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https://www.readbyqxmd.com/read/28092400/aging-the-medical-subspecialties-and-career-development-where-we-were-where-we-are-going
#1
Arti Hurria, Kevin P High, Lona Mody, Frances McFarland Horne, Marcus Escobedo, Jeffrey Halter, William Hazzard, Kenneth Schmader, Heidi Klepin, Sei Lee, Una E Makris, Michael W Rich, Stephanie Rogers, Jocelyn Wiggins, Rachael Watman, Jennifer Choi, Nancy Lundebjerg, Susan Zieman
Historically, the medical subspecialties have not focused on the needs of older adults. This has changed with the implementation of initiatives to integrate geriatrics and aging research into the medical and surgical subspecialties and with the establishment of a home for internal medicine specialists within the annual American Geriatrics Society (AGS) meeting. With the support of AGS, other professional societies, philanthropies, and federal agencies, efforts to integrate geriatrics into the medical and surgical subspecialties have focused largely on training the next generation of physicians and researchers...
January 16, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28089186/predictors-of-same-day-discharge-in-primary-total-joint-arthroplasty-patients-and-risk-factors-for-post-discharge-complications
#2
Alex Sher, Aakash Keswani, Dong-Han Yao, Michael Anderson, Karl Koenig, Calin S Moucha
BACKGROUND: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population...
December 22, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28087231/psychosocial-outcome-in-adult-men-born-with-hypospadias
#3
L Örtqvist, M Andersson, A Strandqvist, A Nordenström, L Frisén, G Holmdahl, A Nordenskjöld
INTRODUCTION: Hypospadias, which is a surgically treated congenital malformation of the male urethra, may have a negative impact on quality of life. This aspect has previously been subject to limited research. This study examined the long-term psychosocial outcome of a large cohort of adult males born with hypospadias. OBJECTIVE: The purpose of this case-control study was to assess a possible negative influence on the psychosocial outcome in adult males with hypospadias...
September 9, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28076623/low-cost-simulator-for-heart-surgery-training
#4
Roberto Rocha E Silva, Artur Lourenção, Maxim Goncharov, Fabio B Jatene
Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses...
November 2016: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28073923/what-to-do-when-patients-with-epilepsy-cannot-take-their-usual-oral-medications
#5
Anna M Bank, Jong Woo Lee, Patricia Krause, Aaron L Berkowitz
When people with epilepsy are hospitalised for medical or surgical conditions, they may be unable to take their home antiepileptic drugs (AEDs). Such 'nil by mouth' people with epilepsy require alternative AED regimens to prevent breakthrough seizures. Here, we describe several strategies for maintaining seizure control in patients with epilepsy who have medical or surgical contraindications to their home oral regimens. These strategies include using non-pill oral formulations, using an intravenous formulation of the patient's home AED(s), using a benzodiazepine bridge and/or using alternative intravenous AED(s) when there are no intravenous formulations...
January 10, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28069850/spending-on-care-after-surgery-driven-by-choice-of-care-settings-instead-of-intensity-of-services
#6
Lena M Chen, Edward C Norton, Mousumi Banerjee, Scott E Regenbogen, Anne H Cain-Nielsen, John D Birkmeyer
The rising popularity of episode-based payment models for surgery underscores the need to better understand the drivers of variability in spending on postacute care. Examining postacute care spending for fee-for-service Medicare beneficiaries after three common surgical procedures in the period 2009-12, we found that it varied widely between hospitals in the lowest versus highest spending quintiles for postacute care, with differences of 129 percent for total hip replacement, 103 percent for coronary artery bypass grafting (CABG), and 82 percent for colectomy...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28069418/splenic-artery-aneurysm-rupture-in-pregnancy
#7
Joshua Jacobson, Chad Gorbatkin, Stacey Good, Scott Sullivan
CASE PRESENTATION: A pregnant woman at 22+5/7weeks gestation presented to the emergency department (ED) from an outpatient clinic, hypotensive after experiencing a syncopal episode. On arrival to the ER she was tachycardic, tachypneic and complaining of abdominal pain. A bedside FAST was performed and noted free fluid in the abdomen. Subsequent CT obtained noted the rare but life-threatening diagnosis of ruptured splenic artery aneurysm that resulted in emergent transfer to the operating room with OB/GYN and general surgery...
December 15, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28062329/managing-symptoms-enhancing-patients-self-management-knowledge-and-skills-for-surgical-recovery
#8
REVIEW
Jan Odom-Forren, Susan Wesmiller
OBJECTIVES: To review postoperative symptoms experienced by patients following surgery for cancer and discuss focused, evidenced-based methods to teach the patient acute pain and symptom management to include both pharmacological and non-pharmacological strategies. DATA SOURCES: Peer reviewed articles and national guidelines. CONCLUSION: Although significant advances have been made in providing effective acute pain control, pain remains a serious consequence after cancer surgery...
January 3, 2017: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/28060006/resolving-epibole-with-polymeric-membrane-dressings-in-home-care
#9
Kimberly S Bare, Jerri Drain
BACKGROUND: The management of chronic (nonhealing) wounds with epibole is challenging and costly, especially when the problem is not promptly identified or the patient is intolerant to conventional treatments. CASE DESCRIPTION: We describe the use of a polymeric membrane dressing (PMD) in 3 patients with chronic (nonhealing) wounds and epibole who were unable to be treated with traditional interventions such as silver nitrate or sharp debridement. Patient 1 was a 51 year-old male with a right foot stasis ulcer with 60% fibrin/slough to the wound bed, patient 2 was a 58-year-old female with a stage 4 pressure injury of the left hip with undermining, and patient 3 was a 62-year-old female with a dehisced abdominal surgical wound...
January 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28052886/intestinal-rehabilitation-for-children-with-intestinal-failure-is-cost-effective-a-simulation-study
#10
Henk Groen, Esther G Neelis, Marten J Poley, Joanne F Olieman, René Scheenstra, Paul Fm Krabbe, Gerard Dijkstra, Edmond Hhm Rings
BACKGROUND: Children with intestinal failure (IF) depend on parenteral nutrition (PN). The goal in the treatment of IF is to wean children off PN through intestinal rehabilitation (IR). Although the healthcare burden of IF is enormous, to our knowledge there has been no previous cost-effectiveness analysis in pediatric IF including IR. OBJECTIVE: We sought to determine the cost-effectiveness of IR in terms of costs and life-years. DESIGN: We simulated the treatment of IF in children in a discrete-event model...
January 4, 2017: American Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28052070/identifying-patient-perceived-barriers-to-trichiasis-surgery-in-kongwa-district-tanzania
#11
Ryan J Bickley, Harran Mkocha, Beatriz Munoz, Sheila West
BACKGROUND: Trachomatous trichiasis (TT), inturned eyelashes from repeated infection with Chlamydia trachomatis, is the leading infectious cause of blindness in the world. Though surgery will correct entropion caused by trachoma, uptake of TT surgery remains low. In this case-control study, we identify barriers that prevent TT patients from receiving sight-saving surgery. METHODOLOGY/PRINCIPAL FINDINGS: Participants were selected from a database of TT cases who did (acceptors) and did not (non-acceptors) have surgery as of August 2015...
January 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28043313/ogilvie-s-syndrome
#12
Muhammad Waqas Khan, Sanniya Khan Ghauri, Sara Shamim
Ogilvie's syndrome, also known as 'paralytic ileus of the colon', is characterised by pseudo-obstruction of the large intestine in the absence of any mechanical obstructing component; and presents as a massively distended abdomen. If left untreated, it may lead to bowel perforation or ischemia. Ogilvie's syndrome usually presents as a postsurgical complication, mainly due to the lack and/or restriction of movement coupled with a possible electrolyte imbalance. Here, we present a case of a pre-surgical 63-year lady, having a right hip fracture, who came with complaints of severe abdominal pain and distension for 4 days...
December 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28034774/the-use-of-the-risk-assessment-and-prediction-tool-in-surgical-patients-in-a-bundled-payment-program
#13
James Slover, Kathleen Mullaly, Raj Karia, John Bendo, Patricia Ursomanno, Aubrey Galloway, Richard Iorio, Joseph Bosco
OBJECTIVES: The purpose of this study was to evaluate the relationship between the Risk Assessment and Predictor Tool (RAPT) and patient discharge disposition in an institution participating in bundled payment program for total joint replacement, spine fusion and cardiac valve surgery patients. METHOD: Between April 2014 and April 2015, RAPT scores of 767 patients (535 primary unilateral total joint arthroplasty; 150 cardiac valve replacement; 82 spinal fusions) were prospectively captured...
December 26, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/28034584/percutaneous-endovascular-aneurysm-repair-in-morbidly-obese-patients
#14
Jason A Chin, Laura Skrip, Bauer E Sumpio, Jonathan A Cardella, Jeffrey E Indes, Timur P Sarac, Alan Dardik, Cassius I Ochoa Chaar
OBJECTIVE: Endovascular aneurysm repair (EVAR) with percutaneous femoral access (PEVAR) has several potential advantages. Morbidly obese (MO) patients present unique anatomical challenges and have not been specifically studied. This study examines the trends in the use of PEVAR and its surgical outcomes compared with open femoral cutdown (CEVAR) in MO patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program files for the years 2005 to 2013 were reviewed...
December 26, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28034481/complications-following-outpatient-total-joint-arthroplasty-an-analysis-of-a-national-database
#15
P Maxwell Courtney, Anthony J Boniello, Richard A Berger
BACKGROUND: As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded from these protocols. METHODS: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary TKA or THA from 2011 to 2014...
December 14, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28031316/implementing-medical-abortion-with-mifepristone-and-misoprostol-in-norway-1998-2013
#16
Mette Løkeland, Tone Bjørge, Ole-Erik Iversen, Rupali Akerkar, Line Bjørge
BACKGROUND: Medical abortion with mifepristone and misoprostol was introduced in Norway in 1998, and since then there has been an almost complete change from predominantly surgical to medical abortions. We aimed to describe the medical abortion implementation process, and to compare characteristics of women obtaining medical and surgical abortion. METHODS: Information from all departments of obstetrics and gynaecology in Norway on the time of implementation of medical abortion and abortion procedures in use up to 12 weeks of gestation was assessed by surveys in 2008 and 2012...
December 28, 2016: International Journal of Epidemiology
https://www.readbyqxmd.com/read/28028673/outcomes-of-elderly-critically-ill-medical-and-surgical-patients-a-multicentre-cohort-study
#17
Ian M Ball, Sean M Bagshaw, Karen E A Burns, Deborah J Cook, Andrew G Day, Peter M Dodek, Demetrios J Kutsogiannis, Sangeeta Mehta, John G Muscedere, Alexis F Turgeon, Henry T Stelfox, George A Wells, Ian G Stiell
PURPOSE: Very elderly (over 80 yr of age) critically ill patients admitted to medical-surgical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and dependent living conditions should they survive. The primary purpose of this study is to describe the outcomes and differences in outcomes between very elderly medical patients and their surgical counterparts admitted to Canadian ICUs, thereby informing decision-making for clinicians and substitute decision-makers...
December 27, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28028281/-sequential-post-operative-nutrition-care-at-home-for-patients-receiving-surgical-treatment-for-esophageal-cancer
#18
Mio Matsuoka, Shohei Iijima
OBJECTIVE AND METHODS: We evaluated the outcomes of sequential nutrition care provided at home to patients who had undergone surgery for esophageal cancer. For 44 such patients, we investigated caloric intake(kcal), percentage of preoperative body weight(%), and requests and complains related to home nutrition care every 3 months for 1 year after surgery. RESULTS: Duringthe observation period, the mean postoperative caloric intake decreased to a minimum level at 1 month, but nearly recovered to the baseline at 12 months...
December 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28027086/an-ambulatory-surgery-perioperative-surgical-home-in-kaiser-permanente-settings-practice-and-outcomes
#19
Chunyuan Qiu, Joseph Rinehart, Vu T Nguyen, Maxime Cannesson, Atef Morkos, Diana LaPlace, Narendra S Trivedi, Philip D Mercado, Zeev N Kain
BACKGROUND: The aim of this study is to describe the design, implementation, and associated outcome changes of a Perioperative Surgical Home (PSH) for patients undergoing ambulatory laparoscopic cholecystectomy in a Kaiser Permanente practice model. METHODS: A multidisciplinary planning committee of 15 individuals developed and implemented a new PSH program. A total of 878 subjects were included in the preimplementation period (T-fast), and 1082 patients were included in the postimplementation period (PSH) based on the date of their surgery...
December 22, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28025918/outcomes-of-upper-airway-stimulation-for-obstructive-sleep-apnea-in-a-multicenter-german-postmarket-study
#20
Clemens Heiser, Joachim T Maurer, Benedikt Hofauer, J Ulrich Sommer, Annemarie Seitz, Armin Steffen
Objective Selective stimulation of the hypoglossal nerve is a new surgical therapy for obstructive sleep apnea, with proven efficacy in well-designed clinical trials. The aim of the study is to obtain additional safety and efficacy data on the use of selective upper airway stimulation during daily clinical routine. Study Design Prospective single-arm study. Setting Three tertiary hospitals in Germany (Munich, Mannheim, Lübeck). Subjects and Methods A multicenter prospective single-arm study under a common implant and follow-up protocol took place in 3 German centers (Mannheim, Munich, Lübeck)...
December 1, 2016: Otolaryngology—Head and Neck Surgery
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