JAMA surgery
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In an effort to expedite delivery of plasma for patients requiring massive transfusions, US medical centers began keeping thawed plasma (TP) in their blood banks (BBs), markedly reducing time to release of plasma; however, the time to transfusion was still excessively long. ⋯ We demonstrated that implementation of an ED-TP protocol expedites transfusion of plasma to severely injured patients. This approach is associated with a reduction in overall blood product use and a 60% decreased odds in 30-day mortality.
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Anastomotic leak is a potentially devastating complication of bowel surgery, yet a leak can refer to a range of clinical problems, with disparate treatment and outcomes. ⋯ A spectrum of clinical entities may be considered to represent an anastomotic leak after low anterior resection, with differing consequences. Presacral and free extravasation of contrast medium led to an increased need for permanent diversion, but even simple pelvic fluid collections were associated with irregular bowel function.
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Pediatric injury outcomes in racial/ethnic minorities in California: diversity may reduce disparity.
Differences in health outcomes are well documented in adult racial/ethnic minorities. We hypothesize that similar differences exist in pediatric racial/ethnic minorities because their care is a function of their parents' access. We investigated this issue by examining pediatric injury outcomes in California. ⋯ Unlike previous studies that have shown that adult racial/ethnic minorities (age, 18-64 years) have higher mortality relative to non-Hispanic whites, our study demonstrated no significant racial/ethnic differences among pediatric patients with injuries. It may be that differential access does not exist for children. In addition, it may also be possible that the diversity in California leads to culturally competent care and such care has been reported to improve patient outcomes.
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To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients. ⋯ Surgeons regularly experience conflict with critical care clinicians about goals of care for patients with poor postoperative outcomes. Higher rates of conflict are associated with less experience and working in a closed intensive care unit.