Medicine and Health Sciences Commons^™

Staged Bilateral Total Shoulder Arthroplasty With Non-Spherical Humeral Head Resurfacing And Inlay Glenoid Replacement, William Davis, Alex Rothfeld, Luis Vargas, John Zvijac, John Uribe

John Uribe

No abstract provided.

Effectiveness Of Mri To Assess The Integrity Of Distal Biceps Tendon Repair During The First Year Postoperatively, Keith Hecthman, Gary Kiebzak

Keith Hechtman

No abstract provided.

First-Case Operating Room Delays: Patterns Across Urban Hospitals Of A Single Health Care System, Callie M. Cox Bauer, Danielle M. Greer, Kiley B. Vander Wyst, Scott A. Kamelle

Callie Cox Bauer, DO, FACOG

Purpose

Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs.

Methods

We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of …

First-Case Operating Room Delays: Patterns Across Urban Hospitals Of A Single Health Care System, Callie M. Cox Bauer, Danielle M. Greer, Kiley B. Vander Wyst, Scott A. Kamelle

Aurora Ob/Gyn Faculty

Purpose

Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs.

Methods

We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of …

Operating Room First Start Efficiency Throughout A Large Urban Hospital System, Callie Cox Bauer, Kiley A. Bernhard, Danielle M. Greer, Scott Kamelle

Aurora Ob/Gyn Faculty

Background: Operating room delays decrease health care system efficiency and increase hospital costs. Data on delays in a multihospital system are sparse.

Purpose: In an effort to improve our operating room efficiency, we investigated operating room delays, the causes and the impending financial impact.

Methods: A retrospective analysis on first case-of-the-day surgeries at three hospitals during 2013 was conducted. Delays were defined as in-room time being after scheduled surgery start time. Length of delay and causes were recorded. Patient demographics, body mass index, hospital facility, total number of procedures, provider specialty and time of patient arrival were incorporated into a …

Extra-Pleural Dermal Solitary Fibrous Tumor On The Posterior Shoulder: A Case Report., Sean J. Wallace Md, Robert Teixeira Md, Nathan F. Miller, Hina A. Sheikh, Genevieve Guzman, Rohit Sharma Md

Hina A. Sheikh, M.D.

No abstract provided.

Segmental Distribution Of Hepatocellular Carcinoma Correlates With Microvascular Invasion In Liver Explants Undergoing Transplantation, Yasir Al-Azzawai, Eva Rouanet, Ryan J. Hendrix, Lidia Spaho, Hesham Malik, Deepika Devuni, Gyongyi Szabo, Graham Barnard

Gyongyi Szabo

Introduction: Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients is a poor prognostic factor after liver transplantation and/or resection. Any correlation between MVI and segmental location of HCC has yet to be studied. Our aim is to evaluate the segmental location of HCC and any correlation with the presence of MVI, portal vein thrombosis (PVT) in explanted livers, and the recurrence of HCC after transplantation. Another objective of the study is to assess the treatment history (ablation or transarterial chemoembolization (TACE)) and size of the tumor with respect to the risk of MVI.

Methods: A single center, retrospective chart review, …

National Pancreatic Fistula Rates After Minimally Invasive Pancreaticoduodenectomy Are Improving With Time: A Nsqip Analysis, Horacio Asbun

Horacio J. Asbun

No abstract provided.

Complications In Brief: Quadriceps And Patellar Tendon Tears, Gautam Yagnik, John Uribe

Gautam Yagnik

No abstract provided.

A Biomechanical Comparison Of New Techniques For Distal Clavicular Fracture Repair Versus Locked Plating, Gautam Yagnik, Joseph Zimmerman, Charles Jordan, David Porter

Gautam Yagnik

No abstract provided.

Arthroscopic Setup, Instrumentation, Portals, And Operative Pearls, Gautam Yagnik, John Uribe

Gautam Yagnik

No abstract provided.

Stereotactic Radiosurgery With Concurrent Lapatinib Is Associated With Improved Local Control For Her2-Positive Breast Cancer Brain Metastases, Rupesh Kotecha

Rupesh Kotecha

No abstract provided.

All-Polyethylene Tibial Components In Octogenarians: Survivorship, Performance, And Cost, Alexander Van Der Ven

Alexander van der Ven

No abstract provided.

Disseminated Adenovirus Nephritis After Kidney Transplantation., Timothy Hatlen, Henry Mroch, Katherine Tuttle, Okechukwu Ojogho, Michele Rooney, Sara Desmond, Samer Bani-Hani

Katherine R. Tuttle, MD, FASN, FACP, FNKF

No abstract provided.

Pregnancy Outcomes In Female Liver Transplant Recipients With A Transplant-To-Conception Interval >- 5 Years, Carlo B. Ramirez, Adam Frank, Warren R. Maley, Cataldo Doria, Lisa A. Coscia, Vincent T. Armenti

Adam M. Franks, MD

Conclusions: Successful pregnancy outcomes have been reported in female liver recipients with a transplant-to-conception interval greater than or equal to 5 years. Long-term graft survival should be discussed with recipients as a component of preconception counseling. All transplant centers are encouraged to report pregnancies to the NTPR.

Utilizing Livers From Donors Older Than 65: A Single Center Experience, Krishnaraj Mahendraraj, Jorge H. Castro, Sean Devitt, Chad Gorn, Cataldo Doria, Adam Frank, Warren Maley, Carlo G. Ramirez

Adam M. Franks, MD

Conclusions:

Use of liver grafts from older donors presents similar survival outcomes as grafts from younger donor age. Therefore, it offers a viable option to expand the donor pool and increase number of OLTs.

However, there is higher incidence of retransplantation due to primary graft non-function, and longer hospital length of stay observed in the older donor age group.

Further studies using larger patient populations are needed to validate our results.

Completely Steroid-Free Immunosuppression In Liver Transplantation: A Randomized Study., Carlo B. Ramirez, Md, Cataldo Doria, Md, Phd, Adam M. Frank, Md, Stephen T. Armenti, Ignazio R. Marino, Md

Adam M. Franks, MD

INTRODUCTION: Corticosteroids (CS) have been standard immunosuppression to prevent and treat rejection. However, CS are associated with increased risk of infection, obesity, hypertension, hyperlipidemia, diabetes, and accelerated hepatitis C virus (HCV) recurrence post-orthotopic liver transplantation (OLT). This study assesses the safety and efficacy of CS-free immunosuppressive regimen in adult OLT.

METHODS: A two-yr, prospective, randomized study of CS with delayed withdrawal (CS) or CS-free regimen with basiliximab, tacrolimus, and enteric-coated mycophenolate sodium (EC-MPS) was performed in 39 patients (CS=20; CS-free=19). CS group received intra-operative methylprednisolone weaned by six months. HCV patients had HCV PCR pre-OLT and 0.5, one, three, and …

Arthroscopic Setup, Instrumentation, Portals, And Operative Pearls, Gautam Yagnik, John Uribe

John Uribe

No abstract provided.

Glenoid Fracture After Arthroscopic Bankart Repair: Case Series And Biomechanical Analysis, John Uribe, Gautam Yagnik

John Uribe

No abstract provided.

Complications In Brief: Quadriceps And Patellar Tendon Tears, Gautam Yagnik, John Uribe

John Uribe

No abstract provided.

Outcomes Of Pulmonary Embolism In A Tertiary Setting., Nicole Stansbury, James K. Wu Md

James K. Wu, M.D.

No abstract provided.

A Retrospective Analysis Of The Outcomes Of Extracorporeal Cardiopulmonary Resuscitation (Ecpr)., Rachel Wills, Kennedy Gallagher, James A. Burke Md, Tim S. Misselbeck Md, James K. Wu Md

James K. Wu, M.D.

No abstract provided.

Creatinine Trends In Transcatheter Aortic Valve Replacement Patients., Sydney Pickering, Taryn Samet Md, Raymond L. Singer Md, Mmm, James K. Wu Md

James K. Wu, M.D.

No abstract provided.

Comparison Of Survival Indicators Between Myocardial Infarction Patients And Septic Patients Who Received Veno-Arterial Extracorporeal Membrane Oxygenation, Niharika Boinpally, Kennedy Gallagher, Allison Eisenhauer Pa-C, Michael Healy, Kristina Postko Pa-C, James K. Wu Md

James K. Wu, M.D.

No abstract provided.

Trends In Patient Selection And Postoperative Outcomes After Pancreatoduodenectomy. A 10-Year Retrospective Acs Nsqip Database Analysis, Jan Grendar, Zelika Jutric, Shu-Ching Chang, L Wang, E Tang, P Newell, C Hammill

Shu-Ching Chang, PhD, MS

Objective: We aimed to assess trends in patient selection and outcomes to evaluate safety in current practice of pancreatoduodenectomy. Methods: NSQIP database from 2005 to 2014 was used to identify patients undergoing a pancreatoduodenectomy. Preoperative optimization measure was created using lack of >10% weight loss, albumin>3 and bilirubin<2. Annual trends in patient characteristics and outcomes were described in univariate and logistic or linear regression analyses for binary and continuous variables, respectively. Results: 23,295 pancreatoduodenectomies were identified. There was no significant trend of age (overall median 65 years, trend p=0.31), severity of systemic disease increased (ASA≥3 in 73% overall, trend OR=1.07, p<0.001), but so did the rate of preoperative optimization (52% overall, trend OR=1.03, p<0.001). Malignant indication percentage was increasing (75% overall, trend OR=1.04, p<0.001) as was rate of associated vascular resection (8% overall, trend OR=1.09, p<0.001), but not multivisceral resections (4% overall, trend p=0.10). The adjusted odds of minor and major complications increased over time (overall 31.2% and 27.7%, trend OR=1.32 and 1.11 respectively, p<0.001 for both). In contrast, unadjusted and adjusted length of stay was shortening (median 9 days, decrease by 1.60% and 1.44% respectively, p<0.001 for both) and mortality continued to decrease (2.5% overall, trend OR=0.95, p=0.002). Conclusion: There has been increasing severity of systemic disease as well as more advanced primary disease in patients undergoing pancreatoduodenectomy. Despite increasing complication rates, preoperative optimization and management of complications were likely improved, as suggested by shortening length of stay and decreasing mortality.

A Case Of Congenital Unilateral Absence Of The Vas Deferens, Bi Mo, Vishnu Garla, Lawrence M. Wyner M.D.

Lawrence M. Wyner, MD

Background

Congenital unilateral absence of the vas deferens occurs in 0.5%–1.0% of males. It has been associated with various genitourinary abnormalities, including renal agenesis. We report a case of congenital unilateral absence of the vas deferens found incidentally during vasectomy in a patient with known unilateral renal agenesis.

Case presentation

A 24-year-old male presented to our urology clinic requesting vasectomy. His past history was significant for left renal agenesis. Following successful right vasectomy, several attempts to locate the left vas deferens were unsuccessful. We diagnosed congenital unilateral absence of the vas deferens. Follow-up semen analysis showed azoospermia.

Conclusion

As vasectomies …

Development Of A Health Care Systems Curriculum., Zachary Pruitt, Rahul Mhaskar, Bryan G. Kane Md, Robert D. Barraco Md, Mph, Deborah J Dewaay, Alexander M. Rosenau Do, Kristin A. Bresnan Md, Marna R. Greenberg Do, Mph, Facep

Marna R Greenberg DO, MPH, FACEP

Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.

Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created …

10-Year Outcome Of The Thoracic Endovascular Aortic Repair (Tevar) Procedure, James K. Wu Md, Tim S. Misselbeck Md, Jacob Fink, Youssef Zaki

James K. Wu, M.D.

No abstract provided.

Development Of A Health Care Systems Curriculum., Zachary Pruitt, Rahul Mhaskar, Bryan G. Kane Md, Robert D. Barraco Md, Mph, Deborah J Dewaay, Alexander M. Rosenau Do, Kristin A. Bresnan Md, Marna R. Greenberg Do, Mph, Facep

Bryan G Kane MD

Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.

Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created …

The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, Milad Modarresi, Brad Gillon, Javad Najjar Mojarrab, Rodrigo Aguilar, Zackary Dylan Hunter, Matthew Steven Schade, Jackie Sanabria, Rebecca Klug, Seth Adkins, Juan R. Sanabria

Juan R. Sanabria

Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an …