A comparative analysis of video-based surgical assessment: is evaluation of the entire critical portion of the operation necessary?

Background: Previous studies of video-based operative assessments using crowd sourcing have established the efficacy of non-expert evaluations. Our group sought to establish the equivalence of abbreviating video content for operative assessment.

Methods: A single institution video repository of six core general surgery operations was submitted for evaluation.

Thresholds and Mortality Associations of Paraspinous Muscle Sarcopenia in Older Trauma Patients.

This cohort study examines the correlation between paraspinous sarcopenia at the T12 level and threshold and the association with long-term outcomes in older trauma patients.

Comparison of costs and short-term clinical outcomes of per-oral endoscopic myotomy and laparoscopic Heller myotomy.

Objective: Per-Oral Endoscopic Myotomy (POEM) has seen increasing application and comparisons to laparoscopic Heller myotomy (LHM). The aim of the present study was to compare perioperative and short-term outcomes, and costs between the two procedures at a single institution.

Methods: Fifty-one consecutive patients documented in a prospective IRB approved database from January 2014 to December 2017 were included.

Association of Brain Atrophy and Masseter Sarcopenia With 1-Year Mortality in Older Trauma Patients.

Importance: Older adults are disproportionately affected by trauma and accounted for 47% of trauma fatalities in 2016. In many populations and disease processes, described risk factors for poor clinical outcomes include sarcopenia and brain atrophy, but these remain to be fully characterized in older trauma patients. Sarcopenia and brain atrophy may be opportunistically evaluated via head computed tomography, which is often performed during the initial trauma evaluation.

Sublobar Resection in the Treatment of Peripheral Typical Carcinoid Tumors of the Lung.

Background: The role of sublobar resection in the treatment of pulmonary typical carcinoids is controversial. This study aims to compare long-term outcomes between sublobar and lobar resections in patients with peripheral typical carcinoid.

Methods: We retrospectively compared consecutive patients who underwent curative sublobar resection with patients who underwent lobectomy for cT1-3 N0 M0 peripheral pulmonary typical carcinoid in eight centers between 2000 and 2015.

Frailty assessment: from clinical to radiological tools.

Frailty is a syndrome of cumulative decline across multiple physiological systems, which predisposes vulnerable adults to adverse events. Assessing vulnerable patients can potentially lead to interventions that improve surgical outcomes. Anaesthesiologists who care for older patients can identify frailty to improve preoperative risk stratification and subsequent perioperative planning.

Trauma Providers' Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs.

Objectives: Quality improvement in geriatric trauma depends on timely identification of frailty, yet little is known about providers' knowledge and beliefs about frailty assessment. This study sought to understand trauma providers' understanding, beliefs, and practices for frailty assessment.

Methods: We developed a 20-question survey using the Health Belief Model of health behavior and surveyed physicians, advanced practice providers, and trainees on the trauma services at a single institution that does not use formal frailty screening of all injured seniors.

Large Cell Neuroendocrine Tumor Size >3 cm Negatively Impacts Long-Term Outcomes After R0 Resection.

Background: Minimal knowledge exists regarding the outcome, prognosis and optimal treatment strategy for patients with pulmonary large cell neuroendocrine carcinomas (LCNEC) due to their rarity. We aimed to identify factors affecting survival and recurrence after resection to inform current treatment strategies.

Methods: We retrospectively reviewed 72 patients who had undergone a curative resection for LCNEC in 8 centers between 2000 and 2015.

Functional Recovery After Lung Resection: A Before and After Prospective Cohort Study of Activity.

Background: Postoperative recovery is an important measure in thoracic operations. Personal activity monitors can be used to track progress in the preoperative and postoperative settings. This study investigates associations of preoperative activity, lung resection extent, and operative approach with inpatient and outpatient functional recovery as measured by activity monitors.

Enucleation, Vaporization, and Resection: How To Choose the Best Surgical Treatment Option for a Patient with Male Lower Urinary Tract Symptoms.

Transurethral resection of the prostate remains the reference technique for patients with a prostate <100ml. Endoscopic enucleation is a safe and effective alternative, while photoselective vaporization of the prostate appears to be the treatment of choice for patients on anticoagulation medication.

Does mesenteric venous imaging assessment accurately predict pathologic invasion in localized pancreatic ductal adenocarcinoma?

Background: Accurate prediction of mesenteric venous involvement in pancreatic ductal adenocarcinoma (PDAC) is necessary for adequate staging and treatment.

Methods: A retrospective cohort study was conducted in PDAC patients at a single institution. All patients with resected PDAC and staging CT and EUS between 2003 and 2014 were included and sub-divided into "upfront resected" and "neoadjuvant chemotherapy (NAC)" groups.

Comparison of bedside screening methods for frailty assessment in older adult trauma patients in the emergency department.

Background: Frailty is linked to poor outcomes in older patients. We prospectively compared the utility of the picture-based Clinical Frailty Scale (CFS9), clinical assessments, and ultrasound muscle measurements against the reference FRAIL scale in older adult trauma patients in the emergency department (ED).

Methods: We recruited a convenience sample of adults 65 yrs.

Resident Wellness and Social Support: Development and Cognitive Validation of a Resident Social Capital Assessment Tool.

Objective: The purpose of this study is to develop and generate validity evidence for an instrument to measure social capital in residents.

Design: Mixed-methods, phased approach utilizing a modified Delphi technique, focus groups, and cognitive interviews.

Setting: Four residency training institutions in Washington state between February 2016 and March 2017.

Assessment of Osteoporosis in Injured Older Women Admitted to a Safety-Net Level One Trauma Center: A Unique Opportunity to Fulfill an Unmet Need.

Background: Older trauma patients often undergo computed tomography (CT) as part of the initial work-up. CT imaging can also be used opportunistically to measure bone density and assess osteoporosis.

Methods: In this retrospective cohort study, osteoporosis was ascertained from admission CT scans in women aged ≥65 admitted to the ICU for traumatic injury during a 3-year period at a single, safety-net, level 1 trauma center.

Older adults and high-risk medication administration in the emergency department.

Background: Older adults are susceptible to adverse effects from opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines (BZDs). We investigated factors associated with the administration of elevated doses of these medications of interest to older adults (≥65 years old) in the emergency department (ED).

Patients And Methods: ED records were queried for the administration of medications of interest to older adults at two academic medical center EDs over a 6-month period.

Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size.

Objective: Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors.

The Effect of Computerized Physician Order Entry Template Modifications on the Administration of High-Risk Medications in Older Adults in the Emergency Department.

Background: Older adults are more susceptible to adverse events when administered certain medications at doses appropriate for younger adults.

Objective: The aim of this study was to investigate the effect of default geriatric dosing on computerized physician order entry (CPOE) templates on the subsequent administration of recommended starting doses of opioids, benzodiazepines (BZDs) and non-steroidal anti-inflammatory drugs (NSAIDs) to older adults in the emergency department (ED).

Methods: This was a before-after comparison of the frequency of the recommended starting doses of high-risk medications to adults aged 65 years and older.

External Validation of a Prognostic Model of Survival for Resected Typical Bronchial Carcinoids.

Background: This study aimed to assess the reliability and the validity of a prognostic model of survival recently developed by the European Society of Thoracic Surgery Neuroendocrine Tumor Working Group to predict 5-year overall survival after surgical resection of pulmonary typical carcinoid.

Methods: We retrospectively collected data on 240 consecutive patients (164 men, 76 women; median age, 58 years [interquartile range, 47 to 68]) who underwent curative lung resection for pulmonary typical carcinoid in seven centers between 2000 and 2015. For each patient, we calculated the corresponding risk class (A, B, C, D) using the following variables: male, age, previous malignancy, Eastern Cooperative Oncology Group performance status, peripheral tumor, TNM stage.

The Importance of Age on Short-Term Outcomes Associated With Repair of Giant Paraesophageal Hernias.

Background: Older patients have an increased incidence of paraesophageal hernia (PEH) and can be denied surgical assessment due to the perception of increased complications and mortality. This study examines the influence of age and comorbidities on early complications and other short-term outcomes of PEH repair.

Methods: From 2000 to 2016, data of surgically treated patients with PEH were prospectively recorded in an Institutional Review Board-approved database.

Is there a role for traditional nuclear medicine imaging in the management of pulmonary carcinoid tumours?

Objectives: The clinical utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and somatostatin receptor scintigraphy (SRS) in pulmonary carcinoids staging is unclear. This study aims to determine the role of FDG-PET and SRS in detecting hilar-mediastinal lymph node metastasis from these tumours.

Methods: We retrospectively collected the data of 380 patients who underwent lung resection for primary pulmonary carcinoid in seven centres between 2000 and 2015.

Association of Radiologic Indicators of Frailty With 1-Year Mortality in Older Trauma Patients: Opportunistic Screening for Sarcopenia and Osteopenia.

Importance: Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide complementary prognostic information on long-term outcomes.

Objective: To determine whether sarcopenia and/or osteopenia are associated with 1-year mortality in an older trauma patient population.

Cardiac Perforation by Migrated Fractured Strut of Inferior Vena Cava Filter Mimicking Acute Coronary Syndrome.

We present a rare late complication after inferior vena cava filter (IVC) placement. A 52-year-old woman with an IVC presented with sudden onset of chest pain. Cardiac catheterisation and echocardiography revealed an embolised IVC filter strut penetrating the right ventricle.

Multidisciplinary treatment of T1a adenocarcinoma in Barrett's esophagus: contemporary comparison of endoscopic and surgical treatment in physiologically fit patients.

Background: Previous reports comparing endoscopic therapy (ET) and surgical therapy (ST) have predominantly assessed patients with high-grade dysplasia. The study aim was to compare ET to ST in physiologically fit patients with cT1a adenocarcinoma (EAC).

Methods: Review of two prospective databases yielded 100 patients presenting with clinical cT1a EAC between 2000 and 2013.

Ultrasound-guided procedures in medical education: a fresh look at cadavers.

Demand for bedside ultrasound in medicine has created a need for earlier exposure to ultrasound education during the clinical years of undergraduate medical education. Although bedside ultrasound is often used for invasive medical procedures, there is no standardized educational model for procedural skills that can provide the learner a real-life simulated experience. The objective of our study was to describe a unique fresh cadaver preparation model, and to determine the impact of a procedure-focused ultrasound training session.