Adolescent Hyperparathyroidism: An Updated Contemporary Surgical Experience at a Tertiary Center.

Introduction: Primary hyperparathyroidism (pHPT) in children is uncommon, resulting in a paucity of data describing the disease process in this population. Herein, in an effort to bridge the information gap, we review our experience with pHPT in adolescent patients under 20 y of age at a specialized tertiary referral center.

Methods: A retrospective chart review included all adolescent patients with pHPT, who underwent surgery at our institution between 2004 and 2023.

When Fulfilling a Professional Obligation Causes Moral Distress: A New Evaluative Approach.

Purpose: The term 'moral distress' was coined by Andrew Jameton to name the anguish that clinicians feel when they cannot pursue what they judge to be right because of institutional constraints. We argue that moral distress in critical care should also be addressed as a function of the constraints of ethics and propose an evaluative approach to the experience considering its implications for professional identity.

Method: We build on a selective review of the literature and analyze a paradigmatic example of moral distress, namely, clinicians who feel compelled to perform procedures on patients that seem futile.

Complexities of autonomy in military medical ethics: A brief report.

The first Fallen Surgeons Military Educational Symposium was convened in conjunction with the the American Association for the Surgery of Trauma (AAST) 23 meeting, under the guidance of the AAST Military Liaison Committee. The daylong session included a 1.5-hour segment on military medical ethics in combat and its unique challenges.

Psychiatric Diagnoses Are Associated With Postoperative Disparities in Patients Undergoing Major Colorectal Operations.

Background: Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited.

Methods: We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures.

Clinician Moral Distress: Toward an Ethics of Agent-Regret.

Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain unclear. Clinicians speak of their moral distress in terms of guilt, regret, anger, or other distressing emotions, and they often invoke them interchangeably.

Professional Identity Formation in Medical Education: Some Virtue-Based Insights.

: In 2010, the Carnegie Foundation published a call to reorient medical education in terms of the formation of identities rather than mere competencies, and the medical education literature on professional identity formation (PIF) has since grown rapidly. As medical learners navigate a hectic clinical learning environment fraught with challenges to professionalism and ethics, they must simultaneously orient their skills, behaviors, and evolving sense of professional identity. The medical education literature on PIF describes the psychosocial dimensions of that identity formation well.

Developing a longitudinal database of surgical skills performance for practicing surgeons: A formal feasibility and acceptance inquiry.

Background: We explored the feasibility and surgeons' perceptions of the utility of a longitudinal skills performance database.

Methods: A 10-station surgical skills assessment center was established at a national scientific meeting. Skills assessment volunteers (n = 189) completed a survey including opinions on practicing surgeons' skills evaluation, ethics, and interest in a longitudinal database.

Ethical Considerations in Vaccine Allocation.

In an effort to establish a consensus position on the ethical principles and ideals that should guide vaccine allocation during the Covid-19 pandemic, various organizations, including the Centers for Disease Control (CDC) and National Academies of Science, Engineering, and Medicine, released sample allocation frameworks to help guide government entities charged with distributing vaccine doses. One area of agreement among these reports is that front line health care workers, especially those who come into regular contact with Covid-19 patients, ought to be afforded highest priority. But this convergence, though significant, raises questions concerning the ethics of vaccine distribution those highest-priority health care workers: If a hospital has inadequate supply to vaccinate its entire workforce, which of its essential workers should it prioritize? In this paper, we begin with a general overview of ethical questions of vaccine administration before narrowing our focus to some of the most pressing theoretical and practical issues hospital officials must face in building justifiable and actionable frameworks for vaccinating their workers.

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.

Background: The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies.

Objective: To characterize the development of ventilator triage policies and compare policy content.

Quality of life in thyroid cancer-assessment of physician perceptions.

Background: Thyroid cancer is the fastest growing malignancy in the United States. Previous studies have shown a decrease in quality of life (QoL) after the treatment of thyroid cancer. To date, there have been no studies assessing physician perceptions regarding how a diagnosis of thyroid cancer affects QoL.

A Tale of Two Cancers: Traveling to Treat Pancreatic and Thyroid Cancer.

Background: Patients diagnosed with a malignancy must decide whether to travel for care at an academic center or receive treatment at a nearby hospital. Here we examine differences in demographics, treatment, and outcomes of those traveling to academic centers for their care vs those not traveling, as well as compare travel for an aggressive vs indolent malignancy.

Study Design: All patients with papillary thyroid carcinoma (PTC) or pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection and in the National Cancer Database were examined.

Ultrasonic, bipolar, and integrated energy devices: comparing heat spread in collateral tissues.

Background: Integrated devices incorporating ultrasonic and bipolar technology have been used in laparoscopic surgery, however, are not yet incorporated into open operations. Here, we compare thermal spread and recurrent laryngeal nerve (RLN) functional data of the integrated THUNDERBEAT Open Fine Jaw device, the bipolar Ligasure Small Jaw, and the ultrasonic Harmonic Focus for open thyroidectomy.

Materials And Methods: The three energy devices were compared in a live porcine model using three tissue types including liver, muscle, and thyroid.

Normohormonal primary hyperparathyroidism is a distinct form of primary hyperparathyroidism.

Background: Normohormonal primary hyperparathyroidism presents diagnostic and intraoperative challenges, and current literature is conflicting about management. We aim to better define normohormonal primary hyperparathyroidism in order to improve the care for these patients.

Methods: In the study, 516 consecutive patients undergoing parathyroidectomy for primary hyperparathyroidism were divided into 2 groups: classic primary hyperparathyroidism (classic primary hyperparathyroidism, increased serum levels of calcium, and parathyroid hormone) and normohormonal primary hyperparathyroidism (hypercalcemia, normal serum levels of parathyroid hormone).

Incidence, Risk Factors, and Clinical Outcomes of Incidental Parathyroidectomy During Thyroid Surgery.

Background: The reported rate of incidental parathyroidectomy (IP) during thyroid surgery is between 5.2 and 21.6 %.

Rates of secondary hyperparathyroidism after bypass operation for super-morbid obesity: An overlooked phenomenon.

Background: With over 110,000 bariatric operations performed in the United States annually, it is important to understand the biochemical abnormalities causing endocrine dysfunction associated with these procedures. Here we compare 2 malabsorptive procedures, duodenal switch and Roux-en-Y gastric bypass, to determine the role malabsorption plays in secondary hyperparathyroidism in this population.

Methods: Data from all super-obese patients undergoing duodenal switch or Roux-en-Y gastric bypass between August 2002 and October 2005 were prospectively collected.

Quality of Life in Thyroid Cancer is Similar to That of Other Cancers with Worse Survival.

Background: The incidence of thyroid cancer is increasing. As such, the number of survivors is rising, and it has been shown that their quality of life (QOL) is worse than expected. Using results from the North American Thyroid Cancer Survivorship Study (NATCSS), a large-scale survivorship study, we aim to compare the QOL of thyroid cancer survivors to the QOL of survivors of other types of cancer.

Mild primary hyperparathyroidism: a literature review.

The biochemical profile of classic primary hyperparathyroidism (pHPT) consists of both elevated calcium and parathyroid hormone levels. The standard of care is parathyroidectomy unless prohibited by medical comorbidities. Because more patients are undergoing routine bone density evaluation and neck imaging studies for other purposes, there is a subset of people identified with a biochemically mild form of the pHPT that expresses itself as either elevated calcium or parathyroid hormone levels.