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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Vaz Ferreira R, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Navas Leon FJ, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Correction: Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002414. [PMID: 37708095 PMCID: PMC10501557 DOI: 10.1371/journal.pgph.0002414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
[This corrects the article DOI: 10.1371/journal.pgph.0002102.].
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2
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Beninato T, Duh QY, Long KL, Kiernan CM, Miller BS, Patel S, Randle RW, Wachtel H, Zanocco KA, Zern NK, Drake FT. Challenges and controversies in adrenal surgery: A practical approach. Curr Probl Surg 2023; 60:101374. [PMID: 37770163 DOI: 10.1016/j.cpsurg.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Toni Beninato
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Quan-Yang Duh
- Veterans Affairs Medical Center, San Francisco, San Francisco, CA
| | | | - Colleen M Kiernan
- Vanderbilt University Medical Center, Veterans Affairs Medical Center, Tennessee Valley Health System, Nashville, TN
| | - Barbra S Miller
- Division of Surgical Oncology, The Ohio State University, Columbus, OH
| | - Snehal Patel
- Emory University School of Medicine, Atlanta, GA
| | | | | | - Kyle A Zanocco
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Ferreira RV, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Leon FJN, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002102. [PMID: 37450426 PMCID: PMC10348592 DOI: 10.1371/journal.pgph.0002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
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Affiliation(s)
- Natalie Pawlak
- Tufts University, Boston, Massachusetts, United States of America
| | - Christine Dart
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Emmanuel Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- University of Global Health Equity, Butaro, Rwanda
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria F. Jimenez
- Department of Surgery, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogota, Colombia
| | | | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
| | - Girma Terfera
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Adesoji O. Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | | | | | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Emmanuel Bua
- Busitema University Mbale Hospital, Mbale, Uganda
| | - Leticia Nunes Campos
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | - Chris Dodgion
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Michalina Drejza
- Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Marcel E. Durieux
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Dhruva Ghosh
- NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, India
| | | | - Walter D. Johnson
- Loma Linda University, Loma Linda, California, United States of America
| | | | | | - Kristin L. Long
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Jana B. A. Macleod
- Kenyatta University, Nairobi, Kenya
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anshul Mahajan
- Global Surgery Fellow, WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs’, Mumbai, India
| | - Rebecca G. Maine
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | | | - Craig D. McClain
- Department of Anesthesiology, Critical Care and Pain Medicine, Program in Global Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Peter M. Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Benedict C. Nwomeh
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | | | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | | | - Jennifer Rickard
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lubna Samad
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | | | - Martin Smith
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Richard J. Stewart
- Global Initiative for Children’s Surgery, Portland, Oregon, United States of America
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Thomas G. Weiser
- Department of Surgery, Stanford University, Palo Alto, California, United States of America
| | | | - Elliot Wollner
- Peter MacCallum Cancer Center and University of California, San Francisco, San Francisco, California, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, United States of America
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Abstract
This survey study assesses physicians’ recommendations regarding overdiagnosis and overtreatment of thyroid nodules and low-risk papillary thyroid cancer.
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Affiliation(s)
- Priya H. Dedhia
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus
| | - Megan C. Saucke
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Kristin L. Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Gerard M. Doherty
- Brigham and Women’s Hospital, Brigham Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Susan C. Pitt
- Department of Surgery, University of Michigan, Ann Arbor
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Hsiao V, Elfenbein DM, Pitt SC, Long KL, Sippel RS, Schneider DF. Evaluating Discrimination of ACS-NSQIP Surgical Risk Calculator in Thyroidectomy Patients. J Surg Res 2022; 271:137-144. [PMID: 34896939 PMCID: PMC8810575 DOI: 10.1016/j.jss.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/18/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The ACS-NSQIP surgical risk calculator (SRC) often guides preoperative counseling, but the rarity of complications in certain populations causes class imbalance, complicating risk prediction. We aimed to compare the performance of the ACS-NSQIP SRC to other classical machine learning algorithms trained on NSQIP data, and to demonstrate challenges and strategies in predicting such rare events. METHODS Data from the NSQIP thyroidectomy module ys 2016 - 2018 were used to train logistic regression, Ridge regression and Random Forest classifiers for predicting 2 different composite outcomes of surgical risk (systemic and thyroidectomy-specific). We implemented techniques to address imbalanced class sizes and reported the area under the receiver operating characteristic (AUC) for each classifier including the ACS-NSQIP SRC, along with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at a 5% - 15% predicted risk threshold. RESULTS Of 18,078 included patients, 405 (2.24%) patients suffered systemic complications and 1670 (9.24%) thyroidectomy-specific complications. Logistic regression performed best for predicting systemic complication risk (AUC 0.723 [0.658 - 0.778]); Random Forest with RUSBoost performed best for predicting thyroidectomy-specific complication risk (0.702; 0.674 - 0.726). The addition of optimizations for class imbalance improved performance for all classifiers. CONCLUSIONS Complications are rare after thyroidectomy even when considered as composite outcomes, and class imbalance poses a challenge in surgical risk prediction. Using the SRC as a classifier where intervention occurs above a certain validated threshold, rather than citing the numeric estimates of complication risk, should be considered in low-risk patients.
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Affiliation(s)
- Vivian Hsiao
- University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin-Madison, Department of Surgery, Madison, Wisconsin.
| | - Dawn M. Elfenbein
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI 53726,University of Wisconsin Department of Surgery, 600 Highland Ave., Madison, WI 53792
| | - Susan C. Pitt
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI 53726,University of Wisconsin Department of Surgery, 600 Highland Ave., Madison, WI 53792
| | - Kristin L. Long
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI 53726,University of Wisconsin Department of Surgery, 600 Highland Ave., Madison, WI 53792
| | - Rebecca S. Sippel
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI 53726,University of Wisconsin Department of Surgery, 600 Highland Ave., Madison, WI 53792
| | - David F. Schneider
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI 53726,University of Wisconsin Department of Surgery, 600 Highland Ave., Madison, WI 53792
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Bach K, Prince S, Pitt SC, Robbins S, Connor NP, Macdonald C, Sippel RS, Long KL. Time Heals Most Wounds - Perceptions of Thyroidectomy Scars in Patients With Thyroid Cancer. J Surg Res 2022; 270:437-443. [PMID: 34798426 PMCID: PMC8712385 DOI: 10.1016/j.jss.2021.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients understandably have concerns about thyroidectomy scars. This study aimed to characterize patients' perceptions of their thyroidectomy scar before and up to 1-y after surgery. METHODS Patients with papillary thyroid cancer (n = 83) completed semi-structured interviews before and at 2-wks, 6-Wk, 6-mo, and 1-y post-thyroidectomy. Interviews probed about scar concerns and appearance. Content analysis was used to identify themes. RESULTS The majority of participants did not express concerns about scar appearance. When expressed, preoperative concerns often stemmed from previous surgery experiences or unease with neck incisions. Postoperatively, concerns about scar appearance decreased over time throughout the healing period with most patients being satisfied with their scar appearance by 6-mo after surgery. CONCLUSIONS Patients with papillary thyroid cancer express few concerns about scar thyroidectomy appearance. Surgeons can reassure patients who have preoperative concerns that most patients are satisfied with their scar appearance by 6-mo after surgery.
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Affiliation(s)
- Kathy Bach
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Samantha Prince
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Susan C. Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Sarah Robbins
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Nadine P. Connor
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Cameron Macdonald
- Qualitative Health Research Consultants,111 King St #23, Madison Wisconsin USA 53703
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Kristin L. Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
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Doubleday AR, Novin S, Long KL, Schneider DF, Sippel RS, Pitt SC. Online Information for Treatment for Low-Risk Thyroid Cancer: Assessment of Timeliness, Content, Quality, and Readability. J Cancer Educ 2021; 36:850-857. [PMID: 32108292 PMCID: PMC11014722 DOI: 10.1007/s13187-020-01713-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Internet is a key source of health information, yet little is known about resources for low-risk thyroid cancer treatment. We examined the timeliness, content, quality, readability, and reference to the 2015 American Thyroid Association (ATA) guidelines in websites about thyroid cancer treatment. We identified the top 60 websites using Google, Bing, and Yahoo for "thyroid cancer." Timeliness and content analysis identified updates in the ATA guidelines (n = 6) and engaged a group of stakeholders to develop essential items (n = 29) for making treatment decisions. Website quality and readability analysis used 4 validated measures: DISCERN; Journal of the American Medical Association (JAMA) benchmark criteria; Health on the Net Foundation certification (HONcode); and the Suitability Assessment of Materials (SAM) method. Of the 60 websites, 22 were unique and investigated. Content analysis revealed zero websites contained all updates from the ATA guidelines and rarely (18.2%) referenced them. Only 31.8% discussed all 3 treatment options: total thyroidectomy, lobectomy, and active surveillance. Websites discussed 28.2% of the 29 essential items for making treatment decisions. Quality analysis with DISCERN showed "fair" scores overall. Only 29.9% of the JAMA benchmarks were satisfied, and 40.9% were HONcode certified. Readability analysis with the SAM method found adequate readability, yet 90.9% scored unsuitable in literacy demand. The overall timeliness, content, quality, and readability of websites about low-risk thyroid cancer treatment is fair and needs improvement. Most websites lack updates from the 2015 ATA guidelines and information about treatment options that are necessary to make informed decisions.
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Affiliation(s)
- Amanda R Doubleday
- Department of Surgery, Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Sherwin Novin
- Department of Surgery, Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Kristin L Long
- Department of Surgery, Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - David F Schneider
- Department of Surgery, Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Rebecca S Sippel
- Department of Surgery, Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Susan C Pitt
- Department of Surgery, Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
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McDow AD, Saucke MC, Marka NA, Long KL, Pitt SC. Thyroid Lobectomy for Low-Risk Papillary Thyroid Cancer: A National Survey of Low- and High-Volume Surgeons. Ann Surg Oncol 2021; 28:3568-3575. [PMID: 33939048 DOI: 10.1245/s10434-021-09898-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The 2015 American Thyroid Association guidelines endorsed lobectomy for patients with low-risk papillary thyroid cancer (PTC) measuring 1-4 cm. Attitudes about the use of lobectomy for these patients are lacking, particularly from low-volume surgeons who perform the majority of thyroidectomies in the US. METHODS A survey was mailed to 1000 surgeons stratified by specialty (500 general surgeons and 500 otolaryngologists) registered with the American Medical Association, to evaluate beliefs and practices about the extent of surgery for low-risk PTC. Comparisons examined differences by surgeon volume. RESULTS Of 320 respondents who have performed thyroidectomy since 2015 (150 general surgeons, 170 otolaryngologists), 206 (64.4%) were low volume (< 26 thyroidectomies/year). The proportion of surgeons recommending lobectomy for low-risk PTC measuring 1.1 to < 4 cm ranged from 43.1 to 2.6%. High-volume surgeons recommended lobectomy more frequently for PTC measuring 1.1-3 cm, although this was not statistically significant. Thirty-three percent of respondents believed lobectomy is underused for low-risk PTC, while 10.0% believed it is overused. Additionally, 19.6% of respondents believed recurrence is more likely after lobectomy than total thyroidectomy, and 3.3% believed mortality is higher. Few believed quality of life is better after lobectomy (12.3%). Low-volume surgeons were less likely to be aware guidelines support lobectomy for low-risk PTC 1-4 cm (p < 0.001) and less likely to use clinical practice guidelines (p = 0.004). CONCLUSIONS Most surgeons do not support lobectomy for patients with low-risk PTC > 1 cm. Awareness of guidelines and concerns about increased risk of recurrence after lobectomy may drive surgeons' preference for total thyroidectomy.
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Affiliation(s)
- Alexandria D McDow
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Megan C Saucke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nicholas A Marka
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kristin L Long
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Long KL, Ingraham AM, Wendt EM, Saucke MC, Balentine C, Orne J, Pitt SC. Informed Consent and Informed Decision-Making in High-Risk Surgery: A Quantitative Analysis. J Am Coll Surg 2021; 233:337-345. [PMID: 34102279 DOI: 10.1016/j.jamcollsurg.2021.05.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Informed consent is an ethical and legal requirement that differs from informed decision-making-a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery. STUDY DESIGN We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons' definition and 9 elements of informed decision-making using Braddock's validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics. RESULTS Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty. CONCLUSIONS Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients' role in the decision, their daily life, uncertainty, understanding, or patient preference.
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Affiliation(s)
- Kristin L Long
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Angela M Ingraham
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Elizabeth M Wendt
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Megan C Saucke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Courtney Balentine
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jason Orne
- Qualitative Health Research Consultants, Madison, WI
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Dedhia PH, Stoeckl EM, McDow AD, Saruni S, Schneider DF, Long KL. Preoperative surgeon-performed ultrasound of massive thyroid goiter in rural Kenya. Am J Surg 2021; 221:925-926. [DOI: 10.1016/j.amjsurg.2020.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 02/03/2023]
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Pitt SC, Yang N, Saucke MC, Marka N, Hanlon B, Long KL, McDow AD, Brito JP, Roman BR. Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey. J Clin Endocrinol Metab 2021; 106:e1728-e1737. [PMID: 33373458 PMCID: PMC7993571 DOI: 10.1210/clinem/dgaa942] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States. OBJECTIVE This work aimed to understand factors associated with the adoption of AS. METHODS We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for 2 hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Outcome measures included adoption of AS (nonadopters vs adopters, who respectively did not recommend or recommended AS at least once; and partial vs full adopters, who respectively recommended AS for one or both cases). RESULTS The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Nonadopters (45.7%) were significantly (P < .001) less likely than adopters to practice in academic settings, see more than 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (P = .04), know how to determine whether a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Nonadopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (P = .03) and more likely to be anxious (P = .04), have reservations (P = .03), and have concerns about the psychological burden (P = .009) of AS. Few respondents (3.2%) believed patients were aware of AS. CONCLUSION Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.
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Affiliation(s)
- Susan C Pitt
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Correspondence: Susan C. Pitt, MD, MPHS, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, CSC H4/721, Madison, WI 53792, USA.
| | - Nan Yang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Megan C Saucke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nicholas Marka
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bret Hanlon
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kristin L Long
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexandria D McDow
- Division of Surgery Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - J P Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin R Roman
- Division of Head and Neck, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Long KL, Galukande M, Kyamanywa P, Tarpley MJ, Dodgion C. Developing Research Potential and Building Partnerships: A Report of the Fundamentals of Surgical Research Course at the College of Surgeons of East, Central, and Southern Africa. J Surg Res 2020; 259:34-38. [PMID: 33278795 DOI: 10.1016/j.jss.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Approximately a decade after the inaugural Fundamentals of Surgical Research Course (FSRC) at the West African College of Surgeons meeting (2008), the Association for Academic Surgery expanded the course offering to the annual meeting of the College of Surgeons of East, Central and Southern Africa (COSECSA). After the second annual offering of the course in 2019, participants were surveyed to assess the impact of the course. METHODS A survey was distributed to the attendees of the 2019 second COSECSA FSRC course, held in December 2019 in Kampala, Uganda. Approximately 80 people attended at least a portion of the full-day course. Forty-nine participants completed the voluntary survey questionnaire distributed to assess each session of the course at course completion. RESULTS Ten different countries were represented among the attendees. Of the 49 evaluations, 35 respondents were male and six were female. Eight respondents did not identify a gender. Surgical residents comprised 19 of the 49 attendees, and one of the 49 attendees was a medical student. Thirty-five respondents indicated that their views of surgical research had changed after attending the course. CONCLUSIONS The second annual FSRC at COSECSA confirmed significant interest in building research skills and partnerships in sub-Saharan Africa. A wide variety of learners attended the course, and a majority of the sessions received overwhelmingly positive feedback. Multiple conference attendees expressed interest in serving as faculty for the course moving forward, highlighting a viable path for sustainability as the Association for Academic Surgery develops an international research education platform.
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Affiliation(s)
- Kristin L Long
- Division of Endocrine Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
| | | | - Patrick Kyamanywa
- Department of Surgery, Kampala International University Western Campus, Kampala, Uganda
| | - Margaret J Tarpley
- Department of Surgery, Vanderbilt University, Nashville, Tennessee; Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Christopher Dodgion
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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13
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Dedhia PH, Stoeckl EM, McDow AD, Pitt SC, Schneider DF, Sippel RS, Long KL. Outcomes after completion thyroidectomy versus total thyroidectomy for differentiated thyroid cancer: A single-center experience. J Surg Oncol 2020; 122:660-664. [PMID: 32468708 DOI: 10.1002/jso.26044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Thyroid cancer diagnoses are often discovered after diagnostic thyroid lobectomy. Completion thyroidectomy (CT) may be indicated for intermediate or high-risk tumors to facilitate surveillance and/or adjuvant treatment. The completeness of thyroid resection and the safety of CT compared to total thyroidectomy (TT) is unclear. We assessed outcomes after TT or CT to determine completeness of resection and risk of complications. METHODS Patients undergoing TT or CT between 2000 and 2018 were retrospectively reviewed. Pathology, unstimulated thyroglobulin (uTg), parathyroid hormone (PTH), rates of hematoma, and recurrent laryngeal nerve (RLN) injury were compared. RESULTS Differentiated thyroid cancer (DTC) was identified in 954 patients undergoing TT and 142 patients undergoing CT. Postoperative uTg at 6 months was not different between TT and CT, 0.2 vs 0.2 ng/mL, P = .37. Transient hypoparathyroidism with immediate postoperative PTH less than 10 was more common after TT, 14.3 vs 6.0% (P = .009). No differences were noted regarding postoperative hematoma, transient RLN injury, permanent hypoparathyroidism, and permanent RLN injury. CONCLUSIONS If CT is required for DTC, a complete resection, as assessed by postoperative uTg, can be achieved. Furthermore, CT is significantly less likely to result in transient hypoparathyroidism and poses no additional risk of RLN injury, hematoma, or permanent hypoparathyroidism.
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Affiliation(s)
- Priya H Dedhia
- Division of Surgical Oncology, Department of Surgery, Ohio State University Comprehensive Cancer Center, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Elizabeth M Stoeckl
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Alexandria D McDow
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Susan C Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - David F Schneider
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Rebecca S Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kristin L Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Blumenfeld A, Velic A, Bingman EK, Long KL, Aughenbaugh W, Jung SA, Liepert AE. A Mastery Learning Module on Sterile Technique to Prepare Graduating Medical Students for Internship. MedEdPORTAL 2020; 16:10914. [PMID: 32704532 PMCID: PMC7373201 DOI: 10.15766/mep_2374-8265.10914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/09/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Sterile technique is a basic technical skill used for a number of bedside procedures. Proper use of sterile technique improves patient safety by reducing infection risk. METHODS We applied the principles of mastery learning to develop a simulation-based mastery learning module for sterile technique that was used as part of a 2-week internship preparatory course for fourth-year medical students. Forty-one medical students entering surgical or emergency medicine internships completed the module. Learners demonstrated baseline skills with a pretest, watched a didactic online video, participated in supervised deliberate practice sessions, and then completed a posttest. Physicians evaluated performance using a nine-item mastery checklist validated by a multispecialty panel of board-certified physicians. Learners who did not demonstrate mastery by correctly performing all nine checklist items received formative feedback and repeated the posttest as needed until mastery was achieved. RESULTS No learners demonstrated mastery of sterile technique during pretesting. A total of 100% of learners demonstrated mastery of sterile technique during either their first or second attempt of the posttest. The learners reported statistically significantly higher levels of confidence at the end of the module. DISCUSSION Our module highlights the skills gap that exists in the transition from undergraduate to graduate medical education and offers a cheap, effective, and easily reproducible curriculum for sterile technique that could be widely adopted for many learner populations.
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Affiliation(s)
- Allison Blumenfeld
- Medical Student, University of Wisconsin School of Medicine and Public Health
| | - Andrew Velic
- Medical Student, University of Wisconsin School of Medicine and Public Health
| | - Elizabeth K. Bingman
- Education Manager, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health
| | - Kristin L. Long
- Assistant Professor, Department of Surgery, University of Wisconsin School of Medicine and Public Health
| | - William Aughenbaugh
- Professor, Department of Dermatology, University of Wisconsin School of Medicine and Public Health; Vice Chair of Education, University of Wisconsin School of Medicine and Public Health
| | - Sarah A. Jung
- Assistant Professor, Department of Surgery, University of Wisconsin School of Medicine and Public Health
| | - Amy E. Liepert
- Assistant Professor, Department of Surgery, University of Wisconsin School of Medicine and Public Health
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Long KL, Hamilton DA, Davenport DL, Bernard AC, Kearney PA, Chang PK. A Prospective, Controlled Evaluation of the Abdominal Reapproximation Anchor Abdominal Wall Closure System in Combination with VAC Therapy Compared with VAC Alone in the Management of an Open Abdomen. Am Surg 2020. [DOI: 10.1177/000313481408000620] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac™ (VAC) or KCI ABThera™ would increase successful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA). All patients underwent regular VAC changes; patients receiving VAC-ABRA also underwent concomitant daily elastomer adjustment of the ABRA system. Primary end points included abdominal closure, number of operating room (OR) visits, and OR time use. Eight patients were included in the VAC-ABRA group and six patients in the control group. Primary closure rates between groups were not statistically different; however, the number of trips to the OR and OR time use were different. Despite higher Acute Physiology and Chronic Health Evaluation II scores, larger starting wound size, and higher rates of abdominal compartment syndrome, closure rates in the VAC-ABRA group were similar to VAC alone. Importantly, however, fewer OR trips and less OR time were required for the VAC-ABRA group.
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Affiliation(s)
- Kristin L. Long
- Division of General Surgery–Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - David A. Hamilton
- Division of General Surgery–Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Daniel L. Davenport
- Division of General Surgery–Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Andrew C. Bernard
- Division of General Surgery–Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Paul A. Kearney
- Division of General Surgery–Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Phillip K. Chang
- Division of General Surgery–Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky
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Dedhia PH, Saucke M, McDow AD, Long KL, Doherty GM, Pitt SC. Overtreatment of Patients with Low-Risk Thyroid Cancer. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chen SS, Zaborek NA, Doubleday AR, Schaefer SC, Long KL, Pitt SC, Sippel RS, Schneider DF. Optimizing Levothyroxine Dose Adjustment After Thyroidectomy With a Decision Tree. J Surg Res 2019; 244:102-106. [PMID: 31279993 DOI: 10.1016/j.jss.2019.06.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/23/2019] [Accepted: 06/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND After thyroidectomy, patients require Levothyroxine (LT4). It may take years of dose adjustments to achieve euthyroidism. During this time, patients encounter undesirable symptoms associated with hypo- or hyper-thyroidism. Currently, providers adjust LT4 dose by clinical estimation, and no algorithm exists. The objective of this study was to build a decision tree that could estimate LT4 dose adjustments and reduce the time to euthyroidism. METHODS We performed a retrospective cohort analysis on 320 patients who underwent total or completion thyroidectomy at our institution. All patients required one or more LT4 dose adjustments from their initial postoperative dose before attaining euthyroidism. Using the Classification and Regression Tree algorithm, we built various decision trees from patient characteristics, estimating the dose adjustment to reach euthyroidism. RESULTS The most accurate decision tree used thyroid-stimulating hormone values at first dose adjustment (mean absolute error = 13.0 μg). In comparison, the expert provider and naïve system had a mean absolute error of 11.7 μg and 17.2 μg, respectively. In the evaluation dataset, the decision tree correctly predicted the dose adjustment within the smallest LT4 dose increment (12.5 μg) 79 of 106 times (75%, confidence interval = 65%-82%). In comparison, expert provider estimation correctly predicted the dose adjustment 76 of 106 times (72%, confidence interval = 62%-80%). CONCLUSIONS A decision tree predicts the correct LT4 dose adjustment with an accuracy exceeding that of a completely naïve system and comparable to that of an expert provider. It can assist providers inexperienced with LT4 dose adjustment.
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Affiliation(s)
- Stephen S Chen
- Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | - Nick A Zaborek
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | | | - Sarah C Schaefer
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kristin L Long
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Rebecca S Sippel
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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McDow AD, Shumway CM, Pitt SC, Schneider DF, Sippel RS, Long KL. Utility of Early Postoperative Unstimulated Thyroglobulin in Influencing Decision Making in Patients with Papillary Thyroid Carcinoma. Ann Surg Oncol 2019; 26:4002-4007. [DOI: 10.1245/s10434-019-07581-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 11/18/2022]
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McDow AD, Salman SO, Abughazaleh KM, Long KL. Improving Surgical Outreach in Palestine: Assessing Goals of Local and Visiting Surgeons. J Surg Res 2019; 233:139-143. [DOI: 10.1016/j.jss.2018.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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Zaborek NA, Cheng A, Imbus JR, Long KL, Pitt SC, Sippel RS, Schneider DF. The optimal dosing scheme for levothyroxine after thyroidectomy: A comprehensive comparison and evaluation. Surgery 2018; 165:92-98. [PMID: 30413325 DOI: 10.1016/j.surg.2018.04.097] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients often struggle to attain euthyroidism after thyroidectomy, and multiple dosing schemes have been proposed to supplant the standard weight-based approach for initial levothyroxine dosing after thyroidectomy. The objectives of this study were to review the literature for existing levothyroxine dosing schemes and compare estimation accuracies with novel schemes developed with machine learning. METHODS This study retrospectively analyzed 598 patients who attained euthyroidism after total or completion thyroidectomy for benign disease. A scoping review identified existing levothyroxine dosing schemes. Thirteen machine learning algorithms estimated euthyroid dose. Using 10-fold cross-validation, we compared schemes by the proportion of patients having a predicted dose within 12.5 µg/day of their euthyroid dose. RESULTS Of 264 reviewed articles, 7 articles proposed retrospectively implementable dosing schemes. A novel Poisson regression model proved most accurate, correctly predicting 64.8% of doses. Incorporating 7 variables, Poisson regression was significantly more accurate than the best scheme in the literature (body mass index/weight based) that correctly predicted 60.9% of doses (P = .031). Standard weight-based dosing (1.6 µg/kg/day) correctly predicted 51.3% of doses, and the least effective scheme (age/sex/weight based) correctly predicted 27.4% of doses. CONCLUSION Using readily available variables, a novel Poisson regression dosing scheme outperforms other machine learning algorithms and all existing schemes in estimating levothyroxine dose.
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Affiliation(s)
- Nick A Zaborek
- Department of Surgery, University of Wisconsin, Madison, WI.
| | | | - Joseph R Imbus
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Kristin L Long
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin, Madison, WI
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21
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Perez AA, Schneider DF, Long KL, Pitt SC, Sippel RS. Timely Evaluation and Management of Primary Hyperparathyroidism in Patients With Kidney Stones. J Surg Res 2018; 232:564-569. [PMID: 30463775 DOI: 10.1016/j.jss.2018.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/19/2018] [Accepted: 07/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nephrolithiasis is a classic, treatable manifestation of primary hyperparathyroidism (PHPT). We examined predictors of kidney stone formation in PHPT patients and determined how efficiently the diagnosis of PHPT is made in patients whose initial presentation is with stones. MATERIALS AND METHODS We performed a retrospective analysis of surgically treated PHPT patients, comparing 247 patients who were kidney stone formers and 1047 patients with no kidney stones. We also analyzed 51 stone-forming patients whose stone evaluation and treatment were completed within our health system before PHPT diagnosis. RESULTS Stone-forming patients had higher 24-h urinary calcium (342 versus 304 mg/d, P = 0.005), higher alkaline phosphatase (92 versus 85 IU/L, P = 0.012), and were more likely to be normocalcemic (26.6% versus 16.9%, P = 0.001). Surprisingly, 47.3% of stone formers had normal urinary calcium levels (<300 mg/d). Of the 51 stone-forming patients treated at our institution, serum calcium was measured within 6 mo of stone diagnosis in 37 (72.5%) patients. Only 16 (31.4%) of these patients had elevated calcium levels, and only 10 (62.5%) of these 16 had a serum parathyroid hormone ordered within the following 3 mo. These patients had a significantly shorter time from their first stone to surgical treatment compared to other patients (median 8.5 versus 49.1 mo, P = 0.001). CONCLUSIONS Elevated serum and urinary calcium levels are not evaluated in the majority of PHPT patients presenting with kidney stones. In nephrolithiasis patients, provider consideration of PHPT with prompt serum calcium and parathyroid hormone evaluation significantly reduces time to treatment.
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Affiliation(s)
- Alberto A Perez
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David F Schneider
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kristin L Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Susan C Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Rebecca S Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Abstract
Parathyroid carcinoma (PC) is a rare disease and presents clinical challenges in diagnosis, management and adjuvant treatment. Rarely diagnosed preoperatively, PC is often discovered in the treatment of primary hyperparathyroidism. PC is predominantly treated surgically with minimal additional treatments available. Given the rarity of the disease, current and future efforts, as discussed in this article, are focused on increasing preoperative diagnosis, recognizing genetic patterns and pathologic markers and delineating nonsurgical options for patients with advanced disease.
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Affiliation(s)
- Kristin L Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI 53792, USA
| | - Rebecca S Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI 53792, USA
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23
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Randle RW, Bates MF, Long KL, Pitt SC, Schneider DF, Sippel RS. Impact of potassium iodide on thyroidectomy for Graves' disease: Implications for safety and operative difficulty. Surgery 2017; 163:68-72. [PMID: 29108701 DOI: 10.1016/j.surg.2017.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/03/2017] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Potassium iodide often is prescribed prior to thyroidectomy for Graves' disease, but the effect of potassium iodide on the ease and safety of thyroidectomy for Graves' is largely unknown. METHODS We conducted a prospective, cohort study of patients with Graves' disease undergoing thyroidectomy. For the first 8 months, no patients received potassium iodide; for the next 8 months, potassium iodide was added to the preoperative protocol for all patients. Outcomes included operative difficulty (based on the Thyroidectomy Difficulty Scale) and complications. RESULTS We included a total of 31 patients in the no potassium iodide group and 28 in the potassium iodide group. According to the Thyroidectomy Difficulty Scale, gland vascularity decreased in the potassium iodide group (mean score 2.6 vs 3.3, P = .04), but there were no differences in friability, fibrosis, or size of the thyroid or in overall difficulty of operation (P = not significant for all). Despite similar operative difficulty, patients prescribed potassium iodide were less likely to experience transient hypoparathyroidism (7% vs 26%, P = .018) and transient hoarseness (0% vs 16%, P = .009) compared with the no potassium iodide group. CONCLUSION Potassium iodide administration decreases gland vascularity, but does not change the overall difficulty of thyroidectomy. Preoperative use of potassium iodide solution was, however, associated with less transient hypoparathyroidism and transient hoarseness, suggesting that potassium iodide improves the safety of thyroidectomy for Graves' disease.
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Affiliation(s)
- Reese W Randle
- Department of Surgery, University of Wisconsin, Madison, WI.
| | - Maria F Bates
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Kristin L Long
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin, Madison, WI
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Long KL, Etzel C, Rich T, Hyde S, Perrier ND, Graham PH, Lee JE, Hu MI, Cote GJ, Gagel R, Grubbs EG. All in the family? Analyzing the impact of family history in addition to genotype on medullary thyroid carcinoma aggressiveness in MEN2A patients. Fam Cancer 2017; 16:283-289. [PMID: 27864651 DOI: 10.1007/s10689-016-9948-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several guidelines for patients with multiple endocrine neoplasia 2A (MEN2A) take into account genotype and family history of medullary thyroid carcinoma (MTC) disease aggressiveness. We sought to determine if an association exists independent of genotype, which could provide important information for counseling MEN2A patients in management of their MTC. Pedigrees of patients with ≥5 family members with MEN2A were retrospectively reviewed. Analysis was performed among kindreds with the most frequently observed codon mutation (RET 634). Familial MTC disease aggressiveness was evaluated using: (1) mean age at diagnosis of MTC, (2) current mean age of carriers without MTC, (3) proportion of kindred with MTC with metastatic disease at diagnosis, (4) proportion of kindred with MTC with metastasis/death from MTC as worst outcome, and (5) proportion of kindred with disease progression. 170 affected patients from 12 different MEN2A kindreds met inclusion criteria. The number of affected family members available for study per kindred ranged from 8 to 43 individuals. A difference in mean age of MTC diagnosis was found in screened patients (p = 0.01); mean age of MTC-free patients did not differ (p = 0.93). No differences were noted among kindreds in disease stage at presentation, worst outcome, or progression; marked variation in these measures was noted within families. In conclusion, a difference in age of MTC diagnosis among different RET 634 kindreds was identified. In contrast, notable intra-familial variability in disease aggressiveness was observed. Based on these findings, we recommend counseling patients with codon 634 mutations that their MTC disease course cannot be predicted by that of their relatives.
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Affiliation(s)
- Kristin L Long
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Carol Etzel
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Thereasa Rich
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Samuel Hyde
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Gilbert J Cote
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Robert Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Long KL, Skinner SC, Ward AN, Strong WR, McGrath PC, Maynard EC. Traumatic Pancreaticoduodenectomy and Superior Mesenteric Vein Injury After Blunt Trauma in a Pediatric Patient. Am Surg 2015; 81:e328-e329. [PMID: 26350647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Kristin L Long
- Department of General Surgery, University of Kentucky, Lexington, Kentucky, USA
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26
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Long KL, Skinner SC, Ward AN, Strong WR, McGrath PC, Maynard EC. Traumatic Pancreaticoduodenectomy and Superior Mesenteric Vein Injury after Blunt Trauma in a Pediatric Patient. Am Surg 2015. [DOI: 10.1177/000313481508100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kristin L. Long
- Department of General Surgery University of Kentucky Lexington, Kentucky
| | - Sean C. Skinner
- Department of Pediatric Surgery University of Kentucky Lexington, Kentucky
| | - Austin N. Ward
- Department of General Surgery University of Kentucky Lexington, Kentucky
| | - William R. Strong
- Department of General Surgery University of Kentucky Lexington, Kentucky
| | - Patrick C. McGrath
- Department of General Surgery University of Kentucky Lexington, Kentucky
| | - Erin C. Maynard
- Department of Transplant Surgery University of Kentucky Lexington, Kentucky
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Lee CY, Long KL, Eldridge RJ, Davenport DL, Sloan DA. Preoperative laryngoscopy in thyroid surgery: Do patients' subjective voice complaints matter? Surgery 2014; 156:1477-82; discussion 1482-3. [DOI: 10.1016/j.surg.2014.08.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/14/2014] [Indexed: 11/30/2022]
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Long KL, Spears C, Kenady DE, Roth JS. Implementation of a low-cost laparoscopic skills curriculum in a third-world setting. J Surg Educ 2014; 71:860-864. [PMID: 24931413 DOI: 10.1016/j.jsurg.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/12/2014] [Accepted: 05/02/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Training outside the operating room has become a mainstay of surgical education. Laparoscopic training often takes place in a simulation setting. Advanced laparoscopic procedures are now commonplace, even in third-world countries with minimal hospital resources. We sought to implement a low-cost laparoscopic skills curriculum in a general surgery residency program in East Africa. STUDY DESIGN The laparoscopic skills curriculum created and validated at the University of Kentucky was presented to the 10 general surgery residents at Tenwek Hospital. The curriculum and all materials were purchased for approximately $50 (USD). The residents in Kenya had access to laparoscopic trainer boxes and personal laptops to perform the simulations. Residents were timed on their performance at the initiation of the project and after 3 weeks of practice. RESULTS Residents were tested on 3 separate tasks (cannulation drill, peg board, and rope pass). At the initiation of the project, residents were unable to complete the 3 tasks chosen for timing without a critical error (i.e., dropping a peg out of view). After 3 weeks of independent practice, residents were able to successfully complete the tasks, nearing the time limits established in the curriculum manual. Additional practice and testing sessions are scheduled for the remainder of the year. CONCLUSIONS Implementation of a low-cost laparoscopic skills curriculum in a third-world setting is feasible. This approach offers much-needed exposure and opportunities for residents with extremely limited resources and promises to be a vital aspect of the growing surgical residency training in third-world settings.
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Affiliation(s)
- Kristin L Long
- Department of General Surgery, University of Kentucky, Lexington, Kentucky.
| | - Carol Spears
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | - Daniel E Kenady
- Department of General Surgery, University of Kentucky, Lexington, Kentucky
| | - John Scott Roth
- Department of General Surgery, University of Kentucky, Lexington, Kentucky
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Long KL, Hamilton DA, Davenport DL, Bernard AC, Kearney PA, Chang PK. A prospective, controlled evaluation of the abdominal reapproximation anchor abdominal wall closure system in combination with VAC therapy compared with VAC alone in the management of an open abdomen. Am Surg 2014; 80:567-571. [PMID: 24887794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac™ (VAC) or KCI ABThera™ would increase successful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA). All patients underwent regular VAC changes; patients receiving VAC-ABRA also underwent concomitant daily elastomer adjustment of the ABRA system. Primary end points included abdominal closure, number of operating room (OR) visits, and OR time use. Eight patients were included in the VAC-ABRA group and six patients in the control group. Primary closure rates between groups were not statistically different; however, the number of trips to the OR and OR time use were different. Despite higher Acute Physiology and Chronic Health Evaluation II scores, larger starting wound size, and higher rates of abdominal compartment syndrome, closure rates in the VAC-ABRA group were similar to VAC alone. Importantly, however, fewer OR trips and less OR time were required for the VAC-ABRA group.
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Affiliation(s)
- Kristin L Long
- Division of General Surgery-Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
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Long KL, Huang B, Guo J, Lee C, Sloan D, McKenzie S. Concerning trends in Appalachian patients with thyroid carcinoma. Am Surg 2014; 80:620-623. [PMID: 24887803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Kristin L Long
- Department of General Surgery, University of Kentucky, Lexington, Kentucky, USA
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Long KL, Huang B, Guo J, Lee C, Sloan D, McKenzie S. Concerning Trends in Appalachian Patients with Thyroid Carcinoma. Am Surg 2014. [DOI: 10.1177/000313481408000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kristin L. Long
- Department of General Surgery University of Kentucky Lexington, Kentucky
| | - Bin Huang
- Division of Surgical Oncology University of Kentucky Lexington, Kentucky
| | - Jing Guo
- Division of Surgical Oncology University of Kentucky Lexington, Kentucky
| | - Cortney Lee
- Division of Endocrine Surgery University of Kentucky Lexington, Kentucky
| | - David Sloan
- Division of Endocrine Surgery University of Kentucky Lexington, Kentucky
| | - Shaun McKenzie
- Division of Surgical Oncology University of Kentucky Lexington, Kentucky
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Long KL, Spears C, Kenady DE. Branchial cleft cyst encircling the hypoglossal nerve. J Surg Case Rep 2013; 2013:rjt068. [PMID: 24963902 PMCID: PMC3813768 DOI: 10.1093/jscr/rjt068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Branchial cleft anomalies are a common cause of lateral neck masses and may present with infection, cyst enlargement or fistulas. They may affect any of the nearby neck structures, causing compressive symptoms or vessel thrombosis. We present a case of a branchial cleft cyst in a 10-year-old boy who had been present for 1year. At the time of operation, the cyst was found to completely envelop the hypoglossal nerve. While reports of hypoglossal nerve palsies due to external compression from cysts are known, we believe this to be the first report of direct nerve involvement by a branchial cleft cyst.
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Affiliation(s)
- Kristin L Long
- Division of General Surgery, University of Kentucky, Lexington, KY, USA
| | - Carol Spears
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | - Daniel E Kenady
- Division of Surgical Oncology, University of Kentucky, Lexington, KY, USA
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Long KL, Spears C, Kenady DE, Roth SJ. Implementation of a low-cost laparoscopic skills curriculum in a third world setting. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Primary hyperparathyroidism from a parathyroid adenoma is common. Ectopic parathyroid glands have been reported in numerous locations, including the chest. We present a single case report of an intrapericardial parathyroid gland found after failed bilateral neck exploration. The patient presented with severe, recurrent nephrolithiasis and acute renal failure prior to his surgical intervention. Repeat imaging identified a parathyroid adenoma in the mediastinum that was localized to the aortopulmonary window. After attempts at minimally invasive thoracotomy and posterolateral thoracotomy, a median sternotomy was ultimately required to identify the adenoma.
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Affiliation(s)
- Kristin L Long
- Department of General Surgery, University of Kentucky, Lexington, KY, USA
| | - Cortney Y Lee
- Division of Endocrine Surgery, University of Kentucky, Lexington, KY, USA
| | - Chand Ramaiah
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY, USA
| | - David A Sloan
- Division of Endocrine Surgery, University of Kentucky, Lexington, KY, USA
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Abstract
Chondromyxoid fibromas are benign tumors which are found most frequently in the metaphyses of long bones. They comprise less than 1% of primary bone neoplasms and display a hypermetabolic appearance on PET imaging. Oftentimes, they are misdiagnosed as chondrosarcomas and are excised due to concern for malignancy. We present a case of a condromyxoid fibroma originating from the second rib of a 15-year-old girl.
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Affiliation(s)
- Kristin L Long
- Department of Surgery, University of Kentucky, Lexington, KY 40536, USA
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Long KL, Gilligan L, Cox KM, Draus JM. Characteristics of Children Referred for Drainage of Sub-cutaneous Soft Tissue Infections. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ijcm.2013.47a2006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Evans JL, Golden BL, Bourdon RM, Long KL. Additive genetic relationships between heifer pregnancy and scrotal circumference in Hereford cattle. J Anim Sci 1999; 77:2621-8. [PMID: 10521020 DOI: 10.2527/1999.77102621x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to determine an appropriate method for using yearling scrotal circumference observations and heifer pregnancy observations to produce EPD for heifer pregnancy. We determined the additive genetic effects of and relationship between scrotal circumference and heifer pregnancy for a herd of Hereford cattle in Solano, New Mexico. The binary trait of heifer pregnancy was defined as the probability of a heifer conceiving and remaining pregnant to 120 d, given that she was exposed at breeding. Estimates of heritability for heifer pregnancy and scrotal circumference were .138+/-.08 and .714+/-.132, respectively. Estimates of fixed effects for age of dam and age were significant for heifer pregnancy and bull scrotal circumference. The estimate of the additive genetic correlation between yearling heifer pregnancy and yearling bull scrotal circumference was .002+/-.45. Additional analyses included models with additive genetic groups for scrotal circumference EPD for heifer pregnancy or heifer pregnancy EPD for scrotal circumference to account for a potential nonlinear relationship between scrotal circumference and heifer pregnancy. Results support the development of a heifer pregnancy EPD because of a higher estimated heritability than previously reported. The development of a heifer pregnancy EPD would be an additional method for improving genetic merit for heifer fertility.
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Affiliation(s)
- J L Evans
- Department of Animal Sciences, Colorado State University, Fort Collins 80523, USA
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Abstract
One hand of each of 10 subjects was immersed in stirred water at 4 °C for 1 h per day, 5 days per week, for 3 weeks, to produce local acclimatization to cold. The opposite hand was immersed at the same time in water at 32 °C. The reactivity of digital vessels in a finger of each hand was measured as the increase in the critical opening pressure of the vessels in response to an intravenous infusion of noradrenaline at 2 and 5 μg/min. The reactivity of digital vessels in the test hand was compared with that in the control hand both before and after the repeated cold exposure of the test hand to see whether the cold exposure altered the reactivity of vessels in the test hand relative to that in the control hand. No evidence of such a relative change was obtained. Resting blood flow at 21 and 32 °C in the test hand was compared with that in the control hand both before and after the repeated cold exposure. No change in the relative flow rate in the two hands was observed as a result of the cold exposure. Roentgen studies of the hands did not reveal any effect of the repeated cold exposure on the mineralization of the bones of the hands.
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