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https://www.readbyqxmd.com/read/28944933/emergency-department-management-of-body-packers-and-body-stuffers
#1
Liv Heymann-Maier, Lionel Trueb, Sabine Schmidt, Pierre-Nicolas Carron, Olivier Hugli, Eric Heymann, Bertrand Yersin
Trafficking and sale of narcotics frequently involves the intra-abdominal transport of large quantities of drugs, usually cocaine or heroin ("body packing"), or, when there is a risk of being arrested, the oral ingestion of minor quantities of narcotics dedicated for immediate resale ("body stuffing"). This study aimed to describe the characteristics, complications and medical follow through of 132 cases of body packing (n = 36), cases of body stuffing (n = 83) or mixed cases (n = 13), referred by the authorities to our emergency department over the course of 12 years...
September 25, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28944703/hospital-costs-for-patients-with-lower-extremity-cellulitis-a-retrospective-population-based-study
#2
Douglas Challener, Jasmine Marcelin, Sue Visscher, Larry Baddour
BACKGROUND: Hospital admissions for non-purulent lower extremity cellulitis (NLEC) are common and can be prolonged and costly. Newer treatment options and preventive strategies are expected to result in cost savings before implementation, but few studies have quantified the cost of conventional treatment. METHODS: Using the Rochester Epidemiology Project, the incidence of NLEC in Olmsted County, MN in 2013 was 176.6 per 100,000 persons. The subset of patients who required hospitalization for NLEC in 2013 was determined...
September 23, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28944141/nationwide-trends-of-hospitalizations-for-cystic-fibrosis-in-the-united-states-from-2003-to-2013
#3
Abhinav Agrawal, Abhishek Agarwal, Dhruv Mehta, Rutuja R Sikachi, Doantrang Du, Janice Wang
Cystic fibrosis (CF) is a multisystem autosomal recessive genetic disorder with significant advances in early diagnosis and treatment in the last decade. It is important to provide updated information regarding these changing demographics as they also reflect a considerable improvement in survival. We analyzed the National Inpatient Sample Database (NIS) in the United States for all patients in which CF was the primary discharge diagnosis (ICD-9: 277.0-277.09) from 2003 to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with CF along with other epidemiological findings...
August 2017: Intractable & Rare Diseases Research
https://www.readbyqxmd.com/read/28943822/decreasing-the-time-to-oral-antibiotics-in-a-university-hospital-pediatric-emergency-department
#4
R Zachary Thompson, Brian Gardner, Thomas Carter, Aric Schadler, Joye Allen, Abby Bailey
OBJECTIVES: To compare time to administration of oral antibiotics in the pediatric emergency department (ED) when antibiotics are stored in the pediatric ED versus when they were dispensed by central pharmacy services within an academic medical center. METHODS: This was a retrospective review of patients who received a one-time dose of oral antibiotics within the pediatric ED and were subsequently discharged home. Two 3-month time periods were compared to determine the metrics of providing oral antibiotics before and after these medications were stocked in the pediatric ED automated dispensing cabinet (ADC)...
July 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28943820/clinical-outcomes-with-continuous-nafcillin-infusions-in-children
#5
Chad A Knoderer, Lauren C Karmire, Kristen R Nichols
OBJECTIVES: The primary objective of this study was to describe the clinical outcomes of continuous nafcillin infusion in pediatric patients. METHODS: This was a retrospective case study performed at a freestanding, tertiary care children's hospital. Subjects were included if they were at least 30 days old and had received more than 1 dose of nafcillin by continuous infusion (CI) between January 1, 2009, and December 31, 2012. Clinical and microbiological data were extracted from the medical record...
July 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28943420/impact-of-hospital-caseload-and-elective-admission-on-outcomes-following-extracranial-intracranial-bypass-surgery
#6
Hesam Akbarian-Tefaghi, Piyush Kalakoti, Hai Sun, Kanika Sharma, Jai Deep Thakur, Devi Prasad Patra, Rimal H Dossani, Amey Savardekar, Christina Notarianni, Gregory J Zipfel, Anil Nanda
BACKGROUND: Limited information exists evaluating the impact of hospital caseload and elective admission on outcomes following patients undergoing extracranial-intracranial (ECIC) bypass surgery. Using the Nationwide Inpatient Sample (NIS) for the years 2001 through 2014, we evaluated the impact of hospital caseload and elective admission on outcomes following bypass. METHODS: In an observational cohort study, weighted estimates were used to investigate the association of hospital caseload and elective admission on short-term outcomes following bypass surgery using multivariable regression techniques...
September 21, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28943371/the-comparative-effectiveness-of-treatments-for-ureteropelvic-junction-obstruction
#7
Bruce L Jacobs, Julie C Lai, Rachana Seelam, Janet M Hanley, J Stuart Wolf, Brent K Hollenbeck, John M Hollingsworth, Andrew W Dick, Claude M Setodji, Christopher S Saigal
OBJECTIVE: To examine the effectiveness of the three primary treatments for ureteropelvic junction obstruction (i.e., open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates. MATERIALS AND METHODS: Using MarketScan(®) data, we identified adults (ages 18-64) who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was failure (i.e., need for a secondary procedure). We fit a Cox proportional hazards model to examine the effects of different patient, regional, and provider characteristics on treatment failure...
September 21, 2017: Urology
https://www.readbyqxmd.com/read/28943272/clinical-outcomes-of-the-upper-urinary-tract-after-ureteral-clipping-for-the-treatment-of-low-or-non-functioning-renal-moieties
#8
Roberto Iglesias Lopes, Nicolas Fernandez, Martin A Koyle, Joana Dos Santos, Jaime Perez, Rodrigo Romao, Armando J Lorenzo
PURPOSE: A growing body of evidence suggest it is safe to ligate the ureter of poorly functioning renal moieties during renal transplantation. Herein, we present clinical outcomes and data on hydronephrosis progression in pediatric cases associated with ectopic ureters and obstructive ureteroceles. MATERIAL AND METHODS: Prospective data collection on 35 consecutive patients (23 female, 12 male) who underwent ureteral clipping between 02/2011 and 08/2016. Patients were divided in four groups [I: duplex system (DS) with ectopic ureter (45...
September 21, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28943213/evaluating-the-feasibility-of-phrenoesophagopexy-during-hiatal-hernia-repair-in-sleeve-gastrectomy-patients
#9
Nathaniel R Ellens, Joshua E Simon, Kimberly D Kemmeter, Tyler W Barreto, Paul R Kemmeter
BACKGROUND: Both hiatal hernias (HH) and morbid obesity significantly contribute to gastroesophageal reflux disease, which increases the risk for esophagitis and esophageal cancer. Therefore, concomitant HH repair is recommended during bariatric surgery procedures. Unfortunately, recurrence of HH after repair is not uncommon and the optimal surgical technique has yet to be established. OBJECTIVE: To evaluate the feasibility of recreating the phrenoesophageal ligaments by adding phrenoesophagopexy to HH repair during sleeve gastrectomy...
August 26, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28943178/factors-associated-with-degree-of-tumour-response-to-neo-adjuvant-radiotherapy-in-rectal-cancer-and-subsequent-corresponding-outcomes
#10
K J Gash, O Baser, R P Kiran
BACKGROUND: Tumour response to neo-adjuvant radiotherapy for rectal cancer varies significantly between patients, as classified by Tumour Regression Grade (TRG 0-3), with 0 equating to pathological complete response (pCR) and 3 denoting minimal/no response. pCR is associated with significantly better local recurrence rates and survival, but is achieved in only 20-30% of patients. The literature contains limited data reporting factors predictive of tumour response and corresponding outcomes according to degree of regression...
August 10, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28943077/evaluation-of-an-evidence-based-throat-pain-protocol-to-reduce-left-without-being-seen-length-of-stay-and-antibiotic-prescribing
#11
Deanna Settelmeyer
BACKGROUND: Increasing numbers of people are seeking unscheduled medical care in United States' emergency departments, which contributes to delayed throughput and increased patient length of stay. Implementation of nurse-initiated protocols, such as those for throat pain, initiates early diagnostic testing, optimizes patient throughput strategies, and promotes adherence to clinic practice guidelines for an additional segment of patients. AIM: To evaluate the effect of an evidence-based throat-pain protocol...
September 21, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28943063/outpatient-laparoscopic-appendectomy-can-be-successfully-performed-for-uncomplicated-appendicitis-a-southwestern-surgical-congress-multicenter-trial
#12
Richard Frazee, Clay Cothren Burlew, Justin Regner, Robert McIntyre, Erik Peltz, Chris Cribari, Julie Dunn, Larry Butler, Paul Reckard, Sharmila Dissanaike, Karen Karimi, Charles Behnfield, Nic Melo, Daniel Margulies
BACKGROUND: Many laparoscopic procedures are now performed on an outpatient basis. We hypothesize laparoscopic appendectomy can be safely performed as an outpatient procedure. METHODS: Seven institutions adopted a previously described outpatient laparoscopic appendectomy protocol for uncomplicated appendicitis. Patients were dismissed unless there was a clinical indication for admission. Patient demographics, success with outpatient management, time of dismissal, morbidity, and readmissions were analyzed...
September 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28942777/optimizing-an-enhanced-recovery-pathway-program-development-of-a-postimplementation-audit-strategy
#13
Michael C Grant, Daniel J Galante, Deborah B Hobson, Annette Lavezza, Michael Friedman, Christopher L Wu, Elizabeth C Wick
BACKGROUND: Enhanced recovery pathways (ERPs) are bundled best-practice process measures associated with reduction of preventable harm, decreased length of stay (LOS), and increased overall value of care. An auditing procedure was developed to assess compliance with 18 ERP process measures and establish a system for identifying and addressing defects in measure implementation. METHODS: For a one-year period, the electronic health records of 413 consecutive patients treated on a multidisciplinary ERP for colorectal surgery at an academic medical center were evaluated with the audit procedure...
October 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28942708/laparoscopic-roux-en-y-gastric-bypass-in-elderly-patients-60%C3%A2-years-or-older-a-meta-analysis-of-comparative-studies
#14
S Giordano, M Victorzon
BACKGROUND AND AIMS: Elderly patient might experience an increased risk of complications after laparoscopic Roux-en-Y gastric bypass. We aimed to perform a meta-analysis of comparative studies on this issue in patients aged 60 years or older. MATERIAL AND METHODS: A systematic literature search was performed. Medline, Cochrane Library, Embase, Scopus, and Google Scholar were searched until July 2016 for studies on outcomes of laparoscopic Roux-en-Y gastric bypass in elderly versus younger patients...
September 1, 2017: Scandinavian Journal of Surgery: SJS
https://www.readbyqxmd.com/read/28941929/minimizing-variance-in-care-of-pediatric-blunt-solid-organ-injury-through-utilization-of-a-hemodynamic-driven-protocol-a-multi-institution-study
#15
Aaron J Cunningham, Katrine M Lofberg, Sanjay Krishnaswami, Marilyn W Butler, Kenneth S Azarow, Nicholas A Hamilton, Elizabeth A Fialkowski, Pamela Bilyeu, Erika Ohm, Erin C Burns, Margo Hendrickson, Preetha Krishnan, Cynthia Gingalewski, Mubeen A Jafri
BACKGROUND: An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. METHODS: Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation...
September 4, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28941725/day-versus-night-laparoscopic-cholecystectomy-for-acute-cholecystitis-a-comparison-of-outcomes-and-cost
#16
Sammy S Siada, Shaina S Schaetzel, Allen K Chen, Huy D Hoang, Fatima G Wilder, Rachel C Dirks, Krista L Kaups, James W Davis
BACKGROUND: Recent studies have suggested higher complication and conversion to open rates for nighttime laparoscopic cholecystectomy (LC) and recommend against the practice. We hypothesize that patients undergoing night LC for acute cholecystitis have decreased hospital length of stay and cost with no difference in complication and conversion rates. METHODS: A retrospective review of patients with acute cholecystitis who underwent LC from October 2011 through June 2015 was performed...
September 18, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28941593/laparoendoscopic-single-site-nephrectomy-in-children-is-it-a-good-alternative-to-conventional-laparoscopic-approach
#17
Belén Aneiros Castro, Daniel Cabezalí Barbancho, Cristina Tordable Ojeda, Isabel Carrillo Arroyo, Jesús Redondo Sedano, Andrés Gómez Fraile
BACKGROUND: Minimally invasive surgery is considered to be the gold standard treatment for nephrectomy in children. In recent decades it has been proposed that laparoendoscopic single-site (LESS) surgery is a feasible alternative to perform laparoscopic nephrectomies. OBJECTIVE: The aim of our study was to compare the safety and efficacy of LESS against conventional laparoscopic (CL) nephrectomy. STUDY DESIGN: From March 2010 to November 2012 charts of pediatric patients who underwent laparoscopic nephrectomy at our tertiary center were revised...
August 24, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28941539/delirium-in-pediatric-critical-care
#18
REVIEW
Anita K Patel, Michael J Bell, Chani Traube
Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment. Pediatric delirium is strongly associated with poor outcomes, including increased mortality, prolonged intensive care unit length of stay, longer time on mechanical ventilation, and increased cost of care...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941139/comparative-outcomes-of-transcatheter-aortic-valve-replacement-in-african-american-and-caucasian-patients-with-severe-aortic-stenosis
#19
Fahad Alqahtani, Sami Aljohani, Ahmad Almustafa, Mohammed Alhijji, Oluseun Ali, David R Holmes, Mohamad Alkhouli
BACKGROUND: Racial disparities in cardiovascular care have been extensively investigated. The introduction of transcatheter aortic valve replacement (TAVR) revolutionized the treatment of aortic stenosis (AS) in the last decade. Whether a racial disparity in the utilization and outcome of TAVR exists is unknown. METHODS: We utilized the nationwide inpatient sample (NIS) to compare utilization rates, and in-hospital outcomes of Caucasians and African American (AA) patients who underwent TAVR between August 2011 and December 2014...
September 23, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28940032/the-impact-of-22q11-2-microdeletion-on-cardiac-surgery-postoperative-outcome
#20
Goran Cuturilo, Danijela Drakulic, Ida Jovanovic, Slobodan Ilic, Jasna Kalanj, Irena Vulicevic, Misela Raus, Dejan Skoric, Marija Mijovic, Biljana Medjo, Snezana Rsovac, Milena Stevanovic
22q11.2 microdeletion is the most common microdeletion in humans. The purpose of this study was to evaluate postoperative outcome in children with 22q11.2 microdeletion who had undergone complete surgical correction of a congenital heart defect. The study included 34 patients who underwent complete correction of conotruncal heart defects. Of these, 17 patients diagnosed with 22q11.2 microdeletion represent the investigated group. Another 17 patients without 22q11.2 microdeletion represent the control group...
September 22, 2017: Pediatric Cardiology
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