Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer.

This study examines the utility of excising facial nonmelanoma skin cancer in very elderly patients.

Comparison of Neurologic Trauma and Motorcycle Helmet Use in Drivers vs Passengers.

This study compares postcrash prevalences of neurological and head and neck injuries in motorcycle drivers and passengers, stratified by helmet use.

Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

Objectives: To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing.

Methods: The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team.

Results: Since implementing the LES, total test volume has decreased by a mean of 11.

Using Facilitative Coaching to Support Patient Aligned Care Teams.

Despite the challenges of implementing facilitative coaching, the Richard L. Roudebush VAMC staff succeeded in translating primary care medical home theory into process.

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

Importance: In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.

Clinical practice guideline: red blood cell transfusion in adult trauma and critical care.

Objective: To develop a clinical practice guideline for red blood cell transfusion in adult trauma and critical care.

Design: Meetings, teleconferences and electronic-based communication to achieve grading of the published evidence, discussion and consensus among the entire committee members.

Methods: This practice management guideline was developed by a joint taskforce of EAST (Eastern Association for Surgery of Trauma) and the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM).

Biloma: a delayed complication of blunt hepatic injury.

We present the case of a patient who sustained blunt liver trauma after a motor vehicle crash that was subsequently complicated by the development of a large biloma. Early use of computed tomography (CT) scan and HIDA (hepatobiliary iminodiacetic acid) imaging enabled the prompt identification and management of the problem.

Isolated jejunal perforation after blunt thoracoabdominal trauma.

A case report of isolated jejunal perforation secondary to a relatively unique mechanism of blunt thoracoabdominal trauma is presented. A thorough and concise review of the multimodal approach that may be necessary to diagnose such a rare clinical problem is discussed.

Best practice recommendations for surgical care in weight loss surgery.

Objective: To establish evidence-based guidelines for best practices for surgical care in weight loss surgery (WLS).

Research Methods And Procedures: We carried out a systematic search of English-language literature on WLS in MEDLINE and the Cochrane Library. Key words were used to narrow the field for a selective review of abstracts.

Profile of chest trauma in a level I trauma center.

Background: Chest injuries are seen with increasing frequency in urban hospitals. The profile of chest injuries depends on the size of the hospital and the level of trauma center. The data regarding the true incidence of chest trauma are scant.

An exploratory study using data envelopment analysis to assess neurotrauma patients in the intensive care unit.

Patients with severe head trauma were studied retrospectively to determine if Data Envelopment Analysis (DEA) could successfully model patients early in their stay in an intensive care unit. Variables examined were cerebral perfusion pressure, body temperature, mean arterial pressure, serum osmolarity and pCO2. Unlike regression-based models that focus on mean values for the group, DEA evaluates each patient individually calculating an "efficiency" score based on a patient's ability to maximize output for a given set of physiologic inputs.