Journal of the American College of Surgeons
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An intrahospital casualty throughput system modeled after air traffic control (ATC) tracking procedures was tested in mass casualty exercises. ATC uses a simple tactile process involving informational progress strips representing each aircraft, which are held in bays representing each stage of flight to prioritize and manage aircraft. These strips can be reordered within the bays to indicate a change in priority of aircraft sequence. In this study, a similar system was designed for patient tracking. ⋯ The ATC model more effectively tracked patient data with fewer errors when compared with the clipboard method. Application of these principles can enhance trauma management and can have application in civilian and military trauma centers and emergency rooms.
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Preprocedural briefings have been adopted in many high consequence environments, but have not been widely accepted in medicine. We sought to develop, implement, and evaluate a preoperative briefing for cardiovascular surgery. ⋯ These findings demonstrate the feasibility of creating a specialty-specific preoperative briefing to decrease surgical flow disruptions and improve patient safety in the operating room.
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Minority groups in the US have comparatively poorer access to a range of health care services. Access can be considered a function of opportunity and use and can vary with the level of segregation within a county. We hypothesized that with varying levels of segregation, increasing the proportion of the minority population within a county was accompanied by decreasing levels of access to surgical care. ⋯ In the most segregated counties, an increase in the African-American or Hispanic population was associated with a decrease in the availability and use of surgical services and an increase in emergency visits after adjustment for socioeconomic and health characteristics.
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Surgical decision-making and informed patient consent both benefit from having accurate information about risk. But currently available risk estimating systems have one or more limitations associated with lack of specificity to operation type, size of sample (reliability), range of outcomes predicted, and appreciation of hospital effects. ⋯ The ACS NSQIP colorectal risk calculator allows surgeons to preoperatively provide patients with detailed information about their personal risks of overall morbidity, serious morbidity, and mortality. Because ACS NSQIP can also categorize hospitals as performing better or worse than expected (or as expected), surgeons have the opportunity to adjust risk probabilities for patients at their institutions accordingly.
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Elderly patients with primary hyperparathyroidism (PHPT) are often not referred for surgical intervention because of concern of comorbid conditions that may increase perioperative complications. Because PHPT is more common in the elderly, we sought to compare indications and complications of minimally invasive parathyroidectomy in patients 70 years of age and older (elderly) with their younger counterparts. ⋯ Minimally invasive parathyroidectomy for PHPT can be performed as safely in elderly patients as in their younger counterparts. Elderly patients with PHPT are more likely to have osteoporosis and higher creatinine levels at the time of surgical referral. Additional study of the role of earlier intervention is warranted.