Journal of vascular surgery
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Comparative Study
Evaluating preventable adverse safety events after elective lower extremity procedures.
Improving patient safety has become a national priority. Patient safety indicators (PSIs) are validated tools to identify potentially preventable adverse events. No studies currently exist for evaluating lower extremity (LE) vascular procedures and the occurrence of PSIs. ⋯ Endovascular procedures were found to have lower mortality rates overall, but were found to have a greater number of safety events occur primarily due to bleeding complications in women and the elderly. PSIs were associated with advanced age, black race, and comorbidities. Adverse events added significant cost, occurred more frequently in teaching and large hospitals, and future organizational analysis may improve safety and reduce cost.
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The physician/surgeon's interactions with industry have come under scrutiny in recent years for several reasons. Although some think that the professional medical association or society may provide an avenue to allow such interactions with less risk, there are concerns and challenges for such organizations as it relates to ethical and professional norms of their members. This is one surgeon's review of some pertinent information regarding what the professional medical society provides to its members and what role industry plays in the society's ability to provide these benefits. There is an exploration of the risks involved and practical methods to control inherent conflicts of interest involved in this interaction.
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This article assesses the current mandates on conflict of interest issues as they affect the practice of community-based vascular surgery and the pharmaceutical and medical technology industries and expresses the views of a private practice vascular surgeon. Scenarios where conflict of interest may occur are presented with assessments on how these scenarios will play out if such mandates are enforced.
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Multicenter Study
Prior failed ipsilateral percutaneous endovascular intervention in patients with critical limb ischemia predicts poor outcome after lower extremity bypass.
Although open surgical bypass remains the standard revascularization strategy for patients with critical limb ischemia (CLI), many centers now perform peripheral endovascular intervention (PVI) as the first-line treatment for these patients. We sought to determine the effect of a prior ipsilateral PVI (iPVI) on the outcome of subsequent lower extremity bypass (LEB) in patients with CLI. ⋯ Prior iPVI is highly predictive for poor outcome in patients undergoing LEB for CLI with higher 1-year amputation and graft occlusion rates than those without prior revascularization, similar to prior ipsilateral bypass These findings provide information, which may help with the complex decisions surrounding revascularization options in patients with CLI.
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The interaction between pharmaceutical and device companies and hospitals and physicians has undergone significant transformation in the past few years due to the public's perception that bias may result when such relationships are not disclosed and monitored. Policies need to be written by medical centers and hospitals to preserve and retain the trust of the public. The policy written by Johns Hopkins Medical Institutions is outlined and its implications discussed in this article. The importance of such policies in guiding young faculty and staff as they begin their careers cannot be overemphasized.