Describing Sacrocolpopexy in Medical Literature: A Proposed Surgical Classification System.

Background: Sacrocolpopexy has become a favored treatment of pelvic organ prolapse due to its durability and efficacy. Sacrocolpopexy has not been standardized and there is no categorization scheme to facilitate communication or research efforts for the procedure. A systematic review was conducted to facilitate construction of a classification system for sacrocolpopexy based on extent of vaginal dissection described in the medical literature.

Renal Hilum Injury with Veress Needle.

Introduction: Since the advent of laparoscopy, the ideal first-port entry technique has not yet been determined. Use of the Veress needle at Palmer's point, although safe in practice under skilled physicians, is not without risk of complications.

Case Description: A female patient with prior abdominal surgeries underwent a laparoscopic surgery for a nonmalignant indication.

Comparison of Higher-Than-Standard to D-Dimer Driven Thromboprophylaxis in Hospitalized Patients With COVID-19.

Coronavirus disease 2019 is a global health threat often accompanied with coagulopathy. Despite use of thromboprophylaxis in this population, thrombotic event rates are high. This was a multicenter, retrospective cohort study comparing the safety and effectiveness of thromboprophylaxis strategies at 2 institutions in hospitalized patients with coronavirus disease 2019.

Risk Factors for Polypropylene Midurethral Sling Extrusion: A Case-Control Study.

Objective: To identify risk factors associated with surgical revision of midurethral sling (MUS) due to mesh extrusion.

Materiald And Methods: This is a case-control study identifying women who underwent primary surgical revision of polypropylene MUS for vaginal mesh extrusion from 2001 to 2016. Cases of surgical revision were compared to a randomly selected control group in a 1:5 ratio.

Frailty Is Associated With Early Hospital Readmission in Older Medical Patients.

Given the pervasiveness of frailty and its negative effects on health care-related outcomes, we evaluated patient frailty and comorbidity and determined the relationship between these measures and the probability of early readmission and length of hospital stay. Our retrospective analysis includes 435 patients evaluated using the Reported Edmonton Frailty Scale and the Age-Adjusted Charlson Comorbidity Index. We found that frailty as measured by the Reported Edmonton Frailty Scale was a significant predictor of hospital readmission and length of stay, and frailty outperformed the explanatory power of our comorbidity metric.

Robotic Repair of Supratrigonal Vesicovaginal Fistula with Sigmoid Epiploica Interposition.

Introduction And Hypothesis: In the United States, vesicovaginal fistula (VVF) most often results from gynecologic surgery causing significant morbidity and distress to both the patient and surgeon. The use of tissue interposition at time of primary repair has been advocated to decrease the risk of recurrence. The aim of this study is to describe our experience with interposition of sigmoid epiploica during robotic extravesical repair of supratrigonal VVF.

Retrospective Evaluation of Postoperative Adverse Drug Events in Patients Receiving Rivaroxaban After Major Orthopedic Surgery Compared with Standard Therapy in a Community Hospital.

Study Objectives: To evaluate the occurrence of bleeding and venous thromboembolic (VTE) events in patients receiving rivaroxaban, warfarin, or warfarin with the addition of enoxaparin during the immediate postoperative period following major orthopedic surgery.

Methods: Patients older than 18 years who received at least one dose of rivaroxaban the morning following surgery, adjusted dose warfarin, or adjusted dose warfarin with the addition of enoxaparin for VTE prophylaxis after major orthopedic surgery between October 1, 2011, and February 28, 2015, were included. Data collected from the electronic health record included patient demographics, renal function, inpatient aspirin, P2Y12 inhibitor and/or nonsteroidal antiinflammatory drug (NSAID) use, type of surgery, postoperative analgesia, and presence of VTE risk factors.

Parapharyngeal Schwannoma of the Mandibular Nerve Associated With Auditory Changes.

We present a case of a parapharyngeal schwannoma of the mandibular nerve with intraosseous extension into the mandible. The initial symptoms included decreased auditory acuity, with subsequent magnetic resonance imaging findings suggestive of Eustachian tube obstruction. This represents a rare symptom of schwannomas of the mandibular nerve.

Influence of Morbid Obesity on Surgical Outcomes in Robotic-Assisted Gynecologic Surgery.

The aim of this research was to estimate the impact of body mass index (BMI) on surgical outcomes in patients undergoing robotic-assisted gynecologic surgery. This study was a retrospective review of prospectively collected cohort data for a consecutive series of patients undergoing gynecologic robotic surgery in a single institution. BMI, expressed as kg/m, was abstracted from the medical charts of all patients undergoing robotic hysterectomy.

A simple technique of laparoscopic port closure.

Background: Laparoscopic and robotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial suture. We report a simple new technique that is easy, cost-effective, and quick to apply using 2 S-retractors for suture placement under direct visualization to secure the abdominal wall fascia and peritoneum.

An analysis of the impact of previous laparoscopic hysterectomy experience on the learning curve for robotic hysterectomy.

To analyze and compare the safety and perioperative outcomes of newly trained robotic surgeons with previous laparoscopic hysterectomy experience (TLH Exp) and those without previous laparoscopic hysterectomy experience (Non-TLH Exp). The purpose is to determine the effect of previous advanced laparoscopic skills on the performance in robotic assisted laparoscopic surgery. We will also compare the perioperative outcomes between the total laparoscopic hysterectomies (TLH), and robotic assisted laparoscopic hysterectomies (RALH) of a single experienced (TLH Exp) robotic surgeon.

Projecting function of stroke patients in rehabilitation using the AlphaFIM instrument in acute care.

Objectives: (1) To establish the reliability and validity of the AlphaFIM instrument; (2) To examine the hypotheses that the 6-item AlphaFIM instrument administered in acute care would closely approximate the full 18-item FIM instrument rating administered at admission to an inpatient rehabilitation facility (IRF); (3) to determine whether the acute AlphaFIM projected rating could predict the full FIM instrument ratings at discharge from the IRF; (4) to test whether the acute AlphaFIM projected rating could predict length of stay (LOS) in the IRF; (5) to determine if the acute AlphaFIM projected rating could predict the likelihood of patients being discharged from the IRF to the community.

Design, Setting, And Participants: A prospective cohort study of 144 stroke patients in an acute care stroke unit with subsequent transfer to an IRF.

Interventions: None.

Economic justification of antimicrobial management programs: implications of antimicrobial resistance.

The relationship between the problem of antimicrobial resistance and efforts to control antimicrobial costs is explored. Antimicrobial drug management typically centers around controlling costs and controlling antimicrobial resistance. Selection of therapeutic alternatives without adherence to a well-developed program or without a rationale based on data from the medical literature may promote antimicrobial resistance.

Cost effectiveness of ciprofloxacin plus metronidazole versus imipenem-cilastatin in the treatment of intra-abdominal infections.

Objective: To compare the cost effectiveness of sequential intravenous (i.v.) to oral ciprofloxacin plus metronidazole (CIP/MTZ i.

How should we evaluate new anti-infectives for respiratory tract infections?

In assessing the outcomes of anti-infective therapy, microbiological and clinical efficacy have been the most important factors considered. However, increasing attention is being paid to pharmacoeconomic considerations, which include much more than simply the cost of the drug. Nursing and pharmacy time involved in drug preparation and administration, laboratory costs and time in therapeutic drug monitoring, and hospital costs for in-patient care are all factors to be considered.

Health and fertility outcomes among women surgically treated for endometriosis.

Study Objective: To assess health and fertility status among women after surgical treatment of endometriosis.

Design: Prospective study.

Setting: Community-based gynecologic specialty practice.

Clinical and economic evaluation of oral ciprofloxacin after an abbreviated course of intravenous antibiotics.

Purpose: Oral ciprofloxacin has the requisite pharmacokinetic and antibacterial properties to rival the potency of intravenous antibiotics. This study was designed to determine whether oral ciprofloxacin could abbreviate the course of intravenous antibiotics in the treatment of serious infections.

Patients And Methods: Hospitalized adult patients were eligible for enrollment if they had a serious infection that was expected to require 8 or more days of intravenous antibiotic treatment.