Journal of the American College of Surgeons
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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.
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Controlled Clinical Trial
Lymphocyte phenotyping to distinguish septic from nonseptic critical illness.
Clinical signs and symptoms of sepsis are nonspecific and often indistinguishable from those of nonseptic critical illness. This ambiguity frequently delays the diagnosis of sepsis until culture results can confirm the presence or absence of an infectious organism. Lymphocyte phenotyping can be conducted rapidly and may provide information on the presence of infection before culture results are available. In this study, we hypothesized that lymphocyte phenotype can distinguish between septic and nonseptic critical illness. ⋯ These data indicated that CD69 expression on lymphocytes may be useful in distinguishing between septic and nonseptic critical illness. Continued investigation into the expression of CD69 during sepsis is warranted.
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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.