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IMPORTANCE: Delayed autotransplantation of cryopreserved parathyroid tissue (DACP) is the only surgical treatment for permanent postoperative hypoparathyroidism. Studies suggest that only a small minority of cryopreserved samples are ultimately autotransplanted with highly variable outcomes. For these reasons, many have questioned the economic utility of the process, although, to the authors’ knowledge, this has never been formally studied. OBJECTIVE: To report the clinical outcomes of parathyroid cryopreservation and DACP at a large academic institution and to determine the cost-effectiveness of this treatment. DESIGN, SETTING, AND PARTICIPANTS: An institutional review board–approved, retrospective review of patients at a single institution who underwent DACP over a 17-year period was conducted with a median follow-up of 48.2 months. A forward-looking cost-utility analysis was then performed to determine the economic utility of cryopreservation/DACP vs usual care (monitoring and supplementation). Patients who had parathyroid tissue in cryopreserved storage between August 2005 to September 2022 at a single-center, academic, quaternary care center were identified. EXPOSURE: Parathyroid cryopreservation and DACP. MAIN OUTCOMES AND MEASURES: Graft functionality, clinical outcomes, and cost utility using a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY). RESULTS: A total of 591 patients underwent cryopreservation. Of these, 10 patients (1.7%; mean [SD] age, 45.6 [17.9] years; 6 male [60%]) underwent DACP. A minority of autografts (2 [20%]) were subsequently fully functional, one-half (5 [50%]) were partially functional, and 3 (30%) were not functional. The cost-utility model estimated that at a large academic center over 10 years, the additional cost of 591 patients undergoing cryopreservation and 10 patients undergoing autotransplantation would be $618 791.64 (2022 dollars) and would add 8.75 QALYs, resulting in a cost per marginal QALY of $70 719.04, which is less than the common willingness-to-pay threshold of $100 000/QALY. CONCLUSIONS AND RELEVANCE: The reimplantation rate of cryopreserved tissue was low (<2%), but when implanted, autografts were at least partially functional 70% of the time. In the first-ever, to the authors’ knowledge, formal cost analysis for this treatment, results of the current model suggest that cryopreservation and autotransplantation were cost-effective compared with the usual care for hypoparathyroidism at a large, academic institution. It is recommended that each surgical center consider whether the economic and logistical commitments necessary for cryopreservation are worthwhile for their individual needs.

IMPORTANCE: Use of postoperative antimicrobial prophylaxis is common in pediatric surgery despite consensus guidelines recommending discontinuation following incision closure. The association between postoperative prophylaxis use and surgical site infection (SSI) in children undergoing surgical procedures remains poorly characterized. OBJECTIVE: To evaluate whether use of postoperative surgical prophylaxis is correlated with SSI rates in children undergoing nonemergent surgery. DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter cohort study using 30-day postoperative SSI data from the American College of Surgeons’ Pediatric National Surgical Quality Improvement Program (ACS NSQIP-Pediatric) augmented with antibiotic-use data obtained through supplemental medical record review from June 2019 to June 2021. This study took place at 93 hospitals participating in the ACS NSQIP-Pediatric Surgical Antibiotic Prophylaxis Stewardship Collaborative. Participants were children (<18 years of age) undergoing nonemergent surgical procedures. Exclusion criteria included antibiotic allergies, conditions associated with impaired immune function, and preexisting infections requiring intravenous antibiotics at time of surgery. EXPOSURES: Continuation of antimicrobial prophylaxis beyond time of incision closure. MAIN OUTCOMES AND MEASURES: Thirty-day postoperative rate of incisional or organ space SSI. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for SSI rates and postoperative prophylaxis use. SSI measures were adjusted for differences in procedure mix, patient characteristics, and comorbidity profiles, while use measures were adjusted for clinically related procedure groups. Pearson correlations were used to examine the associations between hospital-level postoperative prophylaxis use and SSI measures. RESULTS: Forty thousand six hundred eleven patients (47.3% female; median age, 7 years) were included, of which 41.6% received postoperative prophylaxis (hospital range, 0%-71.2%). Odds ratios (ORs) for postoperative prophylaxis use ranged 190-fold across hospitals (OR, 0.10-19.30) and ORs for SSI rates ranged 4-fold (OR, 0.55-1.90). No correlation was found between use of postoperative prophylaxis and SSI rates overall (r = 0.13; P = .20), and when stratified by SSI type (incisional SSI, r = 0.08; P = .43 and organ space SSI, r = 0.13; P = .23), and surgical specialty (general surgery, r = 0.02; P = .83; urology, r = 0.05; P = .64; plastic surgery, r = 0.11; P = .35; otolaryngology, r = −0.13; P = .25; orthopedic surgery, r = 0.05; P = .61; and neurosurgery, r = 0.02; P = .85). CONCLUSIONS AND RELEVANCE: Use of postoperative surgical antimicrobial prophylaxis was not correlated with SSI rates at the hospital level after adjusting for differences in procedure mix and patient characteristics.

This article builds a framework for a new approach to copy testing, based on a theoretical model of advertising that brings affective measures to the forefront. It points the way [...]

Recent developments in neuroscience and psychology are converging in a consistent view of how consumers actually 'feel' and 'think.' This paper will show how we can use that learning to [...]

Denial, anger, bargaining and depression won't fix Y2K. Accept the problem and get to work. In most year 2000 projects, the sequence of events prior to project start goes like […]

I no longer remember the exact date; I can only recall the stark terror of the event. Sometime during the fall of 1979, my employer summoned me to the studio [...]

A review of the inventory analysis methods of rural electric cooperatives during the 1991-92 Management Internship Program led to the development of a common technique that could be applied to various cooperatives and to the establishment of performance measures that would facilitate the evaluation of the effectiveness of inventory controls. The resulting model can be used by generation/transmission and distribution utilities for incurring inventory items on an economic basis to control expenses. Input variables can be modified to signify conditions that characterize particular cooperatives. Inventory controls may be evaluated through the implementation of the model, analysis of the results against existing practices and identification of its effects on inventory turnover and total utility investment. The model provides utilities a way to offer adequate and reliable service at a low cost., Rural electric utilities have significant amounts of money invested in plant materials inventories, and we incur considerable expenses to order and carry this inventory, as well as incurring opportunity costs. [...]

The Princess Alexandra Hospital (PAH) Gamma Knife® Centre of Queensland (GKCoQ) began operations in October of 2015 as a sub‐specialty located within a larger radiation oncology service at PAH. It is uniquely positioned as the only Leksell Gamma Knife® (LGK) treatment unit available in the public hospital system in Australia, and the first and only service in Queensland. The GKCoQ treated the 1000th patient on 23 January 2019. LGK is a non‐invasive alternative to neurosurgery which uses radioactive cobalt sources to treat a variety of intracranial conditions ranging from tumours and metastases to functional disorders. It is a platform for stereotactic radiosurgery, a highly precise form of radiotherapy utilising very high doses to the target while maximally sparing surrounding normal brain. LGK enables patient planning and treatment to be done in one day as an outpatient procedure. This paper will outline our LGK service and provide insight into the expanded role that radiation therapists have within the multidisciplinary team required to deliver radiosurgery in a timely manner. The training programme and radiation licensing pathway that have been established for radiation therapists will also be described. This paper will outline our Gamma Knife service and provide insight into the expanded role that radiation therapists have within the multidisciplinary team required to deliver radiosurgery in a timely manner. The training program and radiation licensing pathway that have been established for radiation therapists will also be described.

From the Department of Medicine, Division of Nephrology, Stanford University Medical Center, Stanford, California. Reprint requests to Bruce M. Hall, MD, Division of Nephrology, Department of Medicine, Rm S-215, Stanford [...]

From 1990 to 1992, investigators with the New York City Police Department (NYPD) conducted a joint investigation with the FBI, the Drug Enforcement Administration, and the Bureau of Alcohol, Tobacco [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2009.07.026 Byline: Bruce L. Hall (a), Karen Richards (b), Angela Ingraham (b), Clifford Y. Ko (b)(c) Keywords: ACS NSQIP; VA NSQIP; Quality Improvement; Specialization; Imputation; Collaboratives Abstract: In honor of the seminal contributions of Dr. Shukri Khuri to the foundation and development of the National Surgical Quality Improvement Program (NSQIP), a review of recent work and new directions within the American College of Surgeons (ACS) NSQIP is presented, according to the following outline: I recent work II potential existing limitations of NSQIP III directions underway for the future IV additional initiatives and topics. Author Affiliation: (a) Department of Surgery, St. Louis Veterans Affairs Medical Center, and Department of Surgery, Olin Business School, and Center for Health Policy, Washington University in St. Louis, St. Louis, MO, USA (b) Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA (c) Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA Article History: Received 28 May 2009 Article Note: (footnote) B.L.H. was supported by the Center for Health Policy, under the direction of Dr. William Peck, Washington University in St. Louis, St. Louis, MO. A.I. is a research fellow of the American College of Surgeons.

All countries need national bodies with statutory power to regulate investigation of complaints of scientific and scholarly misconduct since institutions investigating such allegations are vulnerable to claims that their processes are inadequate or that they have an institutional conflict of interest. An office of academic integrity would be able to ensure that all complaints are thoroughly investigated, fair processes are provided for complainants and respondents and errors in published work are retracted.

The National Surgical Quality Program (NSQIP) Transplant was designed by transplant surgeons from the ground up to track posttransplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient‐donor pairs into the database, including 2876 complete kidney transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI), and reoperation/intervention were evaluated for kidney transplant recipients. We observed impressive variation in the crude incidence between sites for SSI(0%‐17%), UTI(0%‐14%), and reoperation/intervention (0%‐25%). After adjustment for donor and recipient factors, 2 sites were outliers with respect to their incidence of UTI. For the first time, the field of transplantation has data that demonstrate variation in kidney recipient surgical outcomes between sites. More importantly, NSQIPTransplant provides a powerful platform to improve care beyond basic patient and graft survival. The authors present preliminary findings from NSQIP Transplant, highlighting variation in surgical outcomes after kidney transplant across centers.

The National Surgical Quality Program (NSQIP) Transplant was designed by transplant surgeons from the ground up to track posttransplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient-donor pairs into the database, including 2876 complete kidney transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI), and reoperation/intervention were evaluated for kidney transplant recipients. We observed impressive variation in the crude incidence between sites for SSI (0%-17%), UTI (0%-14%), and reoperation/intervention (0%-25%). After adjustment for donor and recipient factors, 2 sites were outliers with respect to their incidence of UTI. For the first time, the field of transplantation has data that demonstrate variation in kidney recipient surgical outcomes between sites. More importantly, NSQIP Transplant provides a powerful platform to improve care beyond basic patient and graft survival.

The National Surgical Quality Program (NSQIP) Transplant program was designed by transplant surgeons from the ground up to track posttransplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient‐donor pairs into the database, including 1444 completed liver transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI), and unplanned reoperation/intervention after liver transplantation were evaluated. We observed impressive variation in the crude incidence between sites for SSI(0%‐29%), UTI(0%‐10%), and reoperation/intervention (0%‐57%). After adjustment for donor and recipient factors, at least 1 site was identified as an outlier for each of the analyzed outcomes. For the first time, the field of transplantation has data that demonstrate variation in liver recipient outcomes beyond death and graft survival between sites. More importantly, NSQIPTransplant provides a powerful platform to improve care beyond basic patient and graft survival. The report details preliminary findings of the NSQIP Transplant beta phase, highlighting significant variation in 30‐day postsurgical outcomes beyond basic patient and graft survival.

Medical errors are a significant source of morbidity and mortality, and while focused efforts to prevent harm have been made, sustaining reductions across multiple categories of patient harm remains a challenge. In 2008 BJC HealthCare initiated a systemwide program to eliminate all major causes of preventable harm and mortality over a five-year period with a goal of sustaining these reductions over the subsequent five years.

The National Surgical Quality Program (NSQIP) Transplant program was designed by transplant surgeons from the ground up to track posttransplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient-donor pairs into the database, including 1444 completed liver transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI), and unplanned reoperation/intervention after liver transplantation were evaluated. We observed impressive variation in the crude incidence between sites for SSI (0%-29%), UTI (0%-10%), and reoperation/intervention (0%-57%). After adjustment for donor and recipient factors, at least 1 site was identified as an outlier for each of the analyzed outcomes. For the first time, the field of transplantation has data that demonstrate variation in liver recipient outcomes beyond death and graft survival between sites. More importantly, NSQIP Transplant provides a powerful platform to improve care beyond basic patient and graft survival.

Incorporating the patient's perspective to evaluate national surgical quality has yet to be achieved in the United States and represents a tremendous unrealized opportunity for continuous quality improvement. The first phase of a multiphase pilot to measure patient-reported outcomes (PROs) using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is described.

This study aimed to determine whether (1) the propensity for concurrent fundoplication during gastrostomy varies among hospitals, and (2) postoperative morbidity differs among institutions performing fundoplication more or less frequently. Children who underwent gastrostomy with or without concurrent fundoplication were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-P). A hierarchical multivariate regression modeled the excess effects that hospitals exerted over propensity for concurrent fundoplication adjusting for preoperative clinical variables. Hospitals were designated as low outliers (significantly lower-adjusted odds of concurrent fundoplication than the average hospital with similar patient mix), average hospitals, and high outliers based on their risk-adjusted concurrent fundoplication practice. The postoperative morbidity rates were compared among low-outlier, average, and high-outlier hospitals. Between 2011 and 2013, 3775 children underwent gastrostomy at one of 54 ACS-NSQIP-P participating hospitals. The mean hospital concurrent fundoplication rate was 11.7% (range 0–64%). There was no significant difference in unadjusted morbidity rate in children with concurrent fundoplication, 11.0% compared to 9.7% in children without concurrent fundoplication. After controlling for clinical variables, 8 hospitals were identified as low outliers (fundoplication rate of 0.4%) and 16 hospitals were identified as high outliers (fundoplication rate of 34.6%). The average unadjusted morbidity rate among hospitals with low, average, and high odds of concurrent fundoplication were 9.6, 10.6, and 8.4%, respectively. Hospitals vary significantly in propensity for concurrent fundoplication during gastrostomy yet postoperative morbidity does not differ significantly among institutions performing fundoplication more or less frequently.

BACKGROUNDSurgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.OBJECTIVETo examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRSDESIGNAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011–2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.SETTINGMulticenter studyPARTICIPANTSOf 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification(ICD-9-CM) codes.MAIN OUTCOMEThe primary outcome of interest was 30-day SSI rate.RESULTSA total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23–2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09–1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06–2.53; P=.02), and longer duration of procedure were associated with development of SSI.CONCLUSIONSPatients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.Infect Control Hosp Epidemiol2018;39:555–562

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The DOE plans to render the 52 tons of plutonium left over from the Cold War unusable for nuclear weapons by using them for commercial energy. The agency also wants commercial power plants to produce radioactive tritium for the country's remaining 10,000 nuclear weapons. DOE's plutonium plan will result in large quantities of radioactive waste and its tritium proposal will make consumers partners in nuclear weapon production.

In the 1970s, the capacity of T cells to inhibit immunity and those from transplant tolerant hosts to transfer alloantigen-specific suppression to lymphopenic recipients was described. CD4+T suppressor cells that ex vivo reverted to effector cells were described in the 1980s. Their antigen-specific suppressor function could be preserved by stimulation by specific donor alloantigen and cytokines from activated lymphocytes. This led to the finding that alloantigen-specific T suppressor cells express IL-2 receptor (CD25) and that IL-2 in part promotes their survival.Whether these alloantigen-specific CD4+CD25+FOXP3+regulatory T (Treg) cells are progeny of thymic-derived CD4+CD25+FOXP3+Treg (tTreg) cells or are induced from peripheral effector CD4+CD25−FOXP3−T cells (iTreg) cells is still debated.In vitro studies of antigen specific Treg has been difficult as they die in the absence of cytokines produced by immune activated cells. The antigen-specific CD4+CD25+T cells that control rejection in tolerant hosts differ from the naive tTreg. Thymic-derived Treg cells are not antigen-specific, and very high ratios are required to suppress rejection. Thymic-derived Treg cells can be expanded ex vivo and are currently being tested in trials to control allograft rejection and graft versus host disease.Thymic-derived Treg cells with specific receptors for alloantigen are activated by either IL-2 or IL-4 but rapidly become dependent on other cytokines, respectively, IFN-γ or IL-12 if activated by IL-2, or IL-5 if activated by IL-4. The Th1 and Th2 pathways for activation of tTreg produce more potent antigen-specific Treg that only suppress specific donor rejection. After 25 years, much remains unknown about antigen-specific CD4+CD25+FOXP3+Treg-mediating transplant tolerance.A personal and extensive overview of CD4+CD25+ regulatory T cells in transplantation discussing key findings and future directions.

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Gastrostomy feeding tube placement in children is associated with a high frequency of adverse events. This study sought to preoperatively estimate postoperative adverse events in children undergoing gastrostomy feeding tube placement.

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Sometimes, masking tape that's been sitting on a shelf for years won't pull off the roll without tearing. Freshen it by microwaving it for 10 seconds. Heat softens the adhesive […]