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https://www.readbyqxmd.com/read/29351675/quality-in-spine-surgery
#1
Christopher Graves, Scott Meyer, John Knightly, Steven Glassman
Health care is expensive in the United States. There is an increasing focus on value rather than volume. Accurately measuring quality is a critically important step in determining value of care delivered. This article discusses the trials and techniques of measuring quality in spine surgery. A detailed analysis of advantages and disadvantages of various measures of quality, including process measurements, patient-reported outcome measurements, and safety measurements is included-from a historical perspective through modern practice...
February 1, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29349711/impact-of-an-embedded-genetic-counselor-on-breast-cancer-treatment
#2
Holly J Pederson, Najaah Hussain, Ryan Noss, Courtney Yanda, Colin O'Rourke, Charis Eng, Stephen R Grobmyer
BACKGROUND: We predicted that embedding a genetic counselor within our breast practice would improve identification of high-risk individuals, timeliness of care, and appropriateness of surgical decision making. The aim of this study is to compare cancer care between 2012 and 2014, prior to embedding a genetic counselor in the breast center and following the intervention, respectively. METHODS: A retrospective review of patients diagnosed with breast cancer in 2012 (n = 471) and 2014 (n = 440) was performed to assess patterns of medical genetics referral, compliance with referral, genetic testing findings, and impact on treatment...
January 18, 2018: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/29345003/investigation-of-attributes-which-guide-choice-in-cataract-surgery-services-in-urban-sydney-australia
#3
Celeste Gilbert, Lisa Keay, Anna Palagyi, Vu Quang Do, Peter McCluskey, Andrew White, Nicole Carnt, Fiona Stapleton, Tracey-Lea Laba
BACKGROUND: It is critical to consult patients to develop patient-centred cataract surgery care. We aimed to identify attributes patients consider when making decisions about cataract surgery in an Australian context, where both publicly and privately funded surgery are available. This is the first step in investigating how decisions are made about cataract surgery services. METHODS: This observational qualitative study was undertaken in two public hospitals and one private practice in Sydney, Australia...
January 17, 2018: Clinical & Experimental Optometry: Journal of the Australian Optometrical Association
https://www.readbyqxmd.com/read/29344778/the-relationship-between-vancomycin-trough-concentrations-and-auc-mic-ratios-in-pediatric-patients-a-qualitative-systematic-review
#4
REVIEW
Stacey Tkachuk, Kyle Collins, Mary H H Ensom
BACKGROUND: In adults, the area under the concentration-time curve (AUC) divided by the minimum inhibitory concentration (MIC) is associated with better clinical and bacteriological response to vancomycin in patients with methicillin-resistant Staphylococcus aureus who achieve target AUC/MIC ≥ 400. This target is often extrapolated to pediatric patients despite the lack of similar evidence. The impracticalities of calculating the AUC in practice means vancomycin trough concentrations are used to predict the AUC/MIC...
January 17, 2018: Paediatric Drugs
https://www.readbyqxmd.com/read/29344100/surgical-site-infection-prevention-an-analysis-of-compliance-with-good-practice-in-a-teaching-hospital
#5
Adriana Cristina de Oliveira, Camila Sarmento Gama
Background: Surgical teams play a critical role in reducing surgery-related risks during preoperative and intraoperative phases. Aim: To analyse the preoperative and intraoperative practices adopted by surgical teams in surgical site infections prevention. Methods: This was a cross-sectional study conducted during April-September 2013 in a large university hospital in Belo Horizonte, Minas Gerais, Brazil. It was conducted through observation of the surgical practice during preoperative and intraoperative phases of procedures used by a gastroenterological, cardiovascular and paediatric surgical team...
November 2017: Journal of Infection Prevention
https://www.readbyqxmd.com/read/29343048/physiology-intervention-and-outcome-three-critical-questions-about-cerebral-tissue-oxygen-saturation-monitoring
#6
Lingzhong Meng, Shaun E Gruenbaum, Feng Dai, Tianlong Wang
The balance between cerebral tissue oxygen consumption and supply can be continuously assessed by cerebral tissue oxygen saturation (SctO2) monitor. A construct consisting of three sequential questions, targeting the physiology monitored, the intervention implemented, and the outcomes affected, is proposed to critically appraise this monitor. The impact of the SctO2- guided care on patient outcome was examined through a systematic literature search and meta- analysis. We concluded that the physiology monitored by SctO2 is robust and dynamic, fragile (prone to derangement), and adversely consequential when deranged...
January 17, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29342070/an-evaluation-of-industry-relationships-among-contributors-to-aaos-clinical-practice-guidelines-and-appropriate-use-criteria
#7
Jake X Checketts, Courtney Cook, Matt Vassar
BACKGROUND: A long-standing relationship between orthopaedic surgeons and industry has made financial conflicts of interest a concerning issue. Research supports that financial conflicts of interest can influence both medical research and clinical practice. Financial conflicts of interest may also influence clinical practice guideline recommendations and their corresponding appropriate use criteria. Because of the influential nature of these guidelines, it is imperative that care be taken to minimize bias during guideline development...
January 17, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29332784/air-transport-of-a-patient-with-impending-cerebral-herniation-from-tension-pneumocephalus
#8
Etzer Augustin, Michael Karsy, Jim Bryan, Jian Guan, Richard H Schmidt
Tension pneumocephalus is a rare but dangerous complication of craniotomy, sinus surgery, and traumatic cranial injury. Compared with simple pneumocephalus, which often resolves spontaneously over the course of a few days, tension pneumocephalus tends to increase with ongoing cerebrospinal fluid leak and requires immediate neurosurgical treatment to prevent cerebral herniation. Air transport of patients with tension pneumocephalus for neurosurgical care entails a risk of neurologic worsening because of changes in ambient air pressure with altitude and cabin pressurization...
January 2018: Air Medical Journal
https://www.readbyqxmd.com/read/29332420/activated-factor-7-versus-4-factor-prothrombin-complex-concentrate-for-critical-bleeding-post-cardiac-surgery
#9
Sarah L Mehringer, Zachary Klick, Jonathan Bain, Elizabeth B McNeely, Sreekumar Subramanian, Lawrence J Pass, Davis Drinkwater, V Seenu Reddy
BACKGROUND: Recombinant and plasma-derived factor products, such as activated factor seven (rFVIIa) and four-factor prothrombin complex concentrate (4-factor PCC), have been used off-label for bleeding after cardiac surgery, but little evidence has been published regarding their efficacy and safety. OBJECTIVE: To determine whether there is a difference in chest tube output in patients who have received 4-factor PCC or rFVIIa for critical postoperative bleeding associated with cardiovascular surgery...
January 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29331398/critical-differences-between-elective-and-emergency-surgery-identifying-domains-for-quality-improvement-in-emergency-general-surgery
#10
Alexandra B Columbus, Megan A Morris, Elizabeth J Lilley, Alyssa F Harlow, Adil H Haider, Ali Salim, Joaquim M Havens
OBJECTIVE: The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. BACKGROUND: Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed...
January 10, 2018: Surgery
https://www.readbyqxmd.com/read/29330634/corrective-osteotomies-using-patient-specific-3d-printed-guides-a-critical-appraisal
#11
Wouter Rosseels, Michiel Herteleer, An Sermon, Stefaan Nijs, Harm Hoekstra
INTRODUCTION: Over the last decade, the technique of 3D planning has found its way into trauma surgery. The use of this technique in corrective osteotomies for treatment of malunions provides the trauma surgeon with a powerful tool. However, this technique is not entirely straightforward. We aimed to define potential pitfalls of this technique and possible solutions to overcome these shortcomings. MATERIALS AND METHODS: Ten patients with either a uni-, bi- or triplanar malunion of the long bones were included in this study...
January 12, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29329124/septic-arthritis-of-the-wrist
#12
John D Jennings, Asif M Ilyas
Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Timely identification and treatment is critical to patient care. No serum laboratory values have been shown to consistently confirm wrist joint infection. Thus, diagnosis is made based mainly on a thorough patient history, physical examination, and joint aspiration. When infection is suspected, aspiration of the wrist should be performed to confirm the diagnosis. Broad-spectrum antibiotics and joint aspiration or surgery are required to manage the infection and prevent sequelae...
January 11, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29318698/nighttime-care-routine-interaction-and-sleep-disruption-in-adult-cardiac-surgery
#13
Jesus M Casida, Jean E Davis, Aaron Zalewski, James J Yang
AIMS AND OBJECTIVES: To explore the context and the influence of nighttime care routine interactions (NCRIs) on nighttime sleep effectiveness (NSE) and daytime sleepiness (DSS) of patients in the cardiac surgery critical-and progressive-care units of a hospital. BACKGROUND: There exists a paucity of empirical data regarding the influence of NCRIs on sleep and associated outcomes in hospitalized adult cardiac surgery patients. METHODS: An exploratory repeated measures research design was employed on the data provided by 38 elective cardiac surgery patients (mean age 60...
January 9, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29318344/severe-casualties-from-bastille-day-attack-in-nice-france
#14
Federico Solla, Joseph Carboni, Arnaud Fernandez, Audrey Dupont, Nathalie Chivoret, Gilles Brézac, Virginie Rampal, Jean Bréaud
PURPOSE: To describe the most severe casualties from the July 14th, 2016 terror attack in Nice that were treated at the Lenval University Children's Hospital (LUCH) of Nice (France). METHODS: Retrospective study about casualties treated at LUCH from Bastille Day Attack with injuries resulting in the need for surgery, resuscitation, or death. The type of lesions and surgery, duration of hospitalizations, complications, psychological status, and outcome at discharge were collected...
January 9, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29317368/interdisciplinary-care-model-independently-decreases-use-of-critical-care-services-after-corrective-surgery-for-adult-degenerative-scoliosis
#15
Owoicho Adogwa, Aladine A Elsamadicy, Amanda R Sergesketter, Michael Ongele, Victoria Vuong, Syed Khalid, Jessica Moreno, Joseph Cheng, Isaac O Karikari, Carlos A Bagley
OBJECTIVE: Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short and long-term outcomes. The aim of this study is to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources. METHODS: A unique co-management model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program(POSH) was launched with the aim of improving outcomes in elderly patients(>65-years-old) undergoing complex lumbar spine surgery...
January 6, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29316598/s-orthopaedic-department-teaching-status-associated-with-adverse-outcomes-of-primary-total-knee-arthroplasty
#16
Dean C Perfetti, Nipun Sodhi, Anton Khlopas, Assem A Sultan, Suela Lamaj, Mathew R Boylan, Jared M Newman, Qais Naziri, William A Cantrell, Aditya V Maheshwari, Carl B Paulino, Michael A Mont
INTRODUCTION: Although resident physicians have a critical role in the daily management of patients, based on their limited experiences, they are thought to potentially create inefficiencies in the hospital. With changes set forth by the Comprehensive Care for Joint Replacement (CJR) program, both teaching and non-teaching hospitals are directly compared on efficiency and outcomes. Therefore, the purpose of this study was to compare outcomes between teaching and non-teaching hospitals in the state of New York...
December 22, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/29313906/respiratory-complications-of-anaesthesia
#17
REVIEW
G H Mills
Postoperative pulmonary complications are a major determinant of outcome for patients and consume huge resources within hospital, particularly in critical care. Prediction and anticipation of postoperative pulmonary complications are vital for patient selection and, in some cases, for informed patient consent. Being able to assess the likelihood of postoperative pulmonary complications also allows research into methods to reduce them by allowing allocation of patients to the appropriate arms of research trials...
January 2018: Anaesthesia
https://www.readbyqxmd.com/read/29310377/fat-grafting-for-resurfacing-an-exposed-implant-in-lower-extremity-a-case-report
#18
Yun-Nan Lin, Chieh-Han Chuang, Shih-Hao Huang, Shu-Hung Huang, Tsai-Ming Lin, I-Wen Lin, Sin-Daw Lin, Yur-Ren Kuo
RATIONALE: Although numerous reconstruction protocols have been reported for lower leg trauma, those for distal leg trauma remain few. We present the case of a woman with an implant exposure wound, who was successfully treated through fat grafting, without major flap surgery. PATIENT CONCERNS: An 83-year-old woman with an exposed implant in lower extremity received reconstruction surgery once and the surgery failed. She refused additional major surgery and negative pressure wound therapy...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29306908/systematic-comparison-of-routine-laboratory-measurements-with-in-hospital-mortality-icu-labome-a-large-cohort-study-of-critically-ill-patients
#19
Edris M Alkozai, Bakhtawar K Mahmoodi, Johan Decruyenaere, Robert J Porte, Annemieke Oude Lansink-Hartgring, Ton Lisman, Maarten W Nijsten
BACKGROUND: In intensive care unit (ICU) patients, many laboratory measurements can be deranged when compared with the standard reference interval (RI). The assumption that larger derangements are associated with worse outcome may not always be correct. The ICU-Labome study systematically evaluated the univariate association of routine laboratory measurements with outcome. METHODS: We studied the 35 most frequent blood-based measurements in adults admitted ≥6 h to our ICU between 1992 and 2013...
January 8, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29305711/early-management-of-retained-hemothorax-in-blunt-head-and-chest-trauma
#20
Fong-Dee Huang, Wen-Bin Yeh, Sheng-Shih Chen, Yuan-Yuarn Liu, I-Yin Lu, Yi-Pin Chou, Tzu-Chin Wu
BACKGROUND: Major blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3-4 days, other critical surgical interventions may be delayed. The purpose of this study is to analyze the outcomes of head injury patients who received early, versus delayed thoracic surgeries. MATERIALS AND METHODS: From May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled...
January 5, 2018: World Journal of Surgery
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