Journal of the American College of Surgeons
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Trauma is the leading cause of death among North Americans between the ages of 1 and 44 years. Resuscitation with hypertonic saline (7.5%) solutions can reduce mortality in hypotensive and brain-injured patients. ⋯ We have successfully designed and implemented two prehospital intervention trials. The proc-ess has helped define the numerous challenges that must be overcome to pursue exception from informed consent resuscitation research in the prehospital setting. The results of these studies will hopefully advance and improve the early care of the severely injured patient.
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Multiple regional trauma systems have been implemented over the past 3 decades to achieve the goal of regionalized care for injured patients. The American College of Surgeons Committee on Trauma (ACS-COT) advocates that seriously injured patients should be treated in designated Level I trauma centers that meet criteria including admitting more than 1,200 injured patients annually. Reliable measures are needed to evaluate the implementation of regionalized care nationally. The goal of this study was to measure the proportion of seriously injured patients treated at high injury-volume hospitals. ⋯ The proportion of seriously injured patients in high-volume hospitals is a functional metric that provides a practicable and comprehensive measure of regionalized trauma care in the US. Injured elder Americans have less access to experienced trauma hospitals.
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To determine prospectively if simulator-based laparoscopic training could improve laparoscopic skills of gynecology residents. ⋯ A dedicated simulator-based laparoscopic training curriculum has the ability to improve basic laparoscopic skills in a gynecologic residency, as measured by timed and scored simulator tasks. Construct validity was demonstrated by measuring substantial improvement in performance with increasing residency training, and with practice.
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Studies have demonstrated improved survival when 12 or more nodes are examined for colon cancer. The elderly comprise a major proportion of patients with colon cancer, but it is unknown if examination of 12 or more nodes is appropriate for older patients. Our objective was to assess differences in lymph node evaluation by age and to determine whether adequate nodal evaluation (12 or more nodes) is associated with improved survival in the elderly. ⋯ The elderly account for nearly half of patients with colon cancer. Older patients undergo inadequate lymph node evaluation more frequently than younger patients do. Improving lymph node evaluation will result in more accurate pathologic staging for the elderly.
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Comparative Study
Outpatient cholecystectomy at hospitals versus freestanding ambulatory surgical centers.
Because of safety concerns, some payers do not reimburse for laparoscopic cholecystectomy performed in freestanding ambulatory surgical centers (ASCs). This policy has been controversial because of increasing competition between ASCs and hospitals for low risk surgical patients. ⋯ In a population of slightly younger, healthier patients, laparoscopic cholecystectomy in freestanding ASCs appears to be performed safely and with substantially lower charges than in hospitals.