Journal of the American College of Surgeons
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There is controversy about the appropriate sequence of urologic investigation in patients with pelvic fracture. Use of retrograde urethrography or cystography may interfere with regular pelvic CT scanning for arterial extravasation. ⋯ Extravasating contrast from lower urologic injuries can interfere with the CT assessment for pelvic arterial extravasation, delaying angiographic embolization.
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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.