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https://www.readbyqxmd.com/read/29342417/a-study-of-the-cost-effectiveness-of-fenestrated-branched-evar-compared-with-open-surgery-for-patients-with-complex-aortic-aneurysms-at-2-years
#1
Morgane Michel, Jean-Pierre Becquemin, Jean Marzelle, Céline Quelen, Isabelle Durand-Zaleski
OBJECTIVES: The aim was to assess the cost-effectiveness of fenestrated and branched stent grafts (f/b EVAR) compared with open surgical repair (OSR) in thoraco-abdominal or complex abdominal aortic aneurysms (TAAA/AAA) at 2 years. METHODS: Two matched cohorts of patients with TAAA or complex AAA were compared after a follow-up of two years. Patients included in the WINDOW French multicentre prospective registry were treated by f/b EVAR, and OSR patients were extracted from the French national hospital discharge database...
January 13, 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29342089/chitosan-gel-to-treat-pressure-ulcers-a-clinical-pilot-study
#2
Virginia Campani, Eliana Pagnozzi, Ilaria Mataro, Laura Mayol, Alessandra Perna, Floriana D'Urso, Antonietta Carillo, Maria Cammarota, Maria Chiara Maiuri, Giuseppe De Rosa
Chitosan is biopolymer with promising properties in wound healing. Chronic wounds represent a significant burden to both the patient and the medical system. Among chronic wounds, pressure ulcers are one of the most common types of complex wound. The efficacy and the tolerability of chitosan gel formulation, prepared into the hospital pharmacy, in the treatment of pressure ulcers of moderate severity were evaluated. The endpoint of this phase II study was the reduction of the area of the lesion by at least 20% after four weeks of treatment...
January 17, 2018: Pharmaceutics
https://www.readbyqxmd.com/read/29342059/patients-living-alone-can-be-safely-discharged-directly-home-after-total-joint-arthroplasty-a-prospective-cohort-study
#3
Andrew N Fleischman, Matthew S Austin, James J Purtill, Javad Parvizi, William J Hozack
BACKGROUND: Despite the expense and potential hazards of inpatient rehabilitation, there is a prevailing belief that patients living alone cannot be safely discharged directly home after total joint arthroplasty. The purpose of this study was to assess the safety and efficacy of direct home discharge for patients living alone during convalescence after primary total joint arthroplasty. METHODS: We prospectively studied 910 consecutive patients undergoing primary, unilateral total hip arthroplasty or total knee arthroplasty over an 8-month period...
January 17, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29342019/hot-spotting-as-a-strategy-to-identify-high-cost-surgical-populations
#4
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
https://www.readbyqxmd.com/read/29341514/opportunity-costs-in-paediatric-training-the-specialist-registrars-experience
#5
M B O'Neill, T Nabialek, N Kandamany
In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression, 2) perceived functional effectiveness at work, 3) psychological impact of hospital based training, and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships...
August 8, 2017: Irish Medical Journal
https://www.readbyqxmd.com/read/29341466/effects-of-intravenous-home-dobutamine-in-palliative-end-stage-heart-failure-on-quality-of-life-heart-failure-hospitalization-and-cost-expenditure
#6
Pieter Martens, Jan Vercammen, Wendy Ceyssens, Linda Jacobs, Evert Luwel, Herwig Van Aerde, Peter Potargent, Monique Renaers, Matthias Dupont, Wilfried Mullens
AIMS: In patients with palliative end-stage heart failure, interventions that could provide symptomatic relief and prevent hospital admissions are important. Ambulatory continuous intravenous inotropes have been advocated by guidelines for such a purpose. We sought to determine the effect of intravenous dobutamine on symptomatic status, hospital stay, mortality, and cost expenditure. METHODS AND RESULTS: All consecutive end-stage heart failure patients not amenable for advanced therapies and discharged with continuous intravenous home dobutamine from a single tertiary centre between April 2011 and January 2017 were retrospectively analysed...
January 17, 2018: ESC Heart Failure
https://www.readbyqxmd.com/read/29341373/antibiotic-allergy-labels-the-impact-of-taking-a-clinical-history
#7
Adrienne Torda, Victor Chan
BACKGROUND: Many patients admitted to hospital have an antibiotic allergy (AAL) documented in their medical record. In many of these, the reaction is not a hypersensitivity reaction or may no longer be relevant. Despite this, the label adversely affects patient care directly in terms of antibiotic selection, and indirectly in terms of patient costs and the development of antimicrobial resistance. AIMS: To estimate the prevalence of AALs in a cohort of hospitalised patients, to investigate the feasibility of de-labelling through re-challenge based solely upon clinical grounds...
January 17, 2018: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/29341066/cerebral-near-infrared-spectroscopy-nirs-for-perioperative-monitoring-of-brain-oxygenation-in-children-and-adults
#8
REVIEW
Yun Yu, Kaiying Zhang, Ling Zhang, Huantao Zong, Lingzhong Meng, Ruquan Han
BACKGROUND: Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients. OBJECTIVES: To assess the effects of perioperative cerebral NIRS monitoring and corresponding treatment strategies in adults and children, compared with blinded or no cerebral oxygenation monitoring, or cerebral oxygenation monitoring based on non-NIRS technologies, on the detection of cerebral oxygen desaturation events (CDEs), neurological outcomes, non-neurological outcomes and socioeconomic impact (including cost of hospitalization and length of hospital stay)...
January 17, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29340940/characterizing-potentially-preventable-admissions-a-mixed-methods-study-of-rates-associated-factors-outcomes-and-physician-decision-making
#9
Lisa M Daniels, Atsushi Sorita, Deanne T Kashiwagi, Masashi Okubo, Evan Small, Eric C Polley, Adam P Sawatsky
BACKGROUND: Potentially preventable admissions are a target for healthcare cost containment. OBJECTIVE: To identify rates of, characterize associations with, and explore physician decision-making around potentially preventable admissions. DESIGN: A comparative cohort study was used to determine rates of potentially preventable admissions and to identify associated factors and patient outcomes. A qualitative case study was used to explore physicians' clinical decision-making...
January 16, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29340924/impact-of-preoperative-opioid-use-after-emergency-general-surgery
#10
Young Kim, Alexander R Cortez, Koffi Wima, Vikrom K Dhar, Krishna P Athota, Jason J Schrager, Timothy A Pritts, Michael J Edwards, Shimul A Shah
BACKGROUND: Preoperative exposure to narcotics has recently been associated with poor outcomes after elective major surgery, but little is known as to how preoperative opioid use impacts outcomes after common, emergency general surgical procedures (EGS). METHODS: A high-volume, single-center analysis was performed on patients who underwent EGS from 2012 to 2013. EGS was defined as the seven emergent operations that account for 80% of the national burden. Preoperative opioid use was defined as having an active opioid prescription within 7 days prior to surgery...
January 16, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29340855/the-relationship-between-target-joints-and-direct-resource-use-in-severe-haemophilia
#11
Jamie O'Hara, Shaun Walsh, Charlotte Camp, Giuseppe Mazza, Liz Carroll, Christina Hoxer, Lars Wilkinson
OBJECTIVES: Target joints are a common complication of severe haemophilia. While factor replacement therapy constitutes the majority of costs in haemophilia, the relationship between target joints and non drug-related direct costs (NDDCs) has not been studied. METHODS: Data on haemophilia patients without inhibitors was drawn from the 'Cost of Haemophilia across Europe - a Socioeconomic Survey' (CHESS) study, a cost assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the United Kingdom) in which 139 haemophilia specialists provided demographic and clinical information for 1285 adult patients...
January 16, 2018: Health Economics Review
https://www.readbyqxmd.com/read/29340826/single-port-laparoscopic-surgery-in-uncomplicated-acute-appendicitis-a-randomized-controlled-trial
#12
Byung Mo Kang, Sung Il Choi, Bum-Soo Kim, Suk-Hwan Lee
BACKGROUND: Single-port laparoscopic surgery (SPLS) is an alternative, minimally invasive surgical approach for managing appendicitis. The aim of this randomized trial was to evaluate the safety and efficacy of SPLS in uncomplicated appendicitis. METHODS: Between December 2009 and November 2010, 194 patients with radiologically diagnosed acute appendicitis were randomly allocated to undergo either SPLS or multiport laparoscopic surgery (MPLS). Patients with intraoperative findings of perforated appendicitis were excluded from the analysis...
January 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29340820/the-development-and-validation-of-a-scoring-tool-to-predict-the-operative-duration-of-elective-laparoscopic-cholecystectomy
#13
Reshma Bharamgoudar, Aniket Sonsale, James Hodson, Ewen Griffiths
BACKGROUND: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. METHODS: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration...
January 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29340815/comparison-between-submucosal-tunneling-endoscopic-resection-and-video-assisted-thoracoscopic-enucleation-for-esophageal-submucosal-tumors-originating-from-the-muscularis-propria-layer-a-randomized-controlled-trial
#14
Ningli Chai, Chen Du, Ying Gao, Xiaotong Niu, Yaqi Zhai, Enqiang Linghu, Yang Liu, Bo Yang, Zhongsheng Lu, Zhenjuan Li, Xiangdong Wang, Ping Tang
BACKGROUND AND AIMS: Surgical resection is considered the first treatment option for submucosal tumors (SMTs) originating from the muscularis propria layer while submucosal tunneling endoscopic resection (STER) is proved to be a safe and effective method for treating SMTs. This study aimed to compare video-assisted thoracoscopic enucleation (VATE) with STER for treating esophageal SMTs. METHODS: Sixty-six patients with small esophageal SMTs were prospectively randomized from July 2014 to December 2015...
January 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29340810/ureteral-stents-increase-risk-of-postoperative-acute-kidney-injury-following-colorectal-surgery
#15
Taryn E Hassinger, J Hunter Mehaffey, Matthew G Mullen, Alex D Michaels, Nathan R Elwood, Shoshana T Levi, Traci L Hedrick, Charles M Friel
BACKGROUND: Ureteral stents are commonly placed before colorectal resection to assist in identification of ureters and prevent injury. Acute kidney injury (AKI) is a common cause of morbidity and increased cost following colorectal surgery. Although previously associated with reflex anuria, prophylactic stents have not been found to increase AKI. We sought to determine the impact of ureteral stents on the incidence of AKI following colorectal surgery. METHODS: All patients undergoing colon or rectal resection at a single institution between 2005 and 2015 were reviewed using American College of Surgeons National Surgical Quality Improvement Program dataset...
January 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29340609/impact-of-antibiotic-stewardship-programmes-in-asia-a-systematic-review-and-meta-analysis
#16
Chun Fan Lee, Benjamin J Cowling, Shuo Feng, Hanae Aso, Peng Wu, Keiji Fukuda, Wing Hong Seto
Background: The use of antibiotic stewardship programmes (ASPs) is increasing in Asia, but their effectiveness in reducing antibiotic consumption and their impact on clinical outcomes is not known. Objectives: To determine the impact of ASPs conducted in Asia on the consumption of antibiotics and on patients' clinical outcomes. Methods: We systematically searched the Embase and Medline (PubMed) databases for studies that compared antibiotic consumption or clinical outcomes of patients in an Asian hospital or clinic with an ASP (intervention) with those in a similar setting without an ASP (control)...
January 11, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29340299/prospective-study-of-the-feasibility-of-point-of-care-testing-strategy-for-carbapenem-resistant-organism-detection
#17
Rahul Pannala, Bruce Baldwin, Vijay Aluru, Thomas E Grys, Jordan Holmes, Laurence J Miller, M Edwyn Harrison, Cuong C Nguyen, Fred C Tenover, David Persing, Douglas O Faigel
Background/aims:  In an investigator-initiated, prospective study, we evaluated the feasibility of a five-gene sequence point-of-care (POC) testing strategy (Xpert CARBA-R Assay, Cepheid Inc., Sunnyvale, CA, USA), compared to reference laboratory PCR (48 - 72 hours turnaround time, two gene sequences), in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and in a hospital outbreak investigation. Methods:  After informed consent, patients undergoing ERCP (September 2015 - April 2016, n = 191) at Mayo Clinic and potential hospital contacts (n = 9) of an index carbapenem-resistant organism (CRO)-positive inpatient were included...
January 2018: Endoscopy International Open
https://www.readbyqxmd.com/read/29340294/a-comparison-of-endoscopic-and-non-endoscopic-biliary-intervention-outcomes-in-patients-with-prior-bariatric-surgery
#18
Amrit K Kamboj, Victorio Pidlaoan, Mohammad H Shakhatreh, Alice Hinton, Darwin L Conwell, Somashekar G Krishna
Background and study aims : Endoscopic biliary intervention (BI) is often difficult to perform in patients with prior bariatric surgery (BRS). We sought to analyze outcomes of patients with prior BRS undergoing endoscopic and non-endoscopic BI. Patients and methods:  The Nationwide Inpatient Sample (2007 - 2011) was reviewed to identify all adult inpatients (≥ 18 years) with a history of BRS undergoing BI. The clinical outcomes of interest were in-patient mortality, length of stay (LOS), and total hospital charges...
January 2018: Endoscopy International Open
https://www.readbyqxmd.com/read/29339916/pediatric-cataract-surgery-with-hydrophilic-acrylic-intraocular-lens-implantation-in-nepalese-children
#19
Srijana Adhikari, Ujjowala D Shrestha
Purpose: To assess the outcome of cataract surgery with hydrophilic acrylic intraocular lens (IOL) implantation in children with congenital and developmental cataracts. Method: A retrospective review of medical records of children with congenital or developmental cataracts who underwent cataract surgery with hydrophilic IOL implantation, from January 2011 to December 2014 in a tertiary eye hospital in Nepal. Primary posterior capsulotomy, anterior vitrectomy, and IOL implantation was done in children 8 years or younger, while older children underwent only lens aspiration and IOL implantation...
2018: Clinical Ophthalmology
https://www.readbyqxmd.com/read/29339385/effectiveness-of-an-antimicrobial-stewardship-program-in-critical-care-a-before-and-after-study
#20
Francisco Álvarez-Lerma, Santiago Grau Cerrato, Daniel Echeverría Esnal, Montserrat Martínez-Alonso, Maria Pilar Gracia Arnillas, Juan Pablo Horcajada, Juan Ramón Masclans
We evaluated the use of antimicrobials expressed as defined daily doses (DDDs) per 1,000 patient days and days of therapy (DOT) per 100 occupied bed-days in a intensive care unit (UCI) of a general hospital in Barcelona, Spain, before and after implementation of an antimicrobial stewardship (AMS) program (2007-2010 versus 2011-2015). The quarterly costs of antimicrobials used in the ICU and its weight in the overall hospital costs of antimicrobials were calculated. The effect of the applied AMS program on DDDs and DOT time series data was analyzed by means of intervention time series analysis...
January 16, 2018: Antimicrobial Agents and Chemotherapy
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