Evaluation of Consumer Health Information Available to Patients on Twitter About Bariatric Surgery.

INTRODUCTION: Patients are increasingly utilizing social media to help them make medical decisions. Previous studies have examined Facebook for the quality of bariatric-related content; however, no research has examined Twitter, a globally favored platform, in this context. The goal of this study is to investigate the quality of bariatric-related content on Twitter that patients use to inform their decisions regarding bariatric surgery. METHODS: Six comprehensive terms were searched on six Twitter accounts for 4 wk. Each keyword generated corresponding tweets that were classified as being either informational or noninformational. The top ten informational posts for each search term were categorized based on content type, tweet posters, and type of evidence used. A DISCERN score was calculated for each tweet to determine its quality of consumer health information. RESULTS: A total of 7531 tweets about bariatric surgery were collected over the course of approximately 1 mo. We found that 58.9% of tweets pertained to surgical interventions, 16.2% were nutrition-related, 11.3% were progress posts, 7.8% were inspirational posts, and 5.9% pertained to lifestyle. Of the tweets pertaining to surgical interventions, 26% were posted by physicians, and 13.7% of those physicians used scientific evidence. The relationship between the average total DISCERN scores and each variable was statistically significant. CONCLUSIONS: Even though physicians posted the highest quality consumer information, that information still correlated with an average DISCERN score of "very poor". Twitter may provide a good way to foster community and get anecdotal information but is not a place to gather high-quality scientific consumer health information.

High Acuity of Postoperative Consults to Emergency General Surgery at an Urban Safety Net Hospital.

BACKGROUND: Emergency general surgery (EGS) has high rates of morbidity, mortality, and readmission. Therefore, it might be expected that an EGS service fields many consultations for postoperative patients. However, with the known overutilization of emergency department visits for nonurgent conditions, we hypothesized most postoperative consults received by an EGS service would be nonurgent and could be appropriately managed as an outpatient. METHODS: We reviewed all EGS consults at a single urban safety net hospital over a 12-month period, screening for patients who had undergone surgery in the previous 12 mo. This included consultations from the emergency room and inpatient setting. Demographics, admission status, procedures performed, and other details were abstracted from the chart and Vizient reports. Consultation questions were categorized and then reviewed by an expert panel to determine if conditions could have been managed as an outpatient. RESULTS: The EGS service received a total of 1112 consults, with 99 (9%) for a postoperative condition. Overall, 85% of postoperative consults were admitted after consultation, 19% underwent surgery and 21% underwent a procedure with gastroenterology or interventional radiology. Expert review classified slightly over one-third (36%) of consults as nonurgent. CONCLUSIONS: Most postoperative consults seen at our urban safety net hospital represent true morbidity that required admission, intervention, or surgery. Despite this high acuity, one-third of postoperative consults could have been managed as an outpatient. Efforts to improve discharge instructions and set patient expectations could limit unnecessary postoperative emergency department visits.

Oversewing staple lines to prevent anastomotic complications in primary ileocolic resections for Crohn's disease.

BACKGROUND: Oversewing staple lines may be a novel way to reduce anastomotic complications after primary ileocolic resections for Crohn's disease (CD). STUDY DESIGN: This is a single-institution, non-concurrent cohort study of CD patients undergoing primary ileocolic resections (ICR) with stapled anastomoses from 2007 to 2013. Demographic and clinical characteristics were collected. Propensity scores were calculated for oversewing versus not. Postoperative outcomes within 30 days of surgery were collected. Anastomotic leak, intra-abdominal abscess, small bowel obstruction, and anastomotic bleed were considered major anastomotic complications (MACs). Multivariate analysis controlling for inverse probability weights was used to identify predictors of MACs. RESULTS: A total of 269 patients were included, of which 120 had undergone oversewing (OS). After controlling for propensity scores, not oversewing (NOS) and OS groups were similar in all preoperative characteristics with the exception of more laparoscopic resections and intracorporeal anastomoses in the NOS group. On univariate analysis, OS was protective against MACs (odds ratio (OR) 0.29, p < 0.01). In a multivariable model using inverse propensity weights and controlling for laparoscopic and intracorporeal approaches, oversewing remained a significant predictor of reduced MACs (OR 0.37, p < 0.001), while intracorporeal anastomoses increased their likelihood (OR 3.7, p < 0.001). CONCLUSIONS: After controlling for clinical and surgical factors, oversewing staple lines in primary ICRs for CD is correlated with reduced MACs.

The importance of improving the quality of emergency surgery for a regional quality collaborative.

INTRODUCTION: Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. METHODS: We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. RESULTS: Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). CONCLUSIONS: Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

GATA-3 is required for early T lineage progenitor development.

Most T lymphocytes appear to arise from very rare early T lineage progenitors (ETPs) in the thymus, but the transcriptional programs that specify ETP generation are not completely known. The transcription factor GATA-3 is required for the development of T lymphocytes at multiple late differentiation steps as well as for the development of thymic natural killer cells. However, a role for GATA-3 before the double-negative (DN) 3 stage of T cell development has to date been obscured both by the developmental heterogeneity of DN1 thymocytes and the paucity of ETPs. We provide multiple lines of in vivo evidence through the analysis of T cell development in Gata3 hypomorphic mutant embryos, in irradiated mice reconstituted with Gata3 mutant hematopoietic cells, and in mice conditionally ablated for the Gata3 gene to show that GATA-3 is required for ETP generation. We further show that Gata3 loss does not affect hematopoietic stem cells or multipotent hematopoietic progenitors. Finally, we demonstrate that Gata3 mutant lymphoid progenitors exhibit neither increased apoptosis nor diminished cell-cycle progression. Thus, GATA-3 is required for the cell-autonomous development of the earliest characterized thymic T cell progenitors.