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Daniel Gardner, Andrew Liman, Victoria Autelli, Casey O'Connell, Nicholas Testa, Glenn Ault
Improving patient safety is vital for all hospitals due to increasing public reporting and pay-for-performance reimbursement. Venous thromboembolism (VTE) remains a leading cause of preventable mortality accounting for 5 per cent of inpatient deaths. The purpose of this study was to outline the process of implementing standard VTE prophylactic order sets in a 600-bed academic safety net hospital and assess the resulting change in patient outcomes. Outcomes were assessed by comparing the rate that eligible inpatients receive VTE prophylaxis and the rate of preventable VTE's compared with total VTE's...
October 2016: American Surgeon
Kyle G Cologne, Sean Byers, David R Rosen, Grace S Hwang, Adrian E Ortega, Glenn T Ault, Sang W Lee
A prospectively maintained database of 415 patients undergoing colectomy was evaluated. We performed a logistic regression analysis to identify factors associated with 1) length of stay (LOS) of 2 days or less and 2) LOS of 10 days or more. Investigated variables included demographics, American Society of Anesthesiology (ASA) score, diagnosis, operative procedure, approach and time, transfusion requirements, and occurrence of any complications. Factors associated with a LOS of two days or less included ASA [odds ratio (OR): 0...
October 2016: American Surgeon
Shanti M Pinto, Gary Galang
OBJECTIVE: The aim of this study was to investigate the impact of venous thromboembolism (VTE) on rate of acute care hospital transfer, inpatient rehabilitation (IPR) length of stay (LOS), and functional outcomes. DESIGN: This was a retrospective cohort study of 2312 consecutive patient discharges from a single IPR facility over an 18-month period. RESULTS: When age, sex, reason for admission, and admission Functional Independence Measure (FIM) scores were controlled for, those with VTE had nearly 2 times greater odds for transfer to acute care hospital than did those without a diagnosis of VTE...
October 22, 2016: American Journal of Physical Medicine & Rehabilitation
Johannes A Govaert, Marc J P M Govaert, Marta Fiocco, Wouter A van Dijk, Rob A E M Tollenaar, Michel W J M Wouters
: Background Due to increasing healthcare costs, discussions regarding increased hospital costs when operating on high-risk patients is rising. Therefore, the aim of this study was to analyze if oldest-old colorectal cancer patients have a greater impact on hospital costs than their younger counterparts. METHODS: All colorectal cancer procedures performed in 29 Dutch hospitals between 2010 and 2012 and listed in the Dutch Surgical Colorectal Audit were analyzed...
October 25, 2016: Journal of Surgical Oncology
Salvatore Docimo, Young Lee, Prav Chatani, Ann M Rogers, Frank Lacqua
INTRODUCTION: There is an association between obesity and more complicated diverticular disease. We hypothesize that this link may be due to an increased level of visceral fat rather than an elevated body mass index alone. Adipose tissue secretes inflammatory cytokines, and chronic inflammation may account for the link between obesity and a more severe presentation of diverticular disease. We have applied a quantitative measure of visceral fat content in a series of patients admitted with diverticulitis, comparing those who required emergent versus elective surgical procedures for diverticulitis...
October 24, 2016: Surgical Endoscopy
M-L Wong, M Arcos-Burgos, S Liu, J I Vélez, C Yu, B T Baune, M C Jawahar, V Arolt, U Dannlowski, A Chuah, G A Huttley, R Fogarty, M D Lewis, S R Bornstein, J Licinio
Major depressive disorder (MDD) affects around 350 million people worldwide; however, the underlying genetic basis remains largely unknown. In this study, we took into account that MDD is a gene-environment disorder, in which stress is a critical component, and used whole-genome screening of functional variants to investigate the 'missing heritability' in MDD. Genome-wide association studies (GWAS) using single- and multi-locus linear mixed-effect models were performed in a Los Angeles Mexican-American cohort (196 controls, 203 MDD) and in a replication European-ancestry cohort (499 controls, 473 MDD)...
October 25, 2016: Molecular Psychiatry
Kalpit Devani, Nirav Patil, Carlos Roberto Simons-Linares, Nilay Patel, Palashkumar Jaiswal, Pranav Patel, Samir Patel, Chirag Savani, Kamlesh Sajnani, Mark Young, Chakradhar Reddy
INTRODUCTION: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients with colon cancer. We assessed nationwide population-based trends in rates of hospitalization and mortality from VTE among patients with colon cancer to determine its impact. METHODS: We queried the Nationwide Inpatient Sample (NIS) database entries from 2003 to 2011 to identify patients with colon cancer. Bivariate group comparisons between hospitalized patients with colon cancer with VTE to those without VTE were made...
September 20, 2016: Clinical Colorectal Cancer
Sujith Konan, Clive P Duncan, Bassam A Masri, Donald S Garbuz
BACKGROUND: Revision hip arthroplasty for metal-on-metal arthroplasty (MOMA) in the presence of an adverse local tissue reaction (ALTR) has been associated with compromised outcomes. We hypothesized that revision of MOMA for painful micromotion of the cup, in the absence of ALTR, would have a more favorable outcome. METHODS: We reviewed our database for Durom acetabular shell revision with minimum 24 months (24 months to 8 years) follow-up. Patients with a diagnosis of painful micromotion in the absence of pseudotumor was identified...
September 28, 2016: Journal of Arthroplasty
Jarrett Williams, Benjamin S Kester, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: To curb the unsustainable rise in health care expenses, health care payers are developing programs to incentivize hospitals and physicians to improve the value of care delivered to patients. Payers are utilizing various metrics, such as length of stay (LOS) and unplanned readmissions, to track progression of quality metrics. Relevant to orthopedic surgeons, the Centers for Medicare and Medicaid Services announced in 2015 the Comprehensive Care for Joint Replacement Payment Model-a program aimed at improving the quality of health care delivered to patients by shifting more of the financial risk of patient care onto providers...
September 28, 2016: Journal of Arthroplasty
Theresa W Gauthier, David M Guidot, Michael S Kelleman, Courtney E McCracken, Lou Ann S Brown
BACKGROUND: We hypothesized that maternal alcohol use occurs in pregnancies that end prematurely and that in utero alcohol exposure is associated with an increased risk of morbidities of premature newborns. METHODS: In an observational study of mothers who delivered very low birth weight newborns (VLBW) ≤1,500 g, maternal alcohol use was determined via a standardized administered questionnaire. We compared the effect of maternal drinking on the odds of developing late-onset sepsis (LOS), bronchopulmonary dysplasia (BPD), death, BPD or death, days on oxygen or any morbidity (either LOS, BPD or death)...
October 2016: American Journal of the Medical Sciences
Appiah-Korang Labi, Noah Obeng-Nkrumah, Stephanie Bjerrum, Christabel Enweronu-Laryea, Mercy Jemima Newman
BACKGROUND: Diagnosis of bloodstream infections (BSI) in neonates is usually difficult due to minimal symptoms at presentation; thus early empirical therapy guided by local antibiotic susceptibility profile is necessary to improve therapeutic outcomes. METHODS: A review of neonatal blood cultures submitted to the microbiology department of the Korle-Bu Teaching Hospital was conducted from January 2010 through December 2013. We assessed the prevalence of bacteria and fungi involved in BSI and the susceptibility coverage of recommended empiric antibiotics by Ghana Standard Treatment guidelines and the WHO recommendations for managing neonatal sepsis...
October 24, 2016: BMC Infectious Diseases
Shaoyun Zhang, Bin Xu, Qiang Huang, Huan Yao, Jinwei Xie, Fuxing Pei
There is no consensus as to whether drainage tube should be used and how long it should remain in use after primary total knee arthroplasty (TKA). As fast-track (FT) program has been implemented in TKA, whether drainage tube could be removed early, and the ideal timing for removal after FT primary TKA has been a new topic. The purpose of this prospective cohort study was to evaluate the safety and feasibility of early removal of drainage tube when FT program was implemented in primary TKA. A total of 101 patients undergoing FT primary TKA were prospectively allocated into three groups...
October 24, 2016: Journal of Knee Surgery
J R Griswold, D G Medvedev, J W Engle, R Copping, J M Fitzsimmons, V Radchenko, J C Cooley, M E Fassbender, D L Denton, K E Murphy, A C Owens, E R Birnbaum, K D John, F M Nortier, D W Stracener, L H Heilbronn, L F Mausner, S Mirzadeh
Actinium-225 and (213)Bi have been used successfully in targeted alpha therapy (TAT) in preclinical and clinical research. This paper is a continuation of research activities aiming to expand the availability of (225)Ac. The high-energy proton spallation reaction on natural thorium metal targets has been utilized to produce millicurie quantities of (225)Ac. The results of sixteen irradiation experiments of thorium metal at beam energies between 78 and 192MeV are summarized in this work. Irradiations have been conducted at Brookhaven National Laboratory (BNL) and Los Alamos National Laboratory (LANL), while target dissolution and processing was carried out at Oak Ridge National Laboratory (ORNL)...
September 28, 2016: Applied Radiation and Isotopes
Anthony R Cai, Erica I Hodgman, Puneet B Kumar, Alvand J Sehat, Alexander L Eastman, Steven E Wolf
A significant proportion of patients appeared to arrive at our American Burn Association-verified burn center intubated without clear benefit. The current study aims to evaluate regional prehospital intubation practices and their outcomes. All consecutive admissions from November 2012 to June 2014 were reviewed for data points associated with intubation. Demographics and outcomes for patients who were intubated before arrival or within 24 hours of admission were compared using χ, Fisher's exact test, and the Kruskal-Wallis test as appropriate...
October 17, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Christopher R Friese, Yun Li, Irina Bondarenko, Timothy P Hofer, Kevin C Ward, Ann S Hamilton, Dennis Deapen, Allison W Kurian, Steven J Katz
BACKGROUND: The 21-gene recurrence score (RS) assay stratifies early-stage, estrogen receptor-positive breast cancer by recurrence risk. Few studies have examined the ways in which physicians use the RS to recommend adjuvant systemic chemotherapy or patients' experiences with testing and decision making. METHODS: This study surveyed 3880 women treated for breast cancer in 2013-2014; they were identified from the Los Angeles County and Georgia Surveillance, Epidemiology, and End Results registries (response rate, 71%)...
October 24, 2016: Cancer
X Liu, J Wang, Z-H Li
OBJECTIVE: To evaluate the role of glutamine-supplemented total parenteral nutrition (TPN) in severe acute pancreatitis. PATIENTS AND METHODS: Forty-seven patients with severe acute pancreatitis were admitted to Huaihe Hospital, China, over a period of one year (July 2013 to June 2014) were randomly divided into two therapeutic groups. Patients in group 1 (24 patients in total) and group 2 (23 patient in total) were treated with glutamine-supplemented TPN and standard TPN respectively...
October 2016: European Review for Medical and Pharmacological Sciences
Lize Cuypers, Guangdi Li, Christoph Neumann-Haefelin, Supinya Piampongsant, Pieter Libin, Kristel Van Laethem, Anne-Mieke Vandamme, Kristof Theys
Despite significant progress in hepatitis C (HCV) treatment, global viral eradication remains a challenge. An in-depth map of its genome diversity within the context of structural and immunological constraints could contribute to the design of pan-genotypic antivirals and preventive vaccines. For such analyses, extensive information is only available for the highly prevalent HCV genotypes (GT) 1a and 1b. Using 647 GT1a and 408 GT1b full-genome sequences obtained from the Los Alamos database, we found that respectively 3 per cent and 82 per cent of all codon positions are under positive and negative selective pressure, suggesting variation mainly accumulates due to random genetic drift...
July 2016: Virus Evolution
L A Peterson, J K Canner, L J Cheskin, G P Prokopowicz, M A Schweitzer, T H Magnuson, K E Steele
OBJECTIVE: To investigate the association between adverse surgical outcomes following bariatric surgery and proxy measures of vitamin D (VitD) status (season and latitude) in the Nationwide Inpatient Sample (NIS). BACKGROUND: Obesity is an independent risk factor for VitD deficiency (25(OH)D < 20 ng ml(-1)). VitD deficiency compounds the chronic inflammation of obesity, increasing the risk of adverse outcomes following bariatric surgery. Epidemiology has long used season and latitude as proxies for group VitD, as VitD status is largely determined by sun exposure, which is greatest during summer and at the Equator...
December 2015: Obesity Science & Practice
Ming Li, Wei Zhang, Li Jiang, Jiayin Yang, Lunan Yan
BACKGROUND: Liver resection (LR) is preferred treatment for malignancies or benign masses of liver. Using multiple elements, fast track (FT) program was introduced to abdominal surgery associating with fast functional recovery and shorter hospital length of stay (LoS). This meta-analysis aims to evaluate the effect of FT program for patients following liver resection. MATERIALS AND METHODS: We searched the PubMed/Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Embase for trials up to December 2015 to compare the FT program to the conventional group...
October 20, 2016: International Journal of Surgery
Rubin Khoddam, Nicholas J Jackson, Adam M Leventhal
AIM: The complex interplay of externalizing and internalizing problems in substance use risk is not well understood. This study tested whether the relationship of conduct problems and several internalizing disorders with future substance use is redundant, incremental, or interactive in adolescents. METHODS: Two semiannual waves of data from the Happiness and Health Study were used, which included 3383 adolescents (M age=14.1years old; 53% females) in Los Angeles who were beginning high school at baseline...
October 17, 2016: Drug and Alcohol Dependence
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