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American College of Surgeons, Oct. 26-30

The 100th Annual American College of Surgeons Clinical Congress

The annual meeting of the American College of Surgeons was held from Oct. 26 to 30 in San Francisco and attracted approximately 14,000 participants from around the world, including surgeons, medical experts, allied health professionals, and administrators. The conference included hundreds of general and specialty sessions, postgraduate courses, scientific paper presentations, video-based educational presentations, and posters focusing on the latest advances in surgical care.

In one study, Peter Adams, M.D., of the Henry Ford Hospital in Detroit, and colleagues found that a modified frailty index is a simple tool that appears to be significantly associated with surgical morbidity and mortality in total joint replacement patients.

"A simplified frailty index consisting of 11 variables is significantly associated with death and serious morbidity in patients undergoing total joint replacement. Non-frail patients have a mortality rate of 0.08 percent and a serious complication rate of 0.67 percent, including a rate of myocardial infarction of 0.01 percent," Adams said.

In comparison, the investigators found that patients having four or more variables present have a mortality rate of 1.94 percent, and a rate of serious morbidity of 6.24 percent, including a rate of myocardial infarction of 2.38 percent.

"The index will require prospective evaluation and external validation. It may be useful for anticipating patients at increased surgical risk, which may aid us in risk stratification, preoperative counseling, and preoperative optimization. It is also important to note that non-frail patients did extremely well in this study, with a less than 1 percent risk of all evaluated complications," Adams said.

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In another study, Bellal Joseph, M.D., of the University of Arizona in Tucson, and colleagues found that states with universal helmet laws had a lower incidence of traumatic brain injury (TBI) and TBI-related death compared to states with age-limited helmet laws. In addition, the investigators found that the presence of universal helmet legislation resulted in decreases in the rate of TBI incidence.

"Not all states have universal helmet laws, and this resulted in worse outcomes in states with no helmet laws. Implementation of universal helmet laws across states may help to reduce the incidence of TBI injury and TBI mortality among motorcycle riders," Joseph said. "This study adds to the evidence to help lawmakers support implementation of universal helmet laws. Currently, fewer than half the states have universal helmet laws and instead have age-limited laws."

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Geoffrey Gurtner, M.D., of the Stanford University School of Medicine in California, and colleagues found that an existing U.S. Food and Drug Administration-approved medicine, deferoxamine, delivered transdermally, was able to prevent the pathophysiologic derangements that underlie non-healing diabetic wounds.

"This is the number one cause of non-traumatic amputations in the United States. By blocking these molecular derangements, it is possible to heal wounds faster and prevent wounds from occurring," Gurtner said. "Since this molecule, deferoxamine, is already FDA approved, it is hoped that this approach can be brought into the clinic rapidly. The ability to pharmacologically prevent or heal diabetic wounds is an area of great unmet clinical need."

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Philip Zhao, M.D., of The Arthur Smith Institute for Urology at the North Shore-Long Island Jewish Health System in New Hyde Park, N.Y., and colleagues evaluated the first-page results of three of the largest search engine platforms, including Google, Bing, and Yahoo!, which perform well over 95 percent of all search queries in the United States. The investigators used "prostate cancer screening" as well as "PSA screening" as a query at the end of 2013 and received 28.59 million hits. There were a combined 29 websites on the first pages of each search engine (seven found on all three).

"Almost two-thirds of websites (65.5 percent) did not support the U.S. Preventive Services Task Force (USPSTF) findings and recommendations; most advocated an individualized discussion about screening between the patient and physician based on the patient's risks factors and preferences. Additionally, 17.2 percent supported the USPSTF recommendation against screening and 17.2 percent offered no conclusion or recommendation either way," Zhao said. "The key conclusion is that over a year after the USPSTF presented their findings and the recommendation score of D to PSA screening, most of the online community do not agree with their recommendation."

The majority of individuals, when they search for prostate cancer screening, will reach websites that advocate a healthy discussion between the patient and physician in regards to screening, according to Zhao. This is what is recommended by the American Urological Association as well as the American Cancer Society.

"We are doing a follow-up evaluation currently to see if the search results and their dispositions regarding screening are any different now compared to a year ago. As more and more laypeople and patients utilize the Internet to search for questions regarding their health care, we feel we can harness studies like ours to paint a picture of what people are exposed to online for specific health-related topics," Zhao added.

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ACS: Unused U.S. Surgical Supplies Can Be Donated

TUESDAY, Oct. 28, 2014 (HealthDay News) -- Unused medical supplies from American hospitals could help alleviate the significant burden of surgical diseases in resource-poor settings around the globe, according to a new report presented at the annual meeting of the American College of Surgeons (ACS), held from Oct. 26 to 30 in San Francisco.

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ACS: Ruptured Appendix Risk Up in Regions Short of Surgeons

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Children and teens with appendicitis who have poor access to general surgeons are at increased risk of ruptured appendix, and the risk is particularly high among young children, according to research presented this week at the annual meeting of the American College of Surgeons, held from Oct. 26 to 30 in San Francisco.

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Physician's Briefing