Starting a Vascular Surgery Fellowship at a Rural Healthcare Center.

Introduction: In the United States, there is an anticipated critical shortage of vascular surgeons in the coming decades. The shortage is expected to be particularly pronounced in rural areas. Our institution serves a rural and underserved population in which the incidence and prevalence of cardiovascular disease continues to rise.

Endoscopic Treatment of Gastroesophageal Reflux Disease.

There have been many devices and ideas to treat reflux disease endoscopically. Several devices have been tried and even FDA approved but now are no longer used. The push for these therapies is to find effective reflux control with lower risk and faster recovery.

Pregnancy in trauma-A Western Trauma Association algorithm.

Background: The Western Trauma Association has undertaken publication of best practice clinical practice guidelines on multiple trauma topics. These guidelines are based on scientific evidence, case reports, and best practices per expert opinion. Some of the topics covered by this consensus group do not have the ability to have randomized controlled studies completed because of complexity, ethical issues, financial considerations or scarcity of experience.

A deadly cold.

This narrative describes how non-execution of screening at an urgent care visit may have delayed the diagnosis of cervical cancer in a young woman.

Real-time infection prediction with wearable physiological monitoring and AI to aid military workforce readiness during COVID-19.

Infectious threats, like the COVID-19 pandemic, hinder maintenance of a productive and healthy workforce. If subtle physiological changes precede overt illness, then proactive isolation and testing can reduce labor force impacts. This study hypothesized that an early infection warning service based on wearable physiological monitoring and predictive models created with machine learning could be developed and deployed.

Recent advances in UroLift: A comprehensive overview.

Objective: Recent years have seen a steep rise in minimally invasive surgical therapy (MIST) for benign prostate hyperplasia (BPH). Prostatic urethral lift (UroLift) is a mechanical intervention aimed at reducing lower urinary tract symptoms, which affect patients with BPH.

Material And Methods: A narrative synthesis of all studies regarding UroLift is performed over the last decade, evaluating its impact on International Prostate Symptom Score (IPSS), quality of life (QoL), Qmax, Benign Prostate Hypertrophy Impact Index, and sexual health metrics.

Influenza Vaccination During COVID-19 in a Rural Community: A Cross-sectional Survey.

Vaccination behavior is an informative metric for assessing flu seasons and is especially important to understand for the 2020-2021 flu season, which coincided with the COVID-19 pandemic. This study aimed to estimate flu vaccine behavior and assess vaccine perceptions during the pandemic season. Using a cross-sectional descriptive study design, we conducted an online survey to assess vaccination behavior and perceptions of both COVID-19 and the flu.

Outcomes of loco-regional anaesthesia in ureteroscopy for stone disease: a systematic review.

Purpose Of Review: Routine ureteroscopy (URS) for stone disease is performed under a general anaesthesia. However, controversy exists on the role of loco-regional anaesthesia and the outcomes associated with it. Here we review the challenges, outcomes and complications of loco-regional anaesthesia for URS.

Caregiver Needs Assessment in Primary Care: Views of Clinicians, Staff, Patients, and Caregivers.

Objectives: To understand current practices, challenges, and opportunities for a systematic assessment of family caregivers' needs and risks in primary care.

Design: Qualitative study consisting of in-depth semi-structured interviews.

Setting: Four primary care practices located in urban and rural settings.

A novel protocol to maintain continuous access to thawed plasma at a rural trauma center.

Background: Early administration of plasma improves mortality in massively transfused patients, but the thawing process causes delay. Small rural centers have been reluctant to maintain thawed plasma due to waste concerns. Our 254-bed rural Level II trauma center initiated a protocol allowing continuous access to thawed plasma, and we hypothesized its implementation would not increase waste or cost.

Donor and post-transplant ureteroscopy for stone disease in patients with renal transplant: evidence from a systematic review.

Purpose Of Review: Renal transplant is needed for end-stage renal disease. Although treatment of donor stones may be needed pretransplant and increases the pool available for renal transplant, posttransplant stone disease may also need treatment to maintain the allograft function. A Cochrane style review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to evaluate the outcomes of donor and posttransplant ureteroscopy (URS) for stone disease, including all English language articles between January 1996 and December 2018.

Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis.

Background: Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI.

Stress Induced Cardiomyopathy Triggered by Acute Myocardial Infarction: A Case Series Challenging the Mayo Clinic Definition.

BACKGROUND Various physical and emotional factors have been previously described as triggers for stress induced cardiomyopathy. However, acute myocardial infarction as a trigger has never been reported. CASE REPORT We describe four patients who presented with an acute myocardial infarction, in whom the initial echocardiography revealed wall motion abnormalities extending beyond the coronary distribution of the infarct artery.

Barrett's esophagus before and after Roux-en-Y gastric bypass for severe obesity.

Introduction: Barrett's esophagus (BE) has been associated with obesity and metabolic syndrome. Laparoscopic Roux-en-Y gastric bypass (LRYGB) may represent a surgical approach which addresses both severe obesity and BE. LRYGB diverts bile away from the gastric pouch and esophagus due to the long Roux limb, and very little acid is produced in the cardia-based gastric pouch.

Evaluation of crowd-sourced assessment of the critical view of safety in laparoscopic cholecystectomy.

Background: Faculty experts (FE) and crowd workers (CW) can assess technical skill, but assessment of operative technique has not been explored. We sought to evaluate if CW could be taught to assess completion of the critical view of safety (CVS) in laparoscopic cholecystectomy.

Methods: We prepared 160 blinded, surgical videos of laparoscopic cholecystectomy from public domain websites.

Documentation of quality improvement exposure by internal medicine residency applicants.

Background: Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown.

Is Endoluminal Bariatric Therapy a New Paradigm of Treatment for Obesity?

The prevalence of obesity has steadily increased throughout recent decades, and along with it, the costs of caring for the associated comorbid conditions has increased as well. Traditional bariatric surgical procedures generally are safe and effective, but patient acceptance, the risk of minor and sometimes serious complications, costs, and insurance coverage have limited the application of these techniques to the treatment of a minority of patients. Endoluminal techniques represent newer approaches to weight loss that can be used independently or in concert with traditional medical and surgical treatments for obesity, with varying degrees of success.