Journal of the American College of Surgeons
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Despite the presence of highly reliable data, studies on packed red blood cells (pRBC):fresh frozen plasma (FFP) ratio suffer from limited sample size and the presence of survivor bias. We sought to study the association between FFP:pRBC and early mortality in the hemorrhaging trauma patient. ⋯ A 1:1 FFP:pRBC ratio is associated with the lowest mortality in the hemorrhaging trauma patient, and mortality increases with decreasing ratios.
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This article proposes systems for the fair distribution of scarce resources to healthcare providers. It builds on classic ethical structures and adapts them to the equitable distribution of personal protective equipment (PPE) to clinicians at risk of contracting novel corona virus-19 (COVID-19). ⋯ It is recognized that unless the supply of PPE is quickly replenished, or viable alternatives to traditional equipment are devised in the coming days to weeks, hospitals and healthcare systems will face the difficult task of rationing PPE to at-risk clinicians. This paper suggests an ethical framework for that process.
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Opiates are the traditional treatment for postoperative pain. Recognition that increased availability of opiates in the community is associated with increased addiction has led to efforts to decrease postoperative opiate distribution. However, there are concerns that without opiates, pain relief might be inadequate. ⋯ Using a stepwise process, we have eliminated the use of opiates for postdischarge pain in children undergoing laparoscopic appendectomy. This intervention has resulted in the elimination of 4,035 doses of oxycodone from the community during the study period, while ensuring that postoperative pain control has been adequate.
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Recurrence after hiatal hernia repair is common. The causes are uncertain. Our observation is the site of recurrence is primarily the nonsutured or nonreinforced anterior-left lateral portion of the hiatus. Our aim was to assess the distribution of hiatal hernia recurrence location as a basis for developing a theory of recurrence. ⋯ Hiatal hernia recurrences due to failure of the crural closure were less common, but early, recurrences. The majority of recurrences were due to stretching of the hiatus anterior and to the left of the esophagus. We theorize that the pathophysiology of late hiatal hernia recurrence is widening of the anterior and left lateral portion of the hiatus secondary to repeated stress from differential pressures that eventually overcomes the tensile strength of the hiatus.