The purpose of this study was to analyze a nationwide database of malpractice lawsuits involving pediatric surgical patients to identify contributing factors in liability claims.
Using the CRICO ...(Controlled Risk Insurance Company Strategies’ Comparative Benchmarking System) database, malpractice claims involving patients ≤18 y old were reviewed from 2008 to 2017. Data were analyzed using descriptive statistics and logistic regression.
Of the 844 claims, 76% of the patients were older than age 5. While the average total indemnity paid was $544,325, cases with claimants <1-year-old accounted for 24% of the total indemnity paid, with an average of $1,135,240 per claimant. The most frequently named responsible services were Orthopedics (34%), General Surgery (15%), and Otolaryngology (11%). Fracture or dislocation, appendectomy, skin/breast surgery, arthroscopy, and tonsillectomy/adenoidectomy were among the frequently involved procedures for the cohort of cases. The most common contributing factors for the top procedures involve issues surrounding patient assessment, technical performance, and communication. Cases with a contributing factor of failure to appreciate and reconcile relevant sign/symptom/test results were associated with a higher likelihood of payment (OR 6.6, P < 0.05). Issues surrounding the selection of therapy also led to an increased likelihood of an indemnity payment (OR 2.8, P < 0.05).
Malpractice claims related to pediatric surgical procedures involve a wide range of specialties. Patient evaluations, technical performance, and communication are modifiable factors to improve surgical care in children. The contributing factors assigned to each procedure may represent an opportunity for focused improvement to improve patient outcomes.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potential adjunct in pediatric trauma patients with noncompressible truncal and pelvic hemorrhage; however, there are little ...data evaluating the anatomic considerations of REBOA in children. We evaluated the vascular dimensions and anatomic limitations of using REBOA in children.
Computed tomography scans of pediatric patients performed between February 2016 and October 2019 were retrospectively reviewed by two investigators. Vascular measurements included diameters of aorta zones I and III, common iliac arteries, external iliac arteries, and common femoral arteries (CFAs), and distances between access site (CFA) and aorta zones I and III. Measurements were grouped within Broselow categories, based upon patient height. Interrater reliability for measurements was determined using intraclass correlation coefficients. Vascular dimensions were correlated with the patient's height, weight, and body mass index using linear regression analysis.
A total of 557 computed tomography scans met the inclusion criteria and were reviewed. Measurements of vessel diameter and distance from the CFA to aorta zones I and III were determined and grouped by Broselow category. Patient age ranged from 0 to 18 years, with a male to female ratio of 1:1. Overall interrater reliability of vessel measurements was good (average intraclass correlation coefficient, 0.90). Vessel diameter had greatest correlation with height (R2 = 0.665, aorta zone I; R2 = 0.611, aorta zone III) and poorly correlated with body mass index (R2 = 0.318 and R2 = 0.290, respectively).
This study represents the largest compilation of REBOA-related pediatric vessel diameter measurements and the first to provide data on distance between access site and balloon deployment zones. Based on our findings, the 7-Fr REBOA catheter would be appropriate for the Black, Green, and Orange Broselow categories, and a 4-Fr REBOA catheter would be warranted for Yellow, White, and Blue Broselow categories.
Prognostic and epidemiological, level III.
Ventriculoperitoneal shunt (VPS) placement into the reoperative abdomen can be challenging due to intraperitoneal adhesions. Laparoscopic guidance may provide safe abdominal access and identify an ...area for optimal cerebrospinal fluid drainage. The study aim was to compare laparoscopic-assisted VPS placement to an “open” approach in patients with prior abdominal surgery.
A retrospective review was performed of children undergoing VPS placement into a reoperative abdomen from 2009-2019. Clinical data were collected, and patients undergoing laparoscopy (LAP) were compared to those undergoing an open approach (OPEN).
A total of 120 children underwent 169 VPS placements at a median age of 8 y (IQR 2-15 y), and a mean number of two prior abdominal operations (IQR 1-2). Laparoscopy was used in 24% of cases. Shunt-related complications within 30 d were lower in the LAP group (0% versus 19%, P = 0.001), as were VPS-related postoperative emergency department visits (0% versus 13%, P = 0.003) and readmissions (0% versus 13%, P = 0.013). Shunt malfunction rates were higher (42% OPEN versus 25% LAP, P = 0.03) and occurred sooner in the OPEN group (median 26 versus 78 wk, P = 0.01). The LAP group demonstrated shorter operative times (63 versus 100 min, P < 0.0001), and the only bowel injury. Time to feeds, length of stay, and mortality were similar between groups.
Laparoscopic guidance during VPS placement into the reoperative abdomen is associated with a decrease in shunt-related complications, longer shunt patency, and shorter operative times. Prospective study may clarify the potential benefits of laparoscopy in this setting.
Gelsolin (GSN) has been implicated in inflammatory reactions in asthmatic patients and may be a marker for acute or chronic reactions in synovial tissue. Detection of increased levels of GSN in ...synovial fluid could differentiate between aseptic loosening (low GSN) and hypersensitivity reaction (high GSN). Synovial fluid from both knees of 7 cadaver specimens with unilateral TKA was analyzed using ELISA for GSN levels. Components were explanted after spiral CT scans to determine wear patterns and loosening. Results were compared to synovial fluid from 7 consecutive TKA revisions for aseptic failure. Average GSN levels for cadaver native and well-functioning TKA knees were 24,534±10,437 ng/mL and 38,430±30,907 ng/mL, respectively (p=0.314). Average GSN level for revision patients was 53,294±19,868 ng/mL, significantly higher than cadaver well-functioning TKAs (p=0.006). The patient with the highest level of GSN at time of revision surgery showed significant metallosis at the time of surgery.
Thyroid carcinoma Sherman, Steven I; Angelos, Peter; Ball, Douglas W ...
Journal of the National Comprehensive Cancer Network
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Journal Article
Introduction
The purpose of this study was to evaluate the use of a cadaveric teaching model for needle compression of pneumothorax simulated by thoracoscopy.
Materials and methods
A standardized ...didactic instruction was provided to medical personnel participants at a single institution tertiary medical center. A thoracoscope was inserted into cadavers and insufflated to 20 mm Hg for simulation of a tension pneumothorax. The study participants performed six needle decompressions (3 anterior, 3 lateral), which were all directly observed thoracoscopically. Demographic data and post-surveys were obtained. The primary endpoint was participant assessment of this teaching model for a simulated pneumothorax. Secondary endpoints were successful decompression of the pneumothorax, perceived success of each attempt, and injury to intrathoracic structures.
Results
Forty participants completed 240 attempted decompressions. Participants reported that 43% had taken ATLS, and 63% had performed a needle decompression on a simulated patient prior to this study. The rate of successful decompressions was 85.86%. Participants reported a perceived successful completion rate of 82%. 73.7% performed this safely, while 88.5% perceived that they performed it safely. 85.7% stated that they felt more confident and capable after the study.
Conclusion
A simulated model is essential for adequate teaching. Our use of a thoracoscopic cadaveric model provides a realistic simulation of the pneumothorax used for training. Participants had similar rates of actual completion and perceived completion including higher rates of perceived safety. Further use of this model as a teaching tool will potentially improve the success of this life-saving procedure.
Animal models of fibrotic lung disease B Moore, Bethany; Lawson, William E; Oury, Tim D ...
American journal of respiratory cell and molecular biology
49, Številka:
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Journal Article
Recenzirano
Odprti dostop
Interstitial lung fibrosis can develop as a consequence of occupational or medical exposure, as a result of genetic defects, and after trauma or acute lung injury leading to fibroproliferative acute ...respiratory distress syndrome, or it can develop in an idiopathic manner. The pathogenesis of each form of lung fibrosis remains poorly understood. They each result in a progressive loss of lung function with increasing dyspnea, and most forms ultimately result in mortality. To better understand the pathogenesis of lung fibrotic disorders, multiple animal models have been developed. This review summarizes the common and emerging models of lung fibrosis to highlight their usefulness in understanding the cell-cell and soluble mediator interactions that drive fibrotic responses. Recent advances have allowed for the development of models to study targeted injuries of Type II alveolar epithelial cells, fibroblastic autonomous effects, and targeted genetic defects. Repetitive dosing in some models has more closely mimicked the pathology of human fibrotic lung disease. We also have a much better understanding of the fact that the aged lung has increased susceptibility to fibrosis. Each of the models reviewed in this report offers a powerful tool for studying some aspect of fibrotic lung disease.
Accelerometer-Determined Steps/Day and Metabolic Syndrome Sisson, Susan B., PhD; Camhi, Sarah M., PhD; Church, Timothy S., MD, MPH, PhD ...
American journal of preventive medicine,
06/2010, Letnik:
38, Številka:
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Background There is a lack of knowledge about the relationship between objectively measured physical activity and the odds of having metabolic syndrome (MetS) and cardiovascular (CVD) risk factors. ...Purpose This study aims to investigate associations between accelerometer-determined steps/day and the odds of having MetS and its individual CVD risk factors in the U.S. population. Methods Adults in 2005–2006 NHANES with accelerometer-determined steps/day and measurements necessary to determine MetS by AHA/NHLBI were included ( n =1446, 48.2% men, 33.5% with MetS, mean age=47.5 years, mean BMI=28.7 kg/m2 ). Logistic regression was used to estimate the odds of having MetS or abnormal CVD risk factors from incrementally higher levels of steps/day. Results MetS prevalence decreased as steps/day increased ( p <0.0001), with 55.7% of participants in the lowest categoric level of steps/day and 13.3% in the highest level having MetS. The odds of having MetS were 10% lower for each additional 1000 steps/day (OR=0.90, 95% CI=0.86, 0.93). The likelihood of having MetS was OR=0.28 (95% CI=0.18, 0.44) for active to highly active and 0.60 (0.43, 0.82) for low to somewhat-active compared to sedentary adults ( p <0.0001). Adults who took more steps/day tended to have lower waist circumference, higher high-density lipoprotein (HDL) cholesterol level, and lower levels of triglycerides. Conclusions Adults who maintain an active lifestyle by accumulating more steps are likely to have a lower prevalence of MetS and its individual CVD risk factors. Although other concomitant lifestyle behaviors may influence this lower prevalence, the evidence presented here on steps/day and metabolic syndrome, and elsewhere on physical activity and other health and disease states, suggest that it is a fundamental component of daily living.
The median survival of patients with idiopathic pulmonary fibrosis (IPF) continues to be approximately 3 years from the time of diagnosis, underscoring the lack of effective medical therapies for ...this disease. In the United States alone, approximately 40,000 patients die of this disease annually. In November 2012, the NHLBI held a workshop aimed at coordinating research efforts and accelerating the development of IPF therapies. Basic, translational, and clinical researchers gathered with representatives from the NHLBI, patient advocacy groups, pharmaceutical companies, and the U.S. Food and Drug Administration to review the current state of IPF research and identify priority areas, opportunities for collaborations, and directions for future research. The workshop was organized into groups that were tasked with assessing and making recommendations to promote progress in one of the following six critical areas of research: (1) biology of alveolar epithelial injury and aberrant repair; (2) role of extracellular matrix; (3) preclinical modeling; (4) role of inflammation and immunity; (5) genetic, epigenetic, and environmental determinants; (6) translation of discoveries into diagnostics and therapeutics. The workshop recommendations provide a basis for directing future research and strategic planning by scientific, professional, and patient communities and the NHLBI.
Net photosynthesis, growth, and ultraviolet (UV) radiation absorbance were determined for the first leaf of Cucurbita pepo L. exposed to two levels of UV-B irradiation and a UV-B radiation-free ...control treatment. Absorbance by extracted flavonoid pigments and other UV-B radiation-absorbing compounds from the first leaves increased with time and level of UV-B radiation impinging on leaf surfaces. Although absorbance of UV-B radiation by extracted pigments increased substantially, UV-B radiation attenuation apparently was insufficient to protect completely the photosynthetic apparatus or leaf growth processes. Leaf expansion was repressed by daily exposure to 1365 Joules per meter per day of biologically effective UV-B radiation but not by exposure to 660 Joules per meter per day. Photosynthesis measured through ontogenesis of the first leaf was depressed by both UV-B radiation treatments. Repression of photosynthesis by UV-B radiation was especially evident during the ontogenetic period of maximum photosynthetic activity.
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