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  1. Article ; Online: Finding My Phenotype.

    Howard, Ryan

    Academic medicine : journal of the Association of American Medical Colleges

    2023  

    Language English
    Publishing date 2023-10-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 96192-9
    ISSN 1938-808X ; 1040-2446
    ISSN (online) 1938-808X
    ISSN 1040-2446
    DOI 10.1097/ACM.0000000000005503
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 112: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Change Begins at the Bottom.

    Howard, Ryan

    Academic medicine : journal of the Association of American Medical Colleges

    2022  Volume 98, Issue 5, Page(s) 540–541

    Language English
    Publishing date 2022-10-25
    Publishing country United States
    Document type Letter
    ZDB-ID 96192-9
    ISSN 1938-808X ; 1040-2446
    ISSN (online) 1938-808X
    ISSN 1040-2446
    DOI 10.1097/ACM.0000000000005058
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Leveraging the perioperative period to improve population health.

    Howard, Ryan / Englesbe, Michael

    Perioperative medicine (London, England)

    2023  Volume 12, Issue 1, Page(s) 21

    Abstract: Although surgical care has become safer, cheaper, and more efficient, it has only a modest impact on the overall health of society, which is driven primarily by health behaviors such as smoking, alcohol use, poor diet, and physical inactivity. Given the ... ...

    Abstract Although surgical care has become safer, cheaper, and more efficient, it has only a modest impact on the overall health of society, which is driven primarily by health behaviors such as smoking, alcohol use, poor diet, and physical inactivity. Given the ubiquity of surgical care in the population, it represents a critical opportunity to screen for and address the health behaviors that drive premature mortality at a population level. Patients are especially receptive to behavior change around the time of surgery, and many health systems already have programs in place to address these issues. In this commentary, we present the case for integrating health behavior screening and intervention into the perioperative pathway as a novel and impactful way to improve the health of society.
    Language English
    Publishing date 2023-06-05
    Publishing country England
    Document type Letter
    ZDB-ID 2683800-X
    ISSN 2047-0525
    ISSN 2047-0525
    DOI 10.1186/s13741-023-00311-5
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  4. Article: Challenges and Strategies in Colorectal Surgery among Patients with Morbid Obesity

    Dualeh, Shukri H.A. / Howard, Ryan

    Clinics in Colon and Rectal Surgery

    (Colorectal Surgery Among Medically Vulnerable and Marginalized Populations)

    2024  

    Abstract: This chapter explores the interplay between morbid obesity and the challenges encountered in colorectal surgery. Understanding the unique considerations in preoperative and intraoperative management along with weight optimization tools such as bariatric ... ...

    Series title Colorectal Surgery Among Medically Vulnerable and Marginalized Populations
    Abstract This chapter explores the interplay between morbid obesity and the challenges encountered in colorectal surgery. Understanding the unique considerations in preoperative and intraoperative management along with weight optimization tools such as bariatric surgery emerges as potential mitigators, demonstrating benefits in reducing colorectal cancer risk and improving perioperative outcomes. Furthermore, the pervasive stigma associated with morbid obesity further complicates patient care, emphasizing the need for empathetic and nuanced approaches. Recommendations for minimizing stigma involve recognizing obesity as a medical diagnosis, fostering respectful communication, and actively dispelling misconceptions. Colorectal surgeons are pivotal in navigating these complexities, ensuring comprehensive and tailored care for patients with morbid obesity.
    Keywords morbid obesity ; colorectal surgery ; bariatric surgery ; stigma
    Language English
    Publishing date 2024-04-25
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2048635-2
    ISSN 1530-9681 ; 1531-0043
    ISSN (online) 1530-9681
    ISSN 1531-0043
    DOI 10.1055/s-0044-1786391
    Database Thieme publisher's database

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    Zs.A 3931: Show issues Location:
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  5. Article ; Online: Citation Accuracy vs Citation Integrity.

    Howard, Ryan / Englesbe, Michael

    JAMA surgery

    2022  Volume 157, Issue 4, Page(s) 361–362

    MeSH term(s) Bibliometrics ; Data Collection ; Humans ; Journal Impact Factor
    Language English
    Publishing date 2022-01-12
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2021.6552
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  6. Article ; Online: Visual Abstracts Come of Age: It's Time for Quality Improvement.

    Howard, Ryan / Ibrahim, Andrew M

    Annals of surgery

    2022  Volume 276, Issue 5, Page(s) e284–e285

    MeSH term(s) Humans ; Quality Improvement ; Periodicals as Topic
    Language English
    Publishing date 2022-06-27
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005542
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Excessive Opioid Prescribing After Surgery - A Uniquely American Problem.

    Howard, Ryan / Waljee, Jennifer F

    Annals of surgery

    2021  Volume 272, Issue 6, Page(s) 887–888

    MeSH term(s) Analgesics, Opioid/therapeutic use ; Drug Prescriptions ; Humans ; Pain, Postoperative/drug therapy ; Practice Patterns, Physicians' ; United States
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2021-01-13
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000004392
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.35/1: Show issues Location:
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  8. Article ; Online: Association Of Opioid Prescribing And Consumption With Patient-Reported Experiences And Satisfaction Following Emergency Surgery In Michigan.

    Rosenthal, Lindsay / Gunaseelan, Vidhya / Waljee, Jennifer / Bicket, Mark / Englesbe, Michael / Howard, Ryan

    Annals of surgery

    2024  

    Abstract: Objective: To investigate the relationships between opioid prescribing, consumption, and patient reported outcomes (PROs) in emergency surgery patients.: Summary background data: Overprescribing of opioids for pain management after surgery has become ...

    Abstract Objective: To investigate the relationships between opioid prescribing, consumption, and patient reported outcomes (PROs) in emergency surgery patients.
    Summary background data: Overprescribing of opioids for pain management after surgery has become a public health concern and major contributor to opioid misuse and dependency. Current guidelines do not address opioid prescribing following emergency surgical procedures, highlighting the importance of understanding the relationship between opioid prescribing and consumption in this setting.
    Methods: Retrospective analysis of the quantity of opioids prescribed and patient-reported outcomes (PROs) in a population-based setting. The sample included adults 18 years and older undergoing emergency surgery across 69 hospitals in Michigan. Patients were included if they received a discharge opioid prescription and had valid data for opioid consumption and PROs. Surgical procedures took place between January 1, 2018 and December 31, 2020.
    Results: During the study period, a total of 3,742 patients underwent an emergency operation. The mean number of opioid pills prescribed was 9.6 and the mean number of opioid pills consumed was 4.6. In a two-model with logit in the first part and a linear regression in the second, prescription size was significantly associated with both the probability of consumption (aOR 1.02, 95% CI 1.01-1.04) and the amount of consumption conditional on any consumption (coefficient 0.70 95% CI 0.54-0.86).
    Conclusions and relevance: Patients only consumed half of the opioids they were prescribed after undergoing emergency surgery. Additionally, patients who were given larger prescriptions consumed more opioids, but did not experience less pain, higher satisfaction, better quality of life, or less regret to undergo surgery. Overall, this suggests that opioids may be excessively prescribed to patients undergoing emergency surgical procedures, and that larger prescriptions do not improve the patient experience after surgery.
    Language English
    Publishing date 2024-03-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000006264
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.35/1: Show issues Location:
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  9. Article ; Online: The Measurement Reliability of Complications and Patient Satisfaction After Common Surgical Procedures.

    Howard, Ryan / Thumma, Jyothi / Englesbe, Michael

    Annals of surgery

    2022  Volume 277, Issue 5, Page(s) 775–780

    Abstract: Objective: To evaluate the reliability of surgeon outcomes.: Background: Surgeons' outcomes are now widely used in public reporting and value-based reimbursement, but the reliability of these measures continues to raise concerns.: Methods: We ... ...

    Abstract Objective: To evaluate the reliability of surgeon outcomes.
    Background: Surgeons' outcomes are now widely used in public reporting and value-based reimbursement, but the reliability of these measures continues to raise concerns.
    Methods: We performed a retrospective study of surgeons performing cholecystectomy, colectomy, and hernia repair on adult patients between January 1, 2017, and December 31, 2020. Outcomes were risk-adjusted rates of complications and high patient satisfaction. We estimated the reliability of each outcome, its relationship with case volume, and the number of surgeons who reached an acceptable level of reliability (≥0.70).
    Results: A total of 23,533 patients with a mean age of 56.8 (16.2) years and 10,191 (43.3%) females underwent operations by 333 surgeons. Risk-adjusted complication rate was 2.5% [95% confidence interval (CI): 2.2%-2.8%] and risk-adjusted high satisfaction rate was 79.9% (95% CI: 78.7%-81.0%). The reliability of the complication rate was 0.27 (95% CI: 0.25-0.29) and the reliability of the high satisfaction rate was 0.53 (95% CI: 0.50-0.55). Reliability increased with case volume; however, only 5 (1.5%) surgeons performed enough cases to reach acceptable reliability for their complication rate, while 86 (25.8%) surgeons reached acceptable reliability for their patient satisfaction rate. After adjustment for reliability, the range of complication rates decreased 29-fold from 0% to 14.3% to 2.4% to 2.9%, and the range of patient satisfaction decreased 2.6-fold from 25.3% to 100.0% to 64.9% to 92.4%.
    Conclusions: Among surgeons performing common operations, complications and patient satisfaction had relatively low reliability. Although reliability increased with volume, most surgeons had insufficient case volume to achieve acceptable reliability of their outcomes. As such, these measures likely offer little to no meaningful information to inform decision-making.
    MeSH term(s) Adult ; Female ; Humans ; Middle Aged ; Male ; Retrospective Studies ; Patient Satisfaction ; Reproducibility of Results ; Postoperative Complications/epidemiology ; Surgeons
    Language English
    Publishing date 2022-07-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005451
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Ruptured ulnar artery aneurysm in vascular Ehlers-Danlos syndrome.

    Howard, Ryan / Osborne, Nicholas

    Journal of vascular surgery cases and innovative techniques

    2020  Volume 6, Issue 1, Page(s) 71–74

    Abstract: Vascular Ehlers-Danlos syndrome (vEDS), also known as type IV Ehlers-Danlos syndrome, is a rare inherited connective tissue disease that affects 1 in 50,000 to 250,000 individuals. It is characterized by catastrophic vascular complications and hollow ... ...

    Abstract Vascular Ehlers-Danlos syndrome (vEDS), also known as type IV Ehlers-Danlos syndrome, is a rare inherited connective tissue disease that affects 1 in 50,000 to 250,000 individuals. It is characterized by catastrophic vascular complications and hollow viscus rupture; 80% of patients with vEDS experience a vascular complication by the age of 40 years, and median life expectancy is 40 to 50 years. The central vasculature and visceral vasculature are most commonly affected; peripheral involvement is much less common. We describe the case of a 40-year-old woman with vEDS previously complicated by ruptured splenic and posterior tibial artery aneurysms who presented with a ruptured left ulnar artery aneurysm resulting in compartment syndrome.
    Language English
    Publishing date 2020-02-12
    Publishing country United States
    Document type Case Reports
    ISSN 2468-4287
    ISSN 2468-4287
    DOI 10.1016/j.jvscit.2019.11.013
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