Journal of the American College of Surgeons
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Comparative Study
Racial and Regional Disparities in the Effect of the Affordable Care Act's Dependent Coverage Provision on Young Adult Trauma Patients.
Disparities in trauma outcomes based on insurance and race are especially pronounced among young adults who have relatively high uninsured rates and incur a disproportionate share of trauma in the population. The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed young adults to remain on their parent's health insurance plans until age 26 years, leading to >3 million young adults gaining insurance. We investigated the impact of the DCP on racial disparities in coverage expansion among trauma patients. ⋯ Although the DCP increased insurance coverage for young adult trauma patients of all races, both absolute and relative racial disparities in insurance coverage widened. The extent of these racial disparities also differed by geographic region. Although this policy produced overall progress toward greater coverage among young adults, its heterogeneous impact by race has important implications for future disparities research in trauma.
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Comparative Study
Comparative Effectiveness of Hybrid Coronary Revascularization vs Coronary Artery Bypass Grafting.
Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery to left anterior descending bypass with percutaneous coronary intervention of non-left anterior descending vessels. Its safety and effectiveness compared with conventional CABG have been under studied. ⋯ The use of HCR appeared to be safe, with faster recovery and similar outcomes when compared with conventional CABG. These findings were consistent irrespective of anatomic or predicted procedural risk.
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A score predictive of tumor recurrence after radical surgery for non-cardia gastric cancer was previously developed in Italian centers. The aim of this study was to validate the score in a consecutive cohort with prospectively collected follow-up data. ⋯ The high predictive value of the score was validated in a consecutive cohort. These results might allow the introduction of the score in clinical practice for Western patients.
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Observational Study
Impact of Hemorrhagic Shock on Pituitary Function.
Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. ⋯ Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.