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Shirali AS, Hu MI, Chiang YJ, Graham PH, Fisher SB, Sosa JA, Perrier N, Brown S, Holla VR, Dadu R, Busaidy N, Sherman SI, Cabanillas M, Waguespack SG, Zafereo ME, Grubbs EG. Next-Generation Sequencing in Sporadic Medullary Thyroid Cancer Patients: Mutation Profile and Disease Aggressiveness. J Endocr Soc 2024; 8:bvae048. [PMID: 38660141 PMCID: PMC11041404 DOI: 10.1210/jendso/bvae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Indexed: 04/26/2024] Open
Abstract
Context Next-generation sequencing (NGS) analysis of sporadic medullary thyroid carcinoma (sMTC) has led to increased detection of somatic mutations, including RET M918T, which has been considered a negative prognostic indicator. Objective This study aimed to determine the association between clinicopathologic behavior and somatic mutation identified on clinically motivated NGS. Methods In this retrospective cohort study, patients with sMTC who underwent NGS to identify somatic mutations for treatment planning were identified. Clinicopathologic factors, time to distant metastatic disease (DMD), disease-specific survival (DSS), and overall survival (OS) were compared between somatic mutations. Results Somatic mutations were identified in 191 sMTC tumors, including RET M918T (53.4%), other RET codons (10.5%), RAS (18.3%), somatic RET indels (8.9%), and RET/RAS wild-type (WT) status (8.9%). The median age at diagnosis was 50 years (range, 11-83); 46.1% were female. When comparing patients with RET M918T, RET-Other, and RET WT (which included RAS and RET/RAS WT), there were no differences in sex, TNM category, systemic therapy use, time to DMD, DSS, or OS. On multivariate analysis, older age at diagnosis (HR 1.05, P < .001; HR 1.06, P< .001) and M1 stage at diagnosis (HR 3.17, P = .001; HR 2.98, P = .001) were associated with decreased DSS and OS, respectively, but mutation cohort was not. When comparing RET M918T to RET indels there was no significant difference in time to DMD, DSS, or OS between the groups. Conclusion Somatic RET mutations do not portend compromised DSS or OS in a cohort of sMTC patients who underwent clinically motivated NGS.
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Affiliation(s)
- Aditya S Shirali
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yi-Ju Chiang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sarah B Fisher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California-San Francisco (UCSF), San Francisco, CA 94143, USA
| | - Nancy Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Spandana Brown
- Department of Endocrinology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Vijaykumar R Holla
- Institute of Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Naifa Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Maria Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Johnson J, Mesiti A, Brouwer J, Shui AM, Sosa JA, Yeo HL. Surgeon Intersectionality and Academic Promotion and Retention in the US. JAMA Surg 2024; 159:383-388. [PMID: 38353990 PMCID: PMC10867775 DOI: 10.1001/jamasurg.2023.7866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/16/2023] [Indexed: 02/17/2024]
Abstract
Introduction Efforts have been made to increase the number of women and physicians who are underrepresented in medicine (UIM). However, surgery has been slow to diversify, and there are limited data surrounding the impact of intersectionality. Objective To assess the combined association of race and ethnicity and sex with rates of promotion and attrition among US academic medical department of surgery faculty. Design, Setting, and Participants This was a retrospective cohort study using faculty roster data from the Association of American Medical Colleges. All full-time academic department of surgery faculty with an appointment any time from January 1, 2005, to December 31, 2020, were included. Study data were analyzed from September 2022 to February 2023. Exposures Full-time academic faculty in a department of surgery with a documented self-reported race, ethnicity, and sex within the designated categories of the faculty roster of Association of American Medical Colleges. Main Outcomes and Measures Trends in race and ethnicity and sex, rates of promotion, and rates attrition from 2010 to 2020 were assessed with Kaplan-Meier and Cox time-to-event analyses. Results A total of 31 045 faculty members (23 092 male [74%]; 7953 female [26%]) from 138 institutions were included. The mean (SD) program percentage of UIM male faculty increased from 8.4% (5.5%) in 2010 to 8.5% (6.2%) in 2020 (P < .001), whereas UIM female faculty members increased from 2.3% (2.6%) to 3.3% (2.5%) over the 10-year period (P < .001). The mean program percentage of non-UIM females increased at every rank (percentage point increase per year from 2010 to 2020 in instructor: 1.1; 95% CI, 0.73-1.5; assistant professor: 1.1; 95% CI, 0.93-1.3; associate professor: 0.55; 95% CI, 0.49-0.61; professor: 0.50; 95% CI, 0.41-0.60; all P < .001). There was no change in the mean program percentage of UIM female instructors or full professors. The mean (SD) percentage of UIM female assistant and associate professors increased from 3.0% (4.1%) to 5.0% (4.0%) and 1.6% (3.2%) to 2.2% (3.4%), respectively (P =.002). There was no change in the mean program percentage of UIM male instructors, associate, or full professors. Compared with non-Hispanic White males, Hispanic females were 32% less likely to be promoted within 10 years (hazard ratio [HR], 0.68; 95% CI, 0.54-0.86; P <.001), non-Hispanic White females were 25% less likely (HR, 0.75; 95% CI, 0.71-0.78; P <.001), Hispanic males were 15% less likely (HR, 0.85; 95% CI, 0.76-0.96; P =.007), and Asian females were 12% less likely (HR, 0.88; 95% CI, 0.80-0.96; P =.03). Non-UIM males had the shortest median (IQR) time to promotion, whereas non-UIM females had the longest (6.9 [6.8-7.0] years vs 7.2 [7.0-7.6] years, respectively; P < .001). After 10 years, 79% of non-UIM males (13 202 of 16 299), 71% of non-UIM females (3784 of 5330), 68% of UIM males (1738 of 2538), and 63% of UIM females (625 of 999) remained on the faculty. UIM females had a higher risk of attrition compared with non-UIM females (HR, 1.3; 95% CI, 1.1-1.5; P = .001) and UIM males (HR, 1.2; 95% CI, 1.0-1.4; P = .05). The mean (SE) time to attrition was shortest for UIM females and longest for non-UIM males (8.2 [0.14] years vs 9.0 [0.02] years, respectively; P < .001). Conclusion and Relevance Results of this cohort study suggest that intersectionality was associated with promotion and attrition, with UIM females least likely to be promoted and at highest risk for attrition. Further efforts to understand these vulnerabilities are essential.
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Affiliation(s)
- Josh Johnson
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York
| | - Andrea Mesiti
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York
| | - Julianna Brouwer
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco, San Francisco
| | - Heather L. Yeo
- Department of Surgery, Department of Population Health Sciences, New York Presbyterian Hospital, Weill Cornell Medicine, New York
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Conroy PC, Wilhelm A, Rajwani T, Mulder M, Gosnell J, Shen WT, Duh QY, Roman S, Sosa JA. Nerve monitoring in endocrine surgery: Practice patterns differ among surgeons for parathyroidectomy and thyroidectomy. Surgery 2024; 175:1040-1048. [PMID: 38135552 DOI: 10.1016/j.surg.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/13/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND It is unknown whether intraoperative nerve monitoring is associated with reduced vocal cord dysfunction after parathyroidectomy. We aimed to investigate intraoperative nerve monitoring use among Collaborative Endocrine Surgery Quality Improvement Program surgeons and factors associated with vocal cord dysfunction after parathyroidectomy. METHODS Patients who underwent parathyroidectomy included in the Collaborative Endocrine Surgery Quality Improvement Program (2014-2022) were identified. The annual percent change in parathyroidectomies performed with intraoperative nerve monitoring was calculated using joinpoint regression. Multivariable logistic regression was used to compare outcomes between patients undergoing parathyroidectomy with/without intraoperative nerve monitoring. To compare surgeon-specific trends, Collaborative Endocrine Surgery Quality Improvement Program thyroidectomy and parathyroidectomy datasets (2014-2021) were combined. Parathyroidectomies performed by surgeons who used intraoperative nerve monitoring consistently in thyroidectomy were identified. Factors associated with intraoperative nerve monitoring were examined using multivariable logistic regression. RESULTS A total of 9,813 patients underwent parathyroidectomy. Intraoperative nerve monitoring was used in 49% of cases (n = 4,818). There was an increase in parathyroidectomies with intraoperative nerve monitoring from 2014 to 2018 (annual percent change 22.2, P = .01), followed by a plateau (2018-2022 annual percent change -0.66, P = .85). Few patients (0.44%, n = 43) developed vocal cord dysfunction. Vocal cord dysfunction was not associated with intraoperative nerve monitoring (adjusted odds ratio 0.92, P = .75). Whereas 41% (n = 56/138) of surgeons used intraoperative nerve monitoring routinely in parathyroidectomy, 65% (n = 90/138) used it routinely in thyroidectomy. Among surgeons who used intraoperative nerve monitoring routinely in thyroidectomy, only 57% used it routinely in parathyroidectomy; factors associated with intraoperative nerve monitoring during parathyroidectomy included reoperation (adjusted odds ratio 2.51, P < .01), secondary/tertiary hyperparathyroidism (adjusted odds ratio 1.42, P = .02), multiglandular disease (adjusted odds ratio 1.76, P < .001), and non-localized disease (adjusted odds ratio 1.65, P < .001). CONCLUSION Endocrine surgeons use intraoperative nerve monitoring selectively. Surgeons who routinely use intraoperative nerve monitoring during thyroidectomy are more likely to use it during parathyroidectomy. Future studies should determine who may benefit most from intraoperative nerve monitoring in parathyroidectomy.
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Affiliation(s)
| | - Alexander Wilhelm
- Department of Surgery, University of California, San Francisco, CA; Department of Surgery, Clarunis, St. Clara Hospital and University Hospital Basel, University of Basel, Switzerland
| | - Taufiq Rajwani
- Department of Surgery, University of California, San Francisco, CA
| | - Michelle Mulder
- Department of Surgery, University of California, San Francisco, CA
| | - Jessica Gosnell
- Department of Surgery, University of California, San Francisco, CA
| | - Wen T Shen
- Department of Surgery, University of California, San Francisco, CA
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, CA
| | - Sanziana Roman
- Department of Surgery, University of California, San Francisco, CA
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, CA.
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Sosa JA, Mangurian C. Addressing Eldercare to Promote Gender Equity in Academic Medicine. JAMA 2023; 330:2245-2246. [PMID: 37983061 DOI: 10.1001/jama.2023.23743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This Viewpoint argues for an expansion of paid family leave policies to include eldercare as a way to support the well-being of faculty members, retain physicians, and promote gender equity in academic medicine.
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Affiliation(s)
- Julie Ann Sosa
- Department of Surgery, School of Medicine, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Christina Mangurian
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco
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Ullmann TM, Sosa JA. Delay in Surgery for Papillary Thyroid Cancer: A Proxy for Lower-Quality Care? J Clin Endocrinol Metab 2023; 108:e1753-e1754. [PMID: 37084398 DOI: 10.1210/clinem/dgad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Timothy M Ullmann
- Section of Endocrine Surgery, Department of Surgery, Albany Medical College, Albany, NY 12208, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, CA 94143, USA
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Sosa JA. World Journal of Surgery is Pleased to Welcome Dr. Diamantis I. Tsilimigras as a New Assistant Editor for Visual Abstracts and Social Media to Our Leadership Team. World J Surg 2023; 47:2599. [PMID: 37679609 DOI: 10.1007/s00268-023-07144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Dr Thomas Weiser to our Editorial Board. World J Surg 2023; 47:2305. [PMID: 37266696 DOI: 10.1007/s00268-023-07057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Dimick JB, Harris C, Barrett M, Kent KC, Sosa JA, Farmer DL. American Surgical Association Presidential Session: Navigating the Collision of Corporate Medicine and Changing Workforce Expectations. Ann Surg 2023; 278:471-478. [PMID: 37436884 DOI: 10.1097/sla.0000000000005989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Affiliation(s)
- Justin B Dimick
- Department of Surgery at the University of Michigan, Ann Arbor, MI
| | - Chelsea Harris
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meredith Barrett
- Department of Surgery at the University of Michigan, Ann Arbor, MI
| | - K Craig Kent
- University of Virginia Health, Charlottesville, VA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA
| | - Diana L Farmer
- Department of Surgery, University of California Davis School of Medicine, Sacramento, CA
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Dr Shrirang Kulkarni to our Editorial Board. World J Surg 2023; 47:2306. [PMID: 37249634 DOI: 10.1007/s00268-023-07058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Dr Yoshihiro Nabeya to Our Editorial Board. World J Surg 2023; 47:2307. [PMID: 37249635 DOI: 10.1007/s00268-023-07059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery Welcomes Dr. Sherry Wren of the USA as a New Associate Editor. World J Surg 2023; 47:2090. [PMID: 37468547 DOI: 10.1007/s00268-023-07117-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Wilhelm A, Conroy PC, Calthorpe L, Frye W, Sosa JA, Roman S. Routine use of intraoperative nerve monitoring is associated with a reduced risk of vocal cord dysfunction after thyroid cancer surgery. BMC Surg 2023; 23:215. [PMID: 37533002 PMCID: PMC10399064 DOI: 10.1186/s12893-023-02122-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the associations between individual surgeon's intraoperative nerve monitoring (IONM) practice and factors associated with vocal cord (VC) dysfunction in patients with thyroid cancer undergoing thyroidectomy. METHODS Using Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) 2014-21 data, multivariable logistic regression analyses investigated variables associated with short- and long-term VC-dysfunction, associations of routine use of IONM with postoperative outcomes, and patient characteristics associated with IONM use. RESULTS Among 5,446 patients (76.7% female, mean age 49 years), 68.5% had surgery by surgeons using IONM in ≥ 90% of cases (63% of surgeons, n = 73). Post-operative VC-dysfunction was diagnosed by laryngoscopy in 3.0% of patients in the short-term and 2.7% in the long-term. When surgeons routinely used IONM, the incidence of VC-dysfunction was 2.4% in the short-term and 2.2% in the long-term, compared to 4.4% and 3.7%, respectively, when surgeons did not routinely use IONM (p < 0.01). After adjustment, routine use of IONM was independently associated with reduced risk of short- (OR 0.48, p < 0.01) and long-term (OR 0.52, p < 0.01) VC-dysfunction, a lower risk of postoperative hypoparathyroidism in the short- (OR 0.67, p < 0.01) and long-term (OR 0.54, p < 0.01), and higher likelihood of same-day discharge (OR 2.03, p < 0.01). Extrathyroidal tumor extension and N1-stage were factors associated with postoperative VC-dysfunction in the short- (OR 3.12, p < 0.01; OR 1.92, p = 0.01, respectively) and long-term (OR 3.11, p < 0.01; OR 2.32, p < 0.01, respectively). CONCLUSION Routine use of IONM was independently associated with a lower risk of endocrine surgery-specific complications and greater likelihood of same-day discharge.
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Affiliation(s)
- Alexander Wilhelm
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Surgery, Clarunis - St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Patricia C Conroy
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lucia Calthorpe
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Willow Frye
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Sanziana Roman
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery Welcomes A/Professor Savio George Alberto da Piedade Barreto of South Australia as a New Associate Editor. World J Surg 2023:10.1007/s00268-023-07084-4. [PMID: 37349578 DOI: 10.1007/s00268-023-07084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Dr I Ethem Gecim to Our Editorial Board. World J Surg 2023:10.1007/s00268-023-07054-w. [PMID: 37277505 DOI: 10.1007/s00268-023-07054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Dr Erin Andrade to Our Editorial Board. World J Surg 2023:10.1007/s00268-023-07070-w. [PMID: 37271764 DOI: 10.1007/s00268-023-07070-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Dr Kiyoshi Hasegawa to Our Editorial Board. World J Surg 2023:10.1007/s00268-023-07055-9. [PMID: 37270448 DOI: 10.1007/s00268-023-07055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Two New Assistant Editors for Visual Abstracts and Social Media to Our Leadership Team. World J Surg 2023:10.1007/s00268-023-07048-8. [PMID: 37264194 DOI: 10.1007/s00268-023-07048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Prof Edoardo Virgilio to Our Editorial Board. World J Surg 2023:10.1007/s00268-023-07053-x. [PMID: 37249631 DOI: 10.1007/s00268-023-07053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery is Pleased to Welcome Dr David Hughes to Our Editorial Board. World J Surg 2023:10.1007/s00268-023-07056-8. [PMID: 37249633 DOI: 10.1007/s00268-023-07056-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Baskin A, Sosa JA. Leveraging social media for mentorship in surgery. Surgery 2023:S0039-6060(23)00262-3. [PMID: 37236894 DOI: 10.1016/j.surg.2023.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Mentorship is a key component of success in surgery that benefits both mentors and mentees. It is associated with increased academic productivity, funding, leadership roles, job retention, and career advancement. Until recently, mentor-mentee dyads have connected through traditional communication channels; however, in an increasingly virtual world, academic communities are adopting new communication methods, including over social media platforms. In recent years, we have witnessed how social media helps effect positive change by facilitating patient and public health initiatives, social movements and campaigns, and professional pursuits. Given its ability to transcend constraints of geography, hierarchy, and time, social media can benefit mentorship, too. Social media helps strengthen preexisting mentorships, identify new mentorship opportunities locally and remotely, and facilitates modern mentorship models, such as team mentorship. Furthermore, it increases the durability of mentor-mentee relationships and helps expand and diversify mentorship networks, which may especially benefit females and those underrepresented in medicine. Despite the many advantages of social media, it is not a replacement for traditional local mentorship. Herein, we discuss the benefits and risks of using social media for mentorship and propose approaches to optimize the virtual mentorship experience. With best practice guidelines that aim to balance virtual and in-person interactions and provide tailored education to all mentorship levels, we believe mentors and mentees will become more adept in using social media professionally, and these platforms will help foster meaningful connections that ensure mutual fulfillment.
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Affiliation(s)
- Alison Baskin
- Department of Surgery, University of California San Francisco, CA. https://twitter.com/alison_baskin
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco, CA.
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Pugh CM, Kirton OC, Tuttle JEB, Maier RV, Hu YY, Stewart JH, Freischlag JA, Sosa JA, Vickers SM, Hawn MT, Eberlein TJ, Farmer DL, Higgins RS, Pellegrini CA, Roman SA, Crandall ML, De Virgilio CM, Tsung A, Britt LD. Addressing the Surgical Workplace: An Opportunity to Create a Culture of Belonging. Ann Surg 2023; 277:551-556. [PMID: 36575980 DOI: 10.1097/sla.0000000000005773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Carla M Pugh
- Department of Surgery, Stanford Medicine, Stanford California
| | - Orlando C Kirton
- Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - J E Betsy Tuttle
- Department of Surgery, E. Carolina University/Brody School of Medicine, Greenville, North Carolina
| | - Ronald V Maier
- Department of Surgery, University of Washington Medicine, Seattle, Washington
| | - Yue-Yung Hu
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - John H Stewart
- Department of Surgery, LSU Health New Orleans, Shreveport, Louisiana
| | - Julie Ann Freischlag
- Department of Vascular and Endovascular Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Selwyn M Vickers
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary T Hawn
- Department of Surgery, Stanford Medicine, Stanford California
| | - Timothy J Eberlein
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Diana L Farmer
- Department of Surgery, University of California Davis Health, Davis, California
| | - Robert S Higgins
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Sanziana A Roman
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Marie L Crandall
- Department of Surgery, University of Florida at Jacksonville, Jacksonville, Florida
| | | | - Allan Tsung
- Department of Surgery, University of Virginia Health, Charlottesville, Virginia
| | - L D Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Sosa JA. The World Journal of Surgery Welcomes Professor Dileep N. Lobo of the UK as a New Associate Editor. World J Surg 2023; 47:563. [PMID: 36656358 DOI: 10.1007/s00268-022-06885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Julie Ann Sosa
- University of California at San Francisco (UCSF), San Francisco, CA, USA.
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23
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Salesky M, Kaur G, Weiser L, Thompson A, Kim EH, Campbell AR, Sosa JA, Gosnell J, Alseidi A, Lin MYC, Roman SA. Surgical support team: Lessons learned after piloting a near peer support program for medical students during their core surgery clerkship. Am J Surg 2023; 225:429-431. [PMID: 36243561 DOI: 10.1016/j.amjsurg.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/22/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Madeleine Salesky
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Gurbani Kaur
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Lucas Weiser
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Avery Thompson
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Edward H Kim
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Andre R Campbell
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Julie Ann Sosa
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Jessica Gosnell
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Matthew Y C Lin
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Sanziana A Roman
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery Welcomes Dr Linwah Yip of the USA as a New Associate Editor. World J Surg 2023; 47:287. [PMID: 36418553 DOI: 10.1007/s00268-022-06840-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Ullmann TM, Papaleontiou M, Sosa JA. Current Controversies in Low-Risk Differentiated Thyroid Cancer: Reducing Overtreatment in an Era of Overdiagnosis. J Clin Endocrinol Metab 2023; 108:271-280. [PMID: 36327392 PMCID: PMC10091361 DOI: 10.1210/clinem/dgac646] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Low-risk differentiated thyroid cancer (DTC) is overdiagnosed, but true incidence has increased as well. Owing to its excellent prognosis with low morbidity and mortality, balancing treatment risks with risks of disease progression can be challenging, leading to several areas of controversy. EVIDENCE ACQUISITION This mini-review is an overview of controversies and difficult decisions around the management of all stages of low-risk DTC, from diagnosis through treatment and follow-up. In particular, overdiagnosis, active surveillance vs surgery, extent of surgery, radioactive iodine (RAI) treatment, thyrotropin suppression, and postoperative surveillance are discussed. EVIDENCE SYNTHESIS Recommendations regarding the diagnosis of DTC, the extent of treatment for low-risk DTC patients, and the intensity of posttreatment follow-up have all changed substantially in the past decade. While overdiagnosis remains a problem, there has been a true increase in incidence as well. Treatment options range from active surveillance of small tumors to total thyroidectomy followed by RAI in select cases. Recommendations for long-term surveillance frequency and duration are similarly broad. CONCLUSION Clinicians and patients must approach each case in a personalized and nuanced fashion to select the appropriate extent of treatment on an individual basis. In areas of evidential equipoise, data regarding patient-centered outcomes may help guide decision-making.
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Affiliation(s)
- Timothy M Ullmann
- Division of General Surgery, Department of Surgery, Albany Medical College, 50 New Scotland Ave., MC-193, Albany, NY 12208, USA
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 453S, Ann Arbor, MI 48109, USA
| | - Julie Ann Sosa
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Ave. Ste. S320, Box 0104, San Francisco, CA 94143, USA
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Wilhelm A, Conroy PC, Calthorpe L, Shui AM, Kitahara CM, Roman SA, Sosa JA. Disease-Specific Survival Trends for Patients Presenting with Differentiated Thyroid Cancer and Distant Metastases in the United States, 1992-2018. Thyroid 2023; 33:63-73. [PMID: 36413032 PMCID: PMC9885538 DOI: 10.1089/thy.2022.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Differentiated thyroid cancer (DTC) is associated with an excellent prognosis, but patients with distant metastatic DTC have a 10-year disease-specific survival (DSS) of just 50%. The incidence of distant metastatic DTC has steadily increased in the United States since the 1980s. The aim of this study was to examine trends in survival and treatment for patients with distant metastatic DTC. Methods: In this population-based, retrospective cohort study, patients with distant metastatic DTC were identified from the Surveillance, Epidemiology, and End Results-13 cancer registry program. Multivariable logistic and Cox regression analyses were used to examine factors associated with DSS and management. Annual percentage changes in treatment patterns were calculated using log-linear regression. Results: During 1992-2018, 1991 patients (69.7% white, 58.0% female, 47.5% aged ≥65 years) were diagnosed with distant metastatic DTC. Papillary thyroid cancer was the most common histological type (74.5%). While the 10-year DSS for overall DTC increased over time (95.4% for patients diagnosed in 1992-1998, 96.6% in 1999-2008, and 97.3% in 2009-2018; p < 0.01), 10-year DSS for DTC with distant metastases did not change (50.2%, 47.3%, and 52.4%, respectively; p = 0.48). Ten-year DSS rates were reduced for patients aged ≥65 years (28.1%), patients undergoing nonsurgical treatment with external beam radiation therapy and/or systemic therapy (6.0%), and patients undergoing no/unknown treatment (32.8%). On multivariable analysis, oncocytic carcinoma, age 65-79 and ≥80 years, male sex, node-positive disease, larger tumor size, nonsurgical treatment, and no/unknown treatment were associated with increased risk of thyroid cancer death. Between 1992 and 2018, the rate of nonsurgical treatment increased, on average, 1.3% per year (1992-1998: 22.9% vs. 2009-2018: 25.6%; p = 0.03), and the rate of patients receiving no/unknown treatment increased 1.9% per year (1992-1998: 11.3% vs. 2009-2018: 15.6%; p = 0.01). Patients aged 65-79 and ≥80 years were more likely than younger patients to receive nonsurgical management or no/unknown treatment. Conclusion: Patients diagnosed with distant metastatic DTC have experienced no improvement in DSS over the past three decades. An increasing proportion of patients diagnosed with distant metastatic DTC are receiving nonsurgical treatment or no/unknown treatment over time; the proportion was highest among the oldest patients.
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Affiliation(s)
- Alexander Wilhelm
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
- Department of Surgery, Clarunis – St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Patricia C. Conroy
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
| | - Lucia Calthorpe
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Sanziana A. Roman
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
| | - Julie Ann Sosa
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
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Collins CR, Abel MK, Shui A, Intinarelli G, Sosa JA, Wick EC. Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery. Perioper Med (Lond) 2022; 11:54. [PMID: 36494765 PMCID: PMC9733045 DOI: 10.1186/s13741-022-00286-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As healthcare costs rise, there is an increasing emphasis on alternative payment models to improve care efficiency. The bundled payment represents an alternative reimbursement model gaining popularity within the surgical sphere. We aimed to assess where the largest opportunities for care improvement lay and how best to identify patients at high risk of suffering costly complications. METHODS We utilized itemized CMS claims data for a retrospective cohort of patients between 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Based on the results of this cost analysis, we identified readmissions as a target for improvement. We then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within our bundled payment population who were at high risk of readmission using a logistic regression model. RESULTS Our study cohort included 252 patients. Readmissions accounted for 12.8% of the average total care episode cost with a coefficient of variation of 2.72, thereby representing the most substantial, non-fixed cost for our bundled payment patients. Patients readmitted within their 90-day care episode were 2.53 times more likely to be high-cost (>$60,000) than patients not readmitted. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days with an AUROC of 0.58. CONCLUSIONS Our study highlights the importance of reducing readmissions as a central component of improving care for bowel surgery bundled payment patients. Preventing such readmissions requires accurate identification of patients at high risk of readmission; however, current risk prediction models lack the adaptability necessary for this task.
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Affiliation(s)
- Caitlin R. Collins
- grid.266102.10000 0001 2297 6811Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA 94143 USA
| | - Mary Kathryn Abel
- grid.266102.10000 0001 2297 6811School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Amy Shui
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA USA
| | - Gina Intinarelli
- grid.266102.10000 0001 2297 6811Office of Population Health, University of California, San Francisco, San Francisco, CA USA
| | - Julie Ann Sosa
- grid.266102.10000 0001 2297 6811Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA 94143 USA
| | - Elizabeth C. Wick
- grid.266102.10000 0001 2297 6811Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA 94143 USA
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Colley A, Finlayson E, Sosa JA, Wick E. "I Wish Someone had Asked Me Earlier"-Perspectives on Advance Care Planning in Surgery. Ann Surg 2022; 276:e649-e651. [PMID: 35848744 PMCID: PMC9643600 DOI: 10.1097/sla.0000000000005602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent controversy has called into question the meaning and clinical utility of Advance Care Planning (ACP), however data have consistently shown potential benefit to patients and their surrogate decision makers. We present the concept of surgery-specific advance care planning and a structured, scalable approach to integrating it into clinical practice.
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Affiliation(s)
- Alexis Colley
- Department of Surgery, University of California, San Francisco, San Francisco, California 94143
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, California 94143
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, San Francisco, California 94143
| | - Elizabeth Wick
- Department of Surgery, University of California, San Francisco, San Francisco, California 94143
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Randolph GW, Sosa JA, Hao Y, Angell TE, Shonka DC, LiVolsi VA, Ladenson PW, Blevins TC, Duh QY, Ghossein R, Harrell M, Patel KN, Shanik MH, Traweek ST, Walsh PS, Yeh MW, Abdelhamid Ahmed AH, Ho AS, Wong RJ, Klopper JP, Huang J, Kennedy GC, Kloos RT, Sadow PM. Preoperative Identification of Medullary Thyroid Carcinoma (MTC): Clinical Validation of the Afirma MTC RNA-Sequencing Classifier. Thyroid 2022; 32:1069-1076. [PMID: 35793115 PMCID: PMC9526471 DOI: 10.1089/thy.2022.0189] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Cytopathological evaluation of thyroid fine-needle aspiration biopsy (FNAB) specimens can fail to raise preoperative suspicion of medullary thyroid carcinoma (MTC). The Afirma RNA-sequencing MTC classifier identifies MTC among FNA samples that are cytologically indeterminate, suspicious, or malignant (Bethesda categories III-VI). In this study we report the development and clinical performance of this MTC classifier. Methods: Algorithm training was performed with a set of 483 FNAB specimens (21 MTC and 462 non-MTC). A support vector machine classifier was developed using 108 differentially expressed genes, which includes the 5 genes in the prior Afirma microarray-based MTC cassette. Results: The final MTC classifier was blindly tested on 211 preoperative FNAB specimens with subsequent surgical pathology, including 21 MTC and 190 non-MTC specimens from benign and malignant thyroid nodules independent from those used in training. The classifier had 100% sensitivity (21/21 MTC FNAB specimens correctly called positive; 95% confidence interval [CI] = 83.9-100%) and 100% specificity (190/190 non-MTC FNAs correctly called negative; CI = 98.1-100%). All positive samples had pathological confirmation of MTC, while all negative samples were negative for MTC on surgical pathology. Conclusions: The RNA-sequencing MTC classifier accurately identified MTC from preoperative thyroid nodule FNAB specimens in an independent validation cohort. This identification may facilitate an MTC-specific preoperative evaluation and resulting treatment.
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Affiliation(s)
- Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Yangyang Hao
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
| | - Trevor E. Angell
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David C. Shonka
- Department of Otolaryngology—Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Virginia A. LiVolsi
- Anatomic Pathology Division, Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul W. Ladenson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ronald Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mack Harrell
- The Memorial Center for Integrative Endocrine Surgery, Hollywood, Weston and Boca Raton, Florida, USA
| | - Kepal Narendra Patel
- Division of Endocrine Surgery, Department of Surgery, NYU Langone Medical Center, New York, New York, USA
| | | | | | - P. Sean Walsh
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
| | - Michael W. Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Amr H. Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen S. Ho
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard J. Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joshua P. Klopper
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California, USA
| | - Jing Huang
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
| | - Giulia C. Kennedy
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California, USA
| | - Richard T. Kloos
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California, USA
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Address correspondence to: Peter M. Sadow, MD, PhD, Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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30
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Sosa JA. The World Journal of Surgery Welcomes Dr George Rakovich to the Editorial Board. World J Surg 2022; 46:2017. [PMID: 35674986 DOI: 10.1007/s00268-022-06614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Conroy PC, Wilhelm A, Calthorpe L, Ullmann TM, Davis S, Huang CY, Shen WT, Gosnell J, Duh QY, Roman S, Sosa JA. Endocrine surgeons are performing more thyroid lobectomies for low-risk differentiated thyroid cancer since the 2015 ATA guidelines. Surgery 2022; 172:1392-1400. [PMID: 36002375 DOI: 10.1016/j.surg.2022.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/20/2022] [Accepted: 06/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The 2015 American Thyroid Association guidelines recommended either total thyroidectomy or lobectomy for surgical treatment of low-risk differentiated thyroid cancer and de-escalated recommendations for central neck dissections. The study aim was to investigate how practice patterns among endocrine surgeons have changed over time. METHODS All adult patients with low-risk differentiated thyroid cancers (T1-T2, N0/Nx, M0/Mx) in the Collaborative Endocrine Surgery Quality Improvement Program (2014-2021) were identified. The outcomes between patients undergoing lobectomy versus total thyroidectomy were compared using multivariable logistic regression. The annual percent change in the proportion of lobectomies and central neck dissections performed was estimated using joinpoint regression. RESULTS In total, 5,567 patients with low-risk differentiated thyroid cancers were identified. Of these, 2,261 (40.6%) were very low-risk tumors ≤1 cm, and 2,983 (53.6%) were low-risk tumors >1 and <4 cm. Most patients (67.9%) underwent total thyroidectomy. Compared to total thyroidectomy, lobectomy was associated with outpatient surgery (adjusted odds ratio 5.19, P < .001), a decreased risk of postoperative emergency department visits (adjusted odds ratio 0.63, P = .03), and decreased risk of hypoparathyroidism events (adjusted odds ratio 0.03, P < .001). Compared to before (2014-2015), patients undergoing surgery after publication of the revised guidelines (2016-2021) had higher odds of lobectomy and lower odds of central neck dissection for tumors ≤1 cm (lobectomy adjusted odds ratio 2.70, P < .001; central neck dissections adjusted odds ratio 0.64, P = .03) and tumors between 1 and 4 cm (lobectomy adjusted odds ratio 2.27, P < .001; central neck dissection adjusted odds ratio 0.62, P < .001). CONCLUSION After publication of the 2015 American Thyroid Association guidelines, there has been an increase in thyroid lobectomies as a proportion of all thyroid operations performed by endocrine surgeons for low-risk differentiated thyroid cancer. This has implications for reduced health care use and costs, with potential population-level benefits.
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Affiliation(s)
- Patricia C Conroy
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/PatriciaCConroy
| | | | - Lucia Calthorpe
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/CalthorpeLucia
| | - Timothy M Ullmann
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/TUllmannMD
| | - Stephanie Davis
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/stedavis21_MD
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Wen T Shen
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/wshen16
| | - Jessica Gosnell
- Department of Surgery, University of California, San Francisco, CA
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/EndoSurgSF
| | - Sanziana Roman
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/PheoSurgeon
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, CA.
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Hernandez S, Song S, Nnamani Silva ON, Anderson C, Kim AS, Campbell AR, Kim EH, Alseidi A, Wick EC, Sosa JA, Gosnell J, Lin MY, Roman SA. Third year medical student knowledge gaps after a virtual surgical rotation. Am J Surg 2022; 224:366-370. [PMID: 35397920 PMCID: PMC9701087 DOI: 10.1016/j.amjsurg.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study describes perceived knowledge gaps of third-year medical students after participating in a virtual surgical didactic rotation (EMLR) and shortened in-person surgery rotation during the COVID-19 Pandemic. METHODS Open-ended and Likert questions were administered at the end of the virtual rotation and inperson-surgical rotation to medical students. Three blinded coders identified themes by semantic analysis. RESULTS 82 students (51% of all MS3s) participated in the EMLR. Semantic analysis revealed gaps in perioperative management (Post-EMLR:18.4%, Post-Inpatient:26.5%), anatomy (Post-EMLR:8.2%, PostInpatient:26.5%). and surgical skills (Post-EMLR: 43.0%, Post-Inpatient: 44.1%). Students also described gaps related to OR etiquette (Post-EMLR: 12.2%, Post-Inpatient: 8.8%) and team dynamics/the hidden curriculum (Post- Inpatient:26.6%). There was a significant improvement in perceived confidence to perform inpatient tasks after completing the inpatient clinical experience (p ≤ 0.01). CONCLUSION Virtual interactive didactics for cognitive skills development cannot replace a full clinical surgical experience for third-year medical students. Future curricula should address perceived gaps.
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Affiliation(s)
- Sophia Hernandez
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Siyou Song
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Chelsie Anderson
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Alexander S. Kim
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Andre R. Campbell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Edward H. Kim
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Elizabeth C. Wick
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Matthew Y.C. Lin
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sanziana A. Roman
- Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA,Corresponding author. FACS Professor of Surgery and Medicine Section of Endocrine Surgery Division of Surgical Oncology University of California, San Francisco 1600 Divisadero Street, Room A726 Box 1674 San Francisco, CA, 94143, USA
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Sosa JA. The World Journal of Surgery Welcomes Dr Hiroharu Yamashita to the Editorial Board. World J Surg 2022; 46:2283. [PMID: 35691967 DOI: 10.1007/s00268-022-06620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Sosa JA. The World Journal of Surgery Welcomes Professor Owen A Ung to the Editorial Board. World J Surg 2022; 46:2018-2019. [PMID: 35688902 DOI: 10.1007/s00268-022-06613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Chou R, Dana T, Brent GA, Goldner W, Haymart M, Leung AM, Ringel MD, Sosa JA. Serum Thyroglobulin Measurement Following Surgery Without Radioactive Iodine for Differentiated Thyroid Cancer: A Systematic Review. Thyroid 2022; 32:613-639. [PMID: 35412871 DOI: 10.1089/thy.2021.0666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The utility of serum thyroglobulin (Tg) measurement following partial thyroidectomy or total/near-total thyroidectomy without radioactive iodine (RAI) for differentiated thyroid cancer is unclear. This systematic review examines the diagnostic accuracy of serum Tg measurement for persistent, recurrent, and/or metastatic cancer in these situations. Methods: Ovid MEDLINE, Embase, and Cochrane Central were searched in October 2021 for studies on Tg measurement following partial thyroidectomy or total/near-total thyroidectomy without or before RAI. Quality assessment was performed, and evidence was synthesized qualitatively. Results: Thirty-seven studies met inclusion criteria. Four studies (N = 561) evaluated serum Tg measurement following partial thyroidectomy, five studies (N = 751) evaluated Tg measurement following total/near-total thyroidectomy without RAI, and 28 studies (N = 7618) evaluated Tg measurement following total or near-total thyroidectomy before RAI administration. Following partial thyroidectomy, Tg measurement was not accurate for diagnosing recurrence or metastasis, or estimates were imprecise. Following total/near-total thyroidectomy without RAI, evidence was limited due to few studies with very low rates of recurrence or metastasis, but indicated that Tg levels were usually stable and low. For Tg measurements before RAI administration, diagnostic accuracy for metastatic disease or persistence varied, although sensitivity appeared high (but specificity low) at a cutoff of >1 to 2.5 ng/mL. However, applicability to patients who do not undergo RAI is uncertain because patients selected for RAI are likely to represent a higher risk group. The evidence was very low quality for all scenarios. All studies had methodological limitations, and there was variability in the Tg thresholds evaluated, patient populations, outcomes assessed, and other factors. Conclusions: Very limited evidence suggests low utility of Tg measurement for identifying recurrent or metastatic disease following partial thyroidectomy. Following total/near-total thyroidectomy, Tg levels using a cutoff of 1-2.5 ng/mL might identify patients at low risk for persistent or metastatic disease. Additional research is needed to clarify the role of Tg measurement in these settings, determine optimal Tg thresholds, and determine appropriate measurement intervals.
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Affiliation(s)
- Roger Chou
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Tracy Dana
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Gregory A Brent
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Whitney Goldner
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Megan Haymart
- Division of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology; University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Matthew D Ringel
- Divison of Endocrinology, Diabetes, and Metabolism and Cancer Biology Program, The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
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Sosa JA. The World Journal of Surgery Welcomes Dr. Tiffany E. Chao to the Editorial Board. World J Surg 2022. [PMID: 35610384 DOI: 10.1007/s00268-022-06600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Ullmann TM, Adam MA, Sosa JA. Surgeon Volume and Outcomes in Primary Hyperparathyroidism-What Is Old Is New Again. JAMA Surg 2022; 157:589. [PMID: 35507376 DOI: 10.1001/jamasurg.2022.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, San Francisco
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Sosa JA, Roman SA. The Path to Academic Success: Perspectives of a LGBTQ+ Chairof Surgery. Am Surg 2022; 88:2807-2809. [PMID: 35486843 DOI: 10.1177/00031348221096588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a growing number of Americans who identify as lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority (LGBTQ+). Unfortunately, in American surgery to date there has been a paucity of discussion about how to make our community as inclusive as possible for its LGBTQ+ members. General surgery learners, in particular, have been shown to be the subject of discrimination, harassment, and bullying. Therefore, it is the responsibility of leaders to deploy their positions of privilege and power to expand discussion and accelerate change by serving as role models and thoughtful advocates. An abbreviated tool kit is provided to get the dialogue and process started. Leading by example, with courage, and enrolling LGBTQ+ colleagues and their allies to organize are critical to accelerate structural change; institutional processes must follow. Training and education are essential. Benefits will be the diversification of the house of surgery and improved patient care.
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Affiliation(s)
- Julie Ann Sosa
- Department of Surgery, 12224University of California San Francisco, San Francisco, CA, USA
| | - Sanziana A Roman
- Department of Surgery, 12224University of California San Francisco, San Francisco, CA, USA
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Pasqual E, Sosa JA, Chen Y, Schonfeld SJ, Berrington de González A, Kitahara CM. Trends in the Management of Localized Papillary Thyroid Carcinoma in the United States (2000-2018). Thyroid 2022; 32:397-410. [PMID: 35078347 PMCID: PMC9048184 DOI: 10.1089/thy.2021.0557] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: In response to evidence of overdiagnosis and overtreatment of papillary thyroid carcinoma (PTC), the 2009 and 2015 American Thyroid Association (ATA) adult guidelines recommended less extensive surgery (lobectomy vs. total thyroidectomy) and more restricted use of postsurgical radioactive iodine (RAI) in management of PTC at low risk of recurrence. In 2015, active surveillance was suggested as a viable option for some <1-cm PTCs, or microcarcinomas. The 2015 ATA pediatric guidelines similarly shifted toward more restricted use of RAI for low-risk PTCs. The impact of these recommendations on low-risk adult and pediatric PTC management remains unclear, particularly after 2015. Methods: Using data from 18 Surveillance, Epidemiology, and End Results (SEER) U.S. registries (2000-2018), we described time trends in reported first-course treatment (total thyroidectomy alone, total thyroidectomy+RAI, lobectomy, no surgery, and other/unknown) for 105,483 patients diagnosed with first primary localized PTC (without nodal/distant metastases), overall and by demographic and tumor characteristics. Results: The declining use of RAI represented the most pronounced change in management of PTCs <4 cm (44-18% during the period 2006-2018), including microcarcinomas (26-6% during the period 2007-2018). In parallel, an increasing proportion of PTCs were managed with total thyroidectomy alone (35-54% during the period 2000-2018), while more subtle changes were observed for lobectomy (declining from 23% to 17% during the period 2000-2006, stabilizing, and then rising from 17% to 24% during the period 2015-2018). Use of nonsurgical management did not meaningfully change over time, impacting <1% of microcarcinomas annually during the period 2000-2018. Similar treatment trends were observed by sex, age, race/ethnicity, metropolitan vs. nonmetropolitan residence, and insurance status. For pediatric patients (<20 years), use of RAI peaked in 2009 (59%), then decreased markedly to 11% (2018), while use of total thyroidectomy alone and, to a lesser extent, lobectomy increased. No changing treatment trends were observed for ≥4-cm PTCs. Conclusions: The declining use of RAI in management of low-risk adult and pediatric PTC is consistent with changing recommendations from the ATA practice guidelines. Post-2015 trends in use of lobectomy and nonsurgical management of low-risk PTCs, particularly microcarcinomas, were more subtle than expected; however, these trends may change as evidence regarding their safety continues to emerge.
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Affiliation(s)
- Elisa Pasqual
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Sara J. Schonfeld
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Cari M. Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Address correspondence to: Cari M. Kitahara, PhD, MHS, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rm. 7E-456, Bethesda, MD 20892, USA
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Abstract
Background: Active surveillance has been proposed as an appropriate management strategy for low-risk differentiated thyroid cancer (DTC), due to the typically favorable prognosis of this condition. This systematic review examines the benefits and harms of active surveillance vs. immediate surgery for DTC, to inform the updated American Thyroid Association guidelines. Methods: A search on Ovid MEDLINE, Embase, and Cochrane Central was conducted in July 2021 for studies on active surveillance vs. immediate surgery. Studies of surgery vs. no surgery for DTC were assessed separately to evaluate relevance to active surveillance. Quality assessment was performed, and evidence was synthesized narratively. Results: Seven studies (five cohort studies [N = 5432] and two cross-sectional studies [N = 538]) of active surveillance vs. immediate surgery, and seven uncontrolled treatment series of active surveillance (N = 1219) were included. One cross-sectional study was rated fair quality, and the remainder were rated poor quality. In patients with low risk (primarily papillary), small (primarily ≤1 cm) DTC, active surveillance, and immediate surgery were associated with similar, low risk of all-cause or cancer-specific mortality, distant metastasis, and recurrence after surgery. Uncontrolled treatment series reported no cases of mortality in low-risk DTC managed with active surveillance. Among patients managed with active surveillance, rates of tumor growth were low; rates of subsequent surgery varied and primarily occurred due to patient preference rather than tumor progression. Four cohort studies (N = 88,654) found that surgery associated with improved all-cause or thyroid cancer mortality compared with nonsurgical management, but findings were potentially influenced by patient age and tumor risk category and highly susceptible to confounding by indication; eligibility for, and receipt of, active surveillance; and timing of surgery was unclear. Conclusions: In patients with small low-risk (primarily papillary) DTC, active surveillance and immediate surgery may be associated with similar mortality, risk of recurrence, and other outcomes, but methodological limitations preclude strong conclusions. Studies of no surgery vs. surgery are difficult to interpret due to clinical heterogeneity and potential confounding factors and are unsuitable for assessing the utility of active surveillance. Research is needed to clarify the benefits and harms of active surveillance and determine outcomes in nonpapillary DTC, larger (>1 cm) cancers, and older patients.
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Affiliation(s)
- Roger Chou
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Tracy Dana
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Megan Haymart
- Division of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Matthew D Ringel
- Divison of Endocrinology, Diabetes, and Metabolism and Cancer Biology Program, The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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Roman S, Sosa JA. The Ombuds for Diversity, Equity, and Inclusion as an Essential Addition to the WJS Editorial Board. World J Surg 2022; 46:973-975. [PMID: 35316398 DOI: 10.1007/s00268-022-06512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sanziana Roman
- University of California at San Francisco-UCSF, San Francisco, CA, USA.
| | - Julie Ann Sosa
- University of California at San Francisco-UCSF, San Francisco, CA, USA
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Sosa JA. Welcome Adam Gyedu of Ghana as a New Associate Editor at the World Journal of Surgery. World J Surg 2022; 46:976. [PMID: 35303131 DOI: 10.1007/s00268-022-06517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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Conroy PC, Calthorpe L, Lin JA, Mohamedaly S, Kim A, Hirose K, Nakakura E, Corvera C, Sosa JA, Sarin A, Kirkwood KS, Alseidi A, Adam MA. Determining Hospital Volume Threshold for Safety of Minimally Invasive Pancreaticoduodenectomy: A Contemporary Cutpoint Analysis. Ann Surg Oncol 2022; 29:1566-1574. [PMID: 34724124 PMCID: PMC9289437 DOI: 10.1245/s10434-021-10984-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Guidelines recommend limiting minimally invasive pancreaticoduodenectomy (MIPD) to high-volume centers. However, the definition of high-volume care remains unclear. We aimed to objectively define a minimum number of MIPD performed annually per hospital associated with improved outcomes in a contemporary patient cohort. PATIENTS AND METHODS Resectable pancreatic adenocarcinoma patients undergoing MIPD were included from the National Cancer Database (2010-2017). Multivariable modeling with restricted cubic splines was employed to identify an MIPD annual hospital volume threshold associated with lower 90-day mortality. Outcomes were compared between patients treated at low-volume (≤ model-identified cutoff) and high-volume (> cutoff) centers. RESULTS Among 3079 patients, 141 (5%) died within 90 days. Median hospital volume was 6 (range 1-73) cases/year. After adjustment, increasing hospital volume was associated with decreasing 90-day mortality for up to 19 (95% CI 16-25) cases/year, indicating a threshold of 20 cases/year. Most cases (82%) were done at low-volume (< 20 cases/year) centers. With adjustment, MIPD at low-volume centers was associated with increased 90-day mortality (OR 2.7; p = 0.002). Length of stay, positive surgical margins, 30-day readmission, and overall survival were similar. On analysis of the most recent two years (n = 1031), patients at low-volume centers (78.2%) were younger and had less advanced tumors but had longer length of stay (8 versus 7 days; p < 0.001) and increased 90-day mortality (7% versus 2%; p = 0.009). CONCLUSIONS The cutpoint analysis identified a threshold of at least 20 MIPD cases/year associated with lower postoperative mortality. This threshold should inform national guidelines and institution-level protocols aimed at facilitating the safe implementation of this complex procedure.
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Affiliation(s)
- Patricia C. Conroy
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lucia Calthorpe
- School of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Joseph A. Lin
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Mohamedaly
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alex Kim
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Julie Ann Sosa
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Ankit Sarin
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly S. Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Mohamed A. Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
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Conroy PC, Calthorpe L, Lin JA, Mohamedaly S, Kim A, Hirose K, Nakakura E, Corvera C, Sosa JA, Sarin A, Kirkwood KS, Alseidi A, Adam MA. ASO Visual Abstract: Determining Hospital Volume Threshold for the Safety of Minimally Invasive Pancreaticoduodenectomy: A Contemporary Cutpoint Analysis. Ann Surg Oncol 2022. [PMID: 35031919 DOI: 10.1245/s10434-021-11075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Patricia C Conroy
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Lucia Calthorpe
- School of Medicine, University of California, San Francisco, CA, USA
| | - Joseph A Lin
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Sarah Mohamedaly
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Alex Kim
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Julie Ann Sosa
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Ankit Sarin
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Kimberly S Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Mohamed A Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA.
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Hernandez S, Nnamani Silva ON, Conroy P, Weiser L, Thompson A, Mohamedaly S, Coe TM, Alseidi A, Campbell AR, Sosa JA, Gosnell J, Lin MYC, Roman SA. Bursting the Hidden Curriculum Bubble: A Surgical Near-Peer Mentorship Pilot Program for URM Medical Students. J Surg Educ 2022; 79:11-16. [PMID: 34315681 PMCID: PMC9308488 DOI: 10.1016/j.jsurg.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
The hidden curriculum of unspoken professional expectations negatively impacts medical student interest in surgery. Medical student mentorship and early surgical exposure have been shown to demystify the hidden curriculum. Although residents and faculty play a vital role, near-peer mentorship may aid in uncovering the hidden curriculum and promoting medical student interest in surgery, especially for those learners who are underrepresented in medicine. We developed and implemented a formalized near-peer mentorship program composed of quarterly small group Surgical Peer Teacher led lessons and one-on-one Surgical Support Team mentorship meetings covering surgical curriculum topics for medical students at an academic medical school. This structured near-peer mentorship model provides a mechanism to demystify surgical culture, increase early access to surgical mentorship, and develop mentorship skills amongst students. This program aims to uncover the surgical hidden curriculum to improve surgical career support and interest among medical students with less exposure and access to physician role models. This longitudinal mentorship model is student-run and can be easily adapted to enhance existing support models at medical schools. Future studies will evaluate utilization, impact on surgical specialty interest, and efficacy in demystifying the surgical hidden curriculum.
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Affiliation(s)
- Sophia Hernandez
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Ogonna N Nnamani Silva
- Department of Surgery, Division of Plastic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Patricia Conroy
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Lucas Weiser
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Avery Thompson
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Sarah Mohamedaly
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Taylor M Coe
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, California.
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Menut KCH, Pearlstein SS, Conroy PC, Roman SA, Shen WT, Gosnell J, Sosa JA, Duh QY, Suh I. Screening for primary aldosteronism in the hypertensive obstructive sleep apnea population is cost-saving. Surgery 2022; 171:96-103. [PMID: 34238603 PMCID: PMC9308489 DOI: 10.1016/j.surg.2021.05.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Guidelines recommend screening for primary aldosteronism in patients diagnosed with hypertension and obstructive sleep apnea. Recent studies have shown that adherence to these recommendations is extremely low. It has been suggested that cost is a barrier to implementation. No analysis has been done to rigorously evaluate the cost-effectiveness of widespread implementation of these guidelines. METHODS We constructed a decision-analytic model to evaluate screening of the hypertensive obstructive sleep apnea population for primary aldosteronism as per guideline recommendations in comparison with current rates of screening. Probabilities, utility values, and costs were identified in the literature. Threshold and sensitivity analyses assessed robustness of the model. Costs were represented in 2020 US dollars and health outcomes in quality-adjusted life-years. The model assumed a societal perspective with a lifetime time horizon. RESULTS Screening per guideline recommendations had an expected cost of $47,016 and 35.27 quality-adjusted life-years. Continuing at current rates of screening had an expected cost of $48,350 and 34.86 quality-adjusted life-years. Screening was dominant, as it was both less costly and more effective. These results were robust to sensitivity analysis of disease prevalence, test sensitivity, patient age, and expected outcome of medical or surgical treatment of primary aldosteronism. The screening strategy remained cost-effective even if screening were conservatively presumed to identify only 3% of new primary aldosteronism cases. CONCLUSIONS For patients with hypertension and obstructive sleep apnea, rigorous screening for primary aldosteronism is cost-saving due to cardiovascular risk averted. Cost should not be a barrier to improving primary aldosteronism screening adherence.
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Affiliation(s)
| | | | - Patricia C. Conroy
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Sanziana A. Roman
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Wen T. Shen
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Jessica Gosnell
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Julie Ann Sosa
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Quan-Yang Duh
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Insoo Suh
- Division of Endocrine Surgery, New York University Langone Health, New York, NY,Reprint requests: Insoo Suh, MD, NYU Endocrine Surgery Associates, 530 1st Ave, Ste 6H New York, NY 10016. (I. Suh)
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Lin JA, Pierce L, Murray SG, Soleimani H, Wick EC, Sosa JA, Hirose K. Estimation of Surgical Resident Duty Hours and Workload in Real Time Using Electronic Health Record Data. J Surg Educ 2021; 78:e232-e238. [PMID: 34507910 PMCID: PMC9335013 DOI: 10.1016/j.jsurg.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the use of electronic health record (EHR) data to estimate surgery resident duty hours and monitor real time workload. DESIGN Retrospective analysis of resident duty hours logged using a voluntary global positioning system (GPS)-based smartphone application compared to duty hour estimates by an EHR-based algorithm. The algorithm estimated duty hours using EHR activity data and operating room logs. A dashboard was developed through Plan-Do-Study-Act cycles for real-time monitoring of workload. SETTING Single tertiary/quaternary medical center general surgery residency program with approximately 90 categorical, preliminary, and integrated residents at eight clinical sites. PARTICIPANTS Categorical, preliminary, and integrated surgery residents of all clinical years who volunteered to pilot a GPS application to track duty hours. RESULTS Of 2,623 work periods by 59 residents were logged with both methods. EHR-estimated work periods started later than GPS logs (median 0.3 hours, interquartile range [IQR] -0.1 - 0.3); EHR-estimated work periods ended earlier than GPS logs (median 0.1 hours, IQR -0.7 - 0.3); and EHR-estimated duty hour totals were less than totals logged by GPS (median -0.3 hours, IQR -0.8 - +0.1). Overall correlation between weekly duty hours logged by EHR and GPS was 0.79. Correlations between the 2 systems stratified from PGY-1 through PGY-5 were 0.76, 0.64, 0.82, 0.87, and 0.83, respectively. The algorithm identified six 80-hour workweek violations (averaged over 4 weeks), while GPS logs identified 8. EHR-based duty hours and operational data were integrated into a dashboard to enable real time monitoring of resident workloads. CONCLUSIONS EHR-based estimation of surgical resident duty hours has good correlation with GPS-based assessment of duty hours and identifies most workweek duty hour violations. This approach allows for dynamic workload monitoring and may be combined with operational data to anticipate and prevent duty hour violations, thereby optimizing learning.
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Affiliation(s)
- Joseph A Lin
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Logan Pierce
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sara G Murray
- Department of Medicine, University of California San Francisco, San Francisco, California; Health Informatics, University of California San Francisco, San Francisco, California
| | - Hossein Soleimani
- Health Informatics, University of California San Francisco, San Francisco, California
| | - Elizabeth C Wick
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California; Department of Medicine, University of California San Francisco, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California
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Heiderscheit EA, Schlick CJR, Ellis RJ, Cheung EO, Irizarry D, Amortegui D, Eng J, Sosa JA, Hoyt DB, Buyske J, Nasca TJ, Bilimoria KY, Hu YY. Experiences of LGBTQ+ Residents in US General Surgery Training Programs. JAMA Surg 2021; 157:23-32. [PMID: 34668969 DOI: 10.1001/jamasurg.2021.5246] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored. Objective To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers. Design, Setting, and Participants A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education-accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination. Main Outcomes and Measures Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity. Results A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P < .001); sexual harassment, 131 (47.5%) vs 1551 (29.3%; P < .001); and bullying, 220 (74.8%) vs 3730 (66.9%; P = .005); attending surgeons were the most common overall source. Compared with non-LGBTQ+ men, LGBTQ+ residents were more likely to report discrimination (men: odds ratio [OR], 2.57; 95% CI, 1.78-3.72; women: OR, 25.30; 95% CI, 16.51-38.79), sexual harassment (men: OR, 2.04; 95% CI, 1.39-2.99; women: OR, 5.72; 95% CI, 4.09-8.01), and bullying (men: OR, 1.51; 95% CI, 1.07-2.12; women: OR, 2.00; 95% CI, 1.37-2.91). LGBTQ+ residents reported similar perceptions of the learning environment, career satisfaction, and burnout (OR, 1.22; 95% CI, 0.97-1.52) but had more frequent considerations of leaving their program (OR, 2.04; 95% CI, 1.52-2.74) and suicide (OR, 1.95; 95% CI, 1.26-3.04). This increased risk of suicidality was eliminated after adjusting for mistreatment (OR, 1.47; 95% CI, 0.90-2.39). Conclusions and Relevance Mistreatment is a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents is associated with this mistreatment. Multifaceted interventions are necessary to develop safer and more inclusive learning environments.
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Affiliation(s)
- Evan A Heiderscheit
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Cary Jo R Schlick
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elaine O Cheung
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dre Irizarry
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Palo Alto, California
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joshua Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco
| | | | - Jo Buyske
- American Board of Surgery, Philadelphia, Pennsylvania
| | - Thomas J Nasca
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Sosa JA. The World Journal of Surgery is Pleased to Announce that Dr. Michelle de Oliveira Will Join Our Editorial Team as Our Associate Editor for Liver Surgery. World J Surg 2021; 45:3479. [PMID: 34613441 DOI: 10.1007/s00268-021-06334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Julie Ann Sosa
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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50
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Nnamani Silva ON, Hernandez S, Kim AS, Campbell AR, Kim EH, Alseidi A, Wick EC, Sosa JA, Gosnell J, Lin MYC, Roman SA. Where Do We Go From Here? Assessing Medical Students' Surgery Clerkship Preparedness During COVID-19. J Surg Educ 2021; 78:1574-1582. [PMID: 33485827 PMCID: PMC7836963 DOI: 10.1016/j.jsurg.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The impact of COVID-19 on surgical education has been profound, and clinical learning experiences transitioned to virtual formats. This study investigated the impact of virtual experiences created to facilitate learning during the pandemic for medical students. METHODS We performed a cohort study to determine the perceived clinical preparedness for medical students enrolled in the preclinical surgery pilot course, surgical Extended Mastery Learning Rotation (EMLR), and longitudinal surgical clerkship (LC). The preclinical surgery pilot course took place before COVID-19 disruptions, and the EMLR and LC experiences took place virtually. Specialty choice was examined in the EMLR and LC cohorts. Performance on the NBME surgical assessments was analyzed among students enrolled in the traditional clerkship and pandemic-disrupted courses and compared to national data using a two-sample t-test. RESULTS Compared to preclinical students, EMLR and LC students demonstrated improvements in their perceived surgical clerkship readiness. After the 3-week EMLR course, in the setting of completing only one-third of the clerkship year, students had an average NBME Surgical Self-Assessment Exam score of 72 (SD 12), comparable to the national average of 71 (SD 9) p = 0.33. The average shelf exam score for students (N = 24) enrolled in the traditional clerkship (block 1), prior to COVID-19, disruptions was 66 (SD 9) compared to an average score of 69 (SD 9) for the longitudinal clerkship students (N = 20) that took the shelf exam later in the year (p = 0.36). COVID-19 disruptions did not affect specialty choice. All LC students have decided on a specialty; 50% nonsurgical and 50% surgical. From the EMLR cohort, 36% and 38% plan to pursue surgical and nonsurgical specialties, respectively, with 26% still undecided. CONCLUSIONS Courses were well-liked and will be implemented in future clerkships. Surgical educators demonstrated flexibility and creativity in the development of the EMLR. Despite COVID-19 disruptions, medical students made progress in their clinical skills and foundational science knowledge. COVID-19 disruptions did not appear to impact specialty choice.
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Affiliation(s)
| | - Sophia Hernandez
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Alexander S Kim
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Edward H Kim
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Elizabeth C Wick
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, California.
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