Journal of the American College of Surgeons
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Multicenter Study Comparative Study
A health system-based critical care program with a novel tele-ICU: implementation, cost, and structure details.
Improving the efficiency of critical care service is needed as the shortfall of intensivists is increasing. Standardizing clinical practice, telemedicine, and organizing critical care service at a health system level improves outcomes. We developed a health system Critical Care Program based at an academic medical center. The main feature of our program is an intensivist who shares on-site and telemedicine clinical responsibilities. Tele-ICU facilitates the standardization of high-quality critical care across the system. A common electronic medical record made the communications among the ICUs feasible. Combining faculty from medical and surgical critical care divisions increased the productivity of intensivists. ⋯ We describe a novel health system level ICU program built using "off the shelf" technology based on a large University medical center and a tele-ICU with a full degree of treatment authority across the system.
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Multicenter Study Comparative Study
Florida Initiative for Quality Cancer Care: improvements in breast cancer quality indicators during a 3-year interval.
The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts. ⋯ The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.
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Multicenter Study
Diminishing relative contraindications for immediate breast reconstruction: a multicenter study.
During the past decade, there has been a rise in US breast reconstruction rates, with a greater expansion in prosthetic-based techniques relative to autologous transfer. Immediate reconstruction in high-risk oncologic and surgical patients might be a contributing factor to these trends. ⋯ Breast reconstruction increased in high-risk surgical and oncologic patients, suggestive of a diminishing set of relative contraindications. Increased implant use in high-risk patients might be a contributing factor toward the preferential national expansion of prosthetic techniques.
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Multicenter Study
Examining national outcomes after thyroidectomy with nerve monitoring.
Previous intraoperative nerve monitoring (IONM) studies have demonstrated modest-to-no benefit and did not include a nationwide sample of hospitals representative of broad thyroidectomy practices. This national study was designed to compare vocal cord paralysis (VCP) rates between thyroidectomy with IONM and without monitoring (conventional). ⋯ According to this study, IONM has not been broadly adopted into practice. Overall, IONM was associated with a higher rate of VCP even after correction for numerous confounders. In particular, low institutional use of IONM and use in partial thyroidectomies are associated with higher rates of VCP. Further studies are warranted to support the broader application of IONM in patients where benefit can be reliably achieved.
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Multicenter Study
Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis.
Reports on recurrence and outcomes of US patients with gastric cancer are scarce. The aim of this study was to determine incidence and pattern of recurrence after curative intent surgery for gastric cancer. ⋯ Nearly one-third of patients experienced recurrence after gastric cancer surgery. The most common site of recurrence was distant.