ACS Surgery News

Trainees in congenital cardiac surgery fellowship programs are doing more operations since the programs became accredited in 2007, but no clear parameters have emerged to determine if certification has improved the quality of training, according to an evaluation of fellowship training programs published in the June issue of the Journal of Thoracic and Cardiovascular Surgery (2016 Jun;151:1488-95).

Overall, the training has become standardized, the fellows’ operative experience is “robust,” and fellows are mostly satisfied since the Accreditation Council of Graduate Medical Education (ACGME) recognized congenital cardiac surgery as a fellowship in 2007, lead study author Dr. Brian Kogon of Emory University, Atlanta, said.

However, Dr. Kogon and his colleagues also found some shortcomings in fellowship training. They received survey responses from 36 of 44 fellows in 12 accredited programs nationwide. To determine if fellows were meeting minimum case requirements, they also reviewed operative logs of 38 of the 44 fellows. They compared their findings to a study of congenital cardiac surgery fellowship programs they did pre-ACGME accreditation (J Thorac Cardiovasc Surg. 2006 Dec;132:1280). “The number of operations performed by the fellows during their training was underwhelming, and most of the fellows were dissatisfied with their operative experience,” Dr. Kogon and his colleagues wrote in the earlier study.

The study found that all fellows achieved the minimum number of 75 total cases the standards require for graduation, with a median of 136; and the minimum standard of 36 specific qualifying cases with a median of 63. However, seven did not meet the minimum of five complex neonate cases. Among other types of operations for which fellows failed to meet the minimum cases were atrioventricular septal defect repair, arch reconstruction including coarctation procedures and systemic-to-pulmonary artery shunt procedures.

The comparative lack of adult cardiac surgery operations was also considered a potential problem, the authors noted, pointing out that “the number of adults who have congenital heart disease now exceeds the number of children who have the disease, and many of these patients will require an operation.”

Another shortcoming the study found was a drop-off in international fellowships since 2007. “This change places us at risk of becoming intellectually isolated and losing international relationships that are critical to the future of our specialty,” Dr. Kogon and his colleagues wrote. Graduated fellows also acknowledged dissatisfaction with their lack of exposure to neonate surgery.

The study also determined the following demographics of the fellows: 83% are men and the median age at graduation was 40 years, with a range of 35-48 years. Only 25% of graduates participated in nonsurgical rotations such as cardiac catheterization and echocardiography.

“Although the operative experience seems to be much more robust, and this finding has been corroborated in other surgical disciplines after the advent of ACGME accreditation, comparing training before and after the accreditation process came into existence is difficult,” Dr. Kogon and his colleagues said.

The study also noted that the Thoracic Surgery Directors Association developed a congenital curriculum for congenital cardiothoracic surgery fellows, but only 28% used that curriculum and only 61% used any formal curriculum. “Unfortunately, regardless of the curriculum, only 50% of the graduates found it helpful,” Dr. Kogon and his colleagues said.

And regardless of the curriculum, only half of the graduates have passed the written qualifying and oral certifying examinations after completing their fellowship. “Although the curriculum is quite robust, the latter statistic suggests that we need either more emphasis on education by the program directors or a better and/or different curriculum,” Dr. Kogon and his colleagues said. However, they added that “after training, former fellows have adequate case volumes and mixes and seem to be thriving in the field.”

Dr. Kogon and his study coauthors had no financial disclosures.

Trainees in congenital cardiac surgery fellowship programs are doing more operations since the programs became accredited in 2007, but no clear parameters have emerged to determine if certification has improved the quality of training, according to an evaluation of fellowship training programs published in the June issue of the Journal of Thoracic and Cardiovascular Surgery (2016 Jun;151:1488-95).

Overall, the training has become standardized, the fellows’ operative experience is “robust,” and fellows are mostly satisfied since the Accreditation Council of Graduate Medical Education (ACGME) recognized congenital cardiac surgery as a fellowship in 2007, lead study author Dr. Brian Kogon of Emory University, Atlanta, said.

However, Dr. Kogon and his colleagues also found some shortcomings in fellowship training. They received survey responses from 36 of 44 fellows in 12 accredited programs nationwide. To determine if fellows were meeting minimum case requirements, they also reviewed operative logs of 38 of the 44 fellows. They compared their findings to a study of congenital cardiac surgery fellowship programs they did pre-ACGME accreditation (J Thorac Cardiovasc Surg. 2006 Dec;132:1280). “The number of operations performed by the fellows during their training was underwhelming, and most of the fellows were dissatisfied with their operative experience,” Dr. Kogon and his colleagues wrote in the earlier study.

The study found that all fellows achieved the minimum number of 75 total cases the standards require for graduation, with a median of 136; and the minimum standard of 36 specific qualifying cases with a median of 63. However, seven did not meet the minimum of five complex neonate cases. Among other types of operations for which fellows failed to meet the minimum cases were atrioventricular septal defect repair, arch reconstruction including coarctation procedures and systemic-to-pulmonary artery shunt procedures.

The comparative lack of adult cardiac surgery operations was also considered a potential problem, the authors noted, pointing out that “the number of adults who have congenital heart disease now exceeds the number of children who have the disease, and many of these patients will require an operation.”

Another shortcoming the study found was a drop-off in international fellowships since 2007. “This change places us at risk of becoming intellectually isolated and losing international relationships that are critical to the future of our specialty,” Dr. Kogon and his colleagues wrote. Graduated fellows also acknowledged dissatisfaction with their lack of exposure to neonate surgery.

The study also determined the following demographics of the fellows: 83% are men and the median age at graduation was 40 years, with a range of 35-48 years. Only 25% of graduates participated in nonsurgical rotations such as cardiac catheterization and echocardiography.

“Although the operative experience seems to be much more robust, and this finding has been corroborated in other surgical disciplines after the advent of ACGME accreditation, comparing training before and after the accreditation process came into existence is difficult,” Dr. Kogon and his colleagues said.

The study also noted that the Thoracic Surgery Directors Association developed a congenital curriculum for congenital cardiothoracic surgery fellows, but only 28% used that curriculum and only 61% used any formal curriculum. “Unfortunately, regardless of the curriculum, only 50% of the graduates found it helpful,” Dr. Kogon and his colleagues said.

And regardless of the curriculum, only half of the graduates have passed the written qualifying and oral certifying examinations after completing their fellowship. “Although the curriculum is quite robust, the latter statistic suggests that we need either more emphasis on education by the program directors or a better and/or different curriculum,” Dr. Kogon and his colleagues said. However, they added that “after training, former fellows have adequate case volumes and mixes and seem to be thriving in the field.”

Dr. Kogon and his study coauthors had no financial disclosures.

Trainees in congenital cardiac surgery fellowship programs are doing more operations since the programs became accredited in 2007, but no clear parameters have emerged to determine if certification has improved the quality of training, according to an evaluation of fellowship training programs published in the June issue of the Journal of Thoracic and Cardiovascular Surgery (2016 Jun;151:1488-95).

Overall, the training has become standardized, the fellows’ operative experience is “robust,” and fellows are mostly satisfied since the Accreditation Council of Graduate Medical Education (ACGME) recognized congenital cardiac surgery as a fellowship in 2007, lead study author Dr. Brian Kogon of Emory University, Atlanta, said.

However, Dr. Kogon and his colleagues also found some shortcomings in fellowship training. They received survey responses from 36 of 44 fellows in 12 accredited programs nationwide. To determine if fellows were meeting minimum case requirements, they also reviewed operative logs of 38 of the 44 fellows. They compared their findings to a study of congenital cardiac surgery fellowship programs they did pre-ACGME accreditation (J Thorac Cardiovasc Surg. 2006 Dec;132:1280). “The number of operations performed by the fellows during their training was underwhelming, and most of the fellows were dissatisfied with their operative experience,” Dr. Kogon and his colleagues wrote in the earlier study.

The study found that all fellows achieved the minimum number of 75 total cases the standards require for graduation, with a median of 136; and the minimum standard of 36 specific qualifying cases with a median of 63. However, seven did not meet the minimum of five complex neonate cases. Among other types of operations for which fellows failed to meet the minimum cases were atrioventricular septal defect repair, arch reconstruction including coarctation procedures and systemic-to-pulmonary artery shunt procedures.

The comparative lack of adult cardiac surgery operations was also considered a potential problem, the authors noted, pointing out that “the number of adults who have congenital heart disease now exceeds the number of children who have the disease, and many of these patients will require an operation.”

Another shortcoming the study found was a drop-off in international fellowships since 2007. “This change places us at risk of becoming intellectually isolated and losing international relationships that are critical to the future of our specialty,” Dr. Kogon and his colleagues wrote. Graduated fellows also acknowledged dissatisfaction with their lack of exposure to neonate surgery.

The study also determined the following demographics of the fellows: 83% are men and the median age at graduation was 40 years, with a range of 35-48 years. Only 25% of graduates participated in nonsurgical rotations such as cardiac catheterization and echocardiography.

“Although the operative experience seems to be much more robust, and this finding has been corroborated in other surgical disciplines after the advent of ACGME accreditation, comparing training before and after the accreditation process came into existence is difficult,” Dr. Kogon and his colleagues said.

The study also noted that the Thoracic Surgery Directors Association developed a congenital curriculum for congenital cardiothoracic surgery fellows, but only 28% used that curriculum and only 61% used any formal curriculum. “Unfortunately, regardless of the curriculum, only 50% of the graduates found it helpful,” Dr. Kogon and his colleagues said.

And regardless of the curriculum, only half of the graduates have passed the written qualifying and oral certifying examinations after completing their fellowship. “Although the curriculum is quite robust, the latter statistic suggests that we need either more emphasis on education by the program directors or a better and/or different curriculum,” Dr. Kogon and his colleagues said. However, they added that “after training, former fellows have adequate case volumes and mixes and seem to be thriving in the field.”

Dr. Kogon and his study coauthors had no financial disclosures.

A postsurgical recovery program featuring early feeding and multimodal pain management hastened the return of bowel function and shortened hospital stay by 2 days for patients undergoing complex ventral hernia repair.

Despite leaving the hospital sooner, however, patients were 75% less likely to be readmitted within 90 days, Dr. Arnab Majumder and his colleagues wrote in the June issue of the Journal of the American College of Surgeons (2016 Jun;222:1106-15). Most of those who did return had wound complications, a stark contrast to readmissions among patients who didn’t experience the enhanced recovery program. Among that group, 75% of the readmissions were caused by bowel obstruction/ileus, deep venous thrombosis or pulmonary embolism, pneumonia, and urinary tract infections – all of them “problems [that] could be related to prolonged hospitalizations,” said Dr. Majumder of the University Hospitals Case Medical Center, Cleveland.

©Kimberly Pack/Thinkstock.com

The investigators created an Enhanced Recovery After Surgery (ERAS) pathway specifically for patients undergoing complex ventral hernia repairs using transversus abdominis release and sublay synthetic mesh placement. The patients “present formidable challenges to the surgeon, not only in the operating room but also during perioperative management,” the authors noted.

The ERAS the team preemptively addressed patient issues in the preoperative, intra- and perioperative, and postoperative periods. They compared the outcomes of 100 patients treated with the protocol to those in a control group of 100 who underwent the same surgery before the protocol was implemented. The main outcomes measures were time to diet advancement, time to return of bowel function, time to oral narcotics, length of stay, and 90-day readmissions.

The ERAS begins with preoperative optimization. This consists of weight loss, smoking cessation, and managing diabetes and obstructive sleep apnea. No surgery occurs until the HbA_1c is less than 8 and patients have been tobacco free for at least 1 month.

All patients receive an arginine and omega-3 supplement thrice daily for 5 days before surgery. The night before surgery, they have a nasal swab screen for methicillin-resistant Staphylococcus aureus (MRSA), and decolonization with mupirocin ointment and a chlorhexidine bath.

Preoperatively, they receive 5,000 units of unfractionated heparin, along with sequential compression devices for deep vein thrombosis protection. Use of both continue postoperatively, with heparin given every 8 hours until the patient is ambulatory.

Those without a history of narcotic use receive a preoperative dose of alvimopan. Everyone also receives oral gabapentin and preoperative antibiotics.

Intraoperatively, intravenous fluids are given judiciously to minimize bowel edema and decrease the risk of respiratory side effects. The surgeon also employs a transversus abdominis plane (TAP) block with liposomal bupivacaine.

There is a multimodal pain management program, which includes intravenous hydromorphone by patient-controlled anesthesia pump and oral gabapentin three times daily. Patients switch to oral analgesics on postoperative day 2. These consist of acetaminophen and NSAIDs on an alternating schedule. Intravenous diazepam can be added as an antispasmodic. Alvimopan is continued twice daily until first bowel movement or hospital discharge.

Clear liquids are limited to 250 mL/8 hours on postoperative day 1, along with a clear protein drink. By day 2, patients are advanced to unrestricted volumes of clear liquids, and on day 3, to a regular solid diet. At that point, the clear protein drink is switched for a regular protein drink (Boost Plus).

Patients who vomit or require a nasogastric tube for decompression, and those with severe persistent nausea are made NPO, but can resume diet when these symptoms improve. Those with mild-moderate nausea receive intravenous ondansetron and are allowed to self-limit oral intake.

Patients were a mean of 57 years old with a mean body mass index of about 33 kg/m². The hernia was recurrent for about 60% of each group, with a mean area of about 300 cm², and a mean width of 14 cm. The mean mesh size was about 1,000 cm². The mean operative time was significantly shorter in the control group: 197 vs. 245 minutes.

Diet was advanced significantly more quickly in the ERAS group than the control group: 1 vs. 2 days on a liquid diet and 3 vs. 4.8 days to regular diet. Emesis after diet advancement was similar (4% for ERAS and 5% for control).

Compared with the control group, the ERAS group experienced significantly shorter average times to flatus (3.1 vs. 3.9 days), bowel movement (3.6 vs. 5.2 days), and reaching GI-3 status (3.4 vs. 4.8 days). Those in the ERAS group switched to oral narcotics sooner (2.2 vs. 3.6 days) also.

The average length of stay was significantly lower in ERAS group as well (4 vs. 6 days). About 18% of those in the ERAS group had a stay of less than 3 days, compared with 2% of the control group.

Readmissions within 90 days occurred in 16% of the control group and 4% of the ERAS group – a significant difference. There were four surgical site complications in the control group and three in the ERAS group. Bowel obstruction occurred in three control patients and one ERAS patient. All other complications requiring readmission occurred in the control group: two pulmonary embolisms, two deep vein thromboses, one pneumonia, one urinary tract infection and three other unspecified causes.

The authors noted that the shift to multimodal pain management and shorter-term use of IV opiates is a large contributor to the protocol’s good bowel outcomes. “Introduction of preoperative and postoperative gabapentin, intraoperative surgeon-delivered TAP block with long-acting liposomal bupivacaine, postoperative use of acetaminophen, and nonsteroidal agents have all appeared to contribute to better pain control and likely decrease in opioid consumption,” they said.

The use of diazepam as a pain medication is unusual, they said, but effective.

“We believe a large component of postoperative pain in hernia patients is due to muscle spasms after myofascial release, irritation from mesh placement, and transabdominal suture fixation. Therefore, in the context of our frequent use of myofascial releases for large incisional hernias, we believe the antispasmodic effects of diazepam potentially alleviate some of the postoperative discomfort caused by major abdominal wall reconstruction.”

None of the investigators reported financial conflicts.

[email protected]

A postsurgical recovery program featuring early feeding and multimodal pain management hastened the return of bowel function and shortened hospital stay by 2 days for patients undergoing complex ventral hernia repair.

Despite leaving the hospital sooner, however, patients were 75% less likely to be readmitted within 90 days, Dr. Arnab Majumder and his colleagues wrote in the June issue of the Journal of the American College of Surgeons (2016 Jun;222:1106-15). Most of those who did return had wound complications, a stark contrast to readmissions among patients who didn’t experience the enhanced recovery program. Among that group, 75% of the readmissions were caused by bowel obstruction/ileus, deep venous thrombosis or pulmonary embolism, pneumonia, and urinary tract infections – all of them “problems [that] could be related to prolonged hospitalizations,” said Dr. Majumder of the University Hospitals Case Medical Center, Cleveland.

©Kimberly Pack/Thinkstock.com

The investigators created an Enhanced Recovery After Surgery (ERAS) pathway specifically for patients undergoing complex ventral hernia repairs using transversus abdominis release and sublay synthetic mesh placement. The patients “present formidable challenges to the surgeon, not only in the operating room but also during perioperative management,” the authors noted.

The ERAS the team preemptively addressed patient issues in the preoperative, intra- and perioperative, and postoperative periods. They compared the outcomes of 100 patients treated with the protocol to those in a control group of 100 who underwent the same surgery before the protocol was implemented. The main outcomes measures were time to diet advancement, time to return of bowel function, time to oral narcotics, length of stay, and 90-day readmissions.

The ERAS begins with preoperative optimization. This consists of weight loss, smoking cessation, and managing diabetes and obstructive sleep apnea. No surgery occurs until the HbA_1c is less than 8 and patients have been tobacco free for at least 1 month.

All patients receive an arginine and omega-3 supplement thrice daily for 5 days before surgery. The night before surgery, they have a nasal swab screen for methicillin-resistant Staphylococcus aureus (MRSA), and decolonization with mupirocin ointment and a chlorhexidine bath.

Preoperatively, they receive 5,000 units of unfractionated heparin, along with sequential compression devices for deep vein thrombosis protection. Use of both continue postoperatively, with heparin given every 8 hours until the patient is ambulatory.

Those without a history of narcotic use receive a preoperative dose of alvimopan. Everyone also receives oral gabapentin and preoperative antibiotics.

Intraoperatively, intravenous fluids are given judiciously to minimize bowel edema and decrease the risk of respiratory side effects. The surgeon also employs a transversus abdominis plane (TAP) block with liposomal bupivacaine.

There is a multimodal pain management program, which includes intravenous hydromorphone by patient-controlled anesthesia pump and oral gabapentin three times daily. Patients switch to oral analgesics on postoperative day 2. These consist of acetaminophen and NSAIDs on an alternating schedule. Intravenous diazepam can be added as an antispasmodic. Alvimopan is continued twice daily until first bowel movement or hospital discharge.

Clear liquids are limited to 250 mL/8 hours on postoperative day 1, along with a clear protein drink. By day 2, patients are advanced to unrestricted volumes of clear liquids, and on day 3, to a regular solid diet. At that point, the clear protein drink is switched for a regular protein drink (Boost Plus).

Patients who vomit or require a nasogastric tube for decompression, and those with severe persistent nausea are made NPO, but can resume diet when these symptoms improve. Those with mild-moderate nausea receive intravenous ondansetron and are allowed to self-limit oral intake.

Patients were a mean of 57 years old with a mean body mass index of about 33 kg/m². The hernia was recurrent for about 60% of each group, with a mean area of about 300 cm², and a mean width of 14 cm. The mean mesh size was about 1,000 cm². The mean operative time was significantly shorter in the control group: 197 vs. 245 minutes.

Diet was advanced significantly more quickly in the ERAS group than the control group: 1 vs. 2 days on a liquid diet and 3 vs. 4.8 days to regular diet. Emesis after diet advancement was similar (4% for ERAS and 5% for control).

Compared with the control group, the ERAS group experienced significantly shorter average times to flatus (3.1 vs. 3.9 days), bowel movement (3.6 vs. 5.2 days), and reaching GI-3 status (3.4 vs. 4.8 days). Those in the ERAS group switched to oral narcotics sooner (2.2 vs. 3.6 days) also.

The average length of stay was significantly lower in ERAS group as well (4 vs. 6 days). About 18% of those in the ERAS group had a stay of less than 3 days, compared with 2% of the control group.

Readmissions within 90 days occurred in 16% of the control group and 4% of the ERAS group – a significant difference. There were four surgical site complications in the control group and three in the ERAS group. Bowel obstruction occurred in three control patients and one ERAS patient. All other complications requiring readmission occurred in the control group: two pulmonary embolisms, two deep vein thromboses, one pneumonia, one urinary tract infection and three other unspecified causes.

The authors noted that the shift to multimodal pain management and shorter-term use of IV opiates is a large contributor to the protocol’s good bowel outcomes. “Introduction of preoperative and postoperative gabapentin, intraoperative surgeon-delivered TAP block with long-acting liposomal bupivacaine, postoperative use of acetaminophen, and nonsteroidal agents have all appeared to contribute to better pain control and likely decrease in opioid consumption,” they said.

The use of diazepam as a pain medication is unusual, they said, but effective.

“We believe a large component of postoperative pain in hernia patients is due to muscle spasms after myofascial release, irritation from mesh placement, and transabdominal suture fixation. Therefore, in the context of our frequent use of myofascial releases for large incisional hernias, we believe the antispasmodic effects of diazepam potentially alleviate some of the postoperative discomfort caused by major abdominal wall reconstruction.”

None of the investigators reported financial conflicts.

[email protected]

A postsurgical recovery program featuring early feeding and multimodal pain management hastened the return of bowel function and shortened hospital stay by 2 days for patients undergoing complex ventral hernia repair.

Despite leaving the hospital sooner, however, patients were 75% less likely to be readmitted within 90 days, Dr. Arnab Majumder and his colleagues wrote in the June issue of the Journal of the American College of Surgeons (2016 Jun;222:1106-15). Most of those who did return had wound complications, a stark contrast to readmissions among patients who didn’t experience the enhanced recovery program. Among that group, 75% of the readmissions were caused by bowel obstruction/ileus, deep venous thrombosis or pulmonary embolism, pneumonia, and urinary tract infections – all of them “problems [that] could be related to prolonged hospitalizations,” said Dr. Majumder of the University Hospitals Case Medical Center, Cleveland.

©Kimberly Pack/Thinkstock.com

The investigators created an Enhanced Recovery After Surgery (ERAS) pathway specifically for patients undergoing complex ventral hernia repairs using transversus abdominis release and sublay synthetic mesh placement. The patients “present formidable challenges to the surgeon, not only in the operating room but also during perioperative management,” the authors noted.

The ERAS the team preemptively addressed patient issues in the preoperative, intra- and perioperative, and postoperative periods. They compared the outcomes of 100 patients treated with the protocol to those in a control group of 100 who underwent the same surgery before the protocol was implemented. The main outcomes measures were time to diet advancement, time to return of bowel function, time to oral narcotics, length of stay, and 90-day readmissions.

The ERAS begins with preoperative optimization. This consists of weight loss, smoking cessation, and managing diabetes and obstructive sleep apnea. No surgery occurs until the HbA_1c is less than 8 and patients have been tobacco free for at least 1 month.

All patients receive an arginine and omega-3 supplement thrice daily for 5 days before surgery. The night before surgery, they have a nasal swab screen for methicillin-resistant Staphylococcus aureus (MRSA), and decolonization with mupirocin ointment and a chlorhexidine bath.

Preoperatively, they receive 5,000 units of unfractionated heparin, along with sequential compression devices for deep vein thrombosis protection. Use of both continue postoperatively, with heparin given every 8 hours until the patient is ambulatory.

Those without a history of narcotic use receive a preoperative dose of alvimopan. Everyone also receives oral gabapentin and preoperative antibiotics.

Intraoperatively, intravenous fluids are given judiciously to minimize bowel edema and decrease the risk of respiratory side effects. The surgeon also employs a transversus abdominis plane (TAP) block with liposomal bupivacaine.

There is a multimodal pain management program, which includes intravenous hydromorphone by patient-controlled anesthesia pump and oral gabapentin three times daily. Patients switch to oral analgesics on postoperative day 2. These consist of acetaminophen and NSAIDs on an alternating schedule. Intravenous diazepam can be added as an antispasmodic. Alvimopan is continued twice daily until first bowel movement or hospital discharge.

Clear liquids are limited to 250 mL/8 hours on postoperative day 1, along with a clear protein drink. By day 2, patients are advanced to unrestricted volumes of clear liquids, and on day 3, to a regular solid diet. At that point, the clear protein drink is switched for a regular protein drink (Boost Plus).

Patients who vomit or require a nasogastric tube for decompression, and those with severe persistent nausea are made NPO, but can resume diet when these symptoms improve. Those with mild-moderate nausea receive intravenous ondansetron and are allowed to self-limit oral intake.

Patients were a mean of 57 years old with a mean body mass index of about 33 kg/m². The hernia was recurrent for about 60% of each group, with a mean area of about 300 cm², and a mean width of 14 cm. The mean mesh size was about 1,000 cm². The mean operative time was significantly shorter in the control group: 197 vs. 245 minutes.

Diet was advanced significantly more quickly in the ERAS group than the control group: 1 vs. 2 days on a liquid diet and 3 vs. 4.8 days to regular diet. Emesis after diet advancement was similar (4% for ERAS and 5% for control).

Compared with the control group, the ERAS group experienced significantly shorter average times to flatus (3.1 vs. 3.9 days), bowel movement (3.6 vs. 5.2 days), and reaching GI-3 status (3.4 vs. 4.8 days). Those in the ERAS group switched to oral narcotics sooner (2.2 vs. 3.6 days) also.

The average length of stay was significantly lower in ERAS group as well (4 vs. 6 days). About 18% of those in the ERAS group had a stay of less than 3 days, compared with 2% of the control group.

Readmissions within 90 days occurred in 16% of the control group and 4% of the ERAS group – a significant difference. There were four surgical site complications in the control group and three in the ERAS group. Bowel obstruction occurred in three control patients and one ERAS patient. All other complications requiring readmission occurred in the control group: two pulmonary embolisms, two deep vein thromboses, one pneumonia, one urinary tract infection and three other unspecified causes.

The authors noted that the shift to multimodal pain management and shorter-term use of IV opiates is a large contributor to the protocol’s good bowel outcomes. “Introduction of preoperative and postoperative gabapentin, intraoperative surgeon-delivered TAP block with long-acting liposomal bupivacaine, postoperative use of acetaminophen, and nonsteroidal agents have all appeared to contribute to better pain control and likely decrease in opioid consumption,” they said.

The use of diazepam as a pain medication is unusual, they said, but effective.

“We believe a large component of postoperative pain in hernia patients is due to muscle spasms after myofascial release, irritation from mesh placement, and transabdominal suture fixation. Therefore, in the context of our frequent use of myofascial releases for large incisional hernias, we believe the antispasmodic effects of diazepam potentially alleviate some of the postoperative discomfort caused by major abdominal wall reconstruction.”

None of the investigators reported financial conflicts.

[email protected]

The International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee has developed proposals for revision of the T, N, and M categories of the 8th edition of the TNM Classification for lung cancer due to be published in late 2016. The new classification will be enacted in January 2017.

The changes proposed were based on the results of an analysis of a new database of 94,708 cases donated from 35 sources in 16 countries around the world.

The methods used and the proposals made were published in the Journal of Thoracic Oncology (2016;11:39-51).

Candidate proposals for the TNM stage groups were developed in conjunction with proposed changes to the T and M categories, which were previously published (J Thorac Oncol 2015;10:990-1003, and 2015;10:1515-22). There were no proposed changes to the N.

Changes to some T and M descriptors will result in these cases being assigned to a different stage than that to which they would have been assigned in the 7th edition. In addition, some TNM subsets have been moved to a new stage grouping, according to Dr. Peter Goldstraw of Imperial College, London, and his colleagues on behalf of the IASLC Staging and Prognostic Factors Committee.

Major new proposals

T1 changes: Size cut points have further proliferated in the proposals for the 8th edition, and outgrowth of the emphasis on tumor size in the 7th edition, such that size will now be a descriptor in all T categories, according to the authors. New stage groupings proposed divide stage T1 into T1a, T1b, and T1c, based on the new size cut points of 1 cm and 2 cm. This results in these cases (when associated with the categories N0 and M0) being assigned to stages 1A1, 1A2, and 1A3, respectively, which reflects the statistically different prognosis of these cases.

T3, T4 changes: A new group has been created for the most advanced local disease categories, T3 and T4 associated with N3 disease, but category M0. Such cases will now be classified as stage IIIC, reflecting their worse outcomes than seen in cases involving tumors that remain in stage IIIB. The prognosis for stage IIIC cases is similar to that of stage IVA cases, however the researchers justified the separation, based upon the different treatment approaches used for such cases.

M changes: Although cases with intrathoracic metastatic disease to the contralateral lung or with pleural/pericardial dissemination remain classified as M1a disease, the category M1b will now be assigned to cases with a single metastatic deposit (in one organ) and M1a and M1b cases will be moored to a new stage grouping called IVA. The more common situation of multiple metastatic deposits, usually in more than one organ, will be classified as M1c and staged as IVB. Separation of the M1a and M1b categories was maintained both for further data analysis and because some patients with oligometastatic disease are now receiving more aggressive local therapy in addition to systemic treatment, according to the authors.

Other proposals

A variety of more minor changes to stage groupings has also been proposed, some of which will result in a T descriptor being allocated to a higher stage. In some cases, tumors may be allocated to a different T category entirely, leading to a reclassification of stage. Among the examples given were tumors associated with diaphragmatic invasion to TV, which, when associated with N0 disease, will move from stage IIB to IIA.

Impact on treatment

The relationship of the proposed classification changes to treatment decisions is not direct, the authors stated in their discussion. “Although such changes might raise the issue of whether consequent changes to treatment algorithms are needed, it is important to remind ourselves that stage does not dictate treatment. Stage is one, and perhaps the most important, of several prognostic factors that guide the appropriate treatment option[s] to offer the patient. Any change to established treatment algorithms should be based on clinical judgment informed by prospective trials,” they emphasized.

New stage groupings should be used in any trials of novel therapies, they added.

“We hope that the thoracic oncology community finds the proposals of value and that, when accepted, will have a positive impact on the effectiveness of treatment for lung cancer, which will benefit patients around the globe,” the researchers concluded.

The research to develop the new proposals was funded by the IASLC, including funds obtained through unrestricted grants obtained from the pharmaceutical industry. The authors reported no other disclosures.

[email protected]

The International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee has developed proposals for revision of the T, N, and M categories of the 8th edition of the TNM Classification for lung cancer due to be published in late 2016. The new classification will be enacted in January 2017.

The changes proposed were based on the results of an analysis of a new database of 94,708 cases donated from 35 sources in 16 countries around the world.

The methods used and the proposals made were published in the Journal of Thoracic Oncology (2016;11:39-51).

Candidate proposals for the TNM stage groups were developed in conjunction with proposed changes to the T and M categories, which were previously published (J Thorac Oncol 2015;10:990-1003, and 2015;10:1515-22). There were no proposed changes to the N.

Changes to some T and M descriptors will result in these cases being assigned to a different stage than that to which they would have been assigned in the 7th edition. In addition, some TNM subsets have been moved to a new stage grouping, according to Dr. Peter Goldstraw of Imperial College, London, and his colleagues on behalf of the IASLC Staging and Prognostic Factors Committee.

Major new proposals

T1 changes: Size cut points have further proliferated in the proposals for the 8th edition, and outgrowth of the emphasis on tumor size in the 7th edition, such that size will now be a descriptor in all T categories, according to the authors. New stage groupings proposed divide stage T1 into T1a, T1b, and T1c, based on the new size cut points of 1 cm and 2 cm. This results in these cases (when associated with the categories N0 and M0) being assigned to stages 1A1, 1A2, and 1A3, respectively, which reflects the statistically different prognosis of these cases.

T3, T4 changes: A new group has been created for the most advanced local disease categories, T3 and T4 associated with N3 disease, but category M0. Such cases will now be classified as stage IIIC, reflecting their worse outcomes than seen in cases involving tumors that remain in stage IIIB. The prognosis for stage IIIC cases is similar to that of stage IVA cases, however the researchers justified the separation, based upon the different treatment approaches used for such cases.

M changes: Although cases with intrathoracic metastatic disease to the contralateral lung or with pleural/pericardial dissemination remain classified as M1a disease, the category M1b will now be assigned to cases with a single metastatic deposit (in one organ) and M1a and M1b cases will be moored to a new stage grouping called IVA. The more common situation of multiple metastatic deposits, usually in more than one organ, will be classified as M1c and staged as IVB. Separation of the M1a and M1b categories was maintained both for further data analysis and because some patients with oligometastatic disease are now receiving more aggressive local therapy in addition to systemic treatment, according to the authors.

Other proposals

A variety of more minor changes to stage groupings has also been proposed, some of which will result in a T descriptor being allocated to a higher stage. In some cases, tumors may be allocated to a different T category entirely, leading to a reclassification of stage. Among the examples given were tumors associated with diaphragmatic invasion to TV, which, when associated with N0 disease, will move from stage IIB to IIA.

Impact on treatment

The relationship of the proposed classification changes to treatment decisions is not direct, the authors stated in their discussion. “Although such changes might raise the issue of whether consequent changes to treatment algorithms are needed, it is important to remind ourselves that stage does not dictate treatment. Stage is one, and perhaps the most important, of several prognostic factors that guide the appropriate treatment option[s] to offer the patient. Any change to established treatment algorithms should be based on clinical judgment informed by prospective trials,” they emphasized.

New stage groupings should be used in any trials of novel therapies, they added.

“We hope that the thoracic oncology community finds the proposals of value and that, when accepted, will have a positive impact on the effectiveness of treatment for lung cancer, which will benefit patients around the globe,” the researchers concluded.

The research to develop the new proposals was funded by the IASLC, including funds obtained through unrestricted grants obtained from the pharmaceutical industry. The authors reported no other disclosures.

[email protected]

The International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee has developed proposals for revision of the T, N, and M categories of the 8th edition of the TNM Classification for lung cancer due to be published in late 2016. The new classification will be enacted in January 2017.

The changes proposed were based on the results of an analysis of a new database of 94,708 cases donated from 35 sources in 16 countries around the world.

The methods used and the proposals made were published in the Journal of Thoracic Oncology (2016;11:39-51).

Candidate proposals for the TNM stage groups were developed in conjunction with proposed changes to the T and M categories, which were previously published (J Thorac Oncol 2015;10:990-1003, and 2015;10:1515-22). There were no proposed changes to the N.

Changes to some T and M descriptors will result in these cases being assigned to a different stage than that to which they would have been assigned in the 7th edition. In addition, some TNM subsets have been moved to a new stage grouping, according to Dr. Peter Goldstraw of Imperial College, London, and his colleagues on behalf of the IASLC Staging and Prognostic Factors Committee.

Major new proposals

T1 changes: Size cut points have further proliferated in the proposals for the 8th edition, and outgrowth of the emphasis on tumor size in the 7th edition, such that size will now be a descriptor in all T categories, according to the authors. New stage groupings proposed divide stage T1 into T1a, T1b, and T1c, based on the new size cut points of 1 cm and 2 cm. This results in these cases (when associated with the categories N0 and M0) being assigned to stages 1A1, 1A2, and 1A3, respectively, which reflects the statistically different prognosis of these cases.

T3, T4 changes: A new group has been created for the most advanced local disease categories, T3 and T4 associated with N3 disease, but category M0. Such cases will now be classified as stage IIIC, reflecting their worse outcomes than seen in cases involving tumors that remain in stage IIIB. The prognosis for stage IIIC cases is similar to that of stage IVA cases, however the researchers justified the separation, based upon the different treatment approaches used for such cases.

M changes: Although cases with intrathoracic metastatic disease to the contralateral lung or with pleural/pericardial dissemination remain classified as M1a disease, the category M1b will now be assigned to cases with a single metastatic deposit (in one organ) and M1a and M1b cases will be moored to a new stage grouping called IVA. The more common situation of multiple metastatic deposits, usually in more than one organ, will be classified as M1c and staged as IVB. Separation of the M1a and M1b categories was maintained both for further data analysis and because some patients with oligometastatic disease are now receiving more aggressive local therapy in addition to systemic treatment, according to the authors.

Other proposals

A variety of more minor changes to stage groupings has also been proposed, some of which will result in a T descriptor being allocated to a higher stage. In some cases, tumors may be allocated to a different T category entirely, leading to a reclassification of stage. Among the examples given were tumors associated with diaphragmatic invasion to TV, which, when associated with N0 disease, will move from stage IIB to IIA.

Impact on treatment

The relationship of the proposed classification changes to treatment decisions is not direct, the authors stated in their discussion. “Although such changes might raise the issue of whether consequent changes to treatment algorithms are needed, it is important to remind ourselves that stage does not dictate treatment. Stage is one, and perhaps the most important, of several prognostic factors that guide the appropriate treatment option[s] to offer the patient. Any change to established treatment algorithms should be based on clinical judgment informed by prospective trials,” they emphasized.

New stage groupings should be used in any trials of novel therapies, they added.

“We hope that the thoracic oncology community finds the proposals of value and that, when accepted, will have a positive impact on the effectiveness of treatment for lung cancer, which will benefit patients around the globe,” the researchers concluded.

The research to develop the new proposals was funded by the IASLC, including funds obtained through unrestricted grants obtained from the pharmaceutical industry. The authors reported no other disclosures.

[email protected]

DENVER – Long-term continuous positive airway pressure (CPAP) for treatment of sleep apnea in patients with a recent mild stroke or transient ischemic attack resulted in improved cardiovascular and metabolic risk factors, better neurologic function, and a reduction in the recurrent vascular event rate, compared with usual care in the SLEEP TIGHT study.

“Up to 25% of patients will have a stroke, cardiovascular event, or death within 90 days after a minor stroke or TIA [transient ischemic attack] despite current preventive strategies. And, importantly, patients with a TIA or stroke have a high prevalence of obstructive sleep apnea – on the order of 60%-80%,” explained Dr. H. Klar Yaggi at the annual meeting of the Associated Professional Sleep Societies.

SLEEP TIGHT’s findings support the hypothesis that diagnosis and treatment of sleep apnea in patients with a recent minor stroke or TIA will address a major unmet need for better methods of reducing the high vascular risk present in this population, said Dr. Yaggi of Yale University in New Haven, Conn.

SLEEP TIGHT was a National Heart, Lung, and Blood Institute–sponsored phase II, 12-month, multicenter, single-blind, randomized, proof-of-concept study. It included 252 patients, 80% of whom had a recent minor stroke, the rest a TIA. These were patients with high levels of cardiovascular risk factors: two-thirds had hypertension, half were hyperlipidemic, 40% had diabetes, 15% had a prior MI, 10% had atrial fibrillation, and the group’s mean body mass index was 30 kg/m². Polysomnography revealed that 76% of subjects had sleep apnea as defined by an apnea-hypopnea index of at least 5 events per hour. In fact, they averaged about 23 events per hour, putting them in the moderate-severity range. As is common among stroke/TIA patients with sleep apnea, they experienced less daytime sleepiness than is typical in a sleep clinic population, with a mean baseline Epworth Sleepiness Scale score of 7.

Participants were randomized to one of three groups: a usual care control group, a CPAP arm, or an enhanced CPAP arm. The enhanced intervention protocol was designed to boost CPAP adherence; it included targeted education, a customized cognitive intervention, and additional CPAP support beyond the standard CPAP protocols used in sleep medicine clinics. Patients with sleep apnea in the two intervention arms were then placed on CPAP.

At 1 year of follow-up, the stroke rate was 8.7 per 100 patient-years in the usual care group, compared with 5.5 per 100 person-years in the combined intervention arms. The composite cardiovascular event rate, composed of all-cause mortality, acute MI, stroke, hospitalization for unstable angina, or urgent coronary revascularization, was 13.1 per 100 person-years with usual care and 11.0 in the CPAP intervention arms. While these results are encouraging, SLEEP TIGHT wasn’t powered to show significant differences in these hard events.

Outcomes across the board didn’t differ significantly between the CPAP and enhanced CPAP groups. And since the mean number of hours of CPAP use per night was also similar in the two groups – 3.9 hours with standard CPAP and 4.3 hours with enhanced CPAP – it’s likely that the phase III trial will rely upon the much simpler standard CPAP intervention, according to Dr. Yaggi.

He deemed CPAP adherence in this stroke/TIA population to be similar to the rates typically seen in routine sleep medicine practice. Roughly 40% of the stroke/TIA patients were rated as having good adherence, 30% made some use of the therapy, and 30% had no or poor adherence.

Nonetheless, patients in the two intervention arms did significantly better than the usual care group in terms of 1-year changes in insulin resistance and glycosylated hemoglobin. They also had lower 24-hour mean systolic blood pressure and were more likely to convert to a favorable pattern of nocturnal blood pressure dipping. However, no differences between the intervention and usual care groups were seen in levels of high-sensitivity C-reactive protein and interleukin-6, the two markers of systemic inflammation analyzed. Nor did the CPAP intervention provide any benefit in terms of heart rate variability and other measures of autonomic function.

Fifty-eight percent of patients in the intervention arms ended up with a desirable National Institutes of Health Stroke Scale score of 0-1, compared with 38% of the usual care group. In addition, daytime sleepiness as reflected in Epworth Sleepiness Scale scores was reduced at last follow-up to a significantly greater extent in the CPAP groups, Dr. Yaggi noted.

Greater CPAP use was associated with a favorable trend for improvement in the modified Rankin score, a measure of functional ability: a 0.3-point reduction with no or poor CPAP use, a 0.4-point decrease with some use, and a 0.9-point reduction with good use.

The encouraging results will be helpful in designing a planned much larger, event-driven, definitive phase III trial, Dr. Yaggi said.

Dr. Yaggi reported having no financial conflicts regarding this National Heart, Lung and Blood Institute-sponsored study.

[email protected]

DENVER – Long-term continuous positive airway pressure (CPAP) for treatment of sleep apnea in patients with a recent mild stroke or transient ischemic attack resulted in improved cardiovascular and metabolic risk factors, better neurologic function, and a reduction in the recurrent vascular event rate, compared with usual care in the SLEEP TIGHT study.

“Up to 25% of patients will have a stroke, cardiovascular event, or death within 90 days after a minor stroke or TIA [transient ischemic attack] despite current preventive strategies. And, importantly, patients with a TIA or stroke have a high prevalence of obstructive sleep apnea – on the order of 60%-80%,” explained Dr. H. Klar Yaggi at the annual meeting of the Associated Professional Sleep Societies.

SLEEP TIGHT’s findings support the hypothesis that diagnosis and treatment of sleep apnea in patients with a recent minor stroke or TIA will address a major unmet need for better methods of reducing the high vascular risk present in this population, said Dr. Yaggi of Yale University in New Haven, Conn.

SLEEP TIGHT was a National Heart, Lung, and Blood Institute–sponsored phase II, 12-month, multicenter, single-blind, randomized, proof-of-concept study. It included 252 patients, 80% of whom had a recent minor stroke, the rest a TIA. These were patients with high levels of cardiovascular risk factors: two-thirds had hypertension, half were hyperlipidemic, 40% had diabetes, 15% had a prior MI, 10% had atrial fibrillation, and the group’s mean body mass index was 30 kg/m². Polysomnography revealed that 76% of subjects had sleep apnea as defined by an apnea-hypopnea index of at least 5 events per hour. In fact, they averaged about 23 events per hour, putting them in the moderate-severity range. As is common among stroke/TIA patients with sleep apnea, they experienced less daytime sleepiness than is typical in a sleep clinic population, with a mean baseline Epworth Sleepiness Scale score of 7.

Participants were randomized to one of three groups: a usual care control group, a CPAP arm, or an enhanced CPAP arm. The enhanced intervention protocol was designed to boost CPAP adherence; it included targeted education, a customized cognitive intervention, and additional CPAP support beyond the standard CPAP protocols used in sleep medicine clinics. Patients with sleep apnea in the two intervention arms were then placed on CPAP.

At 1 year of follow-up, the stroke rate was 8.7 per 100 patient-years in the usual care group, compared with 5.5 per 100 person-years in the combined intervention arms. The composite cardiovascular event rate, composed of all-cause mortality, acute MI, stroke, hospitalization for unstable angina, or urgent coronary revascularization, was 13.1 per 100 person-years with usual care and 11.0 in the CPAP intervention arms. While these results are encouraging, SLEEP TIGHT wasn’t powered to show significant differences in these hard events.

Outcomes across the board didn’t differ significantly between the CPAP and enhanced CPAP groups. And since the mean number of hours of CPAP use per night was also similar in the two groups – 3.9 hours with standard CPAP and 4.3 hours with enhanced CPAP – it’s likely that the phase III trial will rely upon the much simpler standard CPAP intervention, according to Dr. Yaggi.

He deemed CPAP adherence in this stroke/TIA population to be similar to the rates typically seen in routine sleep medicine practice. Roughly 40% of the stroke/TIA patients were rated as having good adherence, 30% made some use of the therapy, and 30% had no or poor adherence.

Nonetheless, patients in the two intervention arms did significantly better than the usual care group in terms of 1-year changes in insulin resistance and glycosylated hemoglobin. They also had lower 24-hour mean systolic blood pressure and were more likely to convert to a favorable pattern of nocturnal blood pressure dipping. However, no differences between the intervention and usual care groups were seen in levels of high-sensitivity C-reactive protein and interleukin-6, the two markers of systemic inflammation analyzed. Nor did the CPAP intervention provide any benefit in terms of heart rate variability and other measures of autonomic function.

Fifty-eight percent of patients in the intervention arms ended up with a desirable National Institutes of Health Stroke Scale score of 0-1, compared with 38% of the usual care group. In addition, daytime sleepiness as reflected in Epworth Sleepiness Scale scores was reduced at last follow-up to a significantly greater extent in the CPAP groups, Dr. Yaggi noted.

Greater CPAP use was associated with a favorable trend for improvement in the modified Rankin score, a measure of functional ability: a 0.3-point reduction with no or poor CPAP use, a 0.4-point decrease with some use, and a 0.9-point reduction with good use.

The encouraging results will be helpful in designing a planned much larger, event-driven, definitive phase III trial, Dr. Yaggi said.

Dr. Yaggi reported having no financial conflicts regarding this National Heart, Lung and Blood Institute-sponsored study.

[email protected]

DENVER – Long-term continuous positive airway pressure (CPAP) for treatment of sleep apnea in patients with a recent mild stroke or transient ischemic attack resulted in improved cardiovascular and metabolic risk factors, better neurologic function, and a reduction in the recurrent vascular event rate, compared with usual care in the SLEEP TIGHT study.

“Up to 25% of patients will have a stroke, cardiovascular event, or death within 90 days after a minor stroke or TIA [transient ischemic attack] despite current preventive strategies. And, importantly, patients with a TIA or stroke have a high prevalence of obstructive sleep apnea – on the order of 60%-80%,” explained Dr. H. Klar Yaggi at the annual meeting of the Associated Professional Sleep Societies.

SLEEP TIGHT’s findings support the hypothesis that diagnosis and treatment of sleep apnea in patients with a recent minor stroke or TIA will address a major unmet need for better methods of reducing the high vascular risk present in this population, said Dr. Yaggi of Yale University in New Haven, Conn.

SLEEP TIGHT was a National Heart, Lung, and Blood Institute–sponsored phase II, 12-month, multicenter, single-blind, randomized, proof-of-concept study. It included 252 patients, 80% of whom had a recent minor stroke, the rest a TIA. These were patients with high levels of cardiovascular risk factors: two-thirds had hypertension, half were hyperlipidemic, 40% had diabetes, 15% had a prior MI, 10% had atrial fibrillation, and the group’s mean body mass index was 30 kg/m². Polysomnography revealed that 76% of subjects had sleep apnea as defined by an apnea-hypopnea index of at least 5 events per hour. In fact, they averaged about 23 events per hour, putting them in the moderate-severity range. As is common among stroke/TIA patients with sleep apnea, they experienced less daytime sleepiness than is typical in a sleep clinic population, with a mean baseline Epworth Sleepiness Scale score of 7.

Participants were randomized to one of three groups: a usual care control group, a CPAP arm, or an enhanced CPAP arm. The enhanced intervention protocol was designed to boost CPAP adherence; it included targeted education, a customized cognitive intervention, and additional CPAP support beyond the standard CPAP protocols used in sleep medicine clinics. Patients with sleep apnea in the two intervention arms were then placed on CPAP.

At 1 year of follow-up, the stroke rate was 8.7 per 100 patient-years in the usual care group, compared with 5.5 per 100 person-years in the combined intervention arms. The composite cardiovascular event rate, composed of all-cause mortality, acute MI, stroke, hospitalization for unstable angina, or urgent coronary revascularization, was 13.1 per 100 person-years with usual care and 11.0 in the CPAP intervention arms. While these results are encouraging, SLEEP TIGHT wasn’t powered to show significant differences in these hard events.

Outcomes across the board didn’t differ significantly between the CPAP and enhanced CPAP groups. And since the mean number of hours of CPAP use per night was also similar in the two groups – 3.9 hours with standard CPAP and 4.3 hours with enhanced CPAP – it’s likely that the phase III trial will rely upon the much simpler standard CPAP intervention, according to Dr. Yaggi.

He deemed CPAP adherence in this stroke/TIA population to be similar to the rates typically seen in routine sleep medicine practice. Roughly 40% of the stroke/TIA patients were rated as having good adherence, 30% made some use of the therapy, and 30% had no or poor adherence.

Nonetheless, patients in the two intervention arms did significantly better than the usual care group in terms of 1-year changes in insulin resistance and glycosylated hemoglobin. They also had lower 24-hour mean systolic blood pressure and were more likely to convert to a favorable pattern of nocturnal blood pressure dipping. However, no differences between the intervention and usual care groups were seen in levels of high-sensitivity C-reactive protein and interleukin-6, the two markers of systemic inflammation analyzed. Nor did the CPAP intervention provide any benefit in terms of heart rate variability and other measures of autonomic function.

Fifty-eight percent of patients in the intervention arms ended up with a desirable National Institutes of Health Stroke Scale score of 0-1, compared with 38% of the usual care group. In addition, daytime sleepiness as reflected in Epworth Sleepiness Scale scores was reduced at last follow-up to a significantly greater extent in the CPAP groups, Dr. Yaggi noted.

Greater CPAP use was associated with a favorable trend for improvement in the modified Rankin score, a measure of functional ability: a 0.3-point reduction with no or poor CPAP use, a 0.4-point decrease with some use, and a 0.9-point reduction with good use.

The encouraging results will be helpful in designing a planned much larger, event-driven, definitive phase III trial, Dr. Yaggi said.

Dr. Yaggi reported having no financial conflicts regarding this National Heart, Lung and Blood Institute-sponsored study.

[email protected]

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is seeking candidates to fill three vacancies on the committee beginning in October 2016. Nominations are due Thursday, June 30.

The committee is seeking to fill the vacancies with men and women surgeons who are interested in advancing the role of women in the ACS and in encouraging and mentoring women in surgery. The committee encourages representation by individuals of diverse cultural, racial, and ethnic backgrounds.

Nominees must be ACS Fellows or Associate Fellows who are able to fulfill the following responsibilities:

• Serve an initial three-year term: 2016-2019

• Attend two in-person meetings annually – one during the ACS Leadership & Advocacy Summit in Washington, DC, in the spring, and the other at the annual ACS Clinical Congress

• Participate in quarterly conference calls

• Actively serve on one subcommittee

• Contribute to committee initiatives

Nominees should submit:

• A letter of interest highlighting their skills and expertise, along with contributions they could offer the committee

• A five-page or shorter summary of their curriculum vitae

Nominations should be submitted to Connie Bura, Associate Director, ACS Division of Member Services, at [email protected].

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is seeking candidates to fill three vacancies on the committee beginning in October 2016. Nominations are due Thursday, June 30.

The committee is seeking to fill the vacancies with men and women surgeons who are interested in advancing the role of women in the ACS and in encouraging and mentoring women in surgery. The committee encourages representation by individuals of diverse cultural, racial, and ethnic backgrounds.

Nominees must be ACS Fellows or Associate Fellows who are able to fulfill the following responsibilities:

• Serve an initial three-year term: 2016-2019

• Attend two in-person meetings annually – one during the ACS Leadership & Advocacy Summit in Washington, DC, in the spring, and the other at the annual ACS Clinical Congress

• Participate in quarterly conference calls

• Actively serve on one subcommittee

• Contribute to committee initiatives

Nominees should submit:

• A letter of interest highlighting their skills and expertise, along with contributions they could offer the committee

• A five-page or shorter summary of their curriculum vitae

Nominations should be submitted to Connie Bura, Associate Director, ACS Division of Member Services, at [email protected].

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is seeking candidates to fill three vacancies on the committee beginning in October 2016. Nominations are due Thursday, June 30.

The committee is seeking to fill the vacancies with men and women surgeons who are interested in advancing the role of women in the ACS and in encouraging and mentoring women in surgery. The committee encourages representation by individuals of diverse cultural, racial, and ethnic backgrounds.

Nominees must be ACS Fellows or Associate Fellows who are able to fulfill the following responsibilities:

• Serve an initial three-year term: 2016-2019

• Attend two in-person meetings annually – one during the ACS Leadership & Advocacy Summit in Washington, DC, in the spring, and the other at the annual ACS Clinical Congress

• Participate in quarterly conference calls

• Actively serve on one subcommittee

• Contribute to committee initiatives

Nominees should submit:

• A letter of interest highlighting their skills and expertise, along with contributions they could offer the committee

• A five-page or shorter summary of their curriculum vitae

Nominations should be submitted to Connie Bura, Associate Director, ACS Division of Member Services, at [email protected].

For the second consecutive year, Becker’s Hospital Review has identified Clifford Y. Ko, MD, MS, MSHS, FACS, as one of 50 experts leading the field of patient safety in the United States. Dr. Ko is Director, American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®), and Director, ACS Division of Research and Optimal Patient Care. He also is a colon and rectal surgeon and professor, University of California, Los Angeles (UCLA), Schools of Medicine and Public Health; Robert and Kelly Day Chair in Surgical Outcomes, UCLA; and a research affiliate, RAND Corp.

The 2016 edition of the Becker’s Hospital Review list includes individuals at national organizations, universities, and health care systems who are working to improve patient safety. This fourth edition includes the names of advocates, professors, researchers, administrators, and health care providers who have won awards, published articles, spoken out, and led initiatives to reduce medical injuries and ensure patient safety. The Becker’s Hospital Review editorial team considered nominations and selected leaders through an editorial review process.

View the full list of recipients on the Becker’s Hospital Review website at http://goo.gl/srQVN3. Dr. Ko’s profile appears on the website at http://goo.gl/NMUUOz.

For the second consecutive year, Becker’s Hospital Review has identified Clifford Y. Ko, MD, MS, MSHS, FACS, as one of 50 experts leading the field of patient safety in the United States. Dr. Ko is Director, American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®), and Director, ACS Division of Research and Optimal Patient Care. He also is a colon and rectal surgeon and professor, University of California, Los Angeles (UCLA), Schools of Medicine and Public Health; Robert and Kelly Day Chair in Surgical Outcomes, UCLA; and a research affiliate, RAND Corp.

The 2016 edition of the Becker’s Hospital Review list includes individuals at national organizations, universities, and health care systems who are working to improve patient safety. This fourth edition includes the names of advocates, professors, researchers, administrators, and health care providers who have won awards, published articles, spoken out, and led initiatives to reduce medical injuries and ensure patient safety. The Becker’s Hospital Review editorial team considered nominations and selected leaders through an editorial review process.

View the full list of recipients on the Becker’s Hospital Review website at http://goo.gl/srQVN3. Dr. Ko’s profile appears on the website at http://goo.gl/NMUUOz.

For the second consecutive year, Becker’s Hospital Review has identified Clifford Y. Ko, MD, MS, MSHS, FACS, as one of 50 experts leading the field of patient safety in the United States. Dr. Ko is Director, American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®), and Director, ACS Division of Research and Optimal Patient Care. He also is a colon and rectal surgeon and professor, University of California, Los Angeles (UCLA), Schools of Medicine and Public Health; Robert and Kelly Day Chair in Surgical Outcomes, UCLA; and a research affiliate, RAND Corp.

The 2016 edition of the Becker’s Hospital Review list includes individuals at national organizations, universities, and health care systems who are working to improve patient safety. This fourth edition includes the names of advocates, professors, researchers, administrators, and health care providers who have won awards, published articles, spoken out, and led initiatives to reduce medical injuries and ensure patient safety. The Becker’s Hospital Review editorial team considered nominations and selected leaders through an editorial review process.

View the full list of recipients on the Becker’s Hospital Review website at http://goo.gl/srQVN3. Dr. Ko’s profile appears on the website at http://goo.gl/NMUUOz.

Nominations for candidates to fill two vacancies on the American College of Surgeons (ACS) Committee on Diversity Issues are due Thursday, June 30, for assignments that will begin in October 2016.

The committee’s mission is to study the educational and professional needs of underrepresented surgeons and surgical trainees. In addition, committee members will study the impact that the committee’s work may have on the elimination of health care disparities among diverse population groups. Committee work will include developing proposals and sessions on diversity for the ACS Clinical Congress, and advancing tools and resources to enhance surgeons’ cultural competency.

Nominees must be ACS Fellows or Associate Fellows who are able to fulfill the following criteria:

• Serve an initial three-year term, 2016-2019

• Attend one in-person meeting at the ACS Clinical Congress and participate in regular committee conference calls

• Actively contribute to committee initiatives

Nominees should submit:

• A letter of interest highlighting their skills and expertise, along with a list of contributions they would offer the committee

• A summary of their curriculum vitae, in fewer than five pages

For additional information and to submit nominations, contact Connie Bura, Associate Director, ACS Division of Member Services, at [email protected].

Nominations for candidates to fill two vacancies on the American College of Surgeons (ACS) Committee on Diversity Issues are due Thursday, June 30, for assignments that will begin in October 2016.

The committee’s mission is to study the educational and professional needs of underrepresented surgeons and surgical trainees. In addition, committee members will study the impact that the committee’s work may have on the elimination of health care disparities among diverse population groups. Committee work will include developing proposals and sessions on diversity for the ACS Clinical Congress, and advancing tools and resources to enhance surgeons’ cultural competency.

Nominees must be ACS Fellows or Associate Fellows who are able to fulfill the following criteria:

• Serve an initial three-year term, 2016-2019

• Attend one in-person meeting at the ACS Clinical Congress and participate in regular committee conference calls

• Actively contribute to committee initiatives

Nominees should submit:

• A letter of interest highlighting their skills and expertise, along with a list of contributions they would offer the committee

• A summary of their curriculum vitae, in fewer than five pages

For additional information and to submit nominations, contact Connie Bura, Associate Director, ACS Division of Member Services, at [email protected].

Nominations for candidates to fill two vacancies on the American College of Surgeons (ACS) Committee on Diversity Issues are due Thursday, June 30, for assignments that will begin in October 2016.

The committee’s mission is to study the educational and professional needs of underrepresented surgeons and surgical trainees. In addition, committee members will study the impact that the committee’s work may have on the elimination of health care disparities among diverse population groups. Committee work will include developing proposals and sessions on diversity for the ACS Clinical Congress, and advancing tools and resources to enhance surgeons’ cultural competency.

Nominees must be ACS Fellows or Associate Fellows who are able to fulfill the following criteria:

• Serve an initial three-year term, 2016-2019

• Attend one in-person meeting at the ACS Clinical Congress and participate in regular committee conference calls

• Actively contribute to committee initiatives

Nominees should submit:

• A letter of interest highlighting their skills and expertise, along with a list of contributions they would offer the committee

• A summary of their curriculum vitae, in fewer than five pages

For additional information and to submit nominations, contact Connie Bura, Associate Director, ACS Division of Member Services, at [email protected].

Applications for the American College of Surgeons (ACS) Mentorship Program for Women Surgeons are due Friday, July 15. Through this program early-career female surgeons develop a mentoring relationship with established surgeons representing all specialties of the ACS.

This year’s mentoring program, October 2016 through October 2017, will include up to 25 mentor/mentee pairs who must attend the ACS Clinical Congress 2016, Oct. 16-20 in Washington, D.C. Applicants must be ACS Fellows or Associate Fellows, or in the process of applying for ACS Fellowship.

The committee also seeks qualified mentors. Visit the Women in Surgery Committee (WiSC) webpage (https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/activities) to download the mentor or mentee application. All applicants will receive notification by Aug. 30 regarding their participation in the program.

Find more information about the WiSC on its webpage at https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/activities. Submit applications to Connie Bura, Associate Director, Division of Member Services, at [email protected].

Applications for the American College of Surgeons (ACS) Mentorship Program for Women Surgeons are due Friday, July 15. Through this program early-career female surgeons develop a mentoring relationship with established surgeons representing all specialties of the ACS.

This year’s mentoring program, October 2016 through October 2017, will include up to 25 mentor/mentee pairs who must attend the ACS Clinical Congress 2016, Oct. 16-20 in Washington, D.C. Applicants must be ACS Fellows or Associate Fellows, or in the process of applying for ACS Fellowship.

The committee also seeks qualified mentors. Visit the Women in Surgery Committee (WiSC) webpage (https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/activities) to download the mentor or mentee application. All applicants will receive notification by Aug. 30 regarding their participation in the program.

Find more information about the WiSC on its webpage at https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/activities. Submit applications to Connie Bura, Associate Director, Division of Member Services, at [email protected].

Applications for the American College of Surgeons (ACS) Mentorship Program for Women Surgeons are due Friday, July 15. Through this program early-career female surgeons develop a mentoring relationship with established surgeons representing all specialties of the ACS.

This year’s mentoring program, October 2016 through October 2017, will include up to 25 mentor/mentee pairs who must attend the ACS Clinical Congress 2016, Oct. 16-20 in Washington, D.C. Applicants must be ACS Fellows or Associate Fellows, or in the process of applying for ACS Fellowship.

The committee also seeks qualified mentors. Visit the Women in Surgery Committee (WiSC) webpage (https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/activities) to download the mentor or mentee application. All applicants will receive notification by Aug. 30 regarding their participation in the program.

Find more information about the WiSC on its webpage at https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/activities. Submit applications to Connie Bura, Associate Director, Division of Member Services, at [email protected].

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is accepting nominations through Thursday, June 30, for a new annual award, the Mary Edwards Walker Inspiring Women in Surgery Award. The award, which will be presented at Clinical Congress 2016, honors the work of Mary Edwards Walker (1832-1919) the first female surgeon employed by the U.S. Army and the only woman ever to receive the Medal of Honor, the highest U.S. Armed Forces decoration for bravery.

Nominees must be ACS members, either in active practice or retired, who meet the following requirements:

• A demonstrated commitment to the advancement and inspiration of women in surgery.

• Current WiSC members are ineligible for this award.

• The awardee is expected to attend the ACS Clinical Congress 2016 in Washington, DC, to accept the award.

Nominations must include a letter of nomination outlining how the nominee has contributed to the advancement of women in surgery and the nominee’s current curriculum vitae. Self-nominations are acceptable and should include a letter of reference. E-mail all materials to Connie Bura, ACS Associate Director, Division of Member Services, at [email protected]. Contact Ms. Bura for additional information.

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is accepting nominations through Thursday, June 30, for a new annual award, the Mary Edwards Walker Inspiring Women in Surgery Award. The award, which will be presented at Clinical Congress 2016, honors the work of Mary Edwards Walker (1832-1919) the first female surgeon employed by the U.S. Army and the only woman ever to receive the Medal of Honor, the highest U.S. Armed Forces decoration for bravery.

Nominees must be ACS members, either in active practice or retired, who meet the following requirements:

• A demonstrated commitment to the advancement and inspiration of women in surgery.

• Current WiSC members are ineligible for this award.

• The awardee is expected to attend the ACS Clinical Congress 2016 in Washington, DC, to accept the award.

Nominations must include a letter of nomination outlining how the nominee has contributed to the advancement of women in surgery and the nominee’s current curriculum vitae. Self-nominations are acceptable and should include a letter of reference. E-mail all materials to Connie Bura, ACS Associate Director, Division of Member Services, at [email protected]. Contact Ms. Bura for additional information.

The American College of Surgeons (ACS) Women in Surgery Committee (WiSC) is accepting nominations through Thursday, June 30, for a new annual award, the Mary Edwards Walker Inspiring Women in Surgery Award. The award, which will be presented at Clinical Congress 2016, honors the work of Mary Edwards Walker (1832-1919) the first female surgeon employed by the U.S. Army and the only woman ever to receive the Medal of Honor, the highest U.S. Armed Forces decoration for bravery.

Nominees must be ACS members, either in active practice or retired, who meet the following requirements:

• A demonstrated commitment to the advancement and inspiration of women in surgery.

• Current WiSC members are ineligible for this award.

• The awardee is expected to attend the ACS Clinical Congress 2016 in Washington, DC, to accept the award.

Nominations must include a letter of nomination outlining how the nominee has contributed to the advancement of women in surgery and the nominee’s current curriculum vitae. Self-nominations are acceptable and should include a letter of reference. E-mail all materials to Connie Bura, ACS Associate Director, Division of Member Services, at [email protected]. Contact Ms. Bura for additional information.

A total of 17 surgeons have been selected to serve as Health Policy Scholars and participate in the Leadership Program for Health Policy and Management, June 12-18 at the Heller School for Social Policy and Management, Brandeis University, Waltham, MA.

Each scholarship includes attendance at the weeklong intensive course, followed by a year’s service in a health policy–related capacity to the American College of Surgeons (ACS) and the surgical specialty society cosponsoring the awardee.

This year’s scholars are as follows:

• ACS Health Policy Scholar for General Surgery: Subhasis Misra, MB, BS, MS, FACS, Texas Tech University Health Sciences Center School of Medicine, Amarillo

• ACS Health Policy Scholar for General Surgery: SreyRam Kuy, MD, MHS, Louisiana State University, Shreveport

• ACS/American Association of Neurological Surgeons Health Policy Scholar: Kimon Bekelis, MD, Dartmouth-Hitchcock Medical Center, Lebanon, NH

• ACS/American Academy of Otolaryngology–Head & Neck Surgery Health Policy Scholar: Alex J. McKinlay, MD, FACS, Darnall Army Medical Center, Fort Hood, TX

• ACS/American Association for the Surgery of Trauma Health Policy Scholar: Saman Arbabi, MD, FACS, Harborview Medical Center, Seattle, WA

• ACS/American Pediatric Surgery Association Health Policy Scholar: David P. Bliss Jr., MD, FACS, Children’s Medical Center, Dallas, TX

• ACS/American Surgical Association Health Policy Scholar: Eileen M. Bulger, MD, FACS, University of Washington, Seattle

• ACS/American Society of Breast Surgeons Health Policy Scholar: Alyssa D. Throckmorton, MD, FACS, Baptist Medical Group, Nashville, TN

• ACS/American Society of Colon and Rectal Surgeons Health Policy Scholar: Jose G. Guillem, MD, FACS, Memorial Sloan Kettering Cancer Center, New York, NY

• ACS/American Society of Plastic Surgeons Health Policy Scholar: Malcolm Z. Roth, MD, FACS, Albany Medical Center, NY

• ACS/American Urogynecologic Society Health Policy Scholar: Mallika Anand, MD, Spectrum Health Medical Group, Grand Rapids, MI

• ACS/American Urological Association Health Policy Scholar: Thomas Rechtschaffen, MD, FACS, Advanced Urology Centers of New York, Yonkers

• ACS/Eastern Association for the Surgery of Trauma Health Policy Scholar: Alexander L. Eastman, MD, MPH, FACS, University of Texas Southwestern Medical Center, Dallas

• ACS/New England Society of Surgery Health Policy Scholar: Christopher S. Muratore, MD, FACS, Hasbro Children’s Hospital/Rhode Island Hospital, Providence

• ACS/Society for Surgery of the Alimentary Tract Health Policy Scholar: Guilherme Mussi Rocha Campos, MD, FACS, Virginia Commonwealth University, Richmond

• ACS/The Society of Thoracic Surgeons Health Policy Scholar: Daniel T. Engelman, MD, FACS, Baystate Medical Center, Springfield, MA

• ACS/Society for Vascular Surgery Health Policy Scholar: Matthew Jay Sideman, MD, FACS, University of Texas Health Sciences Center, San Antonio

A total of 17 surgeons have been selected to serve as Health Policy Scholars and participate in the Leadership Program for Health Policy and Management, June 12-18 at the Heller School for Social Policy and Management, Brandeis University, Waltham, MA.

Each scholarship includes attendance at the weeklong intensive course, followed by a year’s service in a health policy–related capacity to the American College of Surgeons (ACS) and the surgical specialty society cosponsoring the awardee.

This year’s scholars are as follows:

• ACS Health Policy Scholar for General Surgery: Subhasis Misra, MB, BS, MS, FACS, Texas Tech University Health Sciences Center School of Medicine, Amarillo

• ACS Health Policy Scholar for General Surgery: SreyRam Kuy, MD, MHS, Louisiana State University, Shreveport

• ACS/American Association of Neurological Surgeons Health Policy Scholar: Kimon Bekelis, MD, Dartmouth-Hitchcock Medical Center, Lebanon, NH

• ACS/American Academy of Otolaryngology–Head & Neck Surgery Health Policy Scholar: Alex J. McKinlay, MD, FACS, Darnall Army Medical Center, Fort Hood, TX

• ACS/American Association for the Surgery of Trauma Health Policy Scholar: Saman Arbabi, MD, FACS, Harborview Medical Center, Seattle, WA

• ACS/American Pediatric Surgery Association Health Policy Scholar: David P. Bliss Jr., MD, FACS, Children’s Medical Center, Dallas, TX

• ACS/American Surgical Association Health Policy Scholar: Eileen M. Bulger, MD, FACS, University of Washington, Seattle

• ACS/American Society of Breast Surgeons Health Policy Scholar: Alyssa D. Throckmorton, MD, FACS, Baptist Medical Group, Nashville, TN

• ACS/American Society of Colon and Rectal Surgeons Health Policy Scholar: Jose G. Guillem, MD, FACS, Memorial Sloan Kettering Cancer Center, New York, NY

• ACS/American Society of Plastic Surgeons Health Policy Scholar: Malcolm Z. Roth, MD, FACS, Albany Medical Center, NY

• ACS/American Urogynecologic Society Health Policy Scholar: Mallika Anand, MD, Spectrum Health Medical Group, Grand Rapids, MI

• ACS/American Urological Association Health Policy Scholar: Thomas Rechtschaffen, MD, FACS, Advanced Urology Centers of New York, Yonkers

• ACS/Eastern Association for the Surgery of Trauma Health Policy Scholar: Alexander L. Eastman, MD, MPH, FACS, University of Texas Southwestern Medical Center, Dallas

• ACS/New England Society of Surgery Health Policy Scholar: Christopher S. Muratore, MD, FACS, Hasbro Children’s Hospital/Rhode Island Hospital, Providence

• ACS/Society for Surgery of the Alimentary Tract Health Policy Scholar: Guilherme Mussi Rocha Campos, MD, FACS, Virginia Commonwealth University, Richmond

• ACS/The Society of Thoracic Surgeons Health Policy Scholar: Daniel T. Engelman, MD, FACS, Baystate Medical Center, Springfield, MA

• ACS/Society for Vascular Surgery Health Policy Scholar: Matthew Jay Sideman, MD, FACS, University of Texas Health Sciences Center, San Antonio

A total of 17 surgeons have been selected to serve as Health Policy Scholars and participate in the Leadership Program for Health Policy and Management, June 12-18 at the Heller School for Social Policy and Management, Brandeis University, Waltham, MA.

Each scholarship includes attendance at the weeklong intensive course, followed by a year’s service in a health policy–related capacity to the American College of Surgeons (ACS) and the surgical specialty society cosponsoring the awardee.

This year’s scholars are as follows:

• ACS Health Policy Scholar for General Surgery: Subhasis Misra, MB, BS, MS, FACS, Texas Tech University Health Sciences Center School of Medicine, Amarillo

• ACS Health Policy Scholar for General Surgery: SreyRam Kuy, MD, MHS, Louisiana State University, Shreveport

• ACS/American Association of Neurological Surgeons Health Policy Scholar: Kimon Bekelis, MD, Dartmouth-Hitchcock Medical Center, Lebanon, NH

• ACS/American Academy of Otolaryngology–Head & Neck Surgery Health Policy Scholar: Alex J. McKinlay, MD, FACS, Darnall Army Medical Center, Fort Hood, TX

• ACS/American Association for the Surgery of Trauma Health Policy Scholar: Saman Arbabi, MD, FACS, Harborview Medical Center, Seattle, WA

• ACS/American Pediatric Surgery Association Health Policy Scholar: David P. Bliss Jr., MD, FACS, Children’s Medical Center, Dallas, TX

• ACS/American Surgical Association Health Policy Scholar: Eileen M. Bulger, MD, FACS, University of Washington, Seattle

• ACS/American Society of Breast Surgeons Health Policy Scholar: Alyssa D. Throckmorton, MD, FACS, Baptist Medical Group, Nashville, TN

• ACS/American Society of Colon and Rectal Surgeons Health Policy Scholar: Jose G. Guillem, MD, FACS, Memorial Sloan Kettering Cancer Center, New York, NY

• ACS/American Society of Plastic Surgeons Health Policy Scholar: Malcolm Z. Roth, MD, FACS, Albany Medical Center, NY

• ACS/American Urogynecologic Society Health Policy Scholar: Mallika Anand, MD, Spectrum Health Medical Group, Grand Rapids, MI

• ACS/American Urological Association Health Policy Scholar: Thomas Rechtschaffen, MD, FACS, Advanced Urology Centers of New York, Yonkers

• ACS/Eastern Association for the Surgery of Trauma Health Policy Scholar: Alexander L. Eastman, MD, MPH, FACS, University of Texas Southwestern Medical Center, Dallas

• ACS/New England Society of Surgery Health Policy Scholar: Christopher S. Muratore, MD, FACS, Hasbro Children’s Hospital/Rhode Island Hospital, Providence

• ACS/Society for Surgery of the Alimentary Tract Health Policy Scholar: Guilherme Mussi Rocha Campos, MD, FACS, Virginia Commonwealth University, Richmond

• ACS/The Society of Thoracic Surgeons Health Policy Scholar: Daniel T. Engelman, MD, FACS, Baystate Medical Center, Springfield, MA

• ACS/Society for Vascular Surgery Health Policy Scholar: Matthew Jay Sideman, MD, FACS, University of Texas Health Sciences Center, San Antonio