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Sinyard RD, Panda N. Integration of smartphone-based mobile health technology into perioperative care-the patient's perspective. Surgery 2024:S0039-6060(24)00057-6. [PMID: 38508919 DOI: 10.1016/j.surg.2024.01.031] [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: 11/01/2023] [Revised: 01/08/2024] [Accepted: 01/01/2024] [Indexed: 03/22/2024]
Abstract
Although numerous use cases demonstrate the value of mobile health technology, there is limited knowledge regarding patient perceptions of such technology, which may explain the lack of broader implementation of mobile health technology. Achieving meaningful, sustained, and equitable use of mobile health technology in surgery necessitates a human-centered design approach with consideration given to end users. This review article draws on evidence from prior qualitative studies of both surgeons and patients to make recommendations that may assist health care systems in realizing the full potential of mobile health technology for delivering high-quality, patient-centered surgical care.
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Affiliation(s)
- Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Ariadne Labs, Boston, MA
| | - Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Ariadne Labs, Boston, MA.
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Sinyard RD, Cauley CE. Implementing mobile health in your surgical practice: Results of a multidisciplinary convening. Surgery 2024:S0039-6060(24)00062-X. [PMID: 38458819 DOI: 10.1016/j.surg.2024.01.036] [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: 11/01/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 03/10/2024]
Abstract
The perioperative journey remains complex and difficult to navigate for patients and caregivers. Poor communication and lack of care coordination lead to diminished patient satisfaction, outcomes, and system performance. Mobile health platforms have the potential to overcome some of these issues by improving care delivery through timely individualized assessments, improved patient education, and care coordination. Yet mobile health implementation in surgical practice remains limited. Based on a convening of experts using human-centered design techniques, an implementation guide for the integration of mobile health in perioperative care was created to assist with (1) identification of the use of mobile health within a specific surgical practice, (2) identification of the pathway to mobile health implementation, and (3) measurement of successful implementation including patient and surgical system impact. This article reviews those recommendations and provides references to additional literature, including the full implementation guide, to aid those seeking to implement mobile health in a surgical practice or system.
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Affiliation(s)
- Robert D Sinyard
- Ariadne Labs, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Christy E Cauley
- Ariadne Labs, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA.
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Abstract
It is estimated that approximately one in four men and one in 20 women will develop an inguinal hernia over the course of their lifetime. A non-mesh inguinal hernia repair via the Shouldice technique is a unique approach that necessitates dissection of the entire groin region as well as careful assessment for any secondary hernias. Subsequently, a pure tissue laminated closure allows the repair to be performed without tension. Herein, the authors describe a brief overview of inguinal hernias and discuss the relevant patient evaluation, operative steps of the Shouldice procedure, and postoperative considerations.
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Affiliation(s)
- Divyansh Agarwal
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. https://twitter.com/divyansh_aga
| | - Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Ott
- Mass General Brigham, Newton-Wellesley Hospital, Boston Hernia, Tufts University School of Medicine, Boston, MA, USA
| | - Michael Reinhorn
- Mass General Brigham, Newton-Wellesley Hospital, Boston Hernia, Tufts University School of Medicine, Boston, MA, USA.
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Coe TM, McKinley SK, Hamdi I, Sinyard RD, Jogerst KM, Pradarelli AA, Petrusa E, Moses J, Saillant N, Phitayakorn R. The Big Sibling program: Impact of a medical student-resident mentorship program during the surgery clerkship. Am J Surg 2023; 225:650-655. [PMID: 35871028 DOI: 10.1016/j.amjsurg.2022.07.009] [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] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/19/2022] [Accepted: 07/14/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND We created a Big Sibling mentorship program for medical students and studied the program effects. METHODS Between July 2019 to December 2020, students completing their surgery clerkship were paired with a Big Sibling surgical research resident. Participation in and perceptions of the program were assessed by survey. RESULTS 81 medical students and 25 residents participated with a 79% and 95% survey response rate, respectively. The most valuable topics discussed included ward skills, personal development and career advising. Students who interacted >2 times with their Big Sibling were more likely to perceive the operating room as a positive learning environment, view attendings as role models, and receive mentoring and feedback from residents and attendings (p = 0.03, 0.02, 0.01 respectively). 78% of residents thought the program was a positive experience and no residents found it burdensome. CONCLUSION The Big Siblings program enhances the surgery clerkship learning environment. Students who engaged with their Big Sibling had a more positive view of the clerkship and the mentorship provided by residents and attendings.
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Affiliation(s)
- Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Joy Moses
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Etheridge JC, Castillo-Angeles M, Sinyard RD, Jarman MP, Havens JM. Impact of hospital characteristics on best-practice adherence for gallstone pancreatitis: a nationwide analysis. Surg Endosc 2023; 37:127-133. [PMID: 35854127 DOI: 10.1007/s00464-022-09444-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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Current guidelines recommend cholecystectomy during the index admission for gallstone pancreatitis, and a growing body of evidence indicates that patients benefit from cholecystectomy within the first 48 h of admission. We examined the impact of hospital characteristics on adherence to these data-driven practices. METHODS We queried the National Inpatient Sample for patients admitted for gallstone pancreatitis between October 2015 and December 2018. Patients who underwent same-admission cholecystectomy were identified by procedure codes. Cholecystectomies within the first two days were classified as early cholecystectomies. Multivariable logistic regression was used to determine the association between hospital characteristics and adherence to these practices. RESULTS Of 163,390 admissions for gallstone pancreatitis, only 90,790 (55.6%) underwent cholecystectomy before discharge. Mean time from admission to cholecystectomy was 2.9 days; 27.0% of patients (44,005) underwent early cholecystectomy. Odds of same-admission cholecystectomy were highest in large hospitals (OR 1.21, 95% CI 1.13-1.28), urban teaching centers (OR 1.33, 95% CI 1.21-1.46), and the South (OR 1.70, 95% CI 1.57-1.83). Odds of early cholecystectomy did not vary with hospital size, urban-rural status, or teaching status but were highest in the West (OR 1.98, 95% CI 1.80-2.18). CONCLUSION Best-practice adherence for cholecystectomy in gallstone pancreatitis remains low despite an abundance of evidence and clinical practice guidelines. Active interventions are needed to improve delivery of surgical care for this patient population. Implementation efforts should focus on small hospitals, rural areas, and health systems in the Northeast region.
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Affiliation(s)
- James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Manuel Castillo-Angeles
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert D Sinyard
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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Sinyard RD, Veeramani A, Rouanet E, Anteby R, Petrusa E, Phitayakorn R, Gee D, Terhune K. Gaps in Practice Management Skills After Training: A Qualitative Needs Assessment of Early Career Surgeons. J Surg Educ 2022; 79:e151-e160. [PMID: 35842404 DOI: 10.1016/j.jsurg.2022.06.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/23/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Shifts in American healthcare delivery mechanisms pose significant hurdles to new physicians. Surgeons are particularly susceptible to these changes, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula. METHODS This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify early career (<5 years following fellowship completion) surgeons across the United States. A semi-structured interview guide was created from interviews with surgical administrators and physician administrative curricula. Transcripts were de-identified and analyzed using a constructivist grounded theory approach. RESULTS Ten surgeons from 6 specialties and 6 institutions were interviewed along with 3 surgeon administrators. Three major domains of need were identified: (1) fundamentals of procedural coding, clinical billing, & compliance, (2) finding/building a practice, and (3) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire to have dedicated mentorship time, a primer on evaluating job offers with simulated contract negotiation, and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions. CONCLUSIONS There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program. Future research will test the generalizability of these findings as well as build curricula that adequately meet these needs.
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Affiliation(s)
- Robert D Sinyard
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts.
| | | | - Eva Rouanet
- Brigham & Women's Hospital, Department of Surgery; Boston, Massachusetts
| | - Roi Anteby
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Emil Petrusa
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Roy Phitayakorn
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Denise Gee
- Massachusetts General Hospital, Department of Surgery; Boston, Massachusetts
| | - Kyla Terhune
- Department of Surgery, Vanderbilt University Medical Center; Nashville, Tennessee
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Sinyard RD, Coe TM, Healy M, Jogerst KM, Anteby R, Moses J, Hamdi I, Gee D, Phitayakorn R, Saillant N. Gauging the effects of COVID-related changes to the medical student surgical clerkship experience: a mixed-methods study. Global Surg Educ 2022; 1:15. [PMID: 38624994 PMCID: PMC8995688 DOI: 10.1007/s44186-022-00015-2] [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] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/25/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
Purpose This study sought to understand the medical student experience on the restructured surgical clerkship during the COVID-era to provide guidance for future scenarios affecting student participation in clinical activities. Methods Medical students completing an anonymous 70-question survey at the conclusion of their surgical clerkship from June 2019 to October 2020 were divided into 2 cohorts: students completing their clerkship prior to March 2020 and after June 2020. Quantitative assessment was performed to evaluate the clerkship performance and perceptions. Resulting findings were used to construct an interview guide and conduct semi-structured interviews. Results Fifty-nine medical students rotated through the surgical clerkship prior to COVID and 23 during the COVID-era. No differences in perception of the surgical clerkship, participation in essential activities, or shelf examination scores were found. Students completing their clerkship during the COVID-era reported a lower perception of interaction and professional relationships with attending and resident surgeons (p = 0.03). Qualitatively, students completing their clerkship during the COVID-era struggled to balance clinical experiences with personal wellness and noted that building relationships with faculty was substantially more difficult. Conclusions There does not appear to be a difference in the level of participation in essential clerkship activities nor a diminished perception of learning between students completing their surgical clerkship before or during the pandemic. However, there does appear to be a difference in the relationships formed between students and attending surgeons. Altered didactic structures and apprenticeship-type rotations may help mitigate such effects. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00015-2.
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Affiliation(s)
| | - Taylor M. Coe
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Mike Healy
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | | | - Roi Anteby
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Joy Moses
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, USA
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Anteby R, Sinyard RD, Jogerst KM, McKinley SK, Coe TM, Petrusa E, Phitayakorn R, Scott DJ, Brunt LM, Gee DW. Challenges of virtual interviewing for surgical fellowships: a qualitative analysis of applicant experiences. Surg Endosc 2022; 36:3763-3771. [PMID: 34448935 PMCID: PMC8393782 DOI: 10.1007/s00464-021-08691-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The COVID-19 pandemic forced surgical fellowship programs to transition from in-person to remote applicant interviews; the virtual interviewing format presented new and unique challenges. We sought to understand applicants' perceived challenges to virtual interviewing for a surgical fellowship program. METHOD A grounded theory-based qualitative study was performed utilizing semi-structured interviews with fellowship applicants from the 2020 fellowship match. All Fellowship Council-registered applicants were eligible. We purposefully sampled participants to balance across gender, specialty-choice, and academic versus community-program affiliation. Interviews were inductively analyzed by two researchers for prominent themes. RESULTS Fifteen interviews were conducted. Participants were 60% male (n = 9), with 33% (n = 5) from non-academic institutions. They applied for the following fellowships: Advanced Gastrointestinal/Minimal Invasive (55%), Bariatric (30%), Hepatopancreatobiliary (10%) and Surgical Oncology (5%). Four main themes emerged to describe virtual interview process challenges: (1) perceived data deficiency, (2) superficial personal connections, (3) magnification of non-professionalism, and (4) logistical frustrations. Applicants recommend program directors provide more information about the fellowship prior to interview day and offer informal independent interactions with current and previous fellows. CONCLUSIONS According to fellowship applicants, virtual interviews resulted in a lack of information for rank-list decision making ultimately requiring them to rely on other information avenues to base their decisions. These applicants have offered advice to fellowship program directors and future applicants to better optimize this process.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
- School of Public Health, Harvard University, Boston, MA, USA.
| | - Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
- Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L Michael Brunt
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Anteby R, Sinyard RD, Healy MG, Warshaw AL, Hodin R, Ellison EC, Phitayakorn R. Passing the Scalpel: Lessons on retirement planning from retired academic surgeons. Am J Surg 2021; 224:166-171. [PMID: 34865735 DOI: 10.1016/j.amjsurg.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/02/2021] [Revised: 11/05/2021] [Accepted: 11/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Almost half of practicing surgeons in the United States are currently older than 55, but guidelines on how to prepare for retirement are limited. We sought to identify possible facilitators for, and obstacles to, surgeons' preparations for retirement. METHODS A qualitative study was conducted using semi-structured interviews with clinically inactive academic surgeons. Emergent themes were identified via a grounded theory approach. RESULTS We interviewed 12 surgeons (83% male; median age 75 years). Major barriers to retirement from surgery included uncertainty about when to retire, limited identity outside of surgery, and perception of retirement as strictly individual/private. Facilitators of a successful retirement identified by the participants included early career financial planning, awareness of career trajectory, development of post-surgery goals, and utilization of collective knowledge. CONCLUSION There are numerous barriers encountered by surgeons seeking to transition from clinical practice to retirement that could be overcome by dedicated departmental and institutional efforts.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; School of Public Health, Harvard University, Boston, MA, USA.
| | - Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michael G Healy
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Hodin
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - E Christopher Ellison
- Department of Surgery, The Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Sinyard RD, Gleason A, Smink DS. Peer Coaching for Surgical Development: Analysis of Attending Professional Fulfillment Scores in a Multi-institutional Coaching Program. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.275] [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: 11/16/2022]
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Etheridge JC, Castillo-Angeles M, Sinyard RD, Havens JM. Impact of Hospital Characteristics on Best Practice Adherence for Gallstone Pancreatitis: a Nationwide Analysis. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.176] [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: 11/15/2022]
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Panda N, Solsky I, Neal BJ, Hawrusik B, Lipsitz S, Lubitz CC, Gibbons C, Brindle M, Sinyard RD, Onnela JP, Cauley CE, Haynes AB. Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery: A Prospective Cohort Study. Ann Surg Open 2021; 2:e060. [PMID: 34179891 PMCID: PMC8221715 DOI: 10.1097/as9.0000000000000060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/12/2021] [Indexed: 12/30/2022] Open
Abstract
Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery. METHODS Adults undergoing cancer surgery were eligible for inclusion (2017-2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined. RESULTS Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22-0.78], P < 0.001) and physical role limitations (0.41, 95% confidence interval [0.05-0.77], P = 0.024). Patients expected better HRQL than they experienced. CONCLUSIONS Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.
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Affiliation(s)
- Nikhil Panda
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Ian Solsky
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Brandon J. Neal
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
| | - Becky Hawrusik
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
| | - Stuart Lipsitz
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
| | - Carrie C. Lubitz
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston MA
| | - Chris Gibbons
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Mary Brindle
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Robert D. Sinyard
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Jukka-Pekka Onnela
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christy E. Cauley
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Alex B. Haynes
- From the Ariadne Labs, Brigham and Women’s Hospital, Harvard. T.H. School of Public Health, Boston, MA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
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Panda N, Sinyard RD, Henrich N, Cauley CE, Hannenberg AA, Sonnay Y, Bitton A, Brindle M, Molina G. Redeployment of Health Care Workers in the COVID-19 Pandemic: A Qualitative Study of Health System Leaders' Strategies. J Patient Saf 2021; 17:256-263. [PMID: 33797460 DOI: 10.1097/pts.0000000000000847] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 01/10/2023]
Abstract
OBJECTIVES This study aimed to determine the strategies used and critical considerations among an international sample of hospital leaders when mobilizing human resources in response to the clinical demands associated with the COVID-19 pandemic surge. METHODS This was a cross-sectional, qualitative research study designed to investigate strategies used by health system leaders from around the world when mobilizing human resources in response to the global COVD-19 pandemic. Prospective interviewees were identified through nonprobability and purposive sampling methods from May to July 2020. The primary outcomes were the critical considerations, as perceived by health system leaders, when redeploying health care workers during the COVID-19 pandemic determined through thematic analysis of transcribed notes. Redeployment was defined as reassigning personnel to a different location or retraining personnel for a different task. RESULTS Nine hospital leaders from 9 hospitals in 8 health systems located in 5 countries (United States, United Kingdom, New Zealand, Singapore, and South Korea) were interviewed. Six hospitals in 5 health systems experienced a surge of critically ill patients with COVID-19, and the remaining 3 hospitals anticipated, but did not experience, a similar surge. Seven of 8 hospitals redeployed their health care workforce, and 1 had a redeployment plan in place but did not need to use it. Thematic analysis of the interview notes identified 3 themes representing effective practices and lessons learned when preparing and executing workforce redeployment: process, leadership, and communication. Critical considerations within each theme were identified. Because of the various expertise of redeployed personnel, retraining had to be customized and a decentralized flexible strategy was implemented. There were 3 concerns regarding redeployed personnel. These included the fear of becoming infected, the concern over their skills and patient safety, and concerns regarding professional loss (such as loss of education opportunities in their chosen profession). Transparency via multiple different types of communications is important to prevent the development of doubt and rumors. CONCLUSIONS Redeployment strategies should critically consider the process of redeploying and supporting the health care workforce, decentralized leadership that encourages and supports local implementation of system-wide plans, and communication that is transparent, regular, consistent, and informed by data.
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Affiliation(s)
| | | | - Natalie Henrich
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health
| | | | | | - Yves Sonnay
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health
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Kim J, Turner MC, Sun Z, Rialon KL, Sinyard RD, Schooler GR, Tracy ET, Rice HE, Adibe OO. Vascular Complications in Pediatric Port Removal. Am Surg 2017. [DOI: 10.1177/000313481708300414] [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: 11/16/2022]
Affiliation(s)
- Jina Kim
- Department of Surgery Duke University Durham, North Carolina
| | - Megan C. Turner
- Department of Surgery Duke University Durham, North Carolina
| | - Zhifei Sun
- Department of Surgery Duke University Durham, North Carolina
| | | | - Robert D. Sinyard
- Department of Surgery Duke University Medical School Durham, North Carolina
| | - Gary R. Schooler
- Division of Pediatric Radiology Duke University Durham, North Carolina
| | | | - Henry E. Rice
- Division of Pediatric Surgery Duke University Durham, North Carolina
| | - Obinna O. Adibe
- Division of Pediatric Surgery Duke University Durham, North Carolina
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Kim J, Turner MC, Sun Z, Rialon KL, Sinyard RD, Schooler GR, Tracy ET, Rice HE, Adibe OO. Vascular Complications in Pediatric Port Removal. Am Surg 2017; 83:e143-e145. [PMID: 28424122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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16
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Talbot LJ, Sinyard RD, Rialon KL, Englum BR, Tracy ET, Rice HE, Adibe OO. Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation. J Pediatr Surg 2017; 52:35-39. [PMID: 27916444 DOI: 10.1016/j.jpedsurg.2016.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Received: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Neonates after emergent enterostomy creation frequently require reversal at low weight because of complications including cholestasis, dehydration, dumping, failure to thrive, and failure to achieve enteral independence. We investigated whether stoma reversal at low weight (< 2.5kg) is associated with poor surgical outcomes. METHODS Patients who underwent enterostomy reversal from 2005 to 2013 at less than 6months old were identified in our institutional database. Only patients who underwent emergent enterostomy creation (i.e. for necrotizing enterocolitis or spontaneous perforation) were included. Demographics, disease process, comorbidities, stoma type, reversal indication, operative details, and complications were examined. Patients were categorized by weight at reversal of less than 2kg, 2.01-2.5kg, 2.51-3.5kg, and greater than 3.5kg. Data were analyzed using univariable and multivariable regression with significance level of p<0.05. The primary outcome examined was major morbidity, defined as the presence of anastomotic leak, obstruction, hernia, EC fistula, perforation, wound infection, sepsis, or death. RESULTS Eighty-nine patients met inclusion criteria. Demographics (sex, ethnicity, surgical disease process, reversal indication, and ASA score) were similar. The lowest weight group had lower gestational age (p<0.001) and birth weight (p=0.005), and contained a higher proportion of jejunostomies to ileostomies (p=0.013). On univariable analysis, only incisional hernia was significantly different as a complication between weight groups. On multivariable analysis controlling for gestational age and ASA, there was no significant difference in odds of major operative morbidity between groups. CONCLUSIONS Enterostomy reversal at lower weight may not be associated with increased risk of perioperative complications. Early stoma reversal may be acceptable when required for progression of neonatal care. LEVEL OF EVIDENCE Level III, Treatment Study (Retrospective comparative study).
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Affiliation(s)
| | - Robert D Sinyard
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kristy L Rialon
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian R Englum
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, USA
| | - Henry E Rice
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, USA
| | - Obinna O Adibe
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, USA
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Abstract
A 39-year-old Negro woman had the mesenchymal type of generalized amyloidosis and myeloma of bone. Malnutrition and heart failure dominated the clinical course and led to her death. The autopsy study is summarized in the following diagnoses.
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