Recent Publications by CFE Educators
Recent Published articles, books, and other scholarship by Academy members, CFE Education Scientists, and CFE Faculty.
What Is an Innovation Article? A Systematic Overview of Innovation in Health Professions Education Journals.
2021
Authors: Colbert-Getz JM, Bierer SB, Berry A, Bradley E, Han H, Mooney C, Szauter K, Teal CR, Youm J, O'Brien BC
Determining Hospital Volume Threshold for Safety of Minimally Invasive Pancreaticoduodenectomy: A Contemporary Cutpoint Analysis.
2021
Authors: Conroy PC, Calthorpe L, Lin JA, Mohamedaly S, Kim A, Hirose K, Nakakura E, Corvera C, Sosa JA, Sarin A, Kirkwood KS, Alseidi A, Adam MA
BACKGROUND
Guidelines recommend limiting minimally invasive pancreaticoduodenectomy (MIPD) to high-volume centers. However, the definition of high-volume care remains unclear. We aimed to objectively define a minimum number of MIPD performed annually per hospital associated with improved outcomes in a contemporary patient cohort.
PATIENTS AND METHODS
Resectable pancreatic adenocarcinoma patients undergoing MIPD were included from the National Cancer Database (2010-2017). Multivariable modeling with restricted cubic splines was employed to identify an MIPD annual hospital volume threshold associated with lower 90-day mortality. Outcomes were compared between patients treated at low-volume (≤ model-identified cutoff) and high-volume (> cutoff) centers.
RESULTS
Among 3079 patients, 141 (5%) died within 90 days. Median hospital volume was 6 (range 1-73) cases/year. After adjustment, increasing hospital volume was associated with decreasing 90-day mortality for up to 19 (95% CI 16-25) cases/year, indicating a threshold of 20 cases/year. Most cases (82%) were done at low-volume ( 20 cases/year) centers. With adjustment, MIPD at low-volume centers was associated with increased 90-day mortality (OR 2.7; p = 0.002). Length of stay, positive surgical margins, 30-day readmission, and overall survival were similar. On analysis of the most recent two years (n = 1031), patients at low-volume centers (78.2%) were younger and had less advanced tumors but had longer length of stay (8 versus 7 days; p 0.001) and increased 90-day mortality (7% versus 2%; p = 0.009).
CONCLUSIONS
The cutpoint analysis identified a threshold of at least 20 MIPD cases/year associated with lower postoperative mortality. This threshold should inform national guidelines and institution-level protocols aimed at facilitating the safe implementation of this complex procedure.
View on PubMedSurgical Trainee Well-Being: A Synergy of Individual and System-Level Interventions.
2021
Authors: Greenberg AL, Collins CR, Rosser ML, Ascher NL, O'Sullivan PS, Reilly LM, Lebares CC
Enhancers and Inhibitors of Well-Being: A Multicenter Study of Surgical Resident Perspectives.
2021
Authors: Anya Greenberg, Carter C. Lebares
Defining and Validating Flourishing in Surgery: Differences by Race and Gender in a Multicenter Study.
2021
Authors: Anya Greenberg, Carter C. Lebares
Just 10 "CLEQS" Yields Formative Evaluation of the Clinical Learning Environment.
2021
Authors: Simpson D, La Fratta T, Moore L, McDiarmid M, Bidwell JL, Salvo N, Irby DM
Advanced Open Surgical Skill Simulation: Practice, Performance Benchmarking, and Perceptions.
2021
Authors: Riley Brian, Jon Freise, Saira Ahmed, Joseph Lin, Hueylan Chern, Shareef M. Syed
Managing Sexual Dysfunction in 2021 and Beyond.
2021
Authors: Shindel AW, Lue TF
Migration is the driving force of rapid aging in Puerto Rico: A Research Brief.
2021
Authors: Matos-Moreno A, Santos-Lozada AR, Mehta N, de Leon CFM, Lê-Scherban F, De Lima Friche AA
Direct oral anticoagulants or low-molecular-weight heparins for venous thromboembolism in patients with brain tumors.
2021
Authors: Lee A, Oley F, Lo M, Fong R, McGann M, Saunders I, Block S, Mahajan A, Pon TK
INTRODUCTION
Patients with central nervous system malignancies have limited representation in studies evaluating DOACs for VTE treatment. This study evaluated the safety and efficacy of DOACs in comparison with LMWH for cancer-associated VTE in patients with primary brain tumors or secondary brain metastases.
MATERIALS & METHODS
In this multicenter, retrospective cohort study, adult patients with a diagnosis of primary brain tumor or secondary brain metastases who received either a DOAC or LMWH for treatment of cancer-associated VTE were evaluated. The primary outcome was the cumulative incidence of any intracranial hemorrhage within a 6-month period following the initiation of anticoagulation. Secondary outcomes included the cumulative incidence of any bleeding event, and recurrent VTE events.
RESULTS
Between January 1, 2012 and October 9, 2019, one-hundred eleven patients met inclusion criteria. The 6-month cumulative incidence of intracranial hemorrhage was 4.3% (95% CI, 0.74-13.2%) in the DOAC group, compared to 5.9% (95% CI, 1.5-14.9%) in the LMWH group (p = 0.61). The 6-month cumulative incidence of bleeding events was 14.3% (95% CI, 6.2-25.8%) in the DOAC group, compared to 27.8% (95% CI, 15.5-41.6%) in the LMWH group (p = 0.10). The 6-month cumulative incidence of recurrent VTE events was 5.6% in the DOAC group (95% CI, 1.5-14.2%), compared to 6.6% in the LMWH group (95% CI, 1.7-16.5%) (p = 0.96). No differences were found with respect to other secondary outcomes.
CONCLUSION
There were no significant differences in bleeding or recurrent VTE events between DOACs and LMWH. These findings suggest DOACs may be safe and effective for VTE treatment in this patient population.
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