Arch Surg Chicago
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Multicenter Study
Patient outcomes in academic medical centers: influence of fellowship programs and in-house on-call attending surgeon.
There are very few data on characteristics or policies that improve patient outcomes in academic medical institutions. We were interested in 2 such policies or characteristics that are commonly implemented in academic centers: an in-house on-call attending physician policy and the existence of postgraduate medical education. ⋯ An in-house on-call attending surgeon policy is not associated with improved outcomes. In contrast, presence of a trauma and surgical critical care fellowship program, a potential surrogate marker for an institution that is committed to this specialty interest, is associated with improved outcomes for critically injured patients. An investment in advanced postgraduate medical education has potential benefits in patient care and outcomes.
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Comparative Study
Decrease of collagen deposition in wound repair in type 1 diabetes independent of glycemic control.
Type 1 and type 2 diabetes mellitus and glycemic control influence wound healing in humans. ⋯ Collagen deposition in acute wounds is impaired in type 1 diabetes, possibly due to a decreased fibroblast proliferation. In type 2 diabetes, collagen deposition is normal. Glycemic control does not influence collagen deposition in acute wound repair in type 1 or in type 2 diabetes mellitus.
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Comparative Study
Laparoscopic vs conventional ileocolectomy for primary Crohn disease.
Laparoscopic ileocolectomy can reduce the length of hospital stay and hospital charges compared with conventional surgery in the treatment of primary Crohn disease. ⋯ Laparoscopic-assisted ileocolectomy for primary Crohn disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn disease should be considered as the preferred operative approach for primary resections.
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High-volume centers provide superior quality care and therefore have a lower incidence of postoperative complications. ⋯ Patients who undergo hepatic resection at low-volume hospitals are at a higher risk of postoperative complications and death than those who have the same operation at high-volume hospitals. The empirical difference between outcomes at high- and low-volume hospitals seems to be due to a variation in postoperative complications.
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Inhibition of neutrophil-endothelial cell interactions by hypertonic saline (HTS) may confer protection against organ injury in states of immunologic disarray. This study tested the hypothesis that infusion of HTS modulates the development of end-organ injury in a model of lower-torso ischemia-reperfusion injury. ⋯ Resuscitation with HTS attenuates the pulmonary edema and tissue injury due to lower-torso ischemia-reperfusion and maintains a more benign immunologic profile.