Arch Surg Chicago
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Operating room turnover time (TOT) and daily caseload can be improved by analyzing the routine tasks of the operating team and minimizing inefficiencies. ⋯ Interdisciplinary work flow assessment and redesign resulted in decreased operating room TOTs and additional cases being completed each day for 4 different surgeons.
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Dialysis by native arteriovenous fistula (NAVF) clearly offers lower infection rates, fewer procedures, and lower mortality risk compared with access by catheter or graft, in addition to lower cost. However, NAVFs are utilized for vascular access in only 30% of hemodialysis patients in the United States. Wrist NAVFs are not feasible or successful in many patients and upper arm brachial artery NAVFs may be impractical or lead to additional procedures or complications. Careful preoperative evaluation of all options for NAVF construction including the proximal radial artery (PRA) as an arterial inflow site will find most, if not all, patients to be candidates for successful NAVFs. ⋯ No grafts were used in this series of 132 consecutive patients. The PRA NAVF was the most common operation and an important addition to wrist, brachial, and transposition fistulas. Proximal radial artery NAVFs increase the opportunity for construction of successful NAVFs and are reliable, safe, and simple procedures with access sites often available in both the forearm and in the upper arm.
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A transparent adhesive film possessing selective permeability combined with a hydrogel (Burnshield) may be effective in burn patients to reduce skin maceration, improve medication, control pain more effectively, and reduce the incidence of late complications (hypertrophic scars). ⋯ In the reepithelialization phase, complications were recorded in 8 of the 40 patients: 7 (18%) had residual inflammation and 1 (2%) had a hypertrophic scar. During the follow-up, late complications were recorded in 2 (5%) of the 40 patients. A gel was used in 8 patients: in 6 of the 7 patients with residual inflammation, the complication resolved, while in 1, despite therapy, the residual inflammation evolved into hypertrophic scarring. Treatment with the gel in the 2 patients with late lesions reduced the thickness and extent of the lesions, with minimal aesthetic and functional damage.