Is there hospital variation in long-term incisional hernia repair after abdominal surgery?

Background: Currently, hospital benchmarking organizations are often limited to short-term surgical quality comparisons among hospitals. The goal of this study was to determine whether long-term rates of incisional hernia repair after common abdominal operations could be used to compare hospital long-term surgical quality.

Study Design: This was a cohort study with up to 4 years of follow-up.

Hospital costs by cost center of inpatient hospitalization for medicare patients undergoing major abdominal surgery.

Background: This study aims to describe the magnitude of hospital costs among patients undergoing elective colectomy, cholecystectomy, and pancreatectomy, determine whether these costs relate as expected to duration of care, patient case-mix severity and comorbidities, and whether risk-adjusted costs vary significantly by hospital. Correctly estimating the cost of production of surgical care may help decision makers design mechanisms to improve the efficiency of surgical care.

Study Design: Patient data from 202 hospitals in the ACS-NSQIP were linked to Medicare inpatient claims.

Standardizing a control group for comparing open with laparoscopic major liver resection in observational studies: reducing the need for correction of clinical heterogeneity.

Background: The results of comparative observational trials of liver resections can be problematic because of the large number of covariates that need to be balanced by complex statistical methods. Our purpose was to examine a cohort of patients whose outcomes were specifically representative of a major open hepatectomy, therefore reducing the number of covariates requiring statistical correction in future comparative observational trials.

Study Design: The cohort was restricted to a single major common liver resection—open right hepatectomy.

Aberrant Neural Connectivity during Emotional Processing Associated with Posttraumatic Stress.

Given the complexity of the brain, characterizing relations among distributed brain regions is likely essential to describing the neural instantiation of posttraumatic stress symptoms. This study examined patterns of functional connectivity among key brain regions implicated in the pathophysiology of posttraumatic stress disorder (PTSD) in 35 trauma-exposed adults using an emotion-word Stroop task. PTSD symptom severity (particularly hyperarousal symptoms) moderated amygdala-mPFC coupling during the processing of unpleasant words, and this moderation correlated positively with reported real-world impairment and amygdala reactivity.

Vocal fold paralysis: improved adductor recovery by vincristine blockade of posterior cricoarytenoid.

Objectives/hypothesis: A new treatment for acute unilateral vocal-fold paralysis (UVFP) was proposed in which a drug is injected into the posterior cricoarytenoid muscle (PCA) shortly after nerve injury, before the degree of natural recovery is known, to prevent antagonistic synkinetic reinnervation. This concept was tested in a series of canine experiments using vincristine as the blocking agent.

Study Design: Animal experiments.

Uncovering the hidden risk architecture of the schizophrenias: confirmation in three independent genome-wide association studies.

Objective: The authors sought to demonstrate that schizophrenia is a heterogeneous group of heritable disorders caused by different genotypic networks that cause distinct clinical syndromes.

Method: In a large genome-wide association study of cases with schizophrenia and controls, the authors first identified sets of interacting single-nucleotide polymorphisms (SNPs) that cluster within particular individuals (SNP sets) regardless of clinical status. Second, they examined the risk of schizophrenia for each SNP set and tested replicability in two independent samples.

Invasive coronary procedure use and outcomes among veterans with posttraumatic stress disorder: insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

Background: Posttraumatic stress disorder (PTSD) is prevalent in the general population and US veterans in particular and is associated with an increased risk of developing coronary artery disease (CAD). We compared the patient characteristics and postprocedural outcomes of veterans with and without PTSD undergoing coronary angiography.

Methods: This is a multicenter observational study of patients who underwent coronary angiography in Veterans Affairs hospitals nationally from October 2007 to September 2011.

Effect of wound classification on risk adjustment in American College of Surgeons NSQIP.

Background: Surgical wound classification has been used in risk-adjustment models. However, it can be subjective and could potentially improperly bias hospital quality comparisons. The objective is to examine the effect of wound classification on hospital performance risk-adjustment models.

Variations in definition and method of retrieval of complications influence outcomes statistics after pancreatoduodenectomy: comparison of NSQIP with non-NSQIP methods.

Background: NSQIP and the Accordion Severity Grading System have recently been used to develop quantitative methods for measuring the burden of postoperative complications. However, other audit methods such as chart reviews and prospective institutional databases are commonly used to gather postoperative complications. The purpose of this study was to evaluate discordance between different audit methods in pancreatoduodenectomy--a common major surgical procedure.

Are procedures codes in claims data a reliable indicator of intraoperative splenic injury compared with clinical registry data?

Background: Identifying iatrogenic injuries using existing data sources is important for improved transparency in the occurrence of intraoperative events. There is evidence that procedure codes are reliably recorded in claims data. The objective of this study was to assess whether concurrent splenic procedure codes in patients undergoing colectomy procedures are reliably coded in claims data as compared with clinical registry data.

Surveillance imaging for lymphoma: pros and cons.

There is no international consensus on the optimal frequency or duration of computed tomography or positron emission tomography scanning for surveillance in patients who achieve complete remission after initial therapy for lymphoma. Although some clinical practice guidelines suggest periodic imaging is reasonable, others suggest little or no benefit to this practice. From a theoretical perspective, the frequency and duration of surveillance imaging is largely dependent upon the lymphoma subtype.

The importance of extreme weight percentile in postoperative morbidity in children.

Background: Anthropometric data are important indicators of child health. This study sought to determine whether anthropometric data of extreme weight were significant predictors of perioperative morbidity in pediatric surgery.

Study Design: This was a cohort study of children 29 days up to 18 years of age undergoing surgical procedures at participating American College of Surgeons' NSQIP Pediatric hospitals in 2011 and 2012.

Metastatic breast cancer in patients with schizophrenia.

Breast cancer is a major health problem worldwide. The median survival duration for patients with metastatic breast cancer is two to three years. Approximately 1% of populations worldwide have schizophrenia.

Prescription Opioid Analgesics Increase Risk of Major Depression: New Evidence, Plausible Neurobiological Mechanisms and Management to Achieve Depression Prophylaxis.

More than 200 million prescriptions are written annually for opioid analgesics despite limited evidence of their long-term efficacy. These medications currently are prescribed to 10% - 15% of Americans with use of long-acting opioids projected to double in the next three to four years. Despite this widespread use, little is known about the risks of opioids, particularly with chronic use.

Respite utilization and responses to loss among family caregivers: relationship matters.

Family caregivers of physically and cognitively impaired older adults face multiple challenges when providing care, including responses to tangible and anticipated losses. However, little is known about the grief experiences of family caregivers and how these might differentially influence the care-related behaviors of spouses and adult children. The present study examined the longitudinal relationship between grief reactions in current spousal and adult-children caregivers (N = 72) and in-home respite utilization over 3 months.

Incidental gallbladder cancer at cholecystectomy: when should the surgeon be suspicious?

Background: Preoperative predictors of incidental gallbladder cancer (iGBC) have been poorly defined despite the frequency with which cholecystectomy is performed. The objective of this study was to define the incidence of and consider risk factors for iGBC at cholecystectomy.

Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2009) was used to identify all patients who underwent cholecystectomy (N = 91,260).

Variability of methacholine bronchoprovocation and the effect of inhaled corticosteroids in mild asthma.

Background: The methacholine challenge test quantifies airway hyper-responsiveness, which is measured by the provocative concentration of methacholine causing a 20% decrease in forced expiration volume in 1 second (PC20). The dose-response effect of inhaled corticosteroids (ICS) on PC20 has been inconsistent and within-patient variability of PC20 is not well established.

Objective: To determine the effect of high- vs low-dose ICS on PC20 and within-patient variability in those with repeated measurements of PC20.

Comparing multicomponent interventions to improve skin care behaviors and prevent recurrence in veterans hospitalized for severe pressure ulcers.

Objective: To compare a multicomponent motivational interviewing (MI)/self-management (SM) intervention with a multicomponent education intervention to improve skin-protective behaviors and prevent skin worsening in veterans with spinal cord injury (SCI) hospitalized for severe pressure ulcers (PrUs).

Design: Single-blinded, prospective, randomized controlled trial.

Setting: Six Veterans Affairs SCI centers.

Prescription opioid analgesics increase the risk of depression.

Background: Prescription opioid analgesic use has quintupled recently. Evidence linking opioid use with depression emanates from animal models and studies of persons with co-occurring substance use and major depression. Little is known about depressogenic effects of opioid use in other populations.

Cortical organization of inhibition-related functions and modulation by psychopathology.

Individual differences in inhibition-related functions have been implicated as risk factors for a broad range of psychopathology, including anxiety and depression. Delineating neural mechanisms of distinct inhibition-related functions may clarify their role in the development and maintenance of psychopathology. The present study tested the hypothesis that activity in common and distinct brain regions would be associated with an ecologically sensitive, self-report measure of inhibition and a laboratory performance measure of prepotent response inhibition.

The potential role of newer gram-positive antibiotics in the setting of osteomyelitis of adults.

What Is Known And Objective: To summarize available literature regarding the potential role of linezolid, daptomycin, telavancin, tigecycline and ceftaroline for the treatment of osteomyelitis caused by resistant gram-positive organisms.

Methods: Literature was obtained through PubMed searches from January 1980 to October 2011 using the terms osteomyelitis, bone, linezolid, daptomycin, telavancin, tigecycline and ceftaroline. Results were limited to those published in English.

Witnessed versus unwitnessed random urine tests in the treatment of opioid dependence.

Background And Objectives: Clinics licensed to provide pharmacotherapy for opiate dependence disorder are required to perform random urine drug screen (RUDS) tests. The results provide the empirical basis of individual treatment and programmatic effectiveness, and public health policy. Patients consent to witnessed testing but most tests are unwitnessed.

A pilot study of basal ganglia and thalamus structure by high dimensional mapping in children with Tourette syndrome.

Background: Prior brain imaging and autopsy studies have suggested that structural abnormalities of the basal ganglia (BG) nuclei may be present in Tourette Syndrome (TS). These studies have focused mainly on the volume differences of the BG structures and not their anatomical shapes.  Shape differences of various brain structures have been demonstrated in other neuropsychiatric disorders using large-deformation, high dimensional brain mapping (HDBM-LD).

Compassionately caring for LGBT persons in your faith community.

Nurses have a professional duty to provide care for all patients regardless of race, ethnicity, religion, gender, disability, sexual orientation, or gender identity. As Christian nurses, we are called by our profession and faith to welcome and care for those who are stigmatized by others. This article defines LGBT (Lesbian, Gay, Bisexual, Transgender), offers reasons why LGBT persons are at risk for healthcare disparities, discusses referral of LGBT persons to healthcare resources, and states ways to be more welcoming for LGBT persons in a faith setting.

Daptomycin compared to vancomycin for the treatment of osteomyelitis: a single-center, retrospective cohort study.

Background: Osteomyelitis (OM) is a serious infection with high rates of recurrence. Vancomycin has been used for decades in the treatment of OM, but, despite adequate dosing, 30% to 50% of patients experience infection recurrence within 12 months. Daptomycin, a novel lipopetide antibiotic, is also active against resistant gram-positive organisms, but there is little published about its efficacy and tolerability in the treatment of OM.