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High Volume Hospitals

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https://www.readbyqxmd.com/read/28215039/impact-of-surgical-experience-on-management-and-outcome-of-pancreatic-surgery-performed-in-high-and-low-volume-centers
#1
Marco Stella, Massimiliano Bissolati, Daniele Gentile, Alessandro Arriciati
Pancreaticoduodenectomy (PD) is one of the procedures in general surgery with the highest rate of life-threatening complications. The positive impact of the volume-outcome ratio on outcomes and mortality in pancreatic surgery (PS) has led to policy-level efforts toward centralization of care for PS that is currently under evaluation by some Regional Health Services. The role of the surgeon's experience and training is still under debate. The aim of this paper is to compare the outcomes of PS by the same surgeon in a high volume (HV) and in a low volume (LV) hospital to assess whether a specific training in PS could outdo the benefits of hospital volume...
February 18, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28214101/endophthalmitis-reduction-with-intracameral-moxifloxacin-prophylaxis-analysis-of-600%C3%A2-000-surgeries
#2
Aravind Haripriya, David F Chang, Ravilla D Ravindran
PURPOSE: To compare the postoperative endophthalmitis rate before and after initiation of intracameral (IC) moxifloxacin prophylaxis for both phacoemulsification and sutureless, manual small-incision cataract surgery (M-SICS), as well as in patients with posterior capsular rupture (PCR). DESIGN: Retrospective, clinical registry. PARTICIPANTS: All cataract surgeries (617 453) performed during the 29-month period from January 2014 to May 2016 at the 10 regional Aravind eye hospitals were included...
February 14, 2017: Ophthalmology
https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#3
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28210793/a-national-population-based-cohort-study-of-urethral-injection-therapy-for-female-stress-and-mixed-urinary-incontinence-the-danish-urogynaecological-database-2007-2011
#4
Margrethe Foss Hansen, Gunnar Lose, Ulrik Schiøler Kesmodel, Kim Oren Gradel
INTRODUCTION AND HYPOTHESIS: Urethral injection therapy (UIT) has been performed since the early 20th century and a variety of agents have been launched. In 2006, polyacrylamide hydrogel (PAGH) was introduced and is now widely used as an agent. The objective was to evaluate the efficacy of PAGH based on a national population over a 5-year period (2007-2011) and the influence of patient-related factors, surgeon experience, and department volume. METHODS: A retrospective cohort study was carried out based on data from the Danish Urogynaecological Database (DugaBase)...
February 16, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28210527/major-oncologic-surgery-at-a-community-hospital
#5
Hollyann Loui, Pouya Benyamini, Gregorio Maldini
There is a national trend to refer patients requiring complex oncologic surgery to tertiary high-volume cancer centers. However, this presents major access challenges to Hawai'i patients seeking care. The purpose of this study is to demonstrate that complex oncologic surgery can be safely performed at community hospitals like those in Hawai'i. From July 2007 to December 2014, 136 patients underwent complex oncologic procedures at a community hospital in Hawai'i by a single general surgeon. Cases included esophagogastric, hepatobiliary, pancreatic, rectal, and retroperitoneal resections...
February 2017: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
https://www.readbyqxmd.com/read/28209450/the-effect-of-tranexamic-acid-in-traumatic-brain-injury-a-randomized-controlled-trial
#6
Abolfazl Jokar, Koorosh Ahmadi, Tayyebeh Salehi, Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar
PURPOSE: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients. METHODS: This single-blind randomized controlled trial was conducted on patients with traumatic ICH (with less than 30 ml) referring to the emergency department of Vali-Asr Hospital, Arak, Iran in 2014...
January 20, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28207783/patient-experience-with-outpatient-encounters-at-public-hospitals-in-shanghai-examining-different-aspects-of-physician-services-and-implications-of-overcrowding
#7
Yuhua Bao, Guanrong Fan, Dongdong Zou, Tong Wang, Di Xue
BACKGROUND: Over 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care. OBJECTIVE: To assess outpatient experience with different aspects of physician services at China's public hospitals and its association with overcrowding of the hospital outpatient departments. RESEARCH DESIGN: Retrospective analysis of a large survey of outpatient experience in Shanghai, China...
2017: PloS One
https://www.readbyqxmd.com/read/28207625/a-three-dimensional-geometric-morphometric-study-to-quantify-temporal-bone-growth-and-its-consequences-for-the-success-of-implanting-bone-anchored-hearing-devices
#8
Sebastian Schilde, Stefan K Plontke, Torsten Rahne
OBJECTIVE: A computed tomography (CT)-based morphological-investigation to describe temporal bone growth and to devise a predictive test of the likely success of Bonebridge implantation into the growing mastoid region of the temporal bone in young patients. STUDY DESIGN: Retrospective cross-sectional study. SETTING: University Hospital Halle (Saale), Germany. PATIENTS: Two cohorts participated. This first, of patients aged less than 21 years, comprised 42 men, and 33 women patients...
February 15, 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/28205027/risk-factors-affecting-unplanned-reoperation-after-laparoscopic-gastrectomy-for-gastric-cancer-experience-from-a-high-volume-center
#9
Ping Li, Chang-Ming Huang, Ru-Hong Tu, Jian-Xian Lin, Jun Lu, Chao-Hui Zheng, Jian-Wei Xie, Jia-Bin Wang, Qi-Yue Chen, Long-Long Cao, Mi Lin
BACKGROUND: To evaluate the risk factors affecting unplanned reoperation (URO) after laparoscopic gastrectomy (LAG) for gastric cancer (GC) and establish a model to predict URO preoperatively. STUDY DESIGN: Between May 2007 and December 2014, we prospectively collected and retrospectively analyzed the data of 2608 GC patients who underwent LAG. Among them, 2580 patients not requiring an URO were defined as the Non-URO group, and 28 patients requiring an URO were defined as the URO group...
February 15, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28204867/right-versus-left-laparoscopic-colectomy-for-colon-cancer-does-side-make-any-difference
#10
Juan P Campana, Pablo A Pellegrini, Gustavo L Rossi, Guillermo Ojea Quintana, Ricardo E Mentz, Carlos A Vaccaro
PURPOSE: To compare the intraoperative and postoperative outcomes between right laparoscopic colectomy (RLC) and left laparoscopic colectomy (LLC) for colon cancer. METHOD: Patients who underwent elective RLC or LLC for colon cancer between January 2004 and December 2014 were identified and elected for a retrospective analysis. Primary outcomes were technical difficulty (including operative time, intraoperative complications, and conversion rate) and postoperative outcome (including postoperative complications, length of hospital stay, reinterventions, readmissions, and mortality)...
February 15, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28203554/the-13-year-experience-of-performing-pancreaticoduodenectomy-in-a-mid-volume-municipal-hospital
#11
Hongbeom Kim, Jung Kee Chung, Young Joon Ahn, Hae Won Lee, In Mok Jung
PURPOSE: Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. METHODS: From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center...
February 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28196898/increased-radial-access-is-not-associated-with-worse-femoral-outcomes-for-percutaneous-coronary-intervention-in-the-united-kingdom
#12
William Hulme, Matthew Sperrin, Evangelos Kontopantelis, Karim Ratib, Peter Ludman, Alex Sirker, Tim Kinnaird, Nick Curzen, Chun Shing Kwok, Mark De Belder, James Nolan, Mamas A Mamas
BACKGROUND: The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach...
February 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28195890/medial-orbital-wall-reconstruction-with-porous-polyethylene-by-using-a-transconjunctival-approach-with-a-caruncular-extension
#13
Chieh Chou, Yur-Ren Kuo, Chien-Chang Chen, Cheng-Sheng Lai, Sin-Daw Lin, Shu-Hung Huang, Su-Shin Lee
BACKGROUND: The reported rate of isolated medial orbital wall fractures varies widely but has been found to be as high as 55% of all orbital fractures. Identifying and repairing medial orbital wall defects by using appropriate materials improves patient outcome considerably; however, most related research has focused on orbital floor defect management rather than medial orbital wall treatment, and no consensus on repairing medial orbital wall fractures exists. Furthermore, medial orbital wall fracture is a main cause of posttraumatic enophthalmos...
February 14, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28191792/laparoscopic-management-of-recurrent-ureteropelvic-junction-obstruction-following-pyeloplasty-a-single-surgical-team-experience-with-38-cases
#14
Francesco Chiancone, Maurizio Fedelini, Luigi Pucci, Clemente Meccariello, Paolo Fedelini
PURPOSE: To describe and analyze our experience with Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) in the treatment of recurrent ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS: 38 consecutive patients who underwent transperitoneal laparoscopic redo-pyeloplasty between January 2007 and January 2015 at our department were included in the analysis. 36 patients were previously treated with dismembered pyeloplasty and 2 patients underwent a retrograde endopyelotomy...
January 27, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
https://www.readbyqxmd.com/read/28191656/utility-and-safety-of-combined-interventional-catheterization-and-electrophysiology-procedures-in-a-children-s-hospital
#15
S Yukiko Asaki, Jeffrey W Orcutt, Christina Y Miyake, Henri Justino, Caridad M DE LA Uz, Jeffrey J Kim, Santiago O Valdes, Athar M Qureshi
BACKGROUND: Interventional cardiac catheterization (cath) and electrophysiology (EP) procedures are not routinely performed together. There are several perceived barriers affecting this practice, though there are also advantages for both the patient and practitioner to a combined approach. METHODS: This was a single center retrospective study reviewing combined cath and EP procedures with a pre-procedural intention to intervene at Texas Children's Hospital from 2001 to 2014...
February 13, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28188722/prevalence-of-hypokalemia-before-and-after-bowel-preparation-for-colonoscopy-in-high-risk-patients
#16
Ankie Reumkens, Ad A M Masclee, Bjorn Winkens, Cees T van Deursen, Silvia Sanduleanu, C Minke Bakker
BACKGROUND AND AIMS: Bowel preparation for colonoscopy should not cause significant shifts in systemic electrolyte concentrations. We recently encountered 2 cases of severe postcolonoscopy hypokalemia with fatal consequences, prompting us to conduct a study to explore the magnitude of and risk factors for hypokalemia associated with bowel preparation. We paid specific attention to higher risk subgroups, in particular diuretic users, hospitalized patients and patients estimated at to be high risk by the gastroenterologist...
February 7, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28188301/hospital-variations-in-unexpected-complications-among-term-newborns
#17
Yuri V Sebastião, Lindsay S Womack, Humberto López Castillo, Maya Balakrishnan, Karen Bruder, Paige Alitz, Linda A Detman, Emily A Bronson, John S Curran, William M Sappenfield
OBJECTIVES: To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida. METHODS: We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors...
February 10, 2017: Pediatrics
https://www.readbyqxmd.com/read/28187135/pathogen-cross-transmission-via-building-sanitary-plumbing-systems-in-a-full-scale-pilot-test-rig
#18
Michael Gormley, Thomas J Aspray, David A Kelly, Cristina Rodriguez-Gil
The WHO Consensus Document on the epidemiology of the SARS epidemic in 2003, included a report on a concentrated outbreak in one Hong Kong housing block which was considered a 'super-spreading event'. The WHO report conjectured that the sanitary plumbing system was one transmission route for the virus. Empty U-traps allowed the aerosolised virus to enter households from the sewerage system. No biological evidence was presented. This research reports evidence that pathogens can be aerosolised and transported on airstreams within sanitary plumbing systems and enter buildings via empty U-traps...
2017: PloS One
https://www.readbyqxmd.com/read/28185295/irreversible-electroporation-for-the-ablation-of-pancreatic-malignancies-a-patient-specific-methodology
#19
Eduardo L Latouche, Michael B Sano, Melvin F Lorenzo, Rafael V Davalos, Robert C G Martin
BACKGROUND AND OBJECTIVES: Irreversible Electroporation (IRE) is a focal ablation technique highly attractive to surgical oncologists due to its non-thermal nature that allows for eradication of unresectable tumors in a minimally invasive procedure. In this study, our group sought to address the challenge of predicting the ablation volume with IRE for pancreatic procedures. METHODS: In compliance with HIPAA and hospital IRB approval, we established a pre-treatment planning methodology for IRE procedures in pancreas, which optimized treatment protocols for individual cases of locally advanced pancreatic cancer (LAPC)...
February 10, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28183556/blood-loss-and-transfusion-requirements-with-epsilon-aminocaproic-acid-use-during-cranial-vault-reconstruction-surgery
#20
Mark E Thompson, Charles Saadeh, Phillip Watkins, Laszlo Nagy, Joshua Demke
OBJECTIVE: To determine whether epsilon-aminocaproic acid (EACA) load of 50 mg∙kg(-1) before skin incision, and infusion of 25 mg∙kg(-1)∙h(-1) until skin closure during cranial vault reconstruction (CVR) were associated with decreased estimated blood loss and transfusion requirements. BACKGROUND: Antifibrinolytic medications decrease bleeding and transfusion requirements during cardiothoracic and orthopedic surgeries with high blood loss, but practical reductions in blood loss and transfusion requirements have not been consistently realized in children undergoing CVR...
February 2017: Journal of Clinical Anesthesia
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