Optimizing Survival of Patients With Marginally Operable Stage IIIA Non-Small-Cell Lung Cancer Receiving Chemoradiotherapy With or Without Surgery.

Background: For marginally operable stage IIIA non-small-cell lung cancer (NSCLC), surgery might not be done as planned after neoadjuvant concurrent chemoradiotherapy (CCRT) for reasons (unresectable or medically inoperable conditions, or patient refusal). This study aims to investigate the outcomes of a phased CCRT protocol established to maximize the operability of marginally operable stage IIIA NSCLC and to care for reassessed inoperable patients, in comparison with continuous-course definitive CCRT.

Materials And Methods: Forty-seven patients with marginally operable stage IIIA NSCLC receiving CCRT were included.

Surgery Clerkship Evaluations Are Insufficient for Clinical Skills Appraisal: The Value of a Medical Student Surgical Objective Structured Clinical Examination.

Objective: Optimal methods for medical student assessment in surgery remain elusive. Faculty- and housestaff-written evaluations constitute the chief means of student assessment in medical education. However, numerous studies show that this approach has poor specificity and a high degree of subjectivity.

Creation of the first Hartford Consensus compliant elementary school in the USA.

Background: The Hartford Consensus established a framework for minimizing deaths due to mass shootings, specifically eliminating preventable deaths due to limb exsanguination. Two major principles defined within this framework are (1) redefining the first responder role and (2) the ubiquitous availability of proper training in application of hemorrhage control techniques, including tourniquets. We hypothesized that this hemorrhage control posture could be fully translated into an elementary school.

Hypophosphatemia in Enterally Fed Patients in the Surgical Intensive Care Unit.

Introduction: Hypophosphatemia has been associated with refeeding malnourished patients, but its clinical significance is unclear. We investigated the incidence of refeeding hypophosphatemia (RH) in the surgical intensive care unit (SICU) and its association with early enteral nutrition (EN) administration and clinical outcomes.

Methods: We performed a retrospective review of a 2-year database of patients receiving EN in the SICU.

"One-way-street" streamlined admission of critically ill trauma patients reduces emergency department length of stay.

Emergency department (ED) overcrowding remains a significant problem in many hospitals, and results in multiple negative effects on patient care outcomes and operational metrics. We sought to test whether implementing a quality improvement project could decrease ED LOS for trauma patients requiring an ICU admission from the ED, specifically by directly admitting critically ill trauma patients from the ED CT scanner to an ICU bed. This was a retrospective study comparing patients during the intervention period (2013-2014) to historical controls (2011-2013).

The impact of major intraoperative adverse events on hospital readmissions.

Background: Hospital-wide readmission rates recently became a recognized benchmarking quality metric. We sought to study the independent impact of major intraoperative adverse events (iAEs) on 30-day readmission in abdominal surgery.

Methods: The 2007 to 2012 institutional American College of Surgeons National Surgical Quality Improvement Program and administrative databases for abdominal operations were matched then screened for iAEs using the International Classification of Diseases, 9th Revision, Clinical Modification-based Patient Safety Indicator "Accidental Puncture/Laceration".

The Association of Age With Short-Term and Long-Term Mortality in Adults Admitted to the Intensive Care Unit.

Background: Based on the current literature, it is unclear whether advanced age itself leads to higher mortality in critically ill patients or whether it is due to the greater number of comorbidities in the elderly patients. We hypothesized that increasing age would increase the odds of short-term and long-term mortality after adjusting for baseline comorbidities in intensive care unit (ICU) patients.

Methods: We performed a retrospective cohort study of 57 160 adults admitted to any ICU over 5 years at 2 academic tertiary care centers.

Clinical Outcomes of Inadequate Calorie Delivery and Protein Deficit in Surgical Intensive Care Patients.

Background: Adequate nutritional therapy in critically ill patients is integral to optimal outcome.

Objective: To evaluate the association between cumulative macronutrient deficit and overall morbidity in surgical intensive care unit patients.

Methods: Adult patients receiving enteral nutrition for more than 72 hours were included if they had no previous admission to the surgical intensive care unit, had received no enteral feedings before admission, had no intestinal obstruction or ileus, and survived 72 hours or more after admission.

Daily vancomycin dose requirements as a continuous infusion in obese versus non-obese SICU patients.

Background: Limited data are available assessing vancomycin concentrations in obese critically ill patients. Currently, there are no studies evaluating dosing requirements in this population who receive vancomycin administered as a continuous infusion (CI). The aim of this study was to assess whether there was a difference in the weight-based maintenance dose required to reach a therapeutic vancomycin concentration at 24 hours when given as a CI in obese versus non-obese critically ill patients.

Outcome of patients receiving CPR in the ED of an urban academic hospital.

Background: The success of Closed Chest Cardiopulmonary Resuscitation (CC-CPR) degrades with prolonged times. Open Chest CPR (OC-CPR) is an alternative that may lead to superior coronary and cerebral perfusion. It is critical to determine when continued CC-CPR is unlikely to be successful to justify initiating OC-CPR as rescue therapy.

Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients.

Purpose: Recent evidence suggests that red cell distribution width (RDW) is associated with mortality in mixed cohorts of critically ill patients. Our goal was to investigate whether elevated RDW at initiation of critical care in the intensive care unit (ICU) is associated with 90-day mortality in surgical patients.

Methods: We performed a retrospective, single-center cohort study.

Optimizing quality of digital mammographic imaging using Taguchi analysis with an ACR accreditation phantom.

This work demonstrated the improvement of the visualization of lesions by modulating the factors of an X-ray mammography imaging system using Taguchi analysis. Optimal combinations of X-ray operating factors in each group of level combination were determined using the Taguchi method, in which all factors were organized into only 18 groups, yielding analytical results with the same confidence as if each factor had been examined independently. The 4 considered operating factors of the X-ray machine were (1) anode material (target), (2) kVp, (3) mAs and (4) field of view (FOV).

Elevated Red Cell Distribution Width Is Associated With Decreased Ventilator-Free Days in Critically Ill Patients.

Introduction: Elevated red cell distribution width (RDW) is associated with mortality in a variety of respiratory conditions. Recent data also suggest that RDW is associated with mortality in intensive care unit (ICU) patients. Although respiratory failure is common in the ICU, the relationship between RDW and pulmonary outcomes in the ICU has not been previously explored.

Low baseline (pre-injury) blood pressure predicts inpatient mortality in elderly trauma patients: A bi-institutional study.

Objective: The relationship between baseline (i.e., pre-injury) blood pressure and trauma outcomes in elderly patients is unknown.

Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

Background: Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology.

Metastatic mammary carcinoma to the orbit masquerading as maxillary sinusitis.

Introduction: We report on a case of isolated metastatic breast cancer to the medial rectus muscle. This entity is exceedingly rare.

Case: A 44-year-old female with a history of breast cancer presented with unilateral maxillary symptoms and was treated for sinusitis.

Risk of Stroke in Patients With Spontaneous Pneumothorax: A Nationwide, Population-Based Study.

The association between spontaneous pneumothorax (SP) and stroke has not been reported, and this study aimed to explore this association. We used the National Health Insurance Research Database for conducting a nationwide, population-based, retrospective cohort study of patients newly hospitalized for SP from 2000 to 2010. A total of 2541 patients with newly diagnosed SP were included and compared with patients without SP.

Cicatricial Fibromatosis Diagnosis after Suspected Local Recurrence at the Bronchial Stump Following Lobectomy for Lung Cancer.

A mass excision surrounding the bronchial stump was performed to exclude malignancy in a 42-year-old man who had undergone a right lower lobectomy for lung cancer. The mass was identified as a cicatricial fibroma. Cicatricial fibromatosis, which is desmoid fibromatosis that arises in a surgical scar, is a well-known clinical condition.

Derivation and validation of a novel Emergency Surgery Acuity Score (ESAS).

Background: There currently exists no preoperative risk stratification system for emergency surgery (ES). We sought to develop an Emergency Surgery Acuity Score (ESAS) that helps predict perioperative mortality in ES patients.

Methods: Using the 2011 American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database (derivation cohort), we identified all surgical procedures that were classified as "emergent.

Perioperative risk factors impact outcomes in emergency versus nonemergency surgery differently: Time to separate our national risk-adjustment models?

Background: Emergency surgery (ES) is acknowledged to be riskier than nonemergency surgery (NES). Yet, little is known about the relative impact of individual perioperative risk factors on 30-day outcomes in ES versus NES.

Methods: Using the 2011-2012 American College of Surgeons National Surgical Quality Improvement Program nationwide database, the 20 most common ES procedures were identified by Current Procedural Terminology code.

Breast Density Analysis with Automated Whole-Breast Ultrasound: Comparison with 3-D Magnetic Resonance Imaging.

In this study, a semi-automatic breast segmentation method was proposed on the basis of the rib shadow to extract breast regions from 3-D automated whole-breast ultrasound (ABUS) images. The density results were correlated with breast density values acquired with 3-D magnetic resonance imaging (MRI). MRI images of 46 breasts were collected from 23 women without a history of breast disease.