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  • Gruen, Russell L.  (7)
  • SpringerLink  (7)
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  • 1
    Language: English
    In: World Journal of Surgery, 2012, Vol.36(8), pp.1978-1992
    ISSN: 0364-2313
    E-ISSN: 1432-2323
    Source: Springer Science & Business Media B.V.
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  • 2
    Language: English
    In: World Journal of Surgery, 2009, Vol.33(8), pp.1554-1561
    Description: Byline: Russell L. Gruen (1) Abstract: Introduction Saltwater crocodiles are formidable predators in northern Australia, and crocodile attacks on humans are not rare. With recent deaths highlighting this as a public health issue, an evidence-based discourse about effective methods of minimizing the danger to humans is needed. Methods Using the Haddon Matrix for injury prevention, approaches to minimizing crocodile associated death and injury were sought. Results Possibilities for harm minimization before, during and after a crocodile attack are identified, and their merits appriased. The importance of excellent prehospital and surgical and critical care is emphasized. Conclusions A combination of behavior adaptation, mutual respect, and minimizing contact will be the key to minimizing the harm from attacks, and excellent medical and surgical care will always be necessary for those unfortunate to be victims but fortunate to survive. Author Affiliation: (1) National Trauma Research Institute, Alfred Hospital, Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia Article History: Registration Date: 18/05/2009 Online Date: 20/06/2009
    Keywords: Crocodiles -- Health Aspects ; Public Health -- Health Aspects;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 3
    In: Journal of General Internal Medicine, November 2006, Vol.21(11), pp.1150-1155
    Description: Information technology (IT) has been advocated as an important means to improve the practice of clinical medicine. To determine current prevalence of non‐electronic health record (EHR) IT use by a national sample of U.S. physicians, and to identify associated physician, practice, and patient panel characteristics. Survey conducted in early 2004 of 1,662 U.S. physicians engaged in direct patient care selected from 3 primary care specialties (family practice, internal medicine, pediatrics) and 3 nonprimary care specialties (anesthesiology, general surgery, cardiology). Self‐reported frequency of e‐mail communication with patients or other clinicians, online access to continuing medical education or professional journals, and use of any computerized decision support (CDS) during clinical care. Survey results were weighted by specialty and linked via practice zip codes to measures of area income and urbanization. Response rate was 52.5%. Respondents spent 49 (±19) (mean [±standard deviation]) hours per week in direct patient care and graduated from medical school 23 (±11) years earlier. “Frequent” use was highest for CDS (40.8%) and online professional journal access (39.0%), and lowest for e‐mail communication with patients (3.4%). Ten percent of physicians never used any of the 5 IT tools. In separate logistic regression analyses predicting usage of each of the 5 IT tools, the strongest associations with IT use were primary care practice (adjusted odds ratios [aORs] ranging from 1.34 to 2.26) and academic practice setting (aORs 2.17 to 5.41). Years since medical school graduation (aOR 0.85 to 0.87 for every 5 years after graduation) and solo/2‐person practice setting (aORs 0.21 to 0.55) were negatively associated with IT use. Practice location and patient panel characteristics were not independently associated with IT use. In early 2004, the majority of physicians did not regularly use basic, inexpensive, and widely available IT tools in clinical practice. Efforts to increase the use of IT in medicine should focus on practice‐level barriers to adoption.
    Keywords: Information Technology ; Physician Practice Patterns ; Primary Care ; Academic Medicine
    ISSN: 0884-8734
    E-ISSN: 1525-1497
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  • 4
    Language: English
    In: World Journal of Surgery, 2016, Vol.40(11), pp.2611-2619
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00268-016-3614-y Byline: Kathleen M. O'Neill (1,2), Sarah L. M. Greenberg (1,3), Meena Cherian (4), Rowan D. Gillies (5), Kimberly M. Daniels (1,6), Nobhojit Roy (7,8), Nakul P. Raykar (1,9), Johanna N. Riesel (1,10), David Spiegel (11), David A. Watters (12,13), Russell L. Gruen (14,15) Abstract: Background Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care. Methods We convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures--which we term "bellwether procedures"--was associated with performing a full range of essential surgical procedures. Findings The ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p 〈 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery did not correlate with performing the bellwether procedures. Interpretation Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team. Author Affiliation: (1) Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA (2) Department of Surgery, Yale New Haven Hospital, 1245 Chapel Street Apt 503, New Haven, CT, 06510, USA (3) Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA (4) WHO Emergency and Essential Surgical Care Programme, The World Health Organization, Headquarters, Geneva, Switzerland (5) Royal North Shore Hospital, Plastic, Reconstructive and Burns, Reserve Rd, St Leonards, NSW, 2065, Australia (6) Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA (7) Department of Surgery, Bhabha Atomic Research Center (BARC) Hospital, Mumbai, 94, India (8) Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (9) Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA (10) The Harvard Program in Plastic Surgery, Boston, MA, 02114, USA (11) Department of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA (12) Royal Australasian College of Surgeons, East Melbourne, VIC, Australia (13) School of Medicine, Faculty of Health, Barwon Health, Deakin University, Geelong, VIC, Australia (14) The Alfred Hospital and Monash University, Melbourne, VIC, 3051, Australia (15) Nanyang Technological University, 50 Nanyang Drive, Research Techno Plaza, Level 4 X-Frontiers Block, Singapore, 637553, Singapore Article History: Registration Date: 11/06/2016 Online Date: 28/06/2016 Article note: Disclaimer: The authors include WHO staff. The views expressed in this publication reflect their views and not necessarily that of WHO.
    Keywords: Delivery (Childbirth) -- Analysis ; Laparotomy -- Analysis;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 5
    Language: English
    In: World Journal of Surgery, 2015, Vol.39(4), pp.856-864
    Description: Byline: David A. Watters (1), Michael J. Hollands (2), Russell L. Gruen (3), Kiki Maoate (4), Haydn Perndt (5), Robert J. McDougall (6), Wayne W. Morriss (7), Viliami Tangi (8), Kathleen M. Casey (9), Kelly A. McQueen (10) Abstract: Introduction The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery. Methods A consensus meeting was held between representatives of Surgical and Anaesthetic Colleges and Societies to obtain agreement about which indicators were the most appropriate and credible. The literature and state of national reporting of perioperative mortality rates was reviewed by the authors. Results There is a need for a credible national and/or regional indicator that is relevant to emergency and essential surgical care. We recommend introducing the perioperative mortality rate (POMR) as an indicator of access to and safety of surgery and anaesthesia. POMR should be measured at two time periods: death on the day of surgery and death before discharge from hospital or within 30 days of the procedure, whichever is sooner. The rate should be expressed as the number of deaths (numerator) over the number of procedures (denominator). The option of before-discharge or 30 days is practical for those low- to middle-income countries where postdischarge follow-up is likely to be incomplete, but it allows those that currently can report 30-day mortality rates to continue to do so. Clinical interpretation of POMR at a hospital or health service level will be facilitated by risk stratification using age, urgency (elective and emergency), procedure/procedure group, and the American Society of Anesthesiologists grade. Conclusions POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status. Author Affiliation: (1) Deakin University and Barwon Health, Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia (2) Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia (3) Royal Australasian College of Surgeons, National Trauma Research Institute, Level 4, 89 Commercial Road, Melbourne, VIC, Australia (4) Children's Specialist Centre, 58 Colombo Street, Cashmere, Christchurch, New Zealand (5) School of Medicine, Royal Hobart Hospital, The University of Tasmania, GPO Box 1061 L, Hobart, TAS, Australia (6) The Royal Children's Hospital Melbourne, Flemington Road, Parkville, Melbourne, VIC, Australia (7) Christchurch Hospital, Riccarton Avenue, Addington, Christchurch, New Zealand (8) Ministry of Health, Taufa'ahau Road, Nuku'alofa, Tonga (9) American College of Surgeons, 633 N. Saint Clair Street, Chicago, IL, USA (10) Vanderbilt University Medical Centre, 1211 Medical Centre Drive, Nashville, TN, USA Article History: Registration Date: 01/05/2014 Online Date: 20/05/2014
    Keywords: Surgery – Health Aspects ; Anesthesia – Health Aspects;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 6
    Language: English
    In: Lancet (London, England), 08 September 2007, Vol.370(9590), pp.826; author reply 826-7
    Description: OBJECTIVE: To study the metabolism of icodextrin and alpha-amylase activity following daily exposure to dialysis solutions containing either glucose or icodextrin as osmotic agent in rats.METHODS: Male Wistar rats with implanted peritoneal catheters were infused twice daily for 3 weeks with 20 mL 7.5% icodextrin-based peritoneal dialysis fluid (IPDF; ICO group, n = 12) or 3.86% glucose-based peritoneal dialysis fluid (GLU group, n = 11). A 4-hour dwell study using 30 mL IPDF was performed on day 10 (D1) and day 21 (D2) in both the ICO and the GLU groups. Radiolabeled serum albumin (RISA) was used as a macromolecular volume marker. Dialysate samples were collected at 3, 15, 30, 60, 90, 120, and 240 minutes. Blood samples were drawn before the start and at the end of the dwell.RESULTS: During all dwell studies, the dialysate concentrations of total icodextrin decreased due to decrease in high molecular weight (MW) fractions, whereas there was a marked increase in icodextrin low MW metabolites. alpha-Amylase activity increased in dialysate and decreased in plasma. About 60% of the total icodextrin was absorbed from the peritoneal cavity during the 4-hour dwells. Low MW icodextrin metabolites were present in the dialysate already at 3 minutes, and maltose (G2), maltotriose (G3), maltotetraose (G4), and maltopentaose (G5) increased progressively, reaching maximum concentrations at 60 minutes. Maltohexaose (G6) and maltoheptaose (G7) were also detected already at 3 minutes but did not change significantly during the dwells. During the two 4-hour dwell studies (D1 and D2), the concentrations of total icodextrin and icodextrin metabolites and alpha-amylase activity in dialysate did not differ between the ICO and GLU groups, during either D1 or D2. No icodextrin metabolites were detected in plasma at the end of the dwells. alpha-Amylase activity in the dialysate increased six- to eightfold whereas plasma alpha-amylase activity decreased by 21% - 26% during the two 4-hour dwells in both the ICO and the GLU groups; there were no significant differences between the ICO and the GLU groups during either D1 or D2. alpha-Amylase activity in the dialysate correlated strongly with the disappearance rate of icodextrin from the peritoneal cavity during the 4-hour dwells, and with the concentrations of G2, G3, G6, and G7 in dialysate.CONCLUSIONS: The decline in the dialysate concentrations of high MW fractions and the increase in low MW metabolites of icodextrin suggest intraperitoneal alpha-amylase mediated the metabolism of icodextrin and the transport of predominantly the smaller icodextrin metabolites from dialysate. However, no icodextrin could be detected in plasma, suggesting that it was metabolized and excreted by the kidney in these nonuremic rats. In contrast to uremic peritoneal dialysis patients, chronic exposure to IPDF did not seem to further affect alpha-amylase activity or icodextrin metabolism. The much higher alpha-amylase activity in plasma and dialysate in rats than in humans explains the much more rapid metabolism of icodextrin in rats compared with peritoneal dialysis patients.
    Keywords: Evidence-Based Medicine ; Health Policy ; Health Services Needs and Demand ; World Health Organization ; Practice Guidelines As Topic -- Standards
    ISSN: 08968608
    E-ISSN: 1474-547X
    E-ISSN: 26323559
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  • 7
    Language: English
    In: Annals of Surgical Oncology, 2008, Vol.15(9), pp.2542-2549
    Keywords: Breast conserving surgery ; Margins ; Residual disease
    ISSN: 1068-9265
    E-ISSN: 1534-4681
    Source: Springer Science & Business Media B.V.
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