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Operational Excellence

J Q Shen, Q Ji, W J Ding, L M Xia, L Wei, C S Wang
Objective: To evaluate in-hospital and mid-term outcomes of sequential versus separate grafting of in situ skeletonized left internal mammary artery (LIMA) to the left coronary system in a single-center, propensity-matched study. Methods: After propensity score matching, 120 pairs of patients undergoing first, scheduled, isolated coronary artery bypass grafting (CABG) with in situ skeletonized LIMA grafting to the left anterior descending artery (LAD) territory were entered into a sequential group (sequential grafting of LIMA to the diagonal artery and then to the LAD) or a control group (separate grafting of LIMA to the LAD)...
March 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Stephen R Rapp, Ryan T Barnard, Kaycee M Sink, Dana G Chamberlain, Valerie Wilson, Lingyi Lu, Edward H Ip
Introduction: Aim is to evaluate validity, reliability, diagnostic precision, and user acceptability of computer simulations of cognitively demanding tasks when administered to older adults with and without cognitive impairment. Methods: Five simulation modules were administered to 161 individuals aged ≥60 years with no cognitive impairment (N = 81), mild cognitive impairment (N = 52), or dementia (N = 28). Groups were compared on total accuracy and time to complete the tasks (seconds)...
2018: Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring
Zhibiao Bai, Shichang Gao, Zhenming Hu, Anlin Liang
The present study was performed to compare the clinical efficacy of lateral plate and lateral and medial double-plating fixation of distal femoral fractures and explore the indication of lateral and medial double-plating fixation of the distal femoral fractures. From March 2006 to April 2014, 48 and 12 cases of distal femoral fractures were treated with lateral plate (single plate) and lateral and medial plates (double plates), respectively. During the surgery, after setting the lateral plate for the distal femoral fractures, if the varus stress test of the knee was positive and the lateral collateral ligament rupture was excluded, lateral and medial double-plating fixation was used for the stability of the fragments...
March 20, 2018: Scientific Reports
Ashley N Lee, Robert Johnson, Indu Lakhani, Laura E Happe
In 2013, the Centers for Medicare and Medicaid Services reversed their coverage policy that limited bariatric operations to Centers of Excellence (COE). Data from Centers for Medicare and Medicaid Services may not be generalizable to younger, healthier populations; additional data are needed to inform coverage policies for other plans. This retrospective cohort study used the 2010 to 2011 administrative claims data from the TRICARE military healthcare program to evaluate readmission rates, readmission length of stay, and postoperative healthcare costs among patients who had bariatric surgery at a COE versus non-designated centers...
March 1, 2018: American Surgeon
Jennifer Bido, Roya Ghazinouri, Jamie E Collins, Desirée Diez Portela, Luis Alcantara, Thomas S Thornhill, Jeffrey N Katz
BACKGROUND: Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions. METHODS: We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program...
March 21, 2018: Journal of Bone and Joint Surgery. American Volume
Tian Shen, Xingjian Cao, Junwei Shi, Yu Yu, Yihua Zhu, Delin Gu
BACKGROUND: Monocytes play a crucial role in immune response against Mycobacterium tuberculosis infection. The purpose of this current study was to investigate the morphology present on monocytes in peripheral blood from patients with active pulmonary tuberculosis (APTB) and the laboratory performance of the changes for discriminating cases from normal healthy subjects (NHS). METHOD: A total of 71 peripheral blood samples from patients with APTB, and 65 samples from NHS were analyzed...
March 16, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Marten N Basta, John E Fiadjoe, Albert S Woo, Kenneth N Peeples, Oksana A Jackson
OBJECTIVE: This study aimed to identify risk factors for adverse perioperative events (APEs) after cleft palatoplasty to develop an individualized risk assessment tool. DESIGN: Retrospective cohort. SETTING: Tertiary institutional. PATIENTS: Patients younger than 2 years with cleft palate. INTERVENTIONS: Primary Furlow palatoplasty between 2008 and 2011. MAIN OUTCOME MEASURE(S): Adverse perioperative event, defined as laryngo- or bronchospasm, accidental extubation, reintubation, obstruction, hypoxia, or unplanned intensive care unit admission...
April 2018: Cleft Palate-craniofacial Journal
Jonathan Richard Gregory Etnel, Paula Hansen Suss, Gabriela Miotto Schnorr, Myriam Veloso, Daniele Fornazari Colatusso, Eduardo Mendel Balbi Filho, Francisco Diniz Affonso da Costa
OBJECTIVES: Recent studies have shown favourable early results with decellularized allografts (DAs) for right ventricular outflow tract reconstruction during the Ross procedure. However, mid- and long-term outcome data are still scarce. The objective of this study was to compare the durability of fresh DAs with standard cryopreserved allografts (SCAs) in patients undergoing the Ross procedure. METHODS: Two hundred patients underwent the Ross procedure with DA and 202 with SCA...
March 14, 2018: European Journal of Cardio-thoracic Surgery
Timm Oberwahrenbrock, Ghislaine L Traber, Sebastian Lukas, Iñigo Gabilondo, Rachel Nolan, Christopher Songster, Lisanne Balk, Axel Petzold, Friedemann Paul, Pablo Villoslada, Alexander U Brandt, Ari J Green, Sven Schippling
Objective: To evaluate the inter-rater reliability of semiautomated segmentation of spectral domain optical coherence tomography (OCT) macular volume scans. Methods: Macular OCT volume scans of left eyes from 17 subjects (8 patients with MS and 9 healthy controls) were automatically segmented by Heidelberg Eye Explorer (v1.9.3.0) beta-software (Spectralis Viewing Module v6.0.0.7), followed by manual correction by 5 experienced operators from 5 different academic centers...
May 2018: Neurology® Neuroimmunology & Neuroinflammation
Alessio Campisi, Andrea Dell'Amore, Domenica Giunta, Stefano Congiu, Niccolò Daddi, Giampiero Dolci
Primary spontaneous pneumothorax has been defined as the disease of the 'young and healthy'. There are multiple possible therapies and in recent years, surgery has evolved towards the use of the uniportal thoracoscopic approach. The objective of our study is to describe and present an innovative approach to access to the thoracic cavity in patients with spontaneous pneumothorax. The surgery was performed using a single access of 20 mm at the level of the 8th intercostal space. For the isolation and suspension of any dystrophic area, we use a 'loop' of non-absorbable braided suture inserted through the IV intercostal space and successive wedge resection using an endoscopic 10 mm mechanical stapler...
2018: Journal of Visualized Surgery
Ruifu Yang, Mingwu Zhou, Chaofeng Xing, Shimin Li, Li Song, Jia Chen, Yingjie Xiong, Kai Zhang
Objective: To expound the clinical effect of a new operation by transplanting double segment triangular fibula flap with vascular pedicle to repair the forefoot with lateral bone defect, and to study how to improve the operation method in the following stage. Methods: The inclusion criteria: More than 2 phalangeal and metatarsal bones defects of the lateral forefoot, widespread skin and soft tissue defects on pelma and dorsal foot, and destruction of the anterior aspect of foot arch, which seriously affects the foot function...
December 2017: Saudi Journal of Biological Sciences
Luis R Ramos-Pascua, Víctor Bárcena-Tricio, Sergio Sánchez Herráez, Paula Casas-Ramos, Francisco M Izquierdo-García
PURPOSE: To describe the results of nonsurgical and surgical treatment of enchondromas of the distal phalanx of the hand. METHODS: Eleven enchondromas of the distal phalanx were retrospectively reviewed. Five patients underwent surgery (curettage and autogenous cancellous bone graft from the iliac crest) and 6 patients were treated nonsurgically. Clinical records and radiographs were reviewed for each patient. We recorded complications and cosmetic and functional results...
March 15, 2018: Journal of Hand Surgery
Peter Tajti, M Nicholas Burke, Dimitri Karmpaliotis, Khaldoon Alaswad, Gerald S Werner, Lorenzo Azzalini, Mauro Carlino, Mitul Patel, Kambis Mashayekhi, Mohaned Egred, Oleg Krestyaninov, Dmitrii Khelimskii, William J Nicholson, Imre Ungi, Alfredo R Galassi, Subhash Banerjee, Emmanouil S Brilakis
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been rapidly evolving during recent years. With improvement in equipment and techniques, high success rates can be achieved at experienced centers, although overall success rates remain low. Prospective, randomized-controlled data regarding optimal use and indications for CTO PCI remain limited. CTO PCI should be performed when the anticipated benefit exceeds the potential risk. New high-quality studies of the clinical outcomes and techniques of CTO PCI are needed, as is the expansion of expert centers and operators that can achieve excellent clinical outcomes in this challenging patient and lesion subgroup...
March 12, 2018: JACC. Cardiovascular Interventions
A Guerra-Tapia, A Buendía-Eisman, J Ferrando
BACKGROUND AND OBJECTIVE: Female androgenetic alopecia (FAA) has considerable impact on quality of life. Our analysis of the clinical scales available in the literature to measure the impact of FAA led us to choose the Hair Specific Skindex 29 (HSS29) as the most appropriate for adaptation to Spanish as a tool for following patients in treatment for FAA. This tool assesses disease impact on quality of life over time so that treatments can be tailored to patients' needs. The HSS29 score reflects impact in 3 domains (emotions, symptoms, and functioning) on a scale of 0 (no effect) to 100 (maximum effect)...
March 13, 2018: Actas Dermo-sifiliográficas
Rachel A Hoopsick, D Lynn Homish, Paul T Bartone, Gregory G Homish
Background: Much research has focused on stress related to deployments; however, a substantial proportion of soldiers never deploy. In a study of 1.3 million veterans, suicide risk was higher among veterans who had never deployed. Thus, not being deployed may have an impact on soldiers' well-being; however, no measures exist to assess emotions regarding non-deployment. We aimed to develop and test an original measure of non-deployment emotions. Methods: We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174)...
March 14, 2018: Military Medicine
Tahereh Shojaeimehr, Farshad Rahimpour, Michael Schwarze, Jens-Uwe Repke, Hamid Reza Godini, Günter Wozny
The present study evaluates the capability of ion exclusion chromatography (IEC) of short chain aliphatic carboxylic acids using a cation exchange column (8% sulfonated cross-linked styrene-divinylbenzene copolymer) in different experimental conditions. Since one of the prerequisites to the development of an efficient carboxylic acid separation process is to obtain the optimum operational conditions, response surface methodology (RSM) was used to develop an approach to evaluate carboxylic acids separation process in IEC columns...
March 8, 2018: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Hai-Jun Zhang, Alexander W Schuppe, Shi-Tao Pan, Jin-Xiang Chen, Bo-Ran Wang, Timothy R Newhouse, Liang Yin
A mild and operationally simple copper-catalyzed vinylogous aerobic oxidation of ,- and ,-unsaturated esters is described. This method features good yields, broad substrate scope, excellent chemo- and regioselectivity and good functional group tolerance. This method is additionally capable of oxidizing ,- and ,-unsaturated aldehydes, ketones, amides, nitriles and sulfones. Furthermore, the present catalytic system is suitable for bisvinylogous and trisvinylogous oxidation. TMG was found to be crucial in its role as a base, but we also speculate it serves as a ligand to copper(II) triflate to produce the active copper(II) catalyst...
March 16, 2018: Journal of the American Chemical Society
Yang Liu, Dandan Sun, Jingjing Zhou, Yingping Qin, Deyu Wang, Bingkun Guo
In this work, we propose a novel electrolyte additive, isophorone diisocyanate(IPDI), to construct the surface protective interlayer. This membrane is produced via nucleophilic addition between the IPDI's diisocyanate groups and the freeradical-onium ion oxidative intermediate of propylene carbonate(PC). In the electrolyte with IPDI added between 10 ~ 20 mM, LiNi0.5Co0.2Mn0.3O2 presents the excellent performance, demonstrating the relative wide operational window to form the optimal protective membrane. This protective membrane ameliorates the cyclic stability...
March 16, 2018: ACS Applied Materials & Interfaces
Laurent Mathieu, Michel Levadoux, Emmanuel Soucany de Landevoisin, Tarun J McBride Windsor, Sylvain Rigal
INTRODUCTION: Noncombat-related hand injuries are common in current theatres of operations. Crushing is one of the most frequent mechanisms that may cause traumatic amputations of digits. In the military setting, management of these digital amputations is challenging regarding limitation in microsurgical means in medical treatment facilities and aeromedical evacuation delays out of the combat zone. METHODS: Two cases of digital replantation performed in French forward surgical units are described...
2018: SICOT-J
Qingwang Xue, Chunxue Liu, Xia Li, Li Dai, Huaisheng Wang
Various fluorescent sensing systems for miRNAs detection have been developed. But they mostly contain enzymatic amplification reactions and label procedures. The strict reaction conditions of tool enzymes and the high cost of labeling limit their potential applications, especially in complex biological matrix. Here we have addressed the difficult problems and report a strategy for label-free fluorescent DNA dendrimers based on enzyme-free nonlinear hybridization chain reaction (HCR)-mediated multiple G-quadruplex for simple, sensitive and selective detection of miRNAs with low-background signal...
March 16, 2018: Bioconjugate Chemistry
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