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Article ; Online: A novel preoperative score to predict severe acute cholecystitis.

Kuhlenschmidt, Kali / Taveras, Luis R / Schuster, Kevin M / Kaafarani, Haytham M / El Hechi, Majed / Puri, Ruchir / Crandall, Marie / Schroeppel, Thomas J / Cripps, Michael W

The journal of trauma and acute care surgery

2024

Abstract: Background: In a large multicenter trial, The Parkland Grading Scale(PGS) for acute cholecystitis outperformed other grading scales and has a positive correlation with complications but is limited in its inability to preoperatively predict high-grade ... ...

Abstract	Background: In a large multicenter trial, The Parkland Grading Scale(PGS) for acute cholecystitis outperformed other grading scales and has a positive correlation with complications but is limited in its inability to preoperatively predict high-grade cholecystitis. We sought to identify preoperative variables predictive of high-grade cholecystitis(PGS 4 or 5). Methods: In a six-month period, patients undergoing cholecystectomy at a single institution with prospectively graded PGS were analyzed. Stepwise logistic regression models were constructed to predict high-grade cholecystitis. The relative weight of the variables was used to derive a novel score, the Severe Acute Cholecystitis Score(SACS). This score was compared to the Emergency Surgery Acuity Score(ESS), American Association for the Surgery of Trauma(AAST) preoperative score and Tokyo Guidelines(TG) for their ability to predict high-grade cholecystitis. SACS was then validated using the database from the AAST multicenter validation of the grading scale for acute cholecystitis. Results: Of the 575 patients that underwent cholecystectomy, 172(29.9%) were classified as high-grade. The stepwise logistic regression modeling identified 7 independent predictors of high-grade cholecystitis. From these variable the SACS was derived. Scores ranged from 0 to 9 points with a C statistic of 0.76, outperforming the ESS(C statistic of 0.60), AAST(0.53), and TG(0.70)(p-value <0.001). Using a cutoff of 4 or more on the SACS correctly identifies 76.2% of cases with a specificity of 91.3% and a sensitivity of 40.7%.In the multicenter database, there were 464 patients with a prospectively collected PGS. The C statistic for SACS was 0.74. Using the same cutoff of 4, SACS correctly identifies 71.6% of cases with a specificity of 83.8% and a sensitivity of 52.2%. Conclusions: The Severe Acute Cholecystitis Score can preoperatively predict high-grade cholecystitis and may be useful for counseling patients and assisting in surgical decision making. Level of evidence: Prognostic Level III.
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004308
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Article: A case report of a de Garengeot hernia in a nonagenarian veteran.

Taveras, Luis R / Huerta, Sergio

International journal of surgery case reports

2017 Volume 41, Page(s) 301–303

Abstract: Introduction: A hernia containing the vermiform appendix [de Garengeot hernia (DGH)] is an exceedingly rare event. Appendicitis occurring in this setting if further unusual. Most cases of DGH are made during inguinal exploration. In the present report, ... ...

Abstract	Introduction: A hernia containing the vermiform appendix [de Garengeot hernia (DGH)] is an exceedingly rare event. Appendicitis occurring in this setting if further unusual. Most cases of DGH are made during inguinal exploration. In the present report, we discuss a patient who underwent an operation which revealed a DGH with appendicitis. Presentation of a case: A 94-year-old man with a past medical history significant for hypertension and Parkinson's disease was admitted to the hospital for the management of an event of CHF exacerbation. He developed acute onset of a painful right inguinal bulge. He had no prior hernia history. On physical exam, he had a 3-cm, tender, non-reducible right inguinal bulge without skin changes. Laboratory analyses were normal without leukocytosis. An acute abdominal series was obtained and demonstrated no obstruction. A groin exploration was performed under local anesthetic. An abscess was found associated with a femoral hernia containing the vermiform appendix. An appendectomy was performed through the hernia sac. The hernia was repaired via a McVay technique. At thirty days after his procedure, he had no complications and no signs of recurrence. Conclusion: Most cases of DGH are diagnosed intraoperatively. Limited work up might be sufficient for adequate management. Several surgical strategies are acceptable. Groin exploration, plus and minus an appendectomy, and tissue repair versus mesh placement are acceptable surgical strategies. Laparoscopic approach for the management of DGH has been reported.
Language	English
Publishing date	2017-11-03
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2017.10.049
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Article ; Online: Clinical and molecular diagnosis of pathologic complete response in rectal cancer: an update.

Timmerman, Corey / Taveras, Luis R / Huerta, Sergio

Expert review of molecular diagnostics

2018 Volume 18, Issue 10, Page(s) 887–896

Abstract: Introduction: The standard of care for locally advanced rectal cancer includes neoadjuvant chemoradiation with subsequent total mesorectal excision. This approach has shown various degrees of response to neoadjuvant chemoradiation (ranging from complete ...

Abstract	Introduction: The standard of care for locally advanced rectal cancer includes neoadjuvant chemoradiation with subsequent total mesorectal excision. This approach has shown various degrees of response to neoadjuvant chemoradiation (ranging from complete response to further tumor growth), which have substantial prognostic and therapeutic implications. A total regression of the tumor is a predictor of superior oncologic outcomes compared with partial responders and non-responders. Further, this concept has opened the possibility of nonoperative strategies for complete responders and explains the widespread research interest in finding clinical, radiographic, pathologic, and biochemical parameters that allow for identification of these patients. Areas covered: The present review evaluates the most recent efforts in the literature to identify predictors of patients likely to achieve a complete response following neoadjuvant treatment for the management of rectal cancer. This includes clinical predictors of pathologic complete response such as tumor location, size, and stage, molecular predictors such as tumor biology and microRNA, serum biomarkers such as carcinoembryogenic antigen and nomograms. Expert commentary: There has been significant progress in our ability to predict pathological complete response. However, more high-quality research is still needed to use this concept to confidently dictate clinical management.
MeSH term(s)	Biomarkers, Tumor ; Combined Modality Therapy ; Humans ; Molecular Diagnostic Techniques ; Neoplasm Grading/methods ; Neoplasm Staging/methods ; Nomograms ; Prognosis ; Rectal Neoplasms/diagnosis ; Rectal Neoplasms/therapy ; Treatment Outcome
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2018-09-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2112530-2
ISSN	1744-8352 ; 1473-7159
ISSN (online)	1744-8352
ISSN	1473-7159
DOI	10.1080/14737159.2018.1514258
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Article ; Online: Burnout in Surgical Residents of Underrepresented in Medicine Backgrounds: Key Influencing Factors and Possible Solutions.

Teke, Martha E / Taveras, Luis R / Meier, Jennie / Johnson, Courtney C / Marshall, Nicholas J E / Hynan, Linda S / Nwariaku, Fiemu E / Zeh, Herbert J / Abdelfattah, Kareem R

The Journal of surgical research

2023 Volume 291, Page(s) 51–57

Abstract: Introduction: Alarming rates of burnout in surgical training pose a concern due to its deleterious effects on both patients and providers. Datum remains lacking on rates of burnout in surgical residents based on race and ethnicity. This study aims to ... ...

Abstract	Introduction: Alarming rates of burnout in surgical training pose a concern due to its deleterious effects on both patients and providers. Datum remains lacking on rates of burnout in surgical residents based on race and ethnicity. This study aims to document the frequency of burnout in surgical residents of racially underrepresented backgrounds and elucidate contributing factors. Methods: A 35-question anonymized survey was distributed to general surgery residents from 23 programs between August 2018 and May 2019. This survey was designed from the validated Maslach Burnout Inventory, and included additional questions assessing participant demographics, educational, and social backgrounds. Responses were analyzed utilizing chi-square tests and Wilcoxon rank sum tests. There was also a free response portion of the survey which was evaluated using thematic analysis. Results: We received 243 responses from 23 general surgery programs yielding a 9% (23/246) program response rate and 26% (243/935) response rate by surgical residents. One hundred and eighty-five participants (76%) identified as nonunderrepresented in medicine and 58 (24%) of participants identified as underrepresented in medicine. Fifty-three percent were male and 47% female. Overall, sixty-six percent of all surgical residents (n = 161) endorsed burnout with racially underrepresented residents reporting higher rates of burnout at 76% compared to 63% in their nonunderrepresented counterparts (P = 0.07). Conclusions: Although the generalizability of these results is limited, higher rates of reported burnout in racially underrepresented trainees noted in our study illuminates the need for continual dialogue on potential influencing factors and mitigation strategies.
MeSH term(s)	Humans ; Male ; Female ; Internship and Residency ; Burnout, Professional/epidemiology ; Burnout, Professional/etiology ; Surveys and Questionnaires ; Educational Status
Language	English
Publishing date	2023-06-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.05.022
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Article ; Online: Racial disparities in the utilization of invasive neuromodulation devices for the treatment of drug-resistant focal epilepsy.

Alcala-Zermeno, Juan Luis / Fureman, Brandy / Grzeskowiak, Caitlin L / Potnis, Ojas / Taveras, Maria / Logan, Margaret W / Rybacki, Delanie / Friedman, Daniel / Lowenstein, Daniel / Kuzniecky, Ruben / French, Jacqueline

Epilepsia

2024

Abstract: Racial disparities affect multiple dimensions of epilepsy care including epilepsy surgery. This study aims to further explore these disparities by determining the utilization of invasive neuromodulation devices according to race and ethnicity in a ... ...

Abstract	Racial disparities affect multiple dimensions of epilepsy care including epilepsy surgery. This study aims to further explore these disparities by determining the utilization of invasive neuromodulation devices according to race and ethnicity in a multicenter study of patients living with focal drug-resistant epilepsy (DRE). We performed a post hoc analysis of the Human Epilepsy Project 2 (HEP2) data. HEP2 is a prospective study of patients living with focal DRE involving 10 sites distributed across the United States. There were no statistical differences in the racial distribution of the study population compared to the US population using census data except for patients reporting more than one race. Of 154 patients enrolled in HEP2, 55 (36%) underwent invasive neuromodulation for DRE management at some point in the course of their epilepsy. Of those, 36 (71%) were patients who identified as White. Patients were significantly less likely to have a device if they identified solely as Black/African American than if they did not (odds ratio = .21, 95% confidence interval = .05-.96, p = .03). Invasive neuromodulation for management of DRE is underutilized in the Black/African American population, indicating a new facet of racial disparities in epilepsy care.
Language	English
Publishing date	2024-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.17961
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Zs.A 517: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Trainee Reliance on Public Service Loan Forgiveness.

Khoury, Mitri K / Jones, R Ellen / Gee, Kristin M / Taveras, Luis R / Boniakowski, Anna M / Coleman, Dawn M / Abdelfattah, Kareem R / Rectenwald, John E / Minter, Rebecca M

Journal of surgical education

2021 Volume 78, Issue 6, Page(s) 1878–1884

Abstract: Objective: The Public Service Loan Forgiveness (PSLF) program is an option to trainees to help alleviate federal education debt. The prevalence of PSLF utilization and how this may impact career decisions of trainees is unknown. The purpose of this ... ...

Abstract	Objective: The Public Service Loan Forgiveness (PSLF) program is an option to trainees to help alleviate federal education debt. The prevalence of PSLF utilization and how this may impact career decisions of trainees is unknown. The purpose of this study was to understand the prevalence, impact, and understanding of PSLF participation on trainees. Design: IRB-approved anonymous survey asking study subjects to report demographics, financial status, and reliance on PSLF. In addition, study subjects were asked to report their participation in PSLF, the possible impact of PSLF participation on career decisions, and to identify the qualifications needed to complete PSLF. Setting: Online anonymous survey. Participants: The survey was offered to all physician trainees in all specialties at the University of Texas, Southwestern, University of Wisconsin, Madison, and University of Michigan, Ann Arbor. Results: There were 934 respondents, yielding a 37.6% response rate. A total of 416/934 (44.5%) respondents were actively or planning on participating in the PSLF program with 175/934 (18.7%) belonging to a surgical specialty. Those belonging to a surgical specialty were more likely to be PSLF participants compared to medical specialties (53.1% versus 42.6%, p = 0.01). For those participating in PSLF, 82/416 (19.7%) stated this participation impacted career decisions. A total of 275/934 (29.4%) respondents obtained and 437/934 (46.8%) wanted to receive formal training/lectures in regards to the PSLF program. Of those actively or planning on participating in the PSLF program, only 58/416 (13.9%) were able to correctly identify all of the qualifications/criteria to complete the program. Conclusions: A large proportion of trainees rely on the PSLF program for education loan forgiveness with approximately 20% reporting participation impacted career decisions. Additionally, the majority may not fully understand PSLF criteria. Programs should strongly consider providing a formal education regarding PSLF to their trainees.
MeSH term(s)	Career Choice ; Education, Medical ; Forgiveness ; Humans ; Internship and Residency ; Surveys and Questionnaires ; Training Support
Language	English
Publishing date	2021-07-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2021.06.015
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Article ; Online: Association of the Risk of a Venous Thromboembolic Event in Emergency vs Elective General Surgery.

Ross, Samuel W / Kuhlenschmidt, Kali M / Kubasiak, John C / Mossler, Lindsey E / Taveras, Luis R / Shoultz, Thomas H / Phelan, Herbert A / Reinke, Caroline E / Cripps, Michael W

JAMA surgery

2021 Volume 155, Issue 6, Page(s) 503–511

Abstract: Importance: Trauma patients have an increased risk of venous thromboembolism (VTE), partly because of greater inflammation. However, it is unknown if this association is present in patients who undergo emergency general surgery (EGS).: Objectives: To ...

Abstract	Importance: Trauma patients have an increased risk of venous thromboembolism (VTE), partly because of greater inflammation. However, it is unknown if this association is present in patients who undergo emergency general surgery (EGS). Objectives: To investigate whether emergency case status is independently associated with VTE compared with elective case status and to test the hypothesis that emergency cases would have a higher risk of VTE. Design, setting, and participants: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, to December 31, 2016, for all cholecystectomies, ventral hernia repairs (VHRs), and partial colectomies (PCs) to obtain a sample of commonly encountered emergency procedures that have elective counterparts. Emergency surgeries were then compared with elective surgeries. The dates of analysis were January 1 to 31, 2019. Main outcomes and measures: The primary outcome was VTE at 30 days. A multivariable analysis controlling for age, sex, body mass index, bleeding disorder, disseminated cancer, laparoscopy approach, and surgery type was performed. Results: There were 604 537 adults undergoing surgical procedures over 12 years (mean [SD] age, 55.3 [16.6] years; 61.4% women), including 285 847 cholecystectomies, 158 500 VHRs, and 160 190 PCs. The rate of VTE within 30 days was 1.9% for EGS and 0.8% for elective surgery, a statistically significant difference. Overall, 4607 patients (0.8%) had deep vein thrombosis, and 2648 patients (0.4%) had pulmonary embolism. A total of 6624 VTEs (1.1%) occurred in the cohort. As expected, when VTE risk was examined by surgery type, the risk increased with invasiveness (0.5% for cholecystectomy, 0.8% for VHR, and 2.4% for PC; P < .001). On multivariable analysis, EGS was independently associated with VTE (odds ratio [OR], 1.70; 95% CI, 1.61-1.79). Also associated with VTE were open surgery (OR, 3.38; 95% CI, 3.15-3.63) and PC (OR, 1.86; 95% CI, 1.73-1.99). Conclusions and relevance: In this cohort study, emergency surgery and increased invasiveness appeared to be independently associated with VTE compared with elective surgery. Further study on methods to improve VTE chemoprophylaxis is highly recommended for emergency and more extensive operations to reduce the risk of potentially lethal VTE.
MeSH term(s)	Adult ; Aged ; Cohort Studies ; Elective Surgical Procedures ; Emergency Treatment ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Risk Assessment ; Venous Thromboembolism/epidemiology
Language	English
Publishing date	2021-12-08
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2020.0433
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Article ; Online: An analysis of surgical literature trends over four decades.

Comish, Paul B / Madni, Tarik D / Nakonezny, Paul A / Mayo, Helen / Imran, Jonathan B / Kuhlenschmidt, Kali M / Taveras, Luis R / Vela, Ryan J / Goldenmerry, Ypaul L / Clark, Audra T / Weis, Holly B / Cripps, Michael W / Wolf, Steven E

American journal of surgery

2020 Volume 221, Issue 1, Page(s) 53–54

MeSH term(s)	General Surgery ; Publishing/statistics & numerical data ; Publishing/trends ; Time Factors
Language	English
Publishing date	2020-07-16
Publishing country	United States
Document type	Editorial
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2020.07.011
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Article ; Online: Assessment of general surgery resident study habits and use of the TrueLearn question bank for American Board of Surgery In-Training exam preparation.

Imran, Jonathan B / Madni, Tarik D / Taveras, Luis R / Clark, Audra T / Ritchie, Christine / Cunningham, Holly B / Christie, Alana / Abdelfattah, Kareem R / Farr, Deborah

American journal of surgery

2019 Volume 218, Issue 3, Page(s) 653–657

Abstract: Background: Little information exists on the value of online question banks in preparing residents for the American Board of Surgery In-Training Examination (ABSITE).: Methods: We reviewed surgical residents' use of an online question bank (TrueLearn) ...

Abstract	Background: Little information exists on the value of online question banks in preparing residents for the American Board of Surgery In-Training Examination (ABSITE). Methods: We reviewed surgical residents' use of an online question bank (TrueLearn) and compared it to their ABSITE performance. Results: The 2016-2017 records of 44 PGY 2-5 general surgery residents were examined. The total number of TrueLearn questions answered significantly correlated (p < 0.05) with correct answers and percentile rank on the 2017 ABSITE. If a resident was to complete the entire online TL question bank consisting of 1000 questions, the overall percentage correct and overall percentile on the ABSITE is estimated to increase by 3% and 20%, respectively. Conclusions: The use of the TrueLearn question bank is associated with an improved percentage of ABSITE questions answered correctly and improved PGY percentile scores.
MeSH term(s)	Clinical Competence ; General Surgery/education ; Habits ; Internship and Residency/methods ; Retrospective Studies ; Specialty Boards ; Surveys and Questionnaires ; United States
Language	English
Publishing date	2019-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2019.02.031
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Article: Elucidating the Neuropathologic Mechanisms of SARS-CoV-2 Infection.

Pacheco-Herrero, Mar / Soto-Rojas, Luis O / Harrington, Charles R / Flores-Martinez, Yazmin M / Villegas-Rojas, Marcos M / León-Aguilar, Alfredo M / Martínez-Gómez, Paola A / Campa-Córdoba, B Berenice / Apátiga-Pérez, Ricardo / Corniel-Taveras, Carolin N / Dominguez-García, Jesabelle de J / Blanco-Alvarez, Víctor Manuel / Luna-Muñoz, José

Frontiers in neurology

2021 Volume 12, Page(s) 660087

Abstract: The current pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency. To date, March 1, 2021, coronavirus disease 2019 (COVID-19) has caused about 114 million accumulated cases and 2.53 ... ...

Abstract	The current pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency. To date, March 1, 2021, coronavirus disease 2019 (COVID-19) has caused about 114 million accumulated cases and 2.53 million deaths worldwide. Previous pieces of evidence suggest that SARS-CoV-2 may affect the central nervous system (CNS) and cause neurological symptoms in COVID-19 patients. It is also known that angiotensin-converting enzyme-2 (ACE2), the primary receptor for SARS-CoV-2 infection, is expressed in different brain areas and cell types. Thus, it is hypothesized that infection by this virus could generate or exacerbate neuropathological alterations. However, the molecular mechanisms that link COVID-19 disease and nerve damage are unclear. In this review, we describe the routes of SARS-CoV-2 invasion into the central nervous system. We also analyze the neuropathologic mechanisms underlying this viral infection, and their potential relationship with the neurological manifestations described in patients with COVID-19, and the appearance or exacerbation of some neurodegenerative diseases.
Language	English
Publishing date	2021-04-12
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2021.660087
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