Annals of surgery
-
Comparative Study
Communication practices on 4 Harvard surgical services: a surgical safety collaborative.
Communication breakdowns between surgical residents and attending physicians in the pre- and postoperative setting are common contributors to patient injury. These communication transactions might offer an opportunity for safety improvement, but it remains unknown how often resident-attending communication fails, what the current level of attending involvement is, and how often attending input changes the plan for patient care. We conducted a prospective study at 4 Harvard teaching hospitals to address these issues. ⋯ In the context of both critical patient events and routine patient care, residents often fail to obtain attending surgeons' input for management decisions. These failures seem to derive more from residents' perception of necessity than from attending physicians' receptiveness or interest in being contacted. Once involved, attending physicians frequently modify resident's management decisions. It seems, therefore, that there is significant potential for communication failure and information loss among our 4 institutions.
-
Comparative Study
Prognostic significance of the DNA-index in liver transplantation for hepatocellular carcinoma in cirrhosis.
This study was conducted to evaluate the prognostic significance of the tumor DNA index in patients receiving liver transplantation for hepatocellular carcinoma (HCC) in cirrhosis. ⋯ This is the first study to describe the DNA-index as a strong prognostic indicator after liver transplantation for HCC in cirrhosis. At this time, determination of the DNA-index is likely to be the most promising diagnostic tool in the selection of transplant candidates.
-
We sought to understand whether obesity imparts detriment in outcome beyond risk of developing surgical site infection (SSI). ⋯ SSI is associated with detriment to patient and graft survival following renal transplantation. The prevalence of SSI is higher among obese recipients, but those who avoid SSI have comparable outcomes to nonobese recipients. These findings redemonstrate the importance of SSI prevention following renal transplantation.
-
Comparative Study
Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy.
To develop 2 instruments that predict the probability of perioperative red blood cell transfusion in patients undergoing elective liver resection for primary and secondary tumors. ⋯ Preoperative factors can be combined into risk profiles to predict the likelihood of transfusion during or after elective liver resection. These predictions, easy to calculate in the frame of a nomogram or of a transfusion score, can be used to identify patients who are at high risk for red cell transfusions and therefore most likely to benefit from blood conservation techniques.
-
Comparative Study
A novel polypeptide derived from human lactoferrin in sodium hyaluronate prevents postsurgical adhesion formation in the rat.
The objective of the study was to evaluate whether a peptide derived from human lactoferrin, PXL01 could act safely to reduce the formation of peritoneal adhesions in the rat model and to map the molecular mechanisms of its action. ⋯ A new class of synthetically derived water soluble low molecular weight peptide compound, PXL01 showed marked reduction of peritoneal adhesion formation in an animal model without any negative effects on healing. On the basis of these data, a comprehensive adhesion prevention regimen in clinical situation is expected.