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Vassiliades TA, Block PC, Cohn LH, Adams DH, Borer JS, Feldman T, Holmes DR, Laskey WK, Lytle BW, Mack MJ, Williams DO. The Clinical Development of Percutaneous Heart Valve Technology. Ann Thorac Surg 2005; 79:1812-8. [PMID: 15854994 DOI: 10.1016/j.athoracsur.2005.02.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ahberg T, Hentschel J, Engström G. [Introduction of electronic monitoring increased interest for quality work. Nine-year-registration at Hjartcentrum indicates improved medical results]. LAKARTIDNINGEN 2005; 102:26-9. [PMID: 15707103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Medical, administrative and economic data in a cardio-thoracic unit were followed for 9 years in an extensive monitoring system. Several changes in the practice could be observed. There was a general improvement in total quality factors seen as decreased complication rate especially in normal patients, a change in case mix towards older and more complicated patients and a decrease in the costs. The monitoring was a prerequisite for following, initiating and controlling changes. The article is published in English in Interactive Cardiovascular and Thoracic Surgery.
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Shilova MV, Khruleva TS, Tsybikova EB. [Surgical aid to patients with respiratory tuberculosis]. PROBLEMY TUBERKULEZA I BOLEZNEI LEGKIKH 2005:31-6. [PMID: 15988975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Darling GE, Maziak DE, Clifton JC, Finley RJ. The practice of thoracic surgery in Canada. Can J Surg 2004; 47:438-45. [PMID: 15646443 PMCID: PMC3211597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The objective of the consensus conference of the Canadian Association of Thoracic Surgeons (CATS) was to define the scope of thoracic surgery practice in Canada, to develop standards of practice, to define training and resource requirements for the practice of thoracic surgery in Canada and to determine appropriate waiting times for thoracic surgery care. A meeting of the CATS membership was held in September 2001 to address issues facing thoracic surgeons practising in Canada. The discussion was facilitated by an expert panel of surgeons and supplemented by a survey. At the end of the meeting, consensus was reached by the membership regarding the issues outline above. The membership agreed that the scope of practice includes diagnosis and management of conditions of the lungs, mediastinum, pleura and foregut. They agreed that appropriate training in thoracic surgery included completion and certification in general or cardiac surgery prior to completing a 2-year program in thoracic surgery. The membership supported the Canadian Society of Surgical Oncology recommendations for management of cancer patients that new patients should be seen within 2 weeks of referral and cancer therapy initiated within 2 weeks of consultation. Thoracic surgical care is best delivered by 2 or 3 fully certified thoracic surgeons, in regional centres linked to a cancer centre and trauma unit. The establishment of a critical mass of thoracic surgeons in each centre would lead to improved quality and delivery of care and allow for adequate coverage for on-call and continuing medical education.
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Lee DY, Paik HC, Kim DH, Kim HW. Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetic clipping in treatment of palmar hyperhidrosis. Clin Auton Res 2004; 13 Suppl 1:I45-7. [PMID: 14673673 DOI: 10.1007/s10286-003-1115-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Compensatory sweating is a major complaint following endoscopic thoracic sympathetic surgery in treatment of palmar hyperhidrosis. T3 ramicotomy was applied in order to decrease compensatory sweating. From Oct 1999 to June 2002, forty patients underwent T3 sympathetic clipping (group I), and 68 patients underwent T3 ramicotomy (group II) to treat palmar hyperhidrosis. We retrospectively analyzed the rate of satisfaction, result of operation, and grade of compensatory sweating. In group I, 36 patients (90%) showed decreased sweating on both hands, 4 patients (10 %) persistent sweating on both hands. In group II, 46 patients (67.6%) had decreased sweating on both hands, 14 patients (23.5 %) had persistent sweating on both hands, and 8 patients (8.9 %) had persistent sweating in one hand. The rate of satisfaction was 82.5 % (33/40) in group I and 67.6 % (46/68) in group II with no significant statistic difference (p = 0.067). Excluding patients with persistent sweating postoperatively, the rate of compensatory sweating in group II was 67.4%, which was significantly lower than in group I 94.1%, with a p value of 0.003. Although the rate of persisting sweating after operation was high, T3 ramicotomy resulted in lower rate of compensatory sweating compared to T3 sympathetic clipping.
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Off-pump coronary artery bypass. CLINICAL PRIVILEGE WHITE PAPER 2004:1-8. [PMID: 15002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Crawford FA. Presidential address: thoracic surgery education—responding to a changing environment. J Thorac Cardiovasc Surg 2003; 126:1235-42. [PMID: 14665985 DOI: 10.1016/s0022-5223(03)00814-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Piotrowski J. Heartening outcomes. Solucient's annual list of top cardiac hospitals sets benchmarks for reducing complications, cutting costs and saving lives. MODERN HEALTHCARE 2003; 33:20-2, 26, 28. [PMID: 14626612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Ferguson TB. The Society of Thoracic Surgeons' National Cardiac Database: provider engagement in continuous quality improvement. THE AMERICAN HEART HOSPITAL JOURNAL 2003; 1:180-2. [PMID: 15815140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Watts M, Kornovski B. New pressures for hospital boards of directors. HEALTH LAW IN CANADA 2001; 22:5-7. [PMID: 11550587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Brunelli A, Fianchini A, Al Refai M, Gesuita R, Carle F. Internal comparative audit in a thoracic surgery unit using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM). Eur J Cardiothorac Surg 2001; 19:924-8. [PMID: 11404154 DOI: 10.1016/s1010-7940(01)00682-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE The aim of the study was to use the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) to assess the performance of our thoracic surgery unit during two successive periods of activity. METHODS From 1992 through 1997, 801 candidates for thoracic procedures at our institution were considered for the study. After validation of the logistic regression model, including the POSSUM score, observed and POSSUM-predicted morbidities were compared within two groups of patients divided by year of operation (group 1: 1992-1994, n=362; group 2: 1995-1997, n=439) by means of the z-test for the comparison of a proportion with an expected value. RESULTS The POSSUM-predicted morbidity was significantly lower than the observed one in the first period of activity of our unit (19.6 vs. 24.3%, respectively; z-test for the comparison of a proportion with an expected value, 2.25; P=0.01), whereas no difference was found in the second period (20.5 vs. 19.1%, respectively; z-test for the comparison of a proportion with an expected value, -0.71; P=0.76). CONCLUSIONS The result suggests a worse-than-expected performance of our unit in the first period of activity, showing that POSSUM can be reliably applied as an instrument of internal comparative audit in a thoracic surgery unit.
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Thomas N, Bernard Y. Pediatric simple open heart surgery critical pathway. HOSPITAL CASE MANAGEMENT : THE MONTHLY UPDATE ON HOSPITAL-BASED CARE PLANNING AND CRITICAL PATHS 2001; 9:55, 58, 50. [PMID: 11299984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
In 1997, administrators discovered that DRG 108 (other major cardiothoracic procedures), which includes many of the surgical repairs for congenital heart disease, was one of the biggest money losers for Vanderbilt Children's Hospital, resulting in a loss of approximately $1 million dollars per year. Time for action.
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Cordoş I, Saon C, Paleru C, Posea R, Stoica R, Ulmeanu R, Crişan E, Dănăilă E, Orghidan M, Alexe M, Bliorţ S. [The indications of bronchial resection and anastomosis in lung cancer]. PNEUMOLOGIA (BUCHAREST, ROMANIA) 2001; 50:109-14. [PMID: 11584670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients with severe impairment of pulmonary function and/or other diseases which make such radical surgery too risky. The authors present two clinical cases of right upper lobe lung cancer (a squamous-cell carcinoma and an adenocarcinoma) admitted in the Thoracic Surgery Department of the National Institute of Pulmonology "Marius Nasta" from Jan-March 2001, in which they could not perform pneumonectomy because of unacceptable high risks. In both patients a right upper lobectomy with "sleeve" resection was done, with the anastomosis of right main bronchus to the intermediary one. The clinical, bronchoscopic and functional results were excellent. The literature review also shows very good results of this technique in the surgical treatment of lung cancer. For these reasons, the authors recommend this procedure in all the cases in which it can be technically applied; more than that, the survival rate is similar with other more radical techniques, but without any complications.
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Virginia hospitals join to create data repository for cardiac surgery. CLINICAL RESOURCE MANAGEMENT 2001; 2:44-6, 33. [PMID: 11301583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Initiative shares best practices among 17 hospitals and 10 surgery groups.
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Abstract
PURPOSE Despite their popularity, critical pathways have been evaluated in only a few controlled studies. We evaluated the effectiveness of critical pathways in reducing length of hospital stay. SUBJECTS AND METHODS We compared postoperative lengths of stay of patients who underwent coronary artery bypass graft (CABG) surgery, total knee replacement, colectomy, thoracic surgery, or hysterectomy before and after pathway implementation at a university hospital. For three procedures, changes in lengths of stay at neighboring hospitals without pathway programs were assessed for comparison. RESULTS A total of 6,796 patients underwent one of the procedures during the study. The percentage of eligible patients managed on a critical pathway ranged from 94% for hysterectomy to 26% for colectomy. For most procedures, the postoperative length of stay was decreasing during the baseline period. After pathway implementation, the length of stay decreased 21% for total knee replacement, 9% for CABG surgery, 7% for thoracic surgery, 5% for hysterectomy, and 3% for colectomy (all P < 0.01). However, similar decreases were seen in the neighboring hospitals that did not have critical pathways or other specific efficiency initiatives. CONCLUSIONS Critical pathways were associated with a rapid reduction in postoperative length of stay after all five study procedures. Secular trends at nearby hospitals, however, produced comparable reductions for the three procedures available for comparison. These findings raise questions about the effectiveness of critical pathways in a competitive environment.
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Segadal L. Is there a place for a Scandinavian Association for Thoracic Surgery? SCAND CARDIOVASC J 2000; 34:363-4. [PMID: 10983668 DOI: 10.1080/14017430050196162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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DeBois WJ, Girardi LN, Lawrence S, McVey J, Cahill A, Elmer B, Zanichelli M. Perfusion method for thoracoabdominal aneurysm repair using the open distal technique. Perfusion 2000; 15:231-6. [PMID: 10866425 DOI: 10.1177/026765910001500308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Challenges related to perfusion support of thoracoabdominal aneurysm repair include maintenance of distal aortic perfusion, rapidity of fluid resuscitation, and avoidance of both hypothermia and excessive hemodilution. Using available technology, we have devised a circuit and protocol that addresses these issues. To accomplish such support a bypass circuit consisting of 3/8 inch tubing connected to a centrifugal pump and low-prime heat exchanger was constructed. The circuit was primed via 1/4 inch spiked connectors attached to a 3-liter bag of normal saline. After initial de-airing, the solution was recirculated through this bag. Patients were anticoagulated with 1 mg/kg of heparin prior to initiation of support. Left atrial-descending aorta bypass was used primarily. A cell salvage device was used for autotransfusion. All blood products were delivered via a rapid infusion device. During partial exsanguination, shed blood was not processed, but directed to the rapid infusor for immediate retransfusion. Any packed cells given were washed prior to transfusion. Citrate dextrose solution was used as an anticoagulant for the cell scavenger. This configuration was used successfully in 50 procedures during an 18-month period. Use of this low-prime, custom circuit reduced both hemodilution and cost. A connection off the cell salvage pump offers fast retransfusion of shed blood during partial exsanguination. Minimal heparinization and citrate anticoagulation appears to reduce coagulopathy.
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Wallentin L, Nilsson T, Bergfeldt L, Thorvinger B, Held C, Bergstrand L, Nilsson G, Fransson SG, Sonnhag C, Albertsson P. [Use of percutaneous coronary vessel interventions should be increased. 400 interventions per year is a minimum capacity of decentralized services]. LAKARTIDNINGEN 1999; 96:4928-32. [PMID: 10596534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Ceci V, Chieffo C, Giannuzzi P, Boncompagni F, Jesi P, Schweiger C, Assennato P, Griffo R, Scrutinio D. [Standards and guidelines for cardiac rehabilitation. Working Group on Cardiac Rehabilitation of the European Society for Cardiology]. CARDIOLOGIA (ROME, ITALY) 1999; 44:579-84. [PMID: 10443056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Arén C. [Quality projects of the Swedish registry on heart surgery. To study other clinics is to learn, not to judge]. LAKARTIDNINGEN 1999; 96:2498-502. [PMID: 10380497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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