Symptomatic pulmonary bullet emboli should be managed with endovascular retrieval when available or operative therapy. Asymptomatic intravascular bullet emboli may be managed conservatively as seen in our patient.
HighlightsSurgeons should approach the acute abdomen with a broad differential.CT is a valuable diagnostic tool in the evaluation of adult intussusception.Laparoscopy is a useful adjunct for diagnosis and treatment of intussusception.There is a limited role of reduction prior to resection in very select cases.
Introduction: The operating room (OR) is an expensive entity to manage. Efficiency in hospital resource utilization is critical for hospital financial solvency. One measure of efficiency in the OR is percentage of on-time starts for cases at the beginning of each day. This study looks at a community teaching hospital where measures were taken to identify and address causes of tardiness in the OR. Methods: An interdisciplinary team of doctors, nurses, and other hospital staff came together to implement a three-phase agenda. In Phase I, staff identified causes of tardiness. In Phase II, potential solutions to address each specific task were drawn up. Phase III involved maintenance of efficiency measures created in Phase II and documentation of progress for future analysis. Results and Discussion: Over twelve months, the percentage of cases that started on time steadily increased from 14% to 68%. Additionally, of the cases that were late, the average number of minutes late decreased significantly. Of the identified causes of tardiness, surgeon arriving late was found to be the most prevalent. We analyzed the relationship between average minutes late each month and the cost and revenue per unit of service (UOS). Average minutes late per month and hospital revenue per UOS showed a strong inverse correlation of -0.83, while average minutes late per month and cost er UOS showed a moderate positive correlation of 0.62. We analyzed the relationship between average minutes late each month and the cost and revenue per UOS. Average minutes late per month and hospital revenue per UOS showed a strong inverse correlation of -0.83, while average minutes late per month and cost per UOS showed a moderate positive correlation of 0.62. Conclusions: Identifying causes of tardiness based on input from a multidisciplinary healthcare team and addressing each cause with a specific measure to combat it was effective in improving the percentage of on-time starts in the OR. We demonstrated that reducing delays in OR start times can both decrease cost and increase revenue. Documenting progress of efficiency measures is critical in distinguishing measures that work from those that do not. Furthermore, continued analysis of efficiency is required to maintain efficiency standards.
Objectives: To evaluate the reproducibility of catheter-based intracoronary near-infrared spectroscopy (NIRS) for the detection of lipid core coronary plaques (LCPs) and to examine stenting-induced changes in NIRS findings. Background: The in-vivo reproducibility of coronary NIRS findings and their changes after stenting have not previously been characterized. Methods: NIRS assessment using an automated pullback catheter was performed in duplicate in 36 vessels in 31 patients. The reproducibility of the Lipid Core Burden Index (LCBI) and the presence and number of LCPs was assessed. The changes in LCBI after stenting were also assessed in 25 vessels in 22 patients. Results: LCBI of the first and second pullback was 64 6 43 and 70 6 62, respectively, with excellent correlation (Spearman's rho 0.927, intraclass correlation coefficient 0.925). Depending on LCP definition, mean LCP length, and median LCP number ranged from 2.44 to 17.25 mm, and from 0 to 2, respectively per artery studied. High correlation was observed between the two pullbacks for total LCP length (depending on the LCP definition used, the Spearman's rho and the intraclass correlation coefficient ranged from 0.72 to 0.89, and from 0.76 to 0.91, respectively) and for LCP number (depending on the LCP definition used, the Spearman's rho and the intraclass correlation coefficient ranged from 0.70 to 0.87, and from 0.67 to 0.88, respectively). The mean LCBI decreased by 40% from 78 6 47 to 48 6 38 after stenting (P < 0.001). Conclusion: The LCBI and LCP length NIRS measurements have high reproducibility. LCBI significantly decreases after coronary stenting. V C 2010 Wiley-Liss, Inc.
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