To examine outcomes in patients who receive small amounts of intraoperative blood transfusion. Design: Longitudinal, uncontrolled observational study evaluating results of intraoperative transfusion in patients entered into the American College of Surgeons National Surgical Quality Improvement Program database. We made propensity-matched comparisons between patients who received and did not receive intraoperative transfusion to minimize confounding when estimating the effect of intraoperative transfusion on postoperative outcomes.
These observations challenge current assumptions about the treatment of selected patients with end-stage lung disease and suggest that "salvage transplant" is both technically feasible and logistically viable. Widespread adoption of artificial lung technology in lung transplant will require the design of clinical trials that establish the most effective circumstances in which to use these technologies. A discussion of a clinical trial and reconsideration of current allocation policy is warranted.
Each year thousands of patients require extracorporeal life support (ECLS) for a variety of respiratory, cardiac, and emergency reasons. The ECLS registry, a Federal Drug Administration approved control group, provides a database of approximately 37,000 ECLS patients from domestic and international hospitals, with details about demographic factors, diagnosis, treatment, and complications. The report is circulated to Extracorporeal Life Support Organization members with the goal of providing feedback on each center's practices relative to the performance of all of the centers, and to the general public with the goal of enhancing research and improving patient care. In this report, the ECLS Registry Report International Summary for July 2008 is analyzed with a specific focus on neonatal and pediatric cardiac patients. From the data, it is evident that cardiac ECLS patients have a lower chance of survival than respiratory ECLS patients, and furthermore, younger patients have a lower chance of survival. Requirement for inotropes while on ECLS is by far the most common complication, followed by surgical site bleeding, necessitating hemofiltration. The major mechanical complications facing cardiac ECLS patients are oxygenator failure and clots in the circuit. Databases such as this one provide powerful tools for institutions, clinicians, and researchers.
US General Surgery residents are not universally ready to independently perform Core procedures by the time they complete residency training. Progressive resident autonomy is also limited. It is unknown if the amount of autonomy residents do achieve is sufficient to ensure readiness for the entire spectrum of independent practice.
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