Effectiveness of a Dedicated Rural General Surgery Residency Track: A 13-Year Analysis of the First ACGME Designated Rural Track.

Background: The shortage of general surgeons in rural America is well documented. The North Dakota community-based general surgery residency program initiated a unique approach to training for rural practice through a dedicated rural track. The rural track included 9 months of rotations in specialty rotations beneficial for rural practice.

Post-surgical acute care utilization and cost of care among cancer survivors with an ostomy: Findings from three large hospital systems in the United States.

Purpose: To describe patterns of 6-month total cost of care and acute care utilization among cancer survivors who received ostomy surgeries in 3 large hospital systems in the United States between 2018 and 2022 and to identify reasons for acute care utilization.

Methods: A retrospective cohort study using electronic medical records and the corresponding hospital revenue data obtained from 3 geographically diverse hospital systems in the United States was performed. 6-month all-cause post-surgical encounters subsequent to respective ostomy surgery dates were included.

Age-related dysregulation of intestinal epithelium fucosylation is linked to an increased risk of colon cancer.

Colon cancer affects people of all ages. However, its frequency, as well as the related morbidity and mortality, are high among older adults. The complex physiological changes in the aging gut substantially limit the development of cancer therapies.

Improved outcomes for borderline resectable adenocarcinoma of the pancreas after neoadjuvant chemotherapy in a community cancer center.

Background: Borderline resectable adenocarcinoma of the pancreas involves the major vascular structures adjacent to the pancreas and has traditionally led to poor resection rates and survival. Newer chemotherapy regimens have demonstrated improved response and resection rates. We performed a retrospective review of borderline resectable pancreatic cancers who presented to a community cancer program to determine the effect of neoadjuvant chemotherapy to improve resection rates and overall survival.

How to Prepare for the American Board of Surgery In-Training Examination (ABSITE): A Systematic Review.

Introduction: Performance on ABSITE is an important factor when monitoring resident progress. It predicts future performance and has lasting effects. Understanding the highest-yield preparation strategies can help residents in their study efforts and optimize performance.

Current Trends in Surgical Procedures Performed in Rural General Surgery Practice.

Background: The procedures that rural general surgeons perform may be changing. It is important to recognize the trends and practices of the current rural general surgeon in efforts to better prepare general surgeons who desire to enter a practice in a rural environment. The aim of this review is to detail the recent operative case volumes of 6 rural locations in the upper Midwest where general surgery is practiced.

Implementation of a standardized approach to borderline resectable pancreatic cancer in a multisite community oncology program.

Background: Treatment paradigms for borderline resectable pancreatic cancer are evolving with increasing use of neoadjuvant chemotherapy and neoadjuvant chemoradiation. Variations in the definition of borderline resectable pancreatic cancer and neoadjuvant approaches have made standardizing care for borderline resectable pancreatic cancer difficult. We report an effort to standardize management of borderline resectable pancreatic cancer throughout Sanford Health, a large community oncology network.

Advanced Technology and the Rural Surgeon.

Advanced technology has resulted in major changes in surgery and medicine over the past three decades. There are many barriers to the adoption of advanced technologies, which can be more prevalent in rural hospitals and surgical practices. Despite barriers to implementation of new technologies in rural communities, many rural hospitals have endorsed and invested in these technologies for the benefit of the hospital and community.

Multi-institutional study of self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.

Purpose: Correlation exists between people who engage in academic dishonesty as students and unethical behavior once in practice. Previously, we assessed the attitudes of general surgery residents and ethical practices in test taking at a single institution. Most residents had not participated in activities they felt were unethical, yet what constituted unethical behavior was unclear.

Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents' case logs from 2000 to 2011.

Introduction: Since the introduction of laparoscopic surgery for cholecystectomy in 1989, the growth of minimally invasive surgery (MIS) has increased significantly in the United States. There is a growing concern that the pendulum has now shifted too far toward MIS and that current general surgery residents' exposure to open abdominal procedures is lacking.

Objective: We sought to analyze trends in open vs MIS intra-abdominal procedures performed by residents graduating from US general surgery residency programs over the past twelve years.

Effect of alcohol on surgical dexterity after a night of moderate alcohol intake.

Background: Alcohol misuse is commonplace among health professionals. The effects of alcohol on cognition and dexterity have been shown up to 14 hours after alcohol intake. The aerospace industry has restrictions on alcohol intake, and there is pressure for the health care industry to do the same.

Current use and surgical efficacy of laparoscopic colectomy in colon cancer.

Background: The Clinical Outcomes in Surgical Therapy trial demonstrated that laparoscopic colectomy (LC) was equivalent to open colectomy (OC) for 30-day mortality, time to recurrence, and overall survival in colon cancer (CC) patients. Current use of LC for CC is not well known.

Study Design: Surgical data were reviewed for all patients randomized into a national phase III clinical trial for adjuvant therapy in stage III CC (North Central Cancer Treatment Group trial N0147).

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

Background: Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training.

Serum Müllerian inhibiting substance levels are lower in premenopausal women with breast precancer and cancer.

Background: In preclinical studies, müllerian inhibiting substance (MIS) has a protective affect against breast cancer. Our objective was to determine whether serum MIS concentrations were associated with cancerous or precancerous lesions. Blood from 30 premenopausal women was collected and serum extracted prior to their undergoing breast biopsy to assess a suspicious lesion found on imaging or physical examination.

Is the Accreditation Council for Graduate Medical Education (ACGME) Resident/Fellow survey, a valid tool to assess general surgery residency programs compliance with work hours regulations?

The Accreditation Council for Graduate Medical Education (ACGME) uses the resident/fellow survey to assess residency programs compliance with ACGME work hours regulations. Survey results can have significant consequences for residency programs including ACGME letters of warning, shortened program accreditation cycle, immediate full program and institutional site visits, or administrative withdrawal of a program's accreditation. Survey validity was assessed by direct query of general surgery residents who answer the survey each year.

General surgery residents' views on work hours regulations.

Objective: Since 2003, compliance with Accreditation Council on Graduate Medical Education (ACGME) work hours regulations has been required for United States residency training programs. Further work hours restrictions have been proposed by the Institute of Medicine (IOM). This study examines General Surgery residents' views of current work hours restrictions and proposed changes by the IOM.

A comprehensive analysis of surgical procedures in rural surgery practices.

Background: Data regarding the practice patterns of surgeons are derived from indirect information and may not reflect practice patterns in rural surgery. The aim of this study was to analyze all procedures performed by rural surgeons in North Dakota and South Dakota in 2006.

Methods: All surgeons in the Dakotas were identified by state American College of Surgeons databases.

Metastasectomy and surgical resection of the primary tumor in patients with stage IV breast cancer: time for a second look?

Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation.

Outcomes of surgical and radiologic placed implantable central venous access ports.

Background: Recent literature suggests implantable central venous access ports (ICVAPs) can be placed by interventional radiologists with fewer complications and lower expenses when compared with surgeons. An analysis of outcomes and expenses of ICVAP placement by service was conducted.

Methods: Three hundred sixty-eight ICVAPs were placed over 3 years at a 230-bed community teaching hospital.

Preoperative performance status predicts outcome following heated intraperitoneal chemotherapy.

Background: Peritoneal carcinomatosis has a typical natural history of bowel obstruction and death. Significant evidence suggests that cytoreduction with heated intraperitoneal chemotherapy (HIPEC) improves long-term survival for these tumors.

Methods: A retrospective case series of patients who underwent initial HIPEC treatment was performed at 2 moderate-volume centers.