Association between hospital case volume and the use of bronchoscopy and esophagoscopy during head and neck cancer diagnostic evaluation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102212/1/cncr28379.pd

Failure of Small Joint Arthrodesis from Resorption Around a Compression Screw in a Patient with Lupus-Associated Arthritis Mutilans: Case Report

We report the unusual case of a patient with systemic lupus erythematosus (SLE)-associated arthritis mutilans. Arthritis mutilans is a variant of erosive arthritis that is more commonly reported with psoriatic and rheumatoid arthritis and not with SLE. Joint fusion has been shown to be the most effective measure to preserve bone length and prevent further erosive joint changes in arthritis mutilans. We attempted to enhance success of a thumb interphalangeal joint fusion in our patient by adding compression across the fusion with implant screws, given the difficulty of achieving solid bone fusion ordinarily. Osteolysis around the compression screw resulted in arthrodesis failure. We were finally able to achieve successful fusion with iliac crest corticocancellous bone grafts and Kirschner wire fixation. Implant athroplasty in patients with bone loss is risky as it often furthers joint instability because of bone resorption around the prosthesis. This is a point of caution regarding use of any implant (including large screws) in patients with arthritis mutilans, as osteolysis around the implant may occur

Ventral Hernia Repair: How Payment Reform Is Changing Paradigms

Anglo-american countries like the us and the uk allow companies to switch auditors every year. In contrast, some continental european countries restrict auditor switching by allowing only renewable long-term audit mandates. This paper aims to analyse the impact of renewable long-term audit mandates on audit quality. Audit quality is considered from the viewpoint of the external users of the financial statements. It is questioned whether renewable long-term audit mandates have an impact on the auditor's reporting behaviour and on auditor independence. This research is motivated by the lack of consensus in the literature on the impact of the length of the auditor client relationship on audit quality. Moreover, few empirical studies use publicly available secondary data in order to determine whether perceived threats to auditor independence actually compromise auditor independence. Therefore, our research methodology consists in the development of a logistic regression model in which the explanatory variables are measured using publicly available data. The results of the study suggest that long-term auditor client relationships significantly increase the likelihood of an unqualified opinion or significantly reduce the auditor's willingness to qualify audit reports. A significant difference was also found between the auditor's reporting behaviour in the first two years versus the last year of the audit mandate. Auditors are more willing to issue an unqualified audit report in the first two years of their official mandate than in the last year of their mandate. This could be an indication that the decision to renew the auditor's mandate is already taken and known to the auditor before he has issued his last audit report within his current mandate. The policy implications of these findings could be in favour of mandatory auditor rotation to maintain the value of an audit for the external users. However, given recent theoretic evidence on the adverse effects of mandatory auditor rotation, there is a need to develop alternative measures to safeguard auditors' independence

Complications in body contouring stratified according to weight loss method

BACKGROUND: Body contouring procedures following massive weight loss have become increasingly common and, unfortunately, continue to be associated with a high complication rate. OBJECTIVE: To evaluate how weight loss method affects complications following abdominally based body contouring procedures. METHODS: Patients undergoing abdominally based contouring procedures were retrospectively evaluated over an 11-year period and stratified into two groups based on method of weight loss: diet and exercise; or bariatric surgery. Complications, including seroma, wound dehiscence, skin necrosis, infection, hematoma and venous thromboembolism, were included if they required intervention. An adjusted logistic model was used to examine the effect of weight loss method on aggregate complication rates. RESULTS: A total of 307 patients were included: 77 (25%) lost weight through diet and exercise; and 230 (75%) through bariatric surgery. Results from the logistic model showed no difference in complication rates between weight loss methods (OR 1.01 [95% CI 0.51 to 2.02]). However, there was a strong correlation between body mass index at the time of surgery and complication rates (OR 1.05 [95% CI 1.02 to 1.08]; P<0.01). CONCLUSIONS: The findings reveal no difference in complication rates following abdominal body contouring procedures attributable to method of weight loss. Rather, there was a proportional rise in complication rates in patients with a higher body mass index at the time of surgery. Surgeons and patients should be aware of this trend, and it should be part of any discussion of abdominal body contouring procedures and informing patients of their risk profile

Meals and dephytinization affect calcium and zinc absorption in Nigerian children with rickets

Nutritional rickets resulting from calcium insufficiency is common in Nigeria and high dietary phytate is thought to inhibit calcium and zinc absorption. We compared the effects of a high-phytate meal and enzymatic dephytinization on calcium and zinc absorption in Nigerian children with and without rickets. Nineteen children with rickets and 15 age-matched control children, aged 2-10 gamma, were given calcium (600 mg/d) and ergocalciferol (1250 mu g/wk). After 6 wk, calcium and zinc absorption were measured in both groups with and without maize porridge using stable isotopes. One week later, absorption measurements were repeated to assess the effects of enzymatic dephytinization and fermentation of the maize porridge. The phytate concentration of maize porridge (3.87 +/- 0.38 g/kg wet weight) was reduced by enzymatic dephytinization (2.83 +/- 0.41 g/kg; P < 0.001) but not by fermentation (3.35 +/- 0.27 g/kg; P = 0.08). Calcium and zinc absorption were unaffected by the presence of rickets or by fermentation of maize porridge. Calcium absorption was greater with a meal (61.3 +/- 25.1%) than without (27.8 +/- 14.6%; P < 0.001). Zinc absorption was lower with a meal (16.2 +/- 8.0%) than without (63.4 +/- 23.9%; P < 0.001). Enzymatic dephytinization increased relative zinc absorption from a meal by 101 +/- 81% (P < 0.001) but did not affect calcium absorption. Rickets was not associated with impaired calcium or zinc absorption. Calcium absorption was enhanced by maize porridge, but zinc absorption was reduced. Enzymatic dephytinization increased zinc absorption. Multiple strategies may be required to optimize calcium and zinc absorption in deficient populations. J. Nutr. 139: 926-932, 2009

Women Continue to Be Underrepresented in Surgery: A Study of AMA and ACGME Data from 2000-2016

Objective: In the past decade women have comprised nearly half of U.S. medical school graduates. However, women remain underrepresented among surgical residents and practicing surgeons. We conducted the current study to assess recent trends in the female-to-male (F:M) ratios among residents and physicians pursuing careers in surgery. Design: We used retrospective population statistics published by the American Medical Association (AMA) and the Accreditation Council for Graduate Medical Education (ACGME) from 2000-2016. We compared trends of female-to-male ratios among residents and surgeons in surgical subspecialties to evaluate for potential differences over time. Setting: Published online population statistics Participants: We stratified both board-certified surgeons and surgical residents by sex and specialty. Results: From 2000-2013, the proportion of female surgeons among all female physicians remained constant (12-13%). The proportion of board-certified female surgeons to all surgeons increased (from 15% in 2000 to 25% in 2013). The F:M ratios of board-certified surgeons in neurosurgery and orthopedic surgery were 1:10.6 and 1:13.9, with resident ratios 1:4.8 and 1:5.9, respectively. One specialty with increasingly equivalent ratios is plastic surgery with integrated resident F:M ratios of 1:3.1 in 2008 to 1:1.4 in 2015, and board-certified plastic surgeons of 1:9.2 in 2008 to 1:5.3 in 2013. Conclusion: Although the gender gap is narrowing, women continue to be underrepresented in surgical specialties. It is important for fields with disproportionate representation to be aware of these differences and take steps towards creating and supporting a more diverse workforce