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Surgeons’ Disclosures of Clinical Adverse Events
Elwy et al quantitatively assess surgeons’ reports of disclosure of adverse events and aspects of their experiences with the disclosure process. Most of the surgeons completing the web-based surveys used 5 of the 8 recommended disclosure items and discussed steps taken to treat any subsequent problems. It was found that surgeons who reported they were less likely to discuss preventability of the adverse event, or who reported difficult communication experiences, were more negatively affected by disclosure than others.
Sex Bias in Surgical Clinical Research
Sex is a variable that is poorly controlled for in clinical research. Mansukhani and colleagues determine if sex bias exists in human surgical clinical research and if data are reported and analyzed using sex as an independent variable, and they identify specialties in which the greatest and least sex biases exist. They found that sex bias exists in human surgical clinical research, that few studies included men and women equally, and that less than one-third performed data analysis by sex.
Bariatric Surgery and Long-term Weight Loss Durability
Bariatric surgery induces significant weight loss for severely obese patients, but there is limited evidence of the durability of weight loss compared with nonsurgical matches and across bariatric procedures. Maciejewski et al examine 10-year weight change in a large, multisite, clinical cohort of veterans who underwent Roux-en-Y gastric bypass (RYGB) compared with nonsurgical matches and the 4-year weight change in veterans who underwent RYGB, adjustable gastric banding (AGB), or sleeve gastrectomy (SG). They found that patients in the Veterans Administration health care system lost substantially more weight than nonsurgical matches and sustained most of this weight loss in the long term, and that RYGB induced significantly greater weight loss among veterans than SG or AGB at 4 years.
Epidemiology of Fracture Nonunion in 18 Human Bones
Failure of bone fracture healing occurs in 5% to 10% of all patients. Zura et al test a hypothesis that fracture characteristics and patient-related risk factors assessable by the clinician at patient presentation can indicate the probability of fracture nonunion. They found that the probability of fracture nonunion can be based on patient-specific risk factors at presentation and that risk of nonunion is a function of fracture severity, fracture location, disease comorbidity, and medication use.
Clinical Review & Education
Current State of Critical Limb Ischemia
Chronic critical limb ischemia is a highly morbid condition that leads to the loss of ambulation and decreased quality of life. In this narrative review, Farber and Eberhardt summarize recent advances in understanding the epidemiology, pathophysiology, diagnosis, and treatment of critical limb ischemia. Ongoing randomized clinical trials in North America and the United Kingdom aim to provide data to support the best management of affected patients.
Highlights. JAMA Surg. 2016;151(11):997. doi:10.1001/jamasurg.2015.2952
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