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1.
Ann Vasc Surg ; 42: 16-24, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28279725

ABSTRACT

BACKGROUND: Several carotid endarterectomy techniques have been described, including conventional carotid endarterectomy (CCEA) performed with patch repair and eversion carotid endarterectomy (ECEA) performed with transection of the internal carotid artery. We describe our simplified technique of modified eversion carotid endarterectomy (mECEA) with longitudinal arteriotomy limited to the carotid bulb, without transection of the internal carotid artery and present our analysis of its safety, efficacy, and cost effectiveness. METHODS: A retrospective review of all carotid endarterectomies performed by 3 vascular surgeons over a 3-year period was completed. About 197 mECEA were performed during the study period. Follow-up data were obtained on 77.7% of patients. A comparison was made with the contemporary literature with respect to outcomes for both CCEA and ECEA. RESULTS: Between January 2012 and December 2014, a total of 197 mECEA were performed. The perioperative stroke and death rates for those undergoing mECEA was 0.5% and 0.5%, respectively. Late stroke and death rates were 3.0% and 5.1%, respectively. Perioperative rate of myocardial infarction was 1.0%. Early restenosis rates of >70% occurred in 1.4%, whereas late restenosis of >70% occurred in 2.7%. Mean operating time for those undergoing mECEA was 57.9 min. Average costs savings for mECEA compared to CCEA were $5,835. CONCLUSIONS: This simplified technique has comparable outcomes to those described in the contemporary literature for both CCEA and ECEA with respect to postoperative neurologic events as well as restenosis rates. In our institution, the short mean operative times with mECEA has led to reduced resource utilization.


Subject(s)
Carotid Stenosis/economics , Carotid Stenosis/surgery , Endarterectomy, Carotid/economics , Endarterectomy, Carotid/methods , Hospital Costs , Process Assessment, Health Care/economics , Aged , Aged, 80 and over , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/mortality , Cost Savings , Cost-Benefit Analysis , Databases, Factual , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/mortality , Female , Health Resources/economics , Health Resources/statistics & numerical data , Humans , Male , Middle Aged , Myocardial Infarction/economics , Myocardial Infarction/etiology , Operative Time , Recurrence , Retrospective Studies , Risk Factors , Stroke/economics , Stroke/etiology , Time Factors , Treatment Outcome
2.
Clin Nurse Spec ; 22(2): 73-8; quiz 79-80, 2008.
Article in English | MEDLINE | ID: mdl-18418117

ABSTRACT

UNLABELLED: Evidence suggests that medication safety may be improved through more accurate assessment of renal function and appropriate dosing of renally cleared medications. The purpose of this article is to describe patient renal risk groups, associated medication errors, and ways that nurses can improve renal assessment. METHODS: Medication safety data were collected through voluntary reporting, computerized triggers, pharmacist surveillance, and retrospective chart review. Data were analyzed across 3 renal risk groups. RESULTS: Findings indicated that regarding the detected medication errors, elderly women were more likely to have hidden renal risk and that prescribing errors involving a wrong dose occurred more often in patients with high and hidden renal risk. Antibiotic and diabetic medications were the primary drug categories involved in these medication errors. RECOMMENDATIONS: Results indicated that identification of patients with hidden renal risk can be improved by routinely assessing serum creatinine and estimated creatinine clearance levels during renal assessments. Clinical nurse specialists can use this evidence to promote safer nursing care of renal patients.


Subject(s)
Drug-Related Side Effects and Adverse Reactions , Kidney/drug effects , Medication Errors/prevention & control , Aged , Aged, 80 and over , Education, Continuing , Female , Humans , Male , Middle Aged , Nursing , Risk Factors
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