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Carbonell A.M.,Greenville Hospital System University Medical Center | Criss C.N.,University Hospitals Case Medical Center | Cobb W.S.,Greenville Hospital System University Medical Center | Novitsky Y.W.,University Hospitals Case Medical Center | Rosen M.J.,University Hospitals Case Medical Center
Journal of the American College of Surgeons | Year: 2013

Background Given the questionable long-term durability of biologic meshes, additional prosthetic options for ventral hernia repairs (VHR) in contaminated fields are necessary. Recent evidence suggests improved bacterial resistance of reduced-weight, large-pore synthetics, giving a potential mesh alternative for repair of contaminated hernias. We aimed to evaluate the clinical outcomes of 2 institutions' experience implanting lightweight polypropylene synthetic mesh in clean-contaminated and contaminated fields. Study Design Open VHRs performed with polypropylene mesh in the retro-rectus position in clean-contaminated and contaminated fields were evaluated. Primary outcomes parameters included surgical site infection, surgical site occurrence, mesh removal, and hernia recurrence. Results One hundred patients (50 male, 50 female) with a mean age of 60 ± 13 years and a mean body mass index (calculated as kg/m 2) of 32 ± 9.3 met inclusion criteria. There were 42 clean-contaminated and 58 contaminated cases. The incidence of surgical site occurrence was 26.2% in clean-contaminated cases and 34% in contaminated cases. The 30-day surgical site infection rate was 7.1% for clean-contaminated cases and 19.0% for contaminated cases. There were a total of 7 recurrences with a mean follow-up of 10.8 ± 9.9 months (range 1 to 63 months). Mesh removal was required in 4 patients: 2 due to early anastomotic leaks, 1 due to stomal disruption and retraction in a morbidly obese patient, and 1 from a long-term enterocutaneous fistula. Conclusions Although perhaps not yet considered standard of care in the United States, we have demonstrated favorable infection, recurrence, and mesh removal rates associated with the use of synthetic mesh in contaminated VHR. © 2013 by the American College of Surgeons.


Pulcini J.M.,University of Mississippi Medical Center | Sease K.K.,Greenville Hospital System University Medical Center | Marshall G.D.,University of Mississippi Medical Center
Allergy and Asthma Proceedings | Year: 2010

The Joint Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology; the American Academy of Pediatrics; and the National Association of School Nurses all recommend emergency action plans (EAPs) that direct therapy of allergic reactions in children. This study investigated the school nurse's perception of food allergies and their use of EAPs in food-allergic students in a large, socioeconomically diverse school district. An electronic and paper survey was developed and administered to all elementary and middle school nurses in Greenville County, SC. Forty-three of the eligible school nurses participated for a response rate of 64% (43/67). All of the participants worked at schools that had at least one student with food allergies (mean, nine students with food allergies per school; SD, seven students). Forty-four percent (19/43) of schools had a written action plan for all their food-allergic students, whereas in 42% (18/43) of schools, one-half or less of the food-allergic students, had an action plan. Seventy percent (30/43) of schools made at least one accommodation for students with food allergies and 23% (10/43) of schools made multiple accommodations. At least three additional school personnel were trained in administering rescue medications besides the school nurse in 86% (37/43) of schools, but in 5% (2/43) of schools no additional adults were trained to give rescue medications. Although multiple organizations recommend EAPs for food-allergic students, our study highlights their inconsistent use in this school district. Copyright © 2010, OceanSide Publications, Inc.


Gregg M.,Elon University | Lacroix R.L.,Greenville Hospital System University Medical Center
Clinical Pediatrics | Year: 2010

The aim of this study was to examine the viability of methicillin-resistant Staphylococcus aureus (MRSA) in 3 types of swimming pool environments. This study demonstrates that after 1 hour, all MRSA inoculants were found to be nonviable in chlorinated water, saltwater, and biguanide-treated water. This study indicates that swimming pool water that is properly maintained in both public and private swim centers is not likely to be a vehicle to spread MRSA from swimmer to swimmer. © The Author(s) 2010.


Gill S.E.,University Medical Center | Savage K.,Greenville Hospital System University Medical Center | Wysham W.Z.,Oregon Health And Science University | Blackhurst D.W.,Greenville Hospital System University Medical Center | And 2 more authors.
Gynecologic Oncology | Year: 2013

Objective The objective of this study was to determine the cardiac safety of high cumulative doses of pegylated liposomal doxorubicin (PLD) in patients with gynecologic malignancies and the need for routine evaluation of left ventricular ejection fraction (LVEF). Methods Data were collected for all patients treated with PLD with at least one evaluation of LVEF with either Multi-Gated Acquisition (MUGA) scan or echocardiogram from January 2006 to May 2012. Evaluation of LVEF was used to detect PLD-related cardiac toxicity (defined as a decline in LVEF of greater than 10% compared to baseline measurements). Results A total of 141 patients were included. Twenty-two patients were treated with a cumulative dose of 500 mg/m2 or more, and five patients with 1000 mg/m2 or more. Ten patients (7%) had a reduction in LVEF of greater than 10%, 38 had no significant change or increase in LVEF throughout the duration of treatment, and 93 did not require a follow-up evaluation of LVEF. The LVEFs of two patients dropped below 50% at cumulative doses of 1110 mg/m2 and 1670 mg/m2; one began with a baseline of 52%. Conclusions Only one patient had a clinically significant decrease in LVEF at a cumulative dose of 1670 mg/m2, suggesting that PLD does not carry a significant risk of cardiotoxicity, as evidenced by the stability of LVEF even after treatment with large cumulative doses. Routine surveillance of LVEF does not seem to be necessary or cost effective in the absence of other risk factors. © 2013 Elsevier Inc.


Salsman J.M.,Northwestern University | Grunberg S.M.,University of Vermont | Beaumont J.L.,Northwestern University | Rogers M.,Greenville Hospital System University Medical Center | And 3 more authors.
JNCCN Journal of the National Comprehensive Cancer Network | Year: 2012

Despite recent progress, chemotherapy-induced nausea and vomiting (CINV), especially delayed CINV, continues to be a problem. Delayed CINV is underestimated and perceived differently by providers and patients. Communication between providers and patients about this side effect may help improve outcomes. This study identifies patients' and providers' perceptions of management and barriers to quality CINV care. Provider and patient versions of a Nausea and Vomiting Management Barriers Questionnaire were developed to address potential barriers. Providers and patients were given opportunities to add detail in open-ended questions. Providers were recruited through the NCCN and the Oncology Nursing Society mailing lists. Patients who received at least 2 cycles of chemotherapy and experienced CINV were recruited through a consortium of advocacy groups. Both providers (n = 141) and patients (n = 299) completed the survey. Providers (41%) and patients (42%) agreed medication side effects were a concern, but more patients (63%) than providers (36%) tried to limit the number of medications taken (P < .0001). Many providers (67%) spontaneously reported barriers to managing CINV, with financial and patient-related factors among the most common. Few patients (10%) reported cost as a barrier, but 37% endorsed the desire "to be strong by not complaining." Barriers to communication and quality care of CINV differ between caregivers and patients. Addressing misconceptions and establishing mutually consistent goals will lead to more effective overall care. © JNCCN-Journal of the National Comprehensive Cancer Network.


Gill S.E.,Greenville Hospital System University Medical Center | Mills B.B.,Greenville Hospital System University Medical Center
Journal of Minimally Invasive Gynecology | Year: 2013

Study Objective: To gather opinions about the benefits and concerns of performing bilateral salpingectomy without oophorectomy during hysterectomy for benign indications and as a sterilization procedure. Design: Survey study (Canadian Task Force classification III). Setting: Practicing physicians in US institutions that have obstetrics and gynecology residency programs listed on the FREIDA website were surveyed electronically. Intervention: A validated, standardized questionnaire designed to gather opinions about bilateral salpingectomy performed during hysterectomy or for sterilization was administered via SurveyMonkey to practitioners of obstetrics and gynecology. Measurements and Main Results: Results were compiled and presented as percentages of total responders. A total of 234 surveys were returned. Fifty-four percent of physicians perform bilateral salpingectomy during hysterectomy, most commonly to reduce the risks of cancer (75%) and repeat operation (49.1%). Of the 45.5% of physicians who do not perform bilateral salpingectomy during hysterectomy, most (69.4%) believe there is no benefit. Fifty-eight percent of practitioners believe that bilateral salpingectomy is the most effective method of sterilization after age 35 years but choose this method only in patients in whom one sterilization procedure has failed or because of tubal disease. Only 7.2% of surgeons prefer it as an interval sterilization procedure. Conclusion: Most practitioners believe that bilateral salpingectomy is beneficial. Most also believe that bilateral salpingectomy is the most effective sterilization procedure; however, only 7.2% use this method as an interval procedure. More data are needed to evaluate the prophylactic effect of bilateral salpingectomy against postoperative sequelae. © 2013 AAGL.


Davids J.R.,Shriners Hospital for Children | Weigl D.M.,Schneider Childrens Medical Center | Edmonds J.P.,Shriners Hospital for Children | Blackhurst D.W.,Greenville Hospital System University Medical Center
Journal of Bone and Joint Surgery - Series A | Year: 2010

Background: Reference accuracy of articles published in the biomedical literature is determined by the presence of citation and quotation errors. A recent review demonstrated that the median citation error rate per biomedical journal was 39%, and the median quotation error rate per journal was 20%. Reference accuracy in pediatric orthopaedic articles has not been previously reported, to our knowledge. Methods: Two hundred references from twenty articles published in four peer-reviewed orthopaedic journals were randomly selected for assessment of citation and quotation accuracy. Full-text copies of all original references were obtained by interlibrary loan methods and reviewed directly to establish citation accuracy. The presence of citation errors was determined by a single investigator. The relevance of citation errors was determined by assessing the ease of reference retrieval through PubMed. Quotation accuracy was determined by two examiners who reviewed each of the twenty articles and 200 references to compare the claims made for the references in the article against the data and opinions expressed in the actual reference. Results: The total citation error rate across all of the journals was 26% (fifty-one of 200 references) with a 95% confidence interval of 16.5% to 37.3%. The median citation error rate per journal was 27% (range, 10% to 38%). Although citation errors were common, most were of minimal significance, as 196 of the 200 references could be retrieved with ease from PubMed. The total quotation error rate across all of the articles was 38% (152 of 398 reference citations) with a 95% confidence interval of 30.1% to 47.0%. The median quotation error rate per journal was 38% (range, 28% to 46%). Conclusions: Citation and quotation errors are common in the pediatric orthopaedic literature. Reference accuracy continues to be a substantial problem in the biomedical literature despite recent technological advances such as online databases, easily accessible search engines, and widely available bibliographic software. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.


Davids J.R.,Shriners Hospital for Children | Lamoreaux D.C.,Shriners Hospital for Children | Brooker R.C.,Shriners Hospital for Children | Brooker R.C.,Greenville Hospital System University Medical Center | And 2 more authors.
Journal of Pediatric Orthopaedics | Year: 2011

Background: Cubitus varus deformity is the most common complication after the treatment of displaced supracondylar humerus fractures. Methods: A retrospective analysis was performed evaluating patients who had undergone a translation step-cut osteotomy for correction of cubitus varus deformity between 1993 and 2008. Postoperative radiographs to union were reviewed for all patients. Subjective information and range of motion measures were documented from the medical records. Patients and their families were also contacted through telephone and administered a questionnaire as well as the QuickDash functional outcome measure to assess their function and satisfaction. Results: Thirty-seven participants were identified and reviewed. Average age at the time of surgery was 8 years and 10 months, with an average follow-up of 2 years and 4 months. Outcomes were assessed in terms of technical, functional, and satisfaction domains. Technical Domain: Average humeroulnar angle (radiographic carrying angle) correction was 26 degrees. Bauman's angle improved 21 degrees on average in patients who were skeletally immature. Functional Domain: Elbow range of motion was maintained in all planes with few exceptions. The clinical carrying angle improved 26 degrees on average, and was symmetric with the unaffected side in 22 of 25 cases in which it was documented. The QuickDash was applied to 15 participants. Eight participants had perfect scores for the symptoms/disability section, and 7 had scores in the top 20% for function. Satisfaction Domain: A study-specific questionnaire was applied to 16 participants. All patients and parents questioned would recommend the procedure to other parents/patients. Conclusion: The translation step-cut osteotomy reliably corrects the coronal plane angular deformity associated with cubitus varus, resulting in excellent outcomes in technical, functional, and satisfaction domains. The osteotomy is relatively simple to perform, and is inherently more stable than other proposed methods. It also minimizes the prominence of the lateral condyle associated with simple lateral closing wedge osteotomy. Copyright © 2011 by Lippincott Williams & Wilkins.


Moureau N.,Greenville Hospital System University Medical Center | Lamperti M.,Neurological Institute Besta | Kelly L.J.,University of West of Scotland | Dawson R.,University of West of Scotland | And 3 more authors.
British Journal of Anaesthesia | Year: 2013

There is a lack of standard minimal requirements for the training of insertion techniques and maintenance of central venous access devices (CVADs). An international evidence-based consensus task force was established through the World Congress of Vascular Access (WoCoVA) to provide definitions and recommendations for training and insertion of CVADs. Medical literature published from February 1971 to April 2012 regarding 'central vascular access', 'training', 'competency', 'simulation', and 'ultrasound' was reviewed on Pubmed, BioMed Central, ScienceDirect, and Scopus databases. The GRADE and the GRADE-RAND methods were utilized to develop recommendations. Out of 156 papers initially identified, 83 papers described training for central vascular access placement. Sixteen recommendations are proposed by this task force, each with an evidence level, degree of consensus, and recommendation grade. These recommendations suggest central venous access education include didactic or web-based teaching with insertion procedure, infection prevention, complications, care, and maintenance of devices, along with laboratory models and tools for simulation practice incorporating ultrasound. Clinical competence should be determined by observation during clinical practice using a global rating scale rather than by the number of procedures performed. Ensuring safe insertion and management of central venous devices requires standardized education, simulation practice, and supervised insertions. © 2013 © The Author [2013].


Le V.H.,Greenville Hospital System University Medical Center | Smith D.E.,Greenville Hospital System University Medical Center | Johnson B.L.,Greenville Hospital System University Medical Center
American Surgeon | Year: 2012

Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder pathologies. In certain circumstances, the procedure must be converted to open to safely complete the operation. This study aims to evaluate the reasons for conversion of this operation in the current era of laparoscopic surgery. A retrospective review of medical records was undertaken to identify all laparoscopic converted to open cholecystectomy performed at a single center over a 2-year period. Reasons for conversion, surgeon's preoperative indications, and specimen pathologic results were documented. A review of published data from the previous two decades was also conducted for comparison of contemporary versus historical reasons for intraoperative conversion. Between May 2008 and April 2010, 3371 laparoscopic cholecystectomies were performed at Greenville Hospital System University Medical Center. Eighty-six patients (2.6%) required conversion to open cholecystectomy during the study period. A diagnosis of acute cholecystitis (58.8%) was more common among converted cases. Inflammation (35%), adhesions (28%), and anatomic difficulty (22%) were the three most common intraoperative findings leading to conversion. In the years since laparoscopic cholecystectomy was introduced, there has been a noted improvement in the quality of laparoscopic equipment affording a near wholesale shift toward the laparoscopic approach in the surgical management of this condition. However, inflammation, adhesions, and anatomic difficulty continue to challenge the use and safety of this approach in a small number of patients. The willingness and ability of surgeons to convert to open cholecystectomy continues to be important to the safety of this operation.

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