High Reliability Organizations and Surgical Microsystems: Re-engineering Surgical Care.

Surg Clin North Am. 2012 Feb;92(1):1-14

Authors: Sanchez JA, Barach PR

Abstract

Error prevention and mitigation is the primary goal in high-risk health care, particularly in areas such as surgery. There is growing consensus that significant improvement is hard to come by as a result of the vast complexity and inefficient processes of the health care system. Recommendations and innovations that focus on individual processes do not address the larger and often intangible systemic and cultural factors that create vulnerabilities throughout the entire system. This article introduces basic concepts of complexity and systems theory that are useful in redesigning the surgical work environment to create safety, quality, and reliability in surgical care.

PMID: 22269256 [PubMed - in process]

Building high-performance teams in the operating room.

Surg Clin North Am. 2012 Feb;92(1):15-9

Authors: Sax HC

Abstract

Building effective teams requires the delineation of clear goals, an understanding of each member’s role in reaching that goal, and continuous feedback as issues are identified. The solo mentality required to become a health care provider needs to be modified to see a bigger picture. Finally, consistent buy-in and support from senior administration to deal with disruptive personalities is vital for long-term success.

PMID: 22269257 [PubMed - in process]

Human factors and operating room safety.

Surg Clin North Am. 2012 Feb;92(1):21-35

Authors: Elbardissi AW, Sundt TM

Abstract

A human factors model is used to highlight the nature of many systems factors that affect surgical performance, including the OR environment, teamwork and communication, technology and equipment, tasks and workload factors, and organizational variables. If further improvements in the success rate and reliability of cardiac surgery are to be realized, interventions need to be developed to reduce the negative impact that work system failures can have on surgical performance. Some recommendations are proposed here; however, several challenges remain.

PMID: 22269258 [PubMed - in process]

Surgeons’ Non-technical Skills.

Surg Clin North Am. 2012 Feb;92(1):37-50

Authors: Yule S, Paterson-Brown S

Abstract

The importance of non-technical skills to surgical performance is gaining wide acceptance. This article discusses the core cognitive and social skills categories thought to underpin medical knowledge and surgical expertise, and describes the rise of non-technical skill models of assessment in surgery. Behavior rating systems such as NOTSS (Non-Technical Skills for Surgeons) have been developed to support education and assessment in this regard. We now understand more about these critical skills and how they impact surgery. The challenge in the future is to incorporate them into undergraduate teaching, postgraduate training, workplace assessment, and perhaps even selection.

PMID: 22269259 [PubMed - in process]

A Comprehensive Unit-Based Safety Program (CUSP) in Surgery: Improving Quality Through Transparency.

Surg Clin North Am. 2012 Feb;92(1):51-63

Authors: Cooper M, Makary MA

Abstract

Many medical errors can be attributed to large and complex health care systems in which care is increasingly fragmented. Hospitals with good safety cultures have lower complication rates, and improved patient and staff satisfaction. Transparency in health care is an increasingly recognized means to improve outcomes by allowing the free market to reward hospitals with a strong safety culture, good outcomes, and compliance with evidence-based medicine. As more data become available regarding strategies that work to improve patient safety and such strategies are more widely implemented, significant improvements in the quality of care that is delivered nationwide should become apparent.

PMID: 22269260 [PubMed - in process]

Hospital-acquired infections.

Surg Clin North Am. 2012 Feb;92(1):65-77

Authors: Lobdell KW, Stamou S, Sanchez JA

Abstract

Health-acquired infection (HAI) is defined as a localized or systemic condition resulting from an adverse reaction to the presence of infectious agents or its toxins. This article focuses on HAIs that are well studied, common, and costly (direct, indirect, and intangible). The HAIs reviewed are catheter-related bloodstream infection, ventilator-associated pneumonia, surgical site infection, and catheter-associated urinary tract infection. This article excludes discussion of Clostridium difficile infections and vancomycin-resistant Enterococcus.

PMID: 22269261 [PubMed - in process]

Information technologies and patient safety.

Surg Clin North Am. 2012 Feb;92(1):79-87

Authors: Ellner SJ, Joyner PW

Abstract

Advances in health information technology provide significant opportunities for improvements in surgical patient safety. The adoption and use of electronic health records can enhance communication along the surgical spectrum of care. Bar coding and radiofrequency identification technology are strategies to prevent retained surgical sponges and for tracking the operating room supply chain. Computerized intraoperative monitoring systems can improve the performance of the operating room team. Automated data registries collect patient information to be analyzed and used for surgical quality improvement.

PMID: 22269262 [PubMed - in process]

The role of unconscious bias in surgical safety and outcomes.

Surg Clin North Am. 2012 Feb;92(1):137-51

Authors: Santry HP, Wren SM

Abstract

Racial, ethnic, and gender disparities in health outcomes are a major challenge for the US health care system. Although the causes of these disparities are multifactorial, unconscious bias on the part of health care providers plays a role. Unconscious bias occurs when subconscious prejudicial beliefs about stereotypical individual attributes result in an automatic and unconscious reaction and/or behavior based on those beliefs. This article reviews the evidence in support of unconscious bias and resultant disparate health outcomes. Although unconscious bias cannot be entirely eliminated, acknowledging it, encouraging empathy, and understanding patients’ sociocultural context promotes just, equitable, and compassionate care to all patients.

PMID: 22269267 [PubMed - in process]

When bad things happen to good surgeons: reactions to adverse events.

Surg Clin North Am. 2012 Feb;92(1):153-61

Authors: Luu S, Leung SO, Moulton CA

Abstract

Adverse events are, unfortunately, common components of surgical practice. Much has been done to develop safer systems to prevent these adverse events; however, there has been less focus on the surgeon experiencing these events. This article presents a framework to understand surgeons’ reactions to adverse events that was derived from a more recent study as well as a review of relevant psychology literatures. This framework is then situated within the broader picture of mindful practice to explore how the psychological and social dimensions of the surgeon can affect judgment and cognition.

PMID: 22269268 [PubMed - in process]

Open disclosure of adverse events: transparency and safety in health care.

Surg Clin North Am. 2012 Feb;92(1):163-77

Authors: Eaves-Leanos A, Dunn EJ

Abstract

Many patients suffering adverse events in health care turn to the legal system to learn what happened to them and to seek compensation. Health care providers have ethical, professional, and legal duties to disclose the harmful effects of care to the patient, regardless of how small the risk. The purpose of open disclosure is to explain what happened to the patient and to seek a just outcome for patient and provider. This article explores our experience of managing and implementing an open disclosure program in an acute and chronic tertiary care facility with university affiliation in the Veterans Health Administration.

PMID: 22269269 [PubMed - in process]

Patient safety.

Surg Clin North Am. 2012 Feb;92(1):xiii-xv

Authors: Martin RF

PMID: 22269270 [PubMed - in process]

Tipping the balance: the pathophysiology of obesity and type 2 diabetes mellitus.

Surg Clin North Am. 2011 Dec;91(6):1139-48, vii

Authors: McKenney RL, Short DK

Abstract

Obesity plays a major role in the development of type 2 diabetes mellitus, and it has long been accepted that weight loss plays a significant role in diabetes therapy. This weight loss has traditionally been accomplished through lifestyle changes including diet and exercise. What has only more recently gained acceptance is that bariatric surgery may have a role to play in diabetes therapy as well. This article discusses the pathophysiology of type 2 diabetes mellitus and obesity and provides a basic understanding of these diseases, which forms the basis for understanding the importance of weight loss in their treatment.

PMID: 22054144 [PubMed - indexed for MEDLINE]

Physiology of weight loss surgery.

Surg Clin North Am. 2011 Dec;91(6):1149-61, vii

Authors: Park CW, Torquati A

Abstract

The clinical outcomes achieved by bariatric surgery have been impressive. However, the physiologic mechanisms and complex metabolic effects of bariatric surgery are only now beginning to be understood. Ongoing research has contributed a large amount of data and shed new light on the science behind obesity and its treatment, and this article reviews the current understanding of metabolic and bariatric surgery physiology.

PMID: 22054145 [PubMed - indexed for MEDLINE]

Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass.

Surg Clin North Am. 2011 Dec;91(6):1203-24, viii

Authors: Powell MS, Fernandez AZ

Abstract

Over the past 20 years bariatric surgery proved to be a valid treatment for reduction and elimination of obesity-related diseases and long-term sustainable weight loss. Minimally invasive or laparoscopic techniques such as laparoscopic Roux-en-Y (LRNY) have replaced open procedures. Many factors play important roles in the small intricacies and variations of the procedure, chief of which is the creation and size of the gastrojejunostomy. Regardless of the variations in technique, the LRNY remains the gold standard for the surgical treatment of clinically severe or morbid obesity, with relatively low morbidity and mortality.

PMID: 22054149 [PubMed - indexed for MEDLINE]

Complications of laparoscopic Roux-en-Y gastric bypass.

Surg Clin North Am. 2011 Dec;91(6):1225-37, viii

Authors: Al Harakeh AB

Abstract

Despite the well-documented safety of laparoscopic RYGB, several short-term and long-term complications, with varying degrees of morbidity and mortality risk, are known to occur. Bariatric surgeons, all too familiar with these complications, should be knowledgeable in risk-reduction strategies to minimize the incidence of complication occurrence and recurrence. Bariatric and nonbariatric surgeons who evaluate and treat abdominal pain should be familiar with these complications to facilitate early recognition and intervention, thereby minimizing the associated morbidity and mortality.

PMID: 22054150 [PubMed - indexed for MEDLINE]

Complications of adjustable gastric banding.

Surg Clin North Am. 2011 Dec;91(6):1249-64, ix

Authors: Snow JM, Severson PA

Abstract

Adjustable gastric banding (AGB) has become increasingly used by bariatric surgeons and their patients as the surgical weight loss procedure of choice. The popularity of this procedure is in large part a result of the remarkable safety profile and low initial complication rate. Complications of AGB were initially believed to be minor and infrequent, but longer-term studies have increasingly described complications that lead to revisional surgery. In addition, a larger fraction of patients fail to lose weight than with other surgical weight loss procedures, frequently necessitating conversion to these other options.

PMID: 22054152 [PubMed - indexed for MEDLINE]

Sleeve gastrectomy.

Surg Clin North Am. 2011 Dec;91(6):1265-79, ix

Authors: Brethauer SA

Abstract

Sleeve gastrectomy (SG) was originally performed as the restrictive component of the duodenal switch procedure. This partial vertical gastrectomy served to reduce gastric capacity and initiate short-term weight loss while the malabsorptive component of the operation (biliopancreatic diversion) provided the long-term weight loss. Some patients, however, could not undergo the intestinal bypass, and early investigations found that substantial weight loss occurred with the SG alone. The sleeve then developed into a risk management strategy for very large or high-risk patients who would not tolerate a longer or higher-risk procedure.

PMID: 22054153 [PubMed - indexed for MEDLINE]

Biliopancreatic diversion with duodenal switch.

Surg Clin North Am. 2011 Dec;91(6):1281-93, ix

Authors: Sudan R, Jacobs DO

Abstract

The biliopancreatic diversion with a duodenal switch (BPD-DS) is a less commonly performed but very effective bariatric procedure that has been in existence for more than 20 years. It is particularly effective for the resolution of diabetes and is associated with the highest weight loss among other bariatric operations. Typically, the BPD-DS is not associated with postgastrectomy symptoms, such as dumping and marginal ulceration. Because of its complexity, it has usually been performed by laparotomy in the past; but, more recently, minimally invasive techniques are being used with acceptable risk.

PMID: 22054154 [PubMed - indexed for MEDLINE]

Bariatric surgery outcomes.

Surg Clin North Am. 2011 Dec;91(6):1313-38, x

Authors: Dumon KR, Murayama KM

Abstract

Obesity is associated with an increased risk of death, and morbid obesity carries a significant risk of life-threatening complications such as heart disease, diabetes, and high blood pressure. Bariatric surgery is recognized as the only effective treatment of morbid obesity. The estimated number of bariatric operations performed in the United States in 2008 was more than 13 times the number performed in 1992. Despite this increase, only 1% of the eligible morbidly obese population are currently treated with bariatric surgery.

PMID: 22054156 [PubMed - indexed for MEDLINE]

Adolescent bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1339-51, x

Authors: Ibele AR, Mattar SG

Abstract

Obesity has become an increasingly serious problem in pediatric and adolescent populations in the United States. Although bariatric surgery has been offered to morbidly obese adolescents for the past several decades, it remains controversial. However, the benefits of weight loss surgery in this population have been realized, particularly its long-term physical and emotional effects on adolescents. This article reviews the demographics and health implications of adolescent obesity, describes the most common adolescent bariatric surgical procedures and their outcomes, discusses the ethical issues involved in elective surgery in this population, and outlines the key components of an adolescent bariatric surgical program.

PMID: 22054157 [PubMed - indexed for MEDLINE]

Revisional bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1353-71, x

Authors: Kellogg TA

Abstract

With the increase in bariatric surgical procedures, an increase in revision operations is expected. A thorough preoperative work-up is essential to formulate an appropriate revision strategy. Outcomes vary according to the primary operation and chosen approach to revision. Recent studies have shown acceptably low complication rates and good weight loss with the associated health benefits. Although there is no direct evidence in the form of randomized studies indicating which patients with inadequate weight loss or weight regain will benefit most from revision, or to support one particular revision approach rather than another, it is possible to develop general, effective strategies.

PMID: 22054158 [PubMed - indexed for MEDLINE]

Future directions in bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1373-95, x

Authors: Lee SM, Pryor AD

Abstract

Bariatric surgery is a field in rapid evolution, and the speed of this evolution has been accelerating over the last several decades. A thorough understanding of past developments is crucial to anticipating the future intelligently. The trends that have driven evolution historically often persist, and continue to be influential in the future. With this in mind, this article briefly outlines the historical and current trends in bariatric surgery, and follows the trajectory of these trends into the future to anticipate the technologies and techniques that will be most important to the field in the coming years.

PMID: 22054159 [PubMed - indexed for MEDLINE]

Bariatric and metabolic surgery.

Surg Clin North Am. 2011 Dec;91(6):xvii

Authors: Kothari SN

PMID: 22054161 [PubMed - indexed for MEDLINE]

Gastric surgery. Foreword.

Surg Clin North Am. 2011 Oct;91(5):ix-xi

Authors: Martin RF

PMID: 21889022 [PubMed - indexed for MEDLINE]

Gastric surgery. Preface.

Surg Clin North Am. 2011 Oct;91(5):xiii

Authors: Fuhrman GM

PMID: 21889023 [PubMed - indexed for MEDLINE]

Gastric acid and digestive physiology.

Surg Clin North Am. 2011 Oct;91(5):977-82

Authors: Ramsay PT, Carr A

Abstract

The primary function of the stomach is to prepare food for digestion and absorption by the intestine. Acid production is the unique and central component of the stomach’s contribution to the digestive process. Acid bathes the food bolus while stored in the stomach, facilitating digestion. An intact defense against mucosal damage by the stomach’s acid is essential to avoid ulceration. This article focuses on the physiology of gastric acid production, the stomach’s defense mechanisms against acid injury, and the most common challenges to the gastric defenses. A brief description of the stomach’s nonacid digestive capabilities is included.

PMID: 21889024 [PubMed - indexed for MEDLINE]

Gastric motility physiology and surgical intervention.

Surg Clin North Am. 2011 Oct;91(5):983-99

Authors: Rostas JW, Mai TT, Richards WO

Abstract

Disordered gastric motility represents a spectrum of dysfunction ranging from delayed gastric emptying to abnormally rapid gastric transit, commonly referred to as the “dumping syndrome.” Both extremes of gastric motility disorders can arise from similar pathologic processes, and produce remarkably identical symptoms. This fact underscores the need to attain a precise diagnosis to ensure the institution of optimal therapy. Disordered gastric motility is primarily managed with dietary modification followed by pharmacotherapy, as traditional surgical interventions tend to be fraught with complications. However, continued improvements in minimally invasive diagnostic and therapeutic modalities promise novel options for earlier and more effective treatment.

PMID: 21889025 [PubMed - indexed for MEDLINE]

Emergency ulcer surgery.

Surg Clin North Am. 2011 Oct;91(5):1001-13

Authors: Lee CW, Sarosi GA

Abstract

The rate of elective surgery for peptic ulcer disease has been declining steadily over the past 3 decades. During this same period, the rate of emergency ulcer surgery rose by 44%. This means that the gastrointestinal surgeon is likely to be called on to manage the emergent complications of peptic ulcer disease without substantial experience in elective peptic ulcer disease surgery. The goal of this review is to familiarize surgeons with our evolving understanding of the pathogenesis, epidemiology, presentation, and management of peptic ulcer disease in the emergency setting, with a focus on peptic ulcer disease-associated bleeding and perforation.

PMID: 21889026 [PubMed - indexed for MEDLINE]

Gastroesophageal reflux disease.

Surg Clin North Am. 2011 Oct;91(5):1015-29

Authors: Rosemurgy AS, Donn N, Paul H, Luberice K, Ross SB

Abstract

Millions of Americans are affected by gastroesophageal reflux disease (GERD) in many different ways. The magnitude of the problem of GERD was brought to light by the ambulatory pH test, the introduction of minimally invasive surgery, and the advent of the many medications that are effective in acid suppression. Patients with GERD suffer from various consequences associated with the disease. However, interventions beyond medical therapy, such as laparoscopic fundoplication, provide satisfactory outcomes and definitive relief of acid reflux.

PMID: 21889027 [PubMed - indexed for MEDLINE]

Achalasia.

Surg Clin North Am. 2011 Oct;91(5):1031-7

Authors: Beck WC, Sharp KW

Abstract

This article reviews the diagnosis and treatment of achalasia, a rare esophageal motility disorder characterized by absent peristalsis and failure of the lower esophageal sphincter (LES) to relax. Various treatment options including management with sublingual nitrates or calcium channel blockers, injection of the LES with botulism toxin, pneumatic dilation of the LES, and pneumatic dilation are discussed. Laparoscopic Heller myotomy is minimally invasive with incumbent low morbidity and mortality rates, and combined with a partial fundoplication is a durable, safe, and effective treatment option for patients with achalasia.

PMID: 21889028 [PubMed - indexed for MEDLINE]

Gastric adenocarcinoma surgery and adjuvant therapy.

Surg Clin North Am. 2011 Oct;91(5):1039-77

Authors: Patel SH, Kooby DA

Abstract

Gastric adenocarcinoma is one of the most common causes of death worldwide. Surgical resection remains the mainstay of therapy, offering the only chance for complete cure. Resection is based on the principles of obtaining adequate margins, with the extent of lymphadenectomy remaining controversial. Neoadjuvant and adjuvant therapies are used to reduce local recurrence and improve long-term survival. This article reviews the literature and provides a summary of surgical management options and neoadjuvant/adjuvant therapies for gastric adenocarcinoma.

PMID: 21889029 [PubMed - indexed for MEDLINE]

Gastrointestinal stromal tumor surgery and adjuvant therapy.

Surg Clin North Am. 2011 Oct;91(5):1079-87

Authors: Grignol VP, Termuhlen PM

Abstract

Gastrointestinal stromal tumors (GIST) are a unique class of mesenchymal tumors identified within the past decade. Intense molecular and genetic study has been used to characterize these tumors and develop treatment strategies. Although the mainstay of treatment remains surgical resection, therapy targeted at inhibiting tyrosine kinases has had dramatic results. Because of the rapid accumulation of information about the diagnosis and treatment of these tumors, the National Comprehensive Cancer Network convened a GIST task force to provide updated recommendations in 2010. As understanding of these tumors advances, rapid changes in recommendations will continue and should warrant regular updates in tumor management.

PMID: 21889030 [PubMed - indexed for MEDLINE]

Minimally invasive gastric surgery.

Surg Clin North Am. 2011 Oct;91(5):1089-103

Authors: Carbonell AM

Abstract

The most common indications for gastric resection remain benign ulcer disease and neoplasm. Surgery for these diseases can be performed safely with laparoscopy. As surgeons adhere to the original tenets of open gastric resections while performing laparoscopic resections, disease outcomes will remain the same with the improved surgical outcomes of less pain, a shorter hospital stay, and a lower incidence of wound complications. Laparoscopic gastric resections can be divided into the more straightforward wedge/tumor resections performed for submucosal tumors or the more formal anatomic gastric resections. This article reviews the tools and techniques for laparoscopic gastric resection.

PMID: 21889031 [PubMed - indexed for MEDLINE]

Postgastrectomy syndromes.

Surg Clin North Am. 2011 Oct;91(5):1105-22

Authors: Bolton JS, Conway WC

Abstract

The first postgastrectomy syndrome was noted not long after the first gastrectomy was performed. The indications for gastric resection have changed dramatically over the past 4 decades, and the overall incidence of gastric resection has decreased. This article focuses on the small proportion of patients with severe, debilitating symptoms; these symptoms can challenge the acumen of the surgeon who is providing the patient’s long-term follow-up and care. The article does not deal with the sequelae of bariatric surgery.

PMID: 21889032 [PubMed - indexed for MEDLINE]

Miscellaneous disorders and their management in gastric surgery: volvulus, carcinoid, lymphoma, gastric varices, and gastric outlet obstruction.

Surg Clin North Am. 2011 Oct;91(5):1123-30

Authors: Dada SA, Fuhrman GM

Abstract

This article focuses on less common diseases that surgeons are called on for management options. Five topics-volvulus, carcinoid, lymphoma, gastric varices, and gastric outlet obstruction from peptic ulcer disease-are frequently used to evaluate surgical knowledge. Knowledge of these topics is useful for residents preparing for an in-training examination or board certification. Patients with these diseases require multidisciplinary management with oncologists and/or gastroenterologists, and mastery of these topics allows surgeons to effectively participate in the multidisciplinary care of these patients and advocate for surgical management when appropriate.

PMID: 21889033 [PubMed - indexed for MEDLINE]

Epidemiology and economic impact of obesity and type 2 diabetes.

Surg Clin North Am. 2011 Dec;91(6):1163-72

Authors: Shamseddeen H, Getty JZ, Hamdallah IN, Ali MR

Abstract

Obesity has become a major public health concern in the United States and the rest of the world. This disease carries significant health risks that encompass several organ systems. Type 2 diabetes mellitus is a major comorbidity of obesity that predisposes patients to significant end-organ damage. The prevalence of obesity and diabetes is increasing worldwide, and the economic impact of these diseases currently assumes a significant portion of health care expenditure. These factors mandate implementation of therapeutic medical and surgical strategies that target prevention and treatment of obesity and its related medical conditions.

PMID: 22054146 [PubMed - in process]

The economic costs of obesity and the impact of bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1173-80

Authors: Richards NG, Beekley AC, Tichansky DS

Abstract

The obesity epidemic has far-reaching implications for the economic and health care future in the United States. Treatments that show reduction in health care costs over time should be approved and made available to as many patients as possible. It is our opinion that bariatric surgery meets this criterion. However, bariatric surgery cannot provide the impact necessary for reduction in health care and economic costs on a national scale. The obesity epidemic must be addressed by policy efforts at the local, state, and national levels. As experts on obesity, bariatric surgeons must be prepared to guide and inform these efforts.

PMID: 22054147 [PubMed - in process]

The history and evolution of bariatric surgical procedures.

Surg Clin North Am. 2011 Dec;91(6):1181-201

Authors: Baker MT

Abstract

The search for the ideal weight loss operation began more than 50 years ago. Surgical pioneers developed innovative procedures that initially created malabsorption, then restricted volume intake, and eventually combined both techniques. Variations, alterations, and modifications of these original procedures, combined with intense efforts to follow and document outcomes, have led to the evolution of modern bariatric surgery. More recent research has focused on the hormonal and metabolic effects of these procedures. These discoveries at the cellular level will help develop possible mechanisms of weight loss and comorbidity reduction beyond the traditional explanation of reduced food consumption and malabsorption.

PMID: 22054148 [PubMed - in process]

Evolution of laparoscopic adjustable gastric banding.

Surg Clin North Am. 2011 Dec;91(6):1239-47

Authors: McBride CL, Kothari V

Abstract

This article reviews the use of laparoscopic adjustable gastric banding in the United States today. It comments on the history of the procedure as well as technical aspects of the operation. Short-term and long-term outcomes of the procedure are examined, and the advantages and disadvantages of this procedure in comparison with the laparoscopic gastric bypass are discussed.

PMID: 22054151 [PubMed - in process]

Impact of bariatric surgery on comorbidities.

Surg Clin North Am. 2011 Dec;91(6):1295-312

Authors: Kaul A, Sharma J

Abstract

Published data show that bariatric surgery not only leads to significant and sustained weight loss but also resolves or improves multiple comorbidities associated with morbid obesity. Evidence suggests that the earlier the intervention the better the resolution of comorbidities. Patients with metabolic syndrome and comorbidities associated with morbid obesity should be promptly referred for consideration for bariatric surgery earlier in the disease process.

PMID: 22054155 [PubMed - in process]

Bariatric and metabolic surgery.

Surg Clin North Am. 2011 Dec;91(6):xiii-xv

Authors: Martin RF

PMID: 22054160 [PubMed - in process]

Nutrition and metabolism of the surgical patient, Part II.

Surg Clin North Am. 2011 Aug;91(4):xiii-xiv

Authors: Martin RF

PMID: 21787962 [PubMed - indexed for MEDLINE]

The relationships of nutrients, routes of delivery, and immunocompetence.

Surg Clin North Am. 2011 Aug;91(4):737-53, vii

Authors: Jayarajan S, Daly JM

Abstract

Malnutrition has marked consequences on surgical outcomes. Adequate nutrition is important for the proper functioning of all organ systems, particularly the immune system. Determination of the type and amount of nutrient supplementation and the appropriate route of nutrient delivery is essential to bolster the immune system and enhance the host’s response to stress. Correct administration of immunonutrients could lead to reductions in patient morbidity following major surgery, trauma, and critical illness.

PMID: 21787965 [PubMed - indexed for MEDLINE]

Contributions of intestinal bacteria to nutrition and metabolism in the critically ill.

Surg Clin North Am. 2011 Aug;91(4):771-85, viii

Authors: Morowitz MJ, Carlisle EM, Alverdy JC

Abstract

Important advances in the study of bacteria associated with the human gastrointestinal tract have significant implications for clinicians striving to meet the metabolic and nutritional needs of critically ill patients. This article offers a broad overview of the importance of the host-microbe relationship, discusses what is currently known about the role of gut microbes in nutrition and metabolism in the healthy human host, reviews how gut microbes are affected by critical illness, and discusses interventions that have already been used to manipulate the gut microbiome in patients in the intensive care unit.

PMID: 21787967 [PubMed - indexed for MEDLINE]

Nutritional support of surgical patients with inflammatory bowel disease.

Surg Clin North Am. 2011 Aug;91(4):787-803, viii

Authors: Wagner IJ, Rombeau JL

Abstract

Patients with inflammatory bowel disease (IBD) in need of surgery are often malnourished, which in turn increases the risk for postoperative complications. Malnutrition in IBD patients who must undergo surgery is due to the disordered activity of the diseased intestine, decreased dietary intake, and adverse effects of potent medications. IBD operations predispose patients to both macronutrient and micronutrient deficiencies. If the gut can be used safely it is the preferential route for feeding, though preoperative and postoperative parenteral nutrition remains a viable alternative for severely malnourished patients. New nutrient therapies include immunonutrition, fish oils, and probiotics.

PMID: 21787968 [PubMed - indexed for MEDLINE]

Nutritional support in acute and chronic pancreatitis.

Surg Clin North Am. 2011 Aug;91(4):805-20, viii

Authors: Grant JP

Abstract

Nutritional support can have a significant beneficial impact on the course of moderate to severe acute pancreatitis. Enteral nutrition is preferred, with emphasis on establishment of jejunal access; however, parenteral nutrition can also be of value if intestinal failure is present. Early initiation of nutritional support is critical, with benefits decreasing rapidly if begun after 48 hours from admission. Severe malnutrition in chronic pancreatitis can be avoided or treated with dietary modifications or enteral nutrition.

PMID: 21787969 [PubMed - indexed for MEDLINE]

Nutritional support of the obese and critically ill obese patient.

Surg Clin North Am. 2011 Aug;91(4):837-55, viii-ix

Authors: Kaafarani HM, Shikora SA

Abstract

With the dramatic increase in the prevalence of obesity worldwide and in the United States, it is virtually certain that clinicians will be caring for bariatric and obese nonbariatric patients in increasing numbers. This patient population presents several difficulties from the medical and surgical management perspectives. In particular, nutrition of the bariatric patient and critically ill obese patient is challenging. A clear understanding of the nutritional assessment and unique management strategies available for the bariatric and the critically ill obese patient is essential to provide them with the safest and most effective care.

PMID: 21787971 [PubMed - indexed for MEDLINE]

Nutritional considerations in adult cardiothoracic surgical patients.

Surg Clin North Am. 2011 Aug;91(4):857-75, ix

Authors: Sanchez JA, Sanchez LL, Dudrick SJ

Abstract

The importance of the preoperative nutritional status of cardiothoracic surgical patients in determining outcomes is demonstrated and discussed. Demographic, anthropometric, and biochemical changes in patients undergoing cardiothoracic surgery increase the importance of identifying those at risk for postoperative complications resulting from malnutrition. The interrelationships of chronic heart failure, cardiac cachexia, nutritional status, and nutritional support are identified and emphasized. The complexities of myocardial energetics and metabolism are outlined together with the nutrient needs for patients undergoing cardiac, pulmonary, or other intrathoracic operative procedures.

PMID: 21787972 [PubMed - indexed for MEDLINE]

Historical highlights of the development of enteral nutrition.

Surg Clin North Am. 2011 Aug;91(4):945-64, x

Authors: Dudrick SJ, Palesty JA

Abstract

The most significant events and discoveries regarding the development of enteral nutrition (EN) dating back to 1500 BC are chronicled. A more detailed description and discussion of subsequent more recent progress during the past two decades is focused primarily on 3 of the most dynamic areas of endeavor: tight glycemic control; timing and combining of EN and total parenteral nutrition to meet early target nutrition goals in intensive care unit patients; and the role, advances, and future of immunonutrition. An abridged classification of solutions for enteral feeding, and a brief outline of key prudent oral dietary guidelines are also presented.

PMID: 21787977 [PubMed - indexed for MEDLINE]

The prevention and treatment of intestinal failure-associated liver disease in neonates and children.

Surg Clin North Am. 2011 Jun;91(3):543-63

Authors: Nehra D, Fallon EM, Puder M

Abstract

Intestinal Failure Associated Liver Disease (IFALD) is a common and potentially life-threatening problem for pediatric patients receiving long-term parenteral nutrition (PN). Risk factors for IFALD include premature birth, low birth weight, long-term PN, intestinal stasis and sepsis. Preventative strategies are the cornerstone of improving outcomes in IFALD and include enteral feeding, weaning of PN, reduced dose lipid emulsions and the early recognition and treatment of sepsis. Recent work also demonstrates the efficacy of fish-oil based lipid emulsions in the prevention and treatment of IFALD. Transplantation is an option for end-stage liver disease but is associated with significant morbidity and mortality.

PMID: 21621695 [PubMed - indexed for MEDLINE]

Nutrition in critical care.

Surg Clin North Am. 2011 Jun;91(3):595-607

Authors: Bartlett RH, Dechert RE

Abstract

Critical care has evolved from a prolonged recovery room stay for cardiac surgery patients to a full medical and nursing specialty in the last 5 decades. The ability to feed patients who cannot eat has evolved from impossible to routine clinical practice in the last 4 decades. Nutrition in critically ill patients based on measurement of metabolism has evolved from a research activity to clinical practice in the last 3 decades. The authors have been involved in this evolution and this article discusses past, present, and likely future practices in nutrition in critically ill patients.

PMID: 21621698 [PubMed - indexed for MEDLINE]

Nutrition management of patients with malignancies of the head and neck.

Surg Clin North Am. 2011 Jun;91(3):631-9

Authors: O’Neill JP, Shaha AR

Abstract

The importance of nutrition and the prognostic impact of malnutrition in patients with head and neck cancer are not fully appreciated in the surgical world where a pervasive attitude exists that weight loss during treatment is inevitable and nutritional expertise or intervention may be dismissed out of ignorance. In this article, the authors explore the nutritional requirements of these patients and the impact of a multidisciplinary therapeutic approach to head, neck, and skull base cancer care.

PMID: 21621700 [PubMed - indexed for MEDLINE]

Nutrition and Metabolism of the Surgical Patient, Part II.

Surg Clin North Am. 2011 Aug;91(4):xv-xvii

Authors: Dudrick SJ, Sanchez JA

PMID: 21787963 [PubMed - in process]

Total parenteral nutrition and cancer: from the beginning.

Surg Clin North Am. 2011 Aug;91(4):727-36

Authors: Copeland EM, Pimiento JM, Dudrick SJ

The early development of total parenteral nutrition and its evolution as an adjunct to the nutritional, metabolic, and antineoplastic therapy of cancer patients is described. Examples related to the sine wave of responses to new data and discovery are placed in context to understand better past, present, and how and where to proceed in the future to achieve optimal results from multimodal comprehensive management of patients with malignancies. Practical and philosophic thoughts are proffered to justify continued, intensified, logical, controlled clinical studies directed toward establishing the most rational, safe, and effective use of total parenteral nutrition in treating patients with cancer.

PMID: 21787964 [PubMed - in process]

Nutrition and gut immunity.

Surg Clin North Am. 2011 Aug;91(4):755-70

Authors: Fukatsu K, Kudsk KA

The human intestine contains huge amounts of nonpathologic bacteria surviving in an environment that is beneficial to both the host and the bacterial populations. When short pauses in oral intake occur with minimal alterations in the mucosa-microbial interface, critical illness, with its attendant acidosis, prolonged gastrointestinal tract starvation, exogenous antibiotics, and breakdown in mucosal defenses, renders the host vulnerable to bacterial challenge and also threatens the survival of the bacteria. This review examines the altered innate and adaptive immunologic host defenses that occur as a result of altered oral or enteral intake and/or injury.

PMID: 21787966 [PubMed - in process]

The surgical treatment of type two diabetes mellitus.

Surg Clin North Am. 2011 Aug;91(4):821-36

Authors: Pories WJ, Mehaffey JH, Staton KM

Since the discovery that gastric bypass surgery leads to the rapid reversal of type 2 diabetes mellitus in morbidly obese patients, researchers have been searching for possible mechanisms to explain the result. The significance of bariatric surgery is twofold. It offers hope and successful therapy to the severely obese; those with T2DM, sleep apnea, or polycystic ovary disease; and others plagued by the comorbidities of the metabolic syndrome. This article examines four surgical procedures and their outcomes.

PMID: 21787970 [PubMed - in process]

Nutrition management of geriatric surgical patients.

Surg Clin North Am. 2011 Aug;91(4):877-96

Authors: Dudrick SJ

Surgery in geriatric patients is accompanied by increases in morbidity and mortality, increases in functional abnormalities and poor outcomes, and increases in severe malnutrition, compared with surgery of similar magnitude in nongeriatric patients. Hospitalized elderly patients are at significant risk of presenting with, or developing, protein-energy and other nutrient deficiencies. However, nutritional assessment of older geriatric patients, 65 to 100 years of age, is a challenging task because of lack of adequate age-specific reference data in this diverse and heterogeneous population. Dietary counseling and conscientious, aggressive nutritional support are required for optimal metabolic and surgical care of this age group.

PMID: 21787973 [PubMed - in process]

Overview of enteral and parenteral feeding access techniques: principles and practice.

Surg Clin North Am. 2011 Aug;91(4):897-911

Authors: Phillips MS, Ponsky JL

The importance of adequate nutrition has long been established in the surgical patient population. Enteral nutrition provides the safest, most cost-effective approach with endoscopic and surgical options for permanent access. Parenteral nutrition should be reserved for patients in whom enteral nutrition is contradicted. This article summarizes the routes of access for both enteral and parenteral nutrition as well as the indications, procedural pearls, and complications associated with each approach.

PMID: 21787974 [PubMed - in process]

Home parenteral nutrition support for intestinal failure.

Surg Clin North Am. 2011 Aug;91(4):913-32

Authors: Rhoda KM, Suryadevara S, Steiger E

Home parenteral nutrition is a life-saving treatment for many patients with intestinal failure. Expert placement and care of the vascular access device reduces the incidence of access-related complications. Careful monitoring of fluid, electrolyte, and macronutrient and micronutrient status can minimize major organ dysfunction and metabolic complications. A multidisciplined, integrated nutrition support team can allow patients with intestinal failure who need home parenteral nutrition maintain a near-normal life.

PMID: 21787975 [PubMed - in process]

Nutritional supplements in the surgical patient.

Surg Clin North Am. 2011 Aug;91(4):933-44

Authors: Stohs SJ, Dudrick SJ

This article presents an overview of the current knowledge, status, and use of supplements by patients before surgical operations, together with the benefits expected of the supplements by the patients. The indications, potential advantages and disadvantages, and the relationships with various aspects of the preoperative preparation and postoperative management of surgical patients are discussed, with emphasis on the significant percentage of this population that is deficient in fundamental nutrients. Recent revisions and recommendations for some of the macronutrients are presented, together with a summary of federal regulations and an oversight of supplements.

PMID: 21787976 [PubMed - in process]

Nutrition and metabolism of the surgical patient, part I.

Surg Clin North Am. 2011 Jun;91(3):xv-xvii

Authors: Dudrick SJ, Sanchez JA

PMID: 21621690 [PubMed - in process]

Nutrition and metabolism of the surgical patient, part I.

Surg Clin North Am. 2011 Jun;91(3):xiii-xiv

Authors: Martin RF

PMID: 21621689 [PubMed - in process]

Metabolic considerations in management of surgical patients.

Surg Clin North Am. 2011 Jun;91(3):467-80

Authors: Blackburn GL

Metabolic changes after surgery, trauma, or serious illness have a complex pathophysiology. The early posttraumatic stress response is physiologic and associated with a state of hyperinflammation, increased oxygen consumption, and increased energy expenditure. These are part of a systemic reaction that encompasses a wide range of endocrinological, immunologic, and hematological effects. Surgery initiates changes in metabolism that can affect virtually all organs and tissues; the metabolic response results in hormone-mediated mobilization of endogenous substrates that leads to stress catabolism. Hypercatabolism has been associated with severe complications related to hyperglycemia, hypoproteinemia, and immunosuppression. Proper metabolic support is essential to restore homeostasis and ensure survival.

PMID: 21621691 [PubMed - in process]

Management of enterocutaneous fistulas.

Surg Clin North Am. 2011 Jun;91(3):481-91

Authors: Schecter WP

Management of enterocutaneous fistulas (ECFs) involves (1) recognition and stabilization, (2) anatomic definition and decision, and (3) definitive operation. Phase 1 encompasses correction of fluid and electrolyte imbalance, skin protection, and nutritional support. Abdominal imaging defines the anatomy of the fistula in phase 2. ECFs that do not heal spontaneously require segmental resection of the bowel segment communicating with the fistula and restoration of intestinal continuity in phase 3. The enteroatmospheric fistula (EAF) is a malevolent condition requiring prolonged wound care and nutritional support. Complex abdominal wall reconstruction immediately following fistula resection is necessary for all EAFs.

PMID: 21621692 [PubMed - in process]

Nutrition support in the pediatric surgical patient.

Surg Clin North Am. 2011 Jun;91(3):511-41

Authors: Herman R, Btaiche I, Teitelbaum DH

This article deals with the nutritional needs of pediatric patients. It begins by discussing the caloric requirements of different pediatric patients and moves on to a breakdown of the specific nutrients required. It then progresses to a detailed description of the enteral and parenteral modalities for delivery of nutrition to pediatric patients. The article concludes with a discussion of specific problems and disorders encountered in pediatric surgical patients.

PMID: 21621694 [PubMed - in process]

Current management of the short bowel syndrome.

Surg Clin North Am. 2011 Jun;91(3):493-510

Authors: Thompson JS, Weseman R, Rochling FA, Mercer DF

Short bowel syndrome is a challenging clinical problem that benefits from a multidisciplinary approach. Much progress has recently been made in all aspects of management. Medical intestinal rehabilitation should be the initial treatment focus, and several new potential pharmacologic agents are being investigated. Surgical rehabilitation using nontransplant procedures in selected patients may further improve intestinal function. Intestinal lengthening procedures are particularly promising. Intestinal transplantation has increasingly been used with improving success in patients with life-threatening complications of intestinal failure.

PMID: 21621693 [PubMed - in process]

Adjuvant nutrition management of patients with liver failure, including transplant.

Surg Clin North Am. 2011 Jun;91(3):565-78

Authors: Kerwin AJ, Nussbaum MS

This article reviews nutrition support in patients with liver disease, including those who are undergoing surgery or liver transplant. The topics covered include the multifactorial etiology of malnutrition, nutritional assessment, and nutritional therapy. Recommendations for use of both enteral and parenteral nutrition are given in patients with alcoholic hepatitis, cirrhosis, and acute liver failure and in patients undergoing surgery or liver transplant.

PMID: 21621696 [PubMed - in process]

Nutritional therapy in critically ill and injured patients.

Surg Clin North Am. 2011 Jun;91(3):579-93

Authors: Latifi R

Nutritional support of critically ill or injured patients has undergone significant advances in the last few decades. These advances are the direct result of the growing scientific progress and increased knowledge of the biology and biochemistry of key metabolic and nutrient changes induced by injury, sepsis, and other critical illnesses, both in adults and children. As this knowledge has increased, the science of nutritional support has become more disease based and disorder based. This article discusses protein and nitrogen metabolism in critically ill patients, immunomodulation, and the key nutrients involved in an immune-enhancing diet.

PMID: 21621697 [PubMed - in process]

What, How, and How Much Should Patients with Burns be Fed?

Surg Clin North Am. 2011 Jun;91(3):609-29

Authors: Williams FN, Branski LK, Jeschke MG, Herndon DN

The hypermetabolic response to severe burn injury is characterized by hyperdynamic circulation and profound metabolic, physiologic, catabolic, and immune system derangements. Failure to satisfy overwhelming energy and protein requirements after, and during, severe burn injury results in multiorgan dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of patients with severe burn injury. This review focuses on the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its postburn-associated insulin resistance.

PMID: 21621699 [PubMed - in process]

Nutritional Support: We have Failed in Our Ability to Support Patients with Sepsis and Cancer.

Surg Clin North Am. 2011 Jun;91(3):641-51

Authors: Fischer JE

Despite the success of both parenteral and enteral nutrition in supporting patients who cannot eat, patients with either sepsis or cancer cannot be adequately supported. A proposed mechanism by which aerobic glycolysis leads to a shortage of energy production in the liver is discussed. According to this hypothesis, the proximity of sodium-potassium ATPase and glycogen, its fuel source, leads to the continuation of gluconeogenesis with continued proteolysis and muscle wasting. Myostatin and lipokine, newly discovered factors, may also play a role.

PMID: 21621701 [PubMed - in process]

Cachexia, malnutrition, the refeeding syndrome, and lessons from goldilocks.

Surg Clin North Am. 2011 Jun;91(3):653-73

Authors: Palesty JA, Dudrick SJ

Cachexia has plagued clinicians for centuries. Although all cachexia is related to malnutrition, cachexia associated with malignant diseases differs from starvation cachexia in that it is more recalcitrant to nutritional therapy. All cachexia responds to judicious nutritional support; however, cancer cachexia worsens autonomously as the disease advances and cannot be arrested or reversed by any known form of nutrition, hormonal, or pharmacologic therapy. Cachexia must be treated cautiously to avoid overfeeding syndrome, which may result in serious or dangerous complications or death.

PMID: 21621702 [PubMed - in process]

Parenteral nutrition and nutritional support of surgical patients: reflections, controversies, and challenges.

Surg Clin North Am. 2011 Jun;91(3):675-92

Authors: Dudrick SJ, Pimiento JM

An abridged background of the history, cause, and nature of early controversies related to the development and clinical application of total parenteral nutrition (TPN) is presented, followed by discussions of highlights of some of the more prominent controversies that continue to prevail, including nutritional support of geriatric patients with and without cancer, the importance of maintenance of normal glycemia, the primacy of nutrition support teams, and TPN versus total enteral nutrition. Reflections related to nutritional support and TPN are interspersed throughout the discussions, together with a compilation of legacies of TPN to the modern practice of medicine.

PMID: 21621703 [PubMed - in process]

Historical highlights of the development of total parenteral nutrition.

Surg Clin North Am. 2011 Jun;91(3):693-717

Authors: Dudrick SJ, Palesty JA

The events and discoveries thought to be the most significant prerequisites to the development of total parenteral nutrition (TPN) dating back to the early 17th century are chronicled. A more detailed description and discussion of the subsequent early modern highlights of the basic and clinical research beginning in the mid-20th century and the advances culminating in the first demonstration of the feasibility and practicality of TPN, and its successful, safe and efficacious applications clinically, are presented. Some of the reasoning, insights, and philosophy of a pioneer clinician-scientist in the field are shared with readers.

PMID: 21621704 [PubMed - in process]

Foreword update on surgical palliative care.

Surg Clin North Am. 2011 Apr;91(2):xiii-xv

Authors: Martin RF

PMID: 21419248 [PubMed - in process]

Preface update on surgical palliative care.

Surg Clin North Am. 2011 Apr;91(2):xvii-xviii

Authors: Dunn GP

PMID: 21419250 [PubMed - in process]

Dedication.

Surg Clin North Am. 2011 Apr;91(2):xix

Authors: Dunn GP

PMID: 21419249 [PubMed - in process]

Are surgeons capable of introspection?

Surg Clin North Am. 2011 Apr;91(2):293-304

Authors: Page DW

The traditional action-oriented surgical personality, although essential in the service of solving emergent operative dilemmas, may serve as a barrier to introspection. Certainly, challenges of the twenty-first century practice environment, including time constraints, also distract from self-reflection. Without engaging in moments of introspection, surgeons risk not only abandoning dying patients in their time of need, but leave the surgeons themselves at risk for burnout and its consequences. The increase in the number of women surgeons, as well as the less heroic image of surgeons performing laparoscopic operations, may reorient traditional extroverted behavior toward a persona of professional grace.

PMID: 21419252 [PubMed - in process]

Surgical palliative care: recent trends and developments.

Surg Clin North Am. 2011 Apr;91(2):277-92

Authors: Dunn GP

Palliation has been an essential, if not the primary, activity of surgery during much of its history. However, it has been only during the past decade that the modern principles and practices of palliative care developed in the nonsurgical specialties in the United States and abroad have been introduced to surgical institutions, widely varied practice settings, education, and research.

PMID: 21419251 [PubMed - in process]

Inpatient palliative care consultation: enhancing quality of care for surgical patients by collaboration.

Surg Clin North Am. 2011 Apr;91(2):317-24

Authors: Adolph MD

Hospital-based surgeons will likely encounter palliative care service colleagues more frequently, given the growth of approved fellowships and hospital palliative care programs. Surgeons may consult with palliative care colleagues to help patients and families manage pain and other symptoms, cope with the distress of acute and chronic illness, manage complex decisions at end-of-life, and negotiate through a critical illness (or combinations thereof). Inpatient palliative care consultation has been shown to improve quality of care, including quality of life and satisfaction of patients, families, and referring clinicians.

PMID: 21419254 [PubMed - in process]

Spiritual dimensions of surgical palliative care.

Surg Clin North Am. 2011 Apr;91(2):305-15

Authors: Tarpley MJ, Tarpley JL

The spiritual dimensions of surgical palliative care encompass recognition of mortality (physician and patient); knowledge of moral and ethical dilemmas of medical decision making; respect for each individual and for all belief systems; responsibility to remain physically and psychologically present for the patient and family; and knowledge of when chaplains, palliative care professionals, or social workers should be consulted. Certain aspects of surgical palliative care distinguish it from palliative care in other medical disciplines such as the 2 definitions (palliative procedure and palliative care), treating a disproportionate share of patients who suffer unforeseen tragic events, and the surgical system.

PMID: 21419253 [PubMed - in process]

Palliative medicine in the surgical intensive care unit and trauma.

Surg Clin North Am. 2011 Apr;91(2):325-31

Authors: Toevs CC

The purpose of palliative medicine is to prevent and relieve suffering and to help patients and their families set informed goals of care and treatment. Palliative medicine can be provided along with life-prolonging treatment or as the main focus of treatment. Increasingly, palliative medicine has a role in the surgical intensive care unit (SICU) and trauma. Data show involving palliative medicine in the SICU results in decreased length of stay, improved communication with families and patients, and earlier setting of goals of care, without increasing mortality. The use of triggers for palliative medicine consultation improves patient-centered care in the SICU.

PMID: 21419255 [PubMed - in process]

Care of the family in the surgical intensive care unit.

Surg Clin North Am. 2011 Apr;91(2):333-42

Authors: Tyrie LS, Mosenthal AC

In the surgical intensive care unit (SICU), the stress of having a critically ill loved one creates significant bereavement and emotional needs for family members. Surgical palliative care has expanded; clinicians do not just treat the patient, but now include the family within the scope of care. Understanding and treating complicated grief, and the emotional and educational needs of the family improves family outcome, improves the surrogate family’s ability to act as decision makers, and ultimately may positively affect patient survivor outcome. Care of families in the SICU requires interdisciplinary teams and palliative care processes to appropriately address their needs.

PMID: 21419256 [PubMed - in process]

Palliative surgical oncology.

Surg Clin North Am. 2011 Apr;91(2):343-53

Authors: Hanna NN, Bellavance E, Keay T

Palliative surgical oncology is a relatively new concept, but builds on a long tradition in surgery. As the field of palliative medicine grows and becomes its own specialty, surgeons have been receiving some specialized training in palliative care; devising specific palliative surgical procedures; and reevaluating the ethics of their interactions with patients, especially for the selection of palliative surgical procedures. This is leading to a new form of surgical practice in which the emphasis is on relief of present or anticipated symptoms, even if the interventions do not prolong a patient’s life span.

PMID: 21419257 [PubMed - in process]

Communication skills in palliative surgery: skill and effort are key.

Surg Clin North Am. 2011 Apr;91(2):355-66

Authors: Miner TJ

Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.

PMID: 21419258 [PubMed - in process]

Image-guided palliative care procedures.

Surg Clin North Am. 2011 Apr;91(2):367-402

Authors: Requarth J

The image-guided procedures discussed in this article are used to alleviate pain and suffering of patients with malignancies and/or multiple comorbidities. It is not possible to discuss the entire breadth of image-guided palliative procedures; only a few commonly requested procedures are reviewed: cholecystostomy, biliary decompression, enteral feeding and decompression tubes, chemical neurolysis (for pain control), cementoplasty, tunneled drainage catheters, transjugular intrahepatic portasystemic shunt pleurodesis, tube thoracostomy, thermal and chemical tumor ablation, transcatheter arterial chemoembolization, and selective internal radiation therapy. A decision tree is given with each procedure/disease. This review provides referring surgeons a framework for end-of-life treatment and palliation discussions.

PMID: 21419259 [PubMed - in process]

Palliative care in lung cancer.

Surg Clin North Am. 2011 Apr;91(2):403-17

Authors: Ferrell B, Koczywas M, Grannis F, Harrington A

Advancements in the surgical and medical treatment of lung cancer have resulted in more favorable short-term survival outcomes. After initial treatment, lung cancer requires continued surveillance and follow-up for long-term side effects and possible recurrence. The integration of quality palliative care into routine clinical care of patients with lung cancer after surgical intervention is essential in preserving function and optimizing quality of life through survivorship. An interdisciplinary palliative care model can effectively link patients to the appropriate supportive care services in a timely fashion. This article describes the role of palliative care for patients with lung cancer.

PMID: 21419260 [PubMed - in process]

Palliative care and pediatric surgery.

Surg Clin North Am. 2011 Apr;91(2):419-28

Authors: Shelton J, Jackson GP

Pediatric surgeons can play an important role in offering procedures that may improve the quality of life for terminally ill children. As with all palliative interventions, surgical therapies should be evaluated in the context of explicitly defined treatment goals while weighing the risks and benefits of procedures in the context of a shortened life span. It is essential that pediatric surgeons become active members in the multidisciplinary team that provides palliative care.

PMID: 21419261 [PubMed - in process]

Palliative care in urology.

Surg Clin North Am. 2011 Apr;91(2):429-44

Authors: Wu JN, Meyers FJ, Evans CP

Urological malignancies, especially prostate cancer, are relatively common, but patients may live many years before eventually dying of the disease. Caring for these patients is an important role for urologists, although medical training often does not adequately prepare urologists for the palliative care of patients with advanced malignancies. Palliative care is no longer equated with end-of-life care, but rather integrated throughout illness, even when cure is impossible. This article focuses on the various palliative treatments available for the 3 most common urological malignancies: prostate, bladder, and renal cancers.

PMID: 21419262 [PubMed - in process]

Palliative care in urology.

Surg Clin North Am. 2011 Apr;91(2):429-44

Authors: Wu JN, Meyers FJ, Evans CP

Urological malignancies, especially prostate cancer, are relatively common, but patients may live many years before eventually dying of the disease. Caring for these patients is an important role for urologists, although medical training often does not adequately prepare urologists for the palliative care of patients with advanced malignancies. Palliative care is no longer equated with end-of-life care, but rather integrated throughout illness, even when cure is impossible. This article focuses on the various palliative treatments available for the 3 most common urological malignancies: prostate, bladder, and renal cancers.

PMID: 21419262 [PubMed - in process]

Surgical palliative care in haiti.

Surg Clin North Am. 2011 Apr;91(2):445-57

Authors: Huffman JL

Palliative care in itself has many challenges; these challenges are compounded exponentially when placed in the setting of a mass casualty event, such as the 2010 Haiti earthquake. Haiti itself was an austere environment with very little infrastructure before the disaster. US surgeons, intensivists, and nurses worked hand in hand with other international providers and Haitian volunteers to provide the best care for the many. Improvisation and teamwork as well as respect for the Haitian caregivers were crucial to their successes. Sisyphean trials lie ahead. Haiti and its people must not be forgotten.

PMID: 21419263 [PubMed - in process]

Surgical palliative care in haiti.

Surg Clin North Am. 2011 Apr;91(2):445-57

Authors: Huffman JL

Palliative care in itself has many challenges; these challenges are compounded exponentially when placed in the setting of a mass casualty event, such as the 2010 Haiti earthquake. Haiti itself was an austere environment with very little infrastructure before the disaster. US surgeons, intensivists, and nurses worked hand in hand with other international providers and Haitian volunteers to provide the best care for the many. Improvisation and teamwork as well as respect for the Haitian caregivers were crucial to their successes. Sisyphean trials lie ahead. Haiti and its people must not be forgotten.

PMID: 21419263 [PubMed - in process]

Surgical palliative care in haiti.

Surg Clin North Am. 2011 Apr;91(2):445-57

Authors: Huffman JL

Palliative care in itself has many challenges; these challenges are compounded exponentially when placed in the setting of a mass casualty event, such as the 2010 Haiti earthquake. Haiti itself was an austere environment with very little infrastructure before the disaster. US surgeons, intensivists, and nurses worked hand in hand with other international providers and Haitian volunteers to provide the best care for the many. Improvisation and teamwork as well as respect for the Haitian caregivers were crucial to their successes. Sisyphean trials lie ahead. Haiti and its people must not be forgotten.

PMID: 21419263 [PubMed - in process]

Foreword: diagnostic imaging for the general surgeon.

Surg Clin North Am. 2011 Feb;91(1):xiii-xiv

Authors: Martin RF

PMID: 21184896 [PubMed - indexed for MEDLINE]

Preface: diagnostic imaging for the general surgeon.

Surg Clin North Am. 2011 Feb;91(1):xv-xvi

Authors: Cogbill TH, Jarman BT

PMID: 21184897 [PubMed - indexed for MEDLINE]

Computed tomography, magnetic resonance, and ultrasound imaging: basic principles, glossary of terms, and patient safety.

Surg Clin North Am. 2011 Feb;91(1):1-14

Authors: Cogbill TH, Ziegelbein KJ

The basic principles underlying computed tomography, magnetic resonance, and ultrasound are reviewed to promote better understanding of the properties and appropriate applications of these 3 common imaging modalities. A glossary of frequently used terms for each technique is appended for convenience. Risks to patient safety including contrast-induced nephropathy, radiation-induced malignancy, and nephrogenic systemic fibrosis are discussed.

PMID: 21184898 [PubMed - indexed for MEDLINE]

Imaging of the thyroid and parathyroid glands.

Surg Clin North Am. 2011 Feb;91(1):15-32

Authors: Vazquez BJ, Richards ML

Current multimodal imaging techniques offer practicing providers the adequate framework to plan and accomplish care for patients with thyroid and parathyroid disorders. Available imaging modalities include ultrasonography (US), nuclear scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). US remains the most cost-effective and the safest approach for the initial evaluation of the thyroid gland. Parathyroid subtraction scintigraphy provides localization of pathologic parathyroid glands with the greatest sensitivity. Localizing imaging studies allow for surgical planning with minimal risk and morbidity to the patient. CT scan and MRI play an adjunctive role in the further characterization of neck pathology.

PMID: 21184899 [PubMed - indexed for MEDLINE]

Biliary, pancreatic, and hepatic imaging for the general surgeon.

Surg Clin North Am. 2011 Feb;91(1):59-92

Authors: Reitz S, Slam K, Chambers LW

Technologic advancements have allowed imaging modalities to become more useful in the diagnosis of hepatobiliary and pancreatic disorders. Computed tomography scanners now use multidetector row technology with contrast-delayed imaging for quicker and more accurate imaging. Magnetic resonance imaging with cholangiopancreatography can more clearly delineate liver lesions and the biliary and pancreatic ducts, and can diagnose pathologic conditions early in their course. Newer technologies, such as single-operator cholangioscopy and endoscopic ultrasonography, have sometimes shown superiority to traditional modalities. This article addresses the literature regarding available imaging techniques in the diagnosis and treatment of common surgical hepatobiliary and pancreatic diseases.

PMID: 21184901 [PubMed - indexed for MEDLINE]

Contemporary breast imaging and concordance assessment: a surgical perspective.

Surg Clin North Am. 2011 Feb;91(1):33-58

Authors: Landercasper J, Linebarger JH

Disease conditions of the breast are very common. Patients with such conditions often present to surgeons for both diagnostic evaluation and treatment. Nearly all of them will require breast imaging. This article summarizes the use, applicability, and concordance assessment of mammography, ultrasonography, and magnetic resonance imaging in patients who have breast complaints or abnormalities on clinical examination or imaging.

PMID: 21184900 [PubMed - indexed for MEDLINE]

Imaging of gastrointestinal bleeding.

Surg Clin North Am. 2011 Feb;91(1):93-108

Authors: Mellinger JD, Bittner JG, Edwards MA, Bates W, Williams HT

Radiological techniques are important in evaluating patients with gastrointestinal bleeding. Scintigraphic, computed tomographic angiographic, and enterographic techniques are sensitive tools in identifying the source of bleeding and may be useful in identifying patients likely to have a benign course and in selecting patients for therapeutic intervention. Angiography plays a key role in bleeding localization, and modern embolization techniques make this a viable therapeutic option. With the refining developments in body imaging and related reconstructive techniques, it is likely that radiological interventions will play an expanding and critical role in evaluating patients with gastrointestinal hemorrhage in the future.

PMID: 21184902 [PubMed - indexed for MEDLINE]

Small bowel imaging.

Surg Clin North Am. 2011 Feb;91(1):109-25

Authors: Jarman BT

There is a variety of options available to image the small bowel depending on the clinical scenario. This article describes multiple imaging options and focuses on several clinical scenarios common to general surgeons.

PMID: 21184903 [PubMed - indexed for MEDLINE]