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rural surgery

Andrew J Thomas, Kristine A Smith, Christopher I Newberry, Brandon Cardon, Brock Davis, Zhining Ou, Angela P Presson, Jeremy D Meier, Jeremiah A Alt
BACKGROUND: Understanding the variation in costs of endoscopic sinus surgery (ESS) is critical to defining value. Current published costs of ESS have not identified potential sources of variation. Our objective was to analyze ESS costs to identify sources of variance that could guide value-improving decisions. METHODS: ESS cases (n = 1739) performed between 2008 and 2016 were identified from a database of 22 rural to tertiary facilities. Cost and time data were extracted from the database...
August 17, 2018: International Forum of Allergy & Rhinology
Aristithes G Doumouras, Fady Saleh, Dennis Hong
BACKGROUND: While high-volume Centers of Excellence (COE) for bariatric surgery may have improved clinical outcomes, their disparate distribution results in longer travel distances for patients. The purpose of this study was to investigate effect of distance from COE on outcomes and readmission. METHODS: This was a retrospective study of all adults, aged 18 years or older, receiving bariatric surgery from April 2009 to March 2012 in the province of Ontario. Main outcomes included 30-day complication rates and readmission...
August 16, 2018: Surgical Endoscopy
Shiyang Zhang, Ying Liu, Shumei Yun, Min Lian, Goldie Komaie, Graham A Colditz
BACKGROUND: To examine associations of neighborhood characteristics with treatment and outcomes of ductal carcinoma in situ of the breast (DCIS). METHODS: From the Missouri Cancer Registry, we identified 9,195 women with DCIS diagnosed between 1996 and 2011. A composite index using US Census data and American Community Survey data was developed to assess census tract-level socioeconomic deprivation, and rural-urban commuting area codes were used to define rural census tracts...
August 14, 2018: Cancer Epidemiology, Biomarkers & Prevention
Shanley B Deal, Mackenzie R Cook, Dorothy Hughes, Michael Sarap, Tyler G Hughes, Karen Brasel, Adnan A Alseidi
OBJECTIVE: The current shortage of surgeons in rural and smaller communities is predicted to get worse. In this study, we solicited practicing rural surgeons' opinions about the skill set needed in a rural practice in order to inform curriculum development for general surgery residents who intend to embark on rural careers. DESIGN: We developed an online survey consisting of demographic questions and closed- and open-ended questions regarding current practice environment and scope of practice...
August 9, 2018: Journal of Surgical Education
Franklin Dexter, Craig Jarvie, Richard H Epstein
STUDY OBJECTIVE: Our aim was to quantify the extent to which the distribution of patients among payers and changes to the payers' policies has influenced the market of surgery among hospitals in a relatively rural state. DESIGN: Retrospective cohort study. SETTING: Iowa Hospital Association data analyzed were from 2007 through 2016 for the N = 121 hospitals with at least one case performed that included a major therapeutic procedure. MEASUREMENTS: We used five categories of payer (e...
August 9, 2018: Journal of Clinical Anesthesia
Niresh Thapa, Muna Maharjan, Yan Xiong, Daqiong Jiang, Thi-Phuong Nguyen, Marcia A Petrini, Hongbing Cai
We aimed to assess the quality of life (QOL) of the patients with cervical cancer after initial treatment, the factors affecting QOL and their clinical relevance. A total of 256 patients with cervical cancer who visited Zhongnan Hospital of Wuhan University from January 2017 to December 2017 were enrolled in this study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 item (EORTC QLQ-C30) and cervical cancer module (EORTC QLQ-CX24) was used to assess the QOL of patients...
August 10, 2018: Scientific Reports
Alexander V Fisher, Stephanie A Campbell-Flohr, Laura Sell, Emily Osterhaus, Alexandra W Acher, Kristine Leahy-Gross, Maria Brenny-Fitzpatrick, Amy J H Kind, Pascale Carayon, Daniel E Abbott, Emily R Winslow, Caprice C Greenberg, Sara Fernandes-Taylor, Sharon M Weber
BACKGROUND: Transitional care protocols are effective at reducing readmission for medical patients, yet no evidence-based protocols exist for surgical patients. A transitional care protocol was adapted to meet the needs of patients discharged to home after major abdominal surgery. APPROACH: The Coordinated-Transitional Care (C-TraC) protocol, initially designed for medical patients, was used as the initial framework for the development of a surgery-specific protocol (sC-TraC)...
August 7, 2018: Joint Commission Journal on Quality and Patient Safety
Kathryn Beck, Angelique Mukantaganda, Scheilla Bayitondere, Richard Ndikuriyo, Almaque Dushimirimana, Vianney Bihibindi, Souzane Nyiranganji, Michel Habiyaremye, Jennifer Werdenberg
In low-resource settings, inpatient case fatality for severe acute malnutrition (SAM) remains high despite evidenced-based protocols and resources to treat SAM. Key reasons include a combination of insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment guidelines which are proven to reduce mortality. Checklists have been used in surgery and obstetrics to ameliorate similarly complicated yet repetitive work processes and may be a key strategy to improving inpatient SAM protocol adherence and reducing unnecessary death...
2018: Global Health Action
William Krause, Julio Bird
Robotic-assisted surgical procedures are being increasingly used in general surgery, including in the rural and community setting. Although there is no requirement, general surgery residency programs have begun to incorporate curriculums to train residents in this discipline. As a small rural community program, we recently instituted a voluntary and structured curriculum, and our initial experience is shared here. Our curriculum was voluntary for all general surgical residents for the academic years 2016-2017...
August 7, 2018: Journal of Robotic Surgery
J Gajewski, L Bijlmakers, G Mwapasa, E Borgstein, C Pittalis, R Brugha
OBJECTIVES: Surgical services at district level in Malawi are poor, yet the majority of the population resides in rural areas. This study aimed to explore the perceived obstacles to surgery from the perspective of the cadre directly responsible for surgical service delivery at district hospitals. METHODS: Qualitative interviews were conducted with 16 clinical officers (COs) receiving surgical training in 8 public district hospitals and their 12 trainers. Thematic analysis of data was conducted using a top-down coding method...
August 3, 2018: Tropical Medicine & International Health: TM & IH
Avi D Goodman, Joseph P Johnson, Justin E Kleiner, Joseph A Gil, Alan H Daniels
OBJECTIVES: Distal humerus fractures are challenging to treat, with significant morbidity. Precontoured distal humerus locking plates and total elbow arthroplasty implants have become available in the past 15 years, potentially offering the promise of improved outcomes. However, national data regarding the usage of and in-hospital complications associated with these implants is scarce. Therefore, we aimed to determine if the incidence of inpatients with distal humerus fractures treated with arthroplasty or open reduction and internal fixation (ORIF) changed over time...
August 3, 2018: Physician and Sportsmedicine
Aikaterini Charana, Gregory Tripsianis, Vasiliki Matziou, Georgios Vaos, Christos Iatrou, Pelagia Chloropoulou
Background: A surgical operation in pediatric patients is a rather stressful experience for both children and their parents. The aim of this study was to assess the effect of specific demographic characteristics in parent's and children's preoperative anxiety. Methods: The sample was composed of 128 Greek-speaking children (1-14 years of age) who had to undergo minor surgery in a University General Hospital. Before surgical operation, the Spielberger State-Trait Anxiety Inventory (STAI) questionnaire and a questionnaire for the social-demographic characteristics were completed by the parents...
2018: Anesthesiology Research and Practice
Thao Wolbert, Emilia C Leigh, Rahman Barry, Errington C Thompson, Todd Gress, Akash Ajmera, Amanda K Arrington
Although the overall rate of colorectal cancer (CRC) has remained stable, studies have shown an increase in the rate of CRC in young patients (<50) nationwide. We hypothesize that the rectal cancer (RC) rate in young people has increased in rural Appalachia. The goal is to provide insight into the future of RC epidemiology in underserved populations. This Institutional Review Board-approved retrospective study evaluated RC patients diagnosed in 2003 to 2016, and compared the ratio of early-onset RC to the state and national ratios using West Virginia State Cancer Registry, North American Association of Central Cancer Registries (NAACCR) and Surveillance, Epidemiology, and End Results Program Database...
July 1, 2018: American Surgeon
Muhammad Usman Hashmi, Mansoor Ali, Kaleem Ullah, Abdul Aleem, Iftikhar H Khan
Introduction Corrosive ingestion is a grave public health problem. It is a medical emergency and shows diverse clinical presentations. The ingestion of corrosive substances has devastating effects on upper gastrointestinal and respiratory tracts and the corrosive injury is associated with numerous life-threatening complications. The present study aims to explore the clinico-epidemiological characteristics of patients of corrosive ingestion presenting at a tertiary care hospital of Multan, Pakistan. Method The target study population consists of all the patients with primary diagnosis of corrosive ingestion who presented to the department of thoracic surgery, Nishtar Medical University Hospital Multan, Pakistan, from January 2016 to December 2017...
May 29, 2018: Curēus
Sethu Sheeladevi, John G Lawrenson, Alistair Fielder, Ramesh Kekunnaya, Rahul Ali, Rishi R Borah, Catherine Suttle
PURPOSE: Cataract is one of the major causes of avoidable visual disability in children and the aim of this study was to investigate the age at which children with cataract present for surgery at tertiary hospitals across India. METHODS: A prospective multicenter study collected data from 9 eye hospitals in 8 states in India. All children admitted for cataract surgery between Nov 2015 and March 2016 were considered eligible. Parents were interviewed at the hospital by trained personnel and socio demographic information, age at diagnosis and at surgery and the relevant clinical data were obtained from the medical records...
July 30, 2018: Eye
Mark J Ringstrom, Jay Christian, Matthew L Bush, Jeffrey E Levy, Bin Huang, T J Gal
OBJECTIVES: The objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting. METHODS: 6029 cases diagnosed from 2002 to 2011 were obtained from the state cancer registry. Travel time was calculated to the nearest academic medical centers, otolaryngologist, and radiation treatment facilities. Multivariate logistic regression was used to examine the association of travel time with stage of presentation as well as the likelihood of appropriate therapy after adjustment for other demographic variables...
June 28, 2018: American Journal of Otolaryngology
M Ellen Kuenzig, Mohsen Sadatsafavi, J Antonio Aviña-Zubieta, Rebecca M Burne, Michal Abrahamowicz, Marie-Eve Beauchamp, Gilaad G Kaplan, Eric I Benchimol
Purpose: Growing evidence suggests asthma and Crohn's disease commonly cooccur. However, the impact of asthma on the prognosis of Crohn's disease is unknown. The aim of our study was to assess the effect of asthma on the need for intestinal resection in patients with Crohn's disease while adjusting for smoking status, imputed from a smaller, secondary data set. Patients and methods: Using health administrative data from a universally funded healthcare plan in Alberta, Canada, we conducted a cohort study to assess the effect of asthma on the need for surgery in patients with Crohn's disease diagnosed between 2002 and 2008 (N=2,113)...
2018: Clinical Epidemiology
Chima A Osuoha, Karen E Callahan, Carmen P Ponce, Paulo S Pinheiro
BACKGROUND: Lung cancer accounts for the greatest proportion of cancer deaths in the United States. This study aims to characterize lung cancer survival by racial/ethnic group and ascertain any modifiable determinants of identified disparities in the newly diverse Mountain West by using the state of Nevada. MATERIALS AND METHODS: 12,964 first primary lung cancer cases diagnosed between 2003 and 2010 were identified for analysis from the Nevada Central Cancer Registry and followed for vital status until December 31, 2011...
August 2018: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Allison W Lorenzen, Boris Kiriazov, James P De Andrade, Ingrid M Lizarraga, Carol E Scott-Conner, Sonia L Sugg, Lillian M Erdahl, Wenqing Sun, Ronald J Weigel
BACKGROUND: Access to health care poses particular challenges for patients living in rural communities. Intraoperative radiotherapy (IORT) offers a treatment alternative to traditional whole-breast radiation therapy (WBRT) for select patients. This study aimed to analyze the use of IORT for patients undergoing breast-conserving surgery at an academic institution located in a rural state. METHODS: A retrospective review analyzed all patients at a single institution with a diagnosis of ductal carcinoma in situ (DCIS) or invasive breast cancer from April 2012 to January 2017 who were undergoing breast-conserving surgery with either IORT or WBRT...
July 20, 2018: Annals of Surgical Oncology
Sean McKee, Anthony Yang, Sarah Kidwai, Satish Govindaraj, Raj Shrivastava, Alfred Iloreta
BACKGROUND: Prolonged length of stay (pLOS), disease-related complications, and 30-day readmissions are important quality metrics under the Affordable Care Act. The purpose of our study was to investigate the effect of patient-level and hospital-level factors on these outcomes for patients admitted for transsphenoidal pituitary surgery. METHODS: The Statewide Planning and Research Cooperative System (SPARCS) database was queried to investigate 30-day readmissions and pLOS for transsphenoidal pituitary surgery in New York from 1995 to 2015...
July 14, 2018: International Forum of Allergy & Rhinology
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