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Seminars in Pediatric Surgery

journal
https://www.readbyqxmd.com/read/30473043/process-improvement-strategies-designing-and-implementing-quality-improvement-research
#1
Loren Berman, Mehul V Raval, Adam Goldin
Quality improvement (QI) is the practice of continuously evaluating and improving the quality of health care that is delivered to patients. In this article, we will use practical examples to show how quality improvement projects have improved surgical patient care, and can be shared between institutions to accelerate the pace of improvement. We will explain the differences between quality improvement and research, and describe the methodological approach to performing and reporting quality improvement projects...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473042/learning-health-systems
#2
Katherine J Deans, Sara Sabihi, Christopher B Forrest
Healthcare organizations have invested significant resources into integrating comprehensive electronic health record (EHR) systems into clinical care. EHRs digitize healthcare in ways that allow for repurposing of clinical information to support quality improvement, research, population health, and health system analytics. This has facilitated the development of Learning Health Systems. Learning health systems (LHS) merge healthcare delivery with research, data science, and quality improvement processes. The LHS cycle begins and ends with the clinician-patient interaction, and aspires to provide continuous improvements in quality, outcomes, and health care efficiency...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473041/an-overview-of-commonly-used-statistical-methods-in-clinical-research
#3
Yuri V Sebastião, Shawn D St Peter
Statistics plays an essential role in clinical research by providing a framework for making inferences about a population of interest. In order to interpret research datasets, clinicians involved in clinical research should have an understanding of statistical methodology. This article provides a brief overview of statistical methods that are frequently used in clinical research studies. Descriptive and inferential methods, including regression modeling and propensity scores, are discussed, with focus on the rationale, assumptions, strengths, and limitations to their application...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473040/surveys-merging-qualitative-and-quantitative-research-methods
#4
Lorraine I Kelley-Quon
Survey methodologies enable researchers to obtain information not routinely captured in electronic medical records, including how delivery of surgical care is perceived through the lens of a child, a parent or caregiver, or a surgeon. Here we describe the approach to using surveys to aid pediatric surgery practice. This article has two aims, (1) to review key concepts in survey creation, administration, and data management, and (2) to describe previously validated survey instruments in pediatric surgery and how to optimize selection of such instruments...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473039/administrative-databases
#5
Calista M Harbaugh, Jennifer N Cooper
Administrative healthcare databases are created from records of service utilization and payments for payer or hospital billing purposes. Such databases contain large amounts of information on the diagnoses, procedures, resource utilization, and costs or charges of thousands or even millions of patients. However, the patient populations included and data elements available vary widely by database, resulting in different strengths, limitations, and potential uses for each. Therefore, selection of an administrative database should be guided by the research question of interest...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473038/research-using-clinical-registries-in-children-s-surgical-care
#6
Ferdynand Hebal, Yue-Yung Hu, Mehul V Raval
Clinical registries provide a valuable opportunity to study specific diagnoses or conditions with a broader scope than possible using individual center-based series and with more clinical detail than typically available in administrative data sources. These registries amass structured data with uniform definitions, thus facilitating reliable adoption and consistent use across contributing sites. By compiling granular data from a multitude of geographically diverse sites, clinical registries allow investigation of rare outcomes, comparison of practice and cost variation, and benchmarking across institutions...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473037/systematic-reviews-and-meta-analytic-techniques
#7
Robert Baird
Systematic reviews (SRs) are a form of research methodology that addresses a specific research question by collecting, appraising and summarising all empirical evidence that fits pre-specified eligibility criteria. Systematic reviews have grown exponentially since their emergence in the late 1970 s as evidence-based medicine permeated medical culture. With several key advantages and limitations inherent to their design, all health care providers should be familiar with their basic structure, how to critically appraise them, and how to incorporate their findings into clinical practice...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473036/clinical-trials
#8
Peter C Minneci, Katherine J Deans
Clinical trials can be used to generate data on safety, efficacy, and/or effectiveness of treatments. They can be classified based on their purpose, phase, or design. Key components of clinical trial design include: identifying the study question and population; clearly defining the treatment and comparison groups; choosing the method of treatment group allocation; defining the primary and secondary outcomes; performing a power analysis; outlining an analytic plan; and reporting results. Critical issues to consider when either designing a trial or interpreting the results of a trial include evaluating the validity and generalizability of the results and assessing the appropriateness of the control group...
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30473035/preface-evidence-based-care-in-pediatric-surgery
#9
EDITORIAL
Peter C Minneci, Katherine J Deans
No abstract text is available yet for this article.
December 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413265/medium-and-long-term-outcomes-of-gastroschisis
#10
REVIEW
Janne Suominen, Risto Rintala
As survival of gastroschisis patients has improved significantly, it has become apparent that longitudinal follow up strategies need to be developed. Problems concerning patients with gastroschisis are usually associated with gastrointestinal morbidity, but there is mounting evidence that also neurodevelopmental, cognitive, behavioral and late-onset auditory sequelae exist. The presence of associated anomalies, as well as complex features (bowel atresia, necrosis, volvulus, perforation) increase morbidity and impact long-term outcomes...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413264/care-of-infants-with-gastroschisis-in-low-resource-settings
#11
REVIEW
Naomi J Wright, John Sekabira, Niyi Ade-Ajayi
There is great global disparity in the outcome of infants born with gastroschisis. Mortality approaches 100% in many low income countries. Barriers to better outcomes include lack of antenatal diagnosis, deficient pre-hospital care, ineffective neonatal resuscitation and venous access, limited intensive care facilities, poor access to the operating theatre and safe neonatal anesthesia, and lack of neonatal parenteral nutrition. However, lessons can be learned from the evolution in management of gastroschisis in high-income countries, generic efforts to improve neonatal survival in low- and middle-income countries as well as specific gastroschisis management initiatives in low-resource settings...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413263/impact-of-societal-factors-and-health-care-delivery-systems-on-gastroschisis-outcomes
#12
REVIEW
Jordan S Taylor, Stephen B Shew
Care of infants with gastroschisis is associated with a significant burden on health care delivery systems. Mortality rates in patients with gastroschisis have significantly improved over the past few decades. However, the condition is still associated with significant short-term and potentially long-term morbidity. Significant variations in clinical outcomes and resource utilization may be explained by several factors including provider and hospital experience, level of neonatal intensive care, variations in hospital regionalization of care, and differences in healthcare delivery systems...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413262/surgical-strategies-in-complex-gastroschisis
#13
REVIEW
Sherif Emil
Currently, the most important determinant of gastroschisis outcomes in high resource settings is whether the condition is associated with intestinal complications, such as atresia, necrosis, perforation, or volvulus. This form of the anomaly, known as complex gastroschisis, accounts for most of the mortality and a disproportionate burden of the morbidity from gastroschisis. There is some disagreement about what constitutes complex gastroschisis, and little consensus on the type and timing of surgical interventions...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413261/closure-methods-in-gastroschisis
#14
REVIEW
Mikael Petrosyan, Anthony D Sandler
The expected outcome of gastroschisis has evolved from an almost certain death of the child prior to the use of parenteral nutrition to almost certain survival. The primary goal of the surgical intervention is return of eviscerated contents into the abdominal cavity. The optimal surgical technique is dependent on the status of the intestine and the accommodation of abdominal domain. In this review, the various surgical techniques for management are discussed as they have evolved. Ironically, a minimalist surgical intervention originally practiced due to the poor expected outcome is now being adopted as a minimalist surgical approach for abdominal wall closure associated with an expected excellent outcome...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413260/risk-stratification-and-outcome-determinants-in-gastroschisis
#15
REVIEW
Hussein Wissanji, Pramod S Puligandla
Selection of outcome determinants and risk stratification are necessary to identify patients at higher risk for morbidity and mortality. This facilitates human and material resource allocation and allows for improved family counseling. While several different factors, including prenatal ultrasonographic bowel features, the timing and mode of delivery, and the features of bowel injury have been investigated in gastroschisis, there is still significant debate as to which of these best predicts outcome. This article reviews the different outcome predictors and risk prognostication schemata currently available in the literature to help guide clinicians caring for infants with gastroschisis...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413259/advances-in-prenatal-and-perinatal-diagnosis-and-management-of-gastroschisis
#16
REVIEW
Megan C Oakes, Manuel Porto, Judith H Chung
Gastroschisis is a congenital, ventral wall defect associated with bowel evisceration. The defect is usually to the right of the umbilical cord insertion and requires postnatal surgical correction. The fetus is at risk for complications such as intrauterine growth restriction, preterm delivery, and intrauterine fetal demise. In addition, complex cases, defined by the presence of intestinal complications such as bowel atresia, stenosis, perforation, or ischemia, occur in up to one third of pregnancies affected by gastroschisis...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413258/insights-into-the-etiology-and-embryology-of-gastroschisis
#17
REVIEW
Sylvie Beaudoin
The development of gastroschisis has long remained an area of interest and controversy. Successive theories about its pathogenesis are herein reviewed and discussed. Two historical assumptions, that omphalocele results from a persistent umbilical hernia, and that gastroschisis does not involve the umbilical cord, are dismissed. Therefore, one can envision gastroschisis for what it is, i.e. a ruptured physiological hernia. The causal agents for this intrauterine accident to occur are yet to be determined. Further bowel damage and complications can be explained by the mesenteric insult...
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30413257/preface
#18
EDITORIAL
Sherif Emil
No abstract text is available yet for this article.
October 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30342603/health-related-quality-of-life-and-neurodevelopmental-outcomes-among-children-with-intestinal-failure
#19
REVIEW
Maria Hukkinen, Laura Merras-Salmio, Mikko P Pakarinen
Treatment results of pediatric intestinal failure have improved markedly during the last decades. With improved survival the attention is turning to other essential outcomes including quality of life and neurodevelopment. So far, relatively few studies with limited number of patients and variable methodology have addressed these issues. Based on these studies using generic health related quality of life tools, children with intestinal failure demonstrate decreased physical health, while PN-dependence is also associated with compromised emotional functioning...
August 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/30342602/improvements-in-intestine-transplantation
#20
REVIEW
Neslihan Celik, Kaitlin Stanley, Jeff Rudolph, Feras Al-Issa, Beverly Kosmach, Chethan Ashokkumar, Qing Sun, Renee Brown-Bakewell, Dale Zecca, Kyle Soltys, Ajai Khanna, Geoffrey Bond, Armando Ganoza, George Mazariegos, Rakesh Sindhi
Transplantation of the intestine in children has presented significant challenges even as it has become a standard to treat nutritional failure due to short gut syndrome. These challenges have been addressed in part by significant improvements in short and long-term care. Noteworthy enhancements include reduced need for intestine transplantation, drug-sparing immunosuppressive regimens, immune monitoring, and improved surveillance and management of PTLD and non-adherence.
August 2018: Seminars in Pediatric Surgery
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