Surgery
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Evaluating surgical outcomes is an important tool to compare providers and institutions and to drive process improvements. Differing methodologies, however, may provide conflicting measurements of similar clinical outcomes making comparisons difficult. ACS-NSQIP is a validated, risk-adjusted, clinically derived data methodology to compare observed to expected outcomes after a wide variety of operations. The AHRQ-PSI are a set of computer algorithms to identify potential adverse in-patient events using secondary ICD-9-CM diagnosis and procedure codes from hospital discharge abstracts. ⋯ AHRQ-PSI algorithms identified less than a third of the ACS-NSQIP clinically important adverse events. Furthermore, the AHRQ-PSI identified a large number of events with no corresponding clinically important adverse outcomes. The sensitivity of the AHRQ-PSI for detecting clinically relevant adverse events identified by the ACS-NSQIP varied widely. The AHRQ-PSI as applied to postoperative patients is a poor measure of quality performance.
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Obesity is a national epidemic. Prior studies of the impact of body mass index (BMI) on surgical outcomes from cervical endocrine procedures have come from high-volume, single institutions. Our study characterizes the 30-day clinical and economic outcomes in patients with high BMI from a multi-institutional database. ⋯ Patients with high BMI seem to require operations of greater duration and sustain more morbidity after cervical endocrine procedures than patients with normal BMI, but these differences may not be clinically significant. Thyroidectomy and parathyroidectomy can be performed safely, with appropriate surgical decision making.
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Little is known about the longer term status of pain or the factors associated with pain-related outcome in patients after polytrauma. The current study evaluated the prevalence and severity of pain at least 2 years after injury compared with preinjury status using several pain scores in a Swiss cohort of survivors of blunt polytrauma. ⋯ Our study shows a high rate of longer term pain in survivors of polytrauma and important differences in the type and sensitivity of the standard pain measures investigated. Given the potential impact of these findings, international guidelines for the assessment of pain in polytraumatized patients are needed.
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The Japanese herbal medicine Tokishakuyaku-san (TJ-23) has been used to treat neurodegenerative, immune, and respiratory tract diseases, as well as many gynecologic disorders, with few adverse effects. This study investigated the effect of TJ-23 on alloimmune responses in a murine model of cardiac allograft transplantation. ⋯ TJ-23 induced hyporesponsiveness to fully allogeneic cardiac allografts and generated CD4(+) CD25(+) regulatory cells in our model.