Journal of the American College of Surgeons
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Multicenter Study Observational Study
Compliance with recommended care at trauma centers: association with patient outcomes.
State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality. ⋯ Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality.
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Randomized Controlled Trial
Empowering the surgical patient: a randomized, prospective analysis of an innovative strategy for improving patient compliance with preadmission showering protocol.
Surgical site infections (SSIs) are responsible for significant morbidity, mortality, and excess use of health care resources. The preadmission antiseptic shower is accepted as an effective strategy for reducing the risk for SSIs. The study analyzes the benefit of an innovative electronic patient alert system (EAS) for enhancing compliance with a preadmission showering protocol with 4% chlorhexidine gluconate (CHG). ⋯ The findings suggest that EAS was effective in enhancing patient compliance with a preadmission showering protocol, resulting in a significant (p < 0.007) increase in skin-surface concentrations of CHG compared with non-EAS controls. However, variation in amount of unused 4% CHG suggests that rigorous standardization is required to maximize the benefits of this patient-centric interventional strategy.
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We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in patients with bilobar colorectal liver metastases (CRLM). ⋯ This study showed that selection of patients by response to prehepatectomy chemotherapy may be extremely important before planning TSH because tumor progression while receiving prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete the second stage. For patients who completed the TSH strategy, long-term outcomes can be achieved with results similar to those observed after single-stage hepatectomy.