Annals of surgery
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A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery. ⋯ Checklists are effective and economic tools that decrease mortality and morbidity. Compliance of surgical staff with checklists was good overall. Further research in particular relating to implementation is needed.
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Randomized Controlled Trial Comparative Study
Axillary dissection versus no axillary dissection in older patients with T1N0 breast cancer: 15-year results of a randomized controlled trial.
To assess the role of axillary dissection in older breast cancer patients with a clinically clear axilla. ⋯ Older patients with early breast cancer and a clinically clear axilla treated by conservative surgery, postoperative radiotherapy, and adjuvant tamoxifen do not benefit from axillary dissection. This study was registered at clinicaltrials.gov (ID NCT00002720).
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Case Reports
Extracorporeal life support for pancreatitis-induced acute respiratory distress syndrome.
Adult respiratory distress syndrome (ARDS) secondary to acute pancreatitis is associated with a poor prognosis. We hypothesized that extracorporeal life support (ECLS) may be an effective treatment option for the most severe cases of pancreatitis-induced ARDS. ⋯ ECLS is useful in treating severe pancreatitis-induced ARDS. Pancreatic debridement can be performed during ECLS, using a comprehensive protocol to minimize bleeding complications.
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Comparative Study
A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications.
To compare the recording of 30-day postoperative complications between a national clinical registry and Medicare inpatient claims data and to determine whether the addition of outpatient claims data improves concordance with the clinical registry. ⋯ This analysis demonstrates important differences between ACS-NSQIP and Medicare claims data sets for measuring surgical complications. Poor accuracy potentially makes claims data suboptimal for evaluating surgical complications. These findings have meaningful implications for performance measures currently being considered.
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To evaluate the long-term impact of the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hour limits on residents' perception of education. ⋯ After the implementation of the 2003 duty hour limits, residents' perceptions of fatigue improved without any increase in the reported amount of sleep. In addition, decreased resident satisfaction with their education and a diminished sense of clinical preparedness were noted. Additional studies are needed to better understand the influence of work hours and fatigue on the outcomes of education, resident well-being, and patient care to guide the optimal design and delivery of graduate medical education.