Lauritzenmcclanahan9215

To understand the impact of Black race on breast cancer (BC) presentation, treatment, and survival among Hispanics.

It is well-documented that non-Hispanic Blacks (NHB) present with late-stage disease, less likely to complete treatment, and have worse survival compared to their non-Hispanic White (NHW) counterparts. However, no data evaluates whether this disparity extends to Hispanic Blacks (HB) and Hispanic Whites (HW). Given our location in Miami, gateway to Latin America and the Caribbean, we have the diversity to evaluate BC outcomes in HB and HW.

Retrospective cohort study of stage I-IV BC patients treated at our institution from 2005-2017. Kaplan-Meier survival curves were generated and compared using the log-rank test. Multivariable survival models were computed using Cox proportional hazards regression.Results Race/ethnicity distribution of 5,951 patients 28% NHW, 51% HW, 3% HB, and 18% NHB. HB were more economically disadvantaged, had more aggressive disease, and less treatment compliant compailiency associated with Hispanic ethnicity to narrow a persistent BC survival gap.

To investigate the midterm outcomes of fenestrated and branched endovascular aortic repair (FB-EVAR) of pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs).

FB-EVAR has been associated with decreased morbidity compared to open repair, but there is limited midterm data.

430 patients (302 male, mean age 74 ± 8 years old) treated by FB-EVAR were enrolled in a prospective, nonrandomized investigational device exemption study. Endpoints included 30-day mortality and major adverse events (MAEs), freedom from all cause and aortic-related mortality, target vessel patency and freedom from secondary intervention and target vessel instability.

There were 133 PRAs and 297 TAAAs with 1673 renal-mesenteric arteries incorporated by fenestrations or directional branches (3.9 ± 0.5 vessels/patient). At 30-days, there were four (0.9%) deaths. MAEs included new-onset dialysis in eight patients (2%), permanent paraplegia or stroke in 10 patients each (2%) and respiratory failure requiring tracheostomy in two patients (0.5%). After a mean follow up of 26 ± 20 months, there were three (0.7%) aortic-related deaths from SMA stent occlusion, gastrointestinal hemorrhage or complications of open arch repair. At 5-years, freedom from all cause and aortic-related mortality were 57 ± 5% and 98 ± 1% respectly. Freedom from secondary intervention was 64 ± 4%, primary target vessel patency was 94 ± 1% and freedom from target vessel instability was 89 ± 2% at same interval. One patient (0.2%) had non-fatal aneurysm treated using endovascular repair.

FB-EVAR is safe and effective for treatment of PRA and TAAAs with low rate of aortic-related mortality and aneurysm rupture on midterm follow up.

FB-EVAR is safe and effective for treatment of PRA and TAAAs with low rate of aortic-related mortality and aneurysm rupture on midterm follow up.

We implemented routine daily electronic monitoring of patient-reported outcomes (PROs) for 10 days after discharge following ambulatory cancer surgery, with alerts to clinical staff for worrying symptoms. We sought to determine whether enhancing this monitoring by adding immediate automated normative feedback to patients regarding expected symptoms would further improve the patient experience.

PRO monitoring reduces symptom severity in cancer patients. In ambulatory cancer surgery, it reduces potentially avoidable urgent care center (UCC) visits, defined as those UCC visits without readmission.

Patients undergoing ambulatory cancer surgery (n = 2,624) were randomized to receive standard PRO monitoring or enhanced feedback. The primary study outcome was UCC visits without readmission within 30 days; secondary outcomes included patient anxiety and nursing utilization.

There was no significant difference in the risk of a potentially avoidable UCC visit (1.0% higher in enhanced feedback, 95% CI -0.2-3.1%; p = 0.12). There were similarly no significant differences in UCC visits with readmission or readmission overall (p = 0.4 for both). Patients randomized to enhanced feedback demonstrated a quicker reduction in anxiety (p < 0.001) and required 14% (95% CI 8-19%; p < 0.001) and 10% (95% CI 5-16%, p < 0.001) fewer nursing calls over 10 and 30 days postoperatively.

Providing patients with feedback about symptom severity during recovery from ambulatory cancer surgery reduces anxiety and nursing workload without affecting UCC visits or readmissions. These results support wider incorporation of normative feedback in systems for routine PRO monitoring.

Providing patients with feedback about symptom severity during recovery from ambulatory cancer surgery reduces anxiety and nursing workload without affecting UCC visits or readmissions. These results support wider incorporation of normative feedback in systems for routine PRO monitoring.

This analysis aimed to compare failure to rescue after pancreatoduodenectomy across the Atlantic.

Failure to rescue (FTR), or mortality after development of a major complication, is a quality metric originally created to compare hospital results. FTR has been studied in North American and Northern European patients undergoing pancreatoduodenectomy (PD). However, a direct comparison of FTR after PD between North America and Northern Europe has not been performed.

Patients who underwent PD in North America, the Netherlands, Sweden and Germany (GAPASURG dataset) were identified from their respective registries (2014-17). Patients who developed a major complication defined as Clavien-Dindo ≥ 3 or developed a grade B/C postoperative pancreatic fistula (POPF) were included. Preoperative, intraoperative and postoperative variables were compared between patients with and without FTR. Variables significant on univariable analysis were entered into a logistic regression for FTR.

Major complications occurred in rventional radiology is preferred over reoperation.

We sought to characterize the timing of administration of prehospital Tranexamic Acid (TXA) and associated outcome benefits.

TXA has been shown to be safe in the prehospital setting post-injury.

We performed a secondary analysis of a recent prehospital randomized TXA clinical trial in injured patients. Those who received prehospital TXA within 1hr (EARLY) from time of injury were compared to those who received prehospital TXA beyond 1hr (DELAYED). We included patients with a shock index of > 0.9. Primary outcome was 30-day mortality. Kaplan-Meier and Cox Hazard regression were utilized to characterize mortality relationships.

EARLY and DELAYED patients had similar demographics, injury characteristics and shock severity but DELAYED patients had greater prehospital resuscitation requirements and longer prehospital times. Stratified Kaplan-Meier analysis demonstrated significant separation for EARLY patients (N =238, log-rank chi-square test, 4.99; P = .03) with no separation for DELAYED patients (N=238, log-rank chi-square test, 0.04; P = .83). Stratified Cox Hazard regression verified, after controlling for confounders, that EARLY TXA was associated with a 65% lower independent hazard for 30-day mortality (HR 0.35, 95%CI 0.19-0.65, P = .001) with no independent survival benefit found in DELAYED patients (HR 1.00, 95%CI 0.63-1.59, P = .999). EARLY TXA patients had lower incidence of multiple organ failure and 6-hour and 24-hour transfusion requirements compared to placebo.

Administration of prehospital TXA within 1 hour from injury in patients at risk of hemorrhage is associated with 30-day survival benefit, lower incidence of multiple organ failure, and lower transfusion requirements.

Administration of prehospital TXA within 1 hour from injury in patients at risk of hemorrhage is associated with 30-day survival benefit, lower incidence of multiple organ failure, and lower transfusion requirements.

To investigate the long-term effects of medical and surgical treatments of type 2 diabetes mellitus (T2DM) on patient reported outcomes (PROs).

Robust data on PROs from randomized trials comparing medical and surgical treatments for T2DM are lacking.

The Surgical Treatment And Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial showed that 5-years after randomization, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were superior to intensive medical therapy (IMT) alone in achieving glycemic control in patients with T2DM and obesity. selleck products A subset of 104 patients participating in the STAMPEDE trial were administered two generic health-related quality of life (QoL) questionnaires (RAND-36 and EQ-5D-3L) and a diabetes-specific instrument at baseline, and then on an annual basis up to 5-years after randomization.

On longitudinal analysis, RYGB and SG significantly improved the domains of physical functioning, general health perception, energy/fatigue, and diabetes-related QoL coPsychosocial well-being warrants greater attention after metabolic surgery.

We compare neoadjuvant chemotherapy (CT) to neoadjuvant chemotherapy plus chemoradiation (CRT) for patients with gastric adenocarcinoma (GA).

The optimal neoadjuvant therapy regimen for resectable gastric adenocarcinoma is not defined.

Utilizing data from two high-volume cancer centers, we analyzed patients who underwent surgery for localized GA from 1/1/2000-12/31/2017. Standard CT regimens were used according to treatment period. We compared propensity matched cohorts based on age, sex, race, histology, and clinical stage.

405 patients (age 62 ± 12y, 58% male, 56% white) were analyzed. 231 (57%) received CRT and 174 (43%) received CT. Groups differed based on histopathologic characteristics including preoperative stage (p = 0.013). To control for these differences, propensity matched cohorts of 113 CT and 113 CRT patients were compared. CRT had similar frequencies of R0 resections to CT (93% vs 91%, p = 0.81), but higher rates of complete pathologic response (15% vs 4%, p = 0.003) and lower pathologic stage (p = 0.002). Completion of intended perioperative therapy occurred in 63% of CT and 91% of CRT patients (p < 0.001). Median DFS was 45mo (95%CI 20-70) in the CT group and 113mo (95%CI 75-151) in the CRT group (p = 0.018). Median OS was 53mo (95%CI 30-77) versus 120mo (95%CI 101-138); p = 0.015.

In this multi-institutional comparison of neoadjuvant CT and CRT for resectable GA, CRT is associated with higher rates of completed perioperative therapy, higher rates of complete pathologic response, lower pathologic stage, and improved survival.Level of Evidence Level III.

In this multi-institutional comparison of neoadjuvant CT and CRT for resectable GA, CRT is associated with higher rates of completed perioperative therapy, higher rates of complete pathologic response, lower pathologic stage, and improved survival.Level of Evidence Level III.

To examine the alignment between graduating surgical trainee operative performance and a prior survey of surgical program director expectations.

Surgical trainee operative training is expected to prepare residents to independently perform clinically important surgical procedures.

We conducted a cross-sectional observational study of US general surgery residents' rated operative performance for Core general surgery procedures. Residents' expected performance on those procedures at the time of graduation was compared to the current list of Core general surgery procedures ranked by their importance for clinical practice, as assessed via a previous national survey of general surgery program directors. We also examined the frequency of individual procedures logged by residents over the course of their training.

Operative performance ratings for 29,885 procedures performed by 1,861 surgical residents in 54 general surgery programs were analyzed. For each Core general surgery procedure, adjusted mean probability of a graduating resident being deemed practice-ready ranged from 0.