JAMA surgery
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Surgical care is recognized as a growing component of global public health. ⋯ Self-reported determinants of access to surgical care vary widely among Sierra Leone, Rwanda, and Nepal, although commonalities exist. Understanding the epidemiology of barriers to surgical care is essential to effectively provide surgical service as a public health commodity in developing countries.
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Randomized Controlled Trial Multicenter Study
Development of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Protocol: A National Cluster-Randomized Trial of Resident Duty Hour Policies.
Debate continues regarding whether to further restrict resident duty hour policies, but little high-level evidence is available to guide policy changes. ⋯ To our knowledge, the FIRST Trial is the first national randomized clinical trial of duty hour policies. Results of this study may be informative to policymakers and other stakeholders engaged in restructuring graduate medical training to enhance the quality of patient care and resident education.
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Multicenter Study Clinical Trial
Self-harm Emergencies After Bariatric Surgery: A Population-Based Cohort Study.
Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery. ⋯ In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.
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Multicenter Study Comparative Study
Serial Assessment of Trauma Care Capacity in Ghana in 2004 and 2014.
Trauma care capacity assessments in developing countries have generated evidence to support advocacy, detailed baseline capabilities, and informed targeted interventions. However, serial assessments to determine the effect of capacity improvements or changes over time have rarely been performed. ⋯ There has been significant improvement in trauma care capacity during the past decade in Ghana; however, critical deficiencies remain and require urgent redress to avert preventable death and disability. Serial capacity assessment is a valuable tool for monitoring efforts to strengthen trauma care systems, identifying what has been successful, and highlighting needs.
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Multicenter Study
Association of Model for End-Stage Liver Disease Score and Mortality in Trauma Patients With Chronic Liver Disease.
The Model for End-Stage Liver Disease (MELD) score is predictive of trauma outcomes. ⋯ A decrease in MELD score within 72 hours of ICU admission is associated with improved mortality.