Provider education decreases opioid prescribing after pediatric umbilical hernia repair.

Purpose: To improve opioid stewardship for umbilical hernia repair in children.

Methods: An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed.

A multi-centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery.

Aim: Transanal endoscopic microsurgery (TEM) is a technically challenging strategy that allows expanded indications for local excision of rectal lesions. Transluminal suturing is difficult, so open management of the resultant defect is appealing. Expert opinion suggests there is more pain when the defect is left open.

Fixation Effects on Variant Calling in a Clinical Resequencing Panel.

Formalin fixation is the standard method for the preservation of tissue for diagnostic purposes, including pathologic review and molecular assays. However, this method is known to cause artifacts that can affect the accuracy of molecular genetic test results. We assessed the applicability of alternative fixatives to determine whether these perform significantly better on next-generation sequencing assays, and whether adequate morphology is retained for primary diagnosis, in a prospective study using a clinical-grade, laboratory-developed targeted resequencing assay.

Pancreatic islet cell tumors in adolescents and young adults.

Background: Pancreatic islet cell tumors are rare in adolescents, and most studies published to date focus on older patients. We utilized a national database to describe the histology and clinical pattern of pancreatic islet cell tumors in adolescent and young adult (AYA) patients, and to compare AYAs to older adults. We hypothesized that AYAs with pancreatic islet cell tumors would have better overall survival.

Decreased opioid prescribing in children using an enhanced recovery protocol.

Background: A previously implemented Enhanced Recovery Protocol (ERP) for children undergoing elective gastrointestinal operations demonstrated decreased length of stay (LOS) and in-hospital opioid use. We hypothesized that the ERP would be associated with decreased postdischarge opioid prescribing.

Methods: Demographic, operative, and opioid prescription data were retrospectively compared between elective gastrointestinal surgical patients in the pre-ERP (1/2012-12/2014) and the post-ERP periods (1/2015-12/2017).

Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia: A multi-institutional retrospective cohort study.

Introduction: Biliary dyskinesia (BD) is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial.

Methods: We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes.

Pediatric gastric adenocarcinoma: A National Cancer Data Base review.

Purpose: We sought to compare the presentation, management, and outcomes in gastric adenocarcinoma cancer for pediatric and adult patients.

Methods: Using the 2004 to 2014 National Cancer Database (NCDB), patients ≤21 years (pediatric) were retrospectively compared to >21 years (adult). Chi-squared tests were used to compare categorical variables, and Cox regression was used to estimate hazard ratios (HR) for survival differences.

Spontaneous Subdural Hematoma in Patient with Polycythemia Vera.

Background: Polycythemia vera (PV) is a myeloproliferative disorder usually characterized by an increase tendency toward thromboembolic events. Spontaneous hemorrhage/bleeding in PV patients is seldom reported in neurosurgical literature.

Case Description: We report the case of a 76-year-old male with PV who developed a spontaneous subdural hematoma requiring surgical evacuation.

Assessing the safety and outcomes of repeat transanal endoscopic microsurgery.

Background: Transanal endoscopic microsurgery (TEM) is the treatment of choice for benign rectal tumors and select early rectal cancers. This surgical approach has become ubiquitous and surgeons are seeing recurrent lesions after TEM resection. This study aims to outline the safety and outcomes of repeat TEM when compared to primary TEM procedures.

Implementation of an enhanced recovery program in pediatric laparoscopic colorectal patients does not worsen analgesia despite reduced perioperative opioids: a retrospective, matched, non-inferiority study.

Background And Objectives: Enhanced recovery protocols (ERPs) decrease length of stay and postoperative morbidity, but it is important that these benefits do not come at a cost of sacrificing proper perioperative analgesia. In this retrospective, matched cohort study, we evaluated postoperative pain intensity in pediatric patients who underwent laparoscopic colorectal surgeries before and after ERP implementation.

Methods: Patients in each cohort were randomly matched based on age, diagnosis, American Society of Anesthesiologists classification, and surgical procedure.

Development and Validation of Stability Indicating High-Performance Thin-Layer Chromatographic (HPTLC) Method for Quantification of Asiaticoside from L. and its Marketed Formulation.

Ayurvedic medicines help in healing disease with fewer undesirable effects in comparison with an allopathic system of medicine to treat central nervous system (CNS) disorders, as the latter is more expensive. L. is often used in Ayurvedic formulations for the treatment of CNS disorders.

Creation of an Enhanced Recovery After Surgery (ERAS) Guideline for neonatal intestinal surgery patients: a knowledge synthesis and consensus generation approach and protocol study.

Introduction: Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence.

Pediatric Surgical Risk Assessment Tools: A Systematic Review.

Background: Pediatric surgical risk assessment tools use patient- and procedure-specific variables to predict postoperative complications. These tools assist clinicians in preoperative counseling and surgical decision-making. The objective of this systematic literature review was to compile and compare existing pediatric surgical risk tools that are broadly applicable across pediatric surgical specialties.

Process improvement strategies: Designing and implementing quality improvement research.

Quality improvement (QI) is the practice of continuously evaluating and improving the quality of health care that is delivered to patients. In this article, we will use practical examples to show how quality improvement projects have improved surgical patient care, and can be shared between institutions to accelerate the pace of improvement. We will explain the differences between quality improvement and research, and describe the methodological approach to performing and reporting quality improvement projects.

Research using clinical registries in children's surgical care.

Clinical registries provide a valuable opportunity to study specific diagnoses or conditions with a broader scope than possible using individual center-based series and with more clinical detail than typically available in administrative data sources. These registries amass structured data with uniform definitions, thus facilitating reliable adoption and consistent use across contributing sites. By compiling granular data from a multitude of geographically diverse sites, clinical registries allow investigation of rare outcomes, comparison of practice and cost variation, and benchmarking across institutions.

Pediatric Inpatient-Status Volume and Cost at Children's and Nonchildren's Hospitals in the United States: 2000-2009.

Objectives: The evolving role of children's hospitals (CHs) in the setting of rising health care costs has not been fully explored. We compared pediatric inpatient discharge volumes and costs by hospital type and examined the impact of care complexity and hospital-level factors on costs.

Methods: A retrospective, cross-sectional study of care between 2000 and 2009 was performed by using the Kids' Inpatient Database.

Importance of Compliance Audits for a Pediatric Complicated Appendicitis Clinical Practice Guideline.

Clinical practice guidelines (CPG) have been shown to decrease practice variation, reduce resource use, and improve patient outcomes. The purpose of this study was to audit compliance of a pediatric complicated appendicitis CPG to identify areas for continued improvement. A comprehensive complicated appendicitis CPG was implemented in a children's hospital system.

Implementing a surgeon-reported categorization of pediatric appendicitis severity.

Purpose: The purpose of this study was to implement a novel surgeon-reported categorization (SRC) for pediatric appendicitis severity and determine if SRC was associated with outcomes.

Methods: We conducted a retrospective review of appendectomies by 15 surgeons within a single center from January to December 2016. The SRC was defined as: simple (category 1), gangrenous or adherent (category 2A), perforation with localized abscess (category 2B), and perforation with gross contamination (category 2C).

Parent Perspectives on Readiness for Discharge Home after Neonatal Intensive Care Unit Admission.

Objective: To explore the parent perspective on discharge home from the neonatal intensive care unit (NICU).

Study Design: We interviewed parents of NICU graduates with a range of demographic characteristics and medical complexities to explore parent perspectives on readiness for discharge. Interviews were transcribed and coded by a 6-member team.

Attitudes and Beliefs of Pediatric Surgical Specialists on Costs of Care and High Deductible Health Plans.

Health care consumers are burdened with rising out-of-pocket medical expenses. Surgical specialists' experience and attitude towards patients' out-of-pocket costs and the influence of these factors on healthcare utilization are unknown. Our aim was to define the pediatric surgeons' experience with the financial concerns of their patients.

Interventions for Postsurgical Opioid Prescribing: A Systematic Review.

Importance: Over the past 20 years, opioid misuse and opioid addiction have risen to epidemic proportions in the United States. One-third of adults receiving long-term opioid therapy report that their first opioid prescription came from a surgeon, indicating that postsurgical prescribing is an important point of intervention in the opioid epidemic. Such interventions differ from historical interventions on prescribing in that they must be closely monitored to ensure pain continues to be adequately controlled after surgical procedures.

Transmissive silicon photonic dichroic filters with spectrally selective waveguides.

Many optical systems require broadband filters with sharp roll-offs for efficiently splitting or combining light across wide spectra. While free space dichroic filters can provide broadband selectivity, on-chip integration of these high-performance filters is crucial for the scalability of photonic applications in multi-octave interferometry, spectroscopy, and wideband wavelength-division multiplexing. Here we present the theory, design, and experimental characterization of integrated, transmissive, 1 × 2 port dichroic filters using spectrally selective waveguides.

Integrated visible light phased array system for autostereoscopic image projection.

We demonstrate a chip-scale autostereoscopic image projection system that utilizes a system of multiple integrated visible light optical phased arrays to reconstruct virtual light fields. Each phased array in this system serves as a micro-projector that illuminates the desired virtual object from a different angle. This recreates the virtual object in space with continuous parallax observable by the human visual system.

Peritoneal perforation during transanal endoscopic microsurgery is not associated with significant short-term complications.

Background: In patients treated by transanal endoscopic microsurgery (TEM), breach of the peritoneal cavity is a feared intraoperative challenge. Our aim is to analyze predictors and short-term outcomes of patients with peritoneal perforation (TEM-P) when compared to similar patients with no peritoneal compromise (TEM-N).

Methods: At St.