Journal of the American College of Surgeons
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Failure to rescue (ie, mortality after a major complication) has recently been demonstrated as a mechanism underlying differences between high and low mortality hospitals. In this study, we sought to better understand the hospital characteristics that may explain failure to rescue. ⋯ Several hospital characteristics are associated with FTR from major complications. However, a large portion of what makes some hospitals better than others at rescuing patients remains unexplained. Future research should focus on hospital cultures and attitudes that may contribute to the timely recognition and effective management of major complications.
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Multicenter Study
Detection of postoperative respiratory failure: how predictive is the Agency for Healthcare Research and Quality's Patient Safety Indicator?
Patient Safety Indicator (PSI) 11, or postoperative respiratory failure, was developed by the US Agency for Healthcare Research and Quality to detect incident cases of respiratory failure after elective operations through use of ICD-9-CM diagnosis and procedure codes. We sought to determine the positive predictive value (PPV) of this indicator. ⋯ Although PSI 11 predicts true postoperative respiratory failure with relatively high frequency, the indicator does not limit detection to preventable cases. The PPV of PSI 11 might be increased by excluding cases with a principal diagnosis suggestive of a nonelective hospitalization and those with head or neck procedures. Removing the diagnosis code criterion from the indicator might also increase PPV, but would decrease the number of true positive cases detected by 20%.
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Randomized Controlled Trial Comparative Study
Prospective randomized trial of accelerated re-epithelization of skin graft donor sites using extracorporeal shock wave therapy.
Extracorporeal shock wave therapy may enhance revascularization and repair of healing soft tissue. ⋯ For centers that apply nonadherent gauze dressings and topical antiseptics to skin graft donor sites, application of a single defocused shock wave treatment immediately after skin graft harvest can significantly accelerate donor site epithelialization.
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Multicenter Study
Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis.
Use of prosthetic grafts for reconstruction after portal vein (PV) resection during pancreaticoduodenectomy is controversial. We examined outcomes in patients who underwent vein reconstruction using polytetrafluoroethylene (PTFE). ⋯ With careful patient selection, PTFE graft reconstruction of resected PV/SMV during pancreaticoduodenectomy is possible with minimal risk of hepatic necrosis or graft infection. Comparison studies to primary anastomosis and autologous vein reconstruction are necessary.
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Randomized Controlled Trial
Online spaced education generates transfer and improves long-term retention of diagnostic skills: a randomized controlled trial.
Retention of learning from surgical training is often limited, especially if the knowledge and skills are used infrequently. Using histopathology diagnostic skills as an experimental system, we compared knowledge transfer and retention between bolus Web-based teaching (WBT) modules and online spaced education, a novel email-based method of online education founded on the spacing effect. ⋯ Online spaced education generates transfer of histopathology diagnostic skills and substantially improves their long-term retention. Additional research is needed to determine how spaced education can optimize learning, transfer, and retention of surgical skills.