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https://www.readbyqxmd.com/read/28426464/comparative-effectiveness-in-urology-a-state-of-the-art-review-utilizing-a-systematic-approach
#1
Jathin Bandari, Charles B Wessel, Bruce L Jacobs
PURPOSE OF REVIEW: Comparative effectiveness research plays a vital role in healthcare delivery by guiding evidence-based practices. We performed a state-of-the-art review of comparative effectiveness research in the urology literature for 2016, utilizing a systematic approach. Seven high-impact papers are reviewed in detail. RECENT FINDINGS: Across the breadth of urology, there were several important studies in comparative effectiveness research, of which we will highlight two randomized controlled trials and five observational trials: radiotherapy, prostatectomy, and active monitoring have equivalent mortality outcomes in patients with localized prostate cancer; the ideal modality of patient education is yet to be determined, and written education has minimal effect on patient perception of prostate specific antigen screening; robotic prostatectomy is associated with higher perioperative complication rates on a population basis; racial disparities exist in incontinence rates after treatment for localized prostate cancer, but not in irritative, bowel, or sexual function; androgen deprivation therapy is associated with higher fracture, peripheral artery disease, and cardiac-related complications than bilateral orchiectomy; robotic and open cystectomy offer comparable cancer-specific mortality and perioperative outcomes; and bonuses for low-cost hospitals can inadvertently reward low-quality hospitals...
April 19, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28421343/antiplatelets-and-anticoagulants-in-vitreoretinal-surgery-with-a-special-emphasis-on-novel-anticoagulants-a-national-survey-and-review
#2
REVIEW
Rupa Patel, Stephen Charles, Assad Jalil
PURPOSE: To survey current practice and opinion regarding the cessation of antiplatelet and anticoagulant agents prior to vitreoretinal surgery, with special emphasis on novel anticoagulants, and to provide an overview of current literature. METHODS: An online survey was sent to 167 members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). A literature search and analysis was conducted on studies that reviewed the bleeding risk of antiplatelet and anticoagulant agents...
April 18, 2017: Graefe's Archive for Clinical and Experimental Ophthalmology
https://www.readbyqxmd.com/read/28421314/the-impact-of-body-mass-index-on-the-risk-of-high-spinal-block-in-parturients-undergoing-cesarean-delivery-a-retrospective-cohort-study
#3
Agnes M Lamon, Lisa M Einhorn, Mary Cooter, Ashraf S Habib
PURPOSE: To investigate the hypothesis that the risk of high spinal block is not increased in obese parturients undergoing cesarean delivery compared to non-obese parturients. METHODS: This is a retrospective study at an academic center. We searched the perioperative database for women who underwent cesarean delivery under spinal or combined spinal epidural anesthesia with hyperbaric bupivacaine ≥10.5 mg. A body mass index (BMI) ≥30 kg/m(2) was defined as obese...
April 18, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28419035/clinical-practice-guidelines-decrease-unnecessary-echocardiograms-before-hip-fracture-surgery
#4
Chris Adair, Eric Swart, Rachel Seymour, Joshua Patt, Madhav A Karunakar
BACKGROUND: Preoperative assessment of geriatric patients with a hip fracture may include transthoracic echocardiography (TTE), which increases resource utilization and cost and may delay surgery. The purpose of this study was to evaluate preoperative TTE utilization at a single institution in order to determine (1) how often TTE is ordered in accordance with clinical practice guidelines (CPGs), (2) how frequently TTE reveals cardiac disease that may alter medical or anesthesia management, and (3) whether following CPGs reduces unnecessary TTE utilization without potentially missing important disease...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28405540/markedly-improved-success-rate-of-endoscopically-assisted-third-ventriculostomy-is-achieved-by-routine-placement-of-external-lumbar-drain
#5
Justen Watkins, Marc Cabanne, Dan Miulli
Hydrocephalus is a major cause of patient decreased quality of life and high health care financial burden in the United States and throughout the world. The placement of ventricular shunts (ventriculoperitoneal shunt) has proven to be a safe treatment for hydrocephalus, but it is associated with a high complication rate leading to a lower quality of life and continued financial burden for patients, their families, and society as a whole. The endoscopically assisted third ventriculostomy (ETV) has been practiced as an alternative to ventricular shunting since the 1990s...
April 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28402089/perioperative-management-of-obstructive-sleep-apnea-a-systematic-review
#6
Ruggero Corso, Vincenzo Russotto, Cesare Gregoretti, Davide Cattano
Obstructive sleep apnea (OSA) is the leading sleep disordered breathing condition, with a prevalence rate of moderate to severe OSA of approximately 10 - 17% in the general population. Its prevalence in the surgical population seems to be higher. However, a proportion of up to 60% of patients may not have a formal diagnosis at the moment of preoperative visit. OSA is associated with a number of comorbidities and increased perioperative risks. However, most interventions for the perioperative management of OSA patients lack high quality evidence...
April 11, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28400219/comparative-effectiveness-of-anticoagulation-on-midterm-infrainguinal-bypass-graft-patency
#7
Nathan L Liang, Donald T Baril, Efthymios D Avgerinos, Steven A Leers, Michel S Makaroun, Rabih A Chaer
OBJECTIVE: Therapeutic anticoagulation (AC) is used clinically for prolongation of infrainguinal bypass patency, but evidence for the efficacy of this practice is conflicting. The objective of our study was to determine the association of AC with bypass graft primary patency. METHODS: Clinical and comorbid data of patients undergoing infrainguinal bypass grafts to a below-knee target with at least 1 year of follow-up performed from 2003 to 2015 were obtained from the Society for Vascular Surgery Vascular Quality Initiative...
April 8, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28393705/antithrombotic-therapy-for-transcatheter-valvular-interventions-a-revisit
#8
Shaban Mohammed, Ayman El-Menyar, Haifa Al-Janubi, Adel Shabana, Zaid Alanazi
The optimal antithrombotic therapies for transcatheter aortic valve implantation (TAVI) and MitraClip implantation have not been well established. We conducted a narrative review from currently available studies between January 2002 and May 2016 to highlight the advantages and disadvantages of antithrombotic therapy use in cardiac catheter-based therapeutic techniques. Recently, these techniques have dramatically altered the approach towards valvular heart diseases management. The introduction into clinical practice, of TAVI for severe aortic stenosis and MitraClip for mitral regurgitation, has revolutionized interventional cardiology...
April 6, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28392431/-urinary-catheters-prevalence-study-in-a-university-hospital
#9
J Carrouget, C Legeay, A Poirier, A-R Azzouzi, J-R Zahar, P Bigot
INTRODUCTION: Urinary tract infection is the most common healthcare-association infection, especially because of urinary catheter. We evaluated our practices concerning catheter insertion and management in our institution. MATERIALS AND METHODS: We conducted a single-centre descriptive cross-sectional study during 1 week in September 2014 in all adult departments. We noted prevalence, indications, length, management of urinary catheter (UC) and symptomatic catheter-associated urinary tract infections (SCAUTI)...
April 6, 2017: Progrès en Urologie
https://www.readbyqxmd.com/read/28385315/use-of-antiplatelet-therapy-dapt-for%C3%A2-post-pci-patients-undergoing-noncardiac-surgery
#10
REVIEW
Subhash Banerjee, Dominick J Angiolillo, William E Boden, Joseph G Murphy, Houman Khalili, Ahmed A Hasan, Robert A Harrington, Sunil V Rao
Dual antiplatelet therapy (DAPT) is prescribed to millions of patients worldwide following coronary stenting. DAPT is indicated to lower the risk of ischemic events, such as myocardial infarction, including stent thrombosis, ischemic stroke, or death from cardiovascular causes. A significant number of these patients undergo noncardiac surgery and may require DAPT interruption. This poses a significant clinical dilemma because DAPT interruption exposes patients to the potential risk of stent thrombosis, perioperative myocardial infarction, or both...
April 11, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28383375/comparison-of-vaginal-hysterectomy-techniques-and-interventions-for-benign-indications-a-systematic-review
#11
Peter C Jeppson, Sunil Balgobin, David D Rahn, Kristen A Matteson, Alexis A Dieter, David R Ellington, Sarit O Aschkenazi, Cara Grimes, Mamta M Mamik, Ethan M Balk, Miles Murphy
OBJECTIVE: To create evidence-based clinical practice guidelines based on a systematic review of published literature regarding the risks and benefits of available preoperative, intraoperative, and postoperative technical steps and interventions at the time of vaginal hysterectomy for benign indications. DATA SOURCES: We systematically searched the literature to identify studies that compared technical steps or interventions during the preoperative, intraoperative, and postoperative periods surrounding vaginal hysterectomy...
May 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28372915/creation-of-an-online-wiki-improves-post-operative-surgical-protocol-adherence-in-arthroplasty-patients
#12
Eric F Swart, Daniel J Miller, Thomas R Hickernell, Kevin J Bozic, Jeffrey A Geller, William B Macaulay
BACKGROUND: Perioperative care pathways are tools used in high-volume clinical settings to standardize care, reduce variability, and improve outcomes. However, the mechanism by which the information is transmitted to other caregivers is often inconsistent and error-prone. At our institution, we developed an online, user-editable ("wiki") database to communicate post-operative protocols. The purpose of this study is to evaluate the hypothesis that implementation of the wiki would improve protocol adherence and reduce unintentional deviations inpatient care...
March 9, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28371877/comprehensive-analysis-of-13-897-consecutive-regional-anesthetics-at-an-ambulatory-surgery-center
#13
Randall J Malchow, Rajnish K Gupta, Yaping Shi, Matthew S Shotwell, Lisa M Jaeger, Clifford Bowens
Objective.:  The authors investigated a wide range of perioperative outcome measures in the context of a robust regional anesthesia practice. Design.:  Comprehensive review of a prospectively collected six-year database. Setting.:  Freestanding, academic ambulatory surgery center. Subjects.:  There were 13,897 consecutive regional anesthetics in 10,338 patients. Methods.:  We investigated patient satisfaction, postoperative nausea and vomiting (PONV), postoperative pain, catheter analgesia, and complications...
March 24, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28363725/incidence-of-severe-critical-events-in-paediatric-anaesthesia-apricot-a-prospective-multicentre-observational-study-in-261-hospitals-in-europe
#14
Walid Habre, Nicola Disma, Katalin Virag, Karin Becke, Tom G Hansen, Martin Jöhr, Brigitte Leva, Neil S Morton, Petronella M Vermeulen, Marzena Zielinska, Krisztina Boda, Francis Veyckemans
BACKGROUND: Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. METHODS: The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures...
March 28, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28358766/early-complications-and-associated-perioperative-factors-in-nonsyndromic-craniosynostosis
#15
Yunhe Lu, Abdulsamad Ghanem, Tianyi Cai, Junyi Yang, Xiongzheng Mu
This is the first Eastern center-based retrospective report on early complications and associated perioperative factors of nonsyndromic craniosynostosis (NSC). The authors' purpose is to tailor preoperative counseling, convey objective perioperative data, and determinants for early complications in NSC so as to enhance exchanges with international center. Inclusion criteria required a diagnosis of NSC confirmed by 3-dimentional computed tomography scans and complete medical record. Genetic evidence of syndromic craniosynostosis was excluded...
March 29, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28358763/whole-blood-in-pediatric-craniofacial-reconstruction-surgery
#16
Princy Thottathil, Deborah Sesok-Pizzini, Jesse A Taylor, John E Fiadjoe, Ariel Vincent, Paul A Stricker
BACKGROUND: Pediatric complex cranial vault reconstruction (CCVR) surgery is often associated with significant blood loss and transfusion. The authors recently changed our transfusion practice during CCVR to using whole blood (WB) instead of reconstituted blood (RB). The aim of this study was to assess the impact of this practice change. Our hypothesis was that replacement with WB would be as effective as RB for the outcomes of total perioperative blood donor exposures (BDEs) and the incidence of laboratory evidence of postoperative coagulopathy...
March 29, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28338589/managing-hip-fracture-and-lower-limb-surgery-in-the-emergency-setting-potential-role-of-non-vitamin-k-antagonist-oral-anticoagulants
#17
William Fisher
Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thromboembolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338513/restrictive-transfusion-practices-after-esophagectomy-are-associated-with-improved-outcome-a-review-of-the-society-of-thoracic-surgeons-general-thoracic-database
#18
Christopher W Towe, Brian C Gulack, Sunghee Kim, Vanessa P Ho, Yaron Perry, James M Donahue, Philip A Linden
OBJECTIVE: Blood transfusion has been associated with poor outcomes in many disciplines, yet transfusion practices and related outcomes in esophagectomy are unknown. We analyzed the Society of Thoracic Surgeons General Thoracic Database to determine patient factors associated with transfusion after esophagectomy, risk-adjusted variation in transfusion practice among institutions, and the association of transfusion practice with mortality. METHODS: We performed a retrospective review of patients undergoing esophagectomy for cancer from October 2008 to December 31, 2014...
March 23, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28336026/viscoelastic-studies-effective-tools-for-trauma-and-surgical-resuscitation-efforts
#19
Dagoberto Salinas
Trauma-induced coagulopathy (TIC) is an abrupt disruption of all hemostatic components of coagulation resulting from severe tissue injury and hypoperfusion. The effective management of TIC has remained elusive to clinicians using traditional laboratory methods, challenging efforts to improve outcomes related to uncontrolled bleeding. Recent initiatives have aimed to reduce TIC-associated morbidity and mortality, further invoking trauma experts to explore innovative modalities in the field of viscoelastic studies, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM)...
April 2017: AORN Journal
https://www.readbyqxmd.com/read/28334592/using-an-electronic-perioperative-documentation-tool-to-identify-returns-to-operating-room-ror-in-a-tertiary-care-academic-medical-center
#20
Robert R Cima, Sarah R Dhanorker, Christopher L Ostendorf, Mfonabasi Ntekpe, Raghu V Mudundi, Elizabeth B Habermann, Claude Deschamps
BACKGROUND: The metric "Unplanned returns to operating room (ROR)" is being tracked in surgical quality dashboards; 70% of unplanned RORs may be related to surgical complications. With increasing regionalization of trauma and complex surgical care at tertiary care academic centers, it is unclear if a simple ROR metric is a valid assessment of surgical quality at such centers. METHOD: A real-time electronic tool was used to identify all RORs-planned and unplanned-in a high-volume, high-complexity academic surgical practice at Mayo Clinic-Rochester within 45 days of the index operation...
March 2017: Joint Commission Journal on Quality and Patient Safety
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