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In This Issue of JAMA Surgery |

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JAMA Surg. 2016;151(3):205. doi:10.1001/jamasurg.2015.2904.
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RESEARCH

The influx of new surgical residents and interns at the beginning of the academic year (the July phenomenon) is assumed to be associated with poor outcomes. Studies in various surgical specialties provide conflicting results. Shah et al determine whether an association between the July phenomenon and outcomes exists among a nationally representative sample of patients who underwent emergency general surgery at teaching hospitals. No worse outcomes were found.

Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery. Bhatti et al compare the risk of self-harm behaviors before and after bariatric surgery. They found that patients undergoing bariatric surgery have an increased risk for self-harm emergencies after the surgery.

There have been several randomized clinical trials that support neoadjuvant therapy for esophageal adenocarcinoma prior to surgical resection, although it is unclear which patients derive an overall survival benefit. Gabriel et al performed a retrospective analysis using the American College of Surgeons National Cancer Database from 1998 to 2006. They found that patients with node-positive esophageal adenocarcinoma benefit significantly from neoadjuvant chemoradiation, whereas patients with node-negative tumors do not gain significant overall survival as compared with surgery alone.

Protamine use remains controversial owing to concern for increased thrombotic complications with its use. Newhall et al performed a meta-analysis of 12 observational studies of carotid endarterectomy (CEA), comparing risk of stroke or bleeding with protamine use. They found that the use of protamine following CEA is associated with a reduction in bleeding complications, without increasing major thrombotic outcomes.

CLINICAL REVIEW & EDUCATION

The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial is a national, cluster-randomized noninferiority trial that assigned 117 general surgery programs to usual care (current duty hour regulations) vs intervention (regulations regarding maximum shift length and time off between shifts eliminated). The primary outcomes are death or serious morbidity of the patient within 30 days of surgery and resident satisfaction and well-being. The results of this study by Bilimoria et al may be informative to policymakers and other stakeholders engaged in restructuring graduate medical training to enhance the quality of patient care and resident education.

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