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Effect of Vasopressin on Need for Blood Products in Trauma
Severe hemorrhagic shock is associated with a state of vasopressin deficiency and an increased need for blood products. In a single-center randomized clinical trial, Sims and colleagues investigated the outcomes of low-dose vasopressin on blood product use in 100 adult trauma patients who were in hemorrhagic shock. Vasopressin supplementation decreased blood product use by 1.4 L in the initial 48 hours of care without increasing complications.
Continuing Medical Education
Author Audio Interview
Sex Differences in Future Salary Expectations and Career Goals
Female surgeons earn less than male surgeons and hold fewer leadership positions. In a survey of general surgery resident physicians, Gray and colleagues found no sex difference in future career goals, such as desire to hold leadership positions, expected hours of work, or projected retirement age; however, women anticipated earning roughly $30 000 less per year and had a more negative view of salary negotiation. These findings may aid in identifying strategies to help narrow the sex-associated inequities in surgery careers.
Recurrence After Pancreatic Ductal Adenocarcinoma Resection
The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma remain unclear. In this secondary analysis of a randomized clinical trial, Jones and colleagues investigated patterns of recurrence after adjuvant chemotherapy and their association with survival. Adjuvant gemcitabine plus capecitabine was associated with reduced rate of local recurrence and improved overall survival compared with gemcitabine monotherapy. Pancreatic cancer behaves as a systemic disease, requiring effective systemic therapy after resection.
Decreased Opioid Prescribing and Patient Satisfaction
Studies have shown that surgeons overprescribe opioids, although guidelines for appropriate opioid prescribing are available. Concern about patient-reported satisfaction ratings of their surgeon may be a barrier to surgeons adopting guideline-directed prescribing practices. Louie and colleagues found that surgeons could greatly decrease the proportion of patients receiving opioids and the number of pills prescribed with no change in satisfaction ratings.
Clinical Review and Education
Robotic Adoption in Thoracic Surgery
Robotic surgery has been increasingly used in a variety of surgical procedures. Marshall and Wee review the current status of adoption of the robotic instrument as it applies to general thoracic surgery, including the current status in the United States, the outlook for the future, and opportunities and challenges for the incorporation of this tool into general thoracic surgical procedures.
Highlights. JAMA Surg. 2019;154(11):985. doi:10.1001/jamasurg.2018.3845
Artificial Intelligence Resource Center