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1,443 results on '"Talamini, Mark"'

1. SAGES consensus recommendations on surgical video data use, structure, and exploration (for research in artificial intelligence, clinical quality improvement, and surgical education)

Author

Eckhoff, Jennifer A., Rosman, Guy, Altieri, Maria S., Speidel, Stefanie, Stoyanov, Danail, Anvari, Mehran, Meier-Hein, Lena, März, Keno, Jannin, Pierre, Pugh, Carla, Wagner, Martin, Witkowski, Elan, Shaw, Paresh, Madani, Amin, Ban, Yutong, Ward, Thomas, Filicori, Filippo, Padoy, Nicolas, Talamini, Mark, and Meireles, Ozanan R.

Published
2023
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33. Outcomes Improvement is not Continuous Along the Learning Curve for Pancreaticoduodenectomy

Author

Coe, Taylor M, Wilson, Samuel E, Talamini, Mark A, and Chang, David C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Aging, Good Health and Well Being, Adult, Aged, California, Clinical Competence, Databases, Factual, Female, Hospital Mortality, Hospitals, Humans, Learning Curve, Male, Middle Aged, Outcome Assessment, Health Care, Pancreaticoduodenectomy, Learning curve, Mortality, Outcomes improvement, Surgery, Clinical sciences
Abstract

BackgroundMost studies on learning curves for pancreaticoduodenectomy have been based on single-surgeon series at tertiary academic centers or are inferred indirectly from volume-outcome relationships. Our aim is to describe mortality rates associated with cumulative surgical experience among non-teaching hospitals.Study designObservational study of a statewide inpatient database. Analysis included hospitals that began performing pancreaticoduodenectomy between 1996 and 2010, as captured by the California Office of Statewide Health Planning and Development database. Cases were numbered sequentially within each hospital. The same sequential series (e.g., first 10 cases, 11th through 20th cases) were identified across hospitals. The outcome measure was in-hospital mortality.ResultsA total of 1210 cases from 143 non-teaching hospitals were analyzed. The average age was 63 years old, and the majority of patients were non-Hispanic white. The median overall mortality rate was 9.75 %. The mortality rate for the first 10 aggregated cases was 11.3 %. This improved for subsequent cases, reaching 7.1 % for the 21st-30th cases. However, the mortality rate then increased, reaching 16.7 % by the 41st-50th cases before falling to 0.0 % by the 61st-70th cases.ConclusionsInitial improvement in surgical outcomes relative to cumulative surgical experience is not sustained. It is likely that factors other than surgical experience affect outcomes, such as less rigorous assessment of comorbidities or changes in support services. Vigilance regarding outcomes should be maintained even after initial improvements.

Published
2014

34. An efficient risk adjustment model to predict inpatient adverse events after surgery.

Author

Anderson, Jamie, Rose, John, Noorbakhsh, Abraham, Talamini, Mark, Finlayson, Samuel, Bickler, Stephen, and Chang, David

Subjects
Adult, Aged, Cost-Benefit Analysis, Female, Humans, Inpatients, Logistic Models, Male, Middle Aged, Models, Organizational, Outcome Assessment, Health Care, Postoperative Complications, Quality Improvement, ROC Curve, Risk Adjustment
Abstract

BACKGROUND: Risk adjustment is an important component of surgical outcomes and quality analyses. Current models include numerous preoperative variables; however, the relative contribution of these variables may be limited. This research seeks to identify a model with the fewest number of variables necessary to perform an adequate risk adjustment to predict any inpatient adverse event for use in resource-limited settings. METHODS: All patients from the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2010 were included. Outcomes were inpatient mortality or any surgical complication captured by NSQIP. Models were built by sequential addition of preoperative risk variables selected by their area under the receiver operator characteristic curve (AUC). RESULTS: Among 863,349 patients, the single variable with the highest AUC was American Society of Anesthesiologists (ASA) classification (AUC = 0.7127). AUC values reached 0.7923 with five variables (ASA classification, wound classification, functional status prior to surgery, albumin, and age) and 0.7945 with six variables. The sixth variable was one of the following: alkaline phosphatase, weight loss, principal anesthesia technique, gender, or emergency status. The model with the highest discrimination that did not require laboratories included ASA classification, functional status prior to surgery, wound classification, and age (AUC = 0.7810). Including all 66 preoperative variables produced little additional gain (AUC = 0.8006). CONCLUSIONS: Six variables are sufficient to develop a risk adjustment tool for inpatient surgical mortality and morbidity. This research has important implications for the field of surgical outcomes research by improving efficiency of data collection. This limited model can aid the expansion of risk-adjusted analyses to resource-limited settings worldwide.

Published
2014

35. Fluorescently labeled chimeric anti‐CEA antibody improves detection and resection of human colon cancer in a patient‐derived orthotopic xenograft (PDOX) nude mouse model

Author

Metildi, Cristina A, Kaushal, Sharmeela, Luiken, George A, Talamini, Mark A, Hoffman, Robert M, and Bouvet, Michael

Subjects
Biomedical and Clinical Sciences, Oncology and Carcinogenesis, Cancer, Colo-Rectal Cancer, Digestive Diseases, Biotechnology, Animals, Antibodies, Monoclonal, Carbocyanines, Carcinoembryonic Antigen, Chimera, Colonic Neoplasms, Diagnostic Imaging, Fluorescent Antibody Technique, Fluorescent Dyes, Heterografts, Humans, Image Enhancement, Mice, Mice, Nude, orthotopic mouse models, colon cancer, chimeric antibody, fluorescence-guided surgery, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

Background and objectivesThe aim of this study was to evaluate a new fluorescently labeled chimeric anti-CEA antibody for improved detection and resection of colon cancer.MethodsFrozen tumor and normal human tissue samples were stained with chimeric and mouse antibody-fluorophore conjugates for comparison. Mice with patient-derived orthotopic xenografts (PDOX) of colon cancer underwent fluorescence-guided surgery (FGS) or bright-light surgery (BLS) 24 hr after tail vein injection of fluorophore-conjugated chimeric anti-CEA antibody. Resection completeness was assessed using postoperative images. Mice were followed for 6 months for recurrence.ResultsThe fluorophore conjugation efficiency (dye/mole ratio) improved from 3-4 to >5.5 with the chimeric CEA antibody compared to mouse anti-CEA antibody. CEA-expressing tumors labeled with chimeric CEA antibody provided a brighter fluorescence signal on frozen human tumor tissues (P = 0.046) and demonstrated consistently lower fluorescence signals in normal human tissues compared to mouse antibody. Chimeric CEA antibody accurately labeled PDOX colon cancer in nude mice, enabling improved detection of tumor margins for more effective FGS. The R0 resection rate increased from 86% to 96% with FGS compared to BLS.ConclusionImproved conjugating efficiency and labeling with chimeric fluorophore-conjugated antibody resulted in better detection and resection of human colon cancer in an orthotopic mouse model.

Published
2014

36. Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy: Results From a Population-Based Analysis

Author

Cao, Hop S Tran, Lopez, Nicole, Chang, David C, Lowy, Andrew M, Bouvet, Michael, Baumgartner, Joel M, Talamini, Mark A, and Sicklick, Jason K

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Patient Safety, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Comorbidity, Female, Hospital Charges, Hospital Mortality, Hospitals, Teaching, Humans, Length of Stay, Male, Middle Aged, Minimally Invasive Surgical Procedures, Multivariate Analysis, Outcome Assessment, Health Care, Pancreatectomy, Pancreatic Diseases, Pancreatic Neoplasms, Pancreatitis, Postoperative Complications, Robotics, Splenectomy, Treatment Outcome, United States, Clinical sciences
Abstract

ImportanceInterest in minimally invasive distal pancreatectomy (MIDP) has grown in recent years, but currently available data are limited. Greater insight into application patterns and outcomes may be gained from a national database inquiry.ObjectivesTo study trends in the use of MIDP and compare the short-term outcomes of MIDP with those of open distal pancreatectomy.Design, setting, and participantsPopulation-based retrospective cohort study evaluating perioperative outcomes and hospital charge measures for distal pancreatectomy, comparing the surgical approaches and adjusting for patient- and hospital-level factors, among patients undergoing elective distal pancreatectomy from 1998 to 2009 in the Nationwide Inpatient Sample in a 20% stratified sample of all US hospitals.Main outcomes and measuresIn-hospital mortality, rates of perioperative complications and splenectomy, total charges, and length of stay.ResultsA total of 8957 distal pancreatectomies were included in this analysis, of which 382 (4.3%) were MIDPs. On a national level, this projected to 42,320 open distal pancreatectomies and 1908 MIDPs. The proportion of distal pancreatectomies performed via minimally invasive approaches tripled between 1998 and 2009, from 2.4% to 7.3%. The groups were comparable for sex and comorbidity profiles, while patients who underwent MIDP were 1.5 years older. On multivariate analysis, MIDP was associated with lower rates of overall predischarge complications, including lower incidences of postoperative infections and bleeding complications, as well as a shorter length of stay by 1.22 days. There were no differences in rates of in-hospital mortality, concomitant splenectomy, or total charges.Conclusions and relevanceThis population-based study of MIDP reveals that the application of this approach has tripled in practice and provides strong evidence that MIDP has evolved into a safe option in the treatment of benign and malignant pancreatic diseases.

Published
2014

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