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Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CFJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg 2024; 279:429-436. [PMID: 37991182 DOI: 10.1097/sla.0000000000006159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To characterize the current state of mental health within the surgical workforce in the United States. BACKGROUND Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown. METHODS Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed. RESULTS Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months. CONCLUSIONS Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.
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Affiliation(s)
- Reagan A Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Tianna Herman
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Rebecca A Snyder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anne Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, GA
| | | | | | - Diego Vicente
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cornelia L Griggs
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Imani E McElroy
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anji E Wall
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jaber Valinejad
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Andres Alban
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - J Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Mohammad S Jalali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - G Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Erika Rangel
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Karen Donelan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie Cunningham
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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Rasic G, Morris-Wiseman LF, Ortega G, Dent D, Nfonsam V, Arora TK. Effective Mentoring Across Differences-Best Practices and Effective Models to Address the Needs of Underrepresented Trainees in Surgical Residency Programs. J Surg Educ 2023; 80:1242-1252. [PMID: 37460368 DOI: 10.1016/j.jsurg.2023.06.022] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/01/2023] [Accepted: 06/17/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Mentorship plays a critical role in the career development of surgical trainees and faculty. As the surgical workforce continues to diversify, mentoring trainees who differ) race, ethnicity, country of origin, socioeconomic status, educational background, religion, gender, sexual orientation or ability) can pose challenges to the experience for both mentor and mentee. OBJECTIVE The aim of this manuscript is to introduce surgical educators to the systemic barriers faced by trainees and to models of effective mentorship. METHODS At the 2022 APDS Meeting, a panel convened to highlight the current challenges of mentoring across differences and effective models for surgical educators. This paper highlights and expands the summary of this panel. RESULTS Examples of novel mentoring models are described. CONCLUSIONS Acknowledgment of barriers, Implementation of deliberate mentoring strategies, and collaboration with national surgical organizations and surgery departments and faculty may help to reduce physician attrition.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Lilah F Morris-Wiseman
- Division of Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gezzer Ortega
- Department of Surgery, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel Dent
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | | | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, Georgia.
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Rasic G, Arora TK. The abusive learning landscape of medical students: Perception of poor patient outcomes and lack of reporting: Invited commentary to "survey of student mistreatment experienced during the core clinical clerkships". Am J Surg 2023:S0002-9610(23)00083-1. [PMID: 36914529 DOI: 10.1016/j.amjsurg.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023]
Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA, United States
| | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, GA, United States.
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Morris-Wiseman LF, Dent D, Nfonsam VN, Arora TK. Leadership Diversity in the Association of Program Directors in Surgery: A Report of Progress. J Surg Educ 2022; 79:e109-e115. [PMID: 36216769 DOI: 10.1016/j.jsurg.2022.08.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/23/2022] [Accepted: 08/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Across the last several years, numerous surgical departments and societies have focused on addressing the lack of diversity, equity, and inclusion (DEI) in the field. Since the Association of Program Directors in Surgery (APDS) Diversity and Inclusion Taskforce was created in 2017 (and solidified as a formal committee in 2018, herein referred to as the APDS-DIC), it has sought to address gaps in diversity at various phases of training and development from medical student to surgical leader. OBJECTIVE In follow-up to a 2018 study that benchmarked leadership demographics of the APDS, this study analyzed how the APDS' efforts have aligned with recommended DEI strategies and whether this produced demographic changes in organizational leadership. METHODS Fifteen years (2008-2022) of publicly available APDS annual meeting program data and APDS membership lists were analyzed. Leadership positions in the organization were examined by officer, program/vice chair, executive committee, and board of directors. A 2-tailed T-test compared differences in the average proportion of leaders from specific demographic groups before and after the APDS-DIC inception (2008-2016 vs. 2017-2022). RESULTS APDS has 724 unique faculty and 140 resident members. The majority of both groups identified as White (68% of faculty and 58% of residents). Over 15 years, there have been 307 available leadership positions held by 67 individuals. All presidents and president-elect positions have been held by White surgeons; nearly 80% have been men. The average proportion of female leaders and the average proportion of racial/ethnic minority leaders were both significantly higher after implementation of the APDS-DIC in 2017 (p=0.0009 for gender and p=0.036 for racial/ethnic minorities). CONCLUSIONS The APDS' commitment to DEI efforts and establishment of the APDS-DIC in 2017 was associated with a significant increase in women and non-White minorities in organizational leadership positions. The specific role of the APDS-DIC in propelling surgeons from underrepresented groups into leadership and promoting key DEI efforts is broadly applicable to other surgical organizations.
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Affiliation(s)
| | - Daniel Dent
- University of Texas Health San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, Texas
| | | | - Tania K Arora
- The Medical College of Georgia at Augusta University, Augusta, Georgia.
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Ruiz TL, Sellers B, Devarakonda A, Wehrle CJ, Arora TK. A Novel Mock Oral Curriculum for Senior Surgery Residents: Results of a Pilot Study. J Surg Res 2022; 277:92-99. [DOI: 10.1016/j.jss.2022.03.027] [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: 08/02/2021] [Revised: 02/20/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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Joshi A, Abdelsattar J, Castro-Varela A, Wehrle CJ, Cullen C, Pei K, Arora TK, Dechert TA, Kauffmann R. Incorporating mass casualty incidents training in surgical education program. Global Surg Educ 2022; 1:17. [PMID: 38625271 PMCID: PMC9009279 DOI: 10.1007/s44186-022-00018-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/02/2022] [Accepted: 04/02/2022] [Indexed: 12/21/2022]
Affiliation(s)
- Anip Joshi
- Chief Consultant Surgeon and Associate Professor of Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - Jad Abdelsattar
- University of Southern California Keck School of Medicine, Los Angeles, USA
| | | | | | - Christian Cullen
- Medical College of Georgia at Augusta University, Augusta, GA USA
| | - Kevin Pei
- Department of Surgery, Division of Robotic Surgery and Trauma and Acute Care Surgery, Parkview Health, Fort Wayne, IN USA
| | - Tania K. Arora
- Associate Professor of Surgery, Augusta University Medical Center, Augusta, USA
| | - Tracey A. Dechert
- Associate Professor of Surgery, Boston University School of Medicine, Boston, USA
| | - Rondi Kauffmann
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN USA
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Abstract
Importance Social determinants of health have been shown to be key drivers of disparities in access to surgical care and surgical outcomes. Though the concept of social responsibility has received growing attention in the medical field, little has been published contextualizing social responsibility in surgery. In this narrative review, we define social responsibility as it relates to surgery, explore the duty of surgeons to society, and provide examples of social factors associated with adverse surgical outcomes and how they can be mitigated. Observations The concept of social responsibility in surgery has deep roots in medical codes of ethics and evolved alongside changing views on human rights and the role of social factors in disease. The ethical duty of surgeons to society is based on the ethical principles of benevolence and justice and is grounded within the framework of the social contract. Surgeons have a responsibility to understand how factors such as patient demographics, the social environment, clinician awareness, and the health care system are associated with inequitable patient outcomes. Through education, we can empower surgeons to advocate for their patients, address the causes and consequences of surgical disparities, and incorporate social responsibility into their daily practice. Conclusions and Relevance One of the greatest challenges in the field of surgery is ensuring that surgical care is provided in an equitable and sustainable way. Surgeons have a duty to understand the factors that lead to health care disparities and use their knowledge, skills, and privileged position to address these issues at the individual and societal level.
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Affiliation(s)
- Megan Janeway
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Spencer Wilson
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sabrina E Sanchez
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Tania K Arora
- Augusta University at the Medical College of Georgia, Augusta
| | - Tracey Dechert
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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Cox JS, Wehrle CJ, Mejias C, Devarakonda AK, McKenzie JA, Arora TK. General Surgery Twitter during COVID-19: Tweets, Trends, and Implications for Recruitment Strategies. Am Surg 2021:31348211060414. [PMID: 34937400 DOI: 10.1177/00031348211060414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted traditional resident recruitment practices, requiring virtual interviews and new forms of outreach. Social media, such as Twitter, is one tool programs can use to connect with applicants. This study sought to assess changes in Twitter use during the COVID-19 pandemic among general surgery programs. METHODS Twitter and residency program websites were queried for public Twitter accounts related to general surgery residency programs. Publicly available tweets for available accounts were reviewed for all posts for the period March 15, 2019-November 25, 2020. Thematic analysis of each tweet was performed, and engagement was determined by likes and retweets on each tweet. RESULTS The number of programs with active Twitter accounts increased after the onset of COVID-19 pandemic, as did the number of tweets, likes-, and retweets-per-tweet. There was a significant increase in the number of tweets regarding resident promotion, program promotion, and virtual event promotion. Tweets received more likes-per-tweet if the subject was program promotion and resident promotion than tweets regarding virtual events. All results were statistically significant (P < .05). DISCUSSION Twitter use and engagement with residency programs have increased significantly since pandemic onset. Engagement is highest for tweets regarding program and resident promotion as measured by likes-per-tweet and highest for program promotion and virtual events as measured by retweets-per-tweet. Given the nearly nationwide increase in Twitter engagement after pandemic onset, programs should consider the impact of Twitter as a means of communication with applicants and program branding.
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Affiliation(s)
- James Shell Cox
- 1421Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Chase J Wehrle
- 1421Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | | | | | - Tania K Arora
- Department of Surgical Oncology, 1421Medical College of Georgia at Augusta University, Augusta GA, USA
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Rosenkranz KM, Arora TK, Termuhlen PM, Stain SC, Misra S, Dent D, Nfonsam V. Diversity, Equity and Inclusion in Medicine: Why It Matters and How do We Achieve It? J Surg Educ 2021; 78:1058-1065. [PMID: 33279427 DOI: 10.1016/j.jsurg.2020.11.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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: 09/19/2020] [Revised: 11/04/2020] [Accepted: 11/21/2020] [Indexed: 06/12/2023]
Abstract
Diversifying the medical work force is critical to reducing health care disparity and improving patient outcomes. This manuscript offers a comprehensive review of best practices to improve both the recruitment and the retention of underrepresented minorities in training programs and beyond.
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Affiliation(s)
- Kari M Rosenkranz
- Dartmouth Hitchcock Medical Center, Department of Surgery, Lebanon, New Hampshire.
| | - Tania K Arora
- Medical College of Georgia, Department of Surgery, Augusta, Georgia
| | - Paula M Termuhlen
- University of Minnesota Medical School, Department of Surgery, Duluth, Minnesota
| | - Steven C Stain
- Albany Medical Center, Department of Surgery, Albany, New York
| | - Subhasis Misra
- Brandon Regional Hospital, Brandon Surgical Specialists, Brandon, Florida
| | - Daniel Dent
- UT Health San Antonio, Department of Surgery, San Antonia, Texas
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Affiliation(s)
- Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta
| | - Caprice C Greenberg
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta.,Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison
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Wehrle CJ, Lee SW, Devarakonda AK, Arora TK. Patient and Physician Attitudes Toward Telemedicine in Cancer Clinics Following the COVID-19 Pandemic. JCO Clin Cancer Inform 2021; 5:394-400. [PMID: 33822651 DOI: 10.1200/cci.20.00183] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE COVID-19 has infected more than 94 million people worldwide and caused more than 2 million deaths. Patients with cancer are at significantly increased risk compared with the general population. Telemedicine represents a common strategy to prevent viral spread. We sought to evaluate patient with cancer and physician perceptions of telemedicine during the COVID-19 pandemic. METHODS A 16-question survey was e-mailed to 1,843 active e-mails of patients presenting to one of the six cancer clinics at a comprehensive cancer care center from January 1, 2020, to June 1, 2020. A six-question survey was e-mailed to attending physicians of those clinics. Specialties included Medical Oncology, Hematology-Oncology, Surgical Oncology, Urological Oncology, and Gynecologic Oncology. RESULTS Three hundred seventy-four patients (20.3%) and 14 physicians (66.7%) responded. Most (68.2%) currently prefer in-person visits, and 80.4% prefer in-person visits following pandemic resolution. More than half (52.2%) of patients preferring virtual visits do so because of convenience. Most (63.1%) patients with cancer are comfortable with a complete physical examination. Surgical patients are more likely to prefer a complete examination (P = .0476). Physicians prefer in-person visits (64.2%) and believe that virtual visits maybe or probably do not provide comparable care (64.2%). 71.4% believe that virtual visits help prevent the spread of infectious disease. CONCLUSION Given preferences for in-person visits, cancer care teams should be prepared to continue providing in-person visits for many of their patients. The discrepancy between patient and provider concern for spread of infectious disease represents an area where patients may benefit from increased education. Providers should feel comfortable performing physical examinations at their own discretion.
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Affiliation(s)
- Chase J Wehrle
- Medical College of Georgia, Augusta University, Augusta, GA
| | - Sang W Lee
- Medical College of Georgia, Augusta University, Augusta, GA
| | | | - Tania K Arora
- Medical College of Georgia, Augusta University, Augusta, GA
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Wehrle CJ, Walker M, Worthey A, Jones CE, Lewis F, Arora TK. Barriers to Accurate Fluid Measurement in Perioperative Patients: A Mixed Methods Approach. J Surg Res 2020; 260:95-103. [PMID: 33333385 DOI: 10.1016/j.jss.2020.11.073] [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: 07/07/2020] [Revised: 11/07/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgeons depend on fluid intake and output (I/O) measurements for assessment of resuscitation and fluid balance during the perioperative period. Frequently, these measurements are taken by Registered Nurses (RNs) and/or Patient Care Technicians (PCTs). There is variability in the accuracy and consistency of these measurements across nursing units. The goal of this study is to establish what barriers exist in obtaining accurate fluid measurements and potential solutions. MATERIALS AND METHODS A mixed-method, sequential study design was utilized. First, a survey was conducted at a tertiary care institution of 8 nonintensive care nursing units assessing the perceptions of RNs (n = 85) and PCTs (n = 38) regarding fluid intake and output measurements for surgical patients. Four focus groups were then conducted to expand upon the results of the survey. Fourteen participants (10 RNs and 4 PCTs) were interviewed, and transcripts were analyzed by three reviewers. Qualitative data were manually coded by reviewers using a hierarchical methodology. RESULTS Survey response rate was 40.6%. The strongest barriers in the survey were patient load and staff time limitations. About half (49%) of the respondents acknowledged that fluid measurements were inaccurate half of the time. PCTs spend more time collecting and charting I/Os and have higher patient loads (P < 0.001) than RNs. PCTs noted more difficulty with complex patients (P = 0.017) and devices for outputs (P = 0.004). PCT's (94%) handwrite data prior to electronic entry. One-third of nurses reported direct electronic entry (P < 0.001). Overall, 71% would prefer to chart in patient's rooms. Most (80%) of respondents received <5 h of fluids-related training at the time they were hired. Cronbach's alpha for three focus group reviewers was 0.84 (95% CI 0.693-0.923). Themes included understaffing, lack of training, a high percentage of traveling nurses, and poor communication regarding new orders. Recommended solutions to improve I/Os included in-room kiosks for electronic entry and relief of staffing burdens. CONCLUSIONS Fluid I/O measurement accuracy and efficiency may be improved by increased staffing, educational programs, and computer access, streamlining of order sets, simplicity of EMR data entry, and a standardized process for measuring, recording, and charting I/Os.
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Affiliation(s)
- Chase J Wehrle
- Medical College of Georgia at Augusta University, Department of Surgery, Augusta, Georgia.
| | - Morgan Walker
- Medical College of Georgia at Augusta University, Department of Surgery, Augusta, Georgia
| | - Ayana Worthey
- Medical College of Georgia at Augusta University, Department of Surgery, Augusta, Georgia
| | - Caitlin E Jones
- Medical College of Georgia at Augusta University, Department of Surgery, Augusta, Georgia
| | - Frank Lewis
- Medical College of Georgia at Augusta University, Department of Surgery, Augusta, Georgia
| | - Tania K Arora
- Medical College of Georgia at Augusta University, Department of Surgery, Augusta, Georgia
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Driesen AMDS, Romero Arenas MA, Arora TK, Tang A, Nfonsam VN, O'Grady CL, Riall TS, Morris-Wiseman LF. Do General Surgery Residency Program Websites Feature Diversity? J Surg Educ 2020; 77:e110-e115. [PMID: 32600889 DOI: 10.1016/j.jsurg.2020.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/08/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study assesses ways in which General Surgery residency program websites demonstrate diversity. DESIGN Literature review and diversity expert opinion informed selection of diversity elements. We limited our evaluation to residency program-specific webpages. We identified 8 program website elements that demonstrate programmatic commitment to diversity: (1) standard nondiscrimination statement; (2) program-specific diversity and inclusion message; (3) community demographics; (4) personalized biographies of faculty, (5) personalized biographies of residents; (6) individual photographs of faculty; (7) individual photographs of residents; and (8) list of additional resources available for trainees. We evaluated the impact of program type (university, independent, or military); city population; region; program director gender and ethnicity; and program size on incorporation of these eight elements. We dichotomized programs that had ≥4 of these elements on their website and determined association with the above factors using chi-square or Fisher's exact test. SETTING Website review July to December 2019. PARTICIPANTS All nonmilitary-based general surgery residency program members of the Association of Program Directors in Surgery (APDS) (n = 242/251). RESULTS General Surgery residency program websites included a mean of 2.7 ± 1.5 elements that showcase diversity. Most program websites (n = 215, 89%) featured ≤4 elements (range 1-4), while 15 (6.2%) had none. When stratified by programs having 4 or more elements on their website, university-based program (p < 0.001) was the only factor associated. Resident photos (n = 147, 61%), resources available to trainees (n = 146, 60%), faculty photos (n = 139, 57%), and community demographics (n = 93, 38%) were the most common of the 8 website elements. CONCLUSIONS Residency program websites are vital to recruiting applicants. Featuring specific elements on the General Surgery residency website that display a program's commitment to diversity and inclusion may be important in attracting a diverse candidate pool. This research highlights opportunities programs may use to demonstrate more effectively a residency program's commitment to diversity and inclusion.
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Affiliation(s)
| | - Minerva A Romero Arenas
- Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas
| | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, Georgia
| | - Andrew Tang
- Department of Surgery, University of Arizona, Tucson, Tucson, Arizona
| | | | | | - Taylor S Riall
- Department of Surgery, University of Arizona, Tucson, Tucson, Arizona
| | - Lilah F Morris-Wiseman
- Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas.
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Arora TK, Dent D, Morris-Wiseman L, Nfonsam V. Diversity in the Last Decade of the Association of Program Directors in Surgery: A Descriptive Analysis of Leadership and Future Directions. J Surg Educ 2019; 76:e125-e131. [PMID: 31495745 DOI: 10.1016/j.jsurg.2019.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/22/2019] [Revised: 07/03/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The Association of Program Directors in Surgery Diversity and Inclusion Taskforce (APDS-DIT) was created in 2017 after the Executive Committee recognized low diversity in its membership. The DIT was charged to address gaps in diversity and inclusion at various phases of training and development from medical student to surgical leader. The aim of this study was to examine APDS demographics and determine the status of inclusion of women, racial and ethnic minorities, and nonuniversity surgeons. DESIGN Eleven years (2008-2018) of APDS annual-meeting programs, web directory, 2018-membership lists, and 2017-AAMC data were analyzed. Leadership positions were examined by officer (program chair/vice chair, executive committee, and board of directors. Internet searches identified gender, race, and institutional affiliation. Representative members to other organizations, resident liaisons, and historian members were excluded. APDS "Member," "Associate," and "Resident" lists and AAMC data were divided by gender. RESULTS Fifty-one individuals fulfilled 223 leadership positions over 11 years; 13 (25%) were women and 5 (10%) were non-Caucasian. Since 2013, the percentage of nonuniversity surgeons in APDS leadership has declined while, over the last 2 years, the percentage of women and ethnic/racial minority has increased. In 2018, the percentage of women in leadership (38%) was higher than the percentage of women in membership (combined total of program directors and associate program directors [26%]) and nonuniversity-affiliated surgeons comprised 35% of the APDS membership but only 14% of leadership roles. CONCLUSIONS Over the last 11 years, representation of women, non-Caucasians, and nonuniversity surgeons has been at or less than 1/3 of their counterparts. As an organization that is tasked with creating future generations of the surgical workforce, it is imperative to recognize an under-representation of those members with diverse backgrounds that would add to the creative growth of the organization. The creation of the APDS-DIT emphasizes the organization's commitment to diversity and inclusion and an effort to create a pipeline of diverse leaders in the APDS and surgical training in general.
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Affiliation(s)
- Tania K Arora
- Section of Surgical Oncology, Medical College of Georgia at Augusta University, Augusta, Georgia.
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Fisher BW, Fluck M, Young K, Shabahang M, Blansfield J, Arora TK. Urgent Surgery for Gastric Adenocarcinoma: A Study of the National Cancer Database. J Surg Res 2019; 245:619-628. [PMID: 31522035 DOI: 10.1016/j.jss.2019.07.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 03/04/2019] [Revised: 07/13/2019] [Accepted: 07/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gastric adenocarcinoma is a leading cause of cancer death worldwide and, in the United States, can present emergently with upper GI hemorrhage, obstruction, or perforation. No large studies have examined how urgent surgery affects patient outcomes. This study examines the outcomes of urgent versus elective surgery for gastric cancer. MATERIALS AND METHODS Patients with gastric adenocarcinoma from the National Cancer Database from 2004 to 2015 were examined retrospectively. Patients with metastatic disease or incomplete data were excluded. Urgent surgery was defined as definitive surgery within 3 d of diagnosis. Univariate and multivariate analysis of patient factors, surgical outcomes, and oncologic data was performed. P-values <0.05 were statistically significant. RESULTS Of 26,116 total patients, 2964 had urgent surgery and 23,468 had elective surgery. Urgent surgery patients were significantly older, were female, were nonwhite, had higher pathologic stage, and were treated at a low-volume center. Urgent surgery was associated with decreased quality lymph node harvest (odds ratio [OR] 0.68 95% confidence interval {CI} [0.62, 0.74]), increased positive surgical margin (OR 1.48, 95% CI [1.32, 1.65]), increased 30-d mortality (OR 1.38, 95% CI [1.16, 1.65]), increased 90-d mortality (OR 1.30, 95% CI [1.14, 1.49]), and decreased overall survival (hazard ratio 1.21, 95% CI [1.15, 1.27]). CONCLUSIONS Urgent surgery for gastric cancer is associated with significantly worse outcomes than elective surgery. Stable patients requiring urgent surgical resection for gastric cancer may benefit from referral to a high-volume center for resection by an experienced surgeon. Patients undergoing urgent resection for gastric cancer should be referred to surgical and medical oncologists to ensure they receive appropriate adjuvant therapy and surveillance.
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Affiliation(s)
- Benjamin W Fisher
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Marcus Fluck
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Katelyn Young
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Mohsen Shabahang
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Joseph Blansfield
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Tania K Arora
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
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16
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Jayanathan M, Erwin RP, Molacek N, Fluck M, Hunsinger M, Wild J, Arora TK, Shabahang MM, Franko J, Blansfield JA. MAGIC versus MacDonald treatment regimens for gastric cancer: Trends and predictors of multimodal therapy for gastric cancer using the National Cancer Database. Am J Surg 2019; 219:129-135. [PMID: 31262435 DOI: 10.1016/j.amjsurg.2019.06.005] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/24/2019] [Accepted: 06/05/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multimodal therapy is beneficial in gastric cancer, however this practice is not universal. This study examines trends, identifies associative factors, and examines overall survival (OS) benefit from multimodal therapy in gastric cancer. METHODS Gastric cancer patients staged IB-III from 2005 to 2014, identified using the National Cancer Database, were categorized by treatment: surgery alone, perioperative chemotherapy, and adjuvant chemoradiation. Groups were analyzed to identify associative factors of perioperative therapy. RESULTS We examined 9243 patients, with the majority receiving multimodal therapy (57%). The proportion of those receiving perioperative chemotherapy rose dramatically from 7.5% in 2006 to 46% in 2013. Academic center treatment was strongly associated with perioperative over adjuvant therapy (p < 0.0001). An OS advantage was clearly seen in those receiving multimodal therapy versus surgery alone (p < 0.0001), with no difference between perioperative and adjuvant therapies. CONCLUSIONS Treatment of gastric cancer with multimodal therapy has risen significantly since 2005, largely due to increasing use of perioperative chemotherapy. As perioperative therapy becomes more prevalent, more patients will have the opportunity for the improved survival benefit of multimodal therapy.
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Affiliation(s)
- Mark Jayanathan
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States.
| | - Ryan P Erwin
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Nicholas Molacek
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Marcus Fluck
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Marie Hunsinger
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Jeffrey Wild
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Tania K Arora
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Mohsen M Shabahang
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Jan Franko
- Mercy Medical Center, Section of Surgical Oncology, Des Moines, IA, 50314, United States
| | - Joseph A Blansfield
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
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Dudash MJ, Slipak S, Dove J, Hunsinger M, Wild J, Shabahang M, Arora TK, Blansfield JA. Lymph Node Harvest as a Measure of Quality and Effect on Overall Survival in Esophageal Cancer: A National Cancer Database Assessment. Am Surg 2019; 85:201-205. [PMID: 30819299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Surgical therapy for esophageal cancer is the cornerstone of treatment, and the highest quality operation should lead to the highest cure rate. Evaluated lymph node (ELN) count is one quality measure that has been championed. The objective of this study was to explore ELN in esophagectomy, examine predictors of harvesting ≥12 nodes, and determine whether higher ELN improves overall survival (OS). ELN was examined in patients with resected esophageal cancer using the National Cancer Database from 2004 to 2013. In this study, 41,746 patients met the inclusion criteria. Fifty-two per cent of patients had 12 or more nodes harvested. Academic programs were most likely to harvest ≥12 nodes (58% of cases) compared with other programs (43-56% of cases). Seventy per cent of cases with ≥12 nodes harvested were performed at high-volume centers. Preoperative radiation or preoperative chemoradiation led to lower ELN (46% and 48%) versus preoperative chemotherapy alone (66%). Multivariate analysis showed that patients who had ≥12 nodes removed had better OS (Hazard Ratio 0.843 [95 confidence interval 0.820-0.867]). In addition, care at a high-volume facility, care at an academic facility, private insurance, and income ≥$63,000 were all associated with improved OS. Higher ELN count is associated with OS in patients with esophageal cancer. Patients who receive care at high-volume centers and academic centers are more likely to undergo more extensive lymphadenectomy. All centers should strive to examine at least 12 nodes to provide a quality esophagectomy.
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18
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Dudash MJ, Slipak S, Dove J, Hunsinger M, Wild J, Shabahang M, Arora TK, Blansfield JA. Lymph Node Harvest as a Measure of Quality and Effect on Overall Survival in Esophageal Cancer: A National Cancer Database Assessment. Am Surg 2019. [DOI: 10.1177/000313481908500229] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Surgical therapy for esophageal cancer is the cornerstone of treatment, and the highest quality operation should lead to the highest cure rate. Evaluated lymph node (ELN) count is one quality measure that has been championed. The objective of this study was to explore ELN in esophagectomy, examine predictors of harvesting ≥12 nodes, and determine whether higher ELN improves overall survival (OS). ELN was examined in patients with resected esophageal cancer using the National Cancer Database from 2004 to 2013. In this study, 41,746 patients met the inclusion criteria. Fifty-two per cent of patients had 12 or more nodes harvested. Academic programs were most likely to harvest ≥12 nodes (58% of cases) compared with other programs (43–56% of cases). Seventy per cent of cases with ≥12 nodes harvested were performed at high-volume centers. Preoperative radiation or preoperative chemoradiation led to lower ELN (46% and 48%) versus preoperative chemotherapy alone (66%). Multivariate analysis showed that patients who had ≥12 nodes removed had better OS (Hazard Ratio 0.843 [95 confidence interval 0.820–0.867]). In addition, care at a high-volume facility, care at an academic facility, private insurance, and income ≥$63,000 were all associated with improved OS. Higher ELN count is associated with OS in patients with esophageal cancer. Patients who receive care at high-volume centers and academic centers are more likely to undergo more extensive lymphadenectomy. All centers should strive to examine at least 12 nodes to provide a quality esophagectomy.
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Affiliation(s)
- Mark J. Dudash
- From the Geisinger Medical Center, Danville, Pennsylvania
| | - Sasha Slipak
- From the Geisinger Medical Center, Danville, Pennsylvania
| | - James Dove
- From the Geisinger Medical Center, Danville, Pennsylvania
| | | | - Jeffrey Wild
- From the Geisinger Medical Center, Danville, Pennsylvania
| | | | - Tania K. Arora
- From the Geisinger Medical Center, Danville, Pennsylvania
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Hashmi A, Kozick Z, Fluck M, Hunsinger MA, Wild J, Arora TK, Shabahang MM, Blansfield JA. Neoadjuvant versus Adjuvant Chemotherapy for Resectable Pancreatic Adenocarcinoma: A National Cancer Database Analysis. Am Surg 2018; 84:1439-1445. [PMID: 30268172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is controversy regarding the role of neoadjuvant versus adjuvant chemotherapy for pancreatic cancer (PAC). Neoadjuvant therapy has been touted as a method to improve survival in PAC patients. This study's objective is to investigate predictors and potential benefits of neoadjuvant therapy in resectable PAC patients. The National Cancer Data Base was used to retrospectively analyze stage I and II surgically resected PAC patients receiving adjuvant or neoadjuvant therapy from 2004 to 2012. A total of 12,983 patients were identified. A significant increase in the rate of neoadjuvant therapy was observed over time with 5 per cent receiving neoadjuvant therapy in 2004 versus 17 per cent in 2012 (P < 0.0001). Multivariate analysis showed that patients were more likely to receive neoadjuvant therapy if they were treated at an academic facility. Private insurance was associated with higher odds of neoadjuvant chemotherapy (P < 0.0001). Pathological outcomes were improved in neoadjuvant patients compared with adjuvant patients on multivariate analysis with neoadjuvant patients having higher rates of negative surgical margins (OR: 1.273, 95% Confidence interval: 1.099-1.474) and negative lymph nodes (OR: 2.852, 95% Confidence interval: 2.547-3.194). Pathological outcomes are improved after neoadjuvant therapy compared with adjuvant therapy, with more patients achieving negative margins and negative lymph nodes. Prospective studies are needed to compare these two treatment modalities in a head to head comparison.
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Hashmi A, Kozick Z, Fluck M, Hunsinger MA, Wild J, Arora TK, Shabahang MM, Blansfield JA. Neoadjuvant versus Adjuvant Chemotherapy for Resectable Pancreatic Adenocarcinoma: A National Cancer Database Analysis. Am Surg 2018. [DOI: 10.1177/000313481808400946] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is controversy regarding the role of neoadjuvant versus adjuvant chemotherapy for pancreatic cancer (PAC). Neoadjuvant therapy has been touted as a method to improve survival in PAC patients. This study's objective is to investigate predictors and potential benefits of neoadjuvant therapy in resectable PAC patients. The National Cancer Data Base was used to retrospectively analyze stage I and II surgically resected PAC patients receiving adjuvant or neoadjuvant therapy from 2004 to 2012. A total of 12,983 patients were identified. A significant increase in the rate of neoadjuvant therapy was observed over time with 5 per cent receiving neoadjuvant therapy in 2004 versus 17 per cent in 2012 (P < 0.0001). Multivariate analysis showed that patients were more likely to receive neoadjuvant therapy if they were treated at an academic facility. Private insurance was associated with higher odds of neoadjuvant chemotherapy (P < 0.0001). Pathological outcomes were improved in neoadjuvant patients compared with adjuvant patients on multivariate analysis with neoadjuvant patients having higher rates of negative surgical margins (OR: 1.273, 95% Confidence interval: 1.099–1.474) and negative lymph nodes (OR: 2.852, 95% Confidence interval: 2.547–3.194). Pathological outcomes are improved after neoadjuvant therapy compared with adjuvant therapy, with more patients achieving negative margins and negative lymph nodes. Prospective studies are needed to compare these two treatment modalities in a head to head comparison.
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Affiliation(s)
- Ammar Hashmi
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Zachary Kozick
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Marcus Fluck
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Marie A. Hunsinger
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey Wild
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Tania K. Arora
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Mohsen M. Shabahang
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Joseph A. Blansfield
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
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21
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Dudash M, Slipak S, Dove JT, Hunsinger MA, Arora TK, Wild JL, Shabahang M, Blansfield JA. Lymph Node Harvest as a Measure of Quality and Effect on Overall Survival in Esophageal Cancer: A National Cancer Database Assessment. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.442] [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: 10/18/2022]
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22
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Iqbal N, Dove J, Hunsinger M, Petrick AT, Friscia ME, Facktor MA, Arora TK, Blansfield JA, Shabahang MM. Esophagectomy: Comparison of Short-Term Outcomes between Single-versus Two-Team Approach. Am Surg 2016; 82:846-852. [PMID: 27670575] [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: 06/06/2023]
Abstract
Literature about combining expertise of two specialties in esophageal cancer surgery is limited. We present the experience at a single institute comparing single-team (ST) versus two-team (TT) approach combining thoracic and abdominal surgeons. This is a retrospective study from a single tertiary care center. Data were collected from electronic medical records. Patients undergoing esophagectomy for esophageal cancer from November 2006 until August 2014 were included. The primary outcome measured was 30-day postoperative morbidity, secondary outcomes measured were operative time, intraoperative blood loss, and 30-day mortality. Results are reported as mean with an interquartile range. Forty-nine patients underwent esophagectomy by an ST and 51 patients by TT. Patient demographics, tumor characteristics, stage, pathology, and use of neoadjuvant therapy were comparable between groups. Charlson comorbidity index was significantly higher in TT group [3 (2, 4) vs 2 (2, 3), P = 0.02]. The TT group had a significantly shorter operative time compared to the ST group [304 (252,376) minutes vs 438 (375, 494] minutes, P < 0.0001). Intraoperative blood loss was 300 (200, 550) mL for the TT group and 250 (200,400) mL for the ST group (P = 0.29). There was no difference in 30-day postoperative morbidity (68.6% for TT, 59.2% for ST, P = 0.32) and mortality (2% each, P = 1) between the two groups. In conclusion, the operative time by the TT approach was significantly shorter than the ST approach with comparable postoperative morbidity and mortality. Long-term follow-up is needed to study this approach's effect on long-term survival.
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Affiliation(s)
- Naureen Iqbal
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
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23
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Iqbal N, Dove J, Hunsinger M, Petrick AT, Friscia ME, Facktor MA, Arora TK, Blansfield JA, Shabahang MM. Esophagectomy: Comparison of Short-Term Outcomes between Single-versus Two-Team Approach. Am Surg 2016. [DOI: 10.1177/000313481608200949] [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: 11/15/2022]
Abstract
Literature about combining expertise of two specialties in esophageal cancer surgery is limited. We present the experience at a single institute comparing single-team (ST) versus two-team (TT) approach combining thoracic and abdominal surgeons. This is a retrospective study from a single tertiary care center. Data were collected from electronic medical records. Patients undergoing esophagectomy for esophageal cancer from November 2006 until August 2014 were included. The primary outcome measured was 30-day postoperative morbidity, secondary outcomes measured were operative time, intraoperative blood loss, and 30-day mortality. Results are reported as mean with an interquartile range. Forty-nine patients underwent esophagectomy by an ST and 51 patients by TT. Patient demographics, tumor characteristics, stage, pathology, and use of neoadjuvant therapy were comparable between groups. Charlson comorbidity index was significantly higher in TT group [3 (2, 4) vs 2 (2, 3), P = 0.02]. The TT group had a significantly shorter operative time compared to the ST group [304 (252,376) minutes vs 438 (375, 494] minutes, P < 0.0001). Intraoperative blood loss was 300 (200, 550) mL for the TT group and 250 (200,400) mL for the ST group ( P = 0.29). There was no difference in 30-day postoperative morbidity (68.6% for TT, 59.2% for ST, P = 0.32) and mortality (2% each, P = 1) between the two groups. In conclusion, the operative time by the TT approach was significantly shorter than the ST approach with comparable postoperative morbidity and mortality. Long-term follow-up is needed to study this approach's effect on long-term survival.
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Affiliation(s)
- Naureen Iqbal
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - James Dove
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Marie Hunsinger
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Anthony T. Petrick
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Michael E. Friscia
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Matthew A. Facktor
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Tania K. Arora
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Mohsen M. Shabahang
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Allard-Picou A, Dove JT, Arora TK, Shabahang M, Blansfield JA. Prognostic Indicators in Thick Melanoma: A Review of the National Cancer Database. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.346] [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: 10/23/2022]
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Arora TK, Bear HD. Noninvasive Breast Cancer. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_3] [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: 11/29/2022]
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Arora TK, Terracina KP, Soong J, Idowu MO, Takabe K. Primary and secondary angiosarcoma of the breast. Gland Surg 2014; 3:28-34. [PMID: 25083491 DOI: 10.3978/j.issn.2227-684x.2013.12.03] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/19/2013] [Indexed: 01/31/2023]
Abstract
Angiosarcoma is a rare soft tissue tumor of the breast. It occurs in both a primary form without a known precursor, and a secondary form that has been associated to a history of irradiated breast tissue. These forms differ in many ways including median age, precipitating factors, and presentation. Both forms have a malignant behavior and a poor prognosis. The endeavor of this paper is to review what is known about the presentation, diagnostic and therapeutic modalities to date.
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Affiliation(s)
- Tania K Arora
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Krista P Terracina
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - John Soong
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Michael O Idowu
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Kazuaki Takabe
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
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Abstract
OBJECTIVE The goals of this study are to define the demographics of program directors (PDs), characterize professional responsibilities and scholarly activities, assess career goals and perceptions, and determine what resources PDs have and how they use them. METHODS A cross-sectional, confidential, Institutional Review Board (IRB)-approved, Internet-based survey was sent to general surgery PDs. PDs were identified from lists of known residencies from the Association of Program Directors in Surgery (APDS) and the Accreditation Council for Graduate Medical Education (ACGME). E-mail follow-up was used to contact nonresponders and partial responders. Demographic data were analyzed with descriptive statistics. RESULTS The response rate was 58%. The mean age was 51.3 +/- 8.2 years. Most respondents were male (89.7%), Caucasian (86.9%), and fellowship trained (63.7%). Few PDs have teaching credentials (11%), but most PDs have sought additional training in teaching (63%). PDs work a total of 73 hours per week. They spend about 41 hours per week on clinical duties and about 22 hours per week on program director duties. PDs have an average of 4-5 support staff members; 81.5% of PDs have an assistant program director (APD). A few PDs have formal protected time (38.7%). Most PDs feel they have support for professional development and feel supported by their chairperson (90.8% and 94.1%, respectively). Lower job satisfaction scores were observed in measures of feeling valued by colleagues and in the availability of institutional resources. CONCLUSION Most surgery PDs are fellowship trained, are currently conducting research, have an APD in their program, and feel supported by their chairperson. Most PDs do not have protected time, and some feel insufficient institutional resources are available for their responsibilities.
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Affiliation(s)
- Tania K Arora
- Department of Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia 23219, USA.
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Eagleson CA, Gingrich MB, Pastor CL, Arora TK, Burt CM, Evans WS, Marshall JC. Polycystic ovarian syndrome: evidence that flutamide restores sensitivity of the gonadotropin-releasing hormone pulse generator to inhibition by estradiol and progesterone. J Clin Endocrinol Metab 2000; 85:4047-52. [PMID: 11095431 DOI: 10.1210/jcem.85.11.6992] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is a complex disorder with multiple abnormalities, including hyperandrogenism, ovulatory dysfunction, and altered gonadotropin secretion. The majority of patients have elevated LH levels in plasma and a persistent rapid frequency of LH (GnRH) pulse secretion, the mechanisms of which are unclear. Earlier work has suggested that the sensitivity of the GnRH pulse generator to inhibition by ovarian steroids is impaired. We performed a study to determine whether antiandrogen therapy with flutamide could enhance feedback inhibition by estradiol (E2) and progesterone (P) in women with PCOS. Ten anovulatory women with PCOS and nine normal controls (days 8-10 of the cycle) were studied on three occasions. During each admission, LH and FSH were determined every 10 min and E2, P, and testosterone (T) every 2 h for 13 h. After 12 h, GnRH (25 ng/kg) was given iv. After the first admission, patients were started on flutamide (250 mg twice daily), which was continued for the entire study. The second admission occurred on days 8-10 of the next menstrual cycle for normal controls and on study day 28 for PCOS patients. Subjects were then given E2 transdermally (mean plasma E2, 106+/-18 pg/mL) and P by vaginal suppository to obtain varied plasma concentrations of P (mean P, 4.4+/-0.5 ng/mL; range, 0.6-9.0 ng/mL), and a third study was performed 7 days later. At baseline women with PCOS had higher LH pulse amplitude, response to GnRH, T, androstenedione, and insulin and lower sex hormone-binding globulin concentrations (P < 0.05). Most hormonal parameters were not altered by 4 weeks of flutamide, except T in controls and E2 and FSH in PCOS patients, which were lower. Of note, flutamide alone had no effect on LH pulse frequency or amplitude, mean plasma LH, or LH responsiveness to exogenous GnRH. After the addition of E2 and P for 7 days, both PCOS patients and normal controls had similar reductions in LH pulse frequency (4.0+/-0.7 and 5.8+/-0.7 pulses/12 h, respectively). This contrasts with our earlier results in the absence of flutamide, where a plasma P level of less than 10 ng/mL had minimal effects on LH pulse frequency in women with PCOS, but was effective in controls. These results suggest that although the elevated LH pulse frequency in PCOS may in part reflect impaired sensitivity to E2 and P, continuing actions of hyperandrogenemia are important for sustaining the abnormal hypothalamic sensitivity to feedback inhibition by ovarian steroids.
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Affiliation(s)
- C A Eagleson
- Division of Endocrinology and the Center for Research in Reproduction, University of Virginia, Charlottesville 22908, USA
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