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Effect of specialization on surgery Quality

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https://www.readbyqxmd.com/read/29756637/withdrawal-of-immunosuppressant-or-biologic-therapy-for-patients-with-quiescent-crohn-s-disease
#1
REVIEW
Ray K Boyapati, Joana Torres, Carolina Palmela, Claire E Parker, Orli M Silverberg, Sonam D Upadhyaya, Tran M Nguyen, Jean-Frédéric Colombel
BACKGROUND: Crohn's disease (CD) is a chronic, relapsing and remitting disease of the gastrointestinal tract that can cause significant morbidity and disability. Current treatment guidelines recommend early intervention with immunosuppressant or biological therapy in high-risk patients with a severe disease phenotype at presentation. The feasibility of therapeutic de-escalation once remission is achieved is a commonly encountered question in clinical practice, driven by patient and clinician concerns regarding safety, adverse events, cost and national regulations...
May 12, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29724987/platelet-rich-plasma-prp-rinses-for-the-treatment-of-non-responding-oral-lichen-planus-a-case-report
#2
Elisabetta Merigo, Aldo Oppici, Anna Parlatore, Luigi Cella, Fabio Clini, Matteo Fontana, Carlo Fornaini
Platelet-rich plasma (PRP) has been proposed for different applications in the medical field and in maxillofacial surgery thanks to its many growth factors, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), and keratinocyte growth factor (KGF). Oral lichen planus (OLP) is a disease that affects the oral mucosa in a chronic way. This disease frequently worsens the quality of life of patients, particularly when clinical manifestations are of the erythematous or erosive/ulcerative type. The properties of PRP that are supported by scientific literature in both oral medicine and other medical fields have suggested the introduction of PRP in clinical practice for the medical treatment of different soft tissues diseases, such as when OLP patients do not respond to conventional therapies, or when conventional treatments have some contraindications or side effects...
February 6, 2018: Biomedicines
https://www.readbyqxmd.com/read/29667890/novel-quality-indicators-for-radiologists-interpreting-abdominopelvic-ct-images-risk-adjusted-outcomes-among-emergency-department-patients-with-right-lower-quadrant-pain
#3
Matthew S Davenport, Shokoufeh Khalatbari, James H Ellis, Richard H Cohan, Suzanne T Chong, Keith E Kocher
OBJECTIVE: The purpose of this study was to determine whether individual radiologists are predictive of important relevant health outcomes among emergency department (ED) patients undergoing abdominopelvic CT for right lower quadrant pain. MATERIALS AND METHODS: This single-institution retrospective cohort study included 2169 patients undergoing abdominopelvic CT for right lower quadrant pain in the ED from February 1, 2012, through August 31, 2016. CT examinations were interpreted by 15 radiologists (four emergency, 11 abdominal) who each reported on more than 70 CT examinations in the cohort...
April 18, 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29662789/pie-crusting-technique-is-effective-and-safe-to-release-superficial-medial-collateral-ligament-for-total-knee-arthroplasty
#4
Xuan He, Hong Cai, Ke Zhang
Background: Pie-crusting technique is a damage-control soft tissue balance skill of total knee arthroplasty (TKA). The outcome of this technique to release lateral soft tissue is reasonable. A limited number of studies have focused on medial collateral ligament release with pie-crusting technique in the past years because of concerns about its efficacy and safety. Method: All cases underwent superficial medial collateral ligament (SMCL) release with either pie-crusting technique or traditional technique (39 knees in each group) between January 1, 2014 and August 31, 2015...
April 2018: Journal of Orthopaedic Translation
https://www.readbyqxmd.com/read/29658682/sphincter-saving-proctectomy-for-rectal-cancer-with-transanal-tube-no-coil-and-without-ostoma-clinical-outcomes-cost-effectiveness-and-quality-of-life-in-elderly
#5
Severino Montemurro, Michele Ammendola, Gaetano Gallo, Roberto Romano, Antonietta Condoluci, Lucia Curto, Stefano DE Franciscis, Raffaele Serra, Rosario Sacco, Giuseppe Sammarco
BACKGROUND: Colorectal cancer is one of the most common invasive cancers, and it is responsible for considerable physical and psychosocial morbidity specially in older patients. However, only few reports focused on quality of life, cost-effectiveness and clinical outcomes of rectal cancer patients undergone to surgery. This retrospective study compares short-term and long- term outcomes in rectal cancer patients with more and less 75 years of age. METHODS: Four hundred consecutive patients underwent to radical surgery for rectal adenocarcinoma and they were collected in a prospective institutional database and divided into two groups: group 1 (≥ 75 years, n =98); group 2 (<75 years, n=302)...
April 13, 2018: Minerva Chirurgica
https://www.readbyqxmd.com/read/29620792/risk-reducing-mastectomy-for-the-prevention-of-primary-breast-cancer
#6
REVIEW
Nora E Carbine, Liz Lostumbo, Judi Wallace, Henry Ko
BACKGROUND: Recent progress in understanding the genetic basis of breast cancer and widely publicized reports of celebrities undergoing risk-reducing mastectomy (RRM) have increased interest in RRM as a method of preventing breast cancer. This is an update of a Cochrane Review first published in 2004 and previously updated in 2006 and 2010. OBJECTIVES: (i) To determine whether risk-reducing mastectomy reduces death rates from any cause in women who have never had breast cancer and in women who have a history of breast cancer in one breast, and (ii) to examine the effect of risk-reducing mastectomy on other endpoints, including breast cancer incidence, breast cancer mortality, disease-free survival, physical morbidity, and psychosocial outcomes...
April 5, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29566567/exploring-dutch-surgeons-views-on-volume-based-policies-a-qualitative-interview-study
#7
Roos Mesman, Marjan J Faber, Gert P Westert, Bart Berden
Objective In many countries, the evidence for volume-outcome associations in surgery has been transferred into policy. Despite the large body of research that exists on the topic, qualitative studies aimed at surgeons' views on, and experiences with, these volume-based policies are lacking. We interviewed Dutch surgeons to gain more insight into the implications of volume-outcome policies for daily clinical practice, as input for effective surgical quality improvement. Methods Semi-structured interviews were conducted with 20 purposively selected surgeons from a stratified sample for hospital type and speciality...
January 1, 2018: Journal of Health Services Research & Policy
https://www.readbyqxmd.com/read/29531882/creating-a-student-centered-learning-environment-implementation-of-problem-based-learning-to-teach-microbiology-to-undergraduate-medical-students
#8
Venkataramana Kandi, Parimala Reddy Basireddy
Introduction Medical education involves training necessary to become a physician or a surgeon. This includes various levels of training like undergraduate, internship, and postgraduate training. Medical education can be quite complex, since it involves training in pre-clinical subjects (anatomy, physiology, biochemistry), the para-clinical subjects (microbiology, pathology, pharmacology, and forensic medicine), and a discrete group of clinical subjects that include general medicine, surgery, obstetrics and gynaecology, ear, nose and throat specialization, paediatrics, cardiology, pulmonology, dermatology, ophthalmology, and orthopaedics, and many other clinical specializations and super specialities (cardio-thoracic surgery, neurosurgery, etc...
January 5, 2018: Curēus
https://www.readbyqxmd.com/read/29525499/a-quality-improvement-project-incorporating-preoperative-warming-to-prevent-perioperative-hypothermia-in-major-burns
#9
A D Rogers, M Saggaf, N Ziolkowski
BACKGROUND: Patients with extensive burn injuries are susceptible to a host of accompanying adverse effects should they develop perioperative hypothermia, which occurs in up to ¼ of all major burn cases. This quality improvement project aimed to reduce the incidence of perioperative hypothermia to below 10% of cases in patients with major burn (Total Body Surface Area [TBSA] >15%), within a one year period. METHODS: A baseline diagnostic phase was undertaken to provide a greater understanding of the incidence, natural history and risk factors of perioperative hypothermia...
March 7, 2018: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29499339/cost-utility-analysis-of-cervical-deformity-surgeries-using-1-year-outcome
#10
Gregory W Poorman, Peter G Passias, Rabia Qureshi, Hamid Hassanzadeh, Samantha Horn, Cole Bortz, Frank Segreto, Amit Jain, Michael Kelly, Richard Hostin, Christopher Ames, Justin Smith, Virginie LaFage, Douglas Burton, Shay Bess, Chris Shaffrey, Frank Schwab, Munish Gupta
BACKGROUND CONTEXT: Cost-utility analysis, a special case of cost-effectiveness analysis, estimates the ratio between the cost of an intervention to the benefit it produces in number of quality-adjusted life years. Cervical deformity correction has not been evaluated in terms of cost-utility and in the context of value-based health care. Our objective, therefore, was to determine the cost-utility ratio of cervical deformity correction. STUDY DESIGN: This is a retrospective review of a prospective, multicenter cervical deformity database...
February 27, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29464153/sset-project-cost-effectiveness-analysis-of-surgical-specialty-emergency-trays-in-the-emergency-department
#11
Laura S Humphries, Deana S Shenaq, Chad M Teven, Julie E Park, David H Song
Background: We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution. Methods: We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents...
January 2018: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29393041/surgical-treatment-for-urinary-incontinence-in-women-danish-nationwide-cohort-studies
#12
Margrethe Foss Hansen
This PhD thesis is based on three original articles. The studies were performed at the Department of Obstetrics and Gynaecology, Herlev University Hospital and at the Center for Clinical Epidemiology, Odense University Hospital. 
Urinary incontinence (UI) is a frequent disorder among women, which for the individual can have physical, psychological and social consequences. The current standard of surgical treatment is the synthetic midurethral sling (MUS), which is a minimal invasive procedure.
As the synthetic MUSs (TVT,TVT-O,TOT) were introduced in the late 1990s, there are only a few studies at the long-term follow-up based on nationwide populations; only a few have reported on the risk of reoperation and there is sparse evidence on which treatment should be used subsequently to failure of synthetic MUSs...
February 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29284876/dexmedetomidine-versus-magnesium-sulfate-in-anesthesia-for-cochlear-implantation-surgery-in-pediatric-patients
#13
Passaint Fahim Hassan, Amany Hassan Saleh
Context: Cochlear implantation surgery represents a great advance in ENT surgeries. Special anesthetic managements were required to provide bloodless surgical field and monitoring of the facial nerve. Aims: We aimed to compare both dexmedetomidine and magnesium sulfate as regards their efficacy in inducing deliberate hypotension and providing better quality of the surgical field during cochlear implantation in pediatrics. Settings and Design: Prospective, randomized double-blinded study...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29279742/prevalence-and-complications-of-postoperative-transfusion-for-cervical-fusion-procedures-in-spine-surgery-an-analysis-of-11-588-patients-from-the-american-college-of-surgeons-national-surgical-quality-improvement-program-database
#14
Ahmed Aoude, Sultan Aldebeyan, Maryse Fortin, Anas Nooh, Peter Jarzem, Jean A Ouellet, Michael H Weber
Study Design: Retrospective cohort study. Purpose: The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect on complication rates. Overview of Literature: Cervical spine fusions have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion from 2010 to 2013...
December 2017: Asian Spine Journal
https://www.readbyqxmd.com/read/29274521/returns-to-specialization-evidence-from-the-outpatient-surgery-market
#15
Elizabeth L Munnich, Stephen T Parente
Technological changes in medicine have created new opportunities to provide surgical care in lower cost, specialized facilities. This paper examines patient outcomes in ambulatory surgery centers (ASCs), which were developed as a low-cost alternative to outpatient surgery in hospitals. Because we are concerned that selection into ASCs may bias estimates of facility quality, we use predicted changes in federally set Medicare facility payment rates as an instrument for ASC utilization to estimate the effect of location of treatment on patient outcomes...
January 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29245244/effect-of-joint-mobilization-techniques-for-primary-total-knee-arthroplasty-study-protocol-for-a-randomized-controlled-trial
#16
RANDOMIZED CONTROLLED TRIAL
Jiao Xu, Juan Zhang, Xue-Qiang Wang, Xuan-Lin Wang, Ya Wu, Chan-Cheng Chen, Han-Yu Zhang, Zhi-Wan Zhang, Kai-Yi Fan, Qiang Zhu, Zhi-Wei Deng
BACKGROUND: Total knee arthroplasty (TKA) has become the most preferred procedure by patients for the relief of pain caused by knee osteoarthritis. TKA patients aim a speedy recovery after the surgery. Joint mobilization techniques for rehabilitation have been widely used to relieve pain and improve joint mobility. However, relevant randomized controlled trials showing the curative effect of these techniques remain lacking to date. Accordingly, this study aims to investigate whether joint mobilization techniques are valid for primary TKA...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29221456/effect-of-multimorbidity-on-quality-of-life-in-adult-with-cardiovascular-disease-a-cross-sectional-study
#17
Bijan Shad, Asieh Ashouri, Tolou Hasandokht, Fatemeh Rajati, Arsalan Salari, Moona Naghshbandi, Fardin Mirbolouk
BACKGROUND: The aim of present study was to describe the effect of multimorbidity on Health-Related Quality of Life (HRQoL) in patients with coronary artery disease (CAD). METHODS: A cross-sectional study with a simple sampling method of 296 patients undergoing coronary artery bypass surgery in a referral hospital of the northern part of Iran was conducted between April, 2015 and September, 2016. Multimorbidity was defined as the presence of at least two chronic diseases based on self-reporting and medical records...
December 8, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/29205995/volume-and-health-outcomes-evidence-from-systematic-reviews-and-from-evaluation-of-italian-hospital-data
#18
Laura Amato, Danilo Fusco, Anna Acampora, Katia Bontempi, Alessandro Cesare Rosa, Paola Colais, Fabio Cruciani, Mariangela D'Ovidio, Francesca Mataloni, Silvia Minozzi, Zuzana Mitrova, Luigi Pinnarelli, Rosella Saulle, Salvatore Soldati, Chiara Sorge, Simona Vecchi, Martina Ventura, Marina Davoli
BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care». There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions...
September 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/29189967/evaluation-of-a-specialized-oncology-nursing-supportive-care-intervention-in-newly-diagnosed-breast-and-colorectal-cancer-patients-following-surgery-a-cluster-randomized-trial
#19
Jonathan Sussman, Daryl Bainbridge, Timothy J Whelan, Kevin Brazil, Sameer Parpia, Jennifer Wiernikowski, Susan Schiff, Gary Rodin, Myles Sergeant, Doris Howell
BACKGROUND: Better coordination of supportive services during the early phases of cancer care has been proposed to improve the care experience of patients. We conducted a randomized trial to test a community-based nurse-led coordination of care intervention in cancer patients. METHODS: Surgical practices were cluster randomized to a control group involving usual care practices or a standardized nursing intervention consisting of an in-person supportive care assessment with ongoing support to meet identified needs, including linkage to community services...
November 30, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29179761/efficacy-and-safety-of-the-xingnao-kaiqiao-acupuncture-technique-via-intradermal-needling-to-treat-postoperative-gastrointestinal-dysfunction-of-laparoscopic-surgery-study-protocol-for-a-randomized-controlled-trial
#20
Wenli Zhao, Jinting Li, Yuling Wang, Jing Liu, Ying Chen, Guang Zhao, Ye Zhao, Huaien Bu, Yiider Tseng, Xuemin Shi
BACKGROUND: Xingnao Kaiqiao acupuncture involves needling of the Neiguan (PC6), Renzhong (DU26), and Sanyinjiao (SP6) acupoints. The technique has a significant clinical effect in many neurological diseases. In the present report, we have developed a protocol for a scientific trial to analyze whether Xingnao Kaiqiao can be used to treat gastrointestinal dysfunction after laparoscopic surgery. In this context, we intend to execute a double-blind, randomized controlled trial to assess the efficacy and safety of Xingnao Kaiqiao acupuncture via intradermal needling...
November 28, 2017: Trials
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