Treatment of Gastric Cancer Carcinomatosis.

Patients with gastric cancer peritoneal metastases (GCPM) have Stage IV disease. Systemic therapy is a crucial aspect of their care. Patients with GCPM should have their tumors tested for HER2 and PD-L1 expression and microsatellite instability for potential targeted therapies.

Perioperative Support in the Rural Surgery World.

Perioperative support in a rural surgical environment encompasses unique challenges but ultimately should not substantially differ from those in resource-rich, urban hospitals. Perioperative support can be divided into 5 different phases of care, each with their own resource needs and challenges. These phases include (1) preoperative phase, (2) immediate preoperative phase, (3) intraoperative phase, (4) postoperative phase, and (5) postdischarge phase.

Perforated appendicitis among rural and urban patients: implications of access to care.

Objective: To determine whether rural patients are more likely to present with perforated appendicitis compared with urban patients.

Background: Appendiceal perforation has been associated with increased morbidity, length of hospital stay, and overall health care costs. Recent arguments suggest that high rates of appendiceal rupture may be unrelated to the quality of hospital care, and rather associated with inadequate access to surgical care.

The impact of laparoscopy on the volume of open cases in general surgery training.

Objective: The purpose of this study was to evaluate the impact of laparoscopy on the volume of open cases in general surgery residency training over the past 10 years.

Design: The Accreditation Council for Graduate Medical Education (ACGME) database (1999-2008), which records all cases (by Current Procedural Terminology code) performed by graduating general surgery trainees, was retrospectively analyzed.

Setting: ACGME database (1999-2008).

General surgery contributes to the financial health of rural hospitals and communities.

Rural hospitals and communities often profit from the ability to provide surgical services. There can also be substantial financial costs for individuals, hospitals, and communities associated with not having access to surgical care in rural areas. Despite these advantages, limitations that include a shortage of rural general surgeons and other surgical staff and financial constraints prevent some rural institutions from offering surgical services.

Rural surgery: framing the issues.

Many rural residents have limited access to surgical care. Although this problem has been ongoing for the past few decades, several factors threaten to exacerbate the situation. The narrowing of general surgery practice, workforce shortages and inappropriate distribution of surgeons, changes in how surgeons are trained, and increasing health care costs contribute to the problem.

Are general surgery residency programs likely to prepare future rural surgeons?

Background: Too few surgeons practice in small rural areas of the United States. Many newly graduating surgeons choose not to practice rurally because they feel unprepared for rural practice. Family medicine residencies have a track record of placing graduates in rural settings.

Use of locum tenens surgeons to provide surgical care in small rural hospitals.

Background: Too few general surgeons practice in rural American communities, and many hospitals in the smallest rural areas do not have a surgeon. Therefore, it is likely that some small rural hospitals are using alternative arrangements to provide surgical care, including hiring locum tenens surgeons. We describe the degree to which small rural hospitals are using locum tenens surgeons to provide surgical services.

How does degree of rurality impact the provision of surgical services at rural hospitals?

Context: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services.

Operative choledochoscopic laser lithotripsy for impacted intrahepatic gallstones: a novel surgical approach.

Introduction: Occasionally patients present with hepatic duct stones or impacted common bile duct stones that either fail or are not amenable to endoscopic retrograde cholangiopancreatography (ERCP) extraction. More troublesome are patients with prior surgeries resulting in altered anatomy that makes traditional endoscopic extraction of ductal stones very difficult. We present a novel approach to these ductal stones using a combination of surgery, biliary endoscopy, and laser lithotripsy.

General surgery at rural hospitals: a national survey of rural hospital administrators.

Background: Many rural residents have limited access to surgical care. Rural hospitals frequently struggle to provide surgical services due to workforce shortages and financial constraints. The purpose of this study is to describe rural hospital administrators' perceptions regarding the state of their general surgery programs and the impact that providing surgical services has on their hospitals' financial viability.

A multicentre controlled study of the InLine radiofrequency ablation device for liver transection.

Background: Surgical resection is the most effective therapy for liver cancer. Intraoperative blood loss during liver resection remains a major concern due to association with higher postoperative complications. The InLine radiofrequency ablation device (ILRFA) has achieved promising results in liver surgery with minimal blood loss and no increase of postoperative complications.

Trends in adoption of laparoscopic cholecystectomy in rural versus urban hospitals.

Background: For many general surgeons, the professional isolation of rural practice serves as an obstacle to the adoption of new techniques. Whether this obstacle impeded the dissemination of laparoscopy in rural settings is not known.

Study Design: We performed a retrospective, descriptive comparison of the adoption rate of laparoscopic cholecystectomy in small rural versus urban hospitals in the US using the Nationwide Inpatient Sample from 1988 to 1997.

Rural versus non-rural differences in surgeon performed endoscopy: results of a national survey.

The ongoing decline in the number of general surgeons practicing in rural areas of the United States is concerning. Existing data show that rural surgeons perform a broad spectrum of cases including procedures that are not considered to be in the repertoire of most general surgeons. In particular, rural surgeons seem to be performing a sizeable number of endoscopic procedures.

Starting a general surgery program at a small rural critical access hospital: a case study from southeastern Oregon.

Context: Surgical services are frequently unavailable in rural American communities. Therefore, rural residents often must travel long distances to receive surgical care. Rural hospitals commonly have difficulty providing surgical services despite potential economic benefits.

Rural versus urban inpatient case-mix differences in the US.

Background: Preparation of surgeons for practice in rural settings is hindered by limited knowledge of case-mix differences between rural and nonrural surgical practices. Although surgical practice in isolated rural areas is believed to be very different from urban practice, little is known about actual inpatient case-mix differences.

Study Design: We performed a retrospective, descriptive comparison of inpatient general surgical procedures performed at rural versus urban hospitals in the US using the Nationwide Inpatient Sample database (2000 to 2001).

Is a broadly based surgical residency program more likely to place graduates in rural practice?

Background: There is a shortage of general surgeons practicing in rural America. Rural surgical practices differ from those in urban settings encompassing a broader case mix with a larger percentage of time spent performing abdominal, alimentary, gynecological, genitourinary, and orthopedic procedures. Present graduates of many general surgical residencies do not obtain the range of experience necessary to practice effectively in this environment.

Small rural hospitals and high-risk operations: how would regionalization affect surgical volume and hospital revenue?

Background: Because higher hospital procedure volume is associated with better outcomes for many high-risk procedures, regionalization to higher-volume hospitals has been proposed as a way to improve quality of surgical care. The potential impact of such policies on small rural hospital volume and revenue is unknown.

Study Design: We identified all hospitalizations in small rural hospitals (less than 50 beds) in New York State from 1998 to 2001 that included an ICD-9 procedure code for 1 of 9 procedures for which there is a documented volume-outcomes association: abdominal aortic aneurysm repair, aortic-valve replacement, carotid endarterectomy, colectomy, coronary artery bypass, cystectomy, esophagectomy, pancreatectomy, or pulmonary resection.

General surgery programs in small rural New York State hospitals: a pilot survey of hospital administrators.

Context: Hospitals play a central role in small rural communities and are frequently one of the major contributors to the local economy. Surgical services often account for a substantial proportion of hospital revenues. The current shortage of general surgeons practicing in rural communities may further threaten the financial viability of rural hospitals and communities.

Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements.

Background: The purpose of this study is to determine the differences between rural and urban surgeons with regard to practice patterns, factors in choosing a practice location, and educational needs.

Study Design: A list of surgeons obtained from the American Medical Association was examined using the Office of Management and Budget definition of rural. Seventeen hundred rural surgeons were mailed surveys; 421 responded.

The pineal gland hormone melatonin improves survival in a rat model of sepsis/shock induced by zymosan A.

Background: Melatonin has demonstrated protective effects in severe sepsis/shock in the animal model. Zymosan A causes inflammation and shock leading to death in rats. We hypothesized that daily afternoon melatonin administration would improve rat survival after an intraperitoneal (IP) zymosan injection.