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https://www.readbyqxmd.com/read/29150094/-geriatric-assessment-and-prognostic-scores-in-older-cancer-patient-additional-support-to-the-therapeutic-decision
#1
REVIEW
Frédéric Pamoukdjian, Evelyne Liuu, Philippe Caillet, Mathilde Gisselbrecht, Stéphane Herbaud, Pascaline Boudou-Rouquette, Laurent Zelek, Elena Paillaud
Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index...
November 14, 2017: Bulletin du Cancer
https://www.readbyqxmd.com/read/29150035/thoracic-surgery-considerations-in-obese-patients
#2
REVIEW
Douglas Z Liou, Mark F Berry
The obesity epidemic in the United States has increased greatly over the past several decades, and thoracic surgeons are likely to see obese patients routinely in their practices. Obesity has direct deleterious health effects such as metabolic disorder and cardiovascular disease, and is associated with many cancers. Obese patients who need thoracic surgery pose practical challenges to many of the routine elements in perioperative management. Preoperative assessment of obesity-related comorbid conditions and risk stratification for surgery, thorough intraoperative planning for anesthesia and surgery, and postoperative strategies to optimize pulmonary hygiene and mobility minimize the risk of adverse outcomes...
February 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/29120928/oncologic-considerations-in-the-elderly
#3
Mohamed K Kamel, Jeffrey L Port
PURPOSE OF REVIEW: Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. RECENT FINDINGS: Lung resections appears to be relatively safe in the elderly patients presenting with lung cancer...
November 8, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29112549/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-patients-with-preexisting-coagulation-disorders-and-after-severe-perioperative-bleeding
#4
Aamer Ahmed, Sibylle Kozek-Langenecker, François Mullier, Sue Pavord, Cedric Hermans
: In patients with inherited bleeding disorders undergoing surgery, we recommend assessment of individual risk for venous thromboembolism, taking into account the nature of the surgery and anaesthetic, type and severity of bleeding disorder, age, BMI, history of thrombosis, the presence of malignancy and other high-risk comorbidities. Venous thromboembolism risk should be balanced against the increased bleeding risk associated with anticoagulant use in patients with known bleeding disorders (Grade 1C). In these patients undergoing major surgery, we recommend against routine postoperative use of pharmacological thromboprophylaxis, especially for patients with haemophilia A and B (Grade 1B)...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29107263/clinical-issues-november-2017
#5
Esther M Johnstone
Heating, ventilation, and air-conditioning (HVAC) systems in the OR Key words: airborne contaminants, HVAC system, air pressure, air quality, temperature and humidity. Air changes and positive pressure Key words: air changes, positive pressure airflow, unidirectional airflow, outdoor air, recirculated air. Product selection Key word: product evaluation, product selection, selection committee. Entry into practice Key words: associate degree in nursing, bachelor of science in nursing, entry-level position, advanced education, BSN-prepared RNs...
November 2017: AORN Journal
https://www.readbyqxmd.com/read/29107260/back-to-basics-environmental-cleaning-hazards
#6
Lisa Spruce
Perioperative personnel must clean and disinfect the perioperative environment numerous times throughout the day to help prevent the risk of exposing patients to pathogenic microorganisms. However, this practice exposes perioperative team members to chemicals that could be harmful to their health. Exposure to cleaning and disinfecting products has been associated with potential health problems such as skin irritation, burns, rashes, and difficulty breathing. This Back to Basics article offers strategies for perioperative team members to implement to decrease their risk of harmful exposure to these products...
November 2017: AORN Journal
https://www.readbyqxmd.com/read/29102076/prevention-of-surgical-site-infection-analysis-and-narrative-review-of-clinical-practice-guidelines
#7
Francisco Javier Gómez-Romero, Maria Fernández-Prada, Juan Francisco Navarro-Gracia
Surgical site infection is one of the most prevalent healthcare-associated infections and presents a considerable morbidity. The aim of this comprehensive narrative review is to describe the evidence and grade of recommendation of the preventive measures developed in the three phases of the surgical process (preoperative, perioperative and postoperative phases), as well as coincidences and divergences between selected Clinical Practice Guidelines (CPG). Four preventive measures were recommended with similar high grade evidence in all CPG: Hair removal, antibiotic prophylaxis, surgical site preparation and normothermia...
October 25, 2017: Cirugía Española
https://www.readbyqxmd.com/read/29099397/implementation-of-a-blood-management-program-at-a-tertiary-care-hospital-effect-on-transfusion-practices-and-clinical-outcomes-among-patients-undergoing-surgery
#8
Faiz Gani, Marcelo Cerullo, Aslam Ejaz, Pranjal B Gupta, Vincent M Demario, Fabian M Johnston, Steven M Frank, Timothy M Pawlik
BACKGROUND: Patient blood management (PBM) programs represent a perioperative bundle of care that aim to reduce or eliminate unnecessary transfusions. OBJECTIVE: To evaluate the impact of a PBM program on transfusion practices and clinical outcomes at a single surgical department at a tertiary care hospital in the United States. METHODS: This pre-post, cross-sectional study was performed using data from 17,114 patients undergoing gastrointestinal surgery between 2010 and 2013...
November 2, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29089204/the-impact-of-operative-time-and-hypothermia-in-acute-burn-surgery
#9
N Ziolkowski, A D Rogers, W Xiong, B Hong, S Patel, B Trull, M G Jeschke
BACKGROUND: Prolonged operative time and intraoperative hypothermia are known to have deleterious effects on surgical outcomes. Although millions of burn injuries undergo operative treatment globally every year, there remains a paucity of evidence to guide perioperative practice in burn surgery. This study evaluated associations between hypothermia and operative time on post-operative complications in acute burn surgery. METHOD: A historical cohort study from January 1, 2006 to October 31, 2015 was completed at an American Burn Association verified burn centre...
October 28, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29088950/neurosurgical-applications-of-viscoelastic-hemostatic-assays
#10
Svetlana Kvint, James Schuster, Monisha A Kumar
Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient's exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29084236/derivation-and-validation-of-a-preoperative-risk-model-for-postoperative-mortality-sampe-model-an-approach-to-care-stratification
#11
Luciana Cadore Stefani, Claudia De Souza Gutierrez, Stela Maris de Jezus Castro, Rafael Leal Zimmer, Felipe Polgati Diehl, Leonardo Elman Meyer, Wolnei Caumo
Ascertaining which patients are at highest risk of poor postoperative outcomes could improve care and enhance safety. This study aimed to construct and validate a propensity index for 30-day postoperative mortality. A retrospective cohort study was conducted at Hospital de Clínicas de Porto Alegre, Brazil, over a period of 3 years. A dataset of 13524 patients was used to develop the model and another dataset of 7254 was used to validate it. The primary outcome was 30-day in-hospital mortality. Overall mortality in the development dataset was 2...
2017: PloS One
https://www.readbyqxmd.com/read/29078975/laparoscopic-myomectomy-and-morcellation-a-review-of-techniques-outcomes-and-practice-guidelines
#12
REVIEW
Laura M Glaser, Jaclyn Friedman, Susan Tsai, Angela Chaudhari, Magdy Milad
Laparoscopic myomectomy is a minimally invasive surgical approach to treat symptomatic uterine fibroids in women wishing for a uterine-sparing procedure. With careful patient selection, these procedures are associated with favorable reproductive outcomes and low perioperative morbidity. Current available methods for specimen retrieval include power and hand morcellation. The 2014 FDA safety warnings regarding power morcellation arose from concerns about the spread of occult malignancy and prompted widespread use of containment systems that may limit spread of myometrial cells...
September 29, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29067427/association-of-robotic-assisted-vs-laparoscopic-radical-nephrectomy-with-perioperative-outcomes-and-health-care-costs-2003-to-2015
#13
COMPARATIVE STUDY
In Gab Jeong, Yash S Khandwala, Jae Heon Kim, Deok Hyun Han, Shufeng Li, Ye Wang, Steven L Chang, Benjamin I Chung
Importance: Use of robotic surgery has increased in urological practice over the last decade. However, the use, outcomes, and costs of robotic nephrectomy are unknown. Objectives: To examine the trend in use of robotic-assisted operations for radical nephrectomy in the United States and to compare the perioperative outcomes and costs with laparoscopic radical nephrectomy. Design, Setting, and Participants: This retrospective cohort study used the Premier Healthcare database to evaluate outcomes of patients who had undergone robotic-assisted or laparoscopic radical nephrectomy for renal mass at 416 US hospitals between January 2003 and September 2015...
October 24, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29064875/perioperative-patient-blood-management-to-improve-outcomes
#14
Neel Desai, Nick Schofield, Toby Richards
Anemia is common in elective surgery and is an independent risk factor for morbidity and mortality. Historical management of anemia has focused on the use of allogeneic blood transfusion but this in itself is not without risk. It too has been independently associated with morbidity and mortality, let alone the costs and relative shortage of this resource. In recognition of this, patient blood management (PBM) shifts the focus from the product to the patient and views the patient's own blood as a resource that should be conserved and managed appropriately as a standard of care...
October 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29049686/national-practice-variation-in-pneumonectomy-perioperative-care-among-canadian-thoracic-surgeons
#15
Biniam Kidane, John K Peel, Andrew Seely, Richard A Malthaner, Christian Finley, Sean Grondin, Brian E Louie, Sadeesh Srinathan, Gail E Darling
OBJECTIVES: Our objective was to assess perioperative pneumonectomy practices among Canadian thoracic surgeons as part of a quality-improvement initiative to determine practice variability and identify areas for study/improvement. METHODS: After several rounds of survey development and piloting, a 29-item survey was distributed using the Dillman method to all practicing members of the Canadian Association of Thoracic Surgeons. RESULTS: The response rate was 87% (62 of 71)...
July 28, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29049115/an-evidence-based-approach-to-the-prescription-opioid-epidemic-in-orthopedic-surgery
#16
REVIEW
Ellen M Soffin, Seth A Waldman, Roberta J Stack, Gregory A Liguori
Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29033376/evolution-of-prophylaxis-protocols-for-venous-thromboembolism-in-neurosurgery-results-from-a-prospective-comparative-study-on-low-molecular-weight-heparin-elastic-stockings-and-intermittent-pneumatic-compression-devices
#17
Salvatore Chibbaro, Helene Cebula, Julien Todeschi, Marco Fricia, Doris Vigouroux, Houssem Abid, Houssen Kourbanhoussen, Raoul Pop, Beniamino Nannavecchia, Arthur Gubian, Lara Prisco, Gianfranco K I Ligarotti, Francois Proust, Mario Ganau
BACKGROUND: The incidence of venous thromboembolism (VT) in neurosurgical practice is astonishingly high, representing a major cause of morbidity and mortality. Prophylaxis strategies include elastic stockings, low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) devices. OBJECTIVE: To assess the safety and efficacy of 2 different VT prophylaxis protocols implemented in a European neurosurgical center. METHODS: All patients admitted for neurosurgical intervention between 2012 and 2016 were stratified as low, moderate, and high risk of VT and received a combination of elastic stockings and LMWH...
October 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29024977/safer-paediatric-surgical-teams-a-5-year-evaluation-of-crew-resource-management-implementation-and-outcomes
#18
Carl Savage, F Andrew Gaffney, Laith Hussain-Alkhateeb, Pia Olsson Ackheim, Gunilla Henricson, Irini Antoniadou, Mats Hedsköld, Karin Pukk Härenstam
Objective: Evaluate longitudinal changes in technical and non-technical skills (teamwork, situation monitoring, communication and leadership), safety culture, and clinical outcomes before and after implementation of a crew resource management (CRM) safety program. Design: A multi-level prospective single case study in accordance with the SQUIRE-guidelines for reporting quality improvement efforts. Setting: Large university paediatric surgical service...
September 7, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29016553/bleeding-and-neurologic-complications-in-58-000-interventional-pain-procedures
#19
Nafisseh S Warner, W Michael Hooten, Matthew A Warner, Tim J Lamer, Jason S Eldrige, Halena M Gazelka, Daryl J Kor, Bryan C Hoelzer, William D Mauck, Susan M Moeschler
BACKGROUND AND OBJECTIVES: Interventional pain procedures are commonly performed on patients receiving antiplatelet therapy. However, there is limited evidence to support or refute the safety of this practice. The goal of this investigation was to assess the rate of bleeding complications in a large cohort of patients undergoing intermediate- and low-risk pain procedures, with a specific focus on antiplatelet and anticoagulant medication use and baseline coagulation abnormalities. METHODS: This is a retrospective cohort study of adult patients undergoing low- and intermediate-risk pain procedures from 2005 through 2014 by the division of pain medicine at a single academic tertiary care center...
November 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28991109/patient-blood-management-in-pediatric-cardiac-surgery-a-review
#20
Jill M Cholette, David Faraoni, Susan M Goobie, Victor Ferraris, Nabil Hassan
Efforts to reduce blood product transfusions and adopt blood conservation strategies for infants and children undergoing cardiac surgical procedures are ongoing. Children typically receive red blood cell and coagulant blood products perioperatively for many reasons, including developmental alterations of their hemostatic system, and hemodilution and hypothermia with cardiopulmonary bypass that incites inflammation and coagulopathy and requires systemic anticoagulation. The complexity of their surgical procedures, complex cardiopulmonary interactions, and risk for inadequate oxygen delivery and postoperative bleeding further contribute to blood product utilization in this vulnerable population...
October 5, 2017: Anesthesia and Analgesia
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