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Balch JA, Krebs JR, Filiberto AC, Montgomery WG, Berkow LC, Upchurch GR, Loftus TJ. Methods and evaluation metrics for reducing material waste in the operating room: a scoping review. Surgery 2023:S0039-6060(23)00257-X. [PMID: 37277308 DOI: 10.1016/j.surg.2023.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Operating rooms contribute up to 70% of total hospital waste. Although multiple studies have demonstrated reduced waste through targeted interventions, few examine processes. This scoping review highlights methods of study design, outcome assessment, and sustainability practices of operating room waste reduction strategies employed by surgeons. METHODS Embase, PubMed, and Web of Science were screened for operating room-specific waste-reduction interventions. Waste was defined as hazardous and non-hazardous disposable material and energy consumption. Study-specific elements were tabulated by study design, evaluation metrics, strengths, limitations, and barriers to implementation in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS A total of 38 articles were analyzed. Among them, 74% of studies had pre- versus postintervention designs, and 21% used quality improvement instruments. No studies used an implementation framework. The vast majority (92%) of studies measured cost as an outcome, whereas others included disposable waste by weight, hospital energy consumption, and stakeholder perspectives. The most common intervention was instrument tray optimization. Common barriers to implementation included lack of stakeholder buy-in, knowledge gaps, data capture, additional staff time, need for hospital or federal policies, and funding. Intervention sustainability was discussed in few studies (23%) and included regular waste audits, hospital policy change, and educational initiatives. Common methodologic limitations included limited outcome evaluation, narrow scope of intervention, and inability to capture indirect costs. CONCLUSION Appraisal of quality improvement and implementation methods are critical for developing sustainable interventions for reducing operating room waste. Universal evaluation metrics and methodologies may aid in both quantifying the impact of waste reduction initiatives and understanding their implementation in clinical practice.
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Affiliation(s)
- Jeremy A Balch
- University of Florida, Department of Surgery, Gainesville, FL
| | | | | | | | - Lauren C Berkow
- University of Florida, Department of Anesthesiology, Gainesville, FL
| | | | - Tyler J Loftus
- University of Florida, Department of Surgery, Gainesville, FL.
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Spinosa MD, Montgomery WG, Lempicki M, Srikakulapu P, Johnsrude MJ, McNamara CA, Upchurch GR, Ailawadi G, Leitinger N, Meher AK. B Cell-Activating Factor Antagonism Attenuates the Growth of Experimental Abdominal Aortic Aneurysm. Am J Pathol 2021; 191:2231-2244. [PMID: 34509440 DOI: 10.1016/j.ajpath.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/02/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
B cell-activating factor (BAFF), a tumor necrosis factor family of cytokine, was recently identified as a regulator of atherosclerosis; however, its role in aortic aneurysm has not been determined. Here, we examined the effect of selective BAFF antagonism using an anti-BAFF antibody (blocks binding of BAFF to receptors BAFF receptor 3, transmembrane activator and CAML interactor, and B-cell maturation antigen) and mBaffR-mFc (blocks binding of BAFF to BAFF receptor 3) on a murine model of abdominal aortic aneurysm (AAA). In a prevention strategy, the antagonists were injected before the induction of AAA, and in an intervention strategy, the antagonists were injected after the induction of AAA. Both strategies attenuated the formation of AAA. In the intervention group, BAFF antagonism depleted most of the mature B-cell subsets in spleen and circulation, leading to enhanced resolution of inflammation in AAA as indicated by decreased infiltration of B cells and proinflammatory macrophages and a reduced number of apoptotic cells. In AAA tissues, B cells and macrophages were found in close contact. In vitro, B cells, irrespective of treatment with BAFF, impaired the efferocytosis activity of macrophages, suggesting a direct innate role of B cells on macrophage function. Altogether, BAFF antagonism affects survival of the mature B cells, promotes resolution of inflammation in the aorta, and attenuates the growth of AAA in mice.
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Affiliation(s)
- Michael D Spinosa
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Melissa Lempicki
- Department of Microbiology and Immunology, East Carolina University, Greenville, North Carolina
| | - Prasad Srikakulapu
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia
| | - Matthew J Johnsrude
- Department of Microbiology and Immunology, East Carolina University, Greenville, North Carolina
| | - Coleen A McNamara
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia
| | - Gilbert R Upchurch
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Norbert Leitinger
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia
| | - Akshaya K Meher
- Department of Microbiology and Immunology, East Carolina University, Greenville, North Carolina; Department of Pharmacology, University of Virginia, Charlottesville, Virginia.
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Cullen JM, Shannon AH, Lu G, Su G, Spinosa MD, Montgomery WG, Ailawadi G, Salmon M, Upchurch GR. Sex-Based Differences Among Experimental Swine Abdominal Aortic aneurysms. J Surg Res 2021; 260:488-498. [PMID: 33341252 PMCID: PMC7946779 DOI: 10.1016/j.jss.2020.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Female sex protects against abdominal aortic aneurysms (AAAs); however, the mechanisms behind these sex-based differences remain unknown. The purpose of this study was to explore the role of sex and sex hormones in AAA formation among swine. MATERIALS AND METHODS Using a previous validated model, infrarenal AAA were surgically created in uncastrated male (n = 8), female (n = 5), and castrated male (n = 4) swine. Aortic dilation was measured on postoperative day 28 during the terminal procedure and compared to initial aortic diameter measured during the index procedure. Tissue was analyzed for immunohistochemistry, cytokine array, gelatin zymography, serum 17β-estradiol, and testosterone assay. RESULTS Uncastrated males had significantly larger maximal aortic dilation compared to castrated males (113.5% ± 11.4% versus 38.1% ± 4.5%, P = 0.0012). Females had significantly higher mean aortic dilation compared to castrated males (96.2% ± 7.5% versus 38.1% ± 4.5%, P = 0.0004). Aortic diameters between females and uncastrated males were not significantly different on day 28. Female swine had significantly higher concentrations of 17β-estradiol compared with uncastrated males (1590 ± 873.3 ng/mL versus 95.2 ± 2.3 ng/mL, P = 0.047), with no significant difference between females and castrated males. Uncastrated male AAA demonstrated significantly more elastin degradation compared with female and castrated males (P = 0.01 and <0 .01, respectively). No differences existed for T-cells or smooth muscle cells between groups. Multiple proinflammatory cytokines were elevated within uncastrated male aortic walls compared to females and castrated males. CONCLUSIONS Sex hormones, specifically 17β-estradiol and testosterone, influence experimental swine AAA formation as demonstrated by increased aneurysm size, collagen turnover, and elastolysis in uncastrated males in processes reflective of human disease.
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Affiliation(s)
- J Michael Cullen
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Guanyi Lu
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Gang Su
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Michael D Spinosa
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Morgan Salmon
- Department of Surgery, University of Virginia, Charlottesville, Virginia
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Shannon AH, Elder CT, Lu G, Su G, Mast A, Salmon MD, Montgomery WG, Spinosa MD, Upchurch GR, Sharma AK. Pharmacologic inhibition of transient receptor channel vanilloid 4 attenuates abdominal aortic aneurysm formation. FASEB J 2020; 34:9787-9801. [PMID: 32506673 DOI: 10.1096/fj.202000251r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/28/2020] [Accepted: 05/17/2020] [Indexed: 11/11/2022]
Abstract
Abdominal aortic aneurysm (AAA) formation is characterized by inflammation, leukocyte infiltration, and vascular remodeling. This study investigates the role of TRPV4 channels, which are transmembrane calcium channels that can regulate vascular tone, in modulating AAA formation. The elastase-treatment model of AAA in C57BL6 (WT) mice and Angiotensin II treatment model in ApoE-/- mice were used to confirm our hypotheses. The administration of a specific TRPV4 antagonist, GSK2193874, in elastase-treated WT mice and in AngII-treated ApoE-/- mice caused a significant attenuation of aortic diameter, decrease in pro-inflammatory cytokines (IL-1β, IL-6, IL-17, MCP-1, MIP-1α, MIP-2, RANTES, and TNF-α), inflammatory cell infiltration (CD3 + T cells, macrophages, and neutrophils), elastic fiber disruption, and an increase in smooth muscle cell α-actin expression compared to untreated mice. Similarly, elastase-treated TRPV4-/- mice had a significant decrease in AAA formation, aortic inflammation, and vascular remodeling compared to elastase-treated WT mice on Day 14. In vitro studies demonstrated that the inhibition of TRPV4 channels mitigates aortic smooth muscle cell-dependent inflammatory cytokine production as well as decreases neutrophil transmigration through aortic endothelial cells. Therefore, our results suggest that TRPV4 antagonism can attenuate aortic inflammation and remodeling via decreased smooth muscle cell activation and neutrophil transendothelial migration during AAA formation.
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Affiliation(s)
| | - Craig T Elder
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Guanyi Lu
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Gang Su
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Alexis Mast
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Morgan D Salmon
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Michael D Spinosa
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Ashish K Sharma
- Department of Surgery, University of Florida, Gainesville, FL, USA
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Shannon AH, Cullen JM, Dahl JJ, Scott EJ, Tyerman Z, Spinosa MD, Montgomery WG, Johnston WF, Lu G, Salmon M, Ailawadi G, Upchurch GR. Porcine Model of Infrarenal Abdominal Aortic Aneurysm. J Vis Exp 2019:10.3791/60169. [PMID: 31814612 PMCID: PMC11022188 DOI: 10.3791/60169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal abdominal aortic aneurysms (AAA) in swine. To achieve this, we use a combination of balloon angioplasty, elastase and collagenase, and a lysyl oxidase inhibitor, called β-aminopropionitrile (BAPN), to create clinically significant infrarenal aortic aneurysms, analogous to human disease. Noncastrated male swine are fed BAPN for 7 days prior to surgery to achieve a steady state in the blood. A midline laparotomy is performed and the infrarenal aorta is circumferentially dissected. An initial measurement is recorded prior to aneurysm induction with a combination of balloon angioplasty, elastase (500 units)/collagenase (8000 units) perfusion, and topical elastase application. Swine are fed BAPN daily until terminal procedure on either postoperative day 7, 14, or 28, at which time the aneurysm is measured, and tissue procured. BAPN + surgery pigs are compared to pigs that underwent surgery alone. Swine treated with BAPN and surgery had a mean aortic dilation of 89.9% ± 47.4% at day 7, 105.4% ± 58.1% at day 14, and 113.5% ± 30.2% at day 28. Pigs treated with surgery alone had significantly smaller aneurysms compared to BAPN + surgery animals at day 28 (p < 0.0003). The BAPN + surgery group had macroscopic and immunohistochemical evidence of end stage aneurysmal disease. Clinically significant infrarenal AAA can be induced using balloon angioplasty, elastase/collagenase perfusion and topical application, supplemented with oral BAPN. This model creates large, clinically significant AAA with hallmarks of human disease. This has important implications for the elucidation of AAA pathogenesis and testing of novel therapies and devices for the treatment of AAA. Limitations of the model include variation in BAPN ingested by swine, quality of elastase perfusion, and cost of BAPN.
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Affiliation(s)
| | - J Michael Cullen
- Department of Surgery, University of Virginia School of Medicine
| | - Jolian J Dahl
- Department of Surgery, University of Virginia School of Medicine
| | - Erik J Scott
- Department of Surgery, University of Virginia School of Medicine
| | - Zachary Tyerman
- Department of Surgery, University of Virginia School of Medicine
| | | | | | | | - Guanyi Lu
- Department of Surgery, University of Florida
| | - Morgan Salmon
- Department of Surgery, University of Virginia School of Medicine;
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia School of Medicine; The Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine
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Cullen JM, Lu G, Shannon AH, Su G, Sharma A, Salmon M, Fashandi AZ, Spinosa MD, Montgomery WG, Johnston WF, Ailawadi G, Upchurch GR. A novel swine model of abdominal aortic aneurysm. J Vasc Surg 2018; 70:252-260.e2. [PMID: 30591288 DOI: 10.1016/j.jvs.2018.09.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/07/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Few large-animal models exist for the study of aortic aneurysms. β-Aminopropionitrile (BAPN) is a compound known to cause aortic aneurysms by inhibiting lysyl oxidase, a collagen cross-linking enzyme. It is hypothesized that BAPN plus aneurysm induction surgery would result in significant aneurysm formation in swine with biologic properties similar to human disease. METHODS Initial experiments were performed in uncastrated male swine not treated with BAPN (surgery alone). Subsequently, uncastrated male swine were fed BAPN (0.15 g/kg) for 7 days before undergoing surgery; the infrarenal aorta was circumferentially dissected and measured, balloon dilated, and perfused with elastase (500 units) and type I collagenase (8000 units), with extraluminal elastase application. In the BAPN groups, daily BAPN feedings continued until swine harvest at postoperative days 7, 14, and 28. RESULTS Swine undergoing surgery alone (n = 12) had significantly less dilation at 28 days compared with BAPN + surgery swine (51.9% ± 29.2% [0%-100%] vs 113.5% ± 30.2% [52.9%-146.2%]; P < .0003). Mean aortic dilation in animals undergoing treatment with surgery and BAPN was 86.9% ± 47.4% (range, 55.6%-157.1%), 105.4% ± 58.1% (50%-133.3%), and 113.5% ± 30.2% (52.9%-146.2%) at 7, 14, and 28 days, respectively. In the BAPN + surgery group, significant elastolysis was present at all time points, whereas aortic wall collagen content was not significantly different. Smooth muscle cells were significantly depleted at 14 and 28 days, and M1 macrophages were increased at 14 and 28 days (P < .05, all). Matrix metalloproteinase 2 was elevated at 7 days (P < .05). Multiple proinflammatory cytokines were elevated within the aortic wall of BAPN + surgery swine. CONCLUSIONS BAPN plus surgery resulted in significantly larger aortic aneurysms than surgery alone and was critical to aneurysm formation in this novel swine model. Hallmarks of human disease, such as elastin fragmentation, smooth muscle cell depletion, macrophage infiltration, matrix metalloproteinase activation, and proinflammatory cytokine expression, were observed in BAPN-treated swine. This model better parallels many of the characteristics of human AAAs and may be suitable for prehuman drug trials.
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MESH Headings
- Aminopropionitrile
- Angioplasty, Balloon
- Animals
- Aorta, Abdominal/metabolism
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/chemically induced
- Aortic Aneurysm, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/pathology
- Collagenases
- Cytokines/metabolism
- Dilatation, Pathologic
- Disease Models, Animal
- Disease Progression
- Inflammation Mediators/metabolism
- Macrophages/metabolism
- Macrophages/pathology
- Male
- Matrix Metalloproteinase 2/metabolism
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Pancreatic Elastase
- Sus scrofa
- Time Factors
- Vascular Remodeling
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Affiliation(s)
- J Michael Cullen
- Department of Surgery, University of Virginia, Charlottesville, Va
| | - Guanyi Lu
- Department of Surgery, University of Florida, Gainesville, Fla
| | | | - Gang Su
- Department of Surgery, University of Florida, Gainesville, Fla
| | - Ashish Sharma
- Department of Surgery, University of Florida, Gainesville, Fla
| | - Morgan Salmon
- Department of Surgery, University of Virginia, Charlottesville, Va
| | - Anna Z Fashandi
- Department of Surgery, University of Virginia, Charlottesville, Va
| | | | | | | | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
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Montgomery WG, Spinosa MD, Cullen JM, Salmon MD, Su G, Hassinger T, Sharma AK, Lu G, Fashandi A, Ailawadi G, Upchurch GR. Tamsulosin attenuates abdominal aortic aneurysm growth. Surgery 2018; 164:1087-1092. [PMID: 30174141 DOI: 10.1016/j.surg.2018.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/30/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tamsulosin, an α1A-adrenergic receptor inhibitor, is prescribed to treat benign prostatic hyperplasia in men >60 years of age, the same demographic most susceptible to abdominal aortic aneurysm. The goal of this study was to investigate the effect of tamsulosin on abdominal aortic aneurysm pathogenesis. METHODS Abdominal aortic aneurysms were induced in WT C57BL/6 male mice (n = 9-18/group), using an established topical elastase abdominal aortic aneurysm model. Osmotic pumps were implanted in mice 5 days before operation to create the model, administering either low dose (0.125 µg/day tamsulosin), high dose (0.250µg/day tamsulosin), or vehicle treatments with and without topical application of elastase. Blood pressures were measured preoperatively and on postoperative days 0, 3, 7, and 14. On postoperative day 14, aortic diameter was measured before harvest. Sample aortas were prepared for histology and cytokine analysis. RESULTS Measurements of systolic blood pressure did not differ between groups. Mice treated with the low dose of tamsulosin and with the high dose of tamsulosin showed decreased aortic diameter compared with vehicle-treated control (93% ± 24 versus 94% ± 30 versus 132% ± 24, respectively; P = .0003, P = .0003). Cytokine analysis demonstrated downregulation of pro-inflammatory cytokines in both treatment groups compared with the control (P < .05). Histology exhibited preservation of elastin in both low- and high-dose tamsulosin-treated groups (P = .0041 and P = .0018, respectively). CONCLUSION Tamsulosin attenuates abdominal aortic aneurysm formation with increased preservation of elastin and decreased production of pro-inflammatory cytokines. Further studies are necessary to elucidate the mechanism by which tamsulosin attenuates abdominal aortic aneurysm pathogenesis.
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Affiliation(s)
| | | | | | - Morgan D Salmon
- Department of Surgery, University of Virginia, Charlottesville
| | - Gang Su
- Department of Surgery, University of Florida, Gainesville
| | - Taryn Hassinger
- Department of Surgery, University of Virginia, Charlottesville
| | - Ashish K Sharma
- Department of Surgery, University of Virginia, Charlottesville
| | - Guanyi Lu
- Department of Surgery, University of Florida, Gainesville
| | - Anna Fashandi
- Department of Surgery, University of Virginia, Charlottesville
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville
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Baker R, Montgomery WG. Enhancing productivity with modular storage cabinets. J Healthc Mater Manage 1986; 4:50-4. [PMID: 10278642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Several years before the advent of Medicare's prospective payment system and DRGs, which have caused many other hospitals to focus attention on cost reduction and central inventory control for the first time, St. Mary's had adopted central material management techniques. In recognizing that the cost of overhead materials cannot be passed along to the patients, the hospital took steps to keep these costs under control. Modular storage drawer cabinets are being used at the medical center to implement established policies because they proved to be more efficient than other material storage systems, including tote boxes, open shelving and wire-tray carts. As a capital equipment expenditure, the return-on-investment for these cabinets can be justified in terms of space savings estimated at 50% in the case of CSS. The flexibility, modularity and space efficiency of modular storage drawer cabinets meet St. Mary's desire to save time, energy and money.
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Montgomery WG, Cox CE. Cephalexin: clinical and laboratory studies with 500 mg twice daily dosage in urinary infection. Int Z Klin Pharmakol Ther Toxikol 1971; 4:212-5. [PMID: 5573232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Cox CE, Montgomery WG. Cephalosporin therapy of urinary tract infections. Postgrad Med J 1971; 47:Suppl:107-18. [PMID: 5556182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Cox CE, Lacy SS, Montgomery WG, Boyce WH. Renal adenocarcinoma: 28-year review, with emphasis on rationale and feasibility of preoperative radiotherapy. J Urol 1970; 104:53-61. [PMID: 5426710 DOI: 10.1016/s0022-5347(17)61670-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Cox CE, Montgomery WG. Combined trimethoprim-sulfisoxazole therapy of urinary infections. Clinical studies. Postgrad Med J 1969; 45:Suppl:65-71. [PMID: 4902848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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