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Price Graft

Irene Papanicolas, Liana R Woskie, Ashish K Jha
Importance: Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. Objective: To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations...
March 13, 2018: JAMA: the Journal of the American Medical Association
Yogesh Bhadange, Jeferson Lautert, Shimin Li, Edward Lawando, Edward T Kim, Mark C Soper, Francis W Price, Marianne O Price, Joseph A Bonanno
PURPOSE: To determine whether hypoxia preconditioning can protect corneal endothelial cells from mechanical stress and perioperative procedures mimicking Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: Preconditioning was delivered by 2 hours of 0.5% oxygen incubation in a hypoxia chamber or by exposure to the prolyl hydroxylase inhibitor FG-4592, which prevents hypoxia-inducible factor-1 alpha degradation. Damage to whole corneas was produced by brief sonication...
April 2018: Cornea
Sharon Elad, Kevin Zinchuk, Shuli Li, Corey Cutler, Jane Liesveld, Nathaniel Treister
BACKGROUND: Chronic graft-versus-host disease (cGVHD) frequently affects the oral mucosa and is generally responsive to topical immunomodulatory therapies. Clinicians may benefit from guidance in choosing the most appropriate therapy with respect to practicality and cost. OBJECTIVE: To assess the economic considerations related to topical immunomodulatory treatments for management of oral mucosal cGVHD and their practical implications. METHOD: Topical treatments used for management of oral cGVHD were obtained from the NIH Consensus document for ancillary and supportive care...
March 1, 2018: Biology of Blood and Marrow Transplantation
Fan Liang, Hyuma Leland, Breanna Jedrzejewski, Allyn Auslander, Seija Maniskas, Jordan Swanson, Mark Urata, Jeffrey Hammoudeh, William Magee
Alveolar cleft reconstruction has historically relied on autologous iliac crest bone grafting (ICBG), but donor site morbidity, pain, and prolonged hospitalization have prompted the search for bone graft substitutes. The authors evaluated bone graft substitutes with the highest levels of evidence, and highlight the products that show promise in alveolar cleft repair and in maxillary augmentation. This comprehensive review guides the craniofacial surgeon toward safe and informed utilization of biomaterials in the alveolar cleft...
February 14, 2018: Journal of Craniofacial Surgery
Darrell Wu, Arina E Chesnokova, Shahab Akvan, Matt D Price, David J Sugarbaker, Joseph S Coselli, Scott A LeMaire
OBJECTIVE: Chylothorax is a potentially deadly complication that can occur after thoracoabdominal aortic aneurysm (TAAA) repair. We describe our contemporary experience (2005-2014) with this complication, our efforts to identify perioperative variables associated with it, and our attempts to assess treatment outcomes. METHODS: We reviewed the records of 1092 consecutive patients who underwent TAAA repair between 2005 and 2014. Standard bivariate analysis was used to test for between-group differences...
February 8, 2018: Seminars in Thoracic and Cardiovascular Surgery
Tugba Ugurlu, Candan Ozogul, Gulistan Sanem Saribas, Seren Gulsen Gurgen, Seda Nur Akyol, Bahar Kartal
The aim of this study was to investigate the effect of antioxidants on angiogenesis in uterine transplantation. We used 24 female rats equally divided into four groups: Group 1 had the uterus stored in HTK (Histidine-Tryptophan-Ketoglutarate) solution at 4 °C cold storage for 4 h. Group 2 had the uterine tissue stored in HTK solution combined with acetyl L-carnitine (10-8  M) for 4 h at +4 °C. The same procedures with Group 1 and 2 were repeated for 24 h for Groups 3 and 4, respectively. Histological investigation and immunohistochemical analysis were performed...
January 31, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Sarah P Shubeck, Jyothi R Thumma, Justin B Dimick, Hari Nathan
OBJECTIVE: The aim of this study was to determine the feasibility of "hot spotting" in elective surgical populations. BACKGROUND: Prospective identification of high-cost patients, known as "hot spotting," is well developed in medical populations, but has not been performed in surgical populations. Population-based management of surgical expenditures requires identification of high-cost surgical patients to allow for effective implementation of cost-saving strategies...
January 16, 2018: Annals of Surgery
Ourania Preventza, Matt D Price, Konstantinos Spiliotopoulos, Hiruni S Amarasekara, Lorraine D Cornwell, Shuab Omer, Kim I de la Cruz, Qianzi Zhang, Susan Y Green, Scott A LeMaire, Todd K Rosengart, Joseph S Coselli
OBJECTIVE: The preferred arterial cannulation site for elective proximal aortic procedures requiring circulatory arrest varies, and different sites have been tried. We evaluated the relationships between arterial cannulation site and adverse outcomes, including stroke, in patients undergoing elective aortic arch surgery. METHODS: We reviewed the records of 938 patients who underwent elective hemiarch or total arch surgery with circulatory arrest between 2006 and 2016...
December 19, 2017: Journal of Thoracic and Cardiovascular Surgery
Russell J Funk, Jason Owen-Smith, Samuel A Kaufman, Brahmajee K Nallamothu, John M Hollingsworth
Importance: To reduce inefficiency and waste associated with care fragmentation, many current programs target greater clinical integration among physicians. However, these programs have led to only modest Medicare spending reductions. Most programs focus on formal integration, which often bears little resemblance to actual physician interaction patterns. Objectives: To examine how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments...
December 27, 2017: JAMA Surgery
Caitlin M Gibson, Sondra Davis, Darien Bradford
Purpose: Sodium nitroprusside is a vasodilator frequently used in the coronary artery bypass grafting (CABG) setting. However, the price of a 50-mg vial of sodium nitroprusside increased from $5.00 in 2003 to up to $900 in 2016. The purpose of this review is to help health systems balance high-quality patient care with economic responsibility. Methods: A MEDLINE literature search was performed using the search terms "nitroprusside" and "coronary artery bypass." All English-language trials in human subjects assessing the use of sodium nitroprusside in the setting of CABG were evaluated...
July 2017: Hospital Pharmacy
Aihua Pu, Lillian Ding, Jungwon Shin, Joel Price, Peter Skarsgard, Daniel R Wong, John Bozinovski, Guy Fradet, James G Abel
Importance: Although the long-term survival advantage of multiple arterial grafting (MAG) vs the standard use of left internal thoracic artery (LITA) supplemented by saphenous vein grafts (LITA+SVG) has been demonstrated in several observational studies, to our knowledge its safety and other long-term clinical benefits in a large, population-based cohort are unknown. Objective: To compare the safety and long-term outcomes of MAG vs LITA+SVG among overall and selected subgroups of patients...
November 1, 2017: JAMA Cardiology
Robert B Hawkins, J Hunter Mehaffey, Kenan W Yount, Leora T Yarboro, Clifford Fonner, Irving L Kron, Mohammed Quader, Alan Speir, Jeffrey Rich, Gorav Ailawadi
OBJECTIVES: The Centers for Medicare and Medicaid Services plans to institute a 5-year trial of bundled payments for coronary artery bypass grafting through 90 days after discharge. To investigate the impact, we reviewed actual inpatient costs for patients undergoing bypass surgery relative to the target price. METHODS: A total of 13,276 Medicare patients with estimated cost data underwent isolated coronary artery bypass grafting from 2008 to 2015 in 18 hospitals over 8 Medicare-defined regions within the Commonwealth of Virginia...
July 29, 2017: Journal of Thoracic and Cardiovascular Surgery
Tristan M Snowsill, Jason Moore, Ruben E Mujica Mota, Jaime L Peters, Tracey L Jones-Hughes, Nicola J Huxley, Helen F Coelho, Marcela Haasova, Chris Cooper, Jenny A Lowe, Jo L Varley-Campbell, Louise Crathorne, Matt J Allwood, Rob Anderson
Background: Immunosuppression is required in kidney transplantation to prevent rejection and prolong graft survival. We conducted an economic evaluation to support England's National Institute for Health and Care Excellence in developing updated guidance on the use of immunosuppression, incorporating new immunosuppressive agents, and addressing changes in pricing and the evidence base. Methods: A discrete-time state transition model was developed to simulate adult kidney transplant patients over their lifetime...
July 1, 2017: Nephrology, Dialysis, Transplantation
Vinay Guduguntla, John D Syrjamaki, Chad Ellimoottil, David C Miller, Richard L Prager, Edward C Norton, Patricia Theurer, Donald S Likosky, James M Dupree
Importance: Coronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into current CABG payments and their variation is important for understanding the potential effects of bundled payment models in cardiac care. Objective: To examine CABG payment variation and its drivers...
August 23, 2017: JAMA Surgery
Samer Alsidawi, Katharine A Price, Ashish V Chintakuntlawar, Gustavo F Westin, Joaquin J Garcia, Daniel J Ma, Scott H Okuno
INTRODUCTION: Immunosuppression after solid organ transplant prevents graft rejection, but leads to increased incidence of various malignancies including head and neck squamous cell carcinoma (HNSCC). Outcomes of patients with post-transplant HNSCC are unknown. MATERIALS AND METHODS: We retrospectively identified patients who developed HNSCC after solid organ transplant between 1995 and 2010. Adults with pathology-proven HNSCC and adequate follow up were included...
September 2017: Oral Oncology
Marianne O Price, Marek Lisek, Matthew T Feng, Francis W Price
PURPOSE: To evaluate whether donor and/or recipient diabetes status affects the outcomes of Descemet membrane endothelial keratoplasty (DMEK). METHODS: A consecutive, single-center DMEK case series was reviewed. The outcome measures were success of surgeon tissue preparation, air reinjection rate, Kaplan-Meier 4-year graft replacement/failure rate for any reason, and endothelial cell loss. RESULTS: The donor had a history of diabetes in 504 of 1791 cases (28%) and the recipient in 14%...
October 2017: Cornea
Daniel J Price, Mthulisi Khuphe, Robert P W Davies, James R McLaughlan, Nicola Ingram, Paul D Thornton
Biodegradable polymers have emerged as highly effective drug delivery vehicles. We combine N-carboxyanhydride and O-carboxyanhydride ring opening polymerisations to synthesise a poly(amino acid)-polyester graft copolymer capable of encapsulating, and subsequently releasing doxorubicin via acid-mediated hydrolysis. Consequently, the nanoparticles detailed are extremely promising vehicles for the controlled delivery of chemotherapeutic agents.
July 19, 2017: Chemical Communications: Chem Comm
Paul E Caldwell
Osteochondritis dissecans (OCD) of the elbow capitellum is a common disorder that causes pain and functional limitation in the athletic adolescent elbow. Many surgical options have been proposed over the years, but none has stood the test of time. A recent well-written systematic review highlights the treatment options and recognizes a growing trend toward osteochondral allograft transplantation as the ideal solution. Unfortunately, the study also underscores the paucity of evidence on which we base our treatment decisions for OCD of the elbow in the young athlete...
July 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
Konstantinos Spiliotopoulos, Matt D Price, Hiruni S Amarasekara, Susan Y Green, Qianzi Zhang, Ourania Preventza, Joseph S Coselli, Scott A LeMaire
OBJECTIVE: Women fare worse than men after many cardiovascular operations, including coronary artery bypass grafting and valve surgery. We sought to determine whether sex affects outcomes after open thoracoabdominal aortic aneurysm repair. METHODS: We evaluated data on 3353 consecutive patients (1281 women, 38.2%) who underwent open thoracoabdominal aortic aneurysm repair between October 1986 and July 2015. We compared preoperative characteristics, surgical variables, and outcomes between men and women in the overall group...
June 3, 2017: Journal of Thoracic and Cardiovascular Surgery
Freddy Abnousi, Vandana Sundaram, Celina M Yong, Jayne Prats, Efthymios N Deliargyris, Gregg W Stone, Christian W Hamm, Philippe Gabriel Steg, Charles Michael Gibson, Harvey D White, Matthew J Price, Philippe Généreux, Manisha Desai, Lingyao Yang, Victoria Y Ding, Robert A Harrington, Deepak L Bhatt, Kenneth W Mahaffey
OBJECTIVE: To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). BACKGROUND: Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI). METHODS: We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial...
June 2017: American Heart Journal
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