Characteristics of High-Quality Multi-Hospital Health Systems Performing Major Cancer Surgery.

Objective: To identify characteristics associated with high- and low-quality multi-hospital systems for major cancer surgery.

Background: Although multi-hospital health systems provide most inpatient healthcare in the US, our understanding of how these systems can optimize surgical quality among their hospitals remains limited. Identifying the structural characteristics (e.

A Retrospective Analysis of Characteristics Favouring In-Hospital Resuscitation Plan Completion, Their Timing, and Associated Outcomes.

Comprehensive resuscitation plans document treatment recommendations, such as 'Not for cardiopulmonary resuscitation'. When created early in admission as a shared decision-making process, these plans support patient autonomy and guide future treatment. The characteristics of patients who have resuscitation plans documented, their timing, and associations with clinical outcomes remain unclear.

Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction.

Objective: To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes.

Background: mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible.

Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage Areas, 2015-19.

Primary care physicians are often the first to screen and identify patients with access-sensitive surgical conditions that should be treated electively. These conditions require surgery that is preferably planned (elective), but, when access is limited, treatment may be delayed and worsening symptoms lead to emergency surgery (for example, colectomy for cancer, abdominal aortic aneurysm repair, and incisional hernia repair). We evaluated the rates of elective versus emergency surgery for patients with three access-sensitive surgical conditions living in primary care Health Professional Shortage Areas during 2015-19.

Health Insurance Status and Unplanned Surgery for Access-Sensitive Surgical Conditions.

Importance: Access-sensitive surgical conditions, such as abdominal aortic aneurysm, ventral hernia, and colon cancer, are ideally treated with elective surgery, but when left untreated have a natural history requiring an unplanned operation. Patients' health insurance status may be a barrier to receiving timely elective care, which may be associated with higher rates of unplanned surgery and worse outcomes.

Objective: To evaluate the association between patients' insurance status and rates of unplanned surgery for these 3 access-sensitive surgical conditions and postoperative outcomes.

Low-Volume Elective Surgery and Outcomes in Medicare Beneficiaries Treated at Hospital Networks.

Importance: Minimum volume standards have been advocated as a strategy to improve outcomes for certain surgical procedures. Hospital networks could avoid low-volume surgery by consolidating cases within network hospitals that meet volume standards, thus optimizing outcomes while retaining cases and revenue. The rates of compliance with volume standards among hospital networks and the association of volume standards with outcomes at these hospitals remain unknown.

Large intraperitoneal lipoleiomyoma in a pre-menopausal woman: a case report.

Background: Lipoleiomyoma is a rare, benign variant of the commonplace uterine leiomyoma. Unlike leiomyoma, these tumors are composed of smooth muscle cells admixed with mature adipose tissue. While rare, they are most frequently identified in the uterus, but even more infrequently have been described in extrauterine locations.

Synthesis of the C-C fragment of the archazolids by complex -homodimer cross metathesis.

A synthesis of the C-C fragment of the archazolids is described featuring a complex cross-metathesis coupling reaction between a -homodimer (prepared by silyl-tethered ring-closing metathesis) and the -terminal triene containing "eastern domain" of the archazolid natural products. This cross-metathesis was only successful when using the - as opposed to the monomer or -homodimer, with the -dimer added batchwise to minimize -isomerization. The product was obtained in an optimized 78% yield using the Hoveyda-Grubbs catalyst at 50 °C in toluene.

Exploring a Ring-Closing Metathesis Approach to the Archazolid Macrocycle.

The synthesis of a new "eastern domain" of a proposed dihydroarchazolid analogue is described along with initial results from attempted macrocyclization by RCM. This work has revealed a competing backbiting process that may be preventable by alcohol functionalization and installation of a metathesis relay.