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High Volume Hospitals

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https://www.readbyqxmd.com/read/27906440/supramicrosurgical-lymphatico-venular-anastomosis-lva-in-treating-lymphoedema-36-months-preliminary-report
#1
P Gennaro, G Gabriele, M Mihara, K Kikuchi, C Salini, I Aboh, F Cascino, G Chisci, C Ungari
OBJECTIVE: Lymphoedema of the extremities is a widespread pathological condition that mostly occurs as a complication of cancer resections, especially in women. Conventional therapy refers to conservative and physiotherapeutic approaches. Surgical strategies have been widely reported in the literature and are still challenging. Part of this literature focuses on the supra microsurgical lymphaticovenular anastomosis (LVA) technique. LVA is characterized by a high success rate, minimal invasivity and broad indications...
November 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27905691/is-volume-important-in-aneurysm-treatment-outcome
#2
Athanasios Katsargyris, Chris Klonaris, Eric L Verhoeven
Several studies have suggested that surgical procedures performed at high-volume centers may result in superior outcome. Technically more demanding procedures such as aortic aneurysm repair appear to demonstrate a stronger relationship with volume. The present chapter reviewed the literature using the MEDLINE database to identify studies investigating the effect of volume in aortic aneurysm repair outcomes. The great majority of studies identified shows an advantage for high-volume hospitals with regard to perioperative mortality of abdominal (AAA), thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair...
December 1, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27905020/laparoscopic-versus-open-cholecystectomy-a-cost-effectiveness-analysis-at-rwanda-military-hospital
#3
Allison Silverstein, Ainhoa Costas-Chavarri, Mussa R Gakwaya, Joseph Lule, Swagoto Mukhopadhyay, John G Meara, Mark G Shrime
BACKGROUND: Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings. METHODS: A cost-effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda...
November 30, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27903010/heartmate-ii-left-ventricular-assist-device-pump-exchange-a-single-institution-experience
#4
Asad F Shaikh, Susan M Joseph, Brian Lima, Shelley A Hall, Rajasekhar Malyala, Aldo E Rafael, Gonzalo V Gonzalez-Stawinski, Themistokles Chamogeorgakis
Background Left ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange. Materials and Methods We retrospectively reviewed all cases that required pump exchange due to LVAD complication from November 2011 until June 2016 at a single high-volume institution...
November 30, 2016: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/27900416/-intensive-care-treatment-after-aneurysmal-subarachnoid-hemorrhage
#5
U Jaschinski
Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease and nearly one third of patients die in the acute phase. Due to the bleeding event, a hyperactive sympathetic nervous system and an uncontrolled inflammatory response have a profound local and systemic impact on other organ functions. Neuroendocrinological disorders and cardiopulmonary morbidity are dominant. Despite a decrease in hospital mortality for high volume centers, a high proportion of survivors suffer from neurological deficits. Knowledge of the pathophysiology of vasospasms in the later stages of the disease has increased...
November 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27898439/limiting-sedation-for-patients-with-acute-respiratory-distress-syndrome-time-to-wake-up
#6
Faraaz Ali Shah, Timothy D Girard, Sachin Yende
PURPOSE OF REVIEW: Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. RECENT FINDINGS: Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27897172/adaptation-and-external-validation-of-the-european-randomised-study-of-screening-for-prostate-cancer-risk-calculator-for-the-chinese-population
#7
P K Chiu, M J Roobol, D Nieboer, J Y Teoh, S K Yuen, S M Hou, M K Yiu, C F Ng
BACKGROUND: To adapt the well-performing European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator to the Chinese setting and perform an external validation. METHODS: The original ERSPC risk calculator 3 (RC3) for prostate cancer (PCa) and high-grade PCa (HGPCa) was applied to a development cohort of 3006 previously unscreened Hong Kong Chinese men with initial transrectal biopsies performed from 1997 to 2015, age 50-80 years, PSA 0.4-50 ng ml(-1) and prostate volume 10-150 ml...
November 29, 2016: Prostate Cancer and Prostatic Diseases
https://www.readbyqxmd.com/read/27893969/hospital-characteristics-and-favourable-neurological-outcome-among-patients-with-out-of-hospital-cardiac-arrest-in-osaka-japan
#8
Tasuku Matsuyama, Kosuke Kiyohara, Tetsuhisa Kitamura, Chika Nishiyama, Tatsuya Nishiuchi, Yasuyuki Hayashi, Takashi Kawamura, Bon Ohta, Taku Iwami
OBJECTIVE: To assess the association between favourable neurological outcome and hospital characteristics such as hospital volume and number of critical care centres (CCMCs) after out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective, population-based observational study conducted in Osaka Prefecture, Japan included adult patients with OHCA, aged ≥18 years, before the arrival of the emergency medical service and who were transported to acute care hospitals between January 2005 and December 2012...
November 25, 2016: Resuscitation
https://www.readbyqxmd.com/read/27893532/the-effect-of-hospital-volume-on-breast-cancer-mortality
#9
Rachel A Greenup, Samilia Obeng-Gyasi, Samantha Thomas, K Houck, Whitney O Lane, Rachel C Blitzblau, Terry Hyslop, E Shelley Hwang
OBJECTIVE: The aim of this study was to determine whether hospital volume was associated with mortality in breast cancer, and what thresholds of case volume impacted survival. BACKGROUND: Prior literature has demonstrated improved survival with treatment at high volume centers among less common cancers requiring technically complex surgery. METHODS: All adults (18 to 90 years) with stages 0-III unilateral breast cancer diagnosed from 2004 to 2012 were identified from the American College of Surgeons National Cancer Data Base (NCDB)...
November 23, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27893064/effect-of-increased-enteral-protein-intake-on-growth-in-human-milk-fed-preterm-infants-a-randomized-clinical-trial
#10
Christoph Maas, Michaela Mathes, Christine Bleeker, Julia Vek, Wolfgang Bernhard, Cornelia Wiechers, Andreas Peter, Christian F Poets, Axel R Franz
Importance: Protein, supplied in currently available commercial fortifiers, may be inadequate to meet the requirements of very preterm infants; in addition, intraindividual and interindividual variability of human milk protein and energy content potentially contribute to unsatisfactory early postnatal growth. Objective: To determine effects on growth of different levels of enteral protein supplementation in predominantly human milk-fed preterm infants. Design, Setting, and Participants: This randomized clinical and partially blinded single-center trial was conducted in a neonatal tertiary referral center in Germany...
November 21, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/27893017/evaluation-of-cognitive-deficits-and-structural-hippocampal-damage-in-encephalitis-with-leucine-rich-glioma-inactivated-1-antibodies
#11
Carsten Finke, Harald Prüss, Josephine Heine, Sigrid Reuter, Ute A Kopp, Florian Wegner, Florian Then Bergh, Sebastian Koch, Olav Jansen, Thomas Münte, Günther Deuschl, Klemens Ruprecht, Winfried Stöcker, Klaus-Peter Wandinger, Friedemann Paul, Thorsten Bartsch
Importance: Limbic encephalitis with leucine-rich, glioma-inactivated 1 (LGI1) antibodies is one of the most frequent variants of autoimmune encephalitis with antibodies targeting neuronal surface antigens. However, the neuroimaging pattern and long-term cognitive outcome are not well understood. Objective: To study cognitive outcome and structural magnetic resonance imaging (MRI) alterations in patients with anti-LGI1 encephalitis. Design, Setting, and Participants: A cross-sectional study was conducted at the Departments of Neurology at Charité-Universitätsmedizin Berlin and University Hospital Schleswig-Holstein, Kiel, Germany...
November 21, 2016: JAMA Neurology
https://www.readbyqxmd.com/read/27891285/complex-perineal-trauma-with-anorectal-avulsion
#12
Adelina Maria Cruceru, Ionut Negoi, Sorin Paun, Sorin Hostiuc, Ruxandra Irina Negoi, Mircea Beuran
Introduction. The objective of this case report is to illustrate a severe perineal impalement injury, associated with anorectal avulsion and hemorrhagic shock. Results. A 32-year-old male patient was referred to our hospital for an impalement perineal trauma, associated with complex pelvic fracture and massive perineal soft tissue destruction and anorectal avulsion. On arrival, the systolic blood pressure was 85 mm Hg and the hemoglobin was 7.1 g/dL. The patient was transported to the operating room, and perineal lavage, hemostasis, and repacking were performed...
2016: Case Reports in Surgery
https://www.readbyqxmd.com/read/27889486/abdominoplasty-with-scarpa-fascia-preservation-comparative-study-in-a-bariatric-population
#13
Inês Correia-Gonçalves, Rita Valença-Filipe, Jorge Carvalho, Marco Rebelo, Helena Peres, José Amarante, António Costa-Ferreira
BACKGROUND: Abdominoplasty techniques using a more superficial plane of dissection with Scarpa fascia preservation have been shown to improve recovery and reduce complications in nonbariatric patients. Patients who have experienced massive weight loss frequently need body contour procedures and represent a high-risk group. OBJECTIVE: To evaluate the effect of this technique in patients with massive weight loss after bariatric surgery. SETTING: University hospital, Portugal...
September 28, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/27887931/revision-of-primary-sleeve-gastrectomy-to-roux-en-y-gastric-bypass-indications-and-outcomes-from-a-high-volume-center
#14
Robert A Casillas, Scott S Um, Jorge L Zelada Getty, Samantha Sachs, Benjamin B Kim
BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has become an accepted primary bariatric operation. Like other bariatric operations, inadequate weight loss and complications have been reported. OBJECTIVES: The aim of this study was to assess the indications and outcomes of revision of SG to laparoscopic Roux-en-Y gastric bypass (RYGB) at a single community hospital. SETTING: Community hospital, United States. METHODS: Retrospective review of a prospectively collected database identifying SG operations done from February 2009 to June 2014...
October 4, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/27886991/radiation-dose-for-pediatric-and-young-adult-ct-a-survey-to-establish-age-based-reference-levels-of-2015-2016-in-korea
#15
MoonChan Kim, KwangHyun Chang, JeongHoon Hwang, YoonChul Nam, DongKyoon Han, Joon Yoon
To assess the doses delivered to pediatric patients during computed tomography (CT) examinations of the brain, chest, high-resolution lung and abdomen, and to establish diagnostic reference levels (DRLs) for various age groups in Korea. Dose survey was done to the 19 hospitals performing CT on children, addressing the scan parameters, volume CT dose index (CTDIvol) and dose length product (DLP). Per five age group (0, 1, 2-5, 6-10, 11-17 y of age), the proposed DRLs for brain, chest, high-resolution lung and abdomen CT are, respectively, in terms of CTDIvol: 18, 23, 26, 31, 36 mGy; 2, 3, 4, 6, 8 mGy; 2, 3, 4, 5, 7 mGy; 3, 4, 5, 6, 9 mGy; and in terms of DLP: 260, 350, 420, 500, 620 mGy•cm; 50, 80, 100, 170, 340 mGy•cm; 30, 40, 60, 90, 280 mGy•cm; 70, 80, 200, 300, 500 mGy•cm...
November 24, 2016: Radiation Protection Dosimetry
https://www.readbyqxmd.com/read/27884677/mastery-based-virtual-reality-robotic-simulation-curriculum-the-first-step-toward-operative-robotic-proficiency
#16
Melissa E Hogg, Vernissia Tam, Mazen Zenati, Stephanie Novak, Jennifer Miller, Amer H Zureikat, Herbert J Zeh
OBJECTIVE: Hepatobiliary surgery is a highly complex, low-volume specialty with long learning curves necessary to achieve optimal outcomes. This creates significant challenges in both training and measuring surgical proficiency. We hypothesize that a virtual reality curriculum with mastery-based simulation is a valid tool to train fellows toward operative proficiency. This study evaluates the content and predictive validity of robotic simulation curriculum as a first step toward developing a comprehensive, proficiency-based pathway...
November 21, 2016: Journal of Surgical Education
https://www.readbyqxmd.com/read/27884330/factors-associated-with-adverse-events-after-emergency-laparotomy-in-cape-town-south-africa-identifying-opportunities-for-quality-improvement
#17
Richard Trafford Spence, Mark Hampton, Kent Pluke, Miriam Kahn, Nkhabe Chinyepi, Mohamed Elmusbahi, Tirsa van Wyngaard, Eugenio Panieri
BACKGROUND: Surgical outcomes research is limited in areas of the world with the greatest unmet surgical need and likely greatest variation in outcomes. Measurement alone may improve outcomes-the so-called Hawthorne effect. The purpose of this multicenter cohort study was to identify factors that are both feasible to collect and are associated with a major adverse event following a targeted procedure in Cape Town, South Africa. METHODS: A collaborative of four acute care surgical units was formed to develop a data set with minimal data burden describing outcomes after an emergency exploratory laparotomy during a 3-mo period (February-April 2015)...
December 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27883326/renal-replacement-therapy-in-patients-with-heart-and-kidney-failure
#18
Dimitrios S Goumenos, Evangelos Papachristou, Marios Papasotiriou
The incidence of chronic kidney disease (CKD) in patients with chronic heart failure (CHF) is high as CKD and CHF share underlying risk factors such as arterial hypertension, diabetes mellitus and atherosclerosis. Cardiac failure leads to renal hypoperfusion and dysfunction and then fluid overload and need for aggressive diuretic therapy. However, development of diuretic resistance represents a significant problem in the management of these patients. The role of Renal Replacement Therapy (RRT) is important for patients who do not response to conservative management of fluid overload facilitating the failing heart to restore function...
November 1, 2016: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
https://www.readbyqxmd.com/read/27881923/predictive-value-of-serum-uric-acid-in-hospitalized-adolescents-and-adults-with-acute-asthma
#19
Nasser Keshar Abdulnaby, Ashraf Othman Sayed, Nehad Mohamed Shalaby
BACKGROUND: High serum uric acid (sUA) is an indicator of oxidative stress and is linked to tissue hypoxia in asthma. The objective of this case series was to investigate the prognostic role of sUA in patients with acute asthma exacerbations and the link between sUA and spirometric lung tests. PATIENTS AND METHODS: This cross-sectional observational study included 120 patients with acute asthma exacerbations and 120 controls, categorized according to peak expiratory flow rate into moderate, and severe and life-threatening asthma...
2016: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/27878046/back-to-back-comparison-of-mini-open-vs-laparoscopic-technique-for-living-kidney-donation
#20
Christie Rampersad, Premal Patel, Joshua Koulack, Thomas McGregor
INTRODUCTION: Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes. METHODS: From 2007-2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011-2014...
August 2016: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
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