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Effect of specialization on surgery Quality

Jeffrey L Carson, Simon J Stanworth, Nareg Roubinian, Dean A Fergusson, Darrell Triulzi, Carolyn Doree, Paul C Hebert
BACKGROUND: There is considerable uncertainty regarding the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients. Blood is a scarce resource, and in some countries, transfusions are less safe than others because of a lack of testing for viral pathogens. Therefore, reducing the number and volume of transfusions would benefit patients. OBJECTIVES: The aim of this review was to compare 30-day mortality and other clinical outcomes in participants randomized to restrictive versus liberal red blood cell (RBC) transfusion thresholds (triggers) for all conditions...
October 12, 2016: Cochrane Database of Systematic Reviews
Dimitrios Kloukos, Piotr Fudalej, Patrick Sequeira-Byron, Christos Katsaros
BACKGROUND: Cleft lip and palate is one of the most common birth defects and can cause difficulties with feeding, speech and hearing, as well as psychosocial problems. Treatment of orofacial clefts is prolonged; it typically commences after birth and lasts until the child reaches adulthood or even into adulthood. Residual deformities, functional disturbances, or both, are frequently seen in adults with a repaired cleft. Conventional orthognathic surgery, such as Le Fort I osteotomy, is often performed for the correction of maxillary hypoplasia...
September 30, 2016: Cochrane Database of Systematic Reviews
Jann Arends, Patrick Bachmann, Vickie Baracos, Nicole Barthelemy, Hartmut Bertz, Federico Bozzetti, Ken Fearon, Elisabeth Hütterer, Elizabeth Isenring, Stein Kaasa, Zeljko Krznaric, Barry Laird, Maria Larsson, Alessandro Laviano, Stefan Mühlebach, Maurizio Muscaritoli, Line Oldervoll, Paula Ravasco, Tora Solheim, Florian Strasser, Marian de van der Schueren, Jean-Charles Preiser
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment...
August 6, 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Corinna Storz, Tobias Geisler, Mike Notohamiprodjo, Konstantin Nikolaou, Fabian Bamberg
Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment alternative in patients with severe aortic stenosis (AS) who are deemed surgically high-risk or ineligible for surgery. Pre-procedural imaging, in particular computed tomography (CT), plays an integral part in the planning and performance of TAVR and is crucial for a successful treatment. Novel technological advances in CT include high-pitch, low kV acquisitions, and iterative reconstruction resulting in high image quality at substantially reduced scan duration, contrast volume, and radiation exposure...
October 2016: Current Treatment Options in Cardiovascular Medicine
Alexander Rolevich, Alexander Minich, Tatiana Nabebina, Sergey Polyakov, Sergey Krasny, Oleg Sukonko
INTRODUCTION: One of the factors responsible for the risk of recurrence after complete transurethral resection of the bladder tumor (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC) is the quality of surgery that may vary between individual surgeons. The aim of the study was to evaluate the impact of the surgeon on recurrence-free survival in patients with NMIBC. MATERIAL AND METHODS: The long-term results of a series of consecutive TURBTs performed by five staff urologists at a single institution were retrospectively analyzed...
2016: Central European Journal of Urology
Tina W F Yen, Jianing Li, Rodney A Sparapani, Purushuttom W Laud, Ann B Nattinger
BACKGROUND: Several surgeon characteristics are associated with the use of sentinel lymph node biopsy (SLNB) for breast cancer. No studies have systematically examined the relative contribution of both surgeon and hospital factors on receipt of SLNB. OBJECTIVE: To evaluate the relationship between surgeon and hospital characteristics, including a novel claims-based classification of hospital commitment to cancer care (HC), and receipt of SLNB for breast cancer, a marker of quality care...
August 2016: Medicine (Baltimore)
Marielle A Amoli, John M Flynn, Eric W Edmonds, Michael P Glotzbecker, Derek M Kelly, Jeffrey R Sawyer
BACKGROUND: Although the number of women in surgical specialties has increased dramatically over the past two decades, little research exists regarding how a surgeon's gender impacts job selection and practice models. Because the number of women specializing in pediatric orthopaedics continues to increase, it is important to understand how one's gender affects practice choices and how this may affect the future workforce. QUESTIONS/PURPOSES: (1) Among pediatric orthopaedic surgeons, is gender associated with choice of practice type (academic, private practice, hospital-based, solo)? (2) For men and women, what are the most common reasons for choosing a job? (3) For new graduates, do men and women have equal starting salaries? (4) Do men have a higher chance of getting job offers? (5) Is there a difference in workload (call frequency and surgical case volume) for men and women? (6) Finally, is there a difference in imminent retirement plans for men and women? METHODS: The 2015 Pediatric Orthopaedic Society of North American (POSNA) Needs Assessment Survey was sent to POSNA members and a special 36-question survey was sent to recent pediatric orthopaedic fellowship graduates...
September 2016: Clinical Orthopaedics and related Research
Rebecca M Meiring, Emmanuel Frimpong, Lipalo Mokete, Jurek Pietrzak, Dick Van Der Jagt, Mohammed Tikly, Joanne A McVeigh
BACKGROUND: Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA...
2016: BMC Musculoskeletal Disorders
R Tejwani, H-H S Wang, B J Young, N H Greene, S Wolf, J S Wiener, J C Routh
INTRODUCTION: Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. OBJECTIVES: To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used...
June 16, 2016: Journal of Pediatric Urology
Ibrahim Gundogdu, Erhan Arif Ozturk, Ebru Umay, Ozgur Zeliha Karaahmet, Ece Unlu, Aytul Cakci
PURPOSE: Following repeated weaning failures in acute care services, spinal cord injury (SCI) patients who require prolonged mechanical ventilation and tracheostomy are discharged to their homes or skilled nursing facilities, with a portable mechanical ventilator (MV) and/or tracheostomy tube (TT) with excess risk of complications, high cost and low quality of life. We hypothesized that many difficult-to-wean patients with cervical SCI can be successfully managed in a rehabilitation clinic...
June 23, 2016: Disability and Rehabilitation
Vishnu Prasad Nelamangala Ramakrishnaiah, Somanath Malage, G S Sreenath, Sudhakar Kotlapati, Sunu Cyriac
Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient...
2016: Clinical Medicine Insights. Gastroenterology
Safiya I Shaikh, Sarala B Mahesh
BACKGROUND AND AIMS: Alpha (α-2) adrenergic agonists have both analgesic and sedative properties when used as an adjuvant in regional anesthesia. A prospective randomized double-blind study was carried out to evaluate the efficacy of epidural route and to compare the efficacy and clinical profile of dexmedetomidine and clonidine as an adjuvant to bupivacaine with special emphasis on their quality of analgesia, sedation and the ability to provide the smooth intra-operative and postoperative course...
April 2016: Journal of Anaesthesiology, Clinical Pharmacology
H Du, W J Liu, L-H Zhou
OBJECTIVE: The aim of this study is to analyze application effects of specialized emergency nursing mode based on Global Registry Acute Coronary Events (GRACE) scoring system on Acute Coronary System (ACS) patients. PATIENTS AND METHODS: 135 ACS cases in this hospital of the same period were selected and they were divided into control group (65 cases) and observation group (70 cases) according to random number method and their order of hospitalization. The standard specialized nursing mode was applied in the control group while specialized nursing mode based on GRACE scoring system was applied in observation group to compare treatment effects...
April 2016: European Review for Medical and Pharmacological Sciences
Kaisu Ojala, Tuomo J Meretoja, Johanna Mattson, Päivi Salminen-Peltola, Suvi Leutola, Marianne Berggren, Marjut H K Leidenius
BACKGROUND AND OBJECTIVES: This study aims to clarify quality of breast cancer surgery in population-based setting. We aim to elucidate factors influencing waiting periods, and to evaluate the effect of hospital volume on surgical treatment policies. Special interest was given to diagnostic and surgical processes and their impact on waiting times. METHODS: All 1307 patients having primary breast cancer surgery at the Helsinki and Uusimaa Hospital District during 2010 were included in this retrospective study...
April 2016: Breast: Official Journal of the European Society of Mastology
Najma Siddiqi, Jennifer K Harrison, Andrew Clegg, Elizabeth A Teale, John Young, James Taylor, Samantha A Simpkins
BACKGROUND: Delirium is a common mental disorder, which is distressing and has serious adverse outcomes in hospitalised patients. Prevention of delirium is desirable from the perspective of patients and carers, and healthcare providers. It is currently unclear, however, whether interventions for preventing delirium are effective. OBJECTIVES: To assess the effectiveness of interventions for preventing delirium in hospitalised non-Intensive Care Unit (ICU) patients...
March 11, 2016: Cochrane Database of Systematic Reviews
Wen-Qiang Zhang, Shao-Qin Han, Zhen Yuan, Ye-Teng He, Hu Zhang, Ming Zhang
BACKGROUND: Chronic synovitis is a consequence of recurrent intraarticular hemorrhage in patients with hemophilia. Eventually, synovitis leads to degeneration of the articular cartilage, with serious consequences that impact the quality-of-life in hemophiliacs. The aim of our study was to investigate the short term clinical effects of intraarticular injection of the radionuclide preparation(32)P colloid ((32)P-labelled colloidal chromic phosphate suspension) on recurrent intraarticular hemorrhages in patients with hemophilic synovitis of the knee...
January 2016: Indian Journal of Orthopaedics
David A Leske, Sarah R Hatt, Laura Liebermann, Jonathan M Holmes
PURPOSE: We compare two methods of analysis for Rasch scoring pre- to postintervention data: Rasch lookup table versus de novo stacked Rasch analysis using the Adult Strabismus-20 (AS-20). METHODS: One hundred forty-seven subjects completed the AS-20 questionnaire prior to surgery and 6 weeks postoperatively. Subjects were classified 6 weeks postoperatively as "success," "partial success," or "failure" based on angle and diplopia status. Postoperative change in AS-20 scores was compared for all four AS-20 domains (self-perception, interactions, reading function, and general function) overall and by success status using two methods: (1) applying historical Rasch threshold measures from lookup tables and (2) performing a stacked de novo Rasch analysis...
February 2016: Translational Vision Science & Technology
Stephen Lyman, Yuo-Yu Lee, Patricia D Franklin, Wenjun Li, David J Mayman, Douglas E Padgett
BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly in demand for outcomes evaluation by hospitals, administrators, and policymakers. However, assessing total hip arthroplasty (THA) through such instruments is challenging because most existing measures of hip health are lengthy and/or proprietary. QUESTIONS/PURPOSES: The objective of this study was to derive a patient-relevant short-form survey based on the Hip disability and Osteoarthritis Outcome Score (HOOS), focusing specifically on outcomes after THA...
June 2016: Clinical Orthopaedics and related Research
Peter Lukovich, Valery Ben Sionov, Timea Kakucs
OBJECTIVE: Lately single-port surgery is becoming a widespread procedure, but it is more difficult than conventional laparoscopy owing to the lack of triangulation. Although, these operations are also possible with standard laparoscopic instruments, curved instruments are being developed. The aims of the study were to identify the effect of training on a box trainer in single-port setting on the quality of acquired skills, and transferred with the straight and curved instruments for the basic laparoscopic tasks, and highlight the importance of a special laparoscopic training curriculum...
March 2016: Journal of Surgical Education
Mia Schmidt-Hansen, Nathan Bromham, Elise Hasler, Malcolm W Reed
Traditionally, women with node-positive operable breast cancer have received complete axillary lymph node dissection (ALND), which is associated with significant morbidity, but recently less invasive alternatives have been explored. We conducted a systematic review of randomised controlled trials assessing alternative approaches to axillary surgery in patients with pathologically-confirmed sentinel node-positive operable breast cancer. We searched on 16/3/15 the Specialized Register of the Cochrane Breast Cancer group; CENTRAL; MEDLINE; PreMEDLINE; EMBASE; WHO International Clinical Trials Registry Portal; ClinicalTrials...
2016: SpringerPlus
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