Journal of the American College of Surgeons
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Efforts to improve healthcare quality involve profiling hospitals and providers. Whether cancer-specific measures can be used reliably for profiling purposes has not been reported. ⋯ Profiling hospitals based on measures such as these can achieve acceptable reliability in reasonable timeframes, but does not always. Either lower levels of reliability should be accepted to profile surgeons with these measures or longer timeframes should be used.
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Residents are often required to balance whether to adhere to duty hour policies or violate them to care for patients and obtain educational experiences. Little is known about why residents violate duty hour policies and whether there is a relationship between how often residents violate duty hours and concerns about patient safety. Our objective was to assess the association between resident duty hour violations and resident concerns about patient safety. ⋯ Trainees who reported perceiving negative effects of duty hour policies on patient safety were more likely to report frequent duty hour violations.
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Massive localized lymphedema (MLL) is an area of skin and subcutaneous overgrowth associated with obesity. The purpose of this study was to determine whether MLL results from obesity-induced lymphedema (OIL) and to characterize the prevalence and risk factors for the condition. ⋯ Massive localized lymphedema is a consequence of OIL and affects approximately 60% of obese patients with lower-extremity dysfunction; a BMI >56 kg/m(2) significantly increases the risk. Obese individuals should be referred to a bariatric weight-loss center before their BMI reaches a threshold for OIL and MLL to develop.