JAMA surgery
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To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients. ⋯ Surgeons regularly experience conflict with critical care clinicians about goals of care for patients with poor postoperative outcomes. Higher rates of conflict are associated with less experience and working in a closed intensive care unit.
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Of the 200 million adults worldwide who undergo noncardiac surgery each year, more than 1 million will die within 30 days. ⋯ Among patients undergoing noncardiac surgery, the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality.
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Pediatric injury outcomes in racial/ethnic minorities in California: diversity may reduce disparity.
Differences in health outcomes are well documented in adult racial/ethnic minorities. We hypothesize that similar differences exist in pediatric racial/ethnic minorities because their care is a function of their parents' access. We investigated this issue by examining pediatric injury outcomes in California. ⋯ Unlike previous studies that have shown that adult racial/ethnic minorities (age, 18-64 years) have higher mortality relative to non-Hispanic whites, our study demonstrated no significant racial/ethnic differences among pediatric patients with injuries. It may be that differential access does not exist for children. In addition, it may also be possible that the diversity in California leads to culturally competent care and such care has been reported to improve patient outcomes.
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To describe the outcomes and the expected postoperative course for patients with do-not-resuscitate (DNR) orders (DNR patients) who undergo emergency surgical management of bowel obstruction. ⋯ Outcomes are poor after emergency surgical intervention for bowel obstruction in elderly DNR patients, with high postoperative complication and mortality rates. The presence of a DNR order is an independent risk factor for postoperative mortality. Patients, their families, and their physicians must be counseled on surgical expectations preoperatively and made aware of the significantly higher risks involved when a DNR order exists in the setting of emergency surgical management of bowel obstruction.