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Journal of the American College of Surgeons

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https://www.readbyqxmd.com/read/27919741/implementation-of-a-clinical-documentation-improvement-curriculum-improves-quality-metrics-and-hospital-charges-in-an-academic-surgery-department
#1
Cynthia Reyes, Alissa Greenbaum, Catherine Porto, John C Russell
BACKGROUND: Accurate clinical documentation (CD) is necessary for many aspects of modern healthcare, including excellent communication, quality metrics reporting, and legal documentation. New requirements have mandated the adoption of ICD-10-CM coding systems, adding another layer of complexity to CD. A clinical documentation improvement (CDI) and ICD-10 training program was created for healthcare providers in our academic surgery department. We aimed to assess the impact of our CDI curriculum by comparing quality metrics, coding and reimbursement before and after implementation of our CDI program...
December 2, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27916701/the-elite-athlete-the-master-surgeon
#2
Edward D Verrier
No abstract text is available yet for this article.
December 1, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27887981/predictors-of-mortality-in-the-critically-ill-cirrhotic-patient-is-the-model-for-end-stage-liver-disease-enough
#3
Alagappan Annamalai, Megan Y Harada, Melissa Chen, Tram Tran, Ara Ko, Eric J Ley, Miriam Nuno, Andrew Klein, Nicholas Nissen, Mazen Noureddin
BACKGROUND: Critically ill cirrhotics urgently require liver transplantation but are at high risk for perioperative mortality. The Model for End-Stage Liver Disease (MELD) score, recently updated to incorporate serum sodium, estimates survival probability in patients with cirrhosis but needs further evaluation in the critically ill. The purpose of this study was to evaluate the predictive power of intensive care unit (ICU) admission MELD scores and identify clinical risk factors associated with increased mortality...
November 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884800/the-hidden-cost-of-medicine
#4
R James Valentine
No abstract text is available yet for this article.
November 21, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27864155/minimally-invasive-whipple-s-technique-for-laparoscopic-assisted-pylorus-preserving-pancreaticoduodenectomy
#5
Frederick Hong-Xiang Koh, Alfred Wc Kow
No abstract text is available yet for this article.
November 15, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27863889/same-day-discharge-in-laparoscopic-acute-non-perforated-appendectomy
#6
Andrew Scott, Shant Shekherdimian, Joshua D Rouch, Greg D Sacks, Aaron J Dawes, Wendy Y Lui, Letitia Bridges, Tracy Heisler, Steven R Crain, Mang-King W Cheung, Armen Aboulian
BACKGROUND: Small studies done during the past decade have demonstrated same-day discharge after appendectomy as an option for non-perforated appendicitis. Here we have examined a large cohort to confirm that same-day discharge in acute non-perforated appendicitis is a safe option. STUDY DESIGN: This was a retrospective study of patients from 14 Southern California Region Kaiser Permanente medical centers. All patients older than 18 years of age with acute, non-perforated appendicitis who underwent a laparoscopic appendectomy between 2010 and 2014 were included...
November 15, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884803/association-between-resident-perceptions-of-patient-safety-and-duty-hour-violations
#7
Richard S Matulewicz, David D Odell, Jeanette W Chung, Kristen A Ban, Anthony D Yang, Karl Y Bilimoria
BACKGROUND: Residents are often required to balance whether to adhere to duty hour policies or violate them to care for patients and obtain educational experiences. Little is known about why residents violate duty hour policies and whether there is a relationship between how often residents violate duty hours and concerns about patient safety. Our objective was to assess the association between resident duty hour violations and resident concerns about patient safety. STUDY DESIGN: We analyzed survey data collected from surgery residents who completed the 2015 ABSITE, excluding those in the Flexible Policy arm of the FIRST Trial...
November 11, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27915052/massive-localized-lymphedema-a-case-control-study
#8
Reid Maclellan, David Zurakowski, Frederick D Grant, Arin K Greene
BACKGROUND: Massive localized lymphedema (MLL) is an area of skin and subcutaneous overgrowth associated with obesity. The purpose of this project was to determine whether MLL results from obesity-induced lymphedema (OIL), and to characterize the prevalence and risk factors for the condition. STUDY DESIGN: Patients evaluated in our Lymphedema Program between 2009 and 2016 were reviewed for obese individuals [body mass index (BMI) > 30 kg/m(2)] who had lower extremity lymphatic function evaluated by lymphoscintigraphy...
November 10, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884805/utilization-and-underlying-reasons-of-duty-hour-flexibility-in-the-flexibility-in-duty-hour-requirement-for-surgical-trainees-first-trial
#9
Karl Y Bilimoria, Christopher Quinn, Allison R Dahlke, Rachel R Kelz, Judy A Shea, Ravi Rajaram, Remi Love, Lindsey Kreutzer, Thomas Biester, Anthony D Yang, David B Hoyt, Frank R Lewis
BACKGROUND: The Flexibility in Duty-Hour Requirements for Surgical Trainees (FIRST) Trial randomized surgical residency programs to either standard duty-hour policies or flexible policies that eliminated caps on shift lengths and time off between shifts. Our objectives were to assess adherence to duty-hour requirements in the Standard Policy arm and examine how often and why duty-hour flexibility was used in the Flexible Policy arm. STUDY DESIGN: A total of 3,795 residents in the FIRST Trial completed a survey in January 2016 (response rate >95%) that asked how often and why they exceeded current standard duty hour limits in both study arms...
November 10, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884806/exploring-qualitative-perspectives-on-surgical-resident-training-well-being-and-patient-care
#10
Lindsey Kreutzer, Allison R Dahlke, Remi Love, Kristen A Ban, Anthony D Yang, Karl Y Bilimoria, Julie K Johnson
BACKGROUND: The Flexibility In duty hour Requirements for Surgical Trainees (FIRST) Trial found not difference in patient outcomes or resident wellbeing between more restrictive and flexible duty hour policies. Qualitative methods are appropriate for better understanding the experience and perceptions of those affected by duty hour regulations. We conducted a pilot qualitative study on how resident duty hour regulations are perceived by general surgery Program Directors (PDs), surgical residents and attending surgeons who participated in the FIRST Trial...
November 8, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884804/gender-based-differences-in-surgical-residents-perceptions-of-patient-safety-continuity-of-care-and-well-being-an-analysis-from-the-flexibility-in-duty-hour-requirements-for-surgical-trainees-first-trial
#11
Kristen A Ban, Jeanette W Chung, Richard S Matulewicz, Rachel R Kelz, Judy A Shea, Allison R Dahlke, Christopher Quinn, Anthony D Yang, Karl Y Bilimoria
BACKGROUND: Little is known about gender differences in residency training experiences and whether duty hour policies affect these differences. Using data from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, we (1) examined gender differences in surgical resident perceptions of patient safety, education, health/well-being, and job satisfaction and (2) assessed whether duty hour policies affected gender differences. STUDY DESIGN: We compared proportions of male and female residents expressing dissatisfaction or perceiving a negative effect of duty hours on aspects of residency training (patient safety, resident education, well-being, job satisfaction) overall and by postgraduate year (PGY)...
November 8, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884802/association-between-flexible-duty-hour-policies-and-general-surgery-resident-examination-performance-a-flexibility-in-duty-hour-requirement-for-surgical-trainees-first-trial-analysis
#12
Eddie Blay, D Brock Hewitt, Jeanette W Chung, Thomas Biester, James F Fiore, Allison R Dahlke, Christopher M Quinn, Frank R Lewis, Karl Y Bilimoria
BACKGROUND: Concerns persist about the effect of current duty hour reforms on resident educational outcomes. We investigated whether a flexible, less-restrictive duty hour policy (Flexible Policy) was associated with differential general surgery examination performance compared to current Accreditation Council for Graduate Medical Education (ACGME) duty hour policy (Standard Policy). STUDY DESIGN: We obtained examination scores on the American Board of Surgery (ABS) In-Training Examination (ABSITE), Qualifying Examination (QE, written boards), and Certifying Examination (CE, oral boards) for residents in 117 general surgery residency programs that participated in the Flexibility In Duty Hour Requirements for Surgical Trainees (FIRST) Trial...
November 8, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884801/effect-of-flexible-duty-hour-policies-on-length-of-stay-for-complex-intra-abdominal-operations-a-flexibility-in-duty-hour-requirement-for-surgical-trainees-first-trial-analysis
#13
Jonah J Stulberg, Emily Pavey, Mark E Cohen, Clifford Y Ko, David B Hoyt, Karl Y Bilimoria
BACKGROUND: Changes to resident duty hour policies in the Flexibility in Duty Hour Requirements for Surgical Trainees ("FIRST") Trial could impact hospitalized patients' length of stay (LOS) by altering care coordination. LOS may also serve as a reflection of all complications, particularly those not captured in the FIRST Trial (eg, pneumothorax from central line). Programs were randomized to either maintaining current ACGME duty hour policies ("Standard Arm") or more flexible policies waiving rules on maximum shift lengths and time off between shifts ("Flexible Arm")...
November 8, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27825917/intraoperative-hypothermia-and-surgical-site-infections-in-patients-with-class-1-clean-wounds-a-case-control-study
#14
Michael J Brown, Timothy B Curry, Joseph A Hyder, Elie F Berbari, Mark J Truty, Darrell R Schroeder, Andrew C Hanson, Daryl J Kor
BACKGROUND: Numerous surgical quality metrics focus on prevention of unintentional perioperative hypothermia due, in part, to the association between hypothermia and surgical site infections (SSI). However, few studies have comprehensively evaluated the relationship between these metrics and SSI. In this study, we evaluated individual components of one set of hypothermia metrics to determine their association with SSI. METHODS: Patients with clean (Type 1) wounds who developed a SSI within thirty days after surgery from January 2003-December 2012 in one of five surgical specialties were matched to specialty specific controls without SSI...
November 4, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27825916/does-preoperative-bowel-preparation-reduce-surgical-site-infections-during-elective-ventral-hernia-repair
#15
David M Krpata, Ivy N Haskins, Sharon Phillips, Ajita S Prabhu, Steven Rosenblatt, Benjamin K Poulose, Michael J Rosen
BACKGROUND: To date, little is known about the benefits of preoperative bowel preparation in patients undergoing elective ventral hernia repair (VHR). The purpose of this study was to determine the effect of preoperative bowel preparation on 30-day wound events in patients undergoing elective VHR using the Americas Hernia Society Quality Collaborative (AHSQC). STUDY DESIGN: All patients undergoing elective VHR from January 2013 through January 2016 were identified within the AHSQC...
November 4, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27825915/assessment-of-progress-in-early-trauma-care-in-japan-over-the-past-decade-achievements-and-areas-for-future-improvement
#16
Akira Endo, Atsushi Shiraishi, Hiroki Matsui, Kenichi Hondo, Yasuhiro Otomo
BACKGROUND: Strategies to optimize early trauma care have been introduced in Japan; however, detailed evaluation of the progress achieved has not been reported. STUDY DESIGN: In this retrospective observational study, patients registered in the Japanese nationwide trauma registry were stratified according to probability of survival (Ps) > 0.5 or ≤ 0.5, respectively. The mortality rates during the first two days and in-hospital mortality rates were compared between early (2004-2009) and late cohorts (2010-2014) in each group, using mixed effects logistic regression analysis...
November 4, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27825914/differences-in-resident-perceptions-by-postgraduate-year-of-duty-hour-policies-an-analysis-from-the-flexibility-in-duty-hour-requirement-for-surgical-trainees-first-trial
#17
Anthony D Yang, Jeanette W Chung, Allison R Dahlke, Thomas Biester, Christopher M Quinn, Richard S Matulewicz, David D Odell, Rachel R Kelz, Judy Shea, Frank Lewis, Karl Y Bilimoria
BACKGROUND: In the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, there were several differences in residents' perceptions of aspects of their education, well-being, and patient care that differed between standard and flexible duty hour policies. Our objective was to assess whether these perceptions differed by level of training. STUDY DESIGN: A survey assessed residents participating in the FIRST Trial's perceptions of the effect of duty hour policies on aspects of patient safety, continuity of care, resident education, clinical training, and resident well-being...
November 4, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27825913/charles-locke-scudder-1860-1949
#18
David E Clark
No abstract text is available yet for this article.
November 4, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27773776/trust-the-keystone-of-the-patient-physician-relationship
#19
Carlos A Pellegrini
No abstract text is available yet for this article.
October 20, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27773775/using-quality-improvement-principles-to-enhance-long-term-completion-of-patient-reported-outcomes-after-ventral-hernia-repair
#20
Nishant Ganesh Kumar, Adil A Faqih, Michael P Feng, Richard S Miller, Richard A Pierce, Kenneth W Sharp, Michael D Holzman, Benjamin K Poulose
INTRODUCTION: Ventral hernia repair (VHR) is a commonly performed surgical procedure. Unfortunately, long term prospective information about quality of life and outcomes after VHR has been challenging to obtain. Decoupling follow up from clinical visits via patient reported outcomes (PROs) has been proposed as a means of achieving better long term assessments after VHR. The Americas Hernia Society Quality Collaborative (AHSQC) is a national quality improvement (QI) effort in hernia repair which uses PROs to obtain long term follow up...
October 20, 2016: Journal of the American College of Surgeons
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