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In This Issue of JAMA Surgery
June 2014


JAMA Surg. 2014;149(6):497. doi:10.1001/jamasurg.2013.3484


No consensus exists on best practices for reaching resident proficiency in the nonclinical Accreditation Council for Graduate Medical Education core competencies. Tapia and coauthors used an anonymous Likert-type scale needs assessment survey requesting surgery residents to assess their comfort level with subjects within those competencies. A large proportion of negative responses resulted in the development of a formal health care policy and management curriculum.

Bulger and colleagues establish the safety of AB103, a CD28 costimulatory receptor antagonist, in patients with soft-tissue infections and evaluate the potential effects on clinically meaningful parameters related to the disease. This was a phase 2a, multicenter, placebo-controlled randomized trial of the administration of AB103 within 6 hours of diagnosis (43 patients). There were no safety concerns, and a significant reduction in the development of organ failure, based on the Sequential Organ Failure Assessment score, was noted among the treated patients.

Invited Commentary

Continuing Medical Education

Rural dwellers with colorectal cancer have poorer outcomes than their urban counterparts. This study sought to identify the effect of geography on access to colorectal cancer screening and treatment from specialist physicians. Aboagye and coauthors used the 2009 Area Resource File to evaluate the characteristics of 3220 counties in the United States. The study revealed a significantly lower density of gastroenterologists, general surgeons, and radiation oncologists per 100 000 people living in rural vs urban counties.

Given the growing aging US population, Jafari and colleagues aimed to examine the surgical trends and outcomes of colorectal cancer treatment in the elderly. They performed a review of the Nationwide Inpatient Sample (2001-2010) and compared surgical outcomes of the elderly (≥65 years of age) with those of patients 45 to 64 years of age. They demonstrated that most operations for colorectal cancer are performed on the aging population, with an overall decrease in the number of cases performed. Despite the overall improved mortality seen during the past 10 years, the risk-adjusted mortality and morbidity of the elderly continue to be substantially higher than that for the younger population.

Continuing Medical Education

Data on outcomes following surgical management of intrahepatic cholangiocarcinoma (ICC) are limited. Mavros and coauthors performed a systematic review and meta-analysis of 57 studies to evaluate the available evidence regarding the treatment and prognosis of 4756 patients with ICC and to identify predictors of recurrence and overall survival following resection. They report that prognosis of ICC is dictated mainly by tumor factors, such as tumor size and differentiation, presence of multiple tumors, lymph node metastasis, and vascular invasion.