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In This Issue of JAMA Surgery
February 2020

Highlights

JAMA Surg. 2020;155(2):97. doi:10.1001/jamasurg.2019.3855

Research

Because damage to parathyroid glands can lead to postoperative hypocalcemia, their identification and preservation are pivotal during total thyroidectomy. In a randomized clinical trial, Benmiloud and colleagues assessed whether imaging systems using near-infrared autofluorescence light to identify parathyroid glands during surgery could improve parathyroid preservation and reduce postoperative hypocalcemia. They found increased rates of identification and preservation of the parathyroid glands and a lower rate of early postoperative hypocalcemia with the use of near-infrared autofluorescence.

Invited Commentary

Continuing Medical Education

Modern conflict poses considerable challenges to humanitarian responses. Currently, patients do not benefit from mortality reductions learned from civilian and military trauma systems. An international working group was convened to revise long-standing protocols. The result is a consensus framework for humanitarian surgical care that integrates advances in trauma care and systems and is adapted to a changing security environment.

Invited Commentary

In a national cohort of veterans who died within 90 days of high-risk surgery, Yefimova and colleagues examined the role of palliative consultation. Relatively few veterans who later died had received consultation postoperatively (29.9%), but the Veterans Affairs Bereaved Family Survey demonstrated benefits comparable with those seen in serious medical illness. Families of veteran recipients of palliative consultation were 47% more likely to rate end-of-life care as excellent than families of nonrecipients.

Invited Commentary

This study assessed whether plasma transfusion en route to a trauma center was more important to patient outcomes during longer transport times. Pusateri and colleagues examined harmonized data from 2 apparently contradictory prospective clinical trials and found that prehospital plasma administration was associated with improved survival when transport to the trauma center was longer than 20 minutes.

Invited Commentary

Continuing Medical Education

Audio Author Interview

Clinical Review & Education

This review by Loftus and colleagues describes the limitations of hypothetical-deductive reasoning, heuristics, and decision-support tools that require time-consuming manual data entry. Emerging evidence suggests that artificial intelligence models using electronic health record data inputs have the potential to augment the decision to operate, the informed consent process, identification and mitigation of modifiable risk factors, decisions on postoperative management, and shared decisions on resource utilization.

Continuing Medical Education

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