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https://www.readbyqxmd.com/read/29452560/health-care-efficiencies-consolidation-and-alternative-models-vs-health-care-and-antitrust-regulation-irreconcilable-differences
#1
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29450752/racial-and-socioeconomic-differences-in-the-use-of-high-volume-commission-on-cancer-accredited-hospitals-for-cancer-surgery-in-the-united-states
#2
Nabil Wasif, David Etzioni, Elizabeth B Habermann, Amit Mathur, Barbara A Pockaj, Richard J Gray, Yu-Hui Chang
BACKGROUND: Although major cancer surgery at a high-volume hospital is associated with lower postoperative mortality, the use of such hospitals may not be equally distributed. OBJECTIVE: Our aim was to study socioeconomic and racial differences in cancer surgery at Commission on Cancer (CoC)-accredited high-volume hospitals. METHODS: The National Cancer Database (NCDB) was used to identify patients undergoing surgery for colon, esophageal, liver, and pancreatic cancer from 2003 to 2012...
February 15, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29448900/provision-of-surgical-care-in-ethiopia-challenges-and-solutions
#3
Caitrin M Kelly, Nichole Starr, Nakul P Raykar, Rachel R Yorlets, Charles Liu, Miliard Derbew
With the lowest measured rate of surgery in the world, Ethiopia is faced with a number of challenges in providing surgical care. The aim of this study was to elucidate challenges in providing safe surgical care in Ethiopia, and solutions providers have created to overcome them. Semi-structured interviews were conducted with 10 practicing surgeons in Ethiopia. Following de-identification and immersion into field notes, topical coding was completed with an existing coding manual. Codes were adapted and expanded as necessary, and the primary data analyst confirmed reproducibility with a secondary analyst...
February 15, 2018: Global Public Health
https://www.readbyqxmd.com/read/29447899/geographic-health-disparities-in-the-los-angeles-pediatric-esophageal-foreign-body-population
#4
Kevin Hur, Varun Angajala, Dennis Maceri, Christian Hochstim
OBJECTIVE: To assess geographical sociodemographic differences in the pediatric esophageal foreign body population of Los Angeles. METHODS: We retrospectively reviewed the medical records of 128 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014 to 2017 with a diagnosis of a retained foreign body in the esophagus removed by rigid or flexible esophagoscopy. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariable logistic regression...
March 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29446481/clinical-parameters-of-ovarian-hyperstimulation-syndrome-ohss-following-different-hormonal-triggers-of-oocyte-maturation-in-ivf-treatment
#5
A Abbara, R Islam, S A Clarke, L Jeffers, G Christopoulos, A N Comninos, R Salim, S A Lavery, N L Vuong, P Humaidan, T W Kelsey, G H Trew, W S Dhillo
OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic condition, predominantly related to the hormone used to induce oocyte maturation during IVF treatment. Kisspeptin is a hypothalamic neuropeptide that has recently been demonstrated to safely trigger final oocyte maturation during IVF treatment even in women at high risk of OHSS. However to date, the safety of kisspeptin has not been compared to current hormonal triggers of oocyte maturation. DESIGN: We conducted a retrospective single-centre cohort study investigating symptoms and clinical parameters of early OHSS in women at high risk of OHSS (antral follicle count or total number of follicles on day of trigger ≥23) triggered with hCG (n=40), GnRH agonist (GnRHa; n=99), or kisspeptin (n=122) at Hammersmith Hospital IVF unit, London, UK (2013-2016)...
February 15, 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29446205/surgeon-led-prostate-cancer-lymph-node-staging-pathologic-outcomes-stratified-by-robot-assisted-dissection-templates-and-patient-selection
#6
Muammer Altok, Kara Babaian, Mary F Achim, Grace C Achim, Patricia Troncoso, Surena F Matin, Brian F Chapin, John W Davis
OBJECTIVES: To evaluate the peri-operative, pathologic, and oncologic outcomes from surgeon led pathologic staging of pelvic lymph node metastases at the time of robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: Over the 6-year period of 2006-2012, three distinct pelvic lymph node dissection strategies were utilized in chronologic order at a single cancer referral hospital. Strategies were characterized by both a 1) omission of PLND versus inclusion decision threshold, and 2) standard versus extended templates for patients selected for PLND...
February 15, 2018: BJU International
https://www.readbyqxmd.com/read/29444504/the-snp-rs915014-in-mthfr-regulated-by-mirna-associates-with-atherosclerosis
#7
Xinye Liu, Lingxu Wang, Hao Chi, Jin Wang, Qian Zheng, Jingye Li, Yong Li, Dongwei Yang
BACKGROUND/AIMS: The association between the genetic polymorphisms located in either the exon or untranslated region of MTHFR and the risk of human atherosclerosis has been well-documented. This study analyzed MTHFR polymorphisms at the 3'-untranslated region for association with risk and outcome of atherosclerosis in a Chinese Han population. METHODS: The hospital based case-control study was conducted with 500 patients and 600 healthy volunteers as control enrolled...
February 8, 2018: Cellular Physiology and Biochemistry
https://www.readbyqxmd.com/read/29444222/extracorporeal-membrane-oxygenation-as-a-bridge-to-lung-transplantation-may-not-impact-overall-mortality-risk-after-transplantation-results-from-a-7-year-single-centre-experience
#8
Fabio Ius, Ruslan Natanov, Jawad Salman, Christian Kuehn, Wiebke Sommer, Murat Avsar, Thierry Siemeni, Dmitry Bobylev, Reza Poyanmehr, Dietmar Boethig, Joerg Optenhoefel, Nicolaus Schwerk, Axel Haverich, Gregor Warnecke, Igor Tudorache
OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) has an important role in bridging patients to lung transplantation. In this study, we present our experience with pretransplant ECMO during the last 7 years and investigate its impact on graft outcomes. METHODS: Records of all lung-transplanted patients at our institution between January 2010 and April 2017 were retrospectively reviewed. Graft survival was compared between patients who required pretransplant ECMO (pre-Tx ECMO+) and patients who did not (pre-Tx ECMO-)...
February 12, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29442351/milk-alkali-syndrome-mas-as-a-complication-of-the-treatment-of-hypoparathyroidism
#9
Agata Skwarek, Janusz Pachucki, Tomasz Bednarczuk, Zuzanna Żurecka, Michał Popow
Milk-alkali syndrome (MAS), characterized by renal failure, metabolic alkalosis and hypercalcemia, is a severe and life-threatening complication of the treatment of hypoparathyroidism. The clinical course is often sudden and is not preceded by any prodromal symptoms. Occurrence does not depend on the duration of hypoparathyroidism treatment, although it is closely related to the applied therapy, especially the dose of calcium carbonate and active vitamin D preparations. Drugs influencing the glomerular filtration rate (angiotensin receptor blockers, sartans, aldosterone receptor antagonists, thiazide diuretics), lack of adequate routine control, changing the calcium carbonate supplementation, dehydration, a diet rich in pH-basic foods (i...
February 14, 2018: Endokrynologia Polska
https://www.readbyqxmd.com/read/29436192/effects-of-physician-volume-on-readmission-and-mortality-in-elderly-patients-with-heart-failure-nationwide-cohort-study
#10
Joo Eun Lee, Eun Cheol Park, Suk Yong Jang, Sang Ah Lee, Yoon Soo Choy, Tae Hyun Kim
PURPOSE: Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality. MATERIALS AND METHODS: We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002-2013...
March 2018: Yonsei Medical Journal
https://www.readbyqxmd.com/read/29436186/hypofractionated-re-irradiation-after-maximal-surgical-resection-for-recurrent-glioblastoma-therapeutic-adequacy-and-its-prognosticators-of-survival
#11
Jeongshim Lee, Sung Soo Ahn, Jong Hee Chang, Chang Ok Suh
PURPOSE: To evaluate the adequacy of retreatment, including hypofractionated re-irradiation (HFReRT), after surgery for recurrent glioblastoma (GBM) and related prognosticators of outcomes. MATERIALS AND METHODS: From 2011 to 2014, 25 consecutive patients with recurrent (n=17) or secondary (n=7) disease underwent maximal surgery and subsequent HFReRT after meeting the following conditions: 1) confirmation of recurrent or secondary GBM after salvage surgery; 2) Karnofsky performance score (KPS) ≥60; and 3) interval of ≥12 months between initial radiotherapy and HFReRT...
March 2018: Yonsei Medical Journal
https://www.readbyqxmd.com/read/29433991/changes-in-volume-clinical-practice-and-outcome-after-reorganisation-of-oesophago-gastric-cancer-care-in-england-a-longitudinal-observational-study
#12
M Varagunam, R Hardwick, S Riley, G Chadwick, D A Cromwell, O Groene
AIM: The centralisation of oesophago-gastric (O-G) cancer services in England was recommended in 2001, partly because of evidence for a volume-outcome effect for patients having surgery. This study investigated the changes in surgical services for O-G cancer and postoperative mortality since centralisation. METHODS: Patients with O-G cancer who had an oesophageal or gastric resection between April 2003 and March 2014 were identified in the national Hospital Episodes Statistics database...
January 11, 2018: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29433429/the-management-of-children-with-bronchiolitis-in-the-australasian-hospital-setting-development-of-a-clinical-practice-guideline
#13
Sharon O'Brien, Sally Wilson, Fenella J Gill, Elizabeth Cotterell, Meredith L Borland, Edward Oakley, Stuart R Dalziel
BACKGROUND: Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evidence. This paper reports on the process, strengths and challenges of the hybrid approach used to develop the first Australasian management guideline relevant to the local population. METHOD: An adaption of the nine steps recommended by the National Health and Medical Research Council (NHMRC) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology were utilised...
February 12, 2018: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/29430969/retrospective-analysis-of-short-term-outcomes-after-monopolar-versus-laser-endoscopic-enucleation-of-the-prostate-a-single-center-experience
#14
Dmitry Victorovich Enikeev, Petr Vitalievich Glybochko, Zhamshid Okhunov, Yuriy Gennadievich Alyaev, Leonid Mikhailovich Rapoport, Dmitry Tsarichenko, Mikhail Elikovich Enikeev, Nikolay Ivanovich Sorokin, Alim Mukhamedovich Dymov, Mark Sergeevich Taratkin
INTRODUCTION: Endoscopic enucleation of the prostate (EEP) has been recognized as a viable, treatment modality for men with benign prostatic hyperplasia (BPH). The aim of our study was to compare the efficacy and functional outcomes of three different techniques of EEP including monopolar enucleation (MEP), holmium (HoLEP) and thulium laser enucleation (ThuLEP). METHODS: The study consisted of a retrospective comparison of pre- and postoperative parameters in men undergoing three types of EEP: MEP, HoLEP, and ThuLEP...
February 12, 2018: Journal of Endourology
https://www.readbyqxmd.com/read/29429947/hospital-readmission-rates-and-risk-factors-for-readmission-following-cytoreductive-surgery-crs-and-hyperthermic-intraperitoneal-chemotherapy-hipec-for-peritoneal-surface-malignancies
#15
Yael Dreznik, Aviad Hoffman, Tamar Hamburger, Almog Ben-Yaacov, Yossi Dux, Harel Jacoby, Yaniv Berger, Aviram Nissan, Mordechai Gutman
BACKGROUND: Cytoreductive surgery and Hyperthermic intra-peritoneal chemotherapy (CRS/HIPEC) for peritoneal surface malignancies is associated with high morbidity. The increased numbers of patients undergoing CRS/HIPEC in recent years mandates risk analysis and quality assurance. However, only scarce data exist regarding causative parameters for readmission. The aim of this study was to assess readmission rates and risk factors associated with readmission. METHODS: A retrospective-cohort study including patients from two high-volume centers who underwent CRS/HIPEC surgery between the years 2007-2016 was performed...
February 8, 2018: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
https://www.readbyqxmd.com/read/29428925/adjuvant-therapy-yiqiditantongfu-decoction-with-external-diaphragm-pacer-for-chronic-obstructive-pulmonary-disease-patients-with-difficulty-weaning-from-mechanical-ventilation
#16
Cong He, Shan Ren, Quansheng Du, Yong Wang, Hui Liu, Heling Zhao, Limin Shen, Ling Long, Xianlei Wang
Context • Global morbidity from chronic obstructive pulmonary disease (COPD) is high worldwide. Diaphragm pacing (DP) can maintain the natural, negative pressure breathing of COPD patients with diaphragmatic muscle dysfunction. The YiqiDitanTongfu (YDTF) decoction has been used clinically with COPD patients to help them to wean from mechanical ventilation, with their ventilation functions being improved and the success rate of weaning being largely increased. Objective • The study intended to investigate the combined therapeutic effects of external DP and the YDTF decoction for COPD patients who have had difficulty weaning from mechanical ventilation...
February 10, 2018: Alternative Therapies in Health and Medicine
https://www.readbyqxmd.com/read/29427813/life-after-the-neurosurgical-ward-in-subsaharan-africa-neurosurgical-treatment-and-outpatient-outcomes-in-uganda
#17
Linda W Xu, Silvia D Vaca, Juliet Nalwanga, Christine Muhumuza, Daniel Vail, Benjamin J Lerman, Joel Kiryabwire Surg, Hussein Ssenyonjo, John Mukasa, Michael Muhumuza, Michael M Haglund, Gerald Grant
BACKGROUND: In the past decade, neurosurgery in Uganda experienced increasing surgical volume and a new residency training program. While research has examined surgical capacity, minimal data exists on the patient population treated by neurosurgery and their eventual outcomes in sub-Saharan Africa. METHODS: Patients admitted to Mulago National Referral Hospital neurosurgical ward over two years (2014 and 2015) were documented in a prospective database. 1167 were discharged with documented phone numbers, thus eligible for follow-up...
February 7, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29426143/association-of-ultrafine-particles-with-cardiopulmonary-health-among-adult-subjects-in-the-urban-areas-of-northern-taiwan
#18
Jun-Yu Liu, Ta-Chih Hsiao, Kang-Yun Lee, Hsiao-Chi Chuang, Tsun-Jen Cheng, Kai-Jen Chuang
The association between short-term exposure to particulate air pollution, especially fine particles, and cardiopulmonary health has been well-established in previous studies. However, previous findings regarding the effect of ultrafine particles (UFPs) on cardiopulmonary health are inconsistent. We repeatedly measured the mass concentrations of UFPs using a Micro-Orifice Uniform Deposit Impactor (MOUDI) in the apartments of 100 adult participants and collected the participants' health data from the pulmonary outpatient unit of Shuang-Ho Hospital to investigate the association between short-term exposure to UFPs and cardiopulmonary health using mixed-effects models from January 1, 2014 to August 31, 2017...
January 30, 2018: Science of the Total Environment
https://www.readbyqxmd.com/read/29422249/validation-of-an-assessment-tool-estimation-of-postoperative-overall-survival-for-gastric-cancer
#19
Yoshio Haga, Shinji Hato, Masakazu Ikenaga, Kazuyoshi Yamamoto, Akira Tsuburaya, Koichi Doi, Koji Ikejiri, Toshihiko Hirata, Manabu Yamamoto, Shinji Ishikawa, Hitoshi Takeuchi
BACKGROUND: Benchmarking of long-term surgical outcomes has rarely been attempted. We previously devised a prediction model for assessing the outcome of late survival after surgery, termed the Estimation of Postoperative Overall Survival for Gastric Cancer (EPOS-GC). This study was undertaken to validate EPOS-GC in an external data set. METHODS: A retrospective cohort study was conducted in 11 cancer care hospitals in Japan, analyzing a consecutive series of patients who underwent elective gastric cancer resection between April 2007 and March 2009...
January 11, 2018: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29421913/gastrointestinal-stromal-tumors-16-years-experience-within-a-university-hospital
#20
Engin Hatipoğlu, Süleyman Demiryas
AIM: the aim was to convey our 16-year experience regarding gastrointestinal stromal tumors within in a high volume university hospital. Factors that may impact on patient survival were evaluated. MATERIAL AND METHODS: all patients diagnosed with gastrointestinal stromal tumors in our clinic over a 16-year period were retrospectively evaluated. All patients included in the study had their tumors surgically resected. Survival analyses were performed using the Kaplan-Meier method...
February 9, 2018: Revista Española de Enfermedades Digestivas
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