Journal of the American College of Surgeons
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Patients older than 65 years have unique needs and treatment outcomes goals. The objective of this study was to evaluate the impact of Geriatric Surgery Verification (GSV) initiative in oncology patients ≥65 years undergoing major abdominal surgeries. ⋯ The GSV initiative intervention in geriatric oncology patients undergoing major abdominal surgeries was associated with reducing postoperative institutionalization and change in primary residence disposition. Further studies to explore different mechanisms within GSV that lead to improved outcomes in geriatric oncologic population will be informative.
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There remains clinical equipoise regarding the preference for upfront appendectomy or nonoperative management for patients with complicated appendicitis. However, the natural history of the appendix following nonoperative management and pending interval appendectomy in children is not well characterized, and the risk of recurrent appendicitis as a function of time from index admission not known. ⋯ The highest likelihood of recurrent appendicitis or complications following nonoperative management of complicated appendicitis occurs in the first 50 days following index admission. This information will help surgeons during shared decision-making conversations regarding timing of interval appendectomy.
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Cardioplegic ischemia/reperfusion (I/R) injury poses substantial challenges during postoperative recovery, with diabetic patients particularly susceptible to adverse events. Using a model entailing the subjection of human coronary artery endothelial cells (HCAECs) to simulated cardioplegic I/R, we investigated the potential of protein kinase c β (PKC-β) inhibition to augment cellular survival in this context. ⋯ PKC-β inhibitor treatment increased pro-survival signaling and decreased pro-apoptotic signaling in nondiabetic and diabetic HCAECs subjected to simulated I/R, with mechanistic differences observed between these cohorts.
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In the last 30 years, consolidation of healthcare systems in the United States has accelerated through mergers and acquisitions. We completed a systematic literature review on integration to determine if its reputation for enhancing the value of healthcare by reducing price and cost/spending and improving overall quality of care is justified. ⋯ Our review suggests that evidence is lacking to support the theory that integration is an effective strategy for improving the value of healthcare delivery. This finding represents an opportunity for healthcare leaders, including surgeons, to better define value in their efforts to improve quality while balancing the financial stability of the healthcare industry with a focus on benefiting the patient.