Samir Johna - Academia.edu (original) (raw)
Papers by Samir Johna
The Permanente Journal, Jun 1, 2012
World Journal of Surgery, Nov 13, 2017
The Permanente Journal, Dec 1, 2019
This observational study involved sequential implementation of a multidisciplinary team, protocol... more This observational study involved sequential implementation of a multidisciplinary team, protocols, and a craniotomy pathway. Retrospective review of admissions (2008-2017) revealed reduced craniotomy complication rates, case volume increased 73%, and hospital length of stay improved by 63%, as well as increased professional collegiality and satisfaction. A searchable craniotomy discharge summary is an important tool for continuous monitoring of quality and efficiency of care. The authors present outcomes data, including craniotomy indications, operative timing, complications, functional outcomes, delays in discharge, and discharge destinations using the craniotomy discharge summary.
American Journal of Surgery, Dec 1, 2017
Discussion of: “Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiop... more Discussion of: “Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy: Analysis of a large integrated health care system database” Mohammed H. Al-Temimi a, b, , Edwin G. Kim a, , Bindupriya Chandrasekaran a, , Vanessa Franz a, , Charles N. Trujillo a, , Asrai Mousa a, , Deron J. Tessier , Samir D. Johna a, , David A. Santos c
Critical Care Medicine, 1999
American Journal of Surgery, Dec 1, 2017
A best evidence topic in surgery was written according to a structured protocol. The question add... more A best evidence topic in surgery was written according to a structured protocol. The question addressed was: in patients with symptomatic gallstones and concomitant common bile duct (CBD) stones, is a single-stage surgical strategy (laparoscopic cholecystectomy (LC) with common bile duct exploration) preferable, or a two-stage procedure involving LC with pre or post-operative endoscopic retrograde cholangiography (ERCP)? Two hundred and six papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. A recent large meta-analysis concluded no significant difference in the clinical effectiveness or complication rate of either strategy. Three recent smaller studies concurred with this conclusion; however each noted improved cost-effectiveness of the single-stage approach advocating its use as the superior strategy when local resources and expertise are available. We conclude that for patients with symptomatic gallstones and concomitant choledocholithiasis, a single-stage surgical procedure is equivalent to two-stage LC and ERCP in terms of clinical outcomes, is associated with a shorter overall hospital stay and may be more cost-effective. On this basis a singlestage procedure is recommended for management of symptomatic gallstones and choledocholithiasis where local resources and expertise permit.
European Journal of Cardio-Thoracic Surgery, Oct 1, 1998
During a consecutive 12-month period from January 1996 to January 1997 inclusive, 108 aortic valv... more During a consecutive 12-month period from January 1996 to January 1997 inclusive, 108 aortic valve replacements were performed by one group of surgeons in two community hospitals The majority of the valve replacements were done in combination with other procedures or were redo surgeries. Thirty-one patients had primary isolated aortic valve replacement. Fourteen patients underwent aortic valve replacement via a standard sternotomy, and seventeen patients underwent aortic valve replacement using a minimally invasive parasternal approach, as described by Dr. Cosgrove. There were no operative deaths in either group; however there was one hospital death in each of the two groups. Blood loss and postoperative pain were less in the minimally invasive group. Although the cross-clamp times were longer in the minimally invasive group, with a mean of 82.7 min as compared with 63.1 min in the standard group, the length of stay was shortened, with a median of 5 days in the minimally invasive group as compared to 7 days in the sternotomy group. In the follow-up which ranges from 4-15 months, all patients in the minimally invasive group were New York Heart Class I or II. Patients with the parasternal incisions are permitted to return to work much earlier than those with a standard sternotomy incision. The decreased blood loss and postoperative pain, combined with the anticipated ease of re-entry via a median sternotomy in the future (should redo aortic valve replacement become necessary), make this approach our procedure of choice in isolated primary aortic valve replacement.
Journal of The American College of Surgeons, Oct 1, 2015
CRSLS : MIS case reports from SLS, Nov 15, 2014
Immune thrombocytopenic purpura and venous thromboembolism are rare but known complications of ul... more Immune thrombocytopenic purpura and venous thromboembolism are rare but known complications of ulcerative colitis. Although several case studies have examined the treatment options available for ulcerative colitis patients presenting with immune thrombocytopenic purpura, there have been no reported cases that describe the optimal treatment for patients with ulcerative colitis and immune thrombocytopenic purpura complicated by simultaneous deep venous thromboses. We present the case of a 19-year-old woman who presented with ulcerative colitis and immune thrombocytopenic purpura and in whom multiple deep venous thromboses also developed. The patient underwent urgent simultaneous laparoscopic colectomy and splenectomy. She improved clinically, and her platelet count recovered after surgery. When thrombocytopenia develops in patients with ulcerative colitis, a diagnosis of immune thrombocytopenic purpura should be considered. In such patients, pre-existing ulcerative colitis might be involved in the immunologic causal mechanism of immune thrombocytopenic purpura and venous thromboembolism. In cases in which these entities are refractory to medical management or complicated by venous thromboembolism, simultaneous laparoscopic colectomy and splenectomy are safe and well tolerated and can be lifesaving.
World Journal of Surgery, Oct 19, 2013
The Permanente Journal, Dec 1, 2016
Context: Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical E... more Context: Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Objective: Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Design: Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Main Outcome Measures: Knowledge of ACGME core competencies. Results: Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1-10 vs > 10), and number of rotations taught per year (1-6 vs 7-12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10-12 rotations per year) were more likely to provide competency-based teaching. Conclusion: Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies.
World journal of surgery, May 24, 2017
A physician shortage is on the horizon, and surgeons are particularly vulnerable due to attrition... more A physician shortage is on the horizon, and surgeons are particularly vulnerable due to attrition. Reduced job satisfaction leads to increased job turnover and earlier retirement. The purpose of this study is to delineate the risk factors that contribute to reduced job satisfaction. A cross-sectional survey of US surgeons was conducted from September 2016 to May 2017. Screening for job satisfaction was performed using the abridged Job in General scale. Respondents were grouped into more and less satisfied using the median split. Twenty-five potential risk factors were examined that included demographic, occupational, psychological, wellness, and work-environment variables. Overall, 993 respondents were grouped into more satisfied (n = 502) and less satisfied (n = 491) cohorts. Of the demographic variables, female gender and younger age were associated with decreased job satisfaction (p = 0.003 and p = 0.008). Most occupational variables (specialty, experience, academics, practice si...
American Journal of Medical Quality, 2007
development of physicians, the Accreditation Council for Graduate Medical Education (ACGME) launc... more development of physicians, the Accreditation Council for Graduate Medical Education (ACGME) launched its Outcome Project in 1999 to introduce methods of outcome appraisal into graduate medical education (GME) and to uncover the competencies for training the doctor of tomorrow. Now part of the ACGME’s institutional requirements, these 6 competencies include some traditional issues such as a foundation of knowledge on patient care and interpersonal and communication skills; however, they also include 2 nontraditional competencies referred to as “PracticeBased Learning and Improvement” (PBLI) and “Systems-Based Practice” (SBP). These 2 competencies are particularly vexing for residency training program directors because they incorporate elements of care management that complement residents’ clinical training. With regard to PBLI, the ACGME states that “residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to: 1. analyze practice experience and perform practice-based improvement activities using a systematic methodology 2. locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems 3. obtain and use information about their own population of patients and the larger population from which their patients are drawn 4. apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness 5. use information technology to manage information, access online medical information, and support their own education 6. facilitate the learning of students and other health care professionals”
Surgical Endoscopy and Other Interventional Techniques, Feb 17, 2022
The aim of this study is to determine whether regional abdominal wall nerve block is a superior t... more The aim of this study is to determine whether regional abdominal wall nerve block is a superior to epidural anesthesia (EA) after hepatectomy. Patients undergoing open hepatectomy in the NSQIP targeted file (2014–2016) were identified. Those with INR > 1.5, Platelets < 100, bleeding disorders, undergoing liver ablation without resection, and spinal anesthesia were excluded. Patients with regional abdominal wall nerve block (RAB), mostly transversus abdominis plane (TAP) block, were matched (1:1) to those undergoing EA using propensity scores to adjust for baseline differences. Out of 1727 patients who met our inclusion criteria, 361 (21%) had RAB. Of whom 345 were matched (1:1) to those who underwent EA. The matched cohort was well-balanced regarding preoperative characteristics, extent of hepatectomy, concurrent ablations as well as biliary reconstruction. RAB was associated with shorter hospital stay (median: 6 days vs. 5 days, p = 0.007). Overall morbidity (44.1% vs. 39.4%, p = 0.217), serious morbidity (27% vs. 25.2%, p = 0.603), and mortality (2.6% vs. 2.3%, p = 0.806) were not different between the two groups. Individual complications, readmission rate, and blood transfusion were not different between the two groups. Regional abdominal nerve block is associated with shorter hospital stay than epidural anesthesia without an increase in overall postoperative morbidity or mortality. RAB is a viable alternative anesthesia adjunct to EA in patients undergoing hepatectomy. However, given the retrospective nature of this study further studies comparing the modalities should be considered to definitively define the utility of RAB.
Journal of Trauma-injury Infection and Critical Care, 2002
The Permanente Journal, 2009
Surgeons occasionally have to answer some tough ques-tions when it comes to managing small bowel ... more Surgeons occasionally have to answer some tough ques-tions when it comes to managing small bowel obstruction (SBO) in patients with prior history of abdominal malig-nancy. In surgery, it is a fact of life to accept recurrent abdominal malignancy as bad news. The prognosis is grim at best, and most patients rarely live beyond 6–12 months once the diagnosis is made. Therefore, it makes sense to adopt less aggressive strategies for optimal management and compassionate care. On the other hand, non-malignant SBO deserves consideration for timely surgical interven-tion if we are to prevent potential morbidity and mortality. One may then ask: how can we distinguish between the two scenarios? Can we make a correct diagnosis relying on history and physical examination alone? What is the role of imaging, if any, that may help triage such patients?
American Journal of Case Reports, 2004
The Permanente Journal, Jun 1, 2012
World Journal of Surgery, Nov 13, 2017
The Permanente Journal, Dec 1, 2019
This observational study involved sequential implementation of a multidisciplinary team, protocol... more This observational study involved sequential implementation of a multidisciplinary team, protocols, and a craniotomy pathway. Retrospective review of admissions (2008-2017) revealed reduced craniotomy complication rates, case volume increased 73%, and hospital length of stay improved by 63%, as well as increased professional collegiality and satisfaction. A searchable craniotomy discharge summary is an important tool for continuous monitoring of quality and efficiency of care. The authors present outcomes data, including craniotomy indications, operative timing, complications, functional outcomes, delays in discharge, and discharge destinations using the craniotomy discharge summary.
American Journal of Surgery, Dec 1, 2017
Discussion of: “Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiop... more Discussion of: “Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy: Analysis of a large integrated health care system database” Mohammed H. Al-Temimi a, b, , Edwin G. Kim a, , Bindupriya Chandrasekaran a, , Vanessa Franz a, , Charles N. Trujillo a, , Asrai Mousa a, , Deron J. Tessier , Samir D. Johna a, , David A. Santos c
Critical Care Medicine, 1999
American Journal of Surgery, Dec 1, 2017
A best evidence topic in surgery was written according to a structured protocol. The question add... more A best evidence topic in surgery was written according to a structured protocol. The question addressed was: in patients with symptomatic gallstones and concomitant common bile duct (CBD) stones, is a single-stage surgical strategy (laparoscopic cholecystectomy (LC) with common bile duct exploration) preferable, or a two-stage procedure involving LC with pre or post-operative endoscopic retrograde cholangiography (ERCP)? Two hundred and six papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. A recent large meta-analysis concluded no significant difference in the clinical effectiveness or complication rate of either strategy. Three recent smaller studies concurred with this conclusion; however each noted improved cost-effectiveness of the single-stage approach advocating its use as the superior strategy when local resources and expertise are available. We conclude that for patients with symptomatic gallstones and concomitant choledocholithiasis, a single-stage surgical procedure is equivalent to two-stage LC and ERCP in terms of clinical outcomes, is associated with a shorter overall hospital stay and may be more cost-effective. On this basis a singlestage procedure is recommended for management of symptomatic gallstones and choledocholithiasis where local resources and expertise permit.
European Journal of Cardio-Thoracic Surgery, Oct 1, 1998
During a consecutive 12-month period from January 1996 to January 1997 inclusive, 108 aortic valv... more During a consecutive 12-month period from January 1996 to January 1997 inclusive, 108 aortic valve replacements were performed by one group of surgeons in two community hospitals The majority of the valve replacements were done in combination with other procedures or were redo surgeries. Thirty-one patients had primary isolated aortic valve replacement. Fourteen patients underwent aortic valve replacement via a standard sternotomy, and seventeen patients underwent aortic valve replacement using a minimally invasive parasternal approach, as described by Dr. Cosgrove. There were no operative deaths in either group; however there was one hospital death in each of the two groups. Blood loss and postoperative pain were less in the minimally invasive group. Although the cross-clamp times were longer in the minimally invasive group, with a mean of 82.7 min as compared with 63.1 min in the standard group, the length of stay was shortened, with a median of 5 days in the minimally invasive group as compared to 7 days in the sternotomy group. In the follow-up which ranges from 4-15 months, all patients in the minimally invasive group were New York Heart Class I or II. Patients with the parasternal incisions are permitted to return to work much earlier than those with a standard sternotomy incision. The decreased blood loss and postoperative pain, combined with the anticipated ease of re-entry via a median sternotomy in the future (should redo aortic valve replacement become necessary), make this approach our procedure of choice in isolated primary aortic valve replacement.
Journal of The American College of Surgeons, Oct 1, 2015
CRSLS : MIS case reports from SLS, Nov 15, 2014
Immune thrombocytopenic purpura and venous thromboembolism are rare but known complications of ul... more Immune thrombocytopenic purpura and venous thromboembolism are rare but known complications of ulcerative colitis. Although several case studies have examined the treatment options available for ulcerative colitis patients presenting with immune thrombocytopenic purpura, there have been no reported cases that describe the optimal treatment for patients with ulcerative colitis and immune thrombocytopenic purpura complicated by simultaneous deep venous thromboses. We present the case of a 19-year-old woman who presented with ulcerative colitis and immune thrombocytopenic purpura and in whom multiple deep venous thromboses also developed. The patient underwent urgent simultaneous laparoscopic colectomy and splenectomy. She improved clinically, and her platelet count recovered after surgery. When thrombocytopenia develops in patients with ulcerative colitis, a diagnosis of immune thrombocytopenic purpura should be considered. In such patients, pre-existing ulcerative colitis might be involved in the immunologic causal mechanism of immune thrombocytopenic purpura and venous thromboembolism. In cases in which these entities are refractory to medical management or complicated by venous thromboembolism, simultaneous laparoscopic colectomy and splenectomy are safe and well tolerated and can be lifesaving.
World Journal of Surgery, Oct 19, 2013
The Permanente Journal, Dec 1, 2016
Context: Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical E... more Context: Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Objective: Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Design: Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Main Outcome Measures: Knowledge of ACGME core competencies. Results: Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1-10 vs > 10), and number of rotations taught per year (1-6 vs 7-12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10-12 rotations per year) were more likely to provide competency-based teaching. Conclusion: Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies.
World journal of surgery, May 24, 2017
A physician shortage is on the horizon, and surgeons are particularly vulnerable due to attrition... more A physician shortage is on the horizon, and surgeons are particularly vulnerable due to attrition. Reduced job satisfaction leads to increased job turnover and earlier retirement. The purpose of this study is to delineate the risk factors that contribute to reduced job satisfaction. A cross-sectional survey of US surgeons was conducted from September 2016 to May 2017. Screening for job satisfaction was performed using the abridged Job in General scale. Respondents were grouped into more and less satisfied using the median split. Twenty-five potential risk factors were examined that included demographic, occupational, psychological, wellness, and work-environment variables. Overall, 993 respondents were grouped into more satisfied (n = 502) and less satisfied (n = 491) cohorts. Of the demographic variables, female gender and younger age were associated with decreased job satisfaction (p = 0.003 and p = 0.008). Most occupational variables (specialty, experience, academics, practice si...
American Journal of Medical Quality, 2007
development of physicians, the Accreditation Council for Graduate Medical Education (ACGME) launc... more development of physicians, the Accreditation Council for Graduate Medical Education (ACGME) launched its Outcome Project in 1999 to introduce methods of outcome appraisal into graduate medical education (GME) and to uncover the competencies for training the doctor of tomorrow. Now part of the ACGME’s institutional requirements, these 6 competencies include some traditional issues such as a foundation of knowledge on patient care and interpersonal and communication skills; however, they also include 2 nontraditional competencies referred to as “PracticeBased Learning and Improvement” (PBLI) and “Systems-Based Practice” (SBP). These 2 competencies are particularly vexing for residency training program directors because they incorporate elements of care management that complement residents’ clinical training. With regard to PBLI, the ACGME states that “residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to: 1. analyze practice experience and perform practice-based improvement activities using a systematic methodology 2. locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems 3. obtain and use information about their own population of patients and the larger population from which their patients are drawn 4. apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness 5. use information technology to manage information, access online medical information, and support their own education 6. facilitate the learning of students and other health care professionals”
Surgical Endoscopy and Other Interventional Techniques, Feb 17, 2022
The aim of this study is to determine whether regional abdominal wall nerve block is a superior t... more The aim of this study is to determine whether regional abdominal wall nerve block is a superior to epidural anesthesia (EA) after hepatectomy. Patients undergoing open hepatectomy in the NSQIP targeted file (2014–2016) were identified. Those with INR > 1.5, Platelets < 100, bleeding disorders, undergoing liver ablation without resection, and spinal anesthesia were excluded. Patients with regional abdominal wall nerve block (RAB), mostly transversus abdominis plane (TAP) block, were matched (1:1) to those undergoing EA using propensity scores to adjust for baseline differences. Out of 1727 patients who met our inclusion criteria, 361 (21%) had RAB. Of whom 345 were matched (1:1) to those who underwent EA. The matched cohort was well-balanced regarding preoperative characteristics, extent of hepatectomy, concurrent ablations as well as biliary reconstruction. RAB was associated with shorter hospital stay (median: 6 days vs. 5 days, p = 0.007). Overall morbidity (44.1% vs. 39.4%, p = 0.217), serious morbidity (27% vs. 25.2%, p = 0.603), and mortality (2.6% vs. 2.3%, p = 0.806) were not different between the two groups. Individual complications, readmission rate, and blood transfusion were not different between the two groups. Regional abdominal nerve block is associated with shorter hospital stay than epidural anesthesia without an increase in overall postoperative morbidity or mortality. RAB is a viable alternative anesthesia adjunct to EA in patients undergoing hepatectomy. However, given the retrospective nature of this study further studies comparing the modalities should be considered to definitively define the utility of RAB.
Journal of Trauma-injury Infection and Critical Care, 2002
The Permanente Journal, 2009
Surgeons occasionally have to answer some tough ques-tions when it comes to managing small bowel ... more Surgeons occasionally have to answer some tough ques-tions when it comes to managing small bowel obstruction (SBO) in patients with prior history of abdominal malig-nancy. In surgery, it is a fact of life to accept recurrent abdominal malignancy as bad news. The prognosis is grim at best, and most patients rarely live beyond 6–12 months once the diagnosis is made. Therefore, it makes sense to adopt less aggressive strategies for optimal management and compassionate care. On the other hand, non-malignant SBO deserves consideration for timely surgical interven-tion if we are to prevent potential morbidity and mortality. One may then ask: how can we distinguish between the two scenarios? Can we make a correct diagnosis relying on history and physical examination alone? What is the role of imaging, if any, that may help triage such patients?
American Journal of Case Reports, 2004