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general surgery randomised controlled trial

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https://www.readbyqxmd.com/read/28327096/exploring-why-a-complex-intervention-piloted-in-general-practices-did-not-result-in-an-increase-in-chlamydia-screening-and-diagnosis-a-qualitative-evaluation-using-the-fidelity-of-implementation-model
#1
R Allison, D M Lecky, K Town, C Rugman, E J Ricketts, N Ockendon-Powell, K A Folkard, J K Dunbar, C A M McNulty
BACKGROUND: Chlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15-24 year olds regardless of the type of consultation...
March 21, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28326569/the-dynamics-of-the-oesophageal-squamous-epithelium-normalisation-process-in-patients-with-gastro-oesophageal-reflux-disease-treated-with-long-term-acid-suppression-or-anti-reflux-surgery
#2
L Mastracci, R Fiocca, C Engström, S Attwood, C Ell, J P Galmiche, J G Hatlebakk, G Långström, S Eklund, T Lind, L Lundell
BACKGROUND: Proton pump inhibitors and laparoscopic anti-reflux surgery (LARS) offer long-term symptom control to patients with gastro-oesophageal reflux disease (GERD). AIM: To evaluate the process of 'normalisation' of the squamous epithelium morphology of the distal oesophagus on these therapies. METHODS: In the LOTUS trial, 554 patients with chronic GERD were randomised to receive either esomeprazole (20-40 mg daily) or LARS. After 5 years, 372 patients remained in the study (esomeprazole, 192; LARS, 180)...
March 21, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28306591/ventilation-with-high-versus-low-peep-levels-during-general-anaesthesia-for-open-abdominal-surgery-does-not-affect-postoperative-spirometry-a-randomised-clinical-trial
#3
Tanja A Treschan, Maximilian Schaefer, Johann Kemper, Bea Bastin, Peter Kienbaum, Benedikt Pannen, Sabrine N Hemmes, Marcelo G de Abreu, Paolo Pelosi, Marcus J Schultz
BACKGROUND: Invasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function. OBJECTIVE: We investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry. DESIGN: This was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial...
March 16, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28304084/surgical-versus-non-surgical-management-for-pleural-empyema
#4
REVIEW
Mark D Redden, Tze Yang Chin, Mieke L van Driel
BACKGROUND: Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment...
March 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28270387/statin-prescribing-for-people-with-severe-mental-illnesses-a-staggered-cohort-study-of-real-world-impacts
#5
R Blackburn, D Osborn, K Walters, M Falcaro, I Nazareth, I Petersen
OBJECTIVES: To estimate the 'real-world effectiveness of statins for primary prevention of cardiovascular disease (CVD) and for lipid modification in people with severe mental illnesses (SMI), including schizophrenia and bipolar disorder. DESIGN: Series of staggered cohorts. We estimated the effect of statin prescribing on CVD outcomes using a multivariable Poisson regression model or linear regression for cholesterol outcomes. SETTING: 587 general practice (GP) surgeries across the UK reporting data to The Health Improvement Network...
March 7, 2017: BMJ Open
https://www.readbyqxmd.com/read/28258905/role-of-surgery-in-the-management-of-patients-with-supratentorial-spontaneous-intracerebral-hematoma-critical-appraisal-of-evidence
#6
REVIEW
Taiwo Akhigbe, Ardalan Zolnourian
BACKGROUND: Whether surgery improves the outcome more than medical management alone continues to be a subject of intense debate and controversy. However, there is optimism that the management of spontaneous supratentorial intracerebral haemorrhage will change in future based new insight and better understanding of the acute pathophysiology of hematomas and its dynamics. Craniotomy as a surgical approach has been the most studied intervention for spontaneous supratentorial intracerebral haemorrhage but with no significant benefit when compared to best medical management...
February 28, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28179032/management-of-inverted-papilloma-review
#7
REVIEW
B Attlmayr, S G Derbyshire, A V Kasbekar, A C Swift
BACKGROUND: Inverted papilloma is the most common benign tumour affecting the nose. There is a high rate of recurrence and a potential of malignant transformation. This review article aimed to identify the best available management of this pathology today. METHOD: A systematic review of the current English-language literature was performed. Only original articles with a minimum follow up of one year and an average follow up of two years were included. RESULTS: A total of 1385 patients from 16 case series were identified...
April 2017: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/28138973/medical-treatments-for-incomplete-miscarriage
#8
REVIEW
Caron Kim, Sharmani Barnard, James P Neilson, Martha Hickey, Juan C Vazquez, Lixia Dou
BACKGROUND: Miscarriage occurs in 10% to 15% of pregnancies. The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining placental tissues in the uterus ('evacuation of uterus'). However, medical treatments, or expectant care (no treatment), may also be effective, safe, and acceptable. OBJECTIVES: To assess the effectiveness, safety, and acceptability of any medical treatment for incomplete miscarriage (before 24 weeks). SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (13 May 2016) and reference lists of retrieved papers...
January 31, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28108038/the-effect-of-endotracheal-tubes-versus-laryngeal-mask-airways-on-perioperative-respiratory-adverse-events-in-infants-a-randomised-controlled-trial
#9
Thomas F E Drake-Brockman, Anoop Ramgolam, Guicheng Zhang, Graham L Hall, Britta S von Ungern-Sternberg
BACKGROUND: Perioperative respiratory adverse events (PRAE) are the most common critical incidents in paediatric anaesthesia and occur more often in infants. Use of laryngeal mask airways (LMAs) is associated with reduced PRAE compared with endotracheal tubes in older children (>1 year). We aimed to evaluate the effect of these devices on the incidence of PRAE in infants. METHODS: We did a randomised controlled trial at the Princess Margaret Hospital for Children in Perth (WA, Australia) by recruiting infants (aged 0-12 months) undergoing general (with or without regional or local) anaesthesia with anticipated fentanyl dose 1 μg/kg or lower for minor elective surgery...
January 17, 2017: Lancet
https://www.readbyqxmd.com/read/28088218/spinal-versus-general-anaesthesia-in-surgery-for-inguinodynia-spinasia-trial-study-protocol-for-a-randomised-controlled-trial
#10
Willem A R Zwaans, Léon H P M le Mair, Marc R M Scheltinga, Rudi M H Roumen
BACKGROUND: Chronic inguinodynia (groin pain) is a common complication following open inguinal hernia repair or a Pfannenstiel incision but may also be experienced after other types of (groin) surgery. If conservative treatments are to no avail, tailored remedial surgery, including a neurectomy and/or a (partial) meshectomy, may be considered. Retrospective studies in patients with chronic inguinodynia suggested that spinal anaesthesia is superior compared to general anaesthesia in terms of pain relief following remedial operations...
January 14, 2017: Trials
https://www.readbyqxmd.com/read/28087548/early-lens-extraction-with-intraocular-lens-implantation-for-the-treatment-of-primary-angle-closure-glaucoma-an-economic-evaluation-based-on-data-from-the-eagle-trial
#11
Mehdi Javanbakht, Augusto Azuara-Blanco, Jennifer M Burr, Craig Ramsay, David Cooper, Claire Cochran, John Norrie, Graham Scotland
OBJECTIVE: To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. DESIGN: Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon...
January 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28053265/effectiveness-of-open-and-arthroscopic-rotator-cuff-repair-ukuff-a-randomised-controlled-trial
#12
RANDOMIZED CONTROLLED TRIAL
A Carr, C Cooper, M K Campbell, J Rees, J Moser, D J Beard, R Fitzpatrick, A Gray, J Dawson, J Murphy, H Bruhn, D Cooper, C Ramsay
AIMS: The appropriate management for patients with a degenerative tear of the rotator cuff remains controversial, but operative treatment, particularly arthroscopic surgery, is increasingly being used. Our aim in this paper was to compare the effectiveness of arthroscopic with open repair of the rotator cuff. PATIENTS AND METHODS: A total of 273 patients were recruited to a randomised comparison trial (136 to arthroscopic surgery and 137 to open surgery) from 19 teaching and general hospitals in the United Kingdom...
January 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28035669/a-randomised-controlled-trial-comparing-transnasal-humidified-rapid-insufflation-ventilatory-exchange-thrive-pre-oxygenation-with-facemask-pre-oxygenation-in-patients-undergoing-rapid-sequence-induction-of-anaesthesia
#13
F Mir, A Patel, R Iqbal, M Cecconi, S A R Nouraei
Pre-oxygenation is an essential part of rapid sequence induction of general anaesthesia for emergency surgery, in order to increase the oxygen reservoir in the lungs. We performed a randomised controlled trial of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation or facemask pre-oxygenation in patients undergoing emergency surgery. Twenty patients were allocated to each group. No patient developed arterial oxygen saturation < 90% during attempted tracheal intubation. Arterial blood gases were sampled from an arterial catheter immediately after intubation...
April 2017: Anaesthesia
https://www.readbyqxmd.com/read/28012165/stem-cell-therapy-for-chronic-ischaemic-heart-disease-and-congestive-heart-failure
#14
REVIEW
Sheila A Fisher, Carolyn Doree, Anthony Mathur, David P Taggart, Enca Martin-Rendon
BACKGROUND: A promising approach to the treatment of chronic ischaemic heart disease and congestive heart failure is the use of stem cells. The last decade has seen a plethora of randomised controlled trials developed worldwide, which have generated conflicting results. OBJECTIVES: The critical evaluation of clinical evidence on the safety and efficacy of autologous adult bone marrow-derived stem/progenitor cells as a treatment for chronic ischaemic heart disease and congestive heart failure...
December 24, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28003302/cost-effectiveness-of-early-surgery-versus-conservative-treatment-with-optional-delayed-meniscectomy-for-patients-over-45%C3%A2-years-with-non-obstructive-meniscal-tears-escape-study-protocol-of-a-randomised-controlled-trial
#15
Victor A van de Graaf, Vanessa A B Scholtes, Nienke Wolterbeek, Julia C A Noorduyn, Camille Neeter, Maurits W van Tulder, Daniël B F Saris, Arthur de Gast, Rudolf W Poolman
INTRODUCTION: Recent studies show similar outcome between surgery and conservative treatment in patients with non-obstructive meniscal tears. However, surgery is still often preferred over conservative treatment. When conservative treatment is non-inferior to surgery, shifting the current standard treatment choice to conservative treatment alone could save over €30 millions of direct medical costs on an annual basis. Economic evaluation studies comparing surgery to conservative treatment are lacking...
December 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/28000203/comparison-of-continuous-epidural-block-and-continuous-paravertebral-block-in-postoperative-analgaesia-after-video-assisted-thoracoscopic-surgery-lobectomy-a-randomised-non-inferiority-trial
#16
RANDOMIZED CONTROLLED TRIAL
Sylweriusz Kosiński, Edward Fryźlewicz, Michał Wiłkojć, Adam Ćmiel, Marcin Zieliński
BACKGROUND: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27931870/effects-of-early-mobilisation-in-patients-after-cardiac-surgery-a-systematic-review
#17
REVIEW
P M Ramos Dos Santos, N Aquaroni Ricci, É Aparecida Bordignon Suster, D de Moraes Paisani, L Dias Chiavegato
BACKGROUND: Early mobilisation is prescribed after cardiac surgery to prevent postoperative complications, decrease length of hospital stay, and augment return to daily activities. OBJECTIVE: To evaluate the evidence for the effects of early mobilisation in patients after cardiac surgery on length of hospital stay, functional capacity and postoperative complications. DATA SOURCES: The data sources used were Medline, Embase, CINAHL, PEDro, Web of Science and Cochrane Central Register of Controlled Trials...
March 2017: Physiotherapy
https://www.readbyqxmd.com/read/27902849/oral-antivirals-for-preventing-recurrent-herpes-simplex-keratitis-in-people-with-corneal-grafts
#18
REVIEW
Uday K Bhatt, M N Abdul Karim, Jeremy I Prydal, Senthil V Maharajan, Usama Fares
BACKGROUND: Ocular herpes is a viral infection of the eye caused by the herpes simplex virus (HSV), a double-stranded DNA virus. Corneal scarring caused by herpes simplex keratitis (HSK) is the leading infectious cause of penetrating corneal graft in high-income countries. Acyclovir is an antiviral drug known to have a protective effect against recurrences in herpetic eye disease. While there are some studies which have evaluated the effects of intervention with oral antiviral in preventing such recurrences in people with corneal grafts, a systematic review of all comparative clinical trials has not been previously undertaken...
November 30, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27898991/nipple-and-areola-sparing-mastectomy-for-the-treatment-of-breast-cancer
#19
REVIEW
Bruna S Mota, Rachel Riera, Marcos Desidério Ricci, Jessica Barrett, Tiago B de Castria, Álvaro N Atallah, Jose Luiz B Bevilacqua
BACKGROUND: The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. OBJECTIVES: To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women...
November 29, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27898181/endovenous-ablation-therapy-laser-or-radiofrequency-or-foam-sclerotherapy-versus-conventional-surgical-repair-for-short-saphenous-varicose-veins
#20
REVIEW
Sharath Chandra Vikram Paravastu, Margaret Horne, P Dominic F Dodd
BACKGROUND: Short (or small) saphenous vein (SSV) varices occur as a result of an incompetent sapheno-popliteal junction, where the SSV joins the popliteal vein, resulting in reflux in the SSV; they account for about 15% of varicose veins. Untreated varicose veins may sometimes lead to ulceration of the leg, which is difficult to manage. Traditionally, treatment was restricted to surgery or conservative management. Since the 1990s, however, a number of minimally invasive techniques have been developed; these do not normally require a general anaesthetic, are day-case procedures with a quicker return to normal activities and avoid the risk of wound infection which may occur following surgery...
November 29, 2016: Cochrane Database of Systematic Reviews
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