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Kidane B, Wakeam E, Meguid RA, Odell DD. Administrative and clinical databases: General thoracic surgery perspective on approaches and pitfalls. J Thorac Cardiovasc Surg 2021; 162:1146-1153. [PMID: 33892944 PMCID: PMC8448935 DOI: 10.1016/j.jtcvs.2021.03.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 12/16/2022]
Abstract
Databases are created to serve 1 of 2 fundamental functions: (1) research and (2) benchmarking/quality. Their construction and nature affects the extent to which they can accomplish these functions.
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Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - David D Odell
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Ill
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2
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Brescia AA. The second annual Thoracic Surgery Residents Association presidential address: Enter the arena. J Thorac Cardiovasc Surg 2021; 163:189-191. [PMID: 34217532 DOI: 10.1016/j.jtcvs.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
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3
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Habicher M, Zajonz T, Heringlake M, Böning A, Treskatsch S, Schirmer U, Markewitz A, Sander M. [S3 guidelines on intensive medical care of cardiac surgery patients : Hemodynamic monitoring and cardiovascular system-an update]. Anaesthesist 2019; 67:375-379. [PMID: 29644444 DOI: 10.1007/s00101-018-0433-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
An update of the S3- guidelines for treatment of cardiac surgery patients in the intensive care unit, hemodynamic monitoring and cardiovascular system was published by the Association of Scientific Medical Societies in Germany (AWMF) in January 2018. This publication updates the guidelines from 2006 and 2011. The guidelines include nine sections that in addition to different methods of hemodynamic monitoring also reviews the topic of volume therapy as well as vasoactive and inotropic drugs. Furthermore, the guidelines also define the goals for cardiovascular treatment. This article describes the most important innovations of these comprehensive guidelines.
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Affiliation(s)
- M Habicher
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Charité Campus Mitte und Campus Virchow Klinikum, Berlin, Deutschland
| | - T Zajonz
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - M Heringlake
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - A Böning
- Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Charité Campus Mitte und Campus Virchow Klinikum, Berlin, Deutschland
| | - U Schirmer
- Herz- und Diabeteszentrum NRW Institut für Anästhesiologie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - A Markewitz
- Klinik für Herz- und Gefäßchirurgie, Bundeszentralwehrkrankenhaus Koblenz, Koblenz, Deutschland
| | - M Sander
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland.
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4
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Nishimura RA, O'Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, Lindman BR, Linderbaum JA, Little SH, Mack MJ, Mauri L, Miranda WR, Shahian DM, Sundt TM. 2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Soc Echocardiogr 2019; 32:683-707. [PMID: 31010608 DOI: 10.1016/j.echo.2019.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Laura Mauri
- American College of Cardiology representative
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5
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the strengths and weaknesses of systematic reviews and meta-analyses to inform our current understanding of cardiac surgery. RECENT FINDINGS A systematic review and meta-analysis of a focused topic can provide a quantitative estimate for the effect of a treatment intervention or exposure. In cardiac surgery, observational studies and small, single-center prospective trials provide most of the clinical outcomes that form the evidence base for patient management and guideline recommendations. As such, meta-analyses can be particularly valuable in synthesizing the literature for a particular focused surgical question. Since the year 2000, there are over 800 meta-analysis-related publications in our field. There are some limitations to this technique, including clinical, methodological and statistical heterogeneity, among other challenges. Despite these caveats, results of meta-analyses have been useful in forming treatment recommendations or in providing guidance in the design of future clinical trials. SUMMARY There is a growing number of meta-analyses in the field of cardiac surgery. Knowledge translation via meta-analyses will continue to guide and inform cardiac surgical practice and our practice guidelines.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital
| | - Andrea C Tricco
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, Smith PK. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Nucl Cardiol 2017; 24:439-463. [PMID: 28265967 DOI: 10.1007/s12350-017-0780-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes (ACS) and stable ischemic heart disease were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and in an effort to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing ACS and stable ischemic heart disease individually. This document presents the AUC for ACS. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, presence of clinical instability or ongoing ischemic symptoms, prior reperfusion therapy, risk level as assessed by noninvasive testing, fractional flow reserve testing, and coronary anatomy. This update provides a reassessment of clinical scenarios that the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization. A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range (4 to 6) indicate that coronary revascularization may be appropriate for the clinical scenario. Seventeen clinical scenarios were developed by a writing committee and scored by the rating panel: 10 were identified as appropriate, 6 as may be appropriate, and 1 as rarely appropriate. As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction were considered appropriate. Likewise, clinical scenarios with unstable angina and intermediate- or high-risk features were deemed appropriate. Additionally, the management of nonculprit artery disease and the timing of revascularization are now also rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.
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Affiliation(s)
- Manesh R Patel
- Duke University Health System, Duke Clinical Research Institute, Durham, NC, USA
| | - John H Calhoon
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Gregory J Dehmer
- Baylor Scott & White - Temple Memorial, Temple, TX, USA
- Health Science Center, Texas A&M University, Bryan, TX, USA
| | - James Aaron Grantham
- Saint Luke's Hospital, Kansas City, MO, USA
- Kansas City School of Medicine, University of Missouri, Kansas City, MO, USA
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System, Denver, CO, USA
- University of Colorado, Aurora, CO, USA
| | - David J Maron
- Stanford University School of Medicine, Stanford, CA, USA
| | - Peter K Smith
- Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC, USA
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7
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Pedersen JH, Rzyman W, Veronesi G, D’Amico TA, Van Schil P, Molins L, Massard G, Rocco G. Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe. Eur J Cardiothorac Surg 2017; 51:411-420. [PMID: 28137752 PMCID: PMC6279064 DOI: 10.1093/ejcts/ezw418] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/03/2016] [Accepted: 11/30/2016] [Indexed: 12/17/2022] Open
Abstract
In order to provide recommendations regarding implementation of computed tomography (CT) screening in Europe the ESTS established a working group with eight experts in the field. On a background of the current situation regarding CT screening in Europe and the available evidence, ten recommendations have been prepared that cover the essential aspects to be taken into account when considering implementation of CT screening in Europe. These issues are: (i) Implementation of CT screening in Europe, (ii) Participation of thoracic surgeons in CT screening programs, (iii) Training and clinical profile for surgeons participating in screening programs, (iv) the use of minimally invasive thoracic surgery and other relevant surgical issues and (v) Associated elements of CT screening programs (i.e. smoking cessation programs, radiological interpretation, nodule evaluation algorithms and pathology reports). Thoracic Surgeons will play a key role in this process and therefore the ESTS is committed to providing guidance and facilitating this process for the benefit of patients and surgeons.
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Affiliation(s)
- Jesper Holst Pedersen
- Department of Thoracic Surgery RT 2152, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | | | - Thomas A D’Amico
- Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Laureano Molins
- Thoracic Surgery Respiratory Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gilbert Massard
- Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Gaetano Rocco
- Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, National Cancer Institute, Naples, Italy
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8
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Mukamel DB, Weimer DL, Zwanziger J, Gorthy SFH, Mushlin AI. Quality Report Cards, Selection of Cardiac Surgeons, and Racial Disparities: A Study of the Publication of the New York State Cardiac Surgery Reports. INQUIRY 2016; 41:435-46. [PMID: 15835601 DOI: 10.5034/inquiryjrnl_41.4.435] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Quality report cards have become common in many health care markets. This study evaluates their effectiveness by examining the impact of the New York State (NYS) Cardiac Surgery Reports on selection of cardiac surgeons. The analyses compares selection of surgeons in 1991 (pre-report publication) and 1992 (post-report publication). We find that the information about a surgeon's quality published in the reports influences selection directly and diminishes the importance of surgeon experience and price as signals for quality. Furthermore, selection of surgeons for black patients is as sensitive to the published information as is the selection for white patients.
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Affiliation(s)
- Dana B Mukamel
- Department of Medicine, Division of General Internal Medicine and Primary Care, Center for Health Policy Research, University of California, Irvine, 111 Academy Way, Suite 220, Irvine, CA 92697-5800 , USA.
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9
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Abstract
The traditional approach to blunt thoracic aortic injuries has been expedient diagnosis and operative repair due to the significant risk of early exsanguination and death in initial survivors. Nonoperative management has been advocated in patients with multiple injuries to reduce the operative mortality. However, specific clinical parameters and diagnostic tests that may predict the risk of early exsanguination and death have yet to be identified. A retrospective analysis of 80 patients with these injuries was undertaken to identify factors associated with early exsanguination or death. Available aortograms were also examined and graded to determine their utility in predicting these outcomes. Early exsanguination and death were found to be associated with low systolic blood pressure on admission and with short duration from injury to diagnosis. Exsanguination was also associated with the total number of lesions in thoracic injuries, and mortality with age greater than 30 years. Aortographic appearance was not found to correlate with either outcome. Patients with blunt thoracic aortic injuries should continue to be managed expediently, with immediate surgical repair if not contraindicated by associated injuries, to avoid early rupture.
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Affiliation(s)
- Robert A Lancey
- Division of Cardiac Surgery, Mary Imogene Bassett Hospital, New York, USA.
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10
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Abstract
Pharmacists' role may be ideal for improving rationality of drug prescribing practice. We aimed to study the impact of multifaceted pharmacist interventions on antibiotic prophylaxis in patients undergoing clean or clean-contaminated operations in cardiothoracic department. A pre-test-post-test quasiexperimental study was conducted in a cardiothoracic ward at a tertiary teaching hospital in Suzhou, China. Patients admitted to the ward were collected as baseline group (2011.7-2012.12) and intervention group (2013.7-2014.12), respectively. The criteria of prophylaxis antibiotic utilization were established on the basis of the published guidelines and official documents. During the intervention phase, a dedicated pharmacist was assigned and multifaceted interventions were implemented in the ward. Then we compared the differences in antibiotic utilization, bacterial resistance, clinical and economic outcomes between the 2 groups. Furthermore, patients were collected after the intervention (2015.1-2015.6) to evaluate the sustained effects of pharmacist interventions. 412 and 551 patients were included in the baseline and intervention groups, while 156 patients in postintervention group, respectively. Compared with baseline group, a significant increase was found in the proportion of antibiotic prophylaxis, the proportion of rational antibiotic selection, the proportion of suitable prophylactic antibiotic duration, and the proportion of suitable timing of administration of the first preoperative dose (P < 0.001). Meanwhile, a significant reduction was seen in the rate of unnecessary replacement of antibiotics and the rate of unnecessary combinations (P < 0.001). Besides, pharmacist intervention resulted in favorable outcomes with significantly decreased rates of surgical site infections, prophylactic antibiotic cost, and significantly shortened length of stay (P < 0.05). Furthermore, there were also significant decreases of the rates of antibiotic resistant enterobacter cloacae, klebsiella pneumonia, and staphylococcus aureus (P < 0.05). Moreover, the effects were sustained after discontinuation of the active interventions, as shown in prophylactic antibiotic utilization data. Pharmacist interventions in cardiothoracic surgery result in a high adherence to evidence-based treatment guidelines and a profound culture change in drug prescribing with favorable outcomes. The effects of pharmacist intervention are sustained and the role of pharmacists is emphasized for rational medication and optimal outcomes in clinical treatment.
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Affiliation(s)
- Ling Zhou
- From the Department of Pharmacy, The First Affiliated Hospital, School of Medicine, Soochow University, Suzhou, China
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Affiliation(s)
- Amanda S Xi
- Transitional year resident at Henry Ford Hospital in Detroit
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12
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Dyer C. Doctors at Newcastle made unfounded complaints about children's heart surgery at Leeds, finds report. BMJ 2014; 349:g6528. [PMID: 25355428 DOI: 10.1136/bmj.g6528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Mathias JM. Surgeon-nurse duo delivers excellent, efficient patient care. OR Manager 2014; 30:1-13. [PMID: 25004604] [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: 06/03/2023]
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Khubulava GG, Ryzhman NN, Ovchinnikov IV, Tyrenko VV, Peleshko AS. [ Modern condition and prospects of development of cardiac surgery in the Armed Forces]. Voen Med Zh 2014; 335:4-8. [PMID: 25051782] [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: 06/03/2023]
Abstract
Authors consider the problem of delivery cardiac surgical care to contingent of the Defence Ministry. Perspective directions of development of cardiac surgery in the Armed Forces of the Russian Federation are the development of minimally invasive cardio surgery, endovascular development of modern methods of diagnosis and treatment, further development of electrophysiological methods for diagnosis and treatment of disorders of rhythm and conduction, the introduction of various kinds of auxiliary mechanical circulatory support systems in acute and chronic heart failure, development of transplantation in cardiac surgery, improvement of algorithm selection and referral of patients requiring cardiac care by providing primary health care to troop central military medical institutions, creating a single register of cardiac patients as part of the Armed Forces in order to determine the order and place of treatment, etc.
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Thoracotomy. Clin Privil White Pap 2013;:1-16. [PMID: 24701653] [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: 06/03/2023]
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Søreide K, Alderson D, Bergenfelz A, Beynon J, Connor S, Deckelbaum DL, Dejong CH, Earnshaw JJ, Kyamanywa P, Perez RO, Sakai Y, Winter DC. Strategies to improve clinical research in surgery through international collaboration. Lancet 2013; 382:1140-51. [PMID: 24075054 DOI: 10.1016/s0140-6736(13)61455-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
More than 235 million patients undergo surgery every year worldwide, but less than 1% are enrolled in surgical clinical trials--few of which are international collaborations. Several levels of action are needed to improve this situation. International research collaborations in surgery between developed and developing countries could encourage capacity building and quality improvement, and mutually enhance care for patients with surgical disorders. Low-income and middle-income countries increasingly report much the same range of surgical diseases as do high-income countries (eg, cancer, cardiovascular disease, and the surgical sequelae of metabolic syndrome); collaboration is therefore of mutual interest. Large multinational trials that cross cultures and levels of socioeconomic development might have faster results and wider applicability than do single-country trials. Surgeons educated in research methods, and aided by research networks and trial centres, are needed to foster these international collaborations. Barriers to collaboration could be overcome by adoption of global strategies for regulation, health insurance, ethical approval, and indemnity coverage for doctors.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
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17
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Dyer C. NHS medical director defends his decision to pause paediatric heart surgery at Leeds. BMJ 2013; 346:f2245. [PMID: 23572096 DOI: 10.1136/bmj.f2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dyer C. Children's heart surgery might restart at Leeds next week. BMJ 2013; 346:f2204. [PMID: 23564933 DOI: 10.1136/bmj.f2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Ueda Y. Perspectives: Professionalism and cardio-thoracic surgery. Gen Thorac Cardiovasc Surg 2012; 61:241-5. [PMID: 23150227 DOI: 10.1007/s11748-012-0179-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Yuichi Ueda
- Tenri Hospital, Tenri Institute of Medical Research, 200 Mishima, Tenri, Nara, 632, Japan.
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20
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Sharma P. Vulnerable groups mustn't become guinea pigs. BMJ 2012; 345:e7380. [PMID: 23132238 DOI: 10.1136/bmj.e7380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Luther A, Hart C, Mann C. Better to modify the EWTD than go to India for surgical experience. BMJ 2012; 345:e7382. [PMID: 23131249 DOI: 10.1136/bmj.e7382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Cohn LH, Eisenhauer A, Donelan K. Choosing a heart surgeon. Harvard experts recommend how to proceed. Harv Heart Lett 2012; 23:4-5. [PMID: 23405431] [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: 06/01/2023]
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Abstract
A chest-trauma management system, tagged as the "Pécs model" in a tertiary referral center is described with extensive references to the state of the art in thoracic trauma. Chest drainage has utmost importance in primary therapy as well as in surgical decision making (diagnosis). Thoracotomy is a general surgical competence, just as damage control is. Definitive treatment and management of sequelae, however, requires competence in thoracic surgery. Multidisciplinarity is underscored.
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Affiliation(s)
- F Tamás Molnár
- Pécsi Tudományegyetem Klinikai Központ, Sebészeti Klinika, Mellkassebészeti Osztály.
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Patel MR, Bailey SR, Bonow RO, Chambers CE, Chan PS, Dehmer GJ, Kirtane AJ, Samuel Wann L, Parker Ward R, Douglas PS, Patel MR, Bailey SR, Altus P, Barnard DD, Blankenship JC, Casey DE, Dean LS, Fazel R, Gilchrist IC, Kavinsky CJ, Lakoski SG, Le DE, Lesser JR, Levine GN, Mehran R, Russo AM, Sorrentino MJ, Williams MR, Wong JB, Wolk MJ, Bailey SR, Douglas PS, Hendel RC, Kramer CM, Min JK, Patel MR, Shaw L, Stainback RF, Allen JM. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, Society of Thoracic Surgeons. J Thorac Cardiovasc Surg 2012; 144:39-71. [PMID: 22710040 DOI: 10.1016/j.jtcvs.2012.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Pulmonary function testing. Clin Privil White Pap 2012;:1-15. [PMID: 23301266] [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: 06/01/2023]
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28
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Doerr F, Badreldin AMA, Bender EM, Heldwein MB, Lehmann T, Bayer O, Brehm BB, Ferrari M, Hekmat K. Outcome prediction in cardiac surgery: the first logistic scoring model for cardiac surgical intensive care patients. Minerva Anestesiol 2012; 78:879-886. [PMID: 22475805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND In the process of risk stratification, a logistic calculation of mortality risk in percentage is easier to interpret. Unfortunately, there is no reliable logistic model available for postoperative intensive care patients. The aim of this study was to present the first logistic model for postoperative mortality risk stratification in cardiac surgical intensive care units. This logistic version is based on our previously presented and established additive model (CASUS) that proved a very high reliability. METHODS In this prospective study, data from all adult patients admitted to our ICU after cardiac surgery over a period of three years (2007-2009) were collected. The Log-CASUS was developed by weighting the 10 variables of the additive CASUS and adding the number of postoperative day to the model. Risk of mortality is predicted with a logistic regression equation. Statistical performance of the two scores was assessed using calibration (observed/expected mortality ratio), discrimination (area under the receiver operating characteristic curve), and overall correct classification analyses. The outcome measure was ICU mortality. RESULTS A total of 4054 adult cardiac surgical patients was admitted to the ICU after cardiac surgery during the study period. The ICU mortality rate was 5.8%. The discriminatory power was very high for both additive (0.865-0.966) and logistic (0.874-0.963) models. The logistic model calibrated well from the first until the 13th postoperative day (0.997-1.002), but the additive model over- or underestimated mortality risk (0.626-1.193). CONCLUSION The logistic model shows statistical superiority. Because of the precise weighing the individual risk factors, it offers a reliable risk prediction. It is easier to interpret and to facilitate the integration of mortality risk stratification into the daily management more than the additive one.
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Affiliation(s)
- F Doerr
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
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Off-pump coronary artery bypass. Clin Privil White Pap 2012;:1-16. [PMID: 22937550] [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: 06/01/2023]
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30
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Griesinger F, Huber RM, Thomas M, Wolf M. [Thoracic oncology - optimization through integrated approaches, quality assurance, and molecular biology. Forward]. Onkologie 2012; 35 Suppl 3:1. [PMID: 22678016 DOI: 10.1159/000338991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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31
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Peripheral and visceral arteriography. Clin Privil White Pap 2012;:1-20. [PMID: 22953369] [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: 06/01/2023]
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32
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Thoracic surgery. Clin Privil White Pap 2012;:1-21. [PMID: 22715526] [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: 06/01/2023]
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33
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Rusch VW, Calhoon JH, Allen MS, Baumgartner W. The American Board of Thoracic Surgery: update. Ann Thorac Surg 2012; 93:363-5. [PMID: 22269700 DOI: 10.1016/j.athoracsur.2011.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 11/10/2011] [Accepted: 11/17/2011] [Indexed: 11/18/2022]
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Abstract
Cardiothoracic surgeons provide care to neonates, children, adults, and the elderly with a range of disorders of the heart, lungs, esophagus, and major blood vessels of the chest. The field of cardiothoracic surgery continues to thrive among the transformations in thoracic and cardiovascular medicine. This article is intended to provide a guide to medical students and physicians on the training, certification, research, and funding opportunities as well as societies and journals specific to cardiothoracic surgery.
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Affiliation(s)
- Sara A Hennessy
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
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Coronary artery stenting. Clin Privil White Pap 2011;:1-16. [PMID: 21961201] [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: 05/31/2023]
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36
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Ivanovic J, Maziak DE, Gilbert S, Shamji FM, Sundaresan RS, Ramsay T, Seely AJE. Assessing the status of thoracic surgical research and quality improvement programs: a survey of the members of the Canadian Association of Thoracic Surgeons. J Surg Educ 2011; 68:258-265. [PMID: 21708361 DOI: 10.1016/j.jsurg.2011.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/26/2011] [Accepted: 02/09/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Assessing the degree of involvement and participation in thoracic surgical research as well as surgical quality improvement conducted across Canadian institutions is difficult as no common data collection system and no prior studies exist. As a pilot investigation, we designed and conducted a membership survey of the Canadian Association of Thoracic Surgeons (CATS) to evaluate the extent of participation in research and quality improvement processes among thoracic surgeons. DESIGN, SETTING, AND PARTICIPANTS A 45-item needs assessment survey was mailed to all national members of CATS (n = 86) in August 2009. Questions primarily focused on clinical research programs and research activity, research funding, database use and interest, and other methods of quality monitoring. RESULTS The 49 completed surveys represented a 57.0% response rate and 28 institutions across Canada. Research in basic and clinical science is conducted by 17.0% and 80.9% of the respondents, respectively. The annual budget of research funds is most commonly between $5000 and $50,000. A total of 72.0% (n = 18) of institutions do not have a formal surgery quality assessment program and 92.3% (n = 24) do not participate in a national or international thoracic surgery database. Ten institutions (38.6%) have a local thoracic surgery database for quality monitoring. Other systems of monitoring surgical quality include formal morbidity and mortality rounds (69.2%; n = 8 institutions), formal evaluation of surgical wait times (73.1%; n = 19 institutions), and patient satisfaction surveys (71.4%; n = 10 institutions). Overall, 97.8% of surgeons would be willing to share data on morbidity and mortality with other centers, and 73.1% have a high or very high level of interest in participating in a national thoracic surgery quality database. CONCLUSIONS A high level of interest and participation exists in thoracic surgery research. However, more robust quality improvement processes are needed for thoracic surgical oncology services. A national thoracic surgery quality improvement database offers a potential means to improve practice effectiveness, standardize surgical outcomes, and promote thoracic research across Canada.
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Affiliation(s)
- Jelena Ivanovic
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, Canada
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Edwards J, Kelly E, Schieman C, Gelfand G, Grondin SC. Do new thoracic surgeons feel ready to operate? Self-reported comfort level of thoracic surgery trainees and junior thoracic surgeons with core thoracic surgery procedures. J Surg Educ 2011; 68:270-281. [PMID: 21708363 DOI: 10.1016/j.jsurg.2011.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 02/03/2011] [Accepted: 02/08/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate and compare self-reported surgical experience and comfort levels of Canadian thoracic surgery trainees and junior thoracic surgeons (<5 years in practice) with respect to core thoracic surgery procedures. METHODS A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents and newly graduated thoracic surgeons. A descriptive summary, including calculation of frequencies, means, proportions, and standard deviations was conducted. Associations between reported experience and comfort level for residents and surgeons were explored separately using the Pearson product moment correlation. The differences between resident and junior surgeons' rating of experience and comfort for each procedure were explored using Fisher exact tests. RESULTS The response rates were 50% for residents and 85% for staff. Adequate or better experience was reported by residents for 9 of 18 core thoracic surgical procedures and by staff for 10 of 18 procedures. A significant difference in self-reported experience level was found between groups for only 1 of 18 procedures. Staff reported that they would confidently perform 7 of 18 procedures independently at the end of their training. The mean resident response did not reach this level of comfort for any of the 18 procedures. Eight of 16 staff had completed extra training, primarily for personal interest, whereas 4 of 6 residents were planning on further training because of job market factors. DISCUSSION The results of this study help to characterize the comfort levels of thoracic trainees and new attending thoracic surgeons with core thoracic procedures and might assist training programs in identifying and improving areas of weakness.
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Affiliation(s)
- Janet Edwards
- Division of General Surgery, University of Calgary, Calgary, Alberta, Canada
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Friberg O, Engström KG, Hentschel J, Freter W, Aberg B, Dahlin LG, Sandin M, Näslund U. [Carath--a quality registry and process support. Good possibility for thoracic surgery to follow the care process]. Lakartidningen 2011; 108:1365-1369. [PMID: 21848186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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39
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Groom R. Culture matters. J Extra Corpor Technol 2011; 43:1. [PMID: 21449227 PMCID: PMC4680084] [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: 05/30/2023]
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40
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Kirgizov IV, Seniakovich VM, Shishkin IA. [High-tech methods in pediatric surgery]. Vestn Ross Akad Med Nauk 2011:44-50. [PMID: 21786605] [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: 05/31/2023]
Abstract
Scientific and technical progress resulting in the introduction of high technologies in medicine radically changed the concept of surgical treatment of children. It is currently based on low-traumatic and minimally invasive methods for surgical intervention. High-tech surgical interventions implies the availability of modern sophisticated equipment and adequate anesthesiological support with comprehensive intraoperative monitoring all vitally important parameters. In the postoperative period, part of the patients need adequate (sometimes long-term) parenteral feeding with the application of long-term Broviak catheters and Space B-Braun systems. The use of this equipment in our Centre makes possible surgical treatment of children at a qualitatively new (low-traumatic and minimally invasive) level and reduce the duration of surgery by 50% compared with traditional methods.
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Affiliation(s)
- Timothy G Ferris
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, USA
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Epstein AJ. Effects of report cards on referral patterns to cardiac surgeons. J Health Econ 2010; 29:718-731. [PMID: 20599284 DOI: 10.1016/j.jhealeco.2010.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 05/28/2023]
Abstract
Patients' choices of specialist physicians may be guided by referring physicians and report cards. I examine referral patterns to cardiac surgeons to assess whether publication of the May 2002 edition of Pennsylvania's Guide to Coronary Artery Bypass Graft Surgery added information to what referring physicians already knew. To do so, I developed a counterfactual scenario, including a simulated analogue report card, based on comparable data from Florida, a state without CABG report cards. My analysis failed to detect a significant change in referral patterns to either low-mortality or high-mortality cardiac surgeons. At the same time, referring physicians on average appear to have been knowledgeable about the relative performance of cardiac surgeons without report cards. Future report card efforts might benefit from incorporating the quality signals contained in referral patterns.
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Affiliation(s)
- Andrew J Epstein
- Yale University, School of Public Health, Division of Health Policy and Administration, New Haven, CT 06520-8034, USA.
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121:e266-369. [PMID: 20233780 DOI: 10.1161/cir.0b013e3181d4739e] [Citation(s) in RCA: 1171] [Impact Index Per Article: 83.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Welke KF, Diggs BS, Karamlou T. Chance, bias, and confounding: threats to valid measurement of quality in the context of pediatric cardiac surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2010; 13:79-83. [PMID: 20307867 DOI: 10.1053/j.pcsu.2010.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Assessment of quality in pediatric cardiac surgery has frequently been an add-on to efforts to measure adult cardiac surgery, without sufficient acknowledgement of the differences between the specialties. As a result, data reporting has often proceeded without adequate attention to data analysis. Assessment of clinical outcomes relies on the methods of observational epidemiology. Interpretation of the results of such investigations requires an understanding of the limitations inherent in the design of observational studies: chance, bias, and confounding. These limitations are of particular importance when studying pediatric cardiac surgery because of the relatively low number of cases performed at any one institution or by any one surgeon, the diversity of operations, and the heterogeneity of the congenital cardiac patient population.
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Affiliation(s)
- Karl F Welke
- Mary Bridge/Swedish Pediatric Cardiothoracic Surgery Program, Mary Bridge Children's Hospital and Health Center, 311 South L Street, Tacoma, WA 98415, USA.
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45
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Coronary artery bypass graft. Clin Privil White Pap 2010;:1-12. [PMID: 20187311] [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: 05/28/2023]
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46
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Anderson HJ. Measuring what works. A community hospital dives into data to come up with cardiac best practices and guide treatment decisions. Health Data Manag 2009; 17:32. [PMID: 19998770] [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: 05/28/2023]
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Lindblom D. [Heart surgery in Sudan. Experiences from a highly specialized cardiac surgical centre managed by an Italian humanitarian organization]. Lakartidningen 2009; 106:2370-2373. [PMID: 19848344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Dan Lindblom
- Thoraxkliniken, Karolinska universitetssjukhuset, Solna.
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48
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Maze procedure. Clin Privil White Pap 2009;:1-12. [PMID: 19621502] [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: 05/28/2023]
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49
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Myles PS. Bispectral index monitoring in ischemic-hypoxic brain injury. J Extra Corpor Technol 2009; 41:P15-P19. [PMID: 19361035 PMCID: PMC4680226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The BIS monitor is a simple-to-use and widely available monitor used in cardiac surgery. It can provide useful new information regarding the patient's hypnotic state, but also other components of brain function. The detection of cerebral hypoperfusion is of prime importance to perfusionists and others caring for patients undergoing cardiac surgery. BIS values consistent with the anesthetic drug and dose administration should reflect adequate cerebral perfusion and function. Abnormally low or a sudden deterioration in BIS values probably indicate cerebral hypoperfusion and should be taken seriously. A growing number of anecdotal reports and small case series support these contentions, but large prospective outcome studies are needed before this technology can be reliably used to monitor cerebral perfusion and other aspects of brain function during surgery.
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Affiliation(s)
- Paul S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
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O'Dowd A. Publishing data on patient survival does not deter surgeons from taking difficult cases. BMJ 2008; 337:a583. [PMID: 18595944 PMCID: PMC2443572 DOI: 10.1136/bmj.a583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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