Publications by authors named "H Brian Underwood"

Background: The clinical landscape of limb loss rehabilitation across Canada is poorly delineated, lacks standard rehabilitation guidelines, and is without a shared clinical database.

Objective: To address these gaps, the objective of the present study was to undertake an environmental scan of the rehabilitation centers across Canada that provide inpatient and/or outpatient services to the limb loss community.

Study Design: An environmental scan was conducted to describe the rehabilitation service structure, program services, and outcome measures of sites across Canada.

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Background: Although many parathyroid and thyroid operations are performed by nonfellowship-trained general surgeons in the United States, there is growing uncertainty of whether graduating residents can perform these procedures competently. This study investigates trends in competency and autonomy among general surgery residents performing parathyroid and thyroid operations using a national survey-based dataset.

Methods: A retrospective analysis of the Society for Improving Medical Professional Learning database was performed.

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Article Synopsis
  • - The study focused on improving surgical quality for thyroid cancer by selecting 10 specific quality indicators and identifying areas for quality improvement at the state level.
  • - A team of experts found significant gaps in care: over 34% of patients didn’t have preoperative cytology, 50% with small cancers underwent unnecessary extensive surgeries, and nearly 20% lacked follow-up and surveillance plans post-surgery.
  • - The findings suggest that implementing a dedicated quality improvement program for thyroid cancer could enhance surgical care quality and provide a model for similar initiatives in other regions.
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Background: Most thyroid and parathyroid surgeries are performed by nonfellowship trained, low-volume surgeons with associated higher complication rates. Furthermore, the average number of endocrine procedures performed by general surgery residents is decreasing. While previous studies have documented a lack of general surgery resident confidence in performing these procedures, the specific knowledge gaps in endocrine surgery remain unexplored.

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Thyroid cancer is the most common endocrine malignancy. With increasing imaging utilization, there has been an increase in the recognition of small, indolent cancers that would otherwise go undiagnosed. Historically, the surgical recommendation for all patients with thyroid cancer was a total thyroidectomy.

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