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41.
Leo Andrew Benedict Joseph A. Sujka Justin A. Sobrino Hanna Alemayehu Pablo Aguayo Richard Hendrickson Shawn D. St. Peter Tolulope A. Oyetunji 《Journal of pediatric surgery》2021,56(4):663-667
PurposePrevious reports in the literature demonstrate racial and ethnic disparities for children diagnosed with acute appendicitis, with minorities experiencing worse outcomes. At our institution, we have developed an evidence based patient driven protocol for children following laparoscopic appendectomy. However, the influence of such protocol on mitigating racial and ethnic disparities in outcomes remains unknown. The purpose of our study is to assess the impact of our protocol by evaluating the influence of race and ethnicity on surgical outcomes among children treated for acute appendicitis.Material and methodsA retrospective review of prospectively collected data was conducted. Children undergoing a laparoscopic appendectomy at our freestanding children's hospital between December 2015 and July 2017 were included. Demographic data, post-operative length of stay, same day discharge rates and hospital readmission rates were abstracted from patient medical records. Patients were classified by their race and ethnic background. Comparative analysis was performed in STATA with a p value < .05 determined as significant.ResultsA total of 786 children were included, with the majority being either White (70%, n = 547), Black (8%, n = 62) or Hispanic (17%, n = 133); 569 patients (72%) were found to have non-perforated appendicitis. There was no statistically significant difference in the rates of same day discharge among White, Black or Hispanic children respectively (88% vs. 77% vs. 86%, p = .126). Of the 217 children with perforated appendicitis, Hispanic children had increased rates of perforation (41%, n = 55) compared to White and Black children respectively (23%, n = 128 and 29%, n = 18, p = .001). However, average post-operative length of stay were similar among White, Black and Hispanic children (96 h vs. 95 h vs. 98 h, p = .015). On multivariate analysis, the only significant risk factor for an elevated post-operative length of stay was the presence of a perforation.ConclusionOur evidence based patient driven protocol effectively mitigates racial and ethnic disparities found in children with acute appendicitis. Further prospective investigation into the role of such patient-driven protocols to mitigate healthcare disparities is warranted.Levels of EvidenceTherapeutic study; Level 3. 相似文献
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Herremans Kelly M. Cribbin Morgan P. Riner Andrea N. Neal Dan W. Hollen Tracy L. Clevenger Pamela Munoz Derly Blewett Shannon Giap Fantine Okunieff Paul G. Mendenhall Nancy P. Bradley Julie A. Mendenhall William M. Mailhot-Vega Raymond B. Brooks Eric Daily Karen C. Heldermon Coy D. Marshall Julia K. Hanna Mariam W. Leyngold Mark M. Virk Sarah S. Shaw Christiana M. Spiguel Lisa R. 《Annals of surgical oncology》2021,28(10):5775-5787
Annals of Surgical Oncology - Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach... 相似文献
45.
Elżbieta Tabor Hanna Hűpsch Joanna Rokicka Teresa Sierpińska Jerzy Konstantynowicz Karolina Orywal Wojciech Pluskiewicz 《Journal of clinical densitometry》2021,24(1):14-21
Aim: The aim of the study was to investigate whether salivary mineral content may be associated with bone status in women after menopause. Material and methods: The study group consisted of 125 postmenopausal women aged 64.3 ± 6.9 yr, derived from the epidemiological SilesiaOsteoActive Study. All participants underwent hip and spine bone densitometry using dual energy X-ray absorptiometry, dental examination, and saliva content analysis. Data for salivary pH, copper, calcium, phosphorus, and zinc concentrations were evaluated. Results: Mean femoral neck bone mineral density (BMD) was 0.739 ± 0.118 g/cm2, total hip BMD 0.891 ± 0.14 g/cm2, and spine BMD 0.868 ± 0.14 g/cm2. Salivary pH was significantly lower in women with spinal osteoporosis defined as T-score below ?2.5, compared to individuals with normal BMD (pH: 6.65 ± 0.67 vs 6.96 ± 0.58, p < 0.05). There was a significant though weak inverse correlation between Ca concentration in saliva and femoral neck BMD (r = ?0.23, p < 0.05). Conclusions: High salivary calcium content and low salivary pH may be indicative of low hip and decreased spine BMD, respectively. These associations may reflect demineralization process (calcium redistribution) influencing bone, and a negative effect of acidity on mineral tissues, although causal pathway remains not clear. 相似文献
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This paper presents findings from a study investigating differences in the importance of nineteen criteria in the choice of professionals from three professional groups--physicians, dentists, and lawyers. Knowledge is the most important for all three groups but is less so for doctors. Discussions about the problem and its treatment are both less important for dentists. Six characteristics of professional service providers are used to explain differences. 相似文献
48.
P53 overexpression as an indicator of overall survival and response to treatment in osteosarcomas 总被引:5,自引:0,他引:5
Pápai Z Féja CN Hanna EN Sztán M Oláh E Szendrôi M 《Pathology oncology research : POR》1997,3(1):15-19
The p53 gene located at chromosome 17pl3 is found to be altered (allelic loss or other mutation) in multiple human cancers,
including osteosarcomas. The mutated gene produces a protein with a prolonged half-life thus rendering it detectable by conventional
immunohistochemistry. We examined the correlation between p53 expression and clinical prognosis as well as response to therapy.
Twentyone patients with previously untreated and histologically verified highly malignant osteosarcoma were used for this
study. Biopsy material taken both prior to the start of COSS 91 protocol and at the time of surgery (ten weeks later) was
examined for alterations in p53 protein expression and drug resistance. Two patients who had strong (+++) p53 protein expression
and three others who became positive during the chemotherapy had significantly worse prognosis (all of them died within one
year) than those who showed no p53 expression both at biopsy and after chemotherapy (all 11 patients are alive, average follow-up
time: 3.5 years). All patients who showed any kind of positive p53 protein expression on initial biopsy were non-respon-ders
to chemotherapy. In contrast, 69% (9 out of 13) of those who exhibited no p53 expression on initial biopsy were responders
or intermediate responders to chemotherapy. We concluded that p53 expression may be a useful prognostic factor in osteosarcomas.
The direct correlation between p53 positive expression and resistance to therapy can help in identifying patients who are
in need of a more vigorous or different chemotherapeutical protocol. 相似文献
49.
This paper presents the results of an exploratory study designed to (1) ascertain the primary sources of information patients use when selecting physicians and (2) identify differences in patient selection factor importance by type of physician under consideration (specialists versus generalists). The results support previous research which finds word-of-mouth and physician referrals the primary sources of information. Selection factors considered important when selecting a generalist were significantly different from factors considered important when selecting a specialist. Implications of the study's findings for effective physician marketing and future research are discussed. 相似文献
50.
Kerr M Johnson B Martin C Hanna B Swanson D Deutsch M 《Journal of healthcare materiel management》1994,12(11):28, 30, 32-28, 30, 33
St. Paul-Ramsey Medical Center in St. Paul, MN became one of the first hospitals in the United States to initiate a "stockless" par level inventory system. Successes with stockless led the hospital to look at implementing it in the OR to achieve a reduction of expense to revenue. Materiel Management and Surgical Services discussed a number of issues relevant to implementing a stockless program, including product flow, accuracy and cost of case carts and preference cards, item pricing, committed usage of items brought into the system and establishment of a steering committee. Specific OR issues and practices required evaluation and adjustment, such as the routine use of emergency direct ordering. Information systems support was brought in and a products committee established to do education and oversee the program. Savings for 1993-94 were $185,146. 相似文献