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Full-Text Articles in Medicine and Health Sciences
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
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.
Bone Conduction Transmission And Head‐Shadow Effects For Unilateral Hearing Losses Fit With Transcranial Cic Hearing Aids, Marc A. Fagelson, Colleen Noe, Jennifer Blevins, Owen Murnane
Bone Conduction Transmission And Head‐Shadow Effects For Unilateral Hearing Losses Fit With Transcranial Cic Hearing Aids, Marc A. Fagelson, Colleen Noe, Jennifer Blevins, Owen Murnane
Owen D. Murnane
Bone conduction transmission and head‐shadow effects were determined with transcranial completely‐in‐the‐canal (TCCIC) CROS hearing aids. Five subjects with documented profound unilateral hearing loss and experience with traditional CROS/BICROS fittings (TCROS) were tested with a CIC hearing aid placed in their poorer ear. Peak SPL was measured at the tympanic membrane and ranged from 105–115 dB SPL at 2000 Hz. Pure‐tone crossover thresholds and functional gain tested at frequencies from 250–8000 Hz varied considerably more than the SPL measures. The pure‐tone results indicated that sensitivity in the better ear was moderately associated with functional gain across frequency. Speech recognition was then …
Gap Discrimination And Speech Perception In Noise, Marc A. Fagelson
Gap Discrimination And Speech Perception In Noise, Marc A. Fagelson
Marc A. Fagelson
The relation between discrimination of silent gaps and speech‐in‐noise perception was measured in 20 normal‐hearing listeners using speech‐shaped noise as both the gap markers and the noise source for speech testing. In the gap discrimination experiment, subjects compared silent gaps marked by 60 dB SPL 250‐ms noise bursts to standards of either 5, 10, 20, 50, 100, or 200 ms. The gap results were most similar to those reported by Abel [S. M. Abel, J. Acoust. Soc. Am. 52, 519–524 (1972)] as ΔT/T decreased non‐monotonically with increased gap length. In a second experiment, the California Consonant Test (CCT) was administered …
Physician-Pharmacist Communication: Quotes, Quandaries And Quality, Nicholas E. Hagemeier
Physician-Pharmacist Communication: Quotes, Quandaries And Quality, Nicholas E. Hagemeier
Nicholas E. Hagemeier
No abstract provided.