The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2023
Impact of cost-awareness education and surgeon-led positive deviance on intraoperative costs of thoracoscopic lobectomy.
Disposable instrument use during video-assisted thoracoscopic lobectomy is a significant driver of cost. The purpose of the study was to measure the effect of increasing surgeon cost awareness via successive "value improvement initiatives" on instrument costs. ⋯ Cost awareness and surgeon engagement activities were associated with sustained cost reduction for video-assisted thoracoscopic lobectomies. Surgeon self-assessment, peer comparison, and positive deviance seminar were associated with the largest cost reduction. Significant hospital cost-savings may be realized with surgeon-led value improvement initiatives.
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J. Thorac. Cardiovasc. Surg. · Jun 2023
Meta AnalysisDirect oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and bioprosthetic valves: A meta-analysis.
The optimal anticoagulation strategy for patients with bioprosthetic valves and atrial fibrillation remains uncertain. We conducted a meta-analysis using updated evidence comparing direct anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with bioprosthetic valves and atrial fibrillation. ⋯ DOAC might decrease the risk of major bleeding without increasing the risk of stroke or systemic embolism or all-cause death compared with VKA in patients with bioprosthetic valves and atrial fibrillation.
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J. Thorac. Cardiovasc. Surg. · Jun 2023
Transbronchial real-time lung tumor localization with folate receptor-targeted near-infrared molecular imaging: A proof of concept study in animal models.
The diagnostic yield of bronchoscopy is not satisfactory, even with recent navigation technologies, especially for tumors located outside of the bronchial lumen. Our objective was to perform a preclinical assessment of folate receptor-targeted near-infrared imaging-guided bronchoscopy to detect peribronchial tumors. ⋯ Transbronchial detection of pafolacianine-laden folate receptor-positive tumors by near-infrared imaging was feasible in ex vivo swine lungs. Further in vivo preclinical assessment is needed to confirm the feasibility of this technology.