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"Phitayakorn, Roy"
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Incidence and location of ectopic abnormal parathyroid glands
Ectopic parathyroid glands are a cause for failed parathyroid exploration.
Patients with hyperparathyroidism and ectopic parathyroid glands were identified from a parathyroid database. Laboratory data, gland weights, and surgical outcomes were obtained. The locations of the ectopic glands were correlated with results of technetium-99m–sestamibi imaging.
Of 231 patients operated on for hyperparathyroidism, 37 (16%) had ectopic parathyroid glands. Ectopic inferior glands (N = 23 [62%]) were intrathymic, n = 7 (30%); anterosuperior mediastinal, n = 5 (22%); intrathyroidal, n = 5 (22%); within the thyrothymic ligament, n = 4 (17%); and submandibular, n = 2 (9%). Ectopic superior glands (N = 14 [38%]) were in the tracheoesophageal groove, n = 6 (43%); retroesophageal, n = 3 (22%); posterosuperior mediastinal, n = 2 (14%); intrathyroidal, n = 1 (7%); in the carotid sheath, n = 1 (7%); and paraesophageal, n = 1 (7%). Sestamibi scans were true-positive in 81%, identifying 13 of 16 retrosternal glands, and false-negative in 19%.
A 16% incidence of ectopic parathyroid glands and a 100% positive predictive value of sestamibi scintigraphy underscore the importance of sestamibi imaging in patients with primary hyperparathyroidism.
Journal Article
Research priorities for multi-institutional collaborative research in surgical education
Research in surgical education has seen unprecedented growth but originates from single institutions and remains uncoordinated; this study aimed to generate a list of research priorities in surgical educational topics.
The membership of the Association for Surgical Education was asked to submit up to 5 research questions concerned with multi-institutional collaborative surgical education research and to identify challenges faced by surgical education researchers. A modified Delphi methodology was used to create the research agenda based on these responses.
Surgical educators responded to 3 survey rounds. Categories of submitted questions included teaching methods and curriculum development; assessment and competency; simulation; medical student preparation and selection; impact of work hour restrictions; and faculty development. Participants cited institutional culture and practice variability and lack of institutional review board coordination as common barriers to collaborative research, while identifying extensive planning, frequent communication, and availability of dedicated research coordinators as the most important facilitators.
Using a Delphi methodology, a prioritized agenda for multi-institutional surgical education research was developed that may help advance surgeon education.
Journal Article
A multi-institutional study of the emotional intelligence of resident physicians
Although emotional intelligence (EI) may have a role in the development of Accreditation Council for Graduate Medical Education core competencies, few studies have measured resident EI across specialties. This study aimed to describe the EI of resident physicians across multiple specialties.
Three hundred twenty five surgery, pediatric, and pathology residents at 3 large academic institutions were invited to complete the psychometrically validated Trait Emotional Intelligence Questionnaire.
The response rate was 42.8% (n = 139). Global EI of all residents (101.0 ± 8.1) was comparable with, but less variable than, the general population sample and was not statistically different between specialties. Compared with the norm sample, residents in the 3 specialty groups demonstrated unique combinations of areas of relative high and low development.
There exist distinct strengths and opportunities for the development for surgery, pediatrics, and pathology residents. Future investigations could use EI profiling to create educational interventions to develop specific areas of EI and assess correlation with resident performance.
Journal Article
Incidental thyroid carcinoma in patients with Graves’ disease
The clinical significance of incidental thyroid carcinoma in patients with Graves’ disease is uncertain.
The prevalence of incidental thyroid carcinoma was determined in patients with Graves’ disease who underwent surgery from 1990 to 2007 and was compared with patients with nontoxic nodular goiter or toxic multinodular goiter who underwent surgery during the same time period.
Of the 93 patients who underwent thyroidectomy for Graves’ disease, 2 patients (2.2%) had an incidental papillary carcinoma: .4 and .5 cm in size. Neither patient developed recurrent disease after 3 and 13 years of follow-up evaluation. The prevalence of incidental thyroid cancer was 3.6% and 6.2% in patients with nontoxic nodular goiter and toxic multinodular goiter, respectively (
P = not significant).
The prevalence of incidental thyroid carcinoma in patients with Graves’ disease is comparable with patients with nontoxic or toxic goiter. Incidental thyroid carcinomas in patients with Graves’ disease were papillary microcarcinomas of no clinical consequence.
Journal Article
Relationship between physiologic and psychological measures of autonomic activation in operating room teams during a simulated airway emergency
Emotional stability is important for individual and team performance during operating room (OR) emergencies. We compared physiologic and psychological anxiety assessments in OR teams during simulated events.
Twenty-two teams participated in a “cannot intubate/cannot ventilate” simulation. Participants completed the State–Trait Anxiety Inventory and wore a galvanic skin response (GSR) sensor. Differences in State–Trait Anxiety Inventory scores and GSR levels were analyzed. Anxiety scores were correlated with GSR levels.
Resident physicians had significantly higher trait anxiety than the nurses, certified registered nurse anesthetists, and surgical technicians (43.9 ± 9.9 vs 38.3 ± 9.3, P < .01). Senior practitioners had significantly higher trait anxiety than junior practitioners (43.7 ± 9.6 vs 40.0 ± 9.9, P = .03). All groups showed significant increases in GSR. Psychological and physiologic data did not correlate.
Senior practitioners and residents have higher levels of baseline trait anxiety for unclear reasons. Also, OR team training results in physiological signs of anxiety that do not correlate to self-reported psychological measurements.
Journal Article
Patients' Perception On Clinical Outcome And Quality Of Life After A Diagnosis Of Cushing Syndrome
Excess cortisol production (Cushing syndrome, CS) is a chronic disease affecting many organ systems and impacting quality of life (QoL). This study analyzed factors associated with self-reported QoL, including aspects related to the diagnosis and treatment modalities of CS.
In collaboration with the Cushing's Support and Research Foundation (CSRF), surveys using a validated QoL instrument were sent to CSRF members. Data were analyzed for associations between QoL and demographic, treatment, and disease factors.
A total of 269 patients completed the survey. Respondents were 89.9% female, and the mean age was 48 years (SD 12, range 16-76). Respondents visited a median of 4 physicians (range 1-40) prior to the diagnosis of CS, with a median of 5 years (mean 7, SD 5, range 1-30) to obtain a diagnosis, showing a statistically significant negative correlation (P<.001). In one-quarter of cases, someone other than a physician suggested the diagnosis. Multiple regression analysis demonstrated that remission status, time to diagnosis, radiation therapy, and hypopituitarism were significant predictors of QoL. There was no association between QoL and patient's sex, age, replacement steroid use, having follow-up with an endocrinologist, or surgical approach.
This is one of the largest QoL studies of CS patients and provides information for treatment and education goals. It is notable that early diagnosis and treatment was the major predictor of better QoL after achieving remission from disease, highlighting the need for awareness about the disorder. Patients in remission had better QoL, emphasizing the importance of disease control.
Journal Article
WISE-MD usage among millennial medical students
E-learning is increasingly common in undergraduate medical education. Internet-based multimedia materials should be designed with millennial learner utilization preferences in mind for maximal impact.
Medical students used all 20 Web Initiative for Surgical Education of Medical Doctors modules from July 1, 2013 to October 1, 2013. Data were analyzed for topic frequency, time and week day, and access to questions.
Three thousand five hundred eighty-seven students completed 35,848 modules. Students accessed modules for average of 51 minutes. Most frequent use occurred on Sunday (23.1%), Saturday (15.4%), and Monday (14.3%). Friday had the least use (8.2%). A predominance of students accessed the modules between 7 and 10 PM (34.4%). About 80.4% of students accessed questions for at least one module. They completed an average of 40 ± 30 of the questions. Only 827 students (2.3%) repeated the questions.
Web Initiative for Surgical Education of Medical Doctors has peak usage during the weekend and evenings. Most frequently used modules reflect core surgical problems. Multiple factors influence the manner module questions are accessed.
Journal Article
Surgery for Graves’ disease: a 25-year perspective
Optimal treatment of Graves’ disease (GD) remains controversial. The authors retrospectively reviewed the surgical cases of GD at a single academic tertiary center.
Demographic, clinical, and surgical data were analyzed for all patients with GD undergoing thyroidectomy over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177).
There were 300 patients with GD (85.7% women; mean age, 39.3 years; median length of follow-up, 24.6 months). Overall, perioperative morbidity occurred in 36 patients (12.0%), and there was no mortality. Thyroidectomy-specific morbidity was very low, and the incidental malignancy rate was 10.3%.
Surgical treatment of GD has a very high safety profile, with low perioperative and thyroidectomy-specific morbidity, even in patients with overt hyperthyroidism. Incidental malignancy in patients with GD is not uncommon.
Journal Article
Finding my people: Effects of student identity and vulnerability to Stereotype Threat on sense of belonging in surgery
Diversity in surgery lags behind the medical student population. We documented first-year medical students’ vulnerability to stereotype threat (VST) and its impact on a sense of belonging in surgery.
All first-year medical students at a single academic institution were surveyed. Demographics, VST, anticipated clerkship experience, and sense of belonging were assessed.
44% of students were vulnerable to ST in upcoming clerkships, with the majority worried about surgical clerkships. More student from races/ethnicities underrepresented in medicine (URM; 74%) and sexual minorities (62%) were vulnerable than white (30%) and heterosexual (38%) students respectively (p = 0.001 and p = 0.017). Knowing a surgeon with a shared identity would enhance belonging for most students (84%). VST was higher for those who do not anticipate working with (p < 0.001) or do not know a surgeon (p = 0.0001) who shares their identity.
VST significantly influences a student's sense of belonging in surgery. More research is needed to promote inclusivity in surgery.
•44% of first-year medical students were vulnerable to stereotype threat on upcoming clerkships.•URM students and sexual minority students were significantly more likely to be vulnerable to stereotype threat than white and heterosexual students respectively.•Students vulnerable to stereotype threat were significantly less likely to currently know or anticipate working with a surgeon with a shared identity on their upcoming surgical clerkship.
Journal Article