Surgery Commons^™

Breakfast With The Experts, Tbd

Pancreatic Cancer & Related Diseases Symposium

Continental Breakfast, Informational Tables & Scientific Poster Presentations

Potential Role Of Csf Cytokine Profiles In Discriminating Infectious From Non-Infectious Cns Disorders., Danielle Fortuna, D. Craig Hooper, Amity L. Roberts, Larry A. Harshyne, Michelle Nagurney, Mark T. Curtis

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Current laboratory testing of cerebrospinal fluid (CSF) does not consistently discriminate between different central nervous system (CNS) disease states. Rapidly distinguishing CNS infections from other brain and spinal cord disorders that share a similar clinical presentation is critical. New approaches focusing on aspects of disease biology, such as immune response profiles that can have stimulus-specific attributes, may be helpful. We undertook this preliminary proof-of-concept study using multiplex ELISA to measure CSF cytokine levels in various CNS disorders (infections, autoimmune/demyelinating diseases, lymphomas, and gliomas) to determine the potential utility of cytokine patterns in differentiating CNS infections from other CNS diseases ...

The Effects Of A Preoperative Physical Therapy Visit On Patient Outcomes Following Total Knee Arthroplasty, Kelly E. Schneider, Sheldon R. Garrison, Maharaj Singh, Jennifer L. Pogodzinski

Journal of Patient-Centered Research and Reviews

Background: Total knee arthroplasty (TKA), or total knee replacement, is an effective surgical approach used to treat osteoarthritis and knee trauma. Its utilization has grown, and the accompanying financial impact has resulted in an equal need to advance physical therapy practice. Historically, physical therapy is provided postoperatively as the standard of care for TKA. An emerging approach is the inclusion of a preoperative rehabilitation physical therapy program (prehab) focused on functional skill training and education; however, its effectiveness remains untested with TKA.

Purpose: In the current study, we examined the impact of standardized prehab in the health care setting, using ...

Variability In Sentinel Lymph Node Biopsy Retrieval For Breast Cancer At Aurora Health Care, Aaron H. Chevinsky, Judy A. Tjoe, William L. Owens, James L. Weese

Journal of Patient-Centered Research and Reviews

Background: Axillary lymph node involvement has always been one of the most important factors in determining treatment and prognosis for breast cancer. Routine axillary lymph node dissection (ALND) was the standard treatment for breast cancer until the mid-1990s, when sentinel lymph node biopsy (SLNB) became the standard.

Purpose: We undertook an evaluation of the SLNB procedure, comparing dedicated breast surgeons (4) with general surgeons who also perform breast procedures (25) to see if there were any differences and to standardize the approach throughout Aurora Health Care.

Methods: We performed a retrospective chart review at Aurora to evaluate patients undergoing surgical ...

Is Spontaneous Termination Of Atrial Fibrillation During Hybrid Ablation A Predictor Of Clinical Outcome In Patients With Persistent Atrial Fibrillation?, Lynn Erickson, David C. Kress, Firas Zahwe, Tadele Mengesha, David Krum, Jasbir S. Sra

Journal of Patient-Centered Research and Reviews

Background: An epicardial/endocardial (hybrid) ablation approach has emerged as an option to treat a difficult population of patients with persistent atrial fibrillation (AF). Limited information exists on the importance of AF termination as a predictor of clinical outcome during hybrid ablation.

Purpose: This retrospective study aimed to demonstrate the significance of spontaneous AF termination during hybrid ablation of persistent AF.

Methods: We studied results from 63 consecutive hybrid ablations in patients with no prior ablation, a mean (± standard deviation) persistent AF duration of 19 ± 16 months and a mean follow-up of 27 ± 13 months. Patients received both epicardial ablation ...

Metformin Clinical Trial In Hpv+ And Hpv- Head And Neck Squamous Cell Carcinoma: Impact On Cancer Cell Apoptosis And Immune Infiltrate., Joseph M. Curry, Jennifer Johnson, Mehri Mollaee, Patrick Tassone, Dev Amin, Alexander Knops, Diana Whitaker Menezes, My Mahoney, Andrew P. South, Ulrich Rodeck, Tingting Zhan, Larry A. Harshyne, Nancy Philp, Adam J. Luginbuhl, David Cognetti, Madalina Tuluc, Ubaldo E. Martinez-Outshoorn, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Metformin, an oral anti-hyperglycemic drug which inhibits mitochondrial complex I and oxidative phosphorylation has been reported to correlate with improved outcomes in head and neck squamous cell carcinoma (HNSCC) and other cancers. This effect is postulated to occur through disruption of tumor-driven metabolic and immune dysregulation in the tumor microenvironment (TME). We report new findings on the impact of metformin on the tumor and immune elements of the TME from a clinical trial of metformin in HNSCC. Methods: Human papilloma virus-(HPV-) tobacco+ mucosal HNSCC samples (n = 12) were compared to HPV+ oropharyngeal squamous cell carcinoma (OPSCC) samples (n ...

Functional Radical Cervical Dissection For Differentiated Thyroid Cancer: The Experience Of A Single Center, Tulin Adrian, Lucian Alecu, Catalina Poiana, Luminita Tomescu, Iulian Slavu, Raluca Tulin, Silviu Pituru, Cristina Orlov, Radu Jecan, Balalau Cristian, Anca Pantea Stoian, Razvan Hainarosie, Cornelia Nitipir

Journal of Mind and Medical Sciences

There is ongoing debate regarding the role of neck dissection in differentiated thyroid cancer, about its usefulness in elective settings, and the increased costs regarding morbidity and operative time. This retrospective study aimed to determine the rate of metastases in cervical lymph nodes, to examine the morbidity of this surgery, and to assess whether a pattern of distribution of tumor cells concerning neck lymphatic compartments exists. The most frequent type of cancer to metastasize was papillary cancer, the majority of patients were young with a median of 30 years, predominantly females. Differentiated thyroid cancer frequently metastasizes to the central and ...

A Proposed Therapeutic Algorithm For Colorectal Cancer Prevention, Based On Endoscopic Polypectomies In Patients With Multiple Colonic Polyps, Septimiu Alexandru, Florin D. Ungureanu, Reka Incze Kutasi, Cosmin Alec Moldovan

Journal of Mind and Medical Sciences

Introduction. Results from single medical centers having large numbers of patients with multiple colonic polyps that have undergone colonoscopy management are rare.

Material and method. The present study is based on 2,000 cases enrolled during 2009 and 2017, including patients that underwent colonoscopy for various reasons in the Department for Upper and Lower Endoscopy of Witting Clinical Hospital, Bucharest, Romania.

Results. Of the 2,000 patients examined during 2009 - 2017, 594 tumor formations were detected; 148 (24.9%) patients had colorectal malignancies, and 446 (75%) polypoid formations in 313 patients who had one or more colon polyps were found ...

Can Non-Small Cell Lung Cancer Histologic Subtypes Predict Survival? A Single Institution Experience, Cornelia Nitipir, Cristina Orlov, Ana-Maria Popa, Mihaela Olaru, Iulian Slavu, Iaciu Cristian, Razvan Hainarosie, Anca Pantea Stoian, Balalau Cristian

Journal of Mind and Medical Sciences

Introduction. The latest histological classification of lung adenocarcinoma includes lepidic, acinar, papillary, micropapillary, and solid as subtypes. Testing these subtypes for their prognostic and predictive value is an ongoing scientific challenge. The present research article aims to describe the influence this classification has on patient survival.

Materials and Methods. Thirty-three patients were included in the trial. The most important enrollment criterion was the clear specification of the adenocarcinoma subtype in the pathology report. Patients were stratified into three groups which included the adenocarcinoma pathological subtypes as follows: lepidic (LEP), acinar and papillary (ACN/PAP), and micropapillary/solid (MIP/SOL). The ...

Reconstruction Of Heel Soft Tissue Defects Using Sensate Medial Plantar Flap, Mihaela Pertea, Natalia Velenciuc, Oxana Grosu, Bogdan Veliceasa, Vladimir Poroch, Sorinel Lunca

Journal of Mind and Medical Sciences

Introduction. Reconstruction of heel soft tissue defects represents a true challenge for any surgeon due to the particularities of this anatomical region. The tissue used to reconstruct the heel area must be resistant, innervated, and adapted to take over the body weight. Innervated medial plantar fasciocutaneous flap is one of the best solutions to cover defects at the heel level.

Materials and Methods. We studied 5 patients, 4 males and one female, aged 42 to 67 years, who presented heel soft tissue defects of various etiologies. In all cases, the used reconstructive method was an insular innervated medial plantar fasciocutaneous ...

Sentinel Lymph Node In Early Stage Ovarian Cancer; A Literature Review, Irina Balescu, Nicolae Bacalbasa, Mihaela Vilcu, Vladislav Brasoveanu, Iulian Brezean

Journal of Mind and Medical Sciences

Although sentinel lymph node mapping has been widely implemented in gynecological malignancies in order to minimize the number of unnecessary lymph node dissections and to diminish postoperative morbidity rate, little is known about ovarian cancer sentinel lymph node mapping. This article presents a literature review regarding the effectiveness, safety and benefits of this method.

Sentinel lymph node detection in early stage ovarian cancer seems to be a safe and effective method, able to minimize the rate of patients submitted to unnecessary lymph node dissection. The second goal of the procedure, to minimize the risk of missing involved lymph nodes, seems ...

Improving Safe Handoffs & Transitions From The Ed To Adult Inpatient: A Response To The Ahrq Hospital Patient Safety Culture Survey, Natalie Talbot, Joanne Chapman, Rhonda Diphilippo, Gail Savage, Michele Higgins, Nancijean Goudey, Lori Sweatt, Erin Graydon Baker, Joseph East, Stephen Tyzik, Suneela Nayak, Mark Parker, Ruth Hanselman, Amy Sparks

Operational Excellence

SAFE TRANSITIONS AND PATIENT HANDOFFS IN A LARGE ACUTE CARE HOSPITAL

It is well documented in the literature that ineffective patient handoffs and transitions continues to be an area that can lead to adverse patient safety events so it is an urgent opportunity for a performance improvement plan. At an academic tertiary care medical center, the lowest scoring domain from the FY2017 AHRQ Patient Safety Culture Survey was patient handoffs and transitions.

A team was established consisting of staff from the Emergency Department and a medical/surgical unit to develop a plan for implementing improvement interventions. Their goal was to ...

The Development And Implementation Of A Reliable Method For Educating Provider Groups On Stroke Discharge Order Sets, Deborah Gregoire, Shawn Taylor, Suneela Nayak, Mark Parker, Kathryn Cope, Ruth Hanselman, Stephen Tyzik, Amy Sparks, Brendan Lilley

Operational Excellence

THE DEVELOPMENT AND IMPLEMENTATION OF A RELIABLE METHOD FOR EDUCATING PROVIDERS ON STROKE DISCHARGE ORDER SETS

After receiving a comprehensive stroke certification from the Joint Commission, an academic tertiary care medical center created and revised 15 stroke order sets to ensure providers could easily place the correct orders for every stroke patient. Following certification, it was noted that there was inconsistent use of these order sets. This raised concerns that the process to treat a stroke patient may be delayed, creating serious potential risk for the patient.

A goal of this performance improvement plan was to develop and implement a ...

Strategies To Increase Early Discharges To Decrease Hospital Length Of Stay And Avoidable Patient Days For Neuro-Spine Patients, Corey Fravert, R6, Trauma Team, Rehab Medicine, Neurosurgery, Joy Moody, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Excellence

STRATEGIES TO INCREASE MORNING DISCHARGES IN AN ACADEMIC TERTIARY HOSPITAL

Delays in patient discharge result in numerous negative impacts on the health care system. Amongst those are a reduced patient flow and satisfaction, long wait times, and physician/ staff frustration.

An inpatient neurotrauma unit initiated a performance improvement project that utilized a multidisciplinary approach to identify barriers to discharge and coordinate a discharge plan focused on neurospine patients.

A root cause analysis was conducted to collect reasons that these patients were not discharged by 11:00am. As a result of the findings, 4 performance improvement plans were created. Subsequent data ...

Strategies To Improve Post-Procedural Safe Patient Handoffs, Marguerite Anderson, Tara Herman, Janice Nichols, Robyn Dixon, Elizabeth Van Der Linden, Bonnie Boivin, Stephen Tyzik, Mmc Asu, Mmc Pacu, Ssu, Endoscopy, Advanced Endoscopy, One Call Center

Operational Excellence

STRATEGIES TO IMPROVE SAFE PATIENT HANDOFFS AND POST PROCEDURAL FLOW

During patient transfers from one care unit to another, it is imperative for patient safety and satisfaction that timely and complete communication between staff occurs. In an academic tertiary care medical center, a team consisting of representatives from 6 patient care units used improvement methods of operational excellence to improve patient centered movement.

The goal of this project was to improve the percentages of two questions related to information sharing on the FY2018 AHRQ Culture of Patient Safety Survey. Using baseline metrics to reflect the current state of patient wait ...

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

Department of Surgery

No abstract provided.

Editorial: Fundamentals Of Missed Care – Implications For The Perioperative Environment, Nicholas Ralph

Journal of Perioperative Nursing

No abstract provided.

Pressure Injury Prevention For Surgery: Results From A Prospective, Observational Study In A Tertiary Hospital, Isabel Wang, Rachel Walker, Brigid M. Gillespie

Journal of Perioperative Nursing

No abstract provided.

Private Pain – Identifying Gaps In The Management Of Chronic Pain Patients In Private Hospitals: A Case Study, Johanna Gale

Journal of Perioperative Nursing

This is a case study of a patient who experiences chronic pain and was admitted for an acute surgical procedure in a private hospital. It illustrates how communication and teamwork can be overlooked within the multidisciplinary focus when jointly caring for this group of patients within the public and private sectors. This case study offers a nurse-led approach to improving individualised health care for chronic pain patients while preventing gaps in health care.

Establishing A New Cardiac Surgery Service In An Australian University Hospital: Pitfalls And Lessons Learned, Claudia Ciobanu, Sharon Latimer, Brigid M. Gillespie

Journal of Perioperative Nursing

Cardiovascular disease is the leading cause of death among Australians. Creating and delivering a world-class cardiac surgery service in a cost-effective way is the principle goal of health care organisations and managers. Establishing a new health care service is a unique opportunity and requires detailed planning and implementation. Managing change is pivotal to establishing a new patient-focused health care service, and should be coupled with effective communication and teamwork among all stakeholders. There are foreseen and unforeseen challenges associated with any project so sharing the lessons learned is an important way for others in a similar situation to avoid potential ...