Journal of the American College of Surgeons
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Multicenter Study Comparative Study
Pedestrian injuries: the association of alcohol consumption with the type and severity of injuries and outcomes.
Literature on the effect of alcohol ingestion on short-term outcomes for trauma patients shows conflicting results. We performed this study to investigate the prevalence of positive alcohol screens and the effect of alcohol level on injury patterns, injury severity, and outcomes in pedestrians and bicyclists involved in a collision with an automobile. ⋯ In pedestrians and bicyclists involved in a collision with an automobile, a high alcohol level is not associated with body area severity of injury, overall severity of injury, and hospital mortality. But high alcohol level is notably associated with higher overall complication rate and longer hospital length of stay.
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The best surgical treatment for hyperthyroidism caused by Graves' disease remains a controversial subject. ⋯ Total or near-total thyroidectomy is an effective and safe treatment for Graves' disease when performed by an experienced surgeon.
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Comparative Study
Factors influencing DNR decision-making in a surgical ICU.
End-of-life decisions in the surgical ICU can be complicated by the unique characteristics of perioperative illness and the focus on life-extending interventions. We sought to determine whether illness severity correlated with the presence of DNR order in critically ill surgical patients. ⋯ Although acuity of illness and organ dysfunction consistently predicted mortality in critically ill patient populations, only elements of the past medical history were positively associated with a DNR order in critically ill surgical patients. Additional prospective studies need to be performed to determine the relative influences of physiologic, demographic, and sociologic factors on the creation of DNR orders in critically ill surgical patients.
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Comparative Study
Who pays for poor surgical quality? Building a business case for quality improvement.
Both providers and payors bear the financial risk associated with complications of poor quality care. But the stakeholder who bears the largest burden of this risk has a strong incentive to support quality improvement activities. The goal of the present study was to determine whether hospitals or payors incur a larger burden of increased hospital costs associated with complications. ⋯ Hospitals and payors both suffer financial consequences from poor-quality health care, but the greater burden falls on health-care payors. Strong incentives exist for health-care payors to become more involved in supporting quality improvement activities.
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Comparative Study
Diffuse idiopathic skeletal hyperostosis: a rare cause of Dysphagia, airway obstruction, and dysphonia.
We retrospectively query the clinical records of patients with cervical osteophytes to distinguish the clinical features of those presenting with symptomatic dysphagia and airway obstruction. ⋯ Although commonly found and usually asymptomatic in the older population, anterior cervical osteophytes can be a source of considerable morbidity and potential life-threatening airway obstruction. Recognizing this clinical entity is imperative in establishing a diagnosis and initiating appropriate treatment. Surgical decompression appears to be beneficial in relieving symptoms.