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ImportanceThe incidence of chronic pancreatitis is 5 to 12 per 100 000 adults in industrialized countries, and the incidence is increasing. Treatment is multimodal, and involves nutrition optimization, pain management, and when indicated, endoscopic and surgical intervention.ObjectivesTo summarize the most current published evidence on etiology, diagnosis, and management of chronic pancreatitis and its associated complications.Evidence ReviewA literature search of Web of Science, Embase, Cochrane Library, and PubMed was conducted for publications between January 1, 1997, and July 30, 2022. Excluded from review were the following: case reports, editorials, study protocols, nonsystematic reviews, nonsurgical technical publications, studies pertaining to pharmacokinetics, drug efficacy, pilot studies, historical papers, correspondence, errata, animal and in vitro studies, and publications focused on pancreatic diseases other than chronic pancreatitis. Ultimately, the highest-level evidence publications were chosen for inclusion after analysis by 2 independent reviewers.FindingsA total of 75 publications were chosen for review. First-line imaging modalities for diagnosis of chronic pancreatitis included computed tomography and magnetic resonance imaging. More invasive techniques such as endoscopic ultrasonography allowed for tissue analysis, and endoscopic retrograde cholangiopancreatography provided access for dilation, sphincterotomy, and stenting. Nonsurgical options for pain control included behavior modification (smoking cessation, alcohol abstinence), celiac plexus block, splanchnicectomy, nonopioid pain medication, and opioids. Supplemental enzymes should be given to patients with exocrine insufficiency to avoid malnutrition. Surgery was superior to endoscopic interventions for long-term pain control, and early surgery (Conclusions and RelevanceResults of this systematic review suggest that patients with chronic pancreatitis had high rates of disability. Strategies to improve pain control through behavioral modification, endoscopic measures, and surgery must also accompany management of the sequalae of complications that arise from endocrine and exocrine insufficiency.

Importance Collection and analysis of up-to-date and accurate injury surveillance data are a key step in the maturation of trauma systems. Trauma registries have proven to be difficult to establish in low- and middle-income countries owing to the burden of trauma volume, cost, and complexity. Objective To determine whether an electronic trauma health record (eTHR) used by physicians can serve as simultaneous clinical documentation and data acquisition tools. Design, Setting, and Participants This 2-part quality improvement study included (1) preimplementation and postimplementation eTHR study with assessments of satisfaction by 41 trauma physicians, time to completion, and quality of data collected comparing paper and electronic charting; and (2) prospective ecologic study describing the burden of trauma seen at a Level I trauma center, using real-time data collected by the eTHR on consecutive patients during a 12-month study period. The study was conducted from October 1, 2010, to September 30, 2011, at Groote Schuur Hospital, Cape Town, South Africa. Data analysis was performed from October 15, 2011, to January 15, 2013. Main Outcomes and Measures The primary outcome of part 1 was data field competition rates of pertinent trauma registry items obtained through electronic or paper documentation. The main measures of part 2 were to identify risk factors to trauma in Cape Town and quality indicators recommended for trauma system evaluation at Groote Schuur Hospital. Results The 41 physicians included in the study found the electronic patient documentation to be more efficient and preferable. A total of 11 612 trauma presentations were accurately documented and promptly analyzed. Fields relevant to injury surveillance in the eTHR (n = 11 612) had statistically significant higher completion rates compared with paper records (n = 9236) (for all comparisons, P

This study compares use of electronic surgical consent forms with paper-based forms and their association with decreased error rates.

What Is the Innovation? Nanotechnology refers to the applications of science at the nanoscalebetween1and100nm.Toput it intocontext, ifyouhaveprinted this article, 1 nm is 1/100 000of the thickness of the sheet of paper you are holding. The ability to produce and investigatematerials at this scale has provided applications in most scientific fields includingengineering, chemistry, andmaterials science. The conceptwas firstdescribedbyphysicistRichardFeynmaninatalkentitled“There’s Plenty of Room at the Bottom” at the California Institute of Technology in 1959. He envisioned the creation of objects so small that theycouldbecontrolledat thecellular level.Over the last fewyears, there have been a surge of applications arising from nanotechnology for therapeutic and diagnostic use in cancer.

Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

Importance The role of the chairman of a surgery department is critical in academic surgery. However, little is known about the variability of job responsibilities. Objective To evaluate chairmen's responsibilities, methods of support, determinants of job performance success, and concerns. Design Internet-based survey. Setting Electronic survey system. Participants Seventy-two chairmen. Main Outcomes and Measures Survey data on job responsibilities, methods of support, determinants of job performance success, and concerns. Results Of 168 chairmen who received the survey, 72 (43%) responded. The mean age of chairmen was 57 years (range, 44-78 years). Of 72 chairmen who responded, 69 (96%) were men, 67 (93%) were white, 65 (90%) were professors, 11 (15%) held a previous chair, 35 (49%) have advanced degrees, and 19 (26%) are program directors. Respondents are responsible for an average of 8.7 divisions, 60 (83%) spent 1 to 10 hours per week in the clinic, 45 (63%) performed surgery 1 to 10 hours per week, 54 (75%) took less than 6 call days per month, 44 (61%) published 1 to 6 papers per year and attended a mean (SD) of 4.3 (1.7) essential meetings per year, and 48 (67%) took 1 to 3 weeks of vacation annually. Chair salary support includes (from least to most) faculty tax, grants, endowment, school, and hospital. Compensation correlates with age, additional degree, specialty, location, contract, and tenure but not clinical hours. Reported compensation was consistent with data from the Association of American Medical Colleges, but 24 (33%) felt undercompensated. Incentives for job performance were given for clinical productivity (34 chairmen [47%]), department performance (50 [70%]), institutional performance (27 [38%]), and personal accomplishment (14 [19%]). Of 72 chairmen, 30 (42%) were concerned about personal liability related to the job, 15 (21%) had purchased personal liability insurance, and 20 (28%) have defended a lawsuit related to nonclinical responsibilities. Conclusions and Relevance Academic surgery department chairmen have a wide array of responsibilities that have changed from historic standards. Success in the role of chairman may improve by appreciating the responsibilities, time allocation, methods of support, and concerns of other chairmen.

Surgical safety checklists (SSCs) are associated with reductions in postoperativemorbidity andmortality and have now achievedwidespread implementation, although thequalityof implementation remainsunclear inmanysettings.1,2 In this issue of JAMA Surgery, Bock and colleagues3 evaluate the effect of introducing an SSC in a single Italian referral hospital on30-and90-dayall-causemortality,30-dayreadmissionrate, and hospital length of stay. Bock et al3 demonstrate a statistically significant decrease inoverall surgicalmortality at90daysafter surgeryand a reduction in hospital length of stay after implementation of anSSC.Mostpreviouspublications thatexaminedsurgicalmortality focusedonthemoretraditional andwidely accepted 30-daypostoperativemortality and readmission rates. Historically, the 30-day outcomes were chosen because of difficulties with long-term follow-up and issueswith attributing death in the 30to 90-daypostoperative period to the primary surgical procedure.3 We commend the authors for choosing to focus on the 90-day postoperative all-cause mortality rate, and we are reassured that they saw a statistically significant decrease. However, we should also considerwhyno statistically significant change in the 30-day postoperative all-cause mortality rates was observed. This finding could be attributable to inherent differences in the population studied, to the case mix, or to insufficient power to detect change related to sample size. This article also highlights the ongoing challenges of checklist implementation and measurement of the impact of the SSC. First, whether SSC performance underwent direct observation during implementation and whether that observation compared with reported performance are unclear. Checklist performance appears to be measured primarily by checking whether a form was completed. Significant discordance between paper checklist completion and actual completion has been described.4 Second, 80% completion was considered the threshold for complete implementation in this study, whereas recent literature supports that full rather than partial checklist completion provides an opportunity for significant improvement of the effect of the SSC on the quality of patient care and surgical safety.5 With more effective implementation and full SSC use in every case, the improvement in outcomes seen could have been even. If the SSC is not used, it cannot help. Although some investigators question the actual impact of checklists, despite the proliferation of evidence regarding improved patient outcomes and quality of care across countries, these arguments fail to acknowledge fully the difficulty of effectively implementingSSCs ina complexhealth system.6 A focus on the systems of care and promotion of a culture of safety at the institutional level is necessary tooptimize checklist implementation and realize its full potential. Effective implementation is critical tomeaningfuluseofSSCs,whichcan lead to maximally improved outcomes.