Surgery
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Comparative Study
Financial and operational impact of a direct-from-PACU discharge pathway for laparoscopic cholecystectomy patients.
We assessed the operational and financial impact of discharging laparoscopic cholecystectomy (LC) patients directly from the postanesthetic care unit (PACU) in comparison with post-transfer discharge from a hospital bed in a busy academic hospital. ⋯ PACU discharge of LC patients significantly reduces bed utilization, decreases in-hospital transfers, and allows congested hospitals to better accommodate patient care needs and generate additional revenue.
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Prolonged systemic preoperative chemotherapy induces pathologic changes in liver parenchyma. The consequences of vascular occlusion on liver submitted to prolonged preoperative systemic chemotherapy are not known. The aim of this case-matched study was to assess which method of vascular occlusion is most appropriate for major liver resection in patients who have undergone prolonged preoperative systemic chemotherapy. ⋯ Vascular occlusion can be used with no mortality and acceptable morbidity for major liver resection after prolonged preoperative chemotherapy. TC should be preferred to VE, permitted by the location of the neoplasm.
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For hepatic resection, the preoperative estimation of hepatic functional reserve in the predicted remnant liver may be more important than that of the entire liver. We evaluated the maximal removal rate of technetium-99m-galactosyl-human serum albumin (GSA-Rmax) in the remnant. ⋯ We concluded that GSA-RL may be useful for determining the procedure of hepatectomy and that the value should be maintained at greater than 0.15 to avoid postoperative hyperbilirubinemia or hepatic failure.
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Comparative Study
The medical education of United States citizens who train abroad.
Graduates of international medical schools (IMGs) make up approximately one quarter of the physician workforce in the United States. Among IMGs are a number of US citizens (USIMGs) who take graduate training positions and ultimately practice in the United States. Compared with graduates of US medical schools (USMGs), relatively little is known about the undergraduate educational experiences of these US citizens. The objective of this study was to identify the schools that produce the most USIMGs and to describe the educational experiences and examination performance of graduates of these schools. ⋯ There are many similarities; however, there are some noteworthy differences between the educational experiences of USIMGs and USMGs. Further work is needed to better understand the educational experiences of USIMGs, particularly in the clinical clerkships.