The ASBS Bariatric Surgery Centers of excellence program: a blueprint for quality improvement. Surg Obes Relat Dis 2:497-503
ABSTRACT Variations in the techniques of bariatric surgery, coupled with the lack of a common database, has led to variable and, sometimes negative, outcomes from bariatric surgery. Thus, in November 2003, the American Society for Bariatric Surgery established Surgical Review Corporation (SRC) as an independent nonprofit entity for quality control of bariatric surgery and as a resource for data collection and analysis.
In November 2003, the leadership of the American Society for Bariatric Surgery founded SRC as an independent nonprofit entity for quality control of bariatric surgery and as resource for research. A national set of standards for the Bariatric Surgery Centers of Excellence program was developed using a meta-analysis of the relevant published English language data, a consensus conference at Georgetown University, and participation by stakeholders from industry, third-party payors, and malpractice carriers. A software program was developed to provide uniformity in data collection and ease of analysis.
SRC developed standards that have been accepted by the bariatric surgical community and put in place. A system was developed for the designation of two levels for the centers, provisional and full. The growth of the Centers of Excellence program has been rapid. At present, 135 hospitals and 265 surgeons have achieved full approval. The centers for Medicare and Medicaid Services have recognized the program. On the basis of the reports of 55,567 patients from the first 176 applicants for full approval and confirmed by SRC during site inspections, the 90-day operative mortality rate was 0.35%.
The first phase of development has gone well. Future steps include the development of a network of bariatric physicians and the development of a consortium for research.
Article: Bariatric surgery for morbid obesity[Show abstract] [Hide abstract]
ABSTRACT: Bariatric surgery is a treatment for severely obese patients. We examined the efficacy of bariatric surgery, addressing three questions: 1) What is the overall weight reduction following bariatric surgery? 2) What complications are associated with bariatric surgery? 3) What impact does weight loss have on obesity-related comorbidity? Fixed and random effects meta-analyses were used to determine the amount of weight reduction following bariatric surgery. The influence of a variety of co-variates that could affect study results was examined. Information from evidence-based sources was used to explore the impact of weight loss on comorbidities. Meta-analyses results were affected by loss to follow-up, and within-study heterogeneity of variance. Therefore, results were pooled from studies with complete patient follow-up. Meta-analysis of six studies reporting weight loss at 1 year and four studies with mean follow-up of 9 months to 7 years demonstrated BMI reductions of 16.4 kg/m(2) and 13.3 kg/m(2), respectively. Weight reduction following bariatric surgery may be associated with improvements in risk factors for cardiac disease including hypertension, type 2 diabetes and lipid abnormalities, and may decrease the severity of obstructive sleep apnea. Bariatric surgery is appropriate for obese patients (BMI >40 kg/m(2) or > or =35 kg/m(2) with obesity-related comorbidity) in whom non-surgical treatment options were unsuccessful. Additional research is needed to examine the long-term benefits of weight loss following bariatric surgery, particularly with respect to obesity-related comorbidities.Obesity Surgery 11/2000; 10(5):391-401. DOI:10.1381/096089200321594246
Conference Paper: Simulation of phased array techniques for realistic NDE configurations[Show abstract] [Hide abstract]
ABSTRACT: In this communication we briefly present the phased array simulation tools developed at the CEA in the aim of driving delays laws, predicting ultrasonic beams, simulating and processing acquired data. These tools allow to manage NDT inspections in complex configurations. We present some examples on such configurations illustrating the interest and reliability of simulation.Ultrasonics Symposium, 2002. Proceedings. 2002 IEEE; 11/2002
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ABSTRACT: Compared to aluminum the electromigration resistance of copper is higher. This leads to longer test times. Higher acceleration factors are needed to reach reasonable test times. Because of the oven hardware there is a limitation in the stress temperature for standard iso-current tests on package level at 350°C. Self-heated test methods, such as SWEAT and accelerated iso-current test on wafer level, use Joule-heating to to reach stress temperatures up to 600°C and therefore to much lower test times. For aluminum a qualitative analysis with these tests has already been conducted successfully. It would be a major advantage, if quantitative analysis, e.g. extrapolation to operation conditions, would be feasible. During this investigation, we have used three different electromigration stress methods, iso-current test on package level, iso-current test on wafer level and SWEAT, with different stress conditions on the same structure and material. We show an extrapolation of all of the results of the different test methods to operation conditions and a way to calculate the necessary Black's parameters from the results of the highly accelerated self-heated tests.Integrated Reliability Workshop Final Report, 2002. IEEE International; 11/2002