Influence of Early Extubation Location on Outcomes Following Pediatric Cardiac Surgery*
Objectives: Early extubation following pediatric cardiac surgery is common, but debate exists whether location affects outcome, with some centers performing routine early extubations in the operating room (odds ratio) and others in the cardiac ICU. We aimed to define early extubation practice variation across hospitals and assess impact of location on hospital length-of-stay and other outcomes. Design: Secondary analysis of the Pediatric Cardiac Critical Care Consortium registry. Setting: Twenty-eight Pediatric Cardiac Critical Care Consortium hospitals. Patients: Patients undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1–3 operations between August 2014 and February 2018. Interventions: None. Measurements and Main Results: We defined early extubation as extubation less than 6 hours after postoperative admission. Hospitals were categorized based on the proportion of their early extubation patients who underwent an odds ratio extubation. Categories included low- ( 90%, n = 8) frequency odds ratio early extubation centers. The primary outcome of interest was postoperative hospital length-of-stay. We analyzed 16,594 operations (9,143 early extubation, 55%). Rates of early extubation ranged from 16% to 100% across hospitals. Odds ratio early extubation rates varied from 16% to 99%. Patient characteristics were similar across hospital odds ratio early extubation categories. Early extubation rates pa...
Introduction: Patient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department. The primary objective of this study was to determine the characteristics of these patients, the nature of their requests, and the response to these requests. Our secondary objective was to determine the proportion of these medication requests that had street value. Methods: This was a retrospective, electronic chart review of all adult patients requesting a prescription from a two-site ED and/or an UCC in a medium-...
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Modern Approaches to Facial and Athletic Injuries
J. Regan Thomas
J. REGAN THOMAS, MD
FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA
The major needs for cosmetic facial bone surgery come from anatomic differences in facial shape and in personal preference. Especially when consulting patients with different national or ethnic backgrounds, careful attention should be paid during consultation for the ideal or desirable facial shape that they have in mind. Patients generally seek a slim and smooth-contoured face. Surgery of the cosmetic facial bone has developed from surgical experiences in facial bone trauma and congenital anomalies. A limited approach is recommended for satisfactory aesthetic outcome. Surgeons should understand the basic procedures of L-s...
Unlike other surgery aimed at removing tumor or inflammation, facial plastic surgery is unique in that the anatomic characteristics of the patients largely determine the very success of the surgical outcome. The ultimate goal of facial plastic surgery is changing the anatomic structure of the face in ways favored by the subjects or general population. General anatomic differences between ethnicities have tremendous importance in planning and executing various facial plastic surgery procedures.