scholarly journals Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care

Surgery ◽  
2016 ◽  
Vol 160 (4) ◽  
pp. 839-849 ◽  
Author(s):  
Anai N. Kothari ◽  
Barbara A. Blanco ◽  
Sarah A. Brownlee ◽  
Ann E. Evans ◽  
Victor A. Chang ◽  
...  
Keyword(s):  
Surgical Care ◽  
High Volume ◽  
High Quality ◽  
Cancer Resection ◽  
Low Volume

Operative Volume of Newborn Surgery in German University Hospitals: High Volume Versus Low Volume Centers

2022 ◽  
Author(s):  
Martin Lacher ◽  
Winfried Barthlen ◽  
Felicitas Eckoldt ◽  
Guido Fitze ◽  
Jörg Fuchs ◽  
...  
Keyword(s):  
Congenital Malformations ◽  
Surgical Care ◽  
High Volume ◽  
Anorectal Malformations ◽  
Posterior Urethral Valves ◽  
Insurance Companies ◽  
University Hospitals ◽  
Disease Category ◽  
Abdominal Emergencies ◽  
Low Volume

Abstract Introduction Adequate patient volume is essential for the maintenance of quality, meaningful research, and training of the next generation of pediatric surgeons. The role of university hospitals is to fulfill these tasks at the highest possible level. Due to decentralization of pediatric surgical care during the last decades, there is a trend toward reduction of operative caseloads. The aim of this study was to assess the operative volume of the most relevant congenital malformations at German academic pediatric surgical institutions over the past years. Methods Nineteen chairpersons representing university-chairs in pediatric surgery in Germany submitted data on 10 index procedures regarding congenital malformations or neonatal abdominal emergencies over a 3-year period (2015 through 2017). All institutions were categorized according to the total number of respective cases into “high,” “medium,” and “low” volume centers by terciles. Some operative numbers were verified using data from health insurance companies, when available. Finally, the ratio of cumulative case load versus prevalence of the particular malformation was calculated for the study period. Results From 2015 through 2017, a total 2,162 newborns underwent surgery for congenital malformations and neonatal abdominal emergencies at German academic medical centers, representing 51% of all expected newborn cases nationwide. The median of cases per center within the study period was 101 (range 18–258). Four institutions (21%) were classified as “high volume” centers, four (21%) as “medium volume” centers, and 11 (58%) as “low volume” centers. The proportion of patients operated on in high-volume centers varied per disease category: esophageal atresia/tracheoesophageal fistula: 40%, duodenal atresia: 40%, small and large bowel atresia: 39%, anorectal malformations: 40%, congenital diaphragmatic hernia: 56%, gastroschisis: 39%, omphalocele: 41%, Hirschsprung disease: 45%, posterior urethral valves: 39%, and necrotizing enterocolitis (NEC)/focal intestinal perforation (FIP)/gastric perforation (GP): 45%. Conclusion This study provides a national benchmark for neonatal surgery performed in German university hospitals. The rarity of these cases highlights the difficulties for individual pediatric surgeons to gain adequate clinical and surgical experience and research capabilities. Therefore, a discussion on the centralization of care for these rare entities is necessary.

scholarly journals The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention

2020 ◽  
Vol 08 (05) ◽  
pp. E673-E683 ◽  
Author(s):  
Prateek Sharma ◽  
Carol A. Burke ◽  
David A. Johnson ◽  
Brooks D. Cash
Keyword(s):  
Colorectal Cancer ◽  
Bowel Preparation ◽  
Clinical Importance ◽  
High Volume ◽  
High Quality ◽  
Crc Screening ◽  
Incidence And Mortality ◽  
Low Volume ◽  
Split Dosing ◽  
Bowel Preparations

Abstract Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection.This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9−3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.

scholarly journals Accessing surgical care for esophageal cancer: patient travel patterns to reach higher volume center

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Adrian Diaz ◽  
Sarah Burns ◽  
Desmond D’Souza ◽  
Peter Kneuertz ◽  
Robert Merritt ◽  
...  
Keyword(s):  
Health Planning ◽  
Surgical Care ◽  
High Volume ◽  
Travel Patterns ◽  
Care Access ◽  
Patient Travel ◽  
High Volume Hospital ◽  
High Volume Center ◽  
Low Volume ◽  
Esophagectomy For Cancer

SUMMARY While better outcomes at high-volume surgical centers have driven the regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate the travel patterns among patients undergoing esophagectomy to assess willingness of patients to travel for surgical care. The California Office of Statewide Health Planning database was used to identify patients who underwent esophagectomy between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed esophagectomy to get to a higher volume center, was assessed. Overall 3,269 individuals underwent an esophagectomy for cancer in 154 hospitals; only five hospitals were high volume according to Leapfrog standards. Median travel time to a hospital that performed esophagectomy was 26 minutes (IQR: 13.1–50.7). The overwhelming majority of patients (85%) bypassed the nearest providing hospital to seek care at a destination hospital. Among patients who bypassed a closer hospital, only 36% went to a high-volume hospital. Of the 2,248 patients who underwent esophagectomy at a low-volume center, 1,491 patients had bypassed a high-volume hospital. Of the remaining 757 patients who did not bypass a high-volume hospital, half of the individuals would have needed to travel less than an additional hour to reach a high-volume center. Nearly two-thirds of patients undergoing an esophagectomy for cancer received care at a low-volume center; 85% of patients either bypassed a high-volume hospital or would have needed to travel less than an additional hour to reach a high-volume center.

Low-volume centre vs high-volume: the role of a quality assurance programme in colon cancer surgery

2011 ◽  
Vol 13 (9) ◽  
pp. e276-e283 ◽  
Author(s):  
P. Mroczkowski ◽  
R. Kube ◽  
H. Ptok ◽  
U. Schmidt ◽  
S. Hac ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Quality Assurance ◽  
High Volume ◽  
Cancer Surgery ◽  
Quality Assurance Programme ◽  
Colon Cancer Surgery ◽  
Low Volume

scholarly journals Volume-Based Care among Young Women Diagnosed with Uterine Cancer

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6
Author(s):  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Young Women ◽  
Regression Models ◽  
Uterine Cancer ◽  
Surgical Care ◽  
High Volume ◽  
Service Cost ◽  
Health Service Cost ◽  
Logistic Regression Models ◽  
Adjusted Cost ◽  
Low Volume

Purpose. To characterize volume-based care of uterine cancer among women aged ≤50 years. Methods. The Maryland Health Service Cost Review Commission database was accessed for uterine cancer surgical cases from 1994 to 2005. Cross-tabulations and logistic regression models were used to evaluate for significant associations among volume-based care and other variables comparing women ≤50 years with those aged >50 years. Results. Women ≤50 years comprised 13.6% of the cases. Women ≤50 years were less likely to be managed by high-volume surgeons (31.6% versus 35.1%, ). For women ≤50 years, there was a trend toward management at low-volume hospitals (52.0% versus 54.0%, ). No deaths were reported among the group of women ≤50 years treated by high-volume providers or at high-volume centers. Women ≤50 years managed by high-volume surgeons had longer length of stay () and higher adjusted cost of hospital-related care (). Women ≤50 years managed at high-volume centers had higher adjusted cost of hospital-related care (). Conclusion. Primary surgical care of young women with uterine cancer is often performed by low-volume providers.

scholarly journals High-Volume versus Low-Volume for Esophageal Resections for Cancer: The Essential Role of Case-Mix Adjustments based on Clinical Data

2007 ◽  
Vol 15 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Michael W. Wouters ◽  
Bas P. Wijnhoven ◽  
Henrieke E. Karim-Kos ◽  
Harriet G. Blaauwgeers ◽  
Laurents P. Stassen ◽  
...  
Keyword(s):  
Clinical Data ◽  
Essential Role ◽  
High Volume ◽  
Case Mix ◽  
Volume Versus ◽  
Low Volume

Making Movies and Community of Talent

2019 ◽  
Vol 10 (11) ◽  
pp. 1057-1064
Author(s):  
Katsuhiko Hirasawa ◽  
Keyword(s):  
Shop Floor ◽  
High Quality ◽  
Democratic Leadership ◽  
Staff Members

Staff members at a movie company Daiei, known for presumably the world’s best film technology, continued to produce movies for several months even after the company went bankrupt. It was because they desired to make outstanding films. A director can create a high-quality film by combining the skills and ideas of such staff. Akira Kurosawa named the group that could produce excellent works the “Community of Talents”. By using research on a community as a clue, this paper aims to highlight how the “Community of Talents” is organized. First I point out that a “Community of Talents” is formulated primarily by the labor of the staff based on Kumazawa’s “Community on the Shop Floor”. The paper subsequently refers to research by Heinrich Nicklish, a representative researcher on the study of community in Germany, in an attempt to verify that the community is a group of people established on functions. Lastly, the paper explores Guido Fisher’s research to reveal the role of democratic leadership centered on the director who transforms the objectified staff in the organization into an independently-minded presence and help them prove their abilities. The paper continues to emphasize the significance of leadership in the formation of the “Community of Talents”.

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