Journal of the American College of Surgeons
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Randomized Controlled Trial
Partial matrix excision or orthonyxia for ingrowing toenails.
We wanted to evaluate whether partial matrix excision and orthonyxia are equally effective in the treatment of ingrown toenails of the hallux. ⋯ Partial matrix excision and orthonyxia are equally effective treatments for ingrown toenails. But the orthonyxia procedure showed better results, with less postoperative morbidity, shorter time to complete recovery, fewer postoperative symptoms, and greater patient satisfaction.
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Multicenter Study Comparative Study
Mortality impact of less-than-standard therapy in older breast cancer patients.
The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. ⋯ Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment.
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Multicenter Study
National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence.
Bariatric surgery is indicated for severely obese adolescents who have failed nonsurgical treatment. Our objective was to examine national trends in the use of bariatric operations among adolescents. ⋯ Our findings indicate a recent, rapid increase in the frequency of adolescent bariatric procedures. Most hospitals that performed bariatric procedures on adolescents had limited experience with adolescent bariatric patients, although many of these hospitals appear to have been experienced adult centers with high overall bariatric volume (adolescents and adults). Future research must better clarify the institutional qualifications considered mandatory for treatment of eligible adolescents.
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As part of a national program in the Department of Veterans Affairs to improve communication within the health-care environment, the Medical Team Training questionnaire was developed to assess organizational culture, communication, teamwork, and awareness of human factors engineering principles. ⋯ The Medical Team Training questionnaire was helpful in identifying hidden problems with communication before formal team training learning sessions, and it will be useful in focusing efforts to improve communication and teamwork in the operating room.
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Multicenter Study
Secondary overtriage: a consequence of an immature trauma system.
Trauma systems are designed to bring the injured patient to definitive care in the shortest practical time. This depends on prehospital destination criteria (primary triage) and interfacility transfer guidelines (secondary triage). Although primary undertriage is associated with increased costs and worse outcomes for selected injuries, secondary overtriage can overwhelm system resources and delay definitive care. The purpose of this study was to determine the incidence of secondary overtriage in a region without a formal trauma system. ⋯ A substantial proportion of transferred trauma patients require only brief diagnostic or observational care. Excessive overtriage calls for development of a regional inclusive trauma system with established primary and secondary triage guidelines to improve access to care and trauma system efficiency.