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Rosengart TK, Chen JH, Gantt NL, Angelos P, Warshaw AL, Rosen JE, Perrier ND, Kaups KL, Doherty GM, Zoumpou T, Ashley SW, Doscher W, Welsh D, Savarise M, Sutherland MJ, Sidawy AN, Kopelan AM. Sustaining Lifelong Competency of Surgeons: Multimodality Empowerment Personal and Institutional Strategy. J Am Coll Surg 2024:00019464-990000000-00939. [PMID: 38591782 DOI: 10.1097/xcs.0000000000001066] [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: 04/10/2024]
Affiliation(s)
- Todd K Rosengart
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Jennifer H Chen
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Nancy L Gantt
- Department of Surgery, Northeast Ohio Medical University, Youngstown, OH
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jennifer E Rosen
- Division of Endocrine Surgery, MedStar-Washington Hospital Center, Washington, DC
| | - Nancy D Perrier
- Department of Surgical Oncology, Section of Surgical Endocrinology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Krista L Kaups
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Theofano Zoumpou
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William Doscher
- Department of Surgery, Zucker School of Medicine at Hofstra, Northwell, NY
| | | | - Mark Savarise
- Section of Community General Surgery, University of Utah South Jordan Health Center, South Jordan, UT
| | | | - Anton N Sidawy
- Department of Surgery, George Washington University, Washington, DC
| | - Adam M Kopelan
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, NJ
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Huang LC, Johnson JE, Bleicher J, Blumling AN, Savarise M, Wetter DW, Cohan JN, Harris AA, Kaphingst KA. Promoting Disposal of Left-Over Opioids After Surgery in Rural Communities: A Qualitative Description Study. Health Educ Behav 2023; 50:281-289. [PMID: 34963358 PMCID: PMC10473843 DOI: 10.1177/10901981211057540] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients rarely dispose of left-over opioids after surgery. Disposal serves as a primary prevention against misuse, overdose, and diversion. However, current interventions promoting disposal have mixed efficacy. Increasing disposal in rural communities could prevent or reduce the harms caused by prescription opioids. AIMS Identify barriers and facilitators to disposal in the rural communities of the United States Mountain West region. METHODS We conducted a qualitative description study with 30 participants from Arizona, Idaho, Montana, Nevada, Oregon, Utah, and Wyoming. We used a phronetic iterative approach combining inductive content and thematic analysis with deductive interpretation through the Precaution Adoption Process Model (PAPM). RESULTS We identified four broad themes: (a) awareness, engagement, and education; (b) low perceived risk associated with nondisposal; (c) deciding to keep left-over opioids for future use; and (d) converting decisions into action. Most participants were aware of the importance of disposal but perceived the risks of nondisposal as low. Participants kept opioids for future use due to uncertainty about their recovery and future treatments, breakdowns in the patient-provider relationship, chronic illness or pain, or potential future injury. The rural context, particularly convenience, cost, and environmental contamination, contributes to decisional burden. CONCLUSIONS We identified PAPM stage-specific barriers to disposal of left-over opioids. Future interventions should account for where patients are along the spectrum of deciding to dispose or not dispose as well as promoting harm-reduction strategies for those who choose not to dispose.
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Affiliation(s)
| | | | | | | | | | | | | | - Alex A.S. Harris
- Stanford University, CA, USA
- VA Palo Alto Healthcare System, CA, USA
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Johnson JE, Bleicher J, Blumling AN, Cain BT, Cohan JN, Savarise M, Harris AHS, Kaphingst KA, Huang LC. The Influence of Rural Healthcare Systems and Communities on Surgery and Recovery: A Qualitative Study. J Surg Res 2023; 281:155-163. [PMID: 36155272 PMCID: PMC10473841 DOI: 10.1016/j.jss.2022.08.028] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Successful recovery after surgery is complex and highly individual. Rural patients encounter greater barriers to successful surgical recovery than urban patients due to varying healthcare and community factors. Although studies have previously examined the recovery process, rural patients' experiences with recovery have not been well-studied. The rural socioecological context can provide insights into potential barriers or facilitators to rural patient recovery after surgery. METHODS We conducted semi-structured qualitative interviews with a purposeful sample of 30 adult general surgery patients from rural areas in the Mountain West region of the United States. We used the socioecological framework to analyze their responses. Interviews focused on rural participants' experiences accessing healthcare and the impact of family and community support during postoperative recovery. Interviews were transcribed verbatim and coded using content and thematic analysis. RESULTS All participants commented on the quality of their rural healthcare systems and its influence on postoperative care. Some enjoyed the trust developed through long-standing relationships with providers in their communities. However, participants described community providers' lack of money, equipment, and/or knowledge as barriers to care. Following surgery, participants recognized that there are advantages and disadvantages to receiving family and community support. Some participants worried about being stigmatized or judged by their community. CONCLUSIONS Future interventions aimed at improving access to and recovery from surgery for rural patients should take into account the unique perspectives of rural patients. Addressing the socioecological factors surrounding rural surgery patients, such as healthcare, family, and community resources, will be key to improving postoperative recovery.
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Affiliation(s)
- Jordan E Johnson
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | - Brian T Cain
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jessica N Cohan
- Department of Surgery, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Mark Savarise
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Alex H S Harris
- VA HSR&D Center for Innovation to Implementation, Palo Alto VA Health Care System, Washington, District of Columbia
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Lyen C Huang
- Department of Surgery, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
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Savarise M, Buhavac M. "Least favorite consult": Invited commentary to "Fix it while you can: Mortality after umbilical hernia repair in cirrhotic patients". Am J Surg 2020; 220:1400-1401. [PMID: 32854903 DOI: 10.1016/j.amjsurg.2020.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/31/2023]
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Huang LC, Esplin J, Cohan J, Savarise M, Kaphingst KA. Rural Patient Experience after Surgery. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.831] [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: 11/25/2022]
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Senkowski C, Savarise M, Roth JS, Nagle J. Hernia repair and complex abdominal wall reconstruction. Bull Am Coll Surg 2017; 102:52-59. [PMID: 28920648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Barney L, Savarise M, Whitacre E. Frequently asked questions about coding for breast surgery. Bull Am Coll Surg 2014; 99:52-54. [PMID: 25272428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Barney L, Mabry C, Ollapally V, Savarise M, Senkowski C. Reporting patient safety indicator-15. Bull Am Coll Surg 2014; 99:39-42. [PMID: 24868845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Napolitano LM, Savarise M, Paramo JC, Soot LC, Todd SR, Gregory J, Timmerman GL, Cioffi WG, Davis E, Sachdeva AK. Are General Surgery Residents Ready to Practice? A Survey of the American College of Surgeons Board of Governors and Young Fellows Association. J Am Coll Surg 2014; 218:1063-1072.e31. [DOI: 10.1016/j.jamcollsurg.2014.02.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/09/2013] [Accepted: 02/03/2014] [Indexed: 11/28/2022]
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Barney L, Nicoletti B, Savarise M. Billing for services performed by nonphysician practitioners. Bull Am Coll Surg 2014; 99:36-38. [PMID: 24868844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Jackson JJ, Mabry CD, Savarise M. The complexities of coding bilateral procedures. Bull Am Coll Surg 2013; 98:47-49. [PMID: 24266119] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jenny J Jackson
- ACS Division of Advocacy and Health Policy, Washington, DC, USA
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Savarise M, Como JJ. ACS fellows provide surgical leadership and service in India. Bull Am Coll Surg 2013; 98:30-35. [PMID: 23691676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Savarise M. Coding for hospital admission, consultations, and emergency department visits. Bull Am Coll Surg 2013; 98:54-56. [PMID: 23441509] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Barney L, Jackson J, Ollapally V, Savarise M. 2013 payment policy and coding changes affecting surgical practice. Bull Am Coll Surg 2013; 98:9-17. [PMID: 23359908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Barney L, Savarise M, Jackson J. Coding for skin replacement surgery in 2012. Bull Am Coll Surg 2012; 97:41-44. [PMID: 24010255] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Linda Barney
- Department of Surgery, Wright State University Boonshoft School of Medicine, USA
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Barney L, Savarise M, Jackson J. CPT 2012 brings with it new codes and code changes. Bull Am Coll Surg 2012; 97:26-32. [PMID: 22315880] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Linda Barney
- Department of Surgery, Wright State University, Boonshoft School of Medicine
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Barney L, Nagle D, Roddy S, Savarise M, Senkowski C, Whitacre E, Jackson J. Surgical coding across the spectrum. Bull Am Coll Surg 2011; 96:44-47. [PMID: 22319927] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Linda Barney
- Department of Surgery, Wright State University Boonshoft School of Medicine, USA
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Barney L, Savarise M, Whitacre E. Sentinel lymph node mapping and its relation to biopsy. Bull Am Coll Surg 2011; 96:30-59. [PMID: 22319945] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Linda Barney
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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