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Silver CM, Yuce TK, Clarke CN, Schlick CJR, Khorfan R, Amortegui D, Nussbaum M, Turner PL, Bilimoria KY, Hu YY. Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness. JAMA Surg 2024:2817110. [PMID: 38568609 PMCID: PMC10993162 DOI: 10.1001/jamasurg.2024.0533] [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: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 04/06/2024]
Abstract
Importance Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness. Objectives To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship. Design, Setting, and Participants A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022. Exposure Residents were asked, "Do you have a mentor who genuinely cares about you and your career?" Main Outcomes and Measures Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic. Results A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship. Conclusions and Relevance One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents.
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Affiliation(s)
- Casey M. Silver
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Tarik K. Yuce
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | | | - Cary Jo R. Schlick
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Rhami Khorfan
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | | | | | - Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
- American College of Surgeons, Chicago, Illinois
| | - Yue-Yung Hu
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Boffa DJ, Nelson H, Mullett T, Opelka F, Turner PL, Shulman LN. Privacy on the Road to Personalized Medicine. J Natl Compr Canc Netw 2024; 22:1-5. [PMID: 38176100 DOI: 10.6004/jnccn.2023.7101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
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Sakran JV, Bornstein SS, Dicker R, Rivara FP, Campbell BT, Cunningham RM, Betz M, Hargarten S, Williams A, Horwitz JM, Nehra D, Burstin H, Sheehan K, Dreier FL, James T, Sathya C, Armstrong JH, Rowhani-Rahbar A, Charles S, Goldberg A, Lee LK, Stewart RM, Kerby JD, Turner PL, Bulger EM. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg 2023; 236:1242-1260. [PMID: 36877809 DOI: 10.1097/xcs.0000000000000662] [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] [Indexed: 03/08/2023]
Affiliation(s)
- Joseph V Sakran
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD (Sakran)
| | - Sue S Bornstein
- American College of Physicians, Philadelphia, PA (Bornstein)
| | - Rochelle Dicker
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of California Los Angeles, Los Angeles, CA (Dicker)
| | - Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle, WA (Rivara)
| | - Brendan T Campbell
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT (Campbell)
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (Cunningham)
| | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Aurora, CO (Betz)
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (Hargarten)
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL (Williams)
| | - Joshua M Horwitz
- Johns Hopkins Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Horwitz)
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
| | - Helen Burstin
- Council of Medical Specialty Societies, Washington, DC (Burstin)
| | - Karen Sheehan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (Sheehan)
| | - Fatimah L Dreier
- The Health Alliance for Violence Intervention, Jersey City, NJ (Dreier)
| | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA (James)
| | - Chethan Sathya
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Cohen Children's Medical Center, Northwell Health, Queens, NY (Sathya)
| | - John H Armstrong
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Armstrong)
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (Rowhani-Rahbar)
| | - Scott Charles
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Amy Goldberg
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Lois K Lee
- Department of Emergency Medicine, Boston Children's Hospital, Boston, MA (Lee)
| | - Ronald M Stewart
- Department of Surgery, University of Texas San Antonio, San Antonio, TX (Stewart)
| | - Jeffrey D Kerby
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL (Kerby)
| | - Patricia L Turner
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
| | - Eileen M Bulger
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
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Coleman JR, Abdelsattar JM, Dent D, Turner PL. Implications of lack of available personal protective equipment on surgical trainees: Lessons learned from the COVID-19 pandemic. Am J Surg 2022; 224:1492-1493. [PMID: 36088139 PMCID: PMC9420037 DOI: 10.1016/j.amjsurg.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Julia R. Coleman
- Corresponding author. The Ohio State University, Department of Surgery, 410 W 10th Ave, Columbus, OH, 43210, USA
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Tomei KL, Selby LV, Kirk LM, Bello JA, Nolan NS, Varma SK, Turner PL, Elliott VS, Brotherton SE. Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities. Acad Med 2022; 97:1592-1596. [PMID: 35731593 PMCID: PMC9592142 DOI: 10.1097/acm.0000000000004792] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians. When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.
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Affiliation(s)
- Krystal L. Tomei
- K.L. Tomei is associate professor of pediatric neurosurgery, Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luke V. Selby
- L.V. Selby is assistant professor of surgery, Department of Surgery, Division of Colorectal and Oncologic Surgery, University of Kansas Medical Center, Kansas City, Kansas; ORCID: https://orcid.org/0000-0002-0202-9646
| | - Lynne M. Kirk
- L.M. Kirk is chief of accreditation and recognition, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jacqueline A. Bello
- J.A. Bello is director of neuroradiology and professor of radiology and neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York
| | - Nathan S. Nolan
- N.S. Nolan is medical education fellow and infectious disease physician, Washington University Hospital, St. Louis, Missouri
| | - Surendra K. Varma
- S.K. Varma is executive associate dean for graduate medical education and resident affairs, university distinguished professor, and vice chair, Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Patricia L. Turner
- P.L. Turner is executive director, American College of Surgeons, and clinical associate professor of surgery, University of Chicago Medicine, Chicago, Illinois
| | - Victoria Stagg Elliott
- V.S. Elliott is a technical writer, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1223-0084
| | - Sarah E. Brotherton
- S.E. Brotherton is director, Data Acquisition Services, American Medical Association, Chicago, Illinois
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Mainster MA, Desmettre T, Querques G, Turner PL, Ledesma-Gil G. Scanning laser ophthalmoscopy retroillumination: applications and illusions. Int J Retina Vitreous 2022; 8:71. [PMID: 36180893 PMCID: PMC9524008 DOI: 10.1186/s40942-022-00421-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022] Open
Abstract
Scanning laser ophthalmoscopes (SLOs) are used widely for reflectance, fluorescence or autofluorescence photography and less commonly for retroillumination imaging. SLOs scan a visible light or near-infrared radiation laser beam across the retina, collecting light from each retinal spot as it’s illuminated. An SLO’s clinical applications, image contrast and axial resolution are largely determined by an aperture overlying its photodetector. High contrast, reflectance images are produced using small diameter, centered apertures (confocal apertures) that collect retroreflections and reject side-scattered veiling light returned from the fundus. Retroillumination images are acquired with annular on-axis or laterally-displaced off-axis apertures that capture scattered light and reject the retroreflected light used for reflectance imaging. SLO axial resolution is roughly 300 μm, comparable to macular thickness, so SLOs cannot provide the depth-resolved chorioretinal information obtainable with optical coherence tomography’s (OCT’s) 3 μm axial resolution. Retroillumination highlights and shades the boundaries of chorioretinal tissues and abnormalities, facilitating detection of small drusen, subretinal drusenoid deposits and subthreshold laser lesions. It also facilitates screening for large-area chorioretinal irregularities not readily identified with other en face retinal imaging modalities. Shaded boundaries create the perception of lesion elevation or depression, a characteristic of retroillumination but not reflectance SLO images. These illusions are not reliable representations of three-dimensional chorioretinal anatomy and they differ from objective OCT en face topography. SLO retroillumination has been a useful but not indispensable retinal imaging modality for over 30 years. Continuing investigation is needed to determine its most appropriate clinical roles in multimodal retinal imaging.
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Affiliation(s)
- Martin A Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, KS, USA
| | | | - Giuseppe Querques
- Ophthalmology Department, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patricia L Turner
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, KS, USA
| | - Gerardo Ledesma-Gil
- Retina Department, Institute of Ophthalmology, Fundacion Conde de Valenciana, Chimalpopoca 14, Colonia Obrera, Cuauhtemoc, 06800, Mexico City, Mexico.
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Mainster MA, Findl O, Dick HB, Desmettre T, Ledesma-Gil G, Curcio CA, Turner PL. The Blue Light Hazard Versus Blue Light Hype. Am J Ophthalmol 2022; 240:51-57. [PMID: 35227699 PMCID: PMC10243475 DOI: 10.1016/j.ajo.2022.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 10/07/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The blue light hazard is the experimental finding that blue light is highly toxic to the retina (photic retinopathy), in brief abnormally intense exposures, including sungazing or vitreoretinal endoillumination. This term has been misused commercially to suggest, falsely, that ambient environmental light exposure causes phototoxicity to the retina, leading to age-related macular degeneration (AMD). We analyze clinical, epidemiologic, and biophysical data regarding blue-filtering optical chromophores. DESIGN Perspective. METHODS Analysis and integration of data regarding the blue light hazard and blue-blocking filters in ophthalmology and related disciplines. RESULTS Large epidemiologic studies show that blue-blocking intraocular lenses (IOLs) do not decrease AMD risk or progression. Blue-filtering lenses cannot reduce disability glare because image and glare illumination are decreased in the same proportion. Blue light essential for optimal rod and retinal ganglion photoreception is decreased by progressive age-related crystalline lens yellowing, pupillary miosis, and rod and retinal ganglion photoreceptor degeneration. Healthful daily environmental blue light exposure decreases in older adults, especially women. Blue light is important in dim environments where inadequate illumination increases risk of falls and associated morbidities. CONCLUSIONS The blue light hazard is misused as a marketing stratagem to alarm people into using spectacles and IOLs that restrict blue light. Blue light loss is permanent for pseudophakes with blue-blocking IOLs. Blue light hazard misrepresentation flourishes despite absence of proof that environmental light exposure or cataract surgery causes AMD or that IOL chromophores provide clinical protection. Blue-filtering chromophores suppress blue light critical for good mental and physical health and for optimal scotopic and mesopic vision.
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Affiliation(s)
- Martin A Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas, USA.
| | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - H Burkhard Dick
- Department of Ophthalmology, Ruhr University Eye Hospital, Science, Bochum, Germany
| | | | - Gerardo Ledesma-Gil
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia L Turner
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas, USA
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Mainster MA, Findl O, Dick HB, Desmettre T, Ledesma-Gil G, Curcio CA, Turner PL. Reply to Comment on: The Blue Light Hazard Versus Blue Light Hype. Am J Ophthalmol 2022; 241:284-285. [PMID: 35472444 DOI: 10.1016/j.ajo.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
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Iqbal EJ, Sutton T, Akther MS, Samhan A, MacDonald S, Coleman JR, Turner PL, Nikolian VC. Current Surgical Trainee Perceptions and Experiences in Telehealth. Telemed J E Health 2021; 28:789-797. [PMID: 34637650 DOI: 10.1089/tmj.2021.0237] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Broad expansion of telehealth technologies has been implemented during the coronavirus disease 2019 (COVID-19) pandemic to allow for physical distancing and limitation of viral transmission within health care facilities. Although telehealth has been studied for its impact on patients, payors, and practitioners, its educational impact is largely unstudied. To better understand the trainee experience and perception of telehealth during the COVID-19 pandemic, we conducted a survey of the membership of the American College of Surgeons Resident and Associate Society (RAS). Methods: An anonymous survey was sent to members of RAS. Descriptive analysis was used to report experiences and perceptions. Chi-square analysis was used to compare cohorts with and without exposure to telehealth. Results: Of the 465 RAS respondents, 292 (62.8%) reported knowledge of telehealth technologies at their institutions. The majority of these respondents experienced a decrease in in-person clinic volume (94.4%) and an associated increase in virtual clinic volume (95.7%) related to the COVID-19 pandemic. Trainee integration into telehealth workflows increased drastically from prepandemic levels (11% vs. 54.5%, p < 0.001). Likelihood of trainee exposure to telehealth was associated with university-based training programs or larger program size. Trainees demonstrated a desire for more integration and development of curricula. Conclusions: These data serve as the first description of surgical trainee experience with, and opinion of, telehealth. Trainees recognize the importance of their integration and training in telehealth. These results should be used to guide the development of workflows and curricula that integrate trainees into telemedicine clinics.
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Affiliation(s)
- Emaad J Iqbal
- Department of Surgery, Columbia University, New York City, New York, USA
| | - Thomas Sutton
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mudassir S Akther
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Ashraf Samhan
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephanie MacDonald
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Julia R Coleman
- Department of Surgery, University of Colorado, Denver, Colorado, USA
| | - Patricia L Turner
- American College of Surgeons, Chicago, Illinois, USA.,Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Vahagn C Nikolian
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Schlick CJR, Ellis RJ, Etkin CD, Greenberg CC, Greenberg JA, Turner PL, Buyske J, Hoyt DB, Nasca TJ, Bilimoria KY, Hu YY. Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US. JAMA Surg 2021; 156:942-952. [PMID: 34319377 DOI: 10.1001/jamasurg.2021.3195] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions. Objective To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US. Design, Setting, and Participants This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible. Exposures Specific types, sources, and factors associated with gender-based discrimination and sexual harassment. Main Outcomes and Measures Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual- and program-level factors using gender-stratified multivariable logistic regression models. Results The survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experiencing sexual harassment than interns (postgraduate years 4 and 5 vs postgraduate year 1: OR, 1.77 [95% CI, 1.40-2.24] among female residents; 1.31 [95% CI, 1.01-1.70] among male residents). Conclusions and Relevance In this study, gender discrimination and sexual harassment were common experiences among surgical residents and were frequently reported by women. These phenomena warrant multifaceted context-specific strategies for improvement.
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Affiliation(s)
- Cary Jo R Schlick
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Caryn D Etkin
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine, Madison
| | - Jacob A Greenberg
- Department of Surgery, University of Wisconsin School of Medicine, Madison
| | - Patricia L Turner
- American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Chicago, Chicago, Illinois
| | - 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, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, 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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11
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Yuce TK, Turner PL, Glass C, Hoyt DB, Nasca T, Bilimoria KY, Hu YY. National Evaluation of Racial/Ethnic Discrimination in US Surgical Residency Programs. JAMA Surg 2021; 155:526-528. [PMID: 32293655 DOI: 10.1001/jamasurg.2020.0260] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [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)
- Tarik K Yuce
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patricia L Turner
- American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Chicago, Chicago, Illinois
| | - Charity Glass
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Thomas Nasca
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, 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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Demblowski LA, Busse B, Santangelo G, Blakely AM, Turner PL, Hoyt DB, Zeiger MA. NIH Funding for Surgeon-Scientists in the US: What Is the Current Status? J Am Coll Surg 2021; 232:265-274.e2. [PMID: 33588041 DOI: 10.1016/j.jamcollsurg.2020.12.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent literature suggests that the future of surgeon-scientists in the US has been threatened for the past several decades. However, we documented an overall increase in NIH funding for surgeon-scientists, as well as the number of NIH-funded surgeons, from 2010 to 2020. STUDY DESIGN NIH-funded principal investigators (PIs) were identified for June 2010 and June 2020 using the NIH internal data platform iSearch Grants (version 2.4). Biographical sketches were searched for key terms to identify surgeon-scientists. Grant research types and total grant costs were collected. American Association of Medical Colleges data were used to determine total surgeon and physician populations. Bivariate chi-square analyses were performed using population totals and were corroborated using z-tests of population proportions using JMP (version 13.0.0). A 2-tailed p value <0.05 was considered significant. RESULTS In June of 2020, a total of 1,031 surgeon-scientists held $872,456,710 in NIH funding. The percentage of funded surgeons significantly increased from 2010 (0.5%) to 2020 (0.7%) (p < 0.05), and the percentage of funded other physicians significantly decreased from 2.2% in 2010 to 1.6% in 2020 (p < 0.05). All surgeons sustained R grant funding at both time points (58% in 2020 and 60% in 2010), and specifically maintained basic science-focused R grants (73% in 2020 and 78% in 2010). CONCLUSIONS Our study found surgeon-scientists are increasing in number and NIH funding and are becoming more diverse in their research efforts, while maintaining a focus on basic science.
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Affiliation(s)
| | - Brad Busse
- Office of Portfolio Analysis, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD
| | - George Santangelo
- Office of Portfolio Analysis, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD
| | - Andrew M Blakely
- Surgical Oncology Program, National Cancer Institute, NIH, Bethesda, MD
| | | | | | - Martha A Zeiger
- Surgical Oncology Program, National Cancer Institute, NIH, Bethesda, MD.
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Wexner SD, Nelson H, Stain SC, Turner PL, Cortés-Guiral D. The American College of Surgeons Response to the COVID-19 Pandemic (Part I): Cancer Care, COVID-19 Registry, Surgeon Wellness. Am Surg 2020; 86:751-756. [DOI: 10.1177/0003134820940771] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
From the onset of the COVID-19 global pandemic of 2020, the American College of Surgeons has been a leader in disseminating reliable information on the nature of the crisis and assuring quality of surgical care during the enforced lockdown of inpatient and outpatient care.
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Affiliation(s)
- Steven D. Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Steven C. Stain
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | | | - Delia Cortés-Guiral
- Department of Surgical Oncology, King Khalid University Hospital, Najran, Saudi Arabia
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Wilcox AR, Lai CS, Stanzah FE, Farrar JG, Trooboff SW, Turner PL, Wong SL. Gender Representation by Specialty Track at Surgical Meetings: The American and Australasian Experiences. J Surg Res 2020; 253:149-155. [DOI: 10.1016/j.jss.2020.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/10/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
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Mahoney ST, Strassle PD, Schroen AT, Agans RP, Turner PL, Meyer AA, Freischlag JA, Brownstein MR. Survey of the US Surgeon Workforce: Practice Characteristics, Job Satisfaction, and Reasons for Leaving Surgery. J Am Coll Surg 2020; 230:283-293.e1. [DOI: 10.1016/j.jamcollsurg.2019.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
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Wilcox AR, Trooboff SW, Lai CS, Turner PL, Wong SL. Trends in Gender Representation at the American College of Surgeons Clinical Congress and the Academic Surgical Congress: A Mixed Picture of Progress. J Am Coll Surg 2019; 229:397-403. [DOI: 10.1016/j.jamcollsurg.2019.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022]
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Mahoney ST, Strassle PD, Schroen AT, Agans RP, Turner PL, Meyer AA, Freischlag JA, Brownstein MR. Survey of the US Surgeon Workforce: Practice Characteristics, Job Satisfaction, and Work-Life Balance. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hall DJ, Mira JC, Hoffman MR, Keshava HB, Olsen KR, Hardaway JC, Underwood PW, Hawley KL, Turner PL, Antony AB, Vasilopoulos T, Mouawad NJ. Postoperative surgical trainee opioid prescribing practices (POST-OPP): A national survey. J Opioid Manag 2019; 15:307-322. [PMID: 31637683 DOI: 10.5055/jom.2019.0516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Increasing opioid-related deaths have heightened focus on combating the opioid epidemic. The impact of surgical trainees on opioid-related deaths is unclear, and there is little data examining the association between trainee pain management education and opioid prescribing practices. METHODS An anonymous, online survey was distributed to members of the Resident and Associate Society of the American College of Surgeons. The survey covered five themes: education and knowledge, prescribing practices, clinical case scenarios, policy, and beliefs and attitudes. Linear mixed models were used to evaluate the influence of respondent characteristics on reported morphine milligram equivalents (MME) prescribed for common general surgery clinical scenarios. RESULTS Of 427 respondents, 54 percent indicated receiving training in postoperative pain management during medical school and 66 percent during residency. Only 35 percent agreed that they had received adequate training in prescribing opioids. There was a significant association between undergoing formal pain management training in medical school and prescribing fewer MME for common outpatient general surgery scenarios (94 ± 15.2 vs 108 ± 15.0; p = 0.003). Similarly, formal pain management training in residency was associated with prescribing fewer MME in the survey scenarios (92.6 ± 15.2 vs 109 ± 15.2; p = 0.002). CONCLUSION In this survey, nearly two-thirds of surgical residents felt that they were inadequately trained in opioid pre-scribing. Our findings additionally suggest that improving education may result in increased resident comfort with man-aging surgical pain, potentially leading to more responsible opioid prescribing. Further work will facilitate residency pro-grams' development of educational curricula for opioid prescribing best practices.
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Affiliation(s)
- David J Hall
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Juan C Mira
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Melissa R Hoffman
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Hari B Keshava
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kevin R Olsen
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - John C Hardaway
- Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island
| | - Patrick W Underwood
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Kristy L Hawley
- Department of Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Patricia L Turner
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Ajay B Antony
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Nicolas J Mouawad
- Department of Surgery, McLaren Bay Region, Bay City, Michigan; Department of Surgery, Michigan State University, Lansing, Michigan
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Turner PL. The enduring influence of surgical societies. Am J Surg 2018; 215:981-986. [PMID: 29903392 DOI: 10.1016/j.amjsurg.2018.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/28/2018] [Indexed: 11/30/2022]
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Nigri G, Early K, Tsoulfas G, Ferreres A, Ferrone CR, Schulick R, Al-Refaie WB, Turner PL, Velmahos G. Correction to: International Scholarship Programs of the American College of Surgeons: Expansion of the Global Surgical Network. World J Surg 2017; 42:1238. [PMID: 29127463 DOI: 10.1007/s00268-017-4330-y] [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] [Indexed: 02/05/2023]
Abstract
In the original article, the top of Fig. 1 was inadvertently cut off. The original article has been corrected. The publisher regrets the error.
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Affiliation(s)
- Giuseppe Nigri
- American College of Surgeons, Chicago, IL, USA. .,Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Kate Early
- American College of Surgeons, Chicago, IL, USA
| | - George Tsoulfas
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Thessaloniki, Thessaloniki, Greece
| | - Alberto Ferreres
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Buenos Aires "Dr. Carlos A. Bocalandro" Hospital, Buenos Aires, Argentina
| | - Cristina R Ferrone
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Schulick
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Waddah B Al-Refaie
- American College of Surgeons, Chicago, IL, USA.,MedStar Georgetown University Hospital, Washington, DC, USA
| | - Patricia L Turner
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - George Velmahos
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Ferrada P, Sakran JV, Dubose J, Vergis A, Peck G, Alseidi A, Moalem J, Tefera G, Turner PL. Above and beyond: A primer for young surgeons interested in global surgery. Bull Am Coll Surg 2017; 102:33-38. [PMID: 28925237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Moalem J, Alseidi AA, Broghammer J, Suliburk J, Klaristenfeld DD, Sakran JV, Sutherland MJ, Turner PL. Young surgeons speak up: Stringent OR attire restrictions decrease morale without improving outcomes. Bull Am Coll Surg 2016; 101:10-19. [PMID: 28937709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
Using traditional techniques in novel ways often can improve management of common surgical problems. Additionally, established products may find new utility when deployed in a slightly different fashion to enhance patient care in a clinically relevant way. This article describes endoscopic placement of radiopaque markers into the proximal small intestine as a means to evaluate motility in a focused fashion. A method to delineate the location of dysmotility in a patient with several potential sites is described. This technique is safe, feasible, reasonably inexpensive, and is easily performed by a skilled endoscopist. Moreover, this technique has the added benefit of providing functional data in a timely fashion.
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Affiliation(s)
- Patricia L Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Turner PL. Book Review: Atlas of Minimally Invasive Surgery. Surg Innov 2016. [DOI: 10.1177/1553350606293804] [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: 11/15/2022]
Affiliation(s)
- Patricia L. Turner
- Division of General Surgery, University of Maryland Medical Center, Baltimore, Maryland
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Turner PL. Stay connected and informed: Start tweeting. Bull Am Coll Surg 2016; 101:25-26. [PMID: 27405182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Upchurch GR, Freischlag JA, Novicoff W, Early K, Turner PL, Zinner MJ. Survey of the American College of Surgeons scholarship recipients: a story of generating academic leaders. J Am Coll Surg 2015; 220:1122-1127.e3. [PMID: 25998084 DOI: 10.1016/j.jamcollsurg.2015.02.027] [Citation(s) in RCA: 9] [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: 02/17/2015] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this survey was to provide a review of the American College of Surgeons (ACS) scholarship activity. STUDY DESIGN The domestic ACS scholarship recipient survey was electronically transmitted twice to awardees from 1987 to 2007 (n=253). Themes of the survey included type of practice, activities during scholarship period, success of peer review funding, and the role of mentors. All survey responses were evaluated using SPSS version 20. RESULTS There were 123 total responses, with 108 separate respondents (94, 1 award; 13, 2 awards; 1, 3 awards). The group averaged 11.8 years in clinical practice, with the majority (90.2%) having an academic appointment. Seventy-seven percent of respondents were on a tenure track, and almost three-quarters (72.4%) of the respondents hold a major leadership position. In terms of research, 67.5% of respondents have received extramural funding; 10.6% have received patents. The average number of publications related to their funded research is 19.2 (range 0 to 180). Most respondents perform peer review of research (73.2%), learned about the peer review process during their funding period (82.1%), and mentor medical students (88.6%). The average number of students currently mentored is 6.4; the average total trainees mentored is 13. Despite the significant research responsibilities of respondents, they still spend more time performing clinical care (49.2%) than research (30.4%). CONCLUSIONS The ACS scholarship has a significant impact on the recipient's academic career, even in the setting of increasing clinical burdens. This program also appears to tangentially identify surgeons who become leaders in academic surgery.
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Affiliation(s)
| | | | - Wendy Novicoff
- Department of Orthopaedic Surgery and Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Kate Early
- Division of Surgical Education, American College of Surgeon, Chicago, IL
| | - Patricia L Turner
- Division of Surgical Education, American College of Surgeon, Chicago, IL
| | - Michael J Zinner
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA
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Fullum TM, Downing SR, Ortega G, Chang DC, Oyetunji TA, Van Kirk K, Tran DD, Woods I, Cornwell EE, Turner PL. Is laparoscopy a risk factor for bile duct injury during cholecystectomy? JSLS 2014; 17:365-70. [PMID: 24018070 PMCID: PMC3771752 DOI: 10.4293/108680813x13654754535638] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Laparoscopic cholecystectomy, obesity, insurance status, and hospital volume were not associated with an increased risk of bile duct injury. Background and Objectives: Previously, risk factors for bile duct injury have been identified as acute cholecystitis, male gender, older age, aberrant biliary anatomy, and laparoscopic cholecystectomy. Methods: A retrospective analysis of the Nationwide Inpatient Sample from 1998 to 2006 was performed with an inclusion criterion of cholecystectomy performed on hospital day 0 or 1. Patient- and hospital-level factors potentially associated with bile duct injury were examined by logistic regression. Results: A total of 377,424 cholecystectomy patients were identified. There were 1124 bile duct injuries (0.30%), with 177 (0.06%) in the laparoscopic cholecystectomy group and 947 (1.46%) in the open cholecystectomy group (P < .001). On multivariate analysis, significant risk factors for bile duct injury were male gender (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06–1.38; P = .006), age >60 years (OR, 2.23; 95% CI, 1.61–3.09; P < .001), and academic hospital status (OR, 1.37; 95% CI, 1.05–1.79; P = .02). Acute cholecystitis was associated with a lower risk of bile duct injury (OR, 0.67; 95% CI, 0.46–0.99; P = .044). Conclusion: Independent risk factors for bile duct injury included male gender, age >60 years, and academic hospital status. Laparoscopic cholecystectomy, obesity, insurance status, or hospital volume was not associated with an increased risk of bile duct injury.
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Affiliation(s)
- Terrence M Fullum
- Division of Minimally Invasive and Bariatric Surgery, Howard University College of Medicine, 2041 Georgia Ave NW, Ste 4100B, Washington, DC 20059, USA.
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Abràmoff M, Abrams GW, Agarwal A, Ai E, Aiello LM, Aiello LP, Albert DM, Aschbrenner MW, Ávila M, Aylward GW, Bedell M, Belfort R, Bennett J, Bergstrom C, Besirli CG, Bhende PS, Binder S, Bird AC, Blodi BA, Blumenkranz MS, Boldt HC, Bornfeld N, Bottoni F, Boulton ME, Bowne SJ, Brantley MA, Bressler NM, Bressler SB, Bringmann A, Brinton DA, Brown GC, Brown JC, Brunner S, Bush RA, Cao D, Capone A, Carruthers D, Cavallerano JD, Chakravarthy U, Chan CC, Chan W, Charles S, Charteris DG, Chen DF, Chen J, Chen Y, Cheung CYL, Chew EY, Chiang A, Chiang MF, Constable IJ, Coscas G, Cruess AF, Cunningham ET, Curcio CA, Daiger SP, Damato BE, Davis JL, Davis MD, Day S, De Potter P, de Smet MD, Denniston AK, Dhaliwal RS, Ding X, Do DV, Dou G, Dunn WA, Ehlers JP, Engelbert M, Faia LJ, Falsini B, Fawzi AA, Fekrat S, Feldon SE, Fernandes RAB, Ferreyra HA, Ferrington DA, Ferris FL, Finger PT, Fisher SK, Fishman GA, Fleckenstein M, Flynn HW, Fok AC, Foulds WS, Freeman WR, Freton A, Friedlander M, Frishman LJ, Fu AD, Garcia Filho CADA, Garcia-Valenzuela E, Gaudric A, Gayed M, Genead MA, Gerding H, Giani A, Goldberg MF, Gombos DS, Gopal L, Gordon C, Goto H, Gragoudas ES, Grant MB, Green WR, Gregg RG, Gregor Z, Gregori G, Gregory-Evans K, Grob S, Groenewald C, Grossniklaus HE, Grover S, Gullapalli VK, Gupta A, Guthoff RF, Hahn P, Haller JA, Harbour JW, Haritoglou C, Hartnett ME, Hawkins BS, He S, Herwig MC, Heussen FM, Hinton DR, Holz FG, Houston SK, Hui YN, Humayun MS, Ikuno Y, Isaac D, Ishibashi T, Jabs DA, Jaffe GJ, Jampol LM, Joffe L, Johnson M, Johnson MW, Johnson RN, Joussen AM, Julian K, Jumper JM, Kaiser PK, Kampik A, Katamay R, Kay CN, Keane PA, Kenney MC, Khaderi KR, Khodair MA, Kim IK, Kim TW, Kirchhof B, Klein BE, Klein R, Konstantinidis L, Kozak I, Kuppermann BD, Labriola LT, Lai TY, Lam DS, Lam LA, Landers MB, Lane AM, Lavik EB, Leary JF, Lee SY, Lee TC, Leung LSB, Lewis DA, Lewis GP, Leys A, Li X, Liakopoulos S, Lin CP, Lin P, Liu DT, London NJ, Lujan BJ, Luo Y, Lutty GA, MacLaren R, Madreperla S, Maguire AM, Mainster MA, Mansfield NC, Markoe AM, Marmor MF, Martin DF, Massey SC, McCall MA, McCannel TA, McCutchan JA, McDonald HR, Mehta MP, Meier P, Merbs S, Meredith TA, Meyer CH, Mieler WF, Miller JW, Mirza RG, Mitter SK, Mittra RA, Miyake Y, Montemagno C, Moshiri A, Mruthyunjaya P, Muccioli C, Mullins RF, Murata T, Murphree AL, Murphy RP, Murray PI, Murray TG, Nagpal M, Namperumalsamy P, Nanda SK, Nguyen QD, Nussenblatt RB, Oh KT, Ohji M, Ohno-Matsui K, Palanker D, Patel PS, Pavlick AC, Peereboom DM, Pennesi ME, Pepose JS, Perry JD, Puliafito CA, Quiram PA, Raman R, Ramchandran RS, Rao HV, Rao NA, Rao PK, Rathinam SR, Recchia FM, Redmond KJ, Reh TA, Reichenbach A, Ritch R, Rosenfeld PJ, Rubin GS, Ruiz-Garcia H, Ryan SJ, Sadda SR, Sadun AA, Sakamoto T, Sampath AP, Schachat AP, Schmitz-Valckenberg S, Schwartz SG, Scott AW, Sebag J, Seddon JM, Sen HN, Sepah YJ, Sharma S, Sharma T, Sheu SJ, Shields CL, Shields JA, Shinoda K, Shukla D, Sieving PA, Silva PA, Silveira C, Singh AD, Smith SB, Smith WM, Sobrin L, Sodhi A, Sohn EH, Soubrane G, Spielberg L, Srivastava SK, Stachs O, Staurenghi G, Sternberg P, Stone EM, Sugino IK, Sullivan LS, Sullivan P, Sun JK, Sunness JS, Tadayoni R, Tang S, Terasaki H, Thomas MA, Thompson JT, Thumann G, Toth CA, Trese MT, Tsai JH, Turell ME, Turner PL, Udar N, Ulrich JN, Van Gelder RN, van Meurs JC, Vasconcelos-Santos DV, Vavvas DG, Vemulakonda GA, Wang H, Wang Y, Weiland JD, Weleber RG, Wharam MD, Wickham L, Wiedemann P, Wiley HE, Wilkinson C, Wilson DJ, Wolfensberger TJ, Wong D, Wong IY, Wong TY, Wu DM, Yandiev Y, Yang CH, Yang CM, Yannuzzi LA, Yasuda M, Yeh PT, Yehoshua Z, Yiu G, Yoon YH, Yu HG, Yuan A, Zarbin MA, Zhang JJ, Zhang K, Zhao M, Zhou P. Contributors. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Andrew J. Riggin
- Division of General Surgery Department of Surgery University of Maryland Medical Center Baltimore, Maryland
| | - Michael B. Brewer
- Division of General Surgery Department of Surgery University of Maryland Medical Center Baltimore, Maryland
| | - Patricia L. Turner
- Division of General Surgery Department of Surgery University of Maryland Medical Center Baltimore, Maryland
| | - Devinder P. Singh
- Division of General Surgery Department of Surgery University of Maryland Medical Center Baltimore, Maryland
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Riggin AJ, Brewer MB, Turner PL, Singh DP. Paralytic ileus secondary to intestinal ascariasis. Am Surg 2012; 78:E481-E483. [PMID: 23089427] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Andrew J Riggin
- Division of General Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
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Oyetunji TA, Turner PL, Onguti SK, Ehanire ID, Dorsett FO, Fullum TM, Cornwell EE, Haider AH. Predictors of postdischarge complications: role of in-hospital length of stay. Am J Surg 2012; 205:71-6. [PMID: 22771450 DOI: 10.1016/j.amjsurg.2012.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 04/25/2012] [Accepted: 04/25/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical length of stay (LOS) has been correlated with quality of care, with shorter stays implying better care. The relationship between LOS and postdischarge complications (PDCs) has not been evaluated effectively. METHODS The 2005 to 2007 National Surgical Quality Improvement Program data were queried for patients undergoing elective colectomies. The outcome of interest was the development of a PDC. Multivariate analysis was then performed adjusting for demographics, surgical approach, and comorbidities. RESULTS A total of 12,956 colectomies were analyzed with an overall PDC of 8.7%. LOS was not associated with increased odds of developing a PDC. The laparoscopic approach reduced the risk of PDCs by 30% (odds ratio = .70, 95% confidence interval, 0.61-0.81). Body mass index, female sex, the presence of diabetes mellitus, and prolonged operative time increased the odds of developing a PDC. CONCLUSIONS A shorter LOS did not correlate with a reduction in the likelihood of PDCs. Further investigation into the role of LOS as a measure of quality care is needed.
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Affiliation(s)
- Tolulope A Oyetunji
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
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Glenn JA, Ortega G, Gonzalez DO, Reed JA, Turner PL, Tran DD, McKenna S, Bauer CC, Fullum TM. Gastric prolapse with pseudocysts following laparoscopic adjustable gastric banding. JSLS 2012; 15:542-5. [PMID: 22643513 PMCID: PMC3340967 DOI: 10.4293/108680811x13176785204436] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nonpancreatic pseudocysts may be associated with gastric prolapse in patients who have undergone laparoscopic adjustable gastric banding. Introduction: Laparoscopic adjustable gastric banding (LAGB) is a reversible method of surgical gastric restriction. Following LAGB, the adverse event most commonly necessitating subsequent reoperation is prolapse of the gastric corpus or fundus above the band. A review of the medical literature reveals no reports of nonpancreatic pseudocysts being associated with this adverse event. Nonpancreatic pseudocysts, encountered during revisional bariatric surgery should be considered a cause of irreducible gastric prolapse. Case Report: We report the case of a 41-year-old Caucasian female who underwent laparoscopic surgery to revise an adjustable gastric band and to repair an anterior gastric prolapse. Intraoperatively, 2 pseudocysts were found on the gastric fundus above the band in association with the gastric prolapse. The pseudocysts were resected, the gastric prolapse was reduced, and the band was left in place. The patient recovered uneventfully. Conclusion: Nonpancreatic pseudocysts may be associated with gastric prolapse in patients who have undergone LAGB. These pseudocysts can often be excised laparoscopically without violating the gastric lumen. This atypical presentation of gastric prolapse may pose a diagnostic and therapeutic challenge as these patients may present to an outpatient clinic or emergency room with nonspecific symptoms.
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Affiliation(s)
- Jason A Glenn
- Howard University College of Medicine, Washington, DC, USA
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Mainster MA, Turner PL. Glare's causes, consequences, and clinical challenges after a century of ophthalmic study. Am J Ophthalmol 2012; 153:587-93. [PMID: 22445628 DOI: 10.1016/j.ajo.2012.01.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 12/30/2011] [Accepted: 01/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To provide a multidisciplinary synthesis of scientific information on disability, discomfort, dazzling, and scotomatic (photostress) glare. DESIGN Perspective. METHODS Analysis and integration of relevant historical and contemporary publications on glare in ophthalmology, illumination engineering, neurology, and other relevant disciplines. RESULTS Disability glare is caused by scattered intraocular light (straylight) not useful for vision. Straylight casts a veiling luminance on the retina, reducing image contrast and impairing vision. In common environments, glare and target illumination sources have the same or similar spectra. Colored spectacle or intraocular lens filters reduce both proportionately, so they do not increase retinal image contrast or decrease disability glare. Discomfort glare is caused by situational illumination too intense or variable. Dazzling glare occurs when high illuminances are spread across the retina. Neurophysiological research is clarifying how discomfort and dazzling glare depend on different retinal photoreceptors and nociceptive brain pathways involving the trigeminal ganglion and thalamus. Photostress is caused by excessive local retinal photopigment bleaching uncommon in ordinary situations. Optical glare countermeasures are available for daytime driving but not oncoming automobile headlights at night. Filters that decrease daytime discomfort or dazzling glare also reduce nighttime mesopic and scotopic sensitivity. CONCLUSIONS Glare is problematic for patients and clinicians despite a century of scientific research. Advances in understanding glare have been hampered by its complex, multidisciplinary nature and limited interdisciplinary communication. We provide one pathway through the forest of glare nomenclature and mechanisms. Improved diagnostic and therapeutic methodologies await continuing progress in understanding glare.
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Mainster MA, Turner PL. Author reply. Ophthalmology 2011. [DOI: 10.1016/j.ophtha.2011.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Mainster MA, Turner PL. Blue light's benefits vs blue-blocking intraocular lens chromophores. Graefes Arch Clin Exp Ophthalmol 2011; 250:1245-6; author reply 1247-8. [PMID: 21814820 DOI: 10.1007/s00417-011-1748-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/15/2011] [Indexed: 11/25/2022] Open
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Suleiman LI, Ortega G, Ong'uti SK, Gonzalez DO, Tran DD, Onyike A, Turner PL, Fullum TM. Does BMI affect perioperative complications following total knee and hip arthroplasty? J Surg Res 2011; 174:7-11. [PMID: 21816426 DOI: 10.1016/j.jss.2011.05.057] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/29/2011] [Accepted: 05/26/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthopedic surgeons are reluctant to perform total knee (TKA) or hip (THA) arthroplasty on patients with high body mass index (BMI). Recent studies are conflicting regarding the risk of obesity on perioperative complications. Our study investigates the effect of BMI on perioperative complications in patients undergoing TKA and THA using a national risk-adjusted database. METHODS A retrospective analysis was performed using the 2005-2007 American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP dataset. Inclusion criteria were patients between 18 and 90 y of age who underwent TKA or THA. Patients were stratified into five BMI categories: normal, overweight, obese class I, obese class II, and morbidly obese. Demographic characteristics, length of stay, co-morbidities, and complication rates were compared across the BMI categories. RESULTS A total of 1731 patients met the inclusion criteria, with 66% and 34% undergoing TKA and THA, respectively. A majority were female (60%) and >60 y (70%) in age. Of the patients who underwent TKA, 90% were either overweight or obese, compared with 77% in those undergoing THA. The overall preoperative comorbidity rate was 73%. The complication and mortality rates were 7% and 0.4%, respectively. When stratifying perioperative complications by BMI categories, no differences existed in the rates of infection (P = 0.368), respiratory (P = 0.073), cardiac (P = 0.381), renal (P = 0.558), and systemic (P = 0.216) complications. CONCLUSIONS Our study demonstrates no statistical difference in perioperative complication rates in patients undergoing TKA or THA across BMI categories. Performing TKA or THA on patients with high BMI may increase mobility leading to improved quality of life.
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Affiliation(s)
- Linda I Suleiman
- Howard University College of Medicine, Washington, DC 20060, USA.
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De Biasi A, Lumpkins K, Turner PL. Laparoscopic Ventral Hernia Repair with Acute Perforated Cholecystitis and No Short- or Long-Term Evidence of Prosthesis Infection. Am Surg 2011. [DOI: 10.1177/000313481107700439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andreas De Biasi
- Department of Surgery University of Maryland School of Medicine Baltimore, Maryland
| | - Kimberly Lumpkins
- Department of Surgery University of Maryland School of Medicine Baltimore, Maryland
| | - Patricia L. Turner
- Department of Surgery University of Maryland School of Medicine Baltimore, Maryland
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De Biasi A, Lumpkins K, Turner PL. Laparoscopic ventral hernia repair with acute perforated cholecystitis and no short- or long-term evidence of prosthesis infection. Am Surg 2011; 77:510-511. [PMID: 21679572] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Andreas De Biasi
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Brill JB, Turner PL. Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review. Am Surg 2011; 77:458-465. [PMID: 21679556] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although most surgeons report using both transfascial sutures and laparoscopically placed tacks to secure prostheses in laparoscopic ventral hernia repair, a significant minority have reported large series in which sutures were omitted. A systematic review of the available literature was conducted for large case series and controlled trials documenting long-term follow-up. Forty-three articles were identified, including 6015 patients whose prostheses were secured with transfascial sutures (with or without tacks), and 2450 patients receiving tacks or staples alone. The mean follow-up time reported was 30.1 months. No significant difference was found in rates of hernia recurrence, mesh removal, prolonged postoperative pain, patient body mass index, or hernia defect size between the two groups. The suture group did experience a significantly higher rate of surgical site infection. Although suture tensile strength is greater than that of tacks, and despite numerous anecdotal reports of hernia recurrence secondary to suture failure or omission, the existing literature does not show superiority of one mesh fixation technique over the other for recurrence, whereas infection rates increase when transfascial suture is used.
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Affiliation(s)
- Jason B Brill
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Turner PL, Oyetunji TA, Gantt G, Chang DC, Cornwell EE, Fullum TM. Demographically associated variations in outcomes after bariatric surgery. Am J Surg 2011; 201:475-80. [DOI: 10.1016/j.amjsurg.2010.08.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 08/27/2010] [Accepted: 08/27/2010] [Indexed: 10/18/2022]
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Abstract
Although most surgeons report using both transfascial sutures and laparoscopically placed tacks to secure prostheses in laparoscopic ventral hernia repair, a significant minority have reported large series in which sutures were omitted. A systematic review of the available literature was conducted for large case series and controlled trials documenting long-term follow-up. Forty-three articles were identified, including 6015 patients whose prostheses were secured with transfascial sutures (with or without tacks), and 2450 patients receiving tacks or staples alone. The mean follow-up time reported was 30.1 months. No significant difference was found in rates of hernia recurrence, mesh removal, prolonged postoperative pain, patient body mass index, or hernia defect size between the two groups. The suture group did experience a significantly higher rate of surgical site infection. Although suture tensile strength is greater than that of tacks, and despite numerous anecdotal reports of hernia recurrence secondary to suture failure or omission, the existing literature does not show superiority of one mesh fixation technique over the other for recurrence, whereas infection rates increase when transfascial suture is used.
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Affiliation(s)
- Jason B. Brill
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patricia L. Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Turner AP, Shaffer VO, Araki K, Martens C, Turner PL, Gangappa S, Ford ML, Ahmed R, Kirk AD, Larsen CP. Sirolimus enhances the magnitude and quality of viral-specific CD8+ T-cell responses to vaccinia virus vaccination in rhesus macaques. Am J Transplant 2011; 11:613-8. [PMID: 21342450 PMCID: PMC3076606 DOI: 10.1111/j.1600-6143.2010.03407.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Sirolimus is a potent antiproliferative agent used clinically to prevent renal allograft rejection. However, little is known about the effects of maintenance immunosuppressive agents on the immune response to potentially protective vaccines. Here we show that sirolimus paradoxically increases the magnitude and quality of the CD8+ T-cell response to vaccinia vaccination in nonhuman primates, fostering more robust recall responses compared to untreated and tacrolimus-treated controls. Enhancement of both the central and effector memory compartments of the vaccinia-specific CD8+ T-cell response was observed. These data elucidate new mechanistic characteristics of sirolimus and suggest immune applications extending beyond its role as an immunosuppressant.
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Affiliation(s)
- A P Turner
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA, USA
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Mainster MA, Turner PL. Effect of yellow-tinted intraocular lenses on short-wavelength automated perimetry. Am J Ophthalmol 2010; 150:589-90; author reply 590-1. [PMID: 20863923 DOI: 10.1016/j.ajo.2010.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
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Turner PL, Van Someren EJW, Mainster MA. The role of environmental light in sleep and health: Effects of ocular aging and cataract surgery. Sleep Med Rev 2010; 14:269-80. [PMID: 20056462 DOI: 10.1016/j.smrv.2009.11.002] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 11/06/2009] [Accepted: 11/06/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Patricia L Turner
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS 66208-3444, USA.
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Tuggle KRM, Ortega G, Bolorunduro OB, Oyetunji TA, Alexander R, Turner PL, Chang DC, Cornwell EE, Fullum TM. Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 2010; 163:225-8. [PMID: 20599209 DOI: 10.1016/j.jss.2010.03.071] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 03/11/2010] [Accepted: 03/30/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) has been an established treatment method for uncomplicated acute appendicitis. Controversy still exits regarding the superiority of either laparoscopic or open technique for the treatment of complicated appendicitis. OBJECTIVE To examine for benefits in postoperative morbidity comparing laparoscopic versus open appendectomy for complicated appendicitis. METHODS A retrospective analysis was performed using the American College of Surgeon's National Surgical Quality Improvement Project (ACS-NSQIP) dataset between 2005 and 2007. Inclusion criteria were patients undergoing either open or laparoscopic appendectomy, and had complicated appendicitis. Patients with negative appendectomies and age less than 18 y old were excluded. The primary outcome variable was postoperative complications. Multivariate analysis was performed adjusting for demographics and standard NSQIP comorbidities. RESULTS We identified 2,790 complicated appendicitis cases treated with laparoscopic or open appendectomy. The majority were male (56.6%), White (70.3%), and 39.1% were younger than 40 y of age. On unadjusted analyses, the mean length of stay was significantly shorter for LA cases (3.97 d) than OA cases (5.13 d) (P < 0.001). On multivariate analysis, superficial surgical site infection was 70% less likely to occur in LA (OR 0.304 P = 0.000), organ space infection was 2-fold more likely to occur in LA (OR 2.19 P = 0.003), and dehiscence was 78% less likely to occur in LA (OR 0.22 P = 0.015). CONCLUSION In cases of complicated appendicitis, laparoscopic appendectomy is superior in terms of superficial and deep wound infections; however, it is associated with an increased incidence of postoperative intra-abdominal abscess.
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Mainster MA, Turner PL. Ultraviolet-B phototoxicity and hypothetical photomelanomagenesis: intraocular and crystalline lens photoprotection. Am J Ophthalmol 2010; 149:543-9. [PMID: 20346776 DOI: 10.1016/j.ajo.2009.11.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [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: 09/09/2009] [Revised: 11/23/2009] [Accepted: 11/25/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE Ultraviolet-B (UV-B) radiation can cause phototoxic macular injuries in young people who have been sunbathing but not sungazing and in welders. Welders have a reportedly increased risk of uveal melanoma. We analyze phakic and pseudophakic risks for solar and welding arc UV-B exposure. DESIGN Optical radiation measurement, analysis, and perspective. METHODS Spectral transmittances were measured for UV-transmitting, UV-blocking, and blue-blocking intraocular lenses (IOLs). The photoprotective performances of crystalline and intraocular lenses were analyzed using relevant epidemiologic and laboratory data and action spectra for acute retinal phototoxicity and melanoma photocarcinogenesis. RESULTS Crystalline lens UV-B retinal protection is deficient in children and young adults, increasing their potential susceptibility to acute retinal phototoxicity and hypothetical photomelanomagenesis. UV-B radiation has sufficient energy/photon to induce primary melanomagenic DNA lesions, unlike blue light or UV-A radiation. UV-blocking and blue-blocking IOLs have negligible UV-B transmittance. UV-transmitting IOL transmittance of UV-B radiation is equivalent to that of a 15-year-old crystalline lens. CONCLUSIONS If optical radiation exposure is responsible for welders' increased risk of uveal melanoma, then UV-B radiation is the most probable causative agent and spectacle wear is a potential confounding factor in epidemiologic studies of ocular melanoma. Welders under 30 years of age are at greater risk for welding maculopathy than older welders. Children, adults under 30 years of age, and pseudophakic individuals with UV-transmitting IOLs should wear sunglasses in bright environments because of the UV-B window in their crystalline lenses or IOLs.
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Affiliation(s)
- Martin A Mainster
- University of Kansas School of Medicine, Prairie Village, KS 66208-3444, USA.
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