What is the best method of rectovaginal fistula repair? A 25-year single-center experience.

Background: The surgical treatment of rectovaginal fistula (RVF) remains challenging and there is a lack of data to demonstrate the best, single procedure. The aim of this study was to assess the results of different surgical operations for rectovaginal fistula.

Methods: Patients with RVF who underwent surgical repair between 1992 and 2017 at a single, tertiary care center were included.

TB or not TB? Challenges in diagnosing and treating maternal and neonatal tuberculosis.

We present the case of a pregnant woman who died from disseminated tuberculosis (TB), and the difficulties encountered in diagnosing TB disease in her newborn. We discuss the burden of maternal and neonatal TB and the need for a different approach, one that is not solely based on bacteriologic evidence which, in most cases, tends to be inconclusive. We also explore the difficulties physicians and national TB programs face in managing and developing effective policies for these two highly vulnerable and neglected populations.

The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line-Associated Bloodstream Infection Risk-Adjustment Methodology.

BACKGROUND Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation.

Electronically Available Comorbidities Should Be Used in Surgical Site Infection Risk Adjustment.

Background: Healthcare-associated infections such as surgical site infections (SSIs) are used by the Centers for Medicare and Medicaid Services (CMS) as pay-for-performance metrics. Risk adjustment allows a fairer comparison of SSI rates across hospitals. Until 2016, Centers for Disease Control and Prevention (CDC) risk adjustment models for pay-for-performance SSI did not adjust for patient comorbidities.

National treatment trends among older patients with T1-localized renal cell carcinoma.

Objective: To assess the national trends in treatment of localized renal tumors among older patients with limited life expectancy.

Materials And Methods: Using the National Cancer Database, we identified older patients (≥70y) diagnosed with T1 renal cell carcinoma from 2002 to 2011. Primary outcome was the initial treatment-partial nephrectomy (PN), radical nephrectomy, EM, and ablation.

Interrater Reliability of Surveillance for Ventilator-Associated Events and Pneumonia.

OBJECTIVE To compare interrater reliabilities for ventilator-associated event (VAE) surveillance, traditional ventilator-associated pneumonia (VAP) surveillance, and clinical diagnosis of VAP by intensivists. DESIGN A retrospective study nested within a prospective multicenter quality improvement study. SETTING Intensive care units (ICUs) within 5 hospitals of the Centers for Disease Control and Prevention Epicenters.

A Unique Case of Bilateral Microphthalmia That May Be Related to 14q32.33.

A 2-day-old Hispanic boy was transferred to us with concerns of a small left eye. The pregnancy was uncomplicated, and both parents are healthy. Examination showed a left orbit that appeared to be empty with conjunctival tissue.