Articles: cations.
-
World journal of surgery · Apr 2017
Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru.
Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited. ⋯ A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.
-
In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. ⋯ Policy changes in organ allocation can have a significant impact on perioperative costs and outcomes, which can have a downstream influence on transplantation center perisurgical care processes.
-
Case Reports
Application of far-lateral approach to sub-axial spine-Application, technical difficulties and results.
The far-lateral approach has traditionally been used as an approach to ventral foramen magnum pathologies. Ventral pathologies in the cervical spine and cervicodorsal regions also provide unique surgical challenges. Traditional posterior surgical approaches to the ventral cervical pathologies require significant cord retraction, and anterior approaches require significant bone removal with implant stabilization. We approached these lesions using a modification of the far-lateral approach for lesions in the subaxial spine. ⋯ We propose extension of far-lateral approach to ventral intradural extramedullary lesions in the subaxial spine up to the cervicothoracic junction. The far-lateral approach can be extended safely to the ventral and ventrolateral lesions of the subaxial cervical spine, especially for recurrent or residual lesions previously approached from the midline posteriorly.