescribing practices is clear.1,2 We would argue that if practicing surgeons reflected on their own opioid prescribing practices, they would likely identify areas to improve. However, they would also realize the limited resources to appropriately set patient expectations for postprocedure pain and the paucity of evidence available to support approaches to calculating the dose and duration of opioids needed after common surgical procedures or the use of nonopioid analgesic regimens. In this issue of JAMA Surgery, Wetzel et al3 present a systematic review of interventions for postsurgical opioid prescribing, with a focus on system-level interventions, such as practice guidelines and electronic health record modifications. The authors conclude the same thing that many of us have come to realize in our daily practice: that there is evidence that these approaches are effective, but the literature in this area is very limited.

    更新日期:2018-08-15
  • Safeguarding Against Conflicts of Interest in the Surgical Literature
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-15
    Greg D. Sacks, O. Joe Hines

    Of all the biases threatening research validity, perhaps most pernicious is that introduced by a financial incentive exerting influence on a researcher. In some circumstances, remuneration from a company may support a researcher’s time used to perform a study, but unfortunately, a substantial body of literature consistently documents bias attributed to these financial payments, which are ubiquitous in medicine. In 2015, payments from industry to physicians and teaching hospitals reported under the Physician Payment Sunshine Act amounted to $7.5 billion.1 In response, the research community has established safeguards against the potential influence of these relationships. A cornerstone of these safeguards is the requirement that researchers disclose any financial ties that may pose a conflict of interest (COI), thereby informing a reader’s interpretation of a study’s findings. In this issue of JAMA Surgery, Ziai et al2 investigate this important topic by examining the extent to which physicians with strong industry ties report a COI in their research papers. Their main finding is that among the articles published by the 100 physicians who receive the highest payments from 10 device manufacturers, only 37.3% included a COI disclosure when one was noted to be present based on data from the Centers for Medicare & Medicaid Services Open Payments Database. Although this statistic is alarming, the relatively low number of reported conflicts may be in part due to the authors’ use of a strict criterion to determine whether a researcher disclosed his or her COI. For example, Ziai et al2 cite the case of a vascular surgeon with financial ties to W. L. Gore & Associates Inc who dutifully reported this financial relationship in an article evaluating a Gore device. However, the authors counted this surgeon as having failed to disclose his COI because he did not also report an additional industry relationship (Medtronic Inc) that was not directly related to the study in question. This example highlights an important distinction between potential COI and the ensuing potential for bias.3 According to International Committee of Medical Journal Editors guidelines, authors should disclose all potential COIs, even those that readers might perceive as a conflict,4 and by that standard, Ziai et al2 are correct to categorize this surgeon as noncompliant with reporting a potential COI. However, if the goal of disclosure policies is simply to alert the reader of the potential for bias,5 the surgeon’s disclosure is clearly adequate, because a careful reader would be alerted to the reported financial relationship that may bias the findings on that topic.

    更新日期:2018-08-15
  • Association of Radioactive Iodine Administration After Reoperation With Outcomes Among Patients With Recurrent or Persistent Papillary Thyroid Cancer
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-15
    Matthew L. Hung, James X. Wu, Ning Li, Masha J. Livhits, Michael W. Yeh
    更新日期:2018-08-15
  • Association of Compensation From the Surgical and Medical Device Industry to Physicians and Self-declared Conflict of Interest
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-15
    Kasra Ziai, Alessio Pigazzi, Brian R. Smith, Roxana Nouri-Nikbakht, Helene Nepomuceno, Joseph C. Carmichael, Steven Mills, Michael J. Stamos, Mehraneh D. Jafari
    更新日期:2018-08-15
  • Leveraging Health Information Technologies to Support Surgical Practice
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-15
    Gretchen P. Jackson, Susan D. Moffatt-Bruce, Genevieve B. Melton

    Health information technologies (HITs) include a wide variety of tools used for the procurement, storage, processing, and sharing of health information and data. Health information technologies have evolved rapidly over the last several decades alongside advances in hardware, software, telecommunications, and data science capacities. In the last decade, the Health Information Technology for Economic and Clinical Health component of the American Recovery and Reinvestment Act has provided financial incentives to promote the adoption of electronic health records (EHRs) and associated technologies through the Meaningful Use program, and consumer demand has driven the development and use of technologies to support patient access to health information, such as patient portals. Although such HITs are considered essential tools to support modern health care delivery, a recent systematic review1 identified a limited body of research evaluating the outcomes of HIT use in surgical practice. At its Thirteenth Annual Scientific Session on October 22, 2017, the Surgical Outcomes Club convened us as an expert panel to address the opportunities for innovation and improvement in surgical care through HITs. This Viewpoint summarizes our panel discussion about using HITs to measure surgical outcomes, meet consumer needs, and support learning health care systems (LHS).

    更新日期:2018-08-15
  • Association of Immunologic Markers With Survival in Upfront Resectable Pancreatic Cancer
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Ephraim S. Tang, Philippa H. Newell, Ronald F. Wolf, Paul Daniel Hansen, Benjamin Cottam, Carmen Ballesteros-Merino, Michael J. Gough
    更新日期:2018-08-08
  • A Visit to the Emergency Department With Neck and Shoulder Pain
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Manu Kaushik, Sunu Philip, Ramachandra Kolachalam
    更新日期:2018-08-08
  • National Surgical, Obstetric, and Anesthesia Planning in the Context of Global SurgeryThe Way Forward
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Kristin A. Sonderman, Isabelle Citron, John G. Meara

    The human and economic losses from a lack of safe surgery and anesthesia care are too large to ignore. More than 70% of the world’s population lacks access to surgical, obstetric, and anesthesia care, and 50% risk financial catastrophe from surgery.1 By adopting World Health Assembly Resolution 68.15 in 2015, adequate access to safe and affordable emergency surgery and anesthesia has been prioritized for all people worldwide by 2030 as a part of universal health coverage.2 Surgery is a complex intervention, requiring a functioning health system, which in turn requires strategic planning. However, most national health plans have no significant mention of surgical care.3 Development of a national strategy to improve surgical care by simultaneously strengthening appropriate infrastructure, a well-trained and well-distributed workforce, efficient service delivery, integrated information management, quality assurance, and adequate financing and governance in low- and middle-income countries is an innovative approach to improve surgical care. Driven by the national government and supporting a wider health strategic plan, a national surgical, obstetric, and anesthesia plan (NSOAP) identifies the current gaps in health care, prioritizes solutions, and provides an implementation framework (specific time-bound, annually prioritized, costed activities to reach each goal), a monitoring and evaluation plan, and projected cost. The NSOAP establishes a unified vision for strengthening of surgical systems and the coordination of efforts required to achieve this.

    更新日期:2018-08-08
  • Laparoscopic Transabdominal Adrenalectomy—A Procedure That Has Stood the Test of Time
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Masha J. Livhits, Michael W. Yeh

    Laparoscopic transabdominal adrenalectomy was first reported by Gagner et al1 in 1992, and it has since become the standard of care for removal of benign adrenal nodules. Compared with open adrenalectomy, the laparoscopic approach has been consistently associated with decreased morbidity (particularly pulmonary and wound complications) and faster recovery.2,3 In the current issue of JAMA Surgery, Chen et al4 describe what is, to our knowledge, the largest single-institution experience of laparoscopic transabdominal adrenalectomy to date. The authors demonstrate that this is a safe technique with low morbidity (55 of 640 patients [8.4%]), mortality (2 patients [0.3%]), and conversion to hand-assisted or open surgery (9 and 15 patients, respectively [3.7% combined]). Risk factors for perioperative complications in their study included conversion to open surgery, a diagnosis of pheochromocytoma, a tumor size of 6 cm or larger, and a rating of American Society of Anesthesiologists class 3 or 4.

    更新日期:2018-08-08
  • Depth of Propofol Sedation and Postoperative DeliriumThe Jury Is Still Out
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Elizabeth L. Whitlock, Emily Finlayson

    Perioperative delirium is an incredibly complex multifactorial syndrome, which despite a rapidly growing body of inquiry into its risk factors remains one of the most common complications of surgery and anesthesia. Acknowledging that most risk factors, such as underlying cognitive impairment and medical comorbidities, are unmodifiable in the short term, the causal contribution of anesthetic medications to postoperative delirium has proven difficult, and yet is crucial, to determine. In this issue of JAMA Surgery, Sieber and colleagues1 describe an important and ultimately “negative” efficacy trial that investigated the potential contribution of the depth of anesthesia (and anesthetic dosages, which are inextricable) to postoperative delirium. Reproducing an earlier pilot trial, Sieber and colleagues randomized 200 patients to receive light vs deep propofol sedation while undergoing a repair of hip fractures under spinal anesthesia and concluded that there was no statistically significant association between the assignment to deep sedation and postoperative delirium. This result is disappointing, but it is consistent with the interpretation that most delirium risk is due to unmodifiable factors like comorbid disease, “evil humors” that are released by trauma and/or surgery, and an underlying cognitive pathology that may or may not be detectible on preoperative testing results. Because the authors were statistically challenged by a slightly lower rate of postoperative delirium than their pilot trial had indicated2 and because there was substantially less separation between the light and deep sedation groups than the trial’s power calculations had required, it is easy to understand why the article’s Discussion focuses heavily on the prespecified subgroup analysis, the Charlson comorbidity index (CCI) of 0 patients. There is a larger question than preventing postoperative delirium at stake here. The association between delirium and dementia is well documented in observational studies. Although the language around delirium and subsequent dementia is taking on an increasingly causal tone,3 this is probably inappropriate given the potential for the confounding of observational data in a syndrome with incompletely understood, and intersecting, underlying pathologic mechanisms. The key to understanding the association of delirium with dementia is a well-powered randomized clinical trial of a therapy that effectively reduces postoperative delirium. Unfortunately, the trial conducted by Sieber et al1 is not that; the small sample size in the CCI score of 0 subgroup (notably, there was only an imbalance of 3 patients with delirium between the light and heavy sedation groups in this group) means that this finding is highly vulnerable to chance. While we can have cautious enthusiasm for this suggested way to reduce postoperative delirium, we must regard these findings with an appropriate degree of skepticism that is proportional to the uncertainty of placing full confidence in a 72-patient subgroup analysis.

    更新日期:2018-08-08
  • Risk Factors Associated With Perioperative Complications and Prolonged Length of Stay After Laparoscopic Adrenalectomy
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Yufei Chen, Anouk Scholten, Kathryn Chomsky-Higgins, Iheoma Nwaogu, Jessica E. Gosnell, Carolyn Seib, Wen T. Shen, Insoo Suh, Quan-Yang Duh
    更新日期:2018-08-08
  • Effect of Depth of Sedation in Older Patients Undergoing Hip Fracture Repair on Postoperative DeliriumThe STRIDE Randomized Clinical Trial
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Frederick E. Sieber, Karin J. Neufeld, Allan Gottschalk, George E. Bigelow, Esther S. Oh, Paul B. Rosenberg, Simon C. Mears, Kerry J. Stewart, Jean-Pierre P. Ouanes, Mahmood Jaberi, Erik A. Hasenboehler, Tianjing Li, Nae-Yuh Wang
    更新日期:2018-08-08
  • New Editorial Board Member–July 2018
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-08
    Melina R. Kibbe
    更新日期:2018-08-08
  • Questioning Prediction of Lumbar Spine Surgery Outcome—Why We Need to Pay Attention—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Sara Khor, David R. Flum

    In Reply We thank Rigoard et al for their interest in our article1 and acknowledging our intention to provide clinicians and patients with better information to make surgical decisions using our lumbar fusion surgery calculator (https://becertain.shinyapps.io/lumbar_fusion_calculator). The concerns about poorly specified indications for spine surgery among patients who received surgery are worthy of discussion. Distinguishing symptoms and signs and correlating them with pathology is a worthwhile consideration in making spine surgical decisions but does not reflect common practice. Our study took advantage of the Washington State Spine Surgical Care and Outcomes Assessment Program database, which was created using extracted data from medical records, often seen as the criterion standard for classifying surgical indications in lumbar surgery.2 The taxonomy in the database reflects what is typically used in practice in Washington and arguably across the nation. While we agree that indications, diagnoses, and classifications should be better described, better defined, and more granular in clinical records, the taxonomy used in our study may be representative of actual practice. In spine care, the diagnosis is typically solely described by the surgeon, which, as mentioned in the Limitations section of our article,1 has potential for bias. There is little information relating radiographic features of the spine to symptoms after surgery. To better understand this, we are currently conducting a study that looks at radiographic features at baseline that are associated with function improvement among patients undergoing lumbar fusion.

    更新日期:2018-08-01
  • Questioning Prediction of Lumbar Spine Surgery Outcome—Why We Need to Pay Attention
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Philippe Rigoard, Amine Ounajim, Richard B. North

    To the Editor The article published by Khor et al1 represents a well-intentioned effort to predict individual outcomes of lumbar fusion, which has grown in popularity and cost to health care systems despite major unanswered questions about its proper role in managing degenerative lumbosacral spine disease. We have questions about the methods and the reliability of the predictive model presented by Khor et al1 and about its readiness for public release as a web app.

    更新日期:2018-08-01
  • US National Trends in Violent and Unintentional Injuries, 2000 to 2016
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Ryan A. Lawless, Ernest E. Moore, Mitchel J. Cohen, Hunter B. Moore, Angela Sauaia
    更新日期:2018-08-01
  • Combining Antiviral Therapy With Tumor Resection as Optimal Treatment for Hepatocellular Carcinoma
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Yuman Fong

    Optimal care for hepatitis virus–related hepatocellular carcinoma (HCC) would include eradication of tumor and elimination of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Accomplishing these goals could prevent deaths from cancer or cirrhosis and reduce the likelihood of viral transmission. Tremendous progress has recently been achieved for tumor and antiviral therapies. Long-term survival from cancer was previously a rarity. Now, partial hepatectomy, liver transplant, or tumor ablation provide 5-year survival rates of 45% to 80%.1 Direct-acting antivirals (DAA) can now prevent cirrhosis in patients with HBV and can produce cures in patients with HCV2 for most patients and with little morbidity. Data are also accumulating that successful antiviral treatment reduces recurrence of cancer. In this issue of JAMA Surgery, Li et al3 examined a cohort of 2552 patients with resection of HCC and demonstrated that preresection (>90 days) effective treatment for HBV is associated with a lower tumor vascular invasion and decreased recurrence.

    更新日期:2018-08-01
  • Association of Preoperative Antiviral Treatment With Incidences of Microvascular Invasion and Early Tumor Recurrence in Hepatitis B Virus–Related Hepatocellular Carcinoma
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Zheng Li, Zhengqing Lei, Yong Xia, Jun Li, Kui Wang, Han Zhang, Xuying Wan, Tian Yang, Weiping Zhou, Mengchao Wu, Timothy M. Pawlik, Wan Yee Lau, Feng Shen
    更新日期:2018-08-01
  • Factors Associated With Residency and Career Dissatisfaction in Childbearing Surgical Residents
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Erika L. Rangel, Heather Lyu, Adil H. Haider, Manuel Castillo-Angeles, Gerard M. Doherty, Douglas S. Smink
    更新日期:2018-08-01
  • Reporting of Sex as a Variable in Research Published in Surgical Journals
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Melina R. Kibbe

    Conducting sex-inclusive biomedical and clinical research is imperative to improving the health outcomes of women and men.1 (Note that the word sex is being used rather than the term gender. Sex is the genotype that an individual is born with, and gender is the phenotype. For most research, it is the chromosomal sex of the human, animal, tissue, or cell that is important.) Recent studies have shown that most biomedical research in the field of surgery and associated topics is conducted on male animals and male cells, even when the diseases being studied are prevalent in females.2 Human clinical research is challenged by a lack of sex-based reporting and sex-based analysis of study results.3,4 Given these findings, the National Institutes of Health has asked that sex be considered as a biologic variable in all National Institutes of Health–funded research.5 The surgical journals whose editors are members of the Surgery Journals Editors Group will require this information in their journals. As such, defined reporting of the sex used for human, animal, tissue, and cell research in all articles published in JAMA Surgery is required.6 This information can be collected by self-report, administrative data, or (less commonly) genetic evaluation. If only 1 sex is studied, authors must include a justification statement as to why a single-sex study was conducted. Sex-based analysis of data for all human, animal, tissue, and cell research is also required. Additional Information: A version of this Editorial will be published by many journals whose editors are members of the Surgery Journals Editors Group. The Surgery Journal Editors Group is composed of editors from 74 international, surgery-associated journals who meet once a year at the annual meeting of the American College of Surgeons and discuss concerns common among surgery journals.

    更新日期:2018-08-01
  • Challenges in Open Access Publishing
    JAMA Surg. (IF 8.498) Pub Date : 2018-08-01
    Nishant Ganesh Kumar, Keith G. Meador, Brian C. Drolet

    Scientific knowledge is increasing at a remarkable pace. In 2014, nearly 2.5 million peer-reviewed articles were published in 28 000 journals worldwide.1 Once available only through subscription print services, many scientific articles are now published with an open access (OA) license. In contrast to subscription services, OA publishers shift costs for articles to authors to make content available to readers at no direct cost.2 As of 2018, the Directory of Open Access Journals (http://www.doaj.org) reported more than 2.9 million articles published in more than 11 000 OA journals.

    更新日期:2018-08-01
  • Concern Regarding Age Distribution of Breast Cancer—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2018-07-25
    Tawakalitu O. Oseni, Sahael M. Stapleton, David C. Chang
    更新日期:2018-07-25
  • Concern Regarding Age Distribution of Breast Cancer
    JAMA Surg. (IF 8.498) Pub Date : 2018-07-25
    Kathleen A. Cronin, Donald A. Berry
    更新日期:2018-07-25
  • Incidence of Gastroschisis in California
    JAMA Surg. (IF 8.498) Pub Date : 2018-07-25
    Jamie E. Anderson, Yvonne Cheng, Jacob T. Stephenson, Payam Saadai, Rebecca A. Stark, Shinjiro Hirose
    更新日期:2018-07-25
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.
化学 • 材料 期刊列表