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【外科文献】A GETAID/GETAID Chirurgie Multicenter Retrospective Cohort of 343...

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 楼主| 发表于 2016-10-19 11:28:53 | 显示全部楼层

【外科文献】Comparable Short- and Long-term Outcomes in Living Donor and Dece...

  Comparable Short- and Long-term Outcomes in Living Donor and Deceased Donor Liver Transplantations for Patients With Model for End-stage Liver Disease Scores >=35 in a Hepatitis-B Endemic Area.

  作者:Chok, Kenneth S. H. MBBS, MS; Fung, James Y. Y. BHB, MBChB, MD; Chan, Albert C. Y. MBBS; Dai, Wing Chiu MBBS; Sharr, William W. MBBS; Cheung, Tan To MBBS, MS; Chan, See Ching MBBS, MS, PhD, MD; Lo, Chung Mau MBBS, MS

  文章来源:Annals of Surgery:

  Post Author Corrections: February 17, 2016

  Objective: To evaluate if living donor liver transplantation (LDLT) should be offered to patients with Model for End-stage Liver Disease (MELD) scores >=35.

  Background: No data was available to support LDLT of such patients.

  Methods: Data of 672 consecutive adult liver transplant recipients from 2005 to 2014 at our center were reviewed. Patients with MELD scores >=35 were divided into the deceased donor liver transplantation (DDLT) group and the LDLT group and were compared. Univariate analysis was performed to identify risk factors affecting survival.

  Results: The LDLT group (n = 54) had younger (33 yrs vs 50 yrs, P < 0.001) and lighter (56 Kg vs 65 Kg, P = 0.004) donors, lighter grafts (627.5 g vs 1252.5 g, P < 0.001), lower graft-weight-to-recipient-standard-liver-volume rates (51.28% vs 99.76%, P < 0.001), shorter cold ischemic time (106.5 min vs 389 min, P < 0.001), and longer operation time (681.5 min vs 534 min, P < 0.001). The groups were comparable in postoperative complication, hospital mortality, and graft survival and patient survival at one year (88.9% vs 92.5%; 88.9% vs 94.7%), three years (87.0% vs 86.9%; 87.0% vs 88.8%), and five years (84.8% vs 81.8%; 84.8% vs 83.3%). Univariate analysis did not show inferior survival in LDLT recipients.

  Conclusions: At centers with experience, the outcomes of LDLT can be comparable with those of DDLT even in patients with MELD scores >=35. When donor risks and recipient benefits are fully considered and balanced, an MELD score >=35 should not be a contraindication to LDLT. In Hong Kong, where most waitlisted patients have acute-on-chronic liver failure from hepatitis B, LDLT is a wise alternative to DDLT.
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 楼主| 发表于 2016-10-19 13:33:38 | 显示全部楼层

【外科文献】Comprehensive Review on a Data-driven Surgical Scheduling Strategy

  Systematic OR Block Allocation at a Large Academic Medical Center: Comprehensive Review on a Data-driven Surgical Scheduling Strategy.

  作者:Zenteno, Ana C. PhD; Carnes, Tim PhD; Levi, Retsef PhD; Daily, Bethany J. MHA; Dunn, Peter F. MD

  文章来源:Annals of Surgery:

  Post Author Corrections: February 23, 2016

  Background: Massachusetts General Hospital experienced increasing overcrowding of the perioperative environment in 2008. The Post-Anesthesia Care Unit would often be at capacity, forcing patients to wait in the operating room. The cause of congestion was traced back to significant variability in the surgical inpatient-bed occupancy across the days of the week due to elective surgery scheduling practices.

  Methods: We constructed an optimization model to find a rearrangement of the elective block schedule to smooth the average inpatient census by reducing the maximum average occupancy throughout the week. The model was revised iteratively as it was used in the organizational change process that led to an implementable schedule.

  Results: Approximately 21% of the blocks were rearranged. The setting of study is very dynamic. We constructed a hypothetical scenario to analyze the patient population most representative of the circumstances under which the model was built. For this group, the patient volume remained constant, the census peak decreased by 3.2% (P < 0.05), and the average weekday census decreased by 2.8% (P < 0.001). When considering all patients, the volume increased by 9%, the census peak increased 1.6% (P < 0.05), and the average weekday census increased by 2% (P < 0.001).

  Conclusions: This work describes the successful implementation of a data-driven scheduling strategy that increased the effective capacity of the surgical units. The use of the model as an instrument for change and strong managerial leadership was paramount to implement and sustain the new scheduling practices.
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 楼主| 发表于 2016-10-19 14:28:06 | 显示全部楼层

【外科文献】Surgeon Annual and Cumulative Volumes Predict Early Postoperative...

  Surgeon Annual and Cumulative Volumes Predict Early Postoperative Outcomes after Rectal Cancer Resection.

  作者:Yeo, Heather L. MD, MHS; Abelson, Jonathan S. MD; Mao, Jialin MD MS; O’Mahoney, Paul R. A. MD; Milsom, Jeffrey W. MD, FACS, FACRS; Sedrakyan, Art MD, PhD

  文章来源:Annals of Surgery:

  Post Author Corrections: February 16, 2016

  Objective: To determine if 5-year surgeon cumulative and annual volumes predict improved early postoperative outcomes in patients with rectal cancer.

  Background: Operative experience has been shown to effect surgical outcomes. The differential role of cumulative versus annual volume has not yet been explored for rectal surgery.

  Methods: The Statewide Planning and Research Cooperative System database was used to capture patients undergoing surgery in New York State from 2000 to 2013. A population-based sample of patients undergoing major rectal or rectosigmoid resection as their principal procedure during hospitalization between 2000 and 2013 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Surgeons were identified using a unique physician number from 1995 to 2013.

  Results: The percentage of surgeries performed by high cumulative/high annual (HC/HA) surgeons increased from 38.3% to 58.4% (P < 0.01) with a simultaneous decrease in that performed by low cumulative/low annual (LC/LA) surgeons (52.5% to 29.8%, P < 0.01). HC/HA volume surgeons had a significantly lower rate of surgical complications (odd ratio = 0.71, 95% confidence interval = 0.60-0.83, P < 0.05) as compared with LC/LA volume surgeons. There was no significant difference in rates of anastomotic leak, nonroutine discharges or readmission among all four groups.

  Conclusions: The best early postoperative surgical outcomes are achieved in centers where there are high cumulative and high annual volume surgeons caring for these patients. This suggests the need for specialized designation of rectal cancer centers to support ongoing regionalization of care.
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 楼主| 发表于 2016-10-19 15:42:33 | 显示全部楼层

【外科文献】Artesunate Protects Against the Organ Injury and Dysfunction Indu...

  Artesunate Protects Against the Organ Injury and Dysfunction Induced by Severe Hemorrhage and Resuscitation.

  作者:Sordi, Regina PhD; Nandra, Kiran K. PhD; Chiazza, Fausto BSc; Johnson, Florence L. BSc; Cabrera, Claudia P. PhD; Torrance, Hew D. MD; Yamada, Noriaki MD, PhD; Patel, Nimesh S. A. PhD; Barnes, Michael R. PhD; Brohi, Karim MD; Collino, Massimo PhD; Thiemermann, Christoph MD, PhD

  文章来源:Annals of Surgery:

  Post Author Corrections: February 1, 2016

  Objective: To evaluate the effects of artesunate on organ injury and dysfunction associated with hemorrhagic shock (HS) in the rat.

  Background: HS is still a common cause of death in severely injured patients and is characterized by impairment of organ perfusion, systemic inflammatory response, and multiple organ failure. There is no specific therapy that reduces organ injury/dysfunction. Artesunate exhibits pharmacological actions beyond its antimalarial activity, such as anticancer, antiviral, and anti-inflammatory effects.

  Methods: Rats were submitted to HS. Mean arterial pressure was reduced to 30 mm Hg for 90 minutes, followed by resuscitation. Rats were randomly treated with artesunate (2.4 or 4.8 mg/kg i.v.) or vehicle upon resuscitation. Four hours later, parameters of organ injury and dysfunction were assessed.

  Results: Artesunate attenuated the multiple organ injury and dysfunction caused by HS. Pathway analysis of RNA sequencing provided good evidence to support an effect of artesunate on the Akt-survival pathway, leading to downregulation of interleukin-1 receptor-associated kinase 1. Using Western blot analysis, we confirmed that treatment of HS rats with artesunate enhanced the phosphorylation (activation) of Protein kinase B (Akt) and endothelial nitric oxide synthase and the phosphorylation (inhibition) of glycogen synthase kinase-3[beta] (GSK-3[beta]). Moreover, artesunate attenuated the HS-induced activation of nuclear factor kappa B and reduced the expression of proinflammatory proteins (inducible nitric oxide synthase, tumor necrosis factor-[alpha], and interleukin 6).

  Conclusions: Artesunate attenuated the organ injury/dysfunction associated with HS by a mechanism that involves the activation of the Akt-endothelial nitric oxide synthase survival pathway, and the inhibition of glycogen synthase kinase-3[beta] and nuclear factor kappa B. A phase II clinical trial evaluating the effects of good manufacturing practice-artesunate in patients with trauma and severe hemorrhage is planned.

Artesunate_Protects_Against_the_Organ_Injury_and.96827.pdf

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 楼主| 发表于 2016-10-19 16:05:53 | 显示全部楼层

【外科文献】Hospital Outcomes in Inpatient Laparoscopic Cholecystectomy in Me...

  Hospital Outcomes in Inpatient Laparoscopic Cholecystectomy in Medicare Patients.

  作者:Fry, Donald E. MD; Pine, Michael MD, MBA; Nedza, Susan MD, MBA; Locke, David BSc; Reband, Agnes BSc; Pine, Gregory BA

  文章来源:Annals of Surgery:

  Post Author Corrections: February 1, 2016

  Objective: To compare the risk-adjusted outcomes of hospitals in inpatient Medicare laparoscopic cholecystectomy.

  Background: Reduced length-of-stay for inpatient surgical care requires the inclusion of objective postdischarge outcomes to provide a comprehensive assessment of hospital and surgeon performance for quality improvement.

  Methods: The 2010 to 2012 Medicare Limited Data Set was used to develop risk-adjusted prediction models of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths, and 90-day readmissions for inpatient laparoscopic cholecystectomy. To define the opportunity for improved performance, prediction models were used to compute z scores and risk-adjusted adverse outcome rates for all hospitals in the database that had 20 or more evaluable cases for the study period.

  Results: A total of 83,274 patients from 1570 hospitals had an overall adverse outcome rate of 20.7%; 48 hospitals had outcomes that were 2 z scores better than predicted and 76 had 2 z scores poorer than predicted. Risk-adjusted adverse outcomes were 10.0 % in the best performing decile of hospitals and were 32.1% in the poorest performing decile. Gastrointestinal, infectious, and cardiopulmonary complications of care were the most common causes of readmissions with 46.3% occurring between days 30 and 90 after discharge.

  Conclusions: Comparative analysis of overall risk-adjusted inpatient and 90-day postdischarge adverse outcomes identifies considerable opportunity for improved care in this high-risk population of patients.
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 楼主| 发表于 2016-10-19 16:22:08 | 显示全部楼层

【外科文献】Geographical Information System Evaluation and Trends of Nonaccid...

  Geographical Information System Evaluation and Trends of Nonaccidental Trauma at a Level I Trauma Center, Pilot Study.

  作者:Smith, Michael Robert DO; Davis, Robert Lee MD; Phillips, Patricia Anne MSN; Shvilkina, Tatyana BS; Kaur, Kamalijit MSc; Tabolt, Heather Katrina PA; Krause, Matthew BS; Galdi, Vincent BS

  文章来源:Annals of Surgery:

  Post Author Corrections: January 29, 2016

  Premise: Although trauma may be considered a random act, geographical patterns of trauma potentially emerge. Our institution is unique in that it rests at an intersection of two of the highest areas of poverty and assault in New York City and has adequate data to analyze these patterns.

  Methods: We review the incident reports logged by emergency medical services (EMS) technicians arriving with intentionally injured trauma patients from January 1 to December 31, 2013 at a single institution. After acquisition of this data, it was placed into a computer file using an individual identifying numbers for each incident along with latitude and longitude coordinates determined by global positioning software for each event. The data were separated into blunt and penetrating categories. Penetrating trauma was further separated into the type of instrument used: edged weapon or firearm. Kernel density estimate using the Crimestat program was then performed to determine the epicenters with the highest incidents of nonaccidental trauma.

  Results: Two hundred eighty-three patients were evaluated for assault-related trauma. Two hundred fifty-four patients were included in the mapping of the data with almost equal blunt and penetrating trauma. Seventy-four percent of trauma occurred from 6 PM to 6 AM, and 41% occurring between midnight and 6 AM. Of patients, 32.7% were found to be assaulted at their home address. Regression analysis demonstrated that each type of trauma had unique epicenters of likelihood for occurrence.

  Conclusions: We can only speculate the reasons for many of these results at this time and further research into the sociological, psychological, and environmental factors is required. A high proportion of patients are assaulted at their home addresses. Further study is necessary to improve patient care with additional data provided by emergency medical services, police departments and surrounding hospitals.
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 楼主| 发表于 2016-10-19 16:24:53 | 显示全部楼层

【外科文献】A Multicenter Single-blind Randomized Trial

  The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care: A Multicenter Single-blind Randomized Trial.

  作者:Tolsgaard, Martin G. MG, PhD; Ringsted, Charlotte PhD; Rosthøj, Susanne PhD; Nørgaard, Lone LN, MD; Møller, Lars LMA, PhD; Freiesleben, Nina La Cour NLC, PhD; Dyre, Liv Bach, Med; Tabor, Ann Dr, Sci

  文章来源:Annals of Surgery:

  Post Author Corrections: January 25, 2016

  Objective: To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care.

  Background: Simulation-based ultrasound training may be an effective adjunct to clinical training, but no studies have examined its effects on quality and efficiency of care.

  Methods: Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training only (control group, n = 26).

  The primary outcome was patient-reported discomfort during transvaginal ultrasound examinations performed by study participants. Secondary outcomes included patient-reported perceived safety and confidence in ultrasound provider. Finally, the need for trainee supervision or repeated patient examinations was recorded.

  Results: In total, 1150 patient ratings were collected. The intervention was associated with a reduction of patient discomfort by 18.5% [95% confidence interval (CI), 10.7-25.5; P < 0.001), and with a 7.9% (95% CI, 0.5-14.7; P = 0.04) increase in perceived safety. The intervention group participants received 11.1% (95% CI, 2.5-18.9) higher scores on patients' confidence compared with control group participants (P = 0.01). When the number of days of clinical training was doubled, the odds for trainee supervision or repeated patient examination was reduced by 45.3% (95% CI, 33.5-55.1) and 19.8% (95% CI, 4.1-32.9) in the intervention and control group, respectively (P = 0.005).

  Conclusions: Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.
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 楼主| 发表于 2016-10-19 16:30:56 | 显示全部楼层

【外科文献】Still a Long Way to Go

  Postacute Care and Recovery After Cancer Surgery: Still a Long Way to Go.

  作者:Balentine, Courtney J. MD, MPH; Richardson, Peter A. PhD; Mason, Meredith C. MD; Naik, Aanand D. MD; Berger, David H. MD, MHCM; Anaya, Daniel A. MD

  文章来源:Annals of Surgery:

  Post Author Corrections: April 23, 2016

  Objective: To determine whether postacute care (PAC) facilities can compensate for increased mortality stemming from a complicated postoperative recovery (complications or deconditioning).
 
  Conclusions: Discharge to PAC facilities after cancer surgery is not sufficient to overcome the adverse survival effects of a complicated postoperative recovery. Improvement of perioperative care outside the acute hospital setting and development of better postoperative recovery programs for cancer patients are needed to enhance survival after surgery.
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