John Massman

Small Bowel Obstruction Is a Surgical Disease: Patients with Adhesive Small Bowel Obstruction Requiring Operation Have More Cost-Effective Care When Admitted to a Surgical Service

BACKGROUND Adhesive small bowel obstruction (ASBO), although a potential surgical emergency, is increasingly being managed by medical hospitalists due to the likelihood these patients will not require operation. However, the value of care delivered by medical hospitalists to patients with ASBO has not been reported. STUDY DESIGN We hypothesized that patients admitted to the medical hospitalist service (MHS) for presumed ASBO have increased length of stay (LOS) and charges compared with patients admitted to the surgical service (SS). There were 555 consecutive admissions with presumed ASBO from 2008 to 2012; these were reviewed and grouped according to admitting service and whether an operation was performed. Group medians were compared and multivariate analysis was performed to identify variables independently associated with increased LOS, time to operation (TTO), and charges. RESULTS Median LOS among patients whose ASBO resolved nonoperatively was similar for those on SS and MHS (2.85 days vs 2.98 days; p = 0.49). In patients without nonoperative resolution of ASBO, those admitted to MHS had longer median LOS when compared with those admitted to SS (9.57 days vs 6.99 days; p = 0.002) and higher median charges (

Initiation of adjuvant therapy following surgical resection of pancreatic ductal adenocarcinoma (PDAC): Are patients from rural, remote areas disadvantaged?

38,800 vs

Selecting an Electronic Data Capture System

30,100; p = 0.025). Patients admitted to MHS who had an operation, had a greater median TTO than operative patients on SS (51.72 hours vs 8.4 hours; p < 0.001). Multivariate analysis did not identify factors independently predictive of increased LOS, TTO, or charges. CONCLUSIONS Adhesive small bowel obstruction patients are treated in a heterogeneous fashion in our hospital, causing disparate outcomes depending on admitting service when patients undergo operation. Admitting all suspected ASBO patients to SS has the potential to dramatically decrease LOS and reduce waste in those requiring operation, thereby reducing health care expenditures.

Prostate Needle Biopsy Outcomes in the Era of the U.S. Preventive Services Task Force Recommendation against Prostate Specific Antigen Based Screening

Although race and socioeconomic status have been shown to affect outcomes in pancreatic ductal adenocarcinoma (PDAC), the impact of rural residence on the delivery of adjuvant therapy (AT) has not been studied.

MP43-20 RATES OF NON-DEFINITIVE MANAGEMENT FOR LOW AND INTERMEDIATE RISK PROSTATE CANCER ARE SIMILAR BETWEEN AFRICAN AMERICANS AND CAUCASIANS

Introduction: Investigators encounter numerous challenges when initiating a research project, including selecting an appropriate electronic data capture system. Options range from simple stand‐alone spreadsheets to full service, relational databases controlled by certified database administrators. We present an overview of the issues to consider when selecting an electronic data capture system and a survey of available software solutions. We also discuss how to select an electronic data capture system that best meets the data management needs of the study. Methods: We compared software solutions based on several regulatory and budgetary issues that should be considered by investigators. Regulatory issues include HIPAA (Health Insurance Portability and Accountability Act), case report forms and adverse event reports. Technology costs, ease of use and expertise of personnel are examples of budgetary matters. Results: Stand‐alone spreadsheets require extra attention to regulatory matters but are intuitive to investigators. Large‐scale relational database management systems can be configured for all regulatory matters but require dedicated effort from a certified database administrator, greatly increasing data management costs. Low cost, server based solutions sacrifice some of the flexibility of a relational database management system in exchange for being extremely easy to design and manage. Software as a service is a scalable third party solution. Cloud based systems are a new solution that are not widely used in institutional review board approved research. Conclusions: Due to the extensive resources required to implement an electronic data capture system it is important to carefully analyze and understand what options are available. In this way the most informed choice can be made.