Test-specific funnel plots for healthcare provider profiling leveraging individual- and summary-level information.

In addition to applications in meta-analysis, funnel plots have emerged as an effective graphical tool for visualizing the detection of health care providers with unusual performance. Although there already exist a variety of approaches to producing funnel plots in the literature of provider profiling, limited attention has been paid to elucidating the critical relationship between funnel plots and hypothesis testing. Within the framework of generalized linear models, here we establish methodological guidelines for creating funnel plots specific to the statistical tests of interest.

Association of Prophylaxis and Length of Stay With Venous Thromboembolism in Abdominopelvic Surgery.

Introduction: Extended venous thromboembolism prophylaxis (eVTEp) is recommended for select patients who have undergone major abdominopelvic surgery to prevent postdischarge venous thromboembolism (pdVTE). Criteria for selection of these patients are untested for this purpose and may be ineffective. To address this gap, we investigated the effectiveness of eVTEp on pdVTE rates.

D-Day to December 1944: The odyssey of the third auxiliary surgical group in World War II.

As a Major in the US Army Medical Corps, Darrell A. Campbell, MD, led Team 13 of the Third Auxiliary Surgical Group in Europe in World War II. The team began work on June 7, 1944, in a clearing station tent near the beach at Normandy.

Histologic progression of acne inversa/hidradenitis suppurativa: Implications for future investigations and therapeutic intervention.

Since first recognized in 1839, the pathogenesis of acne inversa (AI) has undergone repeated revisions. Although there is agreement that AI involves occlusion of hair follicles with subsequent inflammation and the formation of tracts, the histologic progression of this disease still requires refinement. The objective of this study was to examine the histologic progression of AI based on the examination of a large cohort of punch biopsies and excisional samples that were examined first by hematoxylin and eosin staining.

Contribution of plasma cells and B cells to hidradenitis suppurativa pathogenesis.

Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease characterized by chronic abscess formation and development of multiple draining sinus tracts in the groin, axillae, and perineum. Using proteomic and transcriptomic approaches, we characterized the inflammatory responses in HS in depth, revealing immune responses centered on IFN-γ, IL-36, and TNF, with lesser contribution from IL-17A. We further identified B cells and plasma cells, with associated increases in immunoglobulin production and complement activation, as pivotal players in HS pathogenesis, with Bruton's tyrosine kinase (BTK) and spleen tyrosine kinase (SYK) pathway activation as a central signal transduction network in HS.

Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients.

Background: The surgical treatment of pilonidal disease is highly variable. The present study examines the long-term results in over 500 patients treated by minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings.

Methods: Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed.

35-Year Experience with Surgical Treatment of Hidradenitis Suppurativa.

Background: Hidradenitis suppurativa is a painful and disfiguring chronic inflammatory condition affecting both men and women. Medical treatments, such as antibiotics and immunosuppressive agents, are often ineffective. Over time, patients can suffer from recurrent abscesses, chronic purulent drainage, scarring, and contractures that can only be corrected by surgical excision.

Colovaginal Fistulas: Presentation, Evaluation, and Management.

Objective: The objective of this study was to review a single institution's experience with colovaginal fistulas to provide guidance toward identification and management of this problem.

Methods: Patients with colovaginal fistulas treated by 2 senior surgeons between January 1, 1990, and June 31, 2011, were identified. A retrospective chart review was then performed to determine presenting characteristics and history, evaluation for the fistulas, and treatment outcomes.

Safety and long-term outcomes of percutaneous endoscopic gastrostomy in patients with head and neck cancer.

Background: Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support during treatment in patients with head and neck cancer, but long-term nutritional outcomes have not been reported in detail. The purpose of this study was to determine short- and long-term outcomes and success in meeting nutritional goals in patients with head and neck cancer who had PEGs placed over an 18-year period.

Methods: Medical records of all patients who had PEG procedures performed by one of the authors (REB) from 1997 through 2010 were reviewed.

Vulvar varicosities mimicking a hernia: case report.

Objective: Vulvar varicosities are not uncommon in pregnancy, but there are only a few published reports of symptomatic vulvar varicosities in nonpregnant women.

Case: We report 2 cases of women presenting with symptomatic vulvar masses that were more prominent after exercise or with elevated intra-abdominal pressure. Symptoms included an intermittent vulvar bulge or mass and moderate pain when the masses were present.

Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer.

Background: Prophylactic central lymph node dissection with total thyroidectomy (TT) for the treatment of papillary thyroid cancer (PTC) is controversial because of the possibility of increased morbidity with uncertain benefit. The purpose of this study is to determine whether prophylactic central neck dissection provides any advantages over TT alone.

Methods: Retrospective cohort study of patients with PTC without preoperative evidence of lymph node involvement undergoing either TT or TT with bilateral central lymph node dissection (TT + BCLND).

An international perspective on ultrasound training and use for thyroid and parathyroid disease.

Background: Use of ultrasound (USN) by endocrine surgeons has dramatically increased. Presently, optimal training and certification requirements have not been standardized at any level (resident/fellow/attending). We sought to define the types of USN training endocrine surgeons receive and how USN is employed in practice.

Propofol decreases early postoperative nausea and vomiting in patients undergoing thyroid and parathyroid operations.

Background: As the practice of parathyroid and thyroid surgery shifts toward short stay and outpatient treatment, the occurrence and management of postoperative nausea and vomiting (PONV) increases in importance due to its potential to delay discharge. PONV also may contribute negatively to the patient's experience and thus their level of satisfaction. The purpose of this study was to determine whether anesthetic technique based on propofol decreases the incidence of PONV and, consequently, improves patient satisfaction with their care.

Age- and sex-related incidence of surgically treated primary hyperparathyroidism.

Background: Primary hyperparathyroidism (1 degrees HPT) is reported most often in women over the age of 50. Beyond that, little is known about the epidemiology of this condition, and no studies have specifically examined the age and gender distribution of patients with 1 degrees HPT.

Methods: We analyzed patients from the Nationwide Inpatient Sample (NIS), a 20% random sample of all hospital stays from 2000-2004, and also from the University of Michigan endocrine surgery database from 1999-2005.

Interpretation of intraoperative parathyroid hormone monitoring in patients with baseline parathyroid hormone levels of <100 pg/mL.

Background: Common guidelines for intraoperative parathyroid hormone (IOPTH) interpretation are based on clearly elevated baseline parathyroid hormone (PTH) values. We hypothesize that patients with low-baseline levels (<100 pg/mL) have a higher incidence of multigland disease (MGD) and display differences in PTH kinetics compared with patients with high-baseline levels.

Methods: We retrospectively reviewed the cases of 1151 patients with primary hyperparathyroidism who underwent parathyroidectomy with IOPTH monitoring.

The impact of primary hyperparathyroidism on the oral cavity.

Context: Primary hyperparathyroidism (HPT) is a systemic disease causing bone loss. Periodontal disease is a local inflammatory disease characterized by alveolar bone loss. The older literature records that HPT is associated with loss of radicular lamina dura and brown tumors of the bone, but contemporary studies are lacking.

The influence of sample site on intraoperative PTH monitoring during parathyroidectomy.

Background: Intraoperative parathyroid hormone (IOPTH) monitoring is common during parathyroidectomy. We hypothesized that sample site (peripheral vs central vein) may impact IOPTH interpretation.

Methods: Two hundred and one patients underwent curative parathyroidectomy for single-gland disease.

Comparison of spinal vs general anesthesia via laryngeal mask airway in inguinal hernia repair.

Hypothesis: The use of laryngeal mask airway and propofol in inguinal hernia repair results in shorter operative and recovery room times.

Design: Randomized control trial.

Setting: University hospital.