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Article ; Online: Methods of measurement for pneumothorax in pediatric patients: a systematic review.

Owen, Grant S / Harmon, Kelly A / Sullivan, Gwyneth A / Petit, Hayley J / Westrick, Jennifer / Cameron, James R / Gulack, Brian C / Shah, Ami N

Pediatric surgery international

2024 Volume 40, Issue 1, Page(s) 77

Abstract: Accurate measurement of pneumothorax (PTX) size is necessary to guide clinical decision making; however, there is no consensus as to which method should be used in pediatric patients. This systematic review seeks to identify and evaluate the methods used ...

Abstract	Accurate measurement of pneumothorax (PTX) size is necessary to guide clinical decision making; however, there is no consensus as to which method should be used in pediatric patients. This systematic review seeks to identify and evaluate the methods used to measure PTX size with CXR in pediatric patients. A systematic review of the literature through 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted using the following databases: Ovid/MEDLINE, Scopus, Cochrane Database of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Original research articles that included pediatric patients (< 18 years old) and outlined the PTX measurement method were included. 45 studies were identified and grouped by method (Kircher and Swartzel, Rhea, Light, Collins, Other) and societal guideline used. The most used method was Collins (n = 16; 35.6%). Only four (8.9%) studies compared validated methods. All found the Collins method to be accurate. Seven (15.6%) studies used a standard classification guideline and 3 (6.7%) compared guidelines and found significant disagreement between them. Pediatric-specific measurement guidelines for PTX are needed to establish consistency and uniformity in both research and clinical practice. Until there is a better method, the Collins method is preferred.
MeSH term(s)	Adolescent ; Child ; Humans ; Clinical Decision-Making ; Pneumothorax/therapy
Language	English
Publishing date	2024-03-12
Publishing country	Germany
Document type	Journal Article ; Systematic Review
ZDB-ID	632773-4
ISSN	1437-9813 ; 0179-0358
ISSN (online)	1437-9813
ISSN	0179-0358
DOI	10.1007/s00383-024-05640-0
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Article ; Online: Association of social determinants of health-related diagnosis codes with postoperative outcomes.

Sullivan, Gwyneth A / Krishnan, Vaishnavi / Silver, Casey / Smith, Charesa / Raval, Mehul V / Gulack, Brian C / Shah, Ami N

World journal of surgery

2024

Abstract: Background: The association of an individual's social determinants of health-related problems with surgical outcomes has not been well-characterized. The objective of this study was to determine whether documentation of social determinants of a health- ... ...

Abstract	Background: The association of an individual's social determinants of health-related problems with surgical outcomes has not been well-characterized. The objective of this study was to determine whether documentation of social determinants of a health-related diagnosis code (Z code) is associated with postoperative outcomes. Methods: This retrospective cohort study included surgical cases from a single institution's national surgical quality improvement program (NSQIP) clinical registry from October 2015 to December 2021. The primary predictor of interest was documentation of a Z code for social determinants of health-related problems. The primary outcome was 30-day postoperative morbidity. Secondary outcomes included postoperative length of stay, disposition, and 30-day postoperative mortality, reoperation, and readmission. Multivariable regression models were fit to evaluate the association between the documentation of a Z code and outcomes. Results: Of 10,739 surgical cases, 348 patients (3.2%) had a documented social determinants of health-related Z code. In multivariable analysis, documentation of a Z code was associated with increased odds of morbidity (20.7% vs. 9.9%; adjusted odds ratio [aOR], 1.88; 95% confidence interval [CI], 1.39-2.53), length of stay (median, 3 vs. 1 day; incidence rate ratio, 1.49; 95% CI, 1.33-1.67), odds of disposition to a location other than home (11.3% vs. 3.9%; aOR, 2.86; 95% CI, 1.89-4.33), and odds of readmission (15.3% vs. 6.1%; aOR, 1.99; 95% CI, 1.45-2.73). Conclusions: Social determinants of health-related problems evaluated using Z codes were associated with worse postoperative outcomes. Improved documentation of social determinants of health-related problems among surgical patients may facilitate improved risk stratification, perioperative planning, and clinical outcomes.
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1002/wjs.12135
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Article ; Online: National Trends in Interventions for Pediatric Gallstone Pancreatitis.

Reiter, Audra J / Huang, Lynn / Tian, Yao / Sullivan, Gwyneth A / Hu, Andrew / Raval, Mehul V

Journal of laparoendoscopic & advanced surgical techniques. Part A

2023 Volume 34, Issue 1, Page(s) 82–87

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Adult ; Humans ; Child ; Gallstones/complications ; Gallstones/surgery ; Retrospective Studies ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Cholecystectomy, Laparoscopic/methods ; Pancreatitis/etiology ; Pancreatitis/surgery
Language	English
Publishing date	2023-09-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1381909-4
ISSN	1557-9034 ; 1092-6429
ISSN (online)	1557-9034
ISSN	1092-6429
DOI	10.1089/lap.2023.0238
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Article ; Online: Implementation science for quality improvement in pediatric surgery.

Sullivan, Gwyneth A / Schäfer, Willemijn L A / Raval, Mehul V / Johnson, Julie K

Seminars in pediatric surgery

2023 Volume 32, Issue 2, Page(s) 151282

Abstract: Despite the widespread integration of quality improvement principles into pediatric surgical practice, the actual adoption of evidence-based practices continues to be a challenge. The field of pediatric surgery, in particular, has been slow to adopt ... ...

Abstract	Despite the widespread integration of quality improvement principles into pediatric surgical practice, the actual adoption of evidence-based practices continues to be a challenge. The field of pediatric surgery, in particular, has been slow to adopt clinical pathways and protocols that lead to decreased practice variation and improved clinical outcomes. This manuscript provides an introduction to how implementation science principles into quality improvement efforts may optimize uptake of evidence-based practices, ensure success of these endeavors, and help assess the effectiveness of the interventions. Examples of implementation science application to pediatric surgical quality improvement endeavors are explored.
MeSH term(s)	Child ; Humans ; Quality Improvement ; Implementation Science ; Specialties, Surgical
Language	English
Publishing date	2023-04-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1133381-9
ISSN	1532-9453 ; 1055-8586
ISSN (online)	1532-9453
ISSN	1055-8586
DOI	10.1016/j.sempedsurg.2023.151282
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Article ; Online: Use of International Classification of Diseases, Tenth Revision, Clinical Modification Z Codes to Identify Social Determinants of Health Among Surgical Patients.

Sullivan, Gwyneth A / Gely, Yumiko / Donaldson, Andrew / Rangel, Melissa / Gulack, Brian C / Shah, Ami N

JAMA surgery

2022 Volume 157, Issue 8, Page(s) 735–737

MeSH term(s)	Humans ; International Classification of Diseases ; Social Determinants of Health
Language	English
Publishing date	2022-06-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2022.1211
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Article ; Online: A Practical Guide to Stump Appendicitis.

Williams, Michael D / Page, Niel / Sullivan, Gwyneth A / Shah, Ami N / Sarran, Marc A

The American surgeon

2022 Volume 88, Issue 7, Page(s) 1546–1548

MeSH term(s)	Appendectomy ; Appendicitis/diagnosis ; Appendicitis/surgery ; Humans ; Postoperative Complications
Language	English
Publishing date	2022-04-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221083937
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Article ; Online: Measuring Impact of Simulation-Based Informed Consent Training on Surgical Intern's Long-Term Confidence.

Sullivan, Gwyneth A / Harmon, Kelly / Gill-Wiehl, Genevieve F / Kim, Seungjun / Velasco, Jose M / Chan, Edie Y / Schimpke, Scott W

Journal of surgical education

2023 Volume 80, Issue 6, Page(s) 884–891

Abstract: Objective: Our objective was to evaluate the outcome of a training program on long-term confidence of interns and attending physicians.: Design: In this prospective cohort study, general surgery interns underwent a training program on informed ... ...

Abstract	Objective: Our objective was to evaluate the outcome of a training program on long-term confidence of interns and attending physicians. Design: In this prospective cohort study, general surgery interns underwent a training program on informed consent that involved didactics, standardized patient encounters, and supplemental procedure specific guides at the start of the academic year. At the end of the academic year, we surveyed interns from the classes of 2020 (trained) and 2019 (untrained) about their experience and confidence in obtaining an informed consent. Further, we queried attending physicians on their experience and confidence in the interns at the end of each academic year. Setting: Single academic general surgery residency program based at 2 urban tertiary hospitals. Participants: General surgery interns including unmatched preliminary residents and categorical interns from general surgery, interventional radiology, and urology. Results: Twenty-four incoming interns participated in the training program. Intern confidence discussing operation benefits improved from a median score of 4 to 5 (p = 0.03), and total confidence improved from a median score of 15 to 17.5 (p = 0.08). There was no difference in median total confidence scores (15 vs. 17.5; p = 0.21) between classes. Attending physicians had similar median total confidence scores following intervention (10 vs. 11; p = 0.87). Intern satisfaction was 80% with the didactic session, and 90% with standardized patient encounters. Twenty percent of learners used the supplemental procedure specific guides. Conclusions: Implementation of an intern targeted program on informed consent that incorporated didactics and standardized patient encounters was viewed as useful and may contribute to long-term improvements in confidence.
MeSH term(s)	Humans ; Education, Medical, Graduate/methods ; Prospective Studies ; Internship and Residency ; Curriculum ; Informed Consent ; Clinical Competence
Language	English
Publishing date	2023-03-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2023.02.018
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Article ; Online: Surgeon Understanding and Perceptions of Social Determinants of Health.

Sullivan, Gwyneth A / Gely, Yumiko / Palmisano, Zachary M / Donaldson, Andrew / Rangel, Melissa / Gulack, Brian C / Johnson, Julie K / Shah, Ami N

The Journal of surgical research

2023 Volume 294, Page(s) 73–81

Abstract: Introduction: Social determinants of health impact surgical outcomes. Characterization of surgeon understanding of social determinants of health is necessary prior to implementation of interventions to address patient needs. The study objective was to ... ...

Abstract	Introduction: Social determinants of health impact surgical outcomes. Characterization of surgeon understanding of social determinants of health is necessary prior to implementation of interventions to address patient needs. The study objective was to explore understanding, perceived importance, and practices regarding social determinants of health among surgeons. Methods: Surgical residents and attending surgeons at a single academic medical center completed surveys regarding social determinants of health. We conducted semi-structured interviews to further explore understanding and perceived importance. A conceptual framework from the World Health Organization (WHO) Commission on Social Determinants of Health informed the thematic analysis. Results: Survey response rate was 47.9% (n = 69, 44 residents [63.8%], 25 attendings [36.2%]). Respondents primarily reported good (n = 29, 42.0%) understanding of social determinants of health and perceived this understanding to be very important (n = 42, 60.9%). Documentation occurred seldom (n = 35, 50.7%), and referrals occurred seldom (n = 26, 37.7%) or never (n = 20, 29.0%). Residents reported a higher rate of prior training than attendings (95.5% versus 56.0%, P < 0.001). Ten interviews were conducted (six residents, four attendings). Residents demonstrated greater understanding of socioeconomic positions and hierarchies shaped by structural mechanisms than attendings. Both residents and attendings demonstrated understanding of intermediary determinants of health status and linked social determinants to impacting patients' health and well-being. Specific knowledge gaps were identified regarding underlying structural mechanisms including the social, economic, and political context that influence an individual's socioeconomic position. Conclusions: Self-reported understanding and importance of social determinants of health among surgeons were high. Interviews revealed gaps in understanding that may contribute to limited practices.
MeSH term(s)	Humans ; Social Determinants of Health ; Internship and Residency ; Attitude of Health Personnel ; Surgeons/education ; Surveys and Questionnaires
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.08.050
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Article ; Online: Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy placement.

Williams, Michael D / Skertich, Nicholas / Sullivan, Gwyneth A / Harmon, Kelly / Madonna, Mary Beth / Pillai, Srikumar / Shah, Ami N / Gulack, Brian C

Pediatric surgery international

2023 Volume 39, Issue 1, Page(s) 122

Abstract: Purpose: Fundoplication is frequently used in children with neurologic impairment even in the absence of reflux due to concerns for future gastric feeding intolerance, but supporting data are lacking. We aimed to determine the incidence of secondary ... ...

Abstract	Purpose: Fundoplication is frequently used in children with neurologic impairment even in the absence of reflux due to concerns for future gastric feeding intolerance, but supporting data are lacking. We aimed to determine the incidence of secondary antireflux procedures (fundoplication or gastrojejunostomy (GJ)) post gastrostomy tube (GT) placement in children with and without neurologic impairment. Methods: Children under 18 undergoing a GT placement without fundoplication between 2010 and 2020 were identified utilizing the PearlDiver Mariner national patient claims database. Children with a diagnosis of cerebral palsy or a degenerative neurologic disease were identified and compared to children without these diagnoses. The incidence of delayed fundoplication or conversion to GJ were compared utilizing Kaplan-Meier and Cox proportional hazards regression analyses. Results: A total of 14,965 children underwent GT placement, of which 3712 (24.8%) had a diagnosis of neurologic impairment. The rate of concomitant fundoplication was significantly higher among children with a diagnosis of neurologic impairment as compared to those without (9.3% vs 6.4%, p < 0.001). While children with neurologic impairment had a significantly higher rate of fundoplication or GJ conversion at 5 years compared to children without (12.6% [95% confidence interval (CI): 11.4%-13.8%] vs 8.6% [95% CI 8.0%-9.2%], p < 0.001), the overall incidence remained low. Conclusion: Although children with neurologic impairment have a higher rate of requiring an antireflux procedure or GJ conversion than other children, the overall rate remains less than 15%. Fundoplication should not be utilized in children without clinical reflux on the basis of neurologic impairment alone.
MeSH term(s)	Child ; Humans ; Infant, Newborn ; Infant ; Gastrostomy/methods ; Gastroesophageal Reflux/complications ; Gastroesophageal Reflux/surgery ; Gastroesophageal Reflux/epidemiology ; Fundoplication/methods ; Enteral Nutrition ; Nervous System Diseases/complications ; Nervous System Diseases/surgery ; Retrospective Studies
Language	English
Publishing date	2023-02-14
Publishing country	Germany
Document type	Journal Article
ZDB-ID	632773-4
ISSN	1437-9813 ; 0179-0358
ISSN (online)	1437-9813
ISSN	0179-0358
DOI	10.1007/s00383-023-05398-x
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Article ; Online: Laser Ablation of Pilonidal Sinus Disease: A Pilot Study.

Williams, Michael D / Sullivan, Gwyneth A / Nimmagadda, Neha / Gulack, Brian C / Madonna, Mary Beth / Hayden, Dana M / Govekar, Henry / Shah, Ami N

Diseases of the colon and rectum

2023 Volume 66, Issue 5, Page(s) e224–e227

Abstract: Background: Pilonidal disease is classically treated with wide local excision, although a number of minimally invasive approaches are currently under investigation. We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus ... ...

Abstract	Background: Pilonidal disease is classically treated with wide local excision, although a number of minimally invasive approaches are currently under investigation. We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease. Impact of innovation: Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts without a need for excessive tract dilation. Laser ablation can be performed more than once on the same patient if necessary. Technology materials and methods: This technique uses the NeoV V1470 Diode Laser (neoLaser Ltd, Caesarea, Israel) with a 2-mm probe. We performed laser ablation in adults and pediatric patients. Preliminary results: We performed 27 laser ablation procedures in 25 patients, with a median operative time of 30 minutes. Eighty percent of patients reported either no pain or mild pain at the 2-week postoperative visit. The median time to return to work or school was 3 days. Eighty-eight percent of patients reported being satisfied or very satisfied with the procedure at their most recent follow-up (median, 6 mo). Eighty-two percent of patients were healed at 6 months. Conclusions and future directions: Laser ablation of pilonidal disease is safe and feasible. Patients experienced short recovery time and reported low levels of pain and high levels of satisfaction.
MeSH term(s)	Adult ; Humans ; Child ; Treatment Outcome ; Pilot Projects ; Pilonidal Sinus/surgery ; Laser Therapy ; Pain, Postoperative ; Skin Diseases
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002745
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