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Biomedical subjects

C C Wolferth

Publications and source records attributed to C C Wolferth.

At least 19 recordsLinked to original sources
PubMed1995

Analysis of American College of Surgeons trauma consultation program.

OBJECTIVE: To identify the criteria deficiencies found during peer consultation of hospitals and the relationship to subsequent verification. METHODS: Between September 1987 and December 1992, 52 hospitals had consultation visits using American College of Surgeons criteria. Each report was studied for deficiencies, frequency of deficiencies, and relationship to verification. RESULTS: There are 108 American College of Surgeons criteria. Thirty-five different criteria deficiencies were found. The number of deficiencies per hospital ranged from zero to 12. The more frequent deficiencies included a lack of the following: quality improvement, 35 (67%); trauma service, 20 (38%); trauma surgeon in emergency department, 20 (38%); 24-hour operating room availability, 17 (33%); trauma registry, 17 (33%); trauma continuing medical education, 16 (31%); trauma director, 15 (29%); computed tomography technician in hospital, 15 (29%); research, 14 (27%); trauma coordinator, 14 (27%); and neurosurgeon availability, 13 (25%). No hospital that lacked commitment of surgeons (n = 12) or hospital (n = 3) requested a verification visit. Twenty-four hospitals (46%) achieved verification by February 1994. Twenty-eight hospitals had six or fewer deficiencies, with 19 (68%) verified. Twenty-four hospitals had seven or more deficiencies, with only five (21%) subsequently verified. Verification visits followed consultation by 3 to 52 months. Two hospitals with nine deficiencies were verified after 30 and 48 months, although one failed its first verification visit. CONCLUSIONS: American College of Surgeons consultation assists hospitals to identify their trauma center capability and appears to improve their ability to pass subsequent trauma center verification. Most criteria deficiencies are correctable. Lack of commitment by the surgeons or hospital is difficult to correct. There is an inverse relationship between the number of deficiencies and subsequent verification.

General Surgery↗
PubMed1990

Percutaneous interventional gallbladder procedures: personal experience and literature review.

Our experience with 58 percutaneous gallbladder procedures in 48 patients are discussed. Diagnostic procedures consisted of needle aspiration of bile (n = 5) to evaluate the gallbladder as a source of infections and transcholecystic cholangiography (TCC) (n = 32) for bile duct visualization. Percutaneous cholecystostomy (PC) (n = 21) was performed for gallbladder or bile duct decompression or stone dissolution. Ultrasound and/or fluoroscopic guidance were used, and the procedures were successful in all but one patient. The overall complication rate was 13.8% (8/58 procedures) but only 5.2% were considered serious (three instances of bile peritonitis). No vasovagal reactions or hemorrhage occurred. We also reviewed the complications in 231 cases of PC that have been reported in the English literature. The overall complication rate was 7.8%, and the most significant problems were death (n = 1), peritonitis (n = 3), and severe vasovagal reactions (n = 4).

Adult↗
PubMed1989

Status of trauma center designation.

1) In 1986 20 states are designating trauma centers. 2) ACS guidelines appear to be the accepted standard. 3) Almost all of the states providing designation retain the power of final designation but allow individual hospitals to initiate the process. 4) Designation is usually based on actual capability and frequently requires a site visit team in which surgeons and emergency medicine physicians play a prominent role. 5) Designation appears to be for a finite period of time but half of the states do not provide for de-designation. 6) A national mandate is necessary for timely and uniform implementation of trauma center designation.

General Surgery↗
PubMed1988

Trauma systems. Current status--future challenges.

The national status of regional trauma system development was evaluated by a survey sent to all state emergency medical services directors and state chairpersons of the American College of Surgeons Committee on Trauma. Eight essential components of a regional trauma system based on criteria set forth by the American College of Surgeons were listed. Only two states were found to have all components and statewide coverage. Nineteen states and the District of Columbia lacked one or more components of a regional trauma system. The remaining 29 states had yet to initiate the process of trauma center designation. In response to these shortcomings, an attempt was made to define the barriers to trauma system implementation and a step-by-step process was outlined for the development, management, and analysis of a comprehensive system of trauma care.

Economics, Hospital↗
PubMed1984

Interventional radiology of the biliary system and pancreas.

In recent years, newer techniques have become available to the clinician for the diagnosis and treatment of biliary and pancreatic disease. This article emphasizes interventional procedures through the liver, such as percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, and ancillary techniques. Also discussed are the nonsurgical management of bile duct calculi and the diagnosis and treatment of pancreatic tumors, abscesses, and pseudocysts.

Bile Duct Diseases↗
PubMed1978

Atherosclerosis and the hypoplastic aortoiliac system.

Between January, 1965, and December, 1975, 204 patients (138 men and 66 women) underwent aortoiliac reconstruction for atherosclerotic occlusive disease. Eighteen patients (9%) had a hypoplastic aortoiliac segment and an analysis of these 18 patients constitutes the basis of this report. There were 17 women and one man, and their ages ranged from 28 to 60 years, with an average of 43 years. Hyperlipidema was present in nine of 13 patients tested. All patients were heavy cigarrete smokers and had lower extremity claudication with weak or absent pulses. Carotid or subclavian artery disease was found in 50%. Angiography demonstrated hypoplasia of the aorta distal to the renal arteries with either occlusion, diffuse narrowing, or, most often, an "hourglass" stenosis. The iliac and femoral arteries also were narrowed. Reconstruction was achieved primarily by aortobilateral-iliac or femoral bypass. There were no operative deaths and all patients were improved initially. It appears that normally occurring atherosclerosis in this portion of the aorta, along with congenital narrowing, accounts for symptoms at an early age. The predominence in women is a puzzle. The prognosis does not appear to be too grim. This may be due to absence of diabetes mellitus and the infrequency of coronary artery disease. All patients are still alive; there has been one major amputation following graft infection 1 1/2 years after operation. When progression of atherosclerosis occurs, it seems to involve the superficial femoral, carotid, and subclavian arteries.

Adult↗