Annals of surgery
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Observational Study
Trending Fibrinolytic Dysregulation: Fibrinolysis Shutdown in the Days After Injury Is Associated With Poor Outcome in Severely Injured Children.
To trend fibrinolysis after injury and determine the influence of traumatic brain injury (TBI) and massive transfusion on fibrinolysis status. ⋯ Fibrinolysis shutdown is common postinjury and predicts poor outcomes. Severe TBI is associated with sustained shutdown. Empiric antifibrinolytics for children should be questioned; thromboelastography-directed selective use should be considered for documented HF.
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To determine rates of axillary dissection (ALND) and nodal recurrence in patients eligible for ACOSOG Z0011. ⋯ We confirm that even without preoperative axillary imaging or routine use of nodal RT, ALND can be avoided in a large majority of Z0011-eligible patients with excellent regional control. This approach has the potential to spare substantial numbers of women the morbidity of ALND.
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We present 8-year follow-up data from the intern class of 2007 to 2008 using a novel, nonparametric predictive model to identify those residents who are at greatest risk of not completing their training. ⋯ This is the first longitudinal cohort study to identify factors at the start of training that put residents at risk for not completing training. Data from this study offer a method to identify interns at higher risk for attrition at the start of training, and next steps would be to create and test interventions in a directed fashion.
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Observational Study
Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program.
To determine whether concurrently performed operations are associated with an increased risk for adverse events. ⋯ In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.