Effectiveness of Fluconazole Prophylaxis in a Targeted High-Risk Group in a Surgical Intensive Care Unit.

Candidemia is an important nosocomial infection in intensive care units (ICUs), with total parenteral nutrition (TPN) a well-recognized risk factor. Antifungal prophylaxis may be an effective intervention to prevent candidemia in high-risk patients. In this report, the effectiveness of fluconazole prophylaxis was examined in patients located in a combined surgical-neurosurgical ICU serving an urban Level 1 trauma center who were receiving prolonged courses of TPN.

Critical Care And Emergency Department Response At The Epicenter Of The COVID-19 Pandemic.

New York City has emerged as the global epicenter for the coronavirus disease 2019 (COVID-19) pandemic. The city's public health system, New York City Health + Hospitals, has been key to the city's response because its vulnerable patient population is disproportionately affected by the disease. As the number of cases rose in the city, NYC Health + Hospitals carried out plans to greatly expand critical care capacity.

Staffing Up For The Surge: Expanding The New York City Public Hospital Workforce During The COVID-19 Pandemic.

Confronted with the coronavirus disease 2019 (COVID-19) pandemic, New York City Health + Hospitals, the city's public health care system, rapidly expanded capacity across its eleven acute care hospitals and three new field hospitals. To meet the unprecedented demand for patient care, NYC Health + Hospitals redeployed staff to the areas of greatest need and redesigned recruiting, onboarding, and training processes. The hospital system engaged private staffing agencies, partnered with the Department of Defense, and recruited volunteers throughout the country.

Challenge of uncontrolled enteroatmospheric fistulas.

Introduction: With the popularization of damage control surgery and the use of the open abdomen, a new permutation of fistula arose; the enteroatmospheric fistula (EAF), an opening of exposed intestine spilling uncontrollably into the peritoneal cavity. EAF is the most devastating complication of the open abdomen. We describe and analyze a single institution's experience in controlling high-output EAFs in patients with peritonitis.

Correlation of Venous Lactate and Time of Death in Emergency Department Patients with Noncritical Lactate Levels and Mortality from Trauma.

Background: Serum venous lactate (LAC) levels help guide emergency department (ED) resuscitation of patients with major trauma. Critical LAC level (CLAC, ≥4.0 mmol/L) is associated with increased disease severity and higher mortality in injured patients.

Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis.

Background: Penetrating Extremity Trauma (PET) may result in arterial injury, a rare but limb- and life-threatening surgical emergency. Timely, accurate diagnosis is essential for potential intervention in order to prevent significant morbidity.

Objectives: Using a systematic review/meta-analytic approach, we determined the utility of physical examination, Ankle-Brachial Index (ABI), and Ultrasonography (US) in the diagnosis of arterial injury in emergency department (ED) patients who have sustained PET.

Arterial embolization of retained kidney remnant following blunt traumatic injury: A case report.

Introduction: There has been a recent trend toward nonoperative management of solid organ injuries with arteriography and embolization as alternatives to surgical exploration. We examine the use of arterial embolization in the management of a post-subtotal nephrectomy urinoma in a patient with severe renal injury secondary to blunt trauma.

Methods: This case report has been reported in line with the CARE criteria [13].

Retrograde intussusception seven years after a laparoscopic Roux-en-Y gastric bypass.

Intussusception after Roux-en-Y gastric bypass is more common than previously believed. It usually occurs between one and three years post-operatively, though we present a case that presented with a retrograde intussusception necessitating bowel resection seven years after a laparoscpic Roux-en-Y gastric bypass. The diagnosis and etiological theories are discussed based on findings from the literature.

Health disparity in complicated colorectal cancer.

The purpose of this study was to assess for disparity within a cohort of patients presenting with complicated colorectal cancer. A retrospective study of 522 patients who underwent surgery for colorectal cancer at a tertiary care institution was performed. Complicated cancer was defined by perforating or obstructing colonic lesions.

Evolution of the surgeon-volume, patient-outcome relationship.

Objective: Higher surgeon volume is associated with improved patient outcomes. This finding has prompted recommendations for increasing specialization and referrals to high-volume surgeons, yet their implementation in clinical practice has not been measured.

Methods: We performed cross-sectional analyses using 1999 and 2005 discharge information from the Health Care Utilization Project National Inpatient Sample to measure whether the number of procedures performed by high-volume surgeons increased over time.

Pediatric endocrine surgery: who is operating on our children?

Background: High surgeon volume is associated with improved outcomes in adult endocrine surgery. This is the first population-based outcomes study for thyroidectomy/parathyroidectomy in children.

Methods: Cross-sectional analyses were performed using 1999 to 2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data.

Clinical and economic outcomes of thyroid and parathyroid surgery in children.

Context: Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes.

Objective: The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy.

Design: This study is a cross-sectional analysis of Healthcare Cost and Utilization Project-National Inpatient Sample hospital discharge information from 1999-2005.

A population-based study of outcomes from thyroidectomy in aging Americans: at what cost?

Background: We wanted to evaluate clinical and economic outcomes after thyroidectomy in patients 65 years of age and older, with special analyses of those aged 80 years and older, in the US.

Study Design: This was a population-based study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2003-2004, a national administrative database of all patients undergoing thyroidectomy and their surgeon providers. Independent variables included patient demographic and clinical characteristics and surgeon descriptors, including case volume.

The maturation of a specialty: Workforce projections for endocrine surgery.

Background: There has been an increase in the incidence of endocrine diseases and the number of endocrine procedures in the United States. Higher surgeon volume is associated with improved patient outcomes. Fellowship programs will lead to more specialty-trained endocrine surgeons.

Health services research in endocrine surgery.

Purpose Of Review: We review recent health services research studies examining clinical and economic outcomes in endocrine surgery.

Recent Findings: Recent studies have focused on such important issues as the use of the Internet in medicine, patient quality of life, cost-effectiveness of emerging surgical technologies, and labor-force modeling. There is a need for accurate and informative websites dedicated to thyroid disease, given the large number of patients who use the Internet for healthcare information.

Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism.

Background: Clinical guidelines for the treatment of primary hyperparathyroidism (pHPT) often suggest parathyroidectomy, but generally fail to consider neurocognitive and psychiatric symptoms because of the relative paucity of evidence.

Methods: In this prospective study, patients with pHPT (PTX) and benign euthyroid thyroid disease (THY) referred for operation were evaluated pre- and postoperatively with validated psychometric and neurocognitive instruments to determine whether learning, memory, or concentration improved with after parathyroidectomy. Statistical comparisons between groups were performed with univariate analysis and repeated measures of analysis of variance.