Journal of the American College of Surgeons
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Traumatic brain injury (TBI) is one of the most common causes of injury-related morbidity and mortality. Access to neurosurgical services is critical to optimal outcomes through reduction of secondary injury. We sought to evaluate variations in access to neurosurgical care across a regional trauma system. ⋯ Considerable variation in delivery of initial care to TBI patients was identified. Factors such as age and injury characteristics were associated with TC access. Because early TC care in TBI confers survival benefits, the demonstrated variability necessitates improvements in access to care for patients with severe head injuries.
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Clinical Trial
Getting a head start: high-fidelity, simulation-based operating room team training of interprofessional students.
Effective teamwork in the operating room (OR) is often undermined by the "silo mentality" of the differing professions. Such thinking is formed early in one's professional experience and is fostered by undergraduate medical and nursing curricula lacking interprofessional education. We investigated the immediate impact of conducting interprofessional student OR team training using high-fidelity simulation (HFS) on students' team-related attitudes and behaviors. ⋯ High-fidelity simulation OR interprofessional student team training improves students' team-based attitudes and behaviors. Students tend to overestimate their team-based behaviors.
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The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program. ⋯ The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years.
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Randomized Controlled Trial Comparative Study
Reduced postoperative chronic pain after tension-free inguinal hernia repair using absorbable sutures: a single-blind randomized clinical trial.
Chronic pain after inguinal hernia repair occurs in 16% to 62% of patients. The underlying mechanism probably involves sensory nerve damage and abnormal healing that might be influenced by the materials chosen for the procedure. We hypothesize that nonabsorbable sutures used for mesh fixation to the surrounding tissues are associated with higher rates of chronic groin pain after surgery. ⋯ Nonabsorbable suture use in inguinal hernia repair is associated with a higher rate of chronic pain and a longer time to pain disappearance as compared with absorbable sutures.