Journal of the American College of Surgeons
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In an effort to reduce surgical site infection (SSI) rates, a large number of infection control practices (ICPs), including operating room attire policies, have been recommended. However, few have proven benefits and many are costly, time-consuming, and detrimental to provider morale. The goal of this multi-institution study was to determine which ICPs are associated with lower postoperative SSI rates. ⋯ This analysis suggests that the subset of ICPs that focus on perioperative patient skin and wound hygiene and transparent display of SSI data, not operating room attire policies, correlated with SSI rates. Implementation of this subset of evidence-based ICPs may improve SSI rates at lower-performing hospitals.
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Bowel length is an important factor in the management of patients with intestinal failure and short bowel syndrome. However, it is difficult to accurately measure the length of the small intestine. Our aim was to demonstrate the feasibility of a dedicated software algorithm for calculating small intestine length based on magnetic resonance enterography (MRE) images. ⋯ This study demonstrates the feasibility of a dedicated, computer-vision-based algorithm that can reliably and accurately calculate the length of the small intestine using MRE images. A validated, noninvasive approach to measuring small intestine length that can be implemented using available clinical imaging can have a dramatic clinical impact on management in patients with short bowel syndrome, Crohn's disease, and other intestinal disorders.
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Post-transplant malignancy (PTM) remains a concern among pediatric kidney transplant (PKT) recipients. ⋯ Pediatric kidney transplant recipients are at increased risk of PTM, which adversely affects survival. Children receiving transplants at an older age, from a LURD, or who receive an EBV-positive organ, should be monitored closely for the development of PTM.
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The 2014 Medicaid expansion in participating states increased insurance coverage among people with chronic health conditions, but its implications for access to surgical care remain unclear. We investigated how Medicaid expansion influenced the insurance status of candidates for liver transplantation (LT) and transplant center payor mix. ⋯ Candidates for LT became more likely to use Medicaid after the 2014 Medicaid expansion policy came into effect. Enactment of this policy did not appear to increase access to LT or address socioeconomic and demographic disparities in access to the LT wait list.
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Burn patients who require CPR before admission to a burn center are anecdotally known to suffer higher mortality than those who do not require pre-hospital CPR. ⋯ Patients who undergo CPR before transfer to a burn center are at high risk for early death. Predictors of death and early death after CPR may include elevated initial lactate and lower initial arterial pH.