Placenta previa percreta with surrounding organ involvement: a proposal for management.

Placenta accreta spectrum encompasses cases where the placenta is morbidly adherent to the myometrium. Placenta percreta, the most severe form of placenta accreta spectrum (grade 3E), occurs when the placenta invades through the myometrium and possibly into surrounding structures next to the uterine corpus. Maternal morbidity of placenta percreta is high, including severe maternal morbidity in 82.

Association of Pre-Operative Full-Body Surgical Preparation with Reduced Incidence of Surgical Site Infection at a Large, Urban Safety-Net Medical Center.

Surgical site infections (SSIs) continue to represent a substantial source of morbidity, mortality, and healthcare costs. The purpose of this study was to determine the effect of implementing a protocol using home pre-operative surgical preparation on the SSI rate at a large, urban safety-net medical center. From July through December 2020, Nose-to-Toes (N2T; Sage Products-Stryker Corporation, Cary, IL) full-body preparation was applied by patients at home on the morning of scheduled surgical procedures.

SARS-CoV-2-related outcomes after surgical procedures on SARS-CoV-2-positive patients in a large, urban, safety net medical center.

Background: Beginning on March 16, 2020, nonurgent scheduled operations at a large, urban, safety net medical center were canceled. The purpose of this study was to determine complications associated with severe acute respiratory syndrome coronavirus 2 infection for all operations done from March 16 to June 30, 2020.

Study Design: This study was a single-institution, retrospective observational analysis of data for all surgical procedures and all severe acute respiratory syndrome coronavirus 2 tests done in the medical center from March 16 to June 30, 2020.

Trends, characteristics, and outcomes of placenta accreta spectrum: a national study in the United States.

Background: Although an infrequent occurrence, the placenta can adhere abnormally to the gravid uterus leading to significantly high maternal morbidity and mortality during cesarean delivery. Contemporary national statistics related to a morbidly adherent placenta, referred to as placenta accreta spectrum, are needed.

Objective: This study aimed to examine national trends, characteristics, and perioperative outcomes of women who underwent cesarean delivery for placenta accreta spectrum in the United States.

Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery at a Safety-Net Health System.

Importance: Preoperative testing for cataract surgery epitomizes low-value care and still occurs frequently, even at one of the nation's largest safety-net health systems.

Objective: To evaluate a multipronged intervention to reduce low-value preoperative care for patients undergoing cataract surgery and analyze costs from various fiscal perspectives.

Design, Setting, And Participants: This study took place at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor-UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511).

Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center.

Background: Delays in first cases contribute to multiple operating room (OR) inefficiencies and decreases in OR productivity.

Methods: Lean process improvement methods were used to redesign the existing workflow for elective first cases of the day in a large, urban, public hospital. First case start times were prospectively recorded from May 2, 2016 through December 29, 2017.

Impact of the Standardized Surgical Checklist on Communication and Teamwork Among Interdisciplinary Surgical Team Members.

Traditional timeouts done ineffectively before surgical procedures can result in late blood product requests, inadequate preparation of needed intraoperative apparatus, improper administration of required antibiotics, and operating room (OR) time delays. This clinical concern is important to address because based on current evidence, implementing a Standardized Surgical Checklist (SSC) during timeout can impact patient safety by reducing complications following surgery and can promote good communication and teamwork among the care team. This quality improvement project is aimed to develop, implement, and evaluate the impact of SSC on communication and teamwork among an interdisciplinary surgical care team at Los Angeles County and University of Southern California Medical Center (LAC + USC).

Enhanced polyhydroxyalkanoate production from organic wastes via process control.

This work explores the use of a model-based control scheme to enhance the productivity of polyhroxyalkanoate (PHA) production in a mixed culture two-stage system fed with synthetic wastewater. The controller supplies pulses of substrate while regulating the dissolved oxygen (DO) concentration and uses the data to fit a dynamic mathematical model, which in turn is used to predict the time until the next pulse addition. Experiments in a bench scale system first determined the optimal DO set-point and initial substrate concentration.