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https://www.readbyqxmd.com/read/27914653/antithrombotic-therapy-after-bioprosthetic-aortic-valve-implantation-warfarin-versus-aspirin-a-randomized-controlled-trial
#1
Sulman Rafiq, Daniel Andreas Steinbrüchel, Nikolaj Bang Lilleør, Christian Holdflod Møller, Jens Teglgaard Lund, Jens Juel Thiis, Lars Køber, Peter Skov Olsen
BACKGROUND: The optimal medical strategy for prevention of thromboembolic events after surgical bioprosthetic aortic valve replacement (BAVR) is still debated. The objective of this study was to compare warfarin therapy (target INR of 2.0 to 3.0) with aspirin 150mg daily as antithrombotic therapy for the first three months after BAVR with or without concomitant coronary artery bypass grafting (CABG). The aim was to evaluate thromboembolic complications, major bleeding complications and death...
November 25, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/27913975/clinical-impact-of-an-antibiotic-stewardship-program-at-a-children-s-hospital
#2
Brian R Lee, Jennifer L Goldman, Diana Yu, Angela L Myers, Leslie M Stach, Erin Hedican, Mary Anne Jackson, Jason G Newland
INTRODUCTION: Antibiotic stewardship programs (ASP) improve appropriate antibiotic use. Data are limited on the clinical benefit of ASPs in children's hospitals. This study's objective was to determine the impact of an ASP on length of stay (LOS) and readmission rate among patients admitted to children's hospitals. METHODS: Data from a prospective-audit-with-feedback ASP were used to examine the ASP review characteristics, including antibiotic(s) prescribed, clinical indication, recommendations made by the ASP, and agreement with recommendations...
December 2, 2016: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/27909658/minimally-invasive-surgery-for-lumbar-synovial-cysts-with-coexisting-degenerative-spondylolisthesis
#3
Daniel R Denis, Daniel Hirt, Saumya Shah, Daniel C Lu, Langston T Holly
BACKGROUND: About one third of lumbar synovial cysts are associated with degenerative spondylolisthesis. Segmental instability is thought to contribute to the pathogenesis and recurrence of synovial cysts and lumbar fusion has been advocated as a treatment of choice in the presence of spondylolisthesis. In patients with spondylolisthesis, minimally invasive resection of lumbar synovial cysts, without fusion, could minimize surgically induced segmental instability while providing good pain relief...
2016: International Journal of Spine Surgery
https://www.readbyqxmd.com/read/27908945/norwood-procedure-for-palliation-of-hypoplastic-left-heart-syndrome-right-ventricle-to-pulmonary-artery-conduit-vs-modified-blalock-taussig-shunt
#4
Dorothy M Beke
Patients with hypoplastic left heart syndrome undergo a series of operations to separate the pulmonary and systemic circulations. The first of at least 3 operations occurs in the newborn period, with a stage I palliation. The goal of stage I palliation is to provide pulmonary blood flow and create an unobstructed systemic outflow tract. Advances in surgical techniques and intraoperative and postoperative care have helped decrease morbidity and mortality for patients with hypoplastic left heart syndrome who have the stage I Norwood operation, but the patients continue to be at increased risk for hemodynamic collapse and adverse outcomes...
December 2016: Critical Care Nurse
https://www.readbyqxmd.com/read/27905926/understanding-clinical-and-non-clinical-decisions-under-uncertainty-a-scenario-based-survey
#5
Vlad V Simianu, Margaret A Grounds, Susan L Joslyn, Jared E LeClerc, Anne P Ehlers, Nidhi Agrawal, Rafael Alfonso-Cristancho, Abraham D Flaxman, David R Flum
BACKGROUND: Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty...
December 1, 2016: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/27901412/oral-progestogens-versus-levonorgestrel-releasing-intrauterine-system-for-treatment-of-endometrial-intraepithelial-neoplasia
#6
Mary L Marnach, Kristina A Butler, Michael R Henry, Catherine E Hutz, Carrie L Langstraat, Christine M Lohse, Petra M Casey
BACKGROUND: Limited therapeutic guidelines exist regarding medical therapy, ideal dosing, duration of therapy, or recommendations for timing of endometrial reassessment for women with endometrial intraepithelial neoplasia (EIN) who desire fertility preservation or who are not optimal surgical candidates. We aimed to determine the effectiveness of oral progestogens (OP) versus the levonorgestrel-releasing intrauterine system (LNG IUS) in the medical treatment of EIN. METHODS: We retrospectively identified women with EIN at our institution from 2007 through 2014 and compared the outcomes of those treated with OP versus LNG IUS...
November 30, 2016: Journal of Women's Health
https://www.readbyqxmd.com/read/27896982/predictive-modeling-of-hospital-readmission-rates-using-electronic-medical-record-wide-machine-learning-a-case-study-using-mount-sinai-heart-failure-cohort
#7
Khader Shameer, Kipp W Johnson, Alexandre Yahi, Riccardo Miotto, L I Li, Doran Ricks, Jebakumar Jebakaran, Patricia Kovatch, Partho P Sengupta, Sengupta Gelijns, Alan Moskovitz, Bruce Darrow, David L David, Andrew Kasarskis, Nicholas P Tatonetti, Sean Pinney, Joel T Dudley
Reduction of preventable hospital readmissions that result from chronic or acute conditions like stroke, heart failure, myocardial infarction and pneumonia remains a significant challenge for improving the outcomes and decreasing the cost of healthcare delivery in the United States. Patient readmission rates are relatively high for conditions like heart failure (HF) despite the implementation of high-quality healthcare delivery operation guidelines created by regulatory authorities. Multiple predictive models are currently available to evaluate potential 30-day readmission rates of patients...
2016: Pacific Symposium on Biocomputing
https://www.readbyqxmd.com/read/27895521/impact-of-a-medical-university-on-laparoscopic-surgery-in-a-service-oriented-public-hospital-in-the-caribbean
#8
Shamir O Cawich, Suresh Pooran, Barbara Amow, Ernest Ali, Fawwaz Mohammed, Marlon Mencia, Samuel Ramsewak, Seetharaman Hariharan, Vijay Naraynsingh
INTRODUCTION: The Caribbean lags behind global trends for volume and complexity of laparoscopic operations. In an attempt to promote laparoscopy at a single facility, a partnership was formed between the University of the West Indies (UWI) and the Port of Spain General Hospital in Trinidad and Tobago. This study seeks to document the effect of this partnership on laparoscopic practice. MATERIALS AND METHODS: In this partnership, the UWI took the bold step of volunteering to staff a surgical team if the Ministry of Health provided the necessary legislative changes...
2016: Risk Management and Healthcare Policy
https://www.readbyqxmd.com/read/27893069/new-medical-and-surgical-insights-into-neonatal-necrotizing-enterocolitis-a-review
#9
Brandy L Frost, Biren P Modi, Tom Jaksic, Michael S Caplan
Importance: Necrotizing enterocolitis (NEC) has long remained a significant cause of morbidity and mortality in neonatal intensive care units. While the mainstay of treatment for this devastating condition remains largely supportive, research efforts continue to be directed toward understanding pathophysiology as well as how best to approach surgical management when indicated. Observations: In this review, we first examine recent medical observations, including overviews on the microbiome and a brief review of the use of probiotics...
November 21, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/27893019/occurrence-of-bruise-hematoma-and-pain-in-upper-blepharoplasty-using-blunt-needle-vs-sharp-needle-anesthetic-injection-in-upper-blepharoplasty-a-randomized-clinical-trial
#10
Wenxin Yu, Yunbo Jin, Jingyan Yang, Gang Ma, Yajing Qiu, Hui Chen, Xi Yang, Lei Chang, Xiaoxi Lin
Importance: Though it has been a common practice to use sharp needles to administer local anesthesia for upper blepharoplasty, the evidence for their benefit is lacking. Objective: To evaluate whether there is any benefit of using blunt-needle injection for local anesthesia when performing upper blepharoplasty to reduce postoperative bruise, hematoma, and pain. Design, Setting, and Participants: Randomized clinical trial of 44 patients who underwent bilateral upper blepharoplasty in an academic medical setting were randomized to receive local anesthesia injections (lidocaine, 2%; 27-gauge needle) with a blunt needle in one eyelid and a sharp needle in the other eyelid...
November 23, 2016: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/27892445/drainage-versus-no-drainage-after-elective-laparoscopic-cholecystectomy
#11
A Sharma, S N Gupta
Background Laparoscopic cholecystectomy is the gold standard for the surgical treatment of cholelithiasis. Routine drainage after elective LC is an issue of considerable debate. Objective To evaluate the advantages and disadvantages of drainage in patients undergoing Laparoscopic cholecystectomy. Method The study was conducted at the department of surgery in Nepalgunj Medical College and Teaching Hospital, Kohalpur between March 2013 and May 2014. During the period of study, sixty patients underwent laparoscopic cholecystectomy for symptomatic gall stone...
January 2016: Kathmandu University Medical Journal (KUMJ)
https://www.readbyqxmd.com/read/27890745/mini-open-thoracolumbar-corpectomy-perioperative-outcomes-and-hospital-cost-analysis-compared-to-open-corpectomy
#12
Olawale A R Sulaiman, Juanita Garces, Mansour Mathkour, Tyler Scullen, R Benson Jones, Teresa Arrington, Cuong J Bui
BACKGROUND: Standard open surgical management of thoracolumbar infection, trauma and tumor is associated with significant morbidity. Mini-open and less morbid surgical techniques are being introduced. Our objective is to compare perioperative and immediate post-operative morbidity of open and mini-open thoracolumbar corpectomy techniques including direct hospital costs. METHODS: We retrospectively reviewed the medical records of all patients who underwent open or mini-open corpectomy along with their demographics (age, sex, body mass index (BMI), primary diagnosis), operative data (length of surgery, EBL, blood transfusion-BT), surgical level, pre- and post-operative neurologic status (using ASIA scale), immediate peri-operative complications (within 30 days post-op), overall length of stay (LOS-A), length of stay from surgery (LOS-S), and total direct hospital costs were tabulated and analyzed...
November 24, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27890309/patterns-of-ninety-day-readmissions-following-total-joint-replacement-in-a-bundled-payment-initiative
#13
Omar A Behery, Benjamin S Kester, Jarrett Williams, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis...
November 1, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27888716/family-participation-in-intensive-care-unit-rounds-comparing-family-and-provider-perspectives
#14
Selena S Au, Amanda Roze des Ordons, Andrea Soo, Simon Guienguere, Henry T Stelfox
PURPOSE: To describe and compare intensive care unit (ICU) patient family member and provider experiences, preferences, and perceptions of family participation in ICU rounds. METHODS: Cross-sectional survey of ICU family members and providers of patients admitted to 4 medical-surgical ICUs from September 2014 to March 2015. MEASUREMENTS AND MAIN RESULTS: Surveys were completed by 63 (62%) family members and 258 (43%) providers. Provider respondents included physicians (9%), nurses (56%), respiratory therapists (24%), and other ICU team members (11%)...
November 4, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27888280/an-effective-new-intestinal-anastomosis-method
#15
Libin Yao, Chao Li, Xiaocheng Zhu, Yong Shao, Song Meng, Linsen Shi, Hui Wang
BACKGROUND This study aimed to establish an easy, safe, and cost-saving intestinal anastomotic method. MATERIAL AND METHODS Between January 2014 and February 2016, a total of 150 patients with gastric cancer who underwent surgery in the Department of General Surgery of Xuzhou Medical University Affiliated Hospital were divided into 2 groups: the treatment group (80) using new hand-sewn anastomoses, and the control group (70) using stapled anastomoses. Briefly, a new hand-sewn anastomosis of continuous suture without inversion was performed, with the first layer encompassing the entire layer of the intestinal wall...
November 26, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27887951/a-multi-institutional-comparison-of-clinicopathologic-characteristics-and-oncologic-outcomes-of-upper-tract-urothelial-carcinoma-in-china-and-the-united-states
#16
Nirmish Singla, Dong Fang, Xiaohong Su, Zhengqing Bao, Zhenpeng Cao, Syed M Jafri, Gengyan Xiong, Lei Zhang, Ryan Hutchinson, Arthur Sagalowsky, Yair Lotan, Xuesong Li, Liqun Zhou, Jay D Raman, Vitaly Margulis
PURPOSE: To evaluate differences in clinicopathologic characteristics and oncologic outcomes between upper-tract urothelial carcinoma (UTUC) patients in China and the United States (U.S.). METHODS: Clinicopathologic and oncologic outcomes data of UTUC patients treated surgically at tertiary care medical facilities in the U.S. or China from 1998-2015 were retrospectively compiled. Baseline demographics, comorbidities, and pathologic features were evaluated. Oncologic endpoints including intravesical recurrence and cancer-specific survival (CSS) were obtained following exclusion of patients who received systemic chemotherapy...
November 22, 2016: Journal of Urology
https://www.readbyqxmd.com/read/27884858/hemicraniectomy-versus-medical-treatment-with-large-mca-infarct-a-review-and-meta-analysis
#17
Paul Alexander, Diane Heels-Ansdell, Reed Siemieniuk, Neera Bhatnagar, Yaping Chang, Yutong Fei, Yuqing Zhang, Shelley McLeod, Kameshwar Prasad, Gordon Guyatt
OBJECTIVE: Large middle cerebral artery stroke (space-occupying middle-cerebral-artery (MCA) infarction (SO-MCAi)) results in a very high incidence of death and severe disability. Decompressive hemicraniectomy (DHC) for SO-MCAi results in large reductions in mortality; the level of function in the survivors, and implications, remain controversial. To address the controversy, we pooled available randomised controlled trials (RCTs) that examined the impact of DHC on survival and functional ability in patients with large SO-MCAi and cerebral oedema...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27884802/association-between-flexible-duty-hour-policies-and-general-surgery-resident-examination-performance-a-flexibility-in-duty-hour-requirement-for-surgical-trainees-first-trial-analysis
#18
Eddie Blay, D Brock Hewitt, Jeanette W Chung, Thomas Biester, James F Fiore, Allison R Dahlke, Christopher M Quinn, Frank R Lewis, Karl Y Bilimoria
BACKGROUND: Concerns persist about the effect of current duty hour reforms on resident educational outcomes. We investigated whether a flexible, less-restrictive duty hour policy (Flexible Policy) was associated with differential general surgery examination performance compared to current Accreditation Council for Graduate Medical Education (ACGME) duty hour policy (Standard Policy). STUDY DESIGN: We obtained examination scores on the American Board of Surgery (ABS) In-Training Examination (ABSITE), Qualifying Examination (QE, written boards), and Certifying Examination (CE, oral boards) for residents in 117 general surgery residency programs that participated in the Flexibility In Duty Hour Requirements for Surgical Trainees (FIRST) Trial...
November 8, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884418/heterotopic-ossification-prophylaxis-after-total-hip-arthroplasty-randomized-trial-of-400-vs-700-cgy
#19
Jane Z Liu, Nicholas B Frisch, Regina M Barden, Aaron G Rosenberg, Craig D Silverton, Jorge O Galante
BACKGROUND: Heterotopic ossification (HO) is a known complication following total hip arthroplasty. Radiation is an effective prophylaxis, but an optimal protocol has yet to be determined. We performed a randomized, double-blinded clinical trial in high-risk patients to determine the efficacy of 400 vs 700 cGy doses of radiation. METHODS: One hundred forty-seven patients undergoing total hip arthroplasty and at high risk for HO at an urban medical center were randomized to receive either a single 400 or 700 cGy dose of radiation postoperatively...
November 1, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27882418/compliance-with-guidelines-of-enhanced-recovery-after-surgery-in-elderly-patients-undergoing-gastrectomy
#20
Oh Jeong, Young Kyu Park, Mi Ran Jung, Seong Yeob Ryu
BACKGROUND: Enhanced recovery after surgery (ERAS) aims at expediting postoperative recovery by implementing specific strategies in perioperative management. However, the tolerance to such fast-tracking protocols is under debate, especially in elderly patients. We aimed to investigate rate of compliance with the main ERAS guidelines in elderly gastrectomy patients. METHODS: Using data for 168 gastric cancer patients who underwent ERAS after gastrectomy as part of Clinical Trial NCT01653496, we calculated the rates of compliance with nine main ERAS guidelines and compared the compliance rates of elderly (≥70 years) and non-elderly (<70 years) patients...
November 23, 2016: World Journal of Surgery
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