Eric Brian Pillado

All Publications

• Complex aortic reconstruction using double-barrel frozen elephant trunks. Journal of vascular surgery cases and innovative techniques Mansukhani, N. A., Son, A. Y., Pillado, E. B., Whippo, B., Hoel, A. W., Mehta, C. K. 2026; 12 (2): 102140

  Abstract

  We present a complex aortic reconstruction for a 60-year-old patient presented with chronic type B aortic dissection, with a large proximal entry tear in zone 3, aneurysmal degeneration in the distal arch, and a small true lumen with a calcified septum. Endovascular options were limited by a poor proximal landing zone, difficulty excluding the arch pseudoaneurysm while maintaining true and false lumen flow, lack of septal fenestrations, and a calcified septum. Open extent 2 thoracoabdominal repair carried a significantly higher risk compared with sternotomy and ascending aortic and arch replacement due to the patient size and underlying chronic obstructive pulmonary disease. The patient was not tested for connective tissue disease given age, comorbid conditions, absence of a family history of aortopathy, and no stigmata of connective tissue disease. We describe a hybrid arch reconstruction with "double-barrel" frozen elephant trunks and extension thoracic endovascular aortic repair to address a complex chronic aortic dissection. This technique may be useful in select cases of complex aortic dissection.

  View details for DOI 10.1016/j.jvscit.2026.102140

  View details for PubMedID 41674912

  View details for PubMedCentralID PMC12887257

• Suicidal Ideation Among Vascular Surgery Trainees. Journal of vascular surgery Cui, C. L., Reilly, M. A., Zielke, T. J., Olivere, L. A., Jiang, Y., Pillado, E. B., Li, R. D., Eng, J. S., Grafmuller, L. E., DiLosa, K. L., Conway, A. M., Escobar, G. A., Shaw, P. M., Hu, Y. Y., Bilimoria, K. Y., Sheahan, M. G., Coleman, D. M. 2025

  Abstract

  Suicidal ideation (SI) during surgical training is poorly understood and may be attributed to a variety of personal and environmental risk factors. The purpose of this study is to evaluate the incidence of SI among vascular surgery trainees.Data was collected from a confidential, voluntary survey administered after the 2020-2024 VSITE as part of the SECOND trial. Suicidal ideation was assessed with the following question: "In the past twelve months, have you had thoughts of taking your own life?". Positive screens prompted presentation of the National Suicide Hotline. Descriptive statistics were utilized to evaluate demographic and learning environmental factors associated with suicidality.A total of 3,272 survey results were collected from 2020-2024. 74 respondents (2.3%) reported positive SI. In considering the most recent year of responses (2024), demographic variables were comparable between trainees who did and did not screen positive for SI. However, trainees who screened positive were more likely to report negative learning environment factors, including pressure to underreport hours (31% vs. 6%), lack of a sense of belonging among trainees (15% vs. 4%), sexual harassment (46% vs. 10%), and perception of program unresponsiveness (38% vs. 5%), among other factors.While low rates of SI limit more detailed statistical analysis, this remains the most comprehensive evaluation among vascular surgery trainees. Although rates remain low, they are associated with burnout. Modifiable learning environmental factors, such as harassment, program responsiveness, and trainee camaraderie, may be potential areas for intervention.

  View details for DOI 10.1016/j.jvs.2025.12.161

  View details for PubMedID 41443397

• The Relationships Between Hospital Support Staff and Vascular Trainee Educational Experience and Well-Being ANNALS OF VASCULAR SURGERY Reilly, M. A., Cui, C. L., Pillado, E. B., Li, R., Eng, J. S., Grafmuller, L. E., DiLosa, K. L., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Sheahan III, M. G., Coleman, D. M. 2025; 121: 492-502

  Abstract

  Many stakeholders contribute to effective training environments for surgical residents, including program administrators and nursing staff. This study evaluates associations of hospital support staff with trainee educational time and wellness.Data were collected via confidential voluntary survey of vascular trainees, who were asked about support staff interactions and protected educational time. Responses were recorded on a five-point Likert scale and dichotomized as positive or negative. Multivariable clustered logistic regression was used to evaluate the associations of support staff with educational time and educational time with burnout. A sensitivity analysis was conducted to adjust for experiences of mistreatment.Of 427 trainees with complete data for items of interest (62% response rate), most responded positively to questions of support staff and educational time. On multivariable analysis of associations with support staff, reporting that programs had adequate staffing and clear division of labor were significant predictors for satisfaction with education (odds ratio (OR) 7.0, P < 0.001, and OR 6.3, P < 0.001, respectively). Those who were satisfied with education had lower odds of burnout (OR 0.25, P < 0.001) and thoughts of attrition (OR 0.15, P < 0.001).Trainees with positive support staff relationships were more likely to be satisfied with their education, and satisfaction with education was associated with increased wellness. Addressing sources of mistreatment will likely improve the educational experience. Future work should incorporate support staff experiences to promote successful team-based care.

  View details for DOI 10.1016/j.avsg.2025.08.019

  View details for Web of Science ID 001569197000005

  View details for PubMedID 40818811

• Trainee Autonomy is Associated with Well-being. Annals of vascular surgery Cui, C. L., Reilly, M. A., Pillado, E. B., Li, R. D., Eng, J. S., Jiang, Y., Grafmuller, L. E., DiLosa, K. L., Conway, A. M., Escobar, G. A., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Sheahan, M. G., Coleman, D. M. 2025

  Abstract

  INTRODUCTION: Progressive entrustment is critical to reaching independent practice. Concerns around progressive entrustment during clinical training have grown in the past decade, especially with the evolution of the vascular surgery training pipeline. The purpose of this study is to evaluate vascular surgery trainee perceptions of autonomy and its associations with their well-being and learning environment.METHODS: Data was collected through a confidential, voluntary survey administered after the 2020-2024 VSITEs as an adjunct to the vascular arm of the SECOND trial. Autonomy was defined by operative autonomy, clinical autonomy, and operative time. Trainees ranked their degree of satisfaction with each component on a Likert scale, which was subsequently dichotomized. Univariable logistic regression was used to evaluate the association between autonomy and well-being outcomes. Multivariable logistic regression was used to evaluate learning environment factors associated with trainee dissatisfaction with autonomy.RESULTS: A total of 3,272 survey results were collected from 2020-2024. Approximately 3.9% (n=117) of survey responses reported dissatisfaction with operative autonomy, 2.0% (n=52) of responses reported dissatisfaction with clinical autonomy, and 4.2% (n=93) of responses reported dissatisfaction with the amount of time spent in the operating room. These rates did not change over time (p>0.05). Within 2024 responses, the only statistically significant difference in demographic variables between trainees who were dissatisfied with autonomy and those who were satisfied was gender (dissatisfaction: 12% females versus 5% males, p=0.016). In comparison, all learning environment factors were statistically significantly different between groups (p<0.001). On adjusted analysis, dissatisfaction with autonomy was driven by trainee perceptions of faculty engagement (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 1.9-12, p<0.001) and efficiency and program resources (aOR 10.9, 95%CI 4.4-26.8, p<0.001). Perceptions of autonomy also had significant associations with well-being metrics. Trainees who reported dissatisfaction with their autonomy were also more likely to report burnout, thoughts of attrition, suicidal ideation, professional dissatisfaction, and personal dissatisfaction.CONCLUSION: A minority of vascular trainees expressed dissatisfaction with their autonomy. Those who did had higher odds of adverse training experiences, including burnout, work-life conflict, thoughts of attrition, and suicidal ideation. Program monitoring of trainee autonomy and operative time may mitigate this risk.

  View details for DOI 10.1016/j.avsg.2025.09.010

  View details for PubMedID 40945689

• A multi-method assessment of the vascular surgery program director experience in creating effective training environments. Journal of vascular surgery Reilly, M. A., Cui, C. L., Jiang, Y., Pillado, E. B., Li, R. D., Eng, J. S., Grafmuller, L. E., DiLosa, K. L., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Coleman, D. M., Sheahan, M. G. 2025

  Abstract

  OBJECTIVES: Surgical training has received significant attention in recent years with efforts to improve trainee wellness. Vascular surgery training is subject to unique challenges, and vascular program directors (PDs) are tasked with providing learning environments that produce effective and competent surgeons. The aim of this study is to examine the experience of vascular surgery PDs in promoting effective learning environments for vascular trainees.METHODS: Data was collected from confidential, voluntary surveys of vascular surgery residency PDs with multiple choice and free response questions as part of the SECOND Trial. PDs were asked about their use of wellness interventions, resources available through their institution, and resources still required. PDs indicated the most rewarding and challenging aspects of their role. Program-level wellness data was aggregated from trainee responses to an annual survey of trainee wellness. Associations between program wellness metrics and number of interventions used by PDs were assessed with Wilcoxon rank-sum tests. Qualitative data was analyzed with inductive reasoning to identify themes.RESULTS: Of 33 program directors who participated in the survey (76.7% of programs enrolled in the Vascular SECOND Trial), most PDs had opportunities to engage with other faculty (N=27, 81.8%), support from Graduate Medical Education (N=27, 81.8%), and administrative support from program coordinators (N=26, 78.8%). Many PDs reported a need for additional salary/stipend support to incentivize program leadership (N=23, 69.7%), funded protected effort to decrease clinical responsibilities (N=18, 54.6%), and discretionary educational funds (N=13, 39.4%). The trainee-related issues most frequently encountered by PDs were performance challenges (N=15, 45.5%) and interpersonal issues between trainees and ancillary staff (N=9, 27.3%). The most common institutional-level issues were incongruence between hospital administration goals and clinical priorities (N=9, 27.3%), and protected time for administrative responsibilities (N=8, 24.2%). There were no significant associations between trainee wellness and perception of program responsiveness or resources needed or available to PDs. Themes of the most rewarding aspects of the PD job were participating in trainee growth, training the next generation, and interpersonal relationships. Themes of most challenging aspects were generational differences, interpersonal challenges, lack of resources, and administrative tasks.CONCLUSIONS: Vascular surgery PDs assume a challenging role with unique responsibilities. Certain barriers and facilitators of wellness may be experienced by a majority of PDs, which allows for identification of potentially widely effective interventions. Ultimately, supporting PD efforts should focus on improving resources like funded protected efforts and reducing administrative burden.

  View details for DOI 10.1016/j.jvs.2025.08.034

  View details for PubMedID 40907622

• Implementation of enhanced recovery pathway for lower extremity arterial bypass decreases length of stay. Journal of vascular surgery Chao, C. L., Lopes, L., Reddy, N. K., El-Gabri, D., Broucek, L. A., Sobolewski, R. B., Willens, N., Prochno, K. W., Pillado, E. B., Schneider, J. R., Wilkinson, J. B., Hoel, A. W., Tomita, T. M., Vavra, A. K. 2025; 82 (3): 1014

  Abstract

  OBJECTIVE: Frailty, nutrition, and comorbid conditions are all challenges that contribute to significant morbidity in patients undergoing lower extremity arterial bypass (LEAB). Evidence supports that enhanced recovery pathways (erps) can improve perioperative outcomes. However, few studies have demonstrated successful implementation of an ERP for LEAB. The goal of this study was to demonstrate the successful implementation of an ERP in a complex patient population undergoing LEAB, including elective, urgent, or emergent procedures with the goal of decreasing length of stay (LOS) and morbidity for patients undergoing these procedures at our institution.METHODS: Multistakeholder meetings with representatives from all vascular surgery practice sites in the Northwestern Medicine system were conducted to review current evidence-based practices and finalize an ERP for patients undergoing LEAB. Pathway elements included standardized patient education, minimal perioperative fasting with preoperative carbohydrate loading, opioid-sparing analgesia, and early postoperative diet and mobilization. The ERP was initiated in February 2022 as a pilot at a single institution. At 20 months, patient data and process and outcome measures were abstracted from the medical record and validated by four independent reviewers for univariate analysis.RESULTS: Over the 20-month study period, 112 patients underwent LEAB. Process measures were tracked to determine compliance with the ERP. Patients had to receive >70% of the pathway elements to be considered part of the ERP (n = 60). If patients missed >30% of the elements, they were analyzed as traditional pathway (n = 52). There were no significant differences in patient demographics, body mass index, or hemoglobin a1c. ERP patients were more likely to be elective (76.7% vs 48.1%; P = .0004) and for chronic limb-threatening ischemia (76.7% vs 48.1%; P = .001) and less likely to be urgent or emergent. No significant difference was observed in frequency of infrageniculate bypass target or operative duration. Compliance with 10 perioperative process measures ranged from 28% to 98% in the ERP group. Compliance was most successful with preoperative education (81.6%), chlorhexidine wash (80.0%), postoperative mobilization (90.0%), early solid diet (98.3%), and postoperative opioid sparing strategies (98.3%). Challenges included preoperative acetaminophen (28.3%), carbohydrate load (33.8%), and postoperative protein supplementation (28.3%). Notably, ERP patients demonstrated significantly reduced total LOS (7.8 days vs 13.6 days; P = .014), postoperative LOS (6.0 days vs 11.0 days; P = .0058), and unplanned reoperations (10.0% vs 28.9%; P = .015) when compared with traditional pathway patients. ERP patients trended toward fewer unplanned readmissions (13.3% vs 26.9%; P = .095).CONCLUSIONS: Our findings suggest that an ERP for LEAB is feasible in both elective and nonelective settings, although compliance with the ERP individual elements was more challenging for patients undergoing procedures for emergent or urgent indications. Patients undergoing ERP had improved compliance with process measures, reduced LOS, and fewer unplanned reoperations. Our results highlight the benefits of ERP for LEAB and the complex vascular surgery population and some of the potential barriers worth considering in this patient population.

  View details for DOI 10.1016/j.jvs.2025.05.023

  View details for PubMedID 40404026

• The obstetric experience among vascular surgery trainees JOURNAL OF VASCULAR SURGERY Li, R., Pillado, E. B., Reilly, M., Janczewski, L. M., Cui, C., Dilosa, K., Eng, J. S., Chia, M. C., Iii, M., Bilimoria, K. Y., Rangel, E. L., Hu, Y., Coleman, D. M. 2025; 82 (2): 675-684

  Abstract

  Vascular surgery training poses unique risks to pregnancy, including long hours, physically demanding work, and radiation exposure. Our objectives were to (1) understand pregnancy and parenthood experiences among vascular surgery trainees, (2) assess the rate of obstetric complications among vascular trainees, and (3) evaluate factors associated with trainee-parent wellness.A survey was administered after the 2021 Vascular Surgery In-Training Examination. Residents and fellows who (or whose partners) experienced pregnancies during their clinical years of training were asked about their perceptions of the learning environment (work hours and mistreatment, including discrimination, bullying, and harassment), obstetric complications (miscarriage, pre-eclampsia, placental abruption, intrauterine growth restriction, cesarean section, and postpartum depression), and burnout. Multivariable logistic regression models identified factors associated with burnout.Among 510 trainees from 123 vascular surgery training programs (response rate 85.9%), 128 (25.1%) reported pregnancy during clinical training (12.7% female and 35.4% male; P < .001). Compared with male trainees, female trainees more frequently reported delaying having children owing to training (53.1% vs 30.0%; P < .001) and being advised against having children during residency (7.9% vs 0.4%; P < .001). Both female trainees and the partners of male trainees had high rates of obstetric complications (female 47.1% vs partners of male trainees 34.0%; P = .3). Compared with male trainees who had female partners, female trainees more frequently reported pregnancy/parenthood-related mistreatment (female 60.0% vs male 15.6%; P = .002) and duty-hour violations (female 47.4% vs male 12.0%; P < .001). Female gender was associated with increased risk for burnout (odds ratio, 4.8; 95% confidence interval,1.14-20.15); however, this difference was no longer significant after adjusting for mistreatment and duty-hour violations.Vascular trainees experience high rates of obstetric complications. Senior-level trainees were more likely to experience obstetric complications, potentially owing to older age, longer and more complex surgical cases, and increased frequency of overnight calls. Women experienced more stigma related to pregnancy and childbearing, which may be associated with higher rates of burnout. Increased support for childbearing during training may help to maintain the wellness of a diverse workforce and better maternal-fetal health.

  View details for DOI 10.1016/j.jvs.2025.03.194

  View details for Web of Science ID 001550529100021

  View details for PubMedID 40154928

• Barriers and Facilitators of Trainee Wellness as Encountered by Vascular Surgery Program Directors Reilly, M. A., Cui, C. L., Jiang, Y., Pillado, E. B., Li, R. D., Eng, J. S., Grafmuller, L. E., Dilosa, K., Conway, A. M., Escobar, G. A., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Sheahan III, M. G., Coleman, D. M. MOSBY-ELSEVIER. 2025

  View details for Web of Science ID 001505228000016

• Suicidal Ideation Among Vascular Surgery Trainees Cui, C. L., Reilly, M. A., Pillado, E. B., Li, R. D., Eng, J. S., Grafmuller, L. E., Dilosa, K. L., Conway, A. M., Escobar, G. A., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Sheahan Iii, M. G., Coleman, D. M. MOSBY-ELSEVIER. 2025

  View details for Web of Science ID 001462350500050

• Current State of Interventions to Assist Trainee Parenthood Reilly, M. A., Cui, C. L., Pillado, E. B., Li, R. D., Eng, J. S., Dilosa, K. L., Grafmuller, L. E., Conway, A. M., Escobar, G. A., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Sheahan, M. G., Coleman, D. M. MOSBY-ELSEVIER. 2025

  View details for Web of Science ID 001462350500054

• Trainee Perception of Virtual Interviews and Associations of Virtual Engagement with Vascular Surgery Culture and Community ANNALS OF VASCULAR SURGERY Reilly, M. A., Cui, C. L., Grafmuller, L. E., Eng, J. S., Pillado, E. B., Li, R., Dilosa, K. L., Conway, A. M., Escobar, G. A., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Sheahan III, M. G., Coleman, D. M. 2025; 114: 219-227

  Abstract

  In recent years, the vascular surgery community has increased the utilization of virtual interviews and virtual engagement or use of online technologies for educational, networking, and mentorship activities. This study evaluates trainee preferences of virtual interviews and associations of virtual engagement with wellness.Deidentified data were collected from a confidential, voluntary survey of residents and fellows in vascular surgery programs administered following the 2023 Vascular Surgery In-Training Examination (VSITE). A 5-point Likert scale measured resident perceptions of virtual interviews and virtual interactions. Multivariable logistic regression modeling was used to compare factors associated with preference of virtual interviews and virtual engagement.Of 521 trainees who participated in the survey (78.2% response rate), 60.8% were male, 48.8% were non-White, and there was a relatively equal distribution among training years. Only 41.2% of the trainees reported they would have preferred virtual interviews in retrospect. These trainees were more likely to be non-White and in postgraduate years one or 2 (P = 0.03 and P < 0.001, respectively). Overall, 83.5% of trainees were classified as virtually engaged. These trainees were more likely to be male (86.5% vs. 78.9%, P = 0.033) and had 2.8 increased odds of satisfaction with time for their personal lives (P < 0.001).While most trainees surveyed reported a preference for in-person interviews, trainees report that virtual interviews are reflective of program culture. Additionally, trainees who were virtually engaged were more likely to report satisfaction with their time for their personal lives. Our study supports continued hybrid approaches to interviews and trainee engagement.

  View details for DOI 10.1016/j.avsg.2025.02.008

  View details for Web of Science ID 001456949600001

  View details for PubMedID 40054605

  View details for PubMedCentralID PMC12034471

• Burnout is not associated with trainee performance on the Vascular Surgery In-Training Exam Cui, C. L., Reilly, M. A., Pillado, E. B., Li, R., Eng, J. S., Grafmuller, L. E., Dilosa, K. L., Conway, A. M., Escobar, G. A., Shaw, P. M., Hu, Y., Bilimoria, K. Y., Sheahan, M. G., Coleman, D. M. MOSBY-ELSEVIER. 2025: 243-249.e4

  Abstract

  The Vascular Surgery In-Training Examination (VSITE) is a yearly exam evaluating vascular trainees' knowledge base. Although multiple studies have evaluated variables associated with exam outcomes, few have incorporated training program-specific metrics. The purpose of this study is to evaluate the impact of the learning environment and burnout on VSITE performance.Data was collected from a confidential, voluntary survey administered after the 2020 to 2022 VSITE as part of the SECOND Trial. VSITE scores were calculated as percent correct then standardized per the American Board of Surgery. Generalized estimating equations with robust standard errors and an independent correlation structure were used to evaluate trainee and program factors associated with exam outcomes. Analyses were further stratified by integrated and independent training paradigms.A total of 1385 trainee responses with burnout data were collected over 3 years (408 in 2020, 459 in 2021, 498 in 2022). On average, 46% of responses reported at least weekly burnout symptoms. On unadjusted analysis, burnout symptoms correlated with a 14 point drop in VSITE score (95% confidence interval [CI], -24 to -4; P = .006). However, burnout was no longer significant after adjusted analysis. Instead, higher postgraduate year level, being in a relationship, identifying as male gender with or without kids, identifying as non-Hispanic white, larger programs, and having a sense of belonging within a program were associated with higher VSITE scores.Despite high rates of burnout, trainees generally demonstrate resilience in gaining the medical knowledge necessary to pass the VSITE. Performance on standardized exams is associated with trainee and program characteristics, including availability of support systems and program belongingness.

  View details for DOI 10.1016/j.jvs.2024.08.057

  View details for Web of Science ID 001386037200001

  View details for PubMedID 39233022

• Pain in the Workplace: Are Medicine and Surgical Residents Impacted the Same? Cerier, E. J., Pillado, E., Harrington, C., Kulkarni, S. LIPPINCOTT WILLIAMS & WILKINS. 2024: S417-S418

  View details for Web of Science ID 001348680703028

• The need for standardizing care for pediatric and geriatric vascular trauma patients JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES Pillado, E., O'Banion, L. 2024; 10 (6): 101627

  View details for DOI 10.1016/j.jvscit.2024.101627

  View details for Web of Science ID 001338203700001

  View details for PubMedID 40027265

  View details for PubMedCentralID PMC11868760

• Perception of shared learning environment differs between vascular surgery and general surgery residents Li, R., Pillado, E., Dilosa, K., Chia, M. C., Visenio, M., Zhan, T., Eng, J. S., Amortegui, D., Johnson, J. K., Sheahan III, M. G., Bilimoria, K. Y., Hu, Y., Coleman, D. M., Vasc SECOND Trial Steering Comm MOSBY-ELSEVIER. 2024: 1224-1232

  Abstract

  An enriching learning environment is integral to resident wellness and education. Integrated vascular (VS) and general surgery (GS) residents share 18 months of core GS rotations during the postgraduate years 1-3 (PGY1-3); differences in their experiences may help identify practical levers for change.We used a convergent mixed-methods design. Cross-sectional surveys were administered after the 2020 American Board of Surgery In-Training Examination and Vascular Surgery In-Training Examination, assessing eight domains of the learning environment and resident wellness. Multivariable logistic regression models identified factors associated with thoughts of attrition between categorical PGY1-3 residents at 57 institutions with both GS and VS programs. Resident focus groups were conducted during the 2022 Vascular Annual Meeting to elicit more granular details about the experience of the learning environment. Transcripts were analyzed using inductive and deductive logics until thematic saturation was achieved.Surveys were completed by 205 VS and 1198 GS PGY1-3 residents (response rates 76.8% for VS and 82.5% for GS). After adjusting for resident demographics, PGY level, and program type, GS residents were more likely than their VS peers to consider leaving their programs (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.37-4.99). This finding did not persist after adjusting for differences in perceptions of the learning environment, specifically: GS residents had higher odds of mistreatment (OR: 1.99, 95% CI: 1.36-2.90), poorer work-life integration (OR: 2.88, 95% CI: 1.41-5.87), less resident camaraderie (OR: 3.51, 95% CI: 2.26-5.45), and decreased meaning in work (OR: 2.94, 95% CI: 1.80-4.83). Qualitative data provided insight into how the shared learning environment was perceived differently: (1) vascular trainees expressed that early specialization and a smaller, more invested faculty allow for an apprenticeship model with early operative exposure, hands-on guidance, frequent feedback, and thus early skill acquisition (meaning in work); (2) a smaller program is conducive to closer relationships with co-residents and faculty, increasing familiarity (camaraderie and work-life integration); and (3) due to increased familiarity with program leadership, vascular trainees feel more comfortable reporting mistreatment, allowing for prompt responses (mistreatment).Despite sharing a learning environment, VS and GS residents experience training differently, contributing to differential thoughts of attrition. These differences may be attributable to intrinsic features of the integrated training paradigm that are not easily replicated by GS programs, such as smaller program size and higher faculty investment due to early specialization. Alternative strategies to compensate for these inherent differences should be considered (eg, structured operative entrustment programs and faculty incentivization).

  View details for DOI 10.1016/j.jvs.2023.12.003

  View details for Web of Science ID 001299492800001

  View details for PubMedID 38070784

• Reported pain at work is a risk factor for vascular surgery trainee burnout JOURNAL OF VASCULAR SURGERY Pillado, E., Li, R., Chia, M. C., Eng, J. S., Dilosa, K., Grafmuller, L., Conway, A., Escobar, G. A., Shaw, P., Sheahan, M. G., Bilimoria, K. Y., Hu, Y., Coleman, D. M. 2024; 79 (5): 1217-1223

  Abstract

  Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being.A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study.We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment.Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.

  View details for DOI 10.1016/j.jvs.2024.01.003

  View details for Web of Science ID 001301600500007

  View details for PubMedID 38215953

• Defining sources and ramifications of mistreatment among female vascular surgery trainees JOURNAL OF VASCULAR SURGERY Pillado, E. B., Li, R., Eng, J. S., Chia, M. C., Conway, A., Dilosa, K., Gomez-Sanchez, C., Shaw, P., Sheahan III, M. G., Bilimoria, K. Y., Hu, Y., Coleman, D. M. 2023; 78 (3): 797-804

  Abstract

  Mistreatment among vascular surgery trainees is a known risk factor for physician burnout. This study aims to characterize forms of and identify sources of mistreatment.This is a cross-sectional study of United States vascular surgery trainees who voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between genders. Logistic regression was used for multivariable analysis.Representing all 125 vascular surgery training programs, 510 trainees (66.9% male) participated in the survey (83.6% response rate). Mistreatment was reported by 54.8% of trainees, with twice as many women reporting as men (82.3% vs 41.0%; P < .001). Women reported higher rates of being shouted at (44.1% vs 21.1%; P < .001); repeatedly reminded of errors (24.3% vs 16.1%; P = .04); ignored/treated hostilely (28.9% vs 10.5%; P < .001); subjected to crude/sexually demeaning remarks, stories, jokes (19.2% vs 2.1%; P < .001); evaluated by different standards (29.3% vs 2.1%; P < .001); and mistaken for a non-physician (75.2% vs 3.5%; P < .001). Among trainees reporting bullying, attendings were the most common source (68.5%). Patients and their families were the most common source of sexual harassment (66.7%), gender discrimination (90.4%), and racial discrimination (74.4%). Compared with men, women identified more patients and families as the source of bullying (50.0% vs 29.7%; P = .005), gender discrimination (97.2% vs 50.0%; P < .001), and sexual harassment (78.4% vs 27.3%; P = .003). Compared with men, women more frequently felt unprepared to respond to the behavior in the moment (10.4% vs 4.6%; P = .002), did not know how to report mistreatment at their institution (7.6% vs 3.2%; P = .04), and did not believe that their institution would take their mistreatment report seriously (9.0% vs 3.9%; P = .002). On multivariable analysis, female gender was an independent risk factor for both gender discrimination (odds ratio, 56.62; 95% confidence interval, 27.89-115) and sexual harassment (odds ratio, 26.2; 95% confidence interval, 3.34-14.8) when adjusting for children, training year, relationship status, and training program location.A majority of vascular surgery trainees experience mistreatment during training. Sources and forms of abuse are varied. Understanding the sources of mistreatment is critical to guide intervention strategies such as faculty remediation and/or sanctions; allyship training for staff, residents, and faculty; and institutional procedures for patient-initiated abuse.

  View details for DOI 10.1016/j.jvs.2023.03.504

  View details for Web of Science ID 001066929400001

  View details for PubMedID 37088443

• Perceptions of the Shared Learning Environment by Vascular and General Surgery Residents Li, R., Pillado, E. B., Chia, M., Visenio, M., Zhan, T., Eng, J., Amortegui, D., Johnson, J., Sheahan, M., Bilimoria, K., Hu, Y., Cole-Man, D. M. MOSBY-ELSEVIER. 2023: E46-E47

  View details for Web of Science ID 001038870400005

• Reported Pain at Work Is a Risk Factor for Vascular Surgery Trainee Burnout Pillado, E. B., Li, R., Chia, M., Eng, J., DiLosa, K. L., Conway, A., Escobar, G. A., Shaw, P., Sheahan, M., Bilimoria, K., Hu, Y., Coleman, D. M. MOSBY-ELSEVIER. 2023: E63-E64

  View details for Web of Science ID 001038870400027

• Multidisciplinary Limb Salvage Service Reduces Major Amputations in Diabetic Foot Infections JOURNAL OF THE AMERICAN PODIATRIC MEDICAL ASSOCIATION Pillado, E., de Virgilio, C., Ipp, E., Murphy, R., Bongard, F., Lauer, K., Miller, A. J. 2023; 113 (2)

  Abstract

  Diabetic foot infections (DFIs) can lead to limb loss and mortality. To improve patient care at a safety-net teaching hospital, we created a multidisciplinary limb salvage service (LSS).We recruited a cohort prospectively and compared it to a historical control group. Adults admitted to the newly established LSS for DFI during a 6-month period from 2016 to 2017 were included prospectively. Patients admitted to the LSS had routine endocrine and infectious diseases consultations according to a standardized protocol. A retrospective analysis of patients admitted to the acute care surgical service for DFI before creation of the LSS during an 8-month period from 2014 to 2015 was performed.A total of 250 patients were divided into two groups: the pre-LSS (n = 92) and the LSS (n = 158) groups. There were no significant differences in baseline characteristics. Although all patients were ultimately diagnosed with diabetes, more patients in the LSS group had hypertension (71% versus 56%; P = .01) and a prior diagnosis of diabetes mellitus (92% versus 63%; P < .001) compared to the pre-LSS group. Significantly, with the LSS, fewer patients underwent a below-the-knee amputation (3.6% versus 13%; P = .001). There was no difference in the length of hospital stay or 30-day readmission rate between the groups. Further broken down into Hispanic versus non-Hispanic, we noted that Hispanics had significantly lower rates of below-the-knee amputations (3.6% versus 13.0%; P = .02) in the LSS cohort.The initiation of a multidisciplinary LSS decreased the below-the-knee amputation rate in patients with DFIs. Length of stay was not increased, nor was the 30-day readmission rate affected. These results suggest that a robust multidisciplinary LSS dedicated to the management of DFIs is both feasible and effective, even in safety-net hospitals.

  View details for DOI 10.7547/20-176

  View details for Web of Science ID 001111959400006

  View details for PubMedID 37134060

• Persistent racial discrimination among vascular surgery trainees threatens wellness Pillado, E. B., Li, R., Eng, J. S., Chia, M. C., Conway, A., Gomez-Sanchez, C., Shaw, P., Sheahan, M. G., Bilimoria, K. Y., Hu, Y., Coleman, D. M. MOSBY-ELSEVIER. 2023: 262-268

  Abstract

  Racial/ethnic discrimination is one form of mistreatment and a known risk factor for physician burnout. In the present study, we aimed to characterize the forms and identify the sources of racial/ethnic discrimination among vascular surgery trainees.We performed a cross-sectional study of U.S. vascular surgery trainees who had voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between race and ethnicity groups. We used χ2 tests and logistic regression for bivariate and multivariable analyses, respectively.Representing all 123 vascular surgery training programs, 510 trainees (66.9% men) participated in the survey (83.6% response rate). Most of the trainees had self-identified as White (53.1%), followed by Asian (24.4%), Hispanic/Latinx (7.6%), Black (4.2%), and other/prefer not to say (10.8%). No significant differences were found in the self-reported duty hour violations among the groups. Black (56.3%) and Asian (36.3%) trainees reported higher rates of racial/ethnic discrimination compared with the White, Hispanic/Latinx, and other/prefer not to say groups (P < .001). Patients and their families were reported as the most common source (74.7%). Other reported sources of discrimination included nurses or staff (60%), attendings (37.4%), co-residents (31.3%), and administration (16.9%). Regarding specific forms of racial discrimination, Black and Asian trainees reported the highest rates of different standards of evaluation (20% and 5.9%, respectively), being mistaken for a nonphysician (50.0% and 5.9%, respectively), slurs and/or hurtful comments (13.3% and 5.9%, respectively), social isolation (13.0% and 1.0%, respectively), and being mistaken for another trainee of the same race/ethnicity (60.0% and 33.7%, respectively). Only 62.5% of Black trainees reported their program/institution would take their mistreatment report seriously compared with the White (88.9%), Hispanic/Latinx (88.2%), Asian (83.2%), and other/prefer not to say (71.4%) trainees (P = .01). On multivariable analysis, female gender (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.44-4.33), Asian race (OR, 6.9; 95% CI, 3.53-13.3), Black race (OR, 13.6; 95% CI, 4.25-43.4), and training in the Southeastern United States (OR, 3.8; 95% CI, 1.17-12.80) were risk factors for racial/ethnic discrimination.The results from the survey revealed that racial/ethnic discrimination persists in surgical training programs, with Asian and Black trainees reporting higher rates than other racial and ethnic groups. Overall, patients and family members were the most common source of racial/ethnic discrimination. However, faculty, staff, and co-trainees also contributed to racial/ethnic discrimination. Further interventions that optimize diversity, equity, and inclusion strategies and policies to address all forms of racial/ethnic discrimination with faculty, staff, and patients within the hospital are critically needed.

  View details for DOI 10.1016/j.jvs.2022.09.011

  View details for Web of Science ID 000909476600001

  View details for PubMedID 36245144

• Impact of socioeconomic disparities on major lower extremity revascularization complications VASCULAR McElroy, I. E., Pillado, E. B., Greene, A. J., Majumdar, M., Kirshkaln, A., Nuzzolo, K., Malek, J., Dua, A. 2024; 32 (2): 361-365

  Abstract

  Low socioeconomic status (SES), distance lived from hospital, and insurance status are well documented in the literature to increase the risk of post-operative morbidity and mortality for some disease processes however there is a paucity of data regarding how this association impacts patients with peripheral artery disease (PAD). This study aimed to evaluate if SES, distance lived from hospital, and insurance status increased the risk of developing major graft failure in patients undergoing revascularization procedures for symptomatic PAD in a prospective, observation study.In this prospective, observational study, all patients undergoing lower extremity revascularization (endovascular or open) were included from December 2020 to February 2022. Demographic factors, insurance status, operative details, and median income and distance from hospital were documented through chart review. Complications were defined as thrombosis/occlusion of the revascularized vessel or bypass graft or infection of the distal wound or surgical incision wound. Univariate and multivariate analysis were performed comparing patients that developed complications and those that did not. This project was undertaken at the Massachusetts General Hospital and was governed by the Institutional Review Board (IRB: 2020P000263) all patients agreed to participation via informed written consent prior to enrollment in the study.A total of 108 patients were enrolled in the study of which 94 underwent successful revascularization procedures. Of those 94 patients, 38 (40.4%) underwent open bypass, 39 (41.5%) underwent endovascular revascularization, and 17 (18.1%) underwent a hybrid approach. There were no significant differences in post-operative outcomes between operative approaches. Twenty-five patients (28.7%) experienced major revascularization complications as defined as re-occlusion of the treated vessel/thrombosis of the bypass graft (n = 13) or development of post-operative infection (n = 12). There was no significant difference in median income ($75,295 vs $87,757, p = NS), distance lived from hospital, (27.4 miles vs. 29.7 miles, p = NS), or type of insurance (private 24% vs 26%, government 76% vs 73%, p = NS between patients that experienced complications versus those that did not have complications. These findings suggest the risk of major graft failure is independent of a patient's socioeconomic status, distance lived from hospital, or insurance type in patients undergoing revascularization procedures for PAD.While socioeconomic factors impact access to and have a known association with negative outcomes, complications in patients with PAD appear to be independent of these factors. To mitigate the negative outcomes in patients with peripheral artery disease, a focus should be on patient risk factors and modifiable medical factors that contribute to adverse outcomes.

  View details for DOI 10.1177/17085381221140165

  View details for Web of Science ID 000890477000001

  View details for PubMedID 36384373

• Persistent Racial Discrimination Among Vascular Surgery Trainees Threatens Wellness Pillado, E. B., Li, R. D., Eng, J., Chia, M., Sheahan, M., Bilimoria, K., Hu, Y., Coleman, D. M. MOSBY-ELSEVIER. 2022: E342-E343

  View details for Web of Science ID 000798307600399

• Defining Sources and Ramifications of Mistreatment Among Female Vascular Surgery Trainees Pillado, E. B., Li, R. D., Eng, J., Chia, M., Sheahan, M., Bilimoria, K., Hu, Y., Coleman, D. M. MOSBY-ELSEVIER. 2022: E78-E79

  View details for Web of Science ID 000798307600428

• Outcomes and Reintervention After Repair of Type I Aortic Dissection Chia, M. C., Pollevick, M., Patel, K., Pillado, E., Schroeder, J., Whippo, B., Chiu, S., Mehta, C., Vassallo, P., Malaisrie, S., Hoel, A. MOSBY-ELSEVIER. 2021: E134

  View details for Web of Science ID 000691401100227

• Use of a Novel Simulator and Simulation-based Mastery Learning to Improve Femoral Arterial Access Skills Leya, M., Pillado, E., O'Brien, E., Sweis, R. N., Schimmel, D., Vavra, A., Desai, K., Barsuk, J. H., Hungness, E., Wayne, D., Davidson, L., Tomita, T. MOSBY-ELSEVIER. 2021: E260

  View details for Web of Science ID 000691401100399

• Advance Directive and Do-Not-Resuscitate Status among Advanced Cancer Patients with Acute Care Surgical Consultation AMERICAN SURGEON Marcia, L., Ashman, Z. W., Pillado, E. B., Kim, D. Y., Plurad, D. S. 2018; 84 (10): 1565-1569

  Abstract

  Formal communication of end-of-life preferences is crucial among patients with metastatic cancer. Our objective is to describe the prevalence of advance directives (AD) and do-not-resuscitate (DNR) orders among stage IV cancer patients with acute care surgery consultations, and the associated outcomes. This is a single institution retrospective review over an eight-year period. Two hundred and three patients were identified; mean age was 55.3 ± 11.4 years and 48.8 per cent were male. Fifty (24.6%) patients underwent exploratory surgery. Nineteen (10.6%) patients had another type of surgery. Twenty-one (10.3%) patients had a DNR order, and none had an AD on-admission. Fifty-four (26.6%) patients had a DNR order placed and four (2%) patients completed an AD postadmission. DNR postadmission was associated with the highest mortality at 42.6 per cent compared with 14.3 per cent for DNR on-admission and 1.56 per cent for full-code patients (P < 0.001). Compared with patients that remained full-code and those with DNR on-admission, DNR postadmission was associated with longer length of stay (19.6 days; P < 0.001) and ICU length of stay (7.72 days; P < 0.001). The prevalence of AD and DNR orders among stage IV cancer patients is low. The higher in-hospital mortality of patients with DNR postadmission reflects the use of DNR orders during clinical decline.

  View details for Web of Science ID 000449694500005

  View details for PubMedID 30747670

• Flow Rates at Thirty Days after Construction of Radiocephalic Arteriovenous Fistula Predict Hemodialysis Function Pillado, E., Behdad, M., Williams, R., Wilson, S. E. ELSEVIER SCIENCE INC. 2018: 268-272

  Abstract

  Construction of radiocephalic arteriovenous fistula (RC-AVF) results in successful hemodialysis (HD) in approximately 40% of end-stage renal disease patients. We investigated whether RC-AVF flow measured by ultrasound 30 days postoperative predicted successful HD.In this prospective study, color Doppler ultrasound was used to measure cephalic vein outflow volume at 3 forearm sites at 1 and 3 months postoperatively.Of 45 consecutive patients screened for feasibility of RC-AVF by physical examination and US arterial and vein mapping, 41 were considered suitable for construction of RC-AVF. Mean age was 70 (60-78) years. Of the 41 patients who had a forearm RC-AVF, 25 (61%) proceeded to successful AVF dialysis, 4 (10%) had HD via central venous catheter, and 12 (29%) ceased function within the first 30 days postoperatively. The mean flow at 30 days for patent fistulas was 629 ± 305 ml/min and by the third month had increased to 663 ± 367 mL/min. At 1 month, 8/29 (27.6%) patients had a flow rate <400 mL/min. Two (25%) of these clotted, 2 of 3 with closed revisions went on to HD, and 1 died. Of the 21 patients with a flow rate ≥400 mL/min, 19 (90%) functioned for HD, and 2 (10%) AVF occluded before 1 year, resulting in 17 functioning at 1 year (81% 1-year patency). Sixty-two percent of the low-flow fistulas had successful patency within 1 year.An RC-AVF flow rate of ≥400 mL/min in the first month predicted more successful HD than low flow (<400 mL/min) (81% vs. 62%). Without intervention, low flow rates do not improve significantly and maturation is unlikely. We recommend imaging for all patients at 30 days to identify and promptly correct stenosis in those with low flow rates.

  View details for DOI 10.1016/j.avsg.2018.01.068

  View details for Web of Science ID 000432493600034

  View details for PubMedID 29477679

• Discussion of: "Follow-up trends after Emergency Department discharge for acutely symptomatic hernias" AMERICAN JOURNAL OF SURGERY Spence, L., Pillado, E., Kim, D., Plurad, D. 2017; 214 (6): 1022-1023

  View details for DOI 10.1016/j.amjsurg.2017.09.029

  View details for Web of Science ID 000415294400010

  View details for PubMedID 29050638

• Follow-up trends after Emergency Department discharge for acutely symptomatic hernias AMERICAN JOURNAL OF SURGERY Spence, L., Pillado, E., Kim, D., Plurad, D. 2017; 214 (6): 1018-1021

  Abstract

  Patients frequently present to the Emergency Department (ED) with symptomatic hernias. This study evaluated the outcomes of patients presenting with symptomatic hernias without indication for immediate operation who are discharged for elective repair.A three-year retrospective analysis of patients discharged from the ED with a symptomatic hernia was performed at a university affiliated county referral center. The incidences of ED revisits, clinic follow up and repairs occurring in the elective versus emergency setting were assessed.There were 111 patients evaluated and discharged from the ED with a symptomatic hernia where 21% (23) were recurrent and 27% (30) were chronically incarcerated. Of the 111 patients only 23% (26) followed-up in clinic and only 18% (20) underwent hernia repair. However, 25% (28) of all patients required a return visit to the ED and 45% (9) of herniorrhaphies were emergent.Discharge and failure of follow-up after an ED visit for a symptomatic hernia leaves many patients at risk for recurrent ED visits and emergent surgery.

  View details for DOI 10.1016/j.amjsurg.2017.08.028

  View details for Web of Science ID 000415294400009

  View details for PubMedID 29029783

• Role of Preventability in Redefining Failure to Rescue Among Major Trauma Patients JAMA SURGERY Coates, M., Pillado, E., Kim, J., Vasak, R., Yule, A., Kim, D. Y. 2017; 152 (11): 1083-1084

  Abstract

  This cohort study assesses the role of preventability in the definition of failure to rescue when reviewing surgical performance for trauma patients who died after emergency surgery.

  View details for DOI 10.1001/jamasurg.2017.2351

  View details for Web of Science ID 000415661100021

  View details for PubMedID 28746704

  View details for PubMedCentralID PMC5831420

• The Burden of Tunneled Central Venous Catheters for Hemodialysis in a County Hospital AMERICAN SURGEON Pillado, E., Korn, A., De Virgilio, C., Bowens, N. 2017; 83 (10): 1095-1098

  Abstract

  Prolonged use of central venous catheters (CVCs) for hemodialysis (HD) is associated with greater morbidity and mortality when compared with autogenous arteriovenous fistulas (AVF). The objective was to assess compliance with CVC guidelines in adults referred for hemoaccess at a county teaching hospital. Out of 256 patients, 172 (67.2%) were male, with a mean age of 50.0 ± 12.4 years. Overall 62.5 per cent initiated dialysis via CVC. Patients were divided into two groups (those with CVC (62.5%) and those without (37.5%)). Male gender was associated with initiation of dialysis via CVC versus no CVC (72.5 vs 58.3%, P = 0.02), as was a history of prior vascular access (P < 0.01). There were no significant differences between the groups regarding age, diabetes, smoking, ambulatory status, or insurance status. There were no differences in gender, age, insurance status, or prior vascular access between prolonged CVC use (≥90 days) and short-term CVC use (<90 days). We conclude that most patients initiated HD with CVC and exceed the recommended CVC duration. Men are more likely to initiate HD via CVC. Insurance status was not associated with CVC use. Multidisciplinary action may address barriers to reducing CVC duration.

  View details for Web of Science ID 000414442100016

  View details for PubMedID 29391102

• Financial and clinical outcomes of extracorporeal mechanical support JOURNAL OF CARDIAC SURGERY Chiu, R., Pillado, E., Sareh, S., De la Cruz, K., Shemin, R. J., Benharash, P. 2017; 32 (3): 215-221

  Abstract

  Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period.A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150). Patients were assigned to four groups by indication: post-cardiotomy syndrome, cardiogenic shock requiring cardiopulmonary resuscitation (CPR), cardiogenic shock not requiring CPR, and respiratory failure. Hospital charges from administrative records were analyzed. Trend and correlation analyses were used to evaluate clinical and financial outcomes.Of the 150 patients meeting inclusion criteria, 28% required VA-ECMO for post-cardiotomy syndrome, 31.3% for cardiogenic shock with CPR, 35.3% for cadiogenic shock with no CPR, and 5.4% for respiratory failure. Mean duration on ECMO was 5.0 ± 3.4 days with a survival rate of 64% and no difference between the four groups (p = 0.40). ECMO-associated charges averaged $74,500 ± 61,400 per patient, 6% of total hospital charges. Subgroup analysis of cardiogenic shock patients revealed a nearly twofold increase in ECMO-related charges among patients who did not receive CPR (p = 0.04), as well as a trend toward improved survival (69.8% vs 51.1%, p = 0.06).In view of the variations in survival and costs in ECMO patients, further studies should aim to delineate patient populations that benefit from early initiation of ECMO.

  View details for DOI 10.1111/jocs.13106

  View details for Web of Science ID 000398596300012

  View details for PubMedID 28176385