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Gaurav Sharma, Danny Wong, Dean J Arnaoutakis, Samir K Shah, Alice O'Brien, Stanley W Ashley, C Keith Ozaki
OBJECTIVE: Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and postanesthesia care unit, delayed time to treatment, increased in-hospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics...
September 19, 2016: Journal of Vascular Surgery
Dean J Arnaoutakis, Martin Zammert, Alan Karthikesalingam, Michael Belkin
Endovascular repair of abdominal aortic aneurysms is an important technique in the vascular surgeon's armamentarium, which has created a seismic shift in the management of aortic pathology over the past two decades. In comparison to traditional open repair, the endovascular approach is associated with significantly improved perioperative morbidity and mortality. The early survival benefit of endovascular abdominal aortic aneurysm repair is sustained up to 3 years postoperatively, but longer-term life expectancy remains poor regardless of operative modality...
September 2016: Best Practice & Research. Clinical Anaesthesiology
George J Arnaoutakis, Wilson Y Szeto
No abstract text is available yet for this article.
August 28, 2016: Journal of Thoracic and Cardiovascular Surgery
Issam Makhoul, Pooja Motwani, Liudmila Schafer, Konstantinos Arnaoutakis, Fade Mahmoud, Mazin Safar, Dorothy Graves, Paulette Mehta, Rang Govindarajan, Laura Hutchins, Carol Thrush
New educational methods and structures to improve medical education are needed to face the challenge of an exponential increase and complexity of medical knowledge. Collaborative learning has been increasingly used in education, but its use in medical training programs is in its infancy, and its impact is still unknown; the role of competition in education is more controversial. We introduced these pedagogical methods to the hematology/oncology fellowship program at the University of Arkansas for Medical Sciences to improve attendance and performance at didactic activities and different educational outcomes...
August 12, 2016: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
George J Arnaoutakis, Wilson Y Szeto
No abstract text is available yet for this article.
November 2016: Journal of Thoracic and Cardiovascular Surgery
George J Arnaoutakis, David Blitzer, Stephanie Fuller, Aaron W Eckhauser, Lisa M Montenegro, Joseph W Rossano, J William Gaynor
BACKGROUND: Circulatory failure necessitating cardiac transplantation will ultimately develop in many patients with functional single-ventricle physiology. Interest in the use of mechanical circulatory support (MCS) in this population is growing. METHODS: This was a retrospective case series of patients with functional single-ventricle physiology who underwent MCS with a ventricular assist device or a total artificial heart as a bridge to cardiac transplantation between January 2006 and December 2014...
July 14, 2016: Annals of Thoracic Surgery
Fade Mahmoud, Al-Ola Abdallah, Konstantinos Arnaoutakis, Issam Makhoul
INTRODUCTION: Metastatic renal cell carcinoma (RCC) to the head and neck is rare. It is the third-most common cause of distant metastasis to the head and neck, after breast cancer and lung cancer. Several drugs are available to treat metastatic RCC including high-dose interleukin and targeted therapy. Immunotherapy with nivolumab was recently approved by the US Food and Drug Administration (FDA) as a second-line treatment for patients with metastatic RCC. CASE PRESENTATION: We present a case of metastatic RCC in a 71-year-old man with a single complaint of a 1-year history of pain while chewing food...
2016: Permanente Journal
George J Arnaoutakis, Wilson Y Szeto
No abstract text is available yet for this article.
July 2016: Journal of Thoracic and Cardiovascular Surgery
George J Arnaoutakis, Prashanth Vallabhajosyula, Joseph E Bavaria, Ibrahim Sultan, Mary Siki, Suveeksha Naidu, Rita K Milewski, Matthew L Williams, W Clark Hargrove, Nimesh D Desai, Wilson Y Szeto
BACKGROUND: There remains concern that moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion (ACP) may provide suboptimal distal organ protection compared with deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). We compared postoperative acute kidney injury (AKI) in in patients who underwent elective hemiarch repair with either DHCA/RCP or MHCA/ACP. METHODS: This was a retrospective review of all patients undergoing elective aortic hemiarch reconstruction for aneurysmal disease between 2009 and 2014...
October 2016: Annals of Thoracic Surgery
Moustafa Mourad, Demetri Arnaoutakis, Raja Sawhney, David Chan, Yadranko Ducic
This article aims to review the use of giant bilobed flaps in the reconstruction of various large defects within the head and neck. A single case series study with chart review was performed. Various facial, neck, and mentum defects were documented, and closure was accomplished through a variety of medially and laterally based giant bilobed flaps. Preoperative and postoperative photography, as well as intraoperative planning, was performed. A total of 23 patients were able to achieve closure of facial, head, and neck defects with single-stage closure through the use of a giant bilobed flap...
June 2016: Facial Plastic Surgery: FPS
George J Arnaoutakis, Wilson Y Szeto
No abstract text is available yet for this article.
July 2016: Journal of Thoracic and Cardiovascular Surgery
Rahul Ravilla, Amy K Joiner, Daisy Alapat, Konstantinos Arnaoutakis
No abstract text is available yet for this article.
March 2016: American Journal of the Medical Sciences
Brandyn D Lau, George J Arnaoutakis, Michael B Streiff, Isaac W Howley, Katherine E Poruk, Robert Beaulieu, Trevor A Ellison, Kyle J Van Arendonk, Peggy S Kraus, Deborah B Hobson, Christine G Holzmueller, James H Black, Peter J Pronovost, Elliott R Haut
OBJECTIVE: To investigate the effect of providing personal clinical effectiveness performance feedback to general surgery residents regarding prescription of appropriate venous thromboembolism (VTE) prophylaxis. BACKGROUND: Residents are frequently charged with prescribing medications for patients, including VTE prophylaxis, but rarely receive individual performance feedback regarding these practice habits. METHODS: This prospective cohort study at the Johns Hopkins Hospital compared outcomes across 3 study periods: (1) baseline, (2) scorecard alone, and (3) scorecard plus coaching...
November 25, 2015: Annals of Surgery
Vidya B Pai, Rahul Ravilla, Matthew Lindberg, Matthew Steliga, Konstantinos Arnaoutakis
Myxoid mesenchymal tumours are a heterogeneous group of neoplasms characterised histologically by their abundant mucoid and myxoid extracellular matrix (ECM). Encompassing a broad spectrum of clinical behaviour ranging from benign to malignant, there are more than 60 reactive and neoplastic entities currently classified under its domain. Its varied clinical and histopathologic features continue to pose a diagnostic challenge to clinicians and pathologists. Here, we describe a rare case of myxoid mesenchymal tumour presenting as oedema of the upper extremity with pleural metastasis and partial response to chemotherapy, which to the best of our knowledge has not yet been described in the literature...
2015: Ecancermedicalscience
Demetri Arnaoutakis, Iman Naseri
Objectives Oncogenic osteomalacia is a paraneoplastic syndrome in which the tumor secretes a peptide-like hormone, fibroblast growth factor, resulting in urinary loss of phosphates. Methods We present the case of a 50-year-old woman with a benign phosphaturic mesenchymal tumor (PMT) involving the ethmoid sinus with obstruction of the ostiomeatal complex causing unilateral nasal airway obstruction. Results The tumor was initially thought to be an esthesioneuroblastoma based on primary pathology interpretation and on clinical and radiographic appearance...
November 2015: Journal of Neurological Surgery Reports
Arman Kilic, Dean J Arnaoutakis, Thomas Reifsnyder, James H Black, Christopher J Abularrage, Bruce A Perler, Ying Wei Lum
Infections of vascular grafts are associated with significant mortality and morbidity risk and cost an estimated $640 million annually in the United States. Clinical presentation varies by time elapsed from implantation and by surgical site. A thorough history and physical examination in conjunction with a variety of imaging modalities is often essential to diagnosis. For infected aortic grafts, there are several options for treatment, including graft excision with extra-anatomic bypass, in situ reconstruction, or reconstruction with the neo-aortoiliac system...
February 2016: Vascular Medicine
Murat Gokden, Aurelio Ariza, Konstantinos Arnaoutakis
No abstract text is available yet for this article.
2015: BioMed Research International
Meghana Bansal, Al-Ola Abdallah, Angela Pennisi, Konstantinos Arnaoutakis, Issam Makhoul, Paulette Mehta
Using the standardized ASCO Quality Oncology Practice Initiative (QOPI) guidelines for assessing quality cancer care, we identified communication about intent of chemotherapy as an area needing improvement in our program at the University of Arkansas for Medical Sciences (UAMS) and the Central Arkansas Veterans Healthcare System (CAVHS). We organized training in communications on intent of treatment (palliative vs curative) and added optional checkboxes to our electronic templates for progress notes. Afterwards, we conducted a retrospective review of electronic medical records of initially often randomly selected patient charts...
December 2016: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
Arman Kilic, Ibrahim S Sultan, George J Arnaoutakis, Robert S D Higgins, Ahmet Kilic
BACKGROUND: In this study we derive and validate a composite risk index termed the Assessment of Thoracic Endografting Operative Mortality, or ATOM, risk score. METHODS: All thoracic endovascular aortic repairs (TEVAR) in the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) between 2005 and 2012 were identified. The primary outcome was operative mortality. After evaluating the association of over 60 preoperative variables and operative mortality in univariate analysis, a multivariable model was developed...
September 2015: Annals of Thoracic Surgery
Tammam Obeid, Dean J Arnaoutakis, Isibor Arhuidese, Umair Qazi, Christopher J Abularrage, James Black, Bruce Perler, Mahmoud Malas
BACKGROUND: Whereas carotid endarterectomy (CEA) remains the "gold standard" treatment, given its low complication rate, carotid artery stenting (CAS) has emerged as a valid alternative in patients with prohibitive surgical risks. However, the application of CAS has been scrutinized, given its increased perioperative risk in comparison to CEA. Operators follow general guidelines in intraoperative techniques in CAS. However, few of those are evidence based. We believe that a specific outcome-driven examination of the effect of pre- and poststent deployment ballooning is warranted...
September 2015: Journal of Vascular Surgery
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