Surgery
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The Leapfrog Group aims to improve surgical outcomes through promoting hospital adoption of procedure-specific process measures, although it is unclear whether compliance reflects a hospital's overall quality. The purpose of this study was to evaluate whether implementation of Leapfrog's standard for routine beta-blockade was associated with reductions in mortality after open abdominal aortic aneurysm (AAA) repair alone versus other high-risk operations. ⋯ Compliance with peri-operative beta-blockade resulted in a significant reduction in mortality after open AAA repair over time, but it had no crossover effect on mortality associated with other high-risk operations in the same hospital. These data suggest that improvements in outcomes resulting from the adoption of evidence-based process measures are procedure specific and do not necessarily reflect overall hospital quality.
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This study investigated the feasibility of early computed tomographic (CT) evaluation and the operative results of pediatric small bowel intussusception with deteriorating ischemic or obstructive symptoms, so-called small bowel intussusception disease (SBID). ⋯ Pediatric SBID may present with nonspecific symptoms and may mimic ileocolic intussusception leading to delayed operative intervention. Early CT evaluation of patients with suspicious SBID ultrasonographic features is effective in avoiding futile reduction enema and significantly reducing the waiting time for operative management and the resultant incidence of bowel complications.
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Kangri cancer is a heat-induced skin carcinoma associated with the use of the Kangri. This Kangri, which is a traditional fire pot, is an ingenious mode of providing warmth. The Kangri is an earthenware container with an outer encasement of wickerwork that is filled with ignited coal inside for providing a source of heat in winter months. Its prolonged use may result in formation of erythema ab igne, a reticulate hypermelanosis with erythema, which may transform into cutaneous cancer. Currently, this skin cancer rarely is found in the Kashmir valley. ⋯ Kangri cancer still occurs in patients who live in remote areas of Kashmir where there is a chilling cold in winter months and have no modern and alternative cheap means of warming other than the Kangri.
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Survival in colon cancer is greater in those patients who have more lymph nodes identified at resection and may be due to stage migration, confounding by treatment, social, or clinical characteristics. Identifying factor(s) responsible for the effect may represent an opportunity to improve quality of care for patients with colon cancer by increasing node counts in specimens. ⋯ These findings argue against understaging or confounding as the explanation for the inferior survival observed in patients with fewer nodes identified. National initiatives to increase the number of nodes identified in colon cancer specimens may not improve substantially the cancer-specific outcomes.