Long-term outcome in elderly patients after operation for traumatic intracranial hemorrhage.

Objective: This study examined outcomes in elderly TBI patients who underwent a cranial operation.

Methods: We identified TBI patients > or = 65 who underwent a cranial operation from January 1, 2004 to December 31, 2008. Data collected included: age, admission GCS, mechanism of injury, ISS, Head AIS, type of operation, hemorrhage acuity, time to operation, pre-hospital warfarin or clopidogrel, and in-hospital death.

Training mothers in infant cardiopulmonary resuscitation with an instructional DVD and manikin.

Context: Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly.

Objective: To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR.

Design: Quasi-experimental study with enrollment between January and December 2008.

Weight status and perception of colorectal cancer risk.

Background: Obesity increases the risk of many cancers including colorectal cancer (CRC).

Methods: This is secondary data analysis of the 2010 National Health Interview Survey data. A total of 9360 obese and overweight participants, aged 50 to 80 years, were analyzed according to their perception of their personal cancer risk.

Components of the metabolic syndrome differ between young and old adults in the US population.

Prevalence of the metabolic syndrome (MetS) is high in the United States and is associated with increased risk of cardiovascular disease and diabetes. The authors examined whether the prevalence of the MetS and its components differs across age groups. Data were analyzed from 4 National Health and Nutrition Examination Surveys between the years 1999 and 2006.

The relationship of peripheral arterial disease and metabolic syndrome prevalence in asymptomatic US adults 40 years and older: results from the National Health and Nutrition Examination Survey (1999-2004).

Peripheral arterial disease (PAD) is a subclinical marker of coronary artery disease and identifies asymptomatic individuals at high risk for cardiovascular disease (CVD) events. The metabolic syndrome (MetS) is a constellation of clinical factors that increases the risk of developing diabetes and CVD. The authors' objectives were to estimate the prevalence of MetS in patients with PAD and to determine the prevalence of PAD in the population of asymptomatic US adults 40 years and older with MetS.

Cardiopulmonary resuscitation prescription program: a pilot randomized comparator trial.

Background: The American Heart Association wants to increase the number of citizens who know how to perform cardiopulmonary resuscitation (CPR). It is unknown whether giving patients a prescription (Rx) to learn CPR is effective. We sought to determine if patients with, or at risk for, heart disease and their families were more likely to follow prescriptive advice to buy a CPR Anytime™ kit (American Heart Association, Dallas, TX) or to take a CPR class.

Gender disparity in emergency department non-ST elevation myocardial infarction management.

Background: Many studies have looked at differences between men and women with acute coronary syndrome. These studies demonstrate that women have worse outcomes, receive fewer invasive interventions, and experience delay in the initiation of established medical therapies.

Objective: Using innovative technology, we set out to unveil and resolve any gender disparities in the evaluation and treatment of patients presenting with a positive troponin while in the emergency department.

Delaware's inclusive trauma system: impact on mortality.

Background: The impact of implementing an inclusive state trauma system on injury-related mortality for patients with life-threatening injuries was assessed.

Methods: Using the state trauma registry, trauma patients evaluated in all of Delaware's acute care hospitals from 1998 to 2007 were identified. Patients were categorized by injury severity score (ISS) groups (1-9, 10-15, 16-24, and >24).

Plastic surgeon compliance with national safety initiatives: clinical outcomes and "never events".

Background: Venous thromboembolism and surgical-site infection have been identified as preventable complications that are addressed by the National Quality Forum and the Surgical Care Improvement Project. The authors examined compliance of faculty with venous thromboembolism and surgical-site infection prophylaxis and incidence of adverse outcomes in patients at risk.

Methods: The authors performed retrospective chart reviews on 243 patients who underwent abdominoplasty or panniculectomy from 2000 to 2007 and documented demographics and adverse outcomes.

Odontoid fractures in the elderly: should we operate?

Background: : Treatment of odontoid fractures remains controversial. There are conflicting data in the literature with regard to timing of operative fixation (OP), as well as whether OP should be performed. Within our own institution, treatment is variable depending largely on surgeon preference.

Hindfoot alignment valgus moment arm increases in adult flatfoot with Achilles tendon contracture.

Background: Adult acquired flatfoot is often associated with Achilles tendon contracture and may be associated with isolated spring ligament insufficiency without Achilles tendon contracture. We have studied the hypothesis that standing valgus hindfoot alignment moment arm is increased in adult acquired flatfoot with Achilles tendon contracture when compared to adult acquired flatfoot without Achilles tendon contracture.

Materials And Methods: The standing hindfoot alignment, standing lateral tibial-calcaneal angle, lateral talo-first metatarsal angle, lateral medial cuneiform arch height, and anteroposterior talonavicular coverage angle were measured in 22 patients with a clinical diagnosis of adult acquired flatfoot with one foot with clinical Achilles tendon contracture and one without that diagnosis.

Strokes after cardiac surgery and relationship to carotid stenosis.

Objective: To critically examine the role of significant carotid stenosis in the pathogenesis of postoperative stroke following cardiac operations.

Design: Retrospective cohort study.

Setting: Single tertiary care hospital.

Ask and act: Delaware physicians demonstrate the effectiveness of the American Academy of Family Physicians' initiative to promote tobacco cessation counseling.

The Ask and Act program of the American Academy of Family Physicians promotes family physician tobacco cessation counseling. Smoking and cessation counseling rates were obtained by cross-sectional analysis of electronic medical record data before and after initiation of the Ask and Act program in Delaware. Before the intervention, 24% of the patient population sampled were smokers and 70% of smokers had been counseled to quit smoking.

Robotic camera holder as good as expert camera holder: a randomized crossover trial.

Introduction: This study aimed to compare the impact of robotic camera holder (RCH) and human camera holder (HCH) on product quality and procedure effectiveness of a simulated laparoscopic procedure.

Methods: This was a prospective randomized crossover trial including voluntary surgical residents. Block randomization generated RCH-HCH or HCH-RCH sequence allocation.

Preinjury warfarin worsens outcome in elderly patients who fall from standing.

Introduction: Fall from standing (FFS) has become one of the most common mechanisms of injury for admission to the trauma center in the elderly population. Many of these patients present anticoagulated with warfarin. This two-center study was designed to examine the effects of preinjury warfarin use on outcome in the elderly.

Laparoscopic intracorporeal ileocolic resection for Crohn's disease: is it safe?

Purpose: The aim of this study was to assess the impact of laparoscopic ileocolic resection with intracorporeal vascular division and anastomosis on the outcome of patients with terminal ileal Crohn's disease.

Methods: Prospective data on patients undergoing laparoscopic ileocolic resection for Crohn's disease confined to terminal ileum and cecum with or without fistulas were reviewed. Exclusion criteria were frozen abdomen, recurrent Crohn's disease following resection, and perforated Crohn's disease.

Prevalence of peripheral artery disease varies significantly depending upon the method of calculating ankle brachial index.

Objective: Peripheral artery disease (PAD) identifies individuals at high risk for future cardiovascular disease (CVD) warranting aggressive risk reduction therapies. PAD can be diagnosed noninvasively by calculating the ankle brachial index (ABI), a ratio of ankle and arm blood pressures. We examined the existing various methods of calculating ABI and the resulting estimates of PAD prevalence.

Leg wound infections following greater saphenous vein harvesting: minimally invasive vein harvesting versus conventional vein harvesting.

Wound complications associated with long incisions used to harvest the greater saphenous vein are common and well documented. We compared leg wound infection rates, wound healing disturbances (WHDs), length of vein harvested, vein harvest time, and total surgical time between minimally invasive saphenous vein harvesting (MIVH) and conventional vein harvesting (CVH) techniques. This meta-analysis showed a significant reduction in wound infections in favor of the MIVH group (odds ratio = 0.

Complication rates after Hartmann's reversal: open vs. laparoscopic approach.

Purpose: This study was performed to compare open Hartmann's reversal to laparoscopic Hartmann's reversal with regard to complication, readmission, and reoperation rates.

Methods: Data of patients who underwent open Hartmann's reversal or laparoscopic Hartmann's reversal between 1998 and 2004 at two institutions were collected. End points were complications in the hospital or after discharge, readmission to the hospital, and reoperation within 6 months after initial surgery.

Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients.

Purpose: This study was designed to evaluate the impact of a standardized laparoscopic intracorporeal right colectomy on the short-term outcome of patients with neoplasia.

Methods: Consecutive patients with histologically proven right colon neoplasia underwent a standardized laparoscopic intracorporeal right colectomy with medial to lateral approach encompassing ten sequential steps: 1) ligation of ileocolic vessels, 2) identification of right ureter, 3) dissection along superior mesenteric vein, 4) division of omentum, 5) division of right branch of middle colic vessels, 6) transection of transverse colon, 7) mobilization of right colon, 8) transection of terminal ileum, 9) ileocolic anastomosis, 10) delivery of specimen. Values were medians (ranges).

MRSA infection in lower extremity wounds.

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequently isolated bacteria in wound cultures. MRSA has been linked to lengthened wound healing times, an increase in adverse postoperative outcomes, and mortality. This study investigated the incidence of MRSA in lower extremity wounds and examined outcomes associated with MRSA-infected wounds versus non-MRSA-infected wounds.

The Lowering of Vascular Atherosclerotic Risk (LOVAR) program: an approach to modifying cerebral, cardiac, and peripheral vascular disease.

More than 1 million US citizens die of cerebral, cardiac, and peripheral vascular disease (collectively, CVD) each year. Basic science and clinical outcome research aimed at reducing the burden of this illness is widespread, but the knowledge gleaned from controlled trials has not fully translated into everyday clinical practice and care of patients with CVD and their inherent risk factors. The Lowering of Vascular Atherosclerotic Risk (LOVAR) program was a 5-year observational study that evaluated the feasibility of a high-intensity multidisciplinary program of risk factor reduction in a population with known symptoms of CVD.

Appendicitis outcomes with increasing computed tomographic scanning.

Purpose: The purpose of the study was to examine appendicitis outcomes over time as computed tomographic (CT) scanning was incorporated into practice.

Basic Procedures: Using chart review, appendectomy cases from 1998 to 2004 were analyzed by year for CT scanning rate, delay in treatment, complications, negative appendectomies, and time to surgery. Delay in treatment was defined as discharge from the ED at first visit or more than 20 hours from examination until surgery.

The effect of preoperative clopidogrel on bleeding after coronary artery bypass surgery.

Introduction: Clopidogrel treatment is associated with a reduction in thrombotic complications in coronary stent placement, improved outcome after acute coronary syndromes, and decreased mortality in patients with coronary artery disease. The purpose of this study was to analyze the effect of preoperative clopidogrel exposure on bleeding complications, blood transfusions requirements, and reoperations in patients undergoing coronary artery bypass grafting (CABG).

Patients And Methods: This study included 320 patients from a single institution that underwent an isolated CABG who were discharged between July 2003 and June 2004.