404 results on '"Thoracic Surgery standards"'
Search Results
2. The Society of Thoracic Surgeons General Thoracic Surgery Database: A Unique Society on Quality Healthcare and Outcomes.
- Author
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Campos JH
- Subjects
- Humans, Surgeons standards, Thoracic Surgery standards, Societies, Medical standards, Quality of Health Care standards, Databases, Factual standards, Databases, Factual trends, Thoracic Surgical Procedures standards
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2024
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3. The 2023 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Management of subsolid lung nodules.
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Chen H, Kim AW, Hsin M, Shrager JB, Prosper AE, Wahidi MM, Wigle DA, Wu CC, Huang J, Yasufuku K, Henschke CI, Suzuki K, Tailor TD, Jones DR, and Yanagawa J
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- Humans, Pneumonectomy standards, Pneumonectomy adverse effects, Predictive Value of Tests, Thoracic Surgery methods, Thoracic Surgery standards, Consensus, Lung Neoplasms surgery, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology, Multiple Pulmonary Nodules diagnostic imaging, Multiple Pulmonary Nodules pathology, Multiple Pulmonary Nodules surgery, Solitary Pulmonary Nodule diagnostic imaging, Solitary Pulmonary Nodule pathology, Solitary Pulmonary Nodule surgery
- Abstract
Objective: Lung cancers that present as radiographic subsolid nodules represent a subtype with distinct biological behavior and outcomes. The objective of this document is to review the existing literature and report consensus among a group of multidisciplinary experts, providing specific recommendations for the clinical management of subsolid nodules., Methods: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international, multidisciplinary expert panel composed of radiologists, pulmonologists, and thoracic surgeons with established expertise in the management of subsolid nodules. A focused literature review was performed with the assistance of a medical librarian. Expert consensus statements were developed with class of recommendation and level of evidence for each of 4 main topics: (1) definitions of subsolid nodules (radiology and pathology), (2) surveillance and diagnosis, (3) surgical interventions, and (4) management of multiple subsolid nodules. Using a modified Delphi method, the statements were evaluated and refined by the entire panel., Results: Consensus was reached on 17 recommendations. These consensus statements reflect updated insights on subsolid nodule management based on the latest literature and current clinical experience, focusing on the correlation between radiologic findings and pathological classifications, individualized subsolid nodule surveillance and surgical strategies, and multimodality therapies for multiple subsolid lung nodules., Conclusions: Despite the complex nature of the decision-making process in the management of subsolid nodules, consensus on several key recommendations was achieved by this American Association for Thoracic Surgery expert panel. These recommendations, based on evidence and a modified Delphi method, provide guidance for thoracic surgeons and other medical professionals who care for patients with subsolid nodules., Competing Interests: Conflict of Interest Statement A full list of author’s disclosures is provided in Appendix E1. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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4. The American Association for Thoracic Surgery (AATS) 2024 expert consensus document: Management of neonates and infants with Ebstein anomaly.
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Konstantinov IE, Chai P, Bacha E, Caldarone CA, Da Silva JP, Da Fonseca Da Silva L, Dearani J, Hornberger L, Knott-Craig C, Del Nido P, Qureshi M, Sarris G, Starnes V, and Tsang V
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- Humans, Infant, Newborn, Infant, Risk Assessment, Cardiac Surgical Procedures adverse effects, Risk Factors, Treatment Outcome, Thoracic Surgery standards, Ebstein Anomaly surgery, Ebstein Anomaly physiopathology, Consensus
- Abstract
Objectives: Symptomatic neonates and infants with Ebstein anomaly (EA) require complex management. A group of experts was commissioned by the American Association for Thoracic Surgery to provide a framework on this topic focusing on risk stratification and management., Methods: The EA Clinical Congenital Practice Standards Committee is a multinational and multidisciplinary group of surgeons and cardiologists with expertise in EA. A citation search in PubMed, Embase, Scopus, and Web of Science was performed using key words related to EA. The search was restricted to the English language and the year 2000 or later and yielded 455 results, of which 71 were related to neonates and infants. Expert consensus statements with class of recommendation and level of evidence were developed using a modified Delphi method, requiring 80% of members votes with at least 75% agreement on each statement., Results: When evaluating fetuses with EA, those with severe cardiomegaly, retrograde or bidirectional shunt at the ductal level, pulmonary valve atresia, circular shunt, left ventricular dysfunction, or fetal hydrops should be considered high risk for intrauterine demise and postnatal morbidity and mortality. Neonates with EA and severe cardiomegaly, prematurity (<32 weeks), intrauterine growth restriction, pulmonary valve atresia, circular shunt, left ventricular dysfunction, or cardiogenic shock should be considered high risk for morbidity and mortality. Hemodynamically unstable neonates with a circular shunt should have emergent interruption of the circular shunt. Neonates in refractory cardiogenic shock may be palliated with the Starnes procedure. Children may be assessed for later biventricular repair after the Starnes procedure. Neonates without high-risk features of EA may be monitored for spontaneous closure of the patent ductus arteriosus (PDA). Hemodynamically stable neonates with significant pulmonary regurgitation at risk for circular shunt with normal right ventricular systolic pressure should have an attempt at medical closure of the PDA. A medical trial of PDA closure in neonates with functional pulmonary atresia and normal right ventricular systolic pressure (>20-25 mm Hg) should be performed. Neonates who are hemodynamically stable without pulmonary regurgitation but inadequate antegrade pulmonary blood flow may be considered for a PDA stent or systemic to pulmonary artery shunt., Conclusions: Risk stratification is essential in neonates and infants with EA. Palliative comfort care may be reasonable in neonates with associated risk factors that may include prematurity, genetic syndromes, other major medical comorbidities, ventricular dysfunction, or sepsis. Neonates who are unstable with a circular shunt should have emergent interruption of the circular shunt. Neonates who are unstable are most commonly palliated with the Starnes procedure. Neonates who are stable should undergo ductal closure. Neonates who are stable with inadequate pulmonary flow may have ductal stenting or a systemic-to-pulmonary artery shunt. Subsequent procedures after Starnes palliation include either single-ventricle palliation or biventricular repair strategies., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)
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- 2024
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5. The Society of Thoracic Surgeons/American Society for Radiation Oncology/American Society of Clinical Oncology Recommendations on the Care of Patients With Localized Esophageal Cancers.
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Gelzinis TA
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- Humans, Esophagectomy methods, Medical Oncology standards, Medical Oncology methods, Practice Guidelines as Topic standards, Surgeons standards, Thoracic Surgery standards, United States, Esophageal Neoplasms therapy, Radiation Oncology standards, Radiation Oncology methods, Societies, Medical standards
- Abstract
Competing Interests: Declaration of competing interest None.
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- 2024
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6. High Stakes Surgery Demands Perfect Results.
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Barron DJ
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- Humans, Educational Measurement methods, Thoracic Surgery standards
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- 2023
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7. The American Association for Thoracic Surgery and The Society of Thoracic Surgeons Reasoning for Not Endorsing the 2021 ACC/AHA/SCAI Coronary Revascularization Guidelines.
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Sabik JF 3rd, Bakaeen FG, Ruel M, Moon MR, Malaisrie SC, Calhoon JH, Girardi LN, and Guyton R
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- American Heart Association, Humans, Myocardial Revascularization, United States, Surgeons, Thoracic Surgery standards
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- 2022
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8. The 2021 ESC/EACTS guidelines for the management of valvular heart disease: a new template for Heart Teams and their patients.
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Prendergast B and Vahanian A
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- Clinical Decision-Making, Consensus, Europe, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Heart Valve Prosthesis Implantation adverse effects, Heart Valves diagnostic imaging, Heart Valves physiopathology, Humans, Risk Assessment, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Treatment Outcome, Cardiology standards, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation standards, Heart Valves surgery, Patient Care Team standards, Practice Guidelines as Topic standards, Societies, Medical standards, Thoracic Surgery standards, Transcatheter Aortic Valve Replacement standards
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- 2022
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9. The second annual Thoracic Surgery Residents Association presidential address: Enter the arena.
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Brescia AA
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- Clinical Competence, Education methods, Education trends, Emotional Intelligence, Humans, Leadership, Social Responsibility, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgery trends, Cardiac Surgical Procedures education, Internship and Residency ethics, Internship and Residency methods, Internship and Residency organization & administration, Thoracic Surgery education
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- 2022
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10. Wisdom From Past Presidents of The Society of Thoracic Surgeons.
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Han JJ, Mays JC, Iyengar A, Luc JGY, Patrick WL, Helmers MR, Smood B, Kelly JJ, Williams ML, Szeto WY, and Cevasco M
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- Societies, Medical, Thoracic Surgery standards
- Abstract
The Society of Thoracic Surgeons is a highly impactful professional organization in cardiothoracic surgery and an important network of mentors for trainees. Annually, presidents of The Society of Thoracic Surgeons deliver an address encapsulating their professional experiences, lessons learned, and future vision for the field. We sought to summarize these lessons into salient points for trainees. Transcriptions from 1964 to 2018 were reviewed by residents and expounded into categories of importance for readers. Six overarching themes were identified: (1) leadership, (2) education, (3) clinical excellence and innovation, (4) humanism and professionalism, (5) diversity and inclusion, and (6) the future of cardiothoracic surgery., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2021
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11. Administrative versus clinical databases.
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Subramanian MP, Hu Y, Puri V, and Kozower BD
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- Biomedical Research methods, Data Accuracy, Humans, Information Storage and Retrieval methods, Information Storage and Retrieval statistics & numerical data, Observer Variation, Registries statistics & numerical data, Databases as Topic classification, Databases as Topic statistics & numerical data, Management Information Systems statistics & numerical data, Medical Informatics methods, Outcome Assessment, Health Care methods, Quality Improvement organization & administration, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgery statistics & numerical data
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- 2021
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12. Administrative and clinical databases: General thoracic surgery perspective on approaches and pitfalls.
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Kidane B, Wakeam E, Meguid RA, and Odell DD
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- Comparative Effectiveness Research, Evidence-Based Practice, Humans, Quality Assurance, Health Care, Benchmarking, Biomedical Research methods, Biomedical Research organization & administration, Databases as Topic organization & administration, Databases as Topic statistics & numerical data, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgery statistics & numerical data
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- 2021
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13. The rocky exhilarating journey from data to wisdom.
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Kurlansky P
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- Benchmarking, Biomedical Research methods, Data Science methods, Humans, Information Storage and Retrieval methods, Information Storage and Retrieval statistics & numerical data, Quality Assurance, Health Care, Research Design, Databases as Topic classification, Databases as Topic statistics & numerical data, Management Information Systems, Medical Informatics, Quality Improvement organization & administration, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgery statistics & numerical data
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- 2021
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14. An Update From The Society of Thoracic Surgeons Workforce on Evidence-Based Surgery: Improving the Implementation of Clinical Practice Guidelines.
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Firestone S, Wyler von Ballmoos M, Kissoon K, Goldberg J, Worrell S, and Lawton J
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- Humans, Evidence-Based Medicine, Guideline Adherence, Thoracic Surgery standards, Thoracic Surgical Procedures standards
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- 2021
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15. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection.
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Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM 3rd, Chen EP, Fischbein MP, Gleason TG, Okita Y, Ouzounian M, Patel HJ, Roselli EE, Shrestha ML, Svensson LG, and Moon MR
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- Acute Disease, Analgesics therapeutic use, Aortic Dissection diagnostic imaging, Aortic Dissection mortality, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm mortality, Cardiovascular Agents therapeutic use, Clinical Decision-Making, Consensus, Delphi Technique, Humans, Patient Selection, Postoperative Complications etiology, Risk Assessment, Risk Factors, Treatment Outcome, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures mortality, Aortic Dissection surgery, Aortic Aneurysm surgery, Thoracic Surgery standards, Vascular Surgical Procedures standards
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- 2021
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16. Global health initiatives in cardiothoracic surgery: Ethical considerations and guidelines.
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Fenton KN, Novick WM, Entwistle JW 3rd, Moffatt-Bruce SD, and Sade RM
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- Humans, Practice Guidelines as Topic, Thoracic Surgical Procedures, Global Health ethics, Global Health standards, Healthcare Disparities ethics, Thoracic Surgery ethics, Thoracic Surgery organization & administration, Thoracic Surgery standards
- Published
- 2021
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17. 2019 Presidential Address of The Southern Thoracic Surgical Association: "WHY".
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Jacobs JP
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- Philosophy, Medical, United States, Societies, Medical, Thoracic Surgery standards
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- 2021
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18. Early vascular surgery response to the COVID-19 pandemic: Results of a nationwide survey.
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Latz CA, Boitano LT, Png CYM, Tanious A, Kibrik P, Conrad M, Eagleton M, and Dua A
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- COVID-19 diagnosis, Elective Surgical Procedures standards, Elective Surgical Procedures statistics & numerical data, Health Care Surveys, Humans, Internet, Patient Care standards, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' statistics & numerical data, Professional Practice standards, SARS-CoV-2, Thoracic Surgery standards, Thoracic Surgery statistics & numerical data, United States epidemiology, Vascular Surgical Procedures standards, COVID-19 epidemiology, Pandemics statistics & numerical data, Patient Care statistics & numerical data, Personal Protective Equipment statistics & numerical data, Professional Practice statistics & numerical data, Vascular Surgical Procedures statistics & numerical data
- Abstract
Objective: The COVID-19 pandemic has had major implications for the United States health care system. This survey study sought to identify practice changes, to understand current personal protective equipment (PPE) use, and to determine how caring for patients with COVID-19 differs for vascular surgeons practicing in states with high COVID-19 case numbers vs in states with low case numbers., Methods: A 14-question online survey regarding the effect of the COVID-19 pandemic on vascular surgeons' current practice was sent to 365 vascular surgeons across the country through REDCap from April 14 to April 21, 2020, with responses closed on April 23, 2020. The survey response was analyzed with descriptive statistics. Further analyses were performed to evaluate whether responses from states with the highest number of COVID-19 cases (New York, New Jersey, Massachusetts, Pennsylvania, and California) differed from those with lower case numbers (all other states)., Results: A total of 121 vascular surgeons responded (30.6%) to the survey. All high-volume states were represented. The majority of vascular surgeons are reusing PPE. The majority of respondents worked in an academic setting (81.5%) and were performing only urgent and emergent cases (80.5%) during preparation for the surge. This did not differ between states with high and low COVID-19 case volumes (P = .285). States with high case volume were less likely to perform a lower extremity intervention for critical limb ischemia (60.8% vs 77.5%; P = .046), but otherwise case types did not differ. Most attending vascular surgeons worked with residents (90.8%) and limited their exposure to procedures on suspected or confirmed COVID-19 cases (56.0%). Thirty-eight percent of attending vascular surgeons have been redeployed within the hospital to a vascular access service or other service outside of vascular surgery. This was more frequent in states with high case volume compared with low case volume (P = .039). The majority of vascular surgeons are reusing PPE (71.4%) and N95 masks (86.4%), and 21% of vascular surgeons think that they do not have adequate PPE to perform their clinical duties., Conclusions: The initial response to the COVID-19 pandemic has resulted in reduced elective cases, with primarily only urgent and emergent cases being performed. A minority of vascular surgeons have been redeployed outside of their specialty; however, this is more common among states with high case numbers. Adequate PPE remains an issue for almost a quarter of vascular surgeons who responded to this survey., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2021
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19. Enhancing thoracic surgical trainee competence in the coronavirus disease 2019 (COVID-19) era: Challenges and opportunities for mentorship.
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Boskovski MT, Hirji SA, Brescia AA, Chang AC, and Kaneko T
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- COVID-19, Education, Medical, Graduate standards, Humans, SARS-CoV-2, Thoracic Surgery standards, United States, Betacoronavirus, Clinical Competence, Coronavirus Infections, Education, Medical, Graduate methods, Mentoring, Mentors, Pandemics, Pneumonia, Viral, Thoracic Surgery education
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- 2020
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20. Cardiovascular disease and COVID-19: Australian and New Zealand consensus statement.
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Zaman S, MacIsaac AI, Jennings GL, Schlaich MP, Inglis SC, Arnold R, Kumar S, Thomas L, Wahi S, Lo S, Naismith C, Duffy SJ, Nicholls SJ, Newcomb A, Almeida AA, Wong S, Lund M, Chew DP, Kritharides L, Chow CK, and Bhindi R
- Subjects
- Australia epidemiology, COVID-19 virology, Consensus, Humans, New Zealand epidemiology, Societies, Medical, COVID-19 complications, Cardiology standards, Cardiovascular Diseases virology, SARS-CoV-2, Thoracic Surgery standards
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Introduction: The coronavirus 2019 disease (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pre-existing cardiovascular disease (CVD) increases the morbidity and mortality of COVID-19, and COVID-19 itself causes serious cardiac sequelae. Strategies to minimise the risk of viral transmission to health care workers and uninfected cardiac patients while prioritising high quality cardiac care are urgently needed. We conducted a rapid literature appraisal and review of key documents identified by the Cardiac Society of Australia and New Zealand Board and Council members, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, and key cardiology, surgical and public health opinion leaders., Main Recommendations: Common acute cardiac manifestations of COVID-19 include left ventricular dysfunction, heart failure, arrhythmias and acute coronary syndromes. The presence of underlying CVD confers a five- to tenfold higher case fatality rate with COVID-19 disease. Special precautions are needed to avoid viral transmission to this population at risk. Adaptive health care delivery models and resource allocation are required throughout the health care system to address this need., Changes in Management as a Result of This Statement: Cardiovascular health services and cardiovascular health care providers need to recognise the increased risk of COVID-19 among CVD patients, upskill in the management of COVID-19 cardiac manifestations, and reorganise and innovate in service delivery models to meet demands. This consensus statement, endorsed by the Cardiac Society of Australia and New Zealand, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, the National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia summarises important issues and proposes practical approaches to cardiovascular health care delivery to patients with and without SARS-CoV-2 infection., (© 2020 AMPCo Pty Ltd.)
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- 2020
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21. Digital Health Primer for Cardiothoracic Surgeons.
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Baxter RD, Fann JI, DiMaio JM, and Lobdell K
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- Artificial Intelligence, Computer Simulation, Humans, Telemedicine, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgical Procedures methods, Thoracic Surgical Procedures standards
- Abstract
The burgeoning demands for quality, safety, and value in cardiothoracic surgery, in combination with the advancement and acceleration of digital health solutions and information technology, provide a unique opportunity to improve efficiency and effectiveness simultaneously in cardiothoracic surgery. This primer on digital health explores and reviews data integration, data processing, complex modeling, telehealth with remote monitoring, and cybersecurity as they shape the future of cardiothoracic surgery., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2020
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22. Comparison of Invasive and Noninvasive Blood Pressure Measurements for Assessing Signal Complexity and Surgical Risk in Cardiac Surgical Patients.
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Gibson LE, Henriques TS, Costa MD, Davis RB, Mittleman MA, Mathur P, and Subramaniam B
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- Aged, Arterial Pressure, Blood Pressure Monitors, Catheterization, Female, Humans, Linear Models, Male, Middle Aged, Radial Artery, Regression Analysis, Risk Assessment, Signal Processing, Computer-Assisted, Surgical Procedures, Operative, Thoracic Surgery standards, Blood Pressure, Blood Pressure Determination instrumentation, Blood Pressure Determination methods, Cardiac Surgical Procedures methods
- Abstract
Background: Continuous arterial blood pressure (ABP) is typically recorded by placement of an intraarterial catheter. Recently, noninvasive ABP monitors have been shown to be comparable in accuracy to invasive measurements. In a previous study, we showed that the fluctuations in beat-to-beat ABP measurements were not random variations but had a complex dynamical structure, and that ABP dynamical complexity was inversely associated with surgical risk estimated using the Society of Thoracic Surgeons (STS) index. Dynamical complexity is a mathematical construct that reflects the capacity of a physiological system to adapt to stimuli. The objectives of present study were to: (1) determine whether noninvasive beat-to-beat ABP measurements also exhibit a complex temporal structure; (2) compare the complexity of noninvasive versus invasive ABP time series; and (3) quantify the relationship between the complexity of noninvasive ABP time series and the STS risk scores., Methods: Fifteen adult patients undergoing coronary artery bypass graft, valve, or combined coronary artery bypass graft/valve surgery were enrolled in this observational study. Preoperative ABP waveforms were simultaneously recorded for ≥15 minutes using a radial artery catheter (invasive) and a continuous noninvasive arterial pressure monitor. Beat-to-beat systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) time series were extracted from the continuous waveforms. Complexity was assessed using the multiscale entropy method. The Wilcoxon signed-rank test was used to compare the mean ranks of indices derived from invasive versus noninvasive ABP time series. Spearman correlation coefficients were used to quantify the relationship between invasive and noninvasive indices. Linear regression analysis was used to quantify the association between each of the complexity indices and the STS risk scores., Results: Beat-to-beat fluctuations in noninvasive ABP measurements were not random but complex; however, their degree of complexity was lower than that of fluctuations in invasively obtained ABP signals (SBP: 7.05 vs 8.66, P < .001; DBP: 7.40 vs 8.41, P < .001; PP: 6.83 vs 8.82, P < .001; and MAP: 7.17 vs 8.68, P < .005). Invasive and noninvasive indices for MSEΣ·slope showed good correlation (rs) (0.53 for SBP, 0.79 for DBP, 0.42 for PP, 0.60 for MAP). The complexity of noninvasive ABP time series (-0.70 [-1.28 to -0.11]; P = .023 for DBP), like that of invasive time series (-0.94 [-1.52 to -0.35]; P = .004 for DBP), was inversely associated with estimated surgical risk in patients undergoing cardiovascular operations., Conclusions: Our results support the use of noninvasive ABP monitoring in computations of complexity-based indices that correlate with estimated surgical risk.
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- 2020
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23. [Joint Statement of the German Respiratory Society and German Society of Thoracic Surgery in Cooperation with the German Radiological Society: Structural Prerequisites of Centers for Interventional Treatment of Emphysema].
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Gesierich W, Darwiche K, Döllinger F, Eberhardt R, Eisenmann S, Grah C, Heußel CP, Hübner RH, Ley-Zaporozhan J, Stanzel F, Welter S, and Hoffmann H
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- Emphysema diagnosis, Germany, Humans, Patient Care Team, Pneumonectomy, Pulmonary Medicine standards, Radiography, Thoracic Surgery standards, Emphysema therapy, Interdisciplinary Communication, Lung physiopathology, Societies, Medical
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Interventional treatment of emphysema offers a wide range of surgical and endoscopic options for patientes with advanced disease. Multidsciplinary collaboration of pulmonology, thoracic surgery and imaging disciplines in patient selection, therapy and follow up ensures treatment quality. The present joint statement describes the required structural and quality prerequsites of treatment centres., Competing Interests: W. Gesierich hat Referentenhonorare und Reiseunterstützung von PulmonX, PneumRx/BTG und Astra Zeneca erhalten.K. Darwiche hat Forschungsunterstützung und Referentenhonorare von PulmonX, PneumRx/BTG und Boston Scientific sowie Referentenhonorare bzw. Reiseunterstützung von Olympus und Böhringer Ingelheim erhalten.C.-P. Heußel hat Referentenhonorare von Novartis, Basilea und Bayer erhalten.R.-H. Hübner hat Referentenhonorare von PneumRx/BTG und PulmonX und ein Reisehonorar von Uptake Medical erhalten. Er ist Principle Investigator von industriegeförderten klinischen Studien der Firmen PneumRx (Elevate), Pulmonx (Stage) und Uptake (BTVA Registry). Er ist im Vorstand des Lungenemphysem Registers e. V.F. Döllinger, R. Eberhardt, S. Eisenmann, C. Grah, J. Ley-Zaporozhan, F. Stanzel, S. Welter und H. Hoffmann geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2020
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24. Pan-Canadian standards for cancer surgery
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Prashad A, Mitchell M, Argent-Katwala M, Daly C, Earle CC, and Finley C
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- Breast Neoplasms surgery, Canada, Digestive System Surgical Procedures education, Digestive System Surgical Procedures standards, Female, Genital Neoplasms, Female surgery, Gynecologic Surgical Procedures standards, Humans, Indians, North American, Inuit, Male, Mastectomy standards, Quality of Health Care, Rectal Neoplasms surgery, Specialties, Surgical education, Surgical Procedures, Operative education, Thoracic Neoplasms surgery, Thoracic Surgery standards, Thoracic Surgical Procedures standards, Specialties, Surgical standards, Surgical Procedures, Operative standards
- Abstract
About the Canadian Partnership Against Cancer: The Canadian Partnership Against Cancer (CPAC) is an independent organization funded by the federal government to accelerate action on cancer control for all Canadians. As the steward of the Canadian Strategy for Cancer Control (the Strategy), the Partnership works with Canada’s cancer community to take action to ensure fewer people get cancer, more people survive cancer and those living with the disease have a better quality of life. This work is guided by the Strategy, which was refreshed for 2019 to 2029, and will help drive measurable change for all Canadians affected by cancer. The Strategy includes 5 priorities that will tackle the most pressing challenges in cancer control as well as distinct First Nations, Inuit and Métis Peoples–specific priorities and actions reflecting Canada’s commitment to reconciliation. A specific action in the Strategy calls for reducing the differences in practice and service delivery by setting standards for high-quality care and promoting their adoption. The CPAC will oversee the implementation of the priorities in collaboration with organizations and individuals on the front lines of cancer care: the provinces and territories; health care professionals; people living with cancer and those who care for them; First Nations, Inuit and Métis communities; governments and organizations; and its funder, Health Canada. Learn more about the Partnership and the refreshed Strategy at www.cancerstrategy.ca., Competing Interests: None declared., (© 2019 Joule Inc. or its licensors)
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- 2019
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25. 2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
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Nishimura RA, O'Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, Lindman BR, Linderbaum JA, Little SH, Mack MJ, Mauri L, Miranda WR, Shahian DM, and Sundt TM 3rd
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- Cardiology standards, Computed Tomography Angiography standards, Consensus, Echocardiography standards, Female, Humans, Male, Sensitivity and Specificity, Societies, Medical, United States, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases surgery, Imaging, Three-Dimensional standards, Practice Guidelines as Topic, Thoracic Surgery standards
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- 2019
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26. Preoperative Laboratory Studies for Pediatric Cardiac Surgery Patients: A Multi-Institutional Perspective.
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Jones SE, Jooste EH, Gottlieb EA, Schwartz J, Goswami D, Gautam NK, Benkwitz C, Downey LA, Guzzetta NA, Zabala L, Latham GJ, Faraoni D, Navaratnam M, Wise-Faberowski L, McDaniel M, Spurrier E, and Machovec KA
- Subjects
- Blood Chemical Analysis, Blood Gas Analysis, Canada, Child, Follow-Up Studies, Heart, Hemostasis, Humans, Practice Patterns, Physicians', Retrospective Studies, Specialties, Surgical, Surveys and Questionnaires, United States, Anesthesiology methods, Cardiac Surgical Procedures methods, Pediatrics methods, Thoracic Surgery methods, Thoracic Surgery standards
- Published
- 2019
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27. The Society of Thoracic Surgeons National Database at 30: Honoring Our Heritage, Celebrating the Present, Evolving for the Future.
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Shahian DM, Fernandez FG, and Badhwar V
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- Databases, Factual trends, Forecasting, Humans, Societies, Medical, Thoracic Surgery trends, Total Quality Management, United States, Databases, Factual standards, Practice Guidelines as Topic, Thoracic Surgery standards
- Published
- 2019
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28. The Congenital Heart Technical Skill Study: Rationale and Design.
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Anderson BR, Kumar SR, Gottlieb-Sen D, Liava'a MH, Hill KD, Jacobs JP, Moga FX, Overman DM, Newburger JW, Glied SA, and Bacha EA
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- Cardiac Surgical Procedures education, Cardiac Surgical Procedures methods, Child, Databases, Factual, Humans, Peer Review, Health Care methods, Quality Improvement, Research Design, Societies, Medical, United States, Video Recording, Cardiac Surgical Procedures standards, Clinical Competence, Heart Defects, Congenital surgery, Thoracic Surgery standards
- Abstract
Background: We report the rationale and design for a peer-evaluation protocol of attending congenital heart surgeon technical skill using direct video observation., Methods: All surgeons contributing data to The Society of Thoracic Surgeons-Congenital Heart Surgery Database (STS-CHSD) are invited to submit videos of themselves operating, to rate peers, or both. Surgeons may submit Norwood procedures, complete atrioventricular canal repairs, and/or arterial switch operations. A HIPPA-compliant website allows secure transmission/evaluation. Videos are anonymously rated using a modified Objective Structured Assessment of Technical Skills score. Ratings are linked to five years of contemporaneous outcome data from the STS-CHSD and surgeon questionnaires. The primary outcome is a composite for major morbidity/mortality., Results: Two hundred seventy-six surgeons from 113 centers are eligible for participation: 83 (30%) surgeons from 53 (45%) centers have agreed to participate, with recruitment ongoing. These surgeons vary considerably in years of experience and outcomes. Participants, both early and late in their careers, describe the process as "very rewarding" and "less time consuming than anticipated." An initial subset of 10 videos demonstrated excellent interrater reliability (interclass correlation = 0.85)., Conclusions: This study proposes to evaluate the technical skills of attending pediatric cardiothoracic surgeons by video observation and peer-review. It is notable that over a quarter of congenital heart surgeons, across a range of experiences, from almost half of United States centers have already agreed to participate. This study also creates a mechanism for peer feedback; we hypothesize that feedback could yield broad and meaningful quality improvement.
- Published
- 2019
- Full Text
- View/download PDF
29. A surgical perspective of ERAS guidelines in thoracic surgery.
- Author
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Batchelor TJP and Ljungqvist O
- Subjects
- Consensus, Europe, Evidence-Based Medicine methods, Evidence-Based Medicine standards, Humans, Length of Stay statistics & numerical data, Lung Neoplasms surgery, Perioperative Care methods, Pneumonectomy methods, Postoperative Complications etiology, Postoperative Complications prevention & control, Societies, Medical standards, Surgeons standards, Time Factors, Treatment Outcome, Critical Pathways standards, Perioperative Care standards, Pneumonectomy adverse effects, Practice Guidelines as Topic, Thoracic Surgery standards
- Abstract
Purpose of Review: Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization., Recent Findings: Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications., Summary: The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.
- Published
- 2019
- Full Text
- View/download PDF
30. Conducting high-quality research in cardiothoracic surgical education: Recommendations from the Thoracic Education Cooperative Group.
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Antonoff MB, Nguyen S, Nguyen TC, and Odell DD
- Subjects
- Biomedical Research standards, Curriculum, Data Accuracy, Guidelines as Topic, Humans, Quality Control, Research Design, Surgeons standards, Thoracic Surgery standards, Thoracic Surgical Procedures standards, Biomedical Research education, Education, Medical, Graduate standards, Surgeons education, Thoracic Surgery education, Thoracic Surgical Procedures education
- Abstract
Objective: There is a clear need for improved quality of research publications in the area of cardiothoracic surgical education. With the goals of enhancing the power, rigor, and strength of educational investigations, the Thoracic Education Cooperative Group seeks to outline key concepts in successfully conducting such research., Methods: Literature and established guidelines for conduct of research in surgical education were reviewed, and recommendations were developed for investigators in thoracic surgical education., Results: Key steps in educational research are highlighted and discussed with regard to their application to cardiothoracic surgical education. Specifically, advice is provided in terms of developing a research question, educational methodology, ethical issues, and handling power and sample sizes. Additional caveats of educational research that are addressed include aspects of validity, survey conduct, and simulation research., Conclusions: Educational research can serve to enhance the practices and careers of current trainees, our scientific community, and thoracic surgical educators. To optimize the quality of such educational research, it is imperative that teachers, innovators, and contributors to academic scholarship in our field familiarize themselves with key steps in conducting educational studies., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
31. Examination of the enhanced recovery guidelines in thoracic surgery.
- Author
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Teeter EG, Kolarczyk LM, and Popescu WM
- Subjects
- Anesthesiology methods, Consensus, Europe, Evidence-Based Medicine methods, Evidence-Based Medicine standards, Humans, Length of Stay statistics & numerical data, Perioperative Care methods, Pneumonectomy methods, Societies, Medical standards, Time Factors, Anesthesiology standards, Perioperative Care standards, Pneumonectomy adverse effects, Practice Guidelines as Topic, Thoracic Surgery standards
- Abstract
Purpose of Review: Enhanced Recovery After Thoracic Surgery (ERATS) has gained momentum over the past few years, although the evidence base and expert recommendations lag behind other specialties. This review will present and examine key points from the first guidelines for enhanced recovery after lung surgery, released in 2018, jointly sponsored by the European Society of Thoracic Surgeons and the Enhanced Recovery After Surgery Society., Recent Findings: The recently released guidelines present core components of enhanced recovery as they pertain to lung resection surgery. Although evidence is still sparse in some areas, the guidelines summarize the available literature and incorporate levels of recommendation based upon the strength of available data as well as expert consensus. As of yet, the relative contribution of individual ERATS components to improvement in outcomes is unclear, but overall compliance does seem to be linked to positive results. Since the creation of the guidelines, additional literature related to ERATS has been released, and it will be incorporated and discussed into our review., Summary: The creation of guidelines for enhanced recovery after lung resection will provide the thoracic anesthesiologist a framework upon which to build a comprehensive perioperative anesthetic plan.
- Published
- 2019
- Full Text
- View/download PDF
32. Cardiac surgical operative training: a disincentivized necessity.
- Author
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Tolis G
- Subjects
- Clinical Competence, Humans, Internship and Residency, Cardiac Surgical Procedures education, Thoracic Surgery education, Thoracic Surgery organization & administration, Thoracic Surgery standards
- Published
- 2019
- Full Text
- View/download PDF
33. 2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
- Author
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Bavaria JE, Tommaso CL, Brindis RG, Carroll JD, Deeb GM, Feldman TE, Gleason TG, Horlick EM, Kavinsky CJ, Kumbhani DJ, Miller DC, Seals AA, Shahian DM, Shemin RJ, Sundt TM 3rd, and Thourani VH
- Subjects
- Cardiology organization & administration, Cardiology standards, Humans, Outcome and Process Assessment, Health Care, Thoracic Surgery organization & administration, Thoracic Surgery standards, Registries, Transcatheter Aortic Valve Replacement standards
- Published
- 2019
- Full Text
- View/download PDF
34. New Guidelines and Position papers in the European Journal of Cardio-Thoracic Surgery.
- Author
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Jeppsson A and Beyersdorf F
- Subjects
- Europe, Humans, Thoracic Surgical Procedures standards, Guidelines as Topic standards, Periodicals as Topic standards, Societies, Medical, Thoracic Surgery standards
- Published
- 2019
- Full Text
- View/download PDF
35. Current Practices in the Management of Pulmonary Ground-Glass Opacities: A Survey of SICT Members.
- Author
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Lococo F, Cusumano G, De Filippis AF, Curcurù G, Quercia R, Marulli G, Monaco G, Granone P, Muriana G, Rea F, Crisci R, Di Rienzo G, Cardillo G, and Lococo A
- Subjects
- Attitude of Health Personnel, Female, Health Care Surveys, Humans, Italy, Lung diagnostic imaging, Lung pathology, Lung Neoplasms pathology, Lung Neoplasms surgery, Male, Positron-Emission Tomography trends, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' trends, Risk Assessment, Societies, Medical, Surgeons, Thoracic Surgery standards, Thoracic Surgery trends, Tomography, X-Ray Computed trends, Lung Neoplasms diagnostic imaging, Outcome Assessment, Health Care, Positron-Emission Tomography standards, Surveys and Questionnaires, Tomography, X-Ray Computed standards
- Abstract
Background: Several gray areas and controversies exist concerning the management of pulmonary ground-glass opacities (GGOs), and there is a lack of consensus among clinicians on this topic. One of the main aims of the Italian Society of Thoracic Surgery is to promote education and research, so we decided to perform a survey on this topic to estimate current trends in practice in a large sample of thoracic surgeons., Methods: A total of 160 thoracic surgeons responded, namely, completed our questionnaire (response rate, 53%; 160 of 302). The survey was composed of 36 questions divided into six subsections: (1) demographic characteristics of the respondents; (2) terminology and taxonomy; (3) radiologic and radiometabolic evaluation; (4) diagnostic approach and indications for surgery; (5) surgical management; and (6) radiologic surveillance., Results: We observed some divergence of opinion regarding the definition of mixed GGOs, the role of 18F fluorodeoxyglucose positron emission tomography and computed tomography scans, indications for nonsurgical biopsy, intraoperative techniques for localizing GGOs, indications for surgery, extension of lung resection and lymph node dissection according to the radiologic scenario, use of intraoperative frozen section analysis, and radiologic surveillance of pure GGOs., Conclusions: This topic warrants more investigation in the future. An upcoming consensus conference of Italian Society of Thoracic Surgery experts (also open to experts in other specialties) could provide updated indications for GGO management based on the literature, expert opinions, and the results of the present survey., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
36. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2018 Update on Research.
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Crabtree TD, Gaissert HA, Jacobs JP, Habib RH, and Fernandez FG
- Subjects
- Advisory Committees organization & administration, Databases, Factual, Female, Humans, Leadership, Male, Organizational Innovation, Quality Improvement, Thoracic Surgery trends, United States, Outcome Assessment, Health Care, Patient Safety, Research organization & administration, Societies, Medical organization & administration, Thoracic Surgery standards
- Published
- 2018
- Full Text
- View/download PDF
37. Best Practices for Training, Educating and Introducing New Techniques and Technology into Practice.
- Author
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Sudarshan M and Blackmon SH
- Subjects
- Humans, Practice Guidelines as Topic, Thoracic Surgical Procedures methods, Credentialing standards, Diffusion of Innovation, Thoracic Surgery education, Thoracic Surgery standards, Thoracic Surgical Procedures education, Thoracic Surgical Procedures standards
- Abstract
Adoption of new practices is challenging to the surgeon innovator given lack of standardized processes for implementation. Credentialed surgeons who want to apply new practices need to ensure adequate training depending on the procedure and underlying skills. A competent and motivated team needs to be identified and appropriate privileging sought for the procedure from the local institution. Planning for meticulous monitoring of outcomes ensures continuous safety and quality surveillance. Patients need complete transparency when being informed about a novel practice with information on comparison to standard of care treatments., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
38. Sharing the Airway: The Importance of Good Communication Between Anesthesiologist and Surgeon.
- Author
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Shamji FM and Deslauriers J
- Subjects
- Airway Management history, Anesthesiologists standards, Anesthesiology history, Clinical Competence, Communication, History, 18th Century, History, 19th Century, History, 20th Century, History, 21st Century, Humans, Interprofessional Relations, Patient Care history, Surgeons standards, Thoracic Surgery history, Thoracic Surgical Procedures history, Airway Management standards, Anesthesiology standards, Patient Care standards, Respiratory System surgery, Thoracic Surgery standards, Thoracic Surgical Procedures standards
- Abstract
One of the most challenging tasks during airway surgery is ensuring adequate ventilation throughout the procedure. Because the airway is shared between surgeon and anesthesiologist, successful oxygenation and ventilation of the patient can only be accomplished through close collaboration during the various stages of the procedure. This includes periods in which surgical airway manipulation compromises adequate ventilation and periods in which ventilation interferes with the surgical environment. With continuous communication between surgeon and anesthesiologist, optimal outcomes can be achieved., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
39. A harmonized European training syllabus for thoracic surgery: report from the ESTS-ERS task force.
- Author
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Massard G, Tabin N, Mitchell S, Batirel H, Brunelli A, Elia S, Frick A, Huertgen M, Lerut A, Molins L, Papagiannopoulos K, Subotic D, van Schil P, Varela G, and van Raemdonck D
- Subjects
- Europe, Humans, Curriculum standards, Surgeons education, Thoracic Surgery education, Thoracic Surgery standards
- Abstract
Training of European thoracic surgeons is subject to huge variations in terms of length of training, content of training and operative experience during training. Harmonization of training outcomes has been approached by creating the European Board of Thoracic Surgery, which has been accredited by the European Union of Medical Specialists (UEMS); however, a clear description of the content of training is lacking. Building on their recognized experience with curriculum building, task forces of the European Respiratory Society and the European Society of Thoracic Surgery agreed on a joint task force on training in thoracic surgery. The goal of this study is to report on the mission statement developed from the UEMS-driven survey, describe the Delphi method and the observed results and present the first large consensus-based syllabus. The working group is currently working on a description of the curriculum and assessment of learning outcomes.
- Published
- 2018
- Full Text
- View/download PDF
40. Risk-adjusted performance evaluation in three academic thoracic surgery units using the Eurolung risk models.
- Author
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Pompili C, Shargall Y, Decaluwe H, Moons J, Chari M, and Brunelli A
- Subjects
- Academic Medical Centers statistics & numerical data, Aged, Belgium epidemiology, Canada epidemiology, Databases, Factual, Female, Humans, Male, Middle Aged, Models, Statistical, Morbidity, Postoperative Complications epidemiology, Postoperative Complications mortality, Risk Adjustment, Thoracic Surgery statistics & numerical data, United Kingdom epidemiology, Academic Medical Centers standards, Quality of Health Care, Thoracic Surgery standards
- Abstract
Objectives: The objective of this study was to evaluate the performance of 3 thoracic surgery centres using the Eurolung risk models for morbidity and mortality., Methods: This was a retrospective analysis performed on data collected from 3 academic centres (2014-2016). Seven hundred and twenty-one patients in Centre 1, 857 patients in Centre 2 and 433 patients in Centre 3 who underwent anatomical lung resections were analysed. The Eurolung1 and Eurolung2 models were used to predict risk-adjusted cardiopulmonary morbidity and 30-day mortality rates. Observed and risk-adjusted outcomes were compared within each centre., Results: The observed morbidity of Centre 1 was in line with the predicted morbidity (observed 21.1% vs predicted 22.7%, P = 0.31). Centre 2 performed better than expected (observed morbidity 20.2% vs predicted 26.7%, P < 0.001), whereas the observed morbidity of Centre 3 was higher than the predicted morbidity (observed 41.1% vs predicted 24.3%, P < 0.001). Centre 1 had higher observed mortality when compared with the predicted mortality (3.6% vs 2.1%, P = 0.005), whereas Centre 2 had an observed mortality rate significantly lower than the predicted mortality rate (1.2% vs 2.5%, P = 0.013). Centre 3 had an observed mortality rate in line with the predicted mortality rate (observed 1.4% vs predicted 2.4%, P = 0.17). The observed mortality rates in the patients with major complications were 30.8% in Centre 1 (versus predicted mortality rate 3.8%, P < 0.001), 8.2% in Centre 2 (versus predicted mortality rate 4.1%, P = 0.030) and 9.0% in Centre 3 (versus predicted mortality rate 3.5%, P = 0.014)., Conclusions: The Eurolung models were successfully used as risk-adjusting instruments to internally audit the outcomes of 3 different centres, showing their applicability for future quality improvement initiatives.
- Published
- 2018
- Full Text
- View/download PDF
41. [S3 guidelines on intensive medical care of cardiac surgery patients : Hemodynamic monitoring and cardiovascular system-an update].
- Author
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Habicher M, Zajonz T, Heringlake M, Böning A, Treskatsch S, Schirmer U, Markewitz A, and Sander M
- Subjects
- Cardiovascular Agents therapeutic use, Germany, Guidelines as Topic, Hemodynamic Monitoring, Humans, Cardiac Surgical Procedures standards, Critical Care standards, Thoracic Surgery standards
- Abstract
An update of the S3- guidelines for treatment of cardiac surgery patients in the intensive care unit, hemodynamic monitoring and cardiovascular system was published by the Association of Scientific Medical Societies in Germany (AWMF) in January 2018. This publication updates the guidelines from 2006 and 2011. The guidelines include nine sections that in addition to different methods of hemodynamic monitoring also reviews the topic of volume therapy as well as vasoactive and inotropic drugs. Furthermore, the guidelines also define the goals for cardiovascular treatment. This article describes the most important innovations of these comprehensive guidelines.
- Published
- 2018
- Full Text
- View/download PDF
42. Practical valvular issues in patients requiring ventricular assist devices.
- Author
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Badiwala M and Yau T
- Subjects
- Humans, Heart Failure complications, Heart Failure surgery, Heart Valve Diseases complications, Heart Valve Diseases surgery, Heart Valve Diseases therapy, Heart-Assist Devices, Patient Care Management methods, Thoracic Surgery standards, Thoracic Surgery trends
- Abstract
Purpose of Review: As ventricular assist device (VAD) therapy in patients with advanced heart failure continues to grow, experience with concomitant valvular diseases present either before or after VAD implantation continues to accrue. In this review, we discuss recent data and current practice as it pertains to the subject of concomitant valvular disease in patients requiring VADs., Recent Findings: Persistent aortic valve closure has been identified as a potential contributor to aortic valve 'disuse atrophy' resulting in valve degeneration. Dilation of the aortic root may be predictive of future development of aortic insufficiency. Novel echocardiographic parameters to identify the severity of aortic insufficiency following VAD implantation may be useful for risk stratification. Concomitant repair of significant mitral regurgitation may confer benefit to pulmonary vascular resistance and right ventricular function; however, this remains controversial. Concomitant repair of significant tricuspid regurgitation has not demonstrated early postoperative benefit nor survival benefit. Atrial fibrillation has emerged as a risk factor that may predict accelerated progression of postoperative tricuspid regurgitation., Summary: Management of aortic insufficiency, mitral regurgitation or tricuspid regurgitation in patients requiring VADs continues to be the source of controversy. As experience accrues with varying strategies to prevent or manage these valvular lesions, our understanding of the impact of these strategies continues to evolve.
- Published
- 2018
- Full Text
- View/download PDF
43. Systematic review and meta-analysis in cardiac surgery: a primer.
- Author
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Yanagawa B, Tam DY, Mazine A, and Tricco AC
- Subjects
- Humans, Practice Guidelines as Topic, Translational Research, Biomedical methods, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgery trends
- Abstract
Purpose of Review: The purpose of this article is to review the strengths and weaknesses of systematic reviews and meta-analyses to inform our current understanding of cardiac surgery., Recent Findings: A systematic review and meta-analysis of a focused topic can provide a quantitative estimate for the effect of a treatment intervention or exposure. In cardiac surgery, observational studies and small, single-center prospective trials provide most of the clinical outcomes that form the evidence base for patient management and guideline recommendations. As such, meta-analyses can be particularly valuable in synthesizing the literature for a particular focused surgical question. Since the year 2000, there are over 800 meta-analysis-related publications in our field. There are some limitations to this technique, including clinical, methodological and statistical heterogeneity, among other challenges. Despite these caveats, results of meta-analyses have been useful in forming treatment recommendations or in providing guidance in the design of future clinical trials., Summary: There is a growing number of meta-analyses in the field of cardiac surgery. Knowledge translation via meta-analyses will continue to guide and inform cardiac surgical practice and our practice guidelines.
- Published
- 2018
- Full Text
- View/download PDF
44. Clinical trials in valvular surgery: a 2018 update.
- Author
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Yanagawa B, Mazine A, Tam DY, and Verma S
- Subjects
- Clinical Decision-Making, Humans, Randomized Controlled Trials as Topic, Cardiac Surgical Procedures methods, Heart Valve Diseases surgery, Thoracic Surgery methods, Thoracic Surgery standards, Thoracic Surgery trends
- Abstract
Purpose of Review: There is a growing emphasis on the conduct of large-scale, multicenter randomized controlled trials (RCTs) to guide decision-making in cardiac surgery. Here we review recent landmark RCTs in cardiac valvular surgery., Recent Findings: RCTs are the gold-standard level of data in medicine. However, there are unique challenges of conducting large-scale surgical trials including funding, blinding, generalizability, nonstandardization of the surgical technique, crossover, among others. Thus, the vast majority of clinical outcomes data in cardiac surgery are mainly from observational studies and most prospective data are small, single-center trials. The Cardiothoracic Surgery Network is the largest platform focused on the conduct of high-quality, multicenter cardiac surgical trials, which has already produced several seminal guideline-changing and practice-changing contributions to the surgical approach to functional mitral regurgitation, aortic stenosis, atrial fibrillation, and neuroprotective surgical adjuncts., Summary: There continues to be great interest in the conduct of high-quality, RCTs to help guide surgical management of patients with valvular heart disease.
- Published
- 2018
- Full Text
- View/download PDF
45. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for the Treatment of Patients With Severe Aortic Stenosis: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.
- Author
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Bonow RO, Brown AS, Gillam LD, Kapadia SR, Kavinsky CJ, Lindman BR, Mack MJ, Thourani VH, Dehmer GJ, Bonow RO, Lindman BR, Beaver TM, Bradley SM, Carabello BA, Desai MY, George I, Green P, Holmes DR Jr, Johnston D, Leipsic J, Mick SL, Passeri JJ, Piana RN, Reichek N, Ruiz CE, Taub CC, Thomas JD, Turi ZG, Doherty JU, Dehmer GJ, Bailey SR, Bhave NM, Brown AS, Daugherty SL, Dean LS, Desai MY, Duvernoy CS, Gillam LD, Hendel RC, Kramer CM, Lindsay BD, Manning WJ, Mehrotra P, Patel MR, Sachdeva R, Wann LS, Winchester DE, and Allen JM
- Subjects
- Angiography, Aortic Valve Stenosis diagnosis, Echocardiography standards, Europe, Humans, Magnetic Resonance Imaging, Cine standards, Tomography, X-Ray Computed, United States, American Heart Association, Anesthesiology standards, Aortic Valve Stenosis surgery, Cardiology standards, Diagnostic Imaging standards, Societies, Medical, Thoracic Surgery standards
- Abstract
The American College of Cardiology collaborated with the American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons to develop and evaluate Appropriate Use Criteria (AUC) for the treatment of patients with severe aortic stenosis (AS). This is the first AUC to address the topic of AS and its treatment options, including surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). A number of common patient scenarios experienced in daily practice were developed along with assumptions and definitions for those scenarios, which were all created using guidelines, clinical trial data, and expert opinion in the field of AS. The 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(1) and its 2017 focused update paper (2) were used as the primary guiding references in developing these indications. The writing group identified 95 clinical scenarios based on patient symptoms and clinical presentation, and up to 6 potential treatment options for those patients. A separate, independent rating panel was asked to score each indication from 1 to 9, with 1-3 categorized as "Rarely Appropriate," 4-6 as "May Be Appropriate," and 7-9 as "Appropriate." After considering factors such as symptom status, left ventricular (LV) function, surgical risk, and the presence of concomitant coronary or other valve disease, the rating panel determined that either SAVR or TAVR is Appropriate in most patients with symptomatic AS at intermediate or high surgical risk; however, situations commonly arise in clinical practice in which the indications for SAVR or TAVR are less clear, including situations in which 1 form of valve replacement would appear reasonable when the other is less so, as do other circumstances in which neither intervention is the suitable treatment option. The purpose of this AUC is to provide guidance to clinicians in the care of patients with severe AS by identifying the reasonable treatment and intervention options available based on the myriad clinical scenarios with which patients present. This AUC document also serves as an educational and quality improvement tool to identify patterns of care and reduce the number of rarely appropriate interventions in clinical practice., (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
46. The role of imaging, deliberate practice, structure, and improvisation in approaching surgical perfection.
- Author
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Dearani JA, Gold M, Leibovich BC, Ericsson KA, Khabbaz KR, Foley TA, Julsrud PR, Matsumoto JM, and Daly RC
- Subjects
- Clinical Competence, Humans, Quality Improvement, Cardiac Imaging Techniques trends, Cardiovascular Surgical Procedures standards, Cardiovascular Surgical Procedures trends, Professionalism, Thoracic Surgery ethics, Thoracic Surgery standards
- Published
- 2017
- Full Text
- View/download PDF
47. Setting out into practice: Preparing for the future, today.
- Author
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Hayanga JWA and Amin P
- Subjects
- Clinical Competence, Humans, Cardiovascular Surgical Procedures education, Cardiovascular Surgical Procedures standards, Medical Staff, Hospital economics, Medical Staff, Hospital education, Medical Staff, Hospital psychology, Medical Staff, Hospital standards, Mentors, Professionalism, Thoracic Surgery education, Thoracic Surgery ethics, Thoracic Surgery standards
- Published
- 2017
- Full Text
- View/download PDF
48. How I found a mentor.
- Author
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Alberton LF, Rudersdorf PD, and Herrmann JL
- Subjects
- Clinical Competence, Humans, Intergenerational Relations, Teaching ethics, Teaching psychology, Teaching standards, Cardiovascular Surgical Procedures education, Cardiovascular Surgical Procedures standards, Medical Staff, Hospital education, Medical Staff, Hospital psychology, Mentors psychology, Professionalism, Thoracic Surgery education, Thoracic Surgery ethics, Thoracic Surgery standards
- Published
- 2017
- Full Text
- View/download PDF
49. 2017 ESC/EACTS Guidelines for the management of valvular heart disease.
- Author
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Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, and Zamorano JL
- Subjects
- Humans, Cardiac Surgical Procedures standards, Cardiology standards, Disease Management, Heart Valve Diseases surgery, Societies, Medical, Thoracic Surgery standards
- Published
- 2017
- Full Text
- View/download PDF
50. The establishing of a new thoracic surgery department in Greece in the era of financial crisis.
- Author
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Kapetanakis EI, Sidiropoulou T, Machairas A, and Tomos P
- Subjects
- Greece epidemiology, Humans, Thoracic Surgery standards, Economic Recession trends, Thoracic Surgery economics
- Published
- 2017
- Full Text
- View/download PDF
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