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Protocols to reduce risk in surgery

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https://www.readbyqxmd.com/read/29240639/absorbable-antibiotic-beads-prophylaxis-in-immediate-breast-reconstruction
#1
Denise M Kenna, Busayo Irojah, Kimber Lee Mudge, Kendra Eveler
BACKGROUND: Breast reconstruction with tissue expander is the most common mode of reconstruction following mastectomy. Infection necessitating tissue expander removal is a significant complication leading to patient distress as well as increased health care costs. METHODS: Over 3 years, 127 breast reconstructions with tissue expanders were performed by a single surgeon. Fifty-nine of these reconstructions were performed using a standardized protocol in which patients washed with chlorhexidine several days prior to surgery and received intravenous antibiotics preoperatively...
December 13, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29221765/advances-in-fetal-echocardiography
#2
REVIEW
Helena M Gardiner
The development of fetal echocardiography and success in prenatal cardiac screening programs over the past 30 years has been driven by technical innovation and influenced by the different approaches of the various specialties practicing it. Screening for congenital heart defects no longer focuses on examining a limited number of pregnant women thought to be at increased risk, but instead forms an integrated part of a high-quality anatomical ultrasound performed in the second trimester using the 'five-transverse view' protocol...
December 5, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29210794/effect-of-remote-ischemic-preconditioning-on-outcomes-in-adult-cardiac-surgery-a-systematic-review-and-meta-analysis-of-randomized-controlled-studies
#3
Jianfeng Xie, Xiwen Zhang, Jingyuan Xu, Zhongheng Zhang, Nathan J Klingensmith, Songqiao Liu, Chun Pan, Yi Yang, Haibo Qiu
BACKGROUND: Remote ischemic preconditioning (RIPC) has been demonstrated to prevent organ dysfunction in cardiac surgery patients. However, recent large, prospective, multicenter, randomized controlled trials (RCTs) had controversial results. Thus, a meta-analysis of RCTs was performed to investigate whether RIPC can reduce the incidence of acute myocardial infarction (AMI), acute kidney injury (AKI), and mortality in adult cardiac surgery patients. METHODS: Study data were collected from Medline, Elsevier, Cochrane Central Register of Controlled Trials and Web of Science databases...
November 22, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29209513/can-we-predict-necrosis-intra-operatively-real-time-optical-quantitative-perfusion-imaging-in-surgery-study-protocol-for-a-prospective-observational-in-vivo-pilot-study
#4
Sanne M Jansen, Daniel M de Bruin, Mark I van Berge Henegouwen, Simon D Strackee, Denise P Veelo, Ton G van Leeuwen, Suzanne S Gisbertz
Background: Compromised perfusion as a result of surgical intervention causes a reduction of oxygen and nutrients in tissue and therefore decreased tissue vitality. Quantitative imaging of tissue perfusion during reconstructive surgery, therefore, may reduce the incidence of complications. Non-invasive optical techniques allow real-time tissue imaging, with high resolution and high contrast. The objectives of this study are, first, to assess the feasibility and accuracy of optical coherence tomography (OCT), sidestream darkfield microscopy (SDF), laser speckle contrast imaging (LSCI), and fluorescence imaging (FI) for quantitative perfusion imaging and, second, to identify/search for criteria that enable risk prediction of necrosis during gastric tube and free flap reconstruction...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29203506/effectiveness-of-preoperative-medical-consultations-by-internal-medicine-physicians-a-systematic-review
#5
Clarabelle T Pham, Catherine L Gibb, Robert A Fitridge, Jonathan D Karnon
OBJECTIVE: Clinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients. However, there is uncertainty regarding the effect of such clinics on surgical, in-hospital and long-term outcomes. A systematic review of the literature was conducted to determine the effectiveness of preoperative medical consultations by internal medicine physicians for patients listed for elective surgery...
December 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/29201359/rationale-for-and-approach-to-preoperative-opioid-weaning-a-preoperative-optimization-protocol
#6
REVIEW
Heath McAnally
The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit ratio and the nation reels from the grim mortality statistics associated with the opioid epidemic. Patients struggling with chronic pain tend to use opioids and also seek out operative intervention for their complaints, which combination may be leading to increased postoperative "acute-on-chronic" pain and fueling worsened chronic pain and opioid dependence...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29198186/screening-in-trauma-for-opioid-misuse-prevention-stomp-study-protocol-for-the-development-of-an-opioid-risk-screening-tool-for-victims-of-injury
#7
Randall Brown, Brienna Deyo, Chelsea Riley, Andrew Quanbeck, Joseph E Glass, Rebecca Turpin, Scott Hetzel, Christopher Nicholas, Maireni Cruz, Suresh Agarwal
BACKGROUND: Opioid addiction and overdose are epidemic in the U.S. Victims of traumatic injury are at greater than average risk for opioid misuse and related complications. Potential risk screens and preventive interventions in this clinical population remain under-investigated. The current project seeks to develop and pilot the implementation of a screening tool for opioid risk at American College of Surgeons (ACS) Level I and Level II trauma centers. METHODS: The project began with an online survey, which was sent to Wisconsin trauma center medical directors and trauma coordinators for the purpose of gathering information on current substance use screening practices...
December 4, 2017: Addiction Science & Clinical Practice
https://www.readbyqxmd.com/read/29197340/clinical-significance-and-risk-factors-for-new-onset-and-recurring-atrial-fibrillation-following-cardiac-surgery-a-retrospective-data-analysis
#8
Hristo Todorov, Inka Janssen, Stefanie Honndorf, Daniela Bause, Antje Gottschalk, Silke Baasner, Thomas Volkert, Valentin Faerber, John F Stover, Martin Westphal, Björn Ellger
BACKGROUND: Although mortality after cardiac surgery has significantly decreased in the last decade, patients still experience clinically relevant postoperative complications. Among others, atrial fibrillation (AF) is a common consequence of cardiac surgery, which is associated with prolonged hospitalization and increased mortality. METHODS: We retrospectively analyzed data from patients who underwent coronary artery bypass grafting, valve surgery or a combination of both at the University Hospital Muenster between April 2014 and July 2015...
December 2, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29196831/laser-for-bone-healing-after-oral-surgery-systematic-review
#9
REVIEW
Claudio Noba, Anna Carolina Volpi Mello-Moura, Thais Gimenez, Tamara Kerber Tedesco, Cacio Moura-Netto
The purpose of this study is to perform a systematic review on the use of lasers in oral surgery for bone healing. Selection of articles was carried out by two evaluators in Pubmed and Web of Science databases for published articles and OpenGray for gray literature. Search strategy was developed based on the PICO Question "Does the use of lasers after oral surgery improve bone healing?". Eligibility criteria were: being on laser; evaluate bone healing; involve oral surgery; do not be about implant, periodontics, orthodontics, osteonecrosis or radiotherapy, nor revisions, clinical cases, etc...
December 1, 2017: Lasers in Medical Science
https://www.readbyqxmd.com/read/29195854/hypothermia-in-total-joint-arthroplasty-a-wake-up-call
#10
Jordan B Simpson, Vijai S Thomas, Sabir K Ismaily, Pavel I Muradov, Philip C Noble, Stephen J Incavo
BACKGROUND: Total joint patients are particularly vulnerable to perioperative hypothermia (PH) (combined effects of anesthesia, radiation, and convective heat loss from exposed skin surfaces and cool temperatures in the operating room). There are limited studies on PH in these patients. METHODS: In a retrospective review of 204 patients undergoing primary hip and 179 undergoing primary knee replacement surgeries, time and temperature parameters were collected from the electronic health records from preoperative and postoperative recovery room nursing assessments, intraoperative anesthesia records, and floor nursing notes...
November 8, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29189830/-ambulatory-cardiac-rehabilitation-in-trieste-protocols-of-intervention-activities-and-outcomes
#11
Sara Doimo, Patrizia Maras, Giulia Barbati, Enrico Fabris, Alessio Della Mattia, Kareem Salame, Giuseppe Gatti, Gianfranco Sinagra
BACKGROUND: Cardiac rehabilitation (CR) is a model of care proven to reduce mortality and morbidity in patients with coronary artery disease. The aim of this study is to describe the ambulatory CR model of the Cardiovascular Department of Trieste (Italy), analyzing the outcome of the population. METHODS: We analyzed clinical and instrumental characteristics of all consecutive patients after ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), coronary artery bypass graft with or without valve surgery (CABG/CABGV), or planned percutaneous coronary intervention (PCI), referred for CR from January 1, 2009, to December 31, 2015...
December 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29189279/alkalinized-lidocaine-preloaded-endotracheal-tube-cuffs-reduce-emergence-cough-after-brief-surgery-a-prospective-randomized-trial
#12
Papu Nath, Stephan Williams, Luis Fernando Herrera Méndez, Nathalie Massicotte, François Girard, Monique Ruel
BACKGROUND: Alkalinized lidocaine in the endotracheal tube (ETT) cuff decreases the incidence of cough and throat pain on emergence after surgery lasting more than 2 hours. However, alkalinized lidocaine needs 60-120 minutes to cross the ETT cuff membrane; therefore, its usefulness in shorter duration surgery is unknown. This prospective double-blind randomized controlled trial tested the hypothesis that alkalinized lidocaine would reduce the incidence of emergence cough after surgeries lasting <120 minutes...
November 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29183393/prophylactic-penehyclidine-inhalation-for-prevention-of-postoperative-pulmonary-complications-in-high-risk-patients-study-protocol-of-a-randomized-controlled-trial
#13
Ting Yan, Xin-Quan Liang, Tong Wang, Wei-Ou Li, Hui-Juan Li, Sai-Nan Zhu, Dong-Xin Wang
BACKGROUND: Postoperative pulmonary complications (PPCs) are major causes of morbidity, mortality, and prolonged hospital stay in patients after surgery. Using effective strategies to prevent its occurrence is essential to improve outcome. However, despite various efforts, the incidence of PPCs remains elevated in high-risk patients. Anticholinergic inhalation is used to reduce high airway resistance and improve pulmonary function; it may be helpful to decrease the risk of PPCs. Penehyclidine is a long-acting anticholinergic agent which selectively blocks M1 and M3 receptors...
November 28, 2017: Trials
https://www.readbyqxmd.com/read/29182003/modification-validation-and-implementation-of-a-protocol-for-post-thyroidectomy-hypocalcaemia
#14
T Stedman, P Chew, P Truran, C B Lim, S P Balasubramanian
Introduction The management of post-thyroidectomy hypocalcaemia should facilitate early discharge, and reduce risks of hypocalcaemia, readmission and treatment related hypercalcaemia. This paper describes the implementation, evaluation and revision a protocol for the optimal management of this condition. Methods Day 1 parathyroid hormone (PTH) measurements in addition to calcium measurements were commenced following review of the unit's outcomes and literature on post-thyroidectomy hypocalcaemia. Outcomes from a three-year cohort of patients undergoing thyroid surgery helped amend this protocol (revision 1) to reduce biochemical tests, stipulate the need, nature and dose of vitamin D/calcium supplements, and encourage early discharge...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29164130/comparison-of-an-innovative-rehabilitation-combining-reduced-conventional-rehabilitation-with-balneotherapy-and-a-conventional-rehabilitation-after-anterior-cruciate-ligament-reconstruction-in-athletes
#15
Laetitia Peultier-Celli, Didier Mainard, Frank Wein, Nicolas Paris, Patrick Boisseau, Alexandre Ferry, René Gueguen, Isabelle Chary-Valckenaere, Jean Paysant, Philippe Perrin
Background: Instability of the knee, related to anterior cruciate ligament injury, is treated by surgical reconstruction. During recovery, a loss of proprioceptive input can have a significant impact. Few studies have evaluated the benefits of rehabilitation of the knee in aquatic environment on functional outcomes. Objective: This study aimed to compare an innovative rehabilitation protocol combining reduced conventional rehabilitation with aquatic rehabilitation, with a conventional rehabilitation, according to the National French Health Authority, in terms of kinetics, development of proprioceptive skills, and functional improvement of the knee...
2017: Frontiers in Surgery
https://www.readbyqxmd.com/read/29152551/bladder-cancer-recovery-pathways-a-systematic-review
#16
Ian Maloney, Daniel C Parker, Michael S Cookson, Sanjay Patel
Background: Enhanced recovery pathways, also known as fast-track protocols, have been adopted since the early 2000s by various surgical specialties with the goal of improving patient outcomes and reducing the cost burden of major surgery on the health care system. Objective: To review the scientific literature on the origin of enhanced recovery pathways, track the contemporary utilization of such practices for patients undergoing radical cystectomy, and analyze the available data regarding their effect on morbidity, mortality, and treatment cost...
October 27, 2017: Bladder Cancer
https://www.readbyqxmd.com/read/29151009/risk-stratification-triage-and-implementation-of-an-expedited-hip-fracture-treatment-protocol-is-it-safe-and-effective
#17
William Zelenty, Richard Yoon, Lorraine Hutzler, Nirmal Tejwani, Joseph Bosco
INTRODUCTION: The population of patients in the USA over the age of 65 is expected to significantly increase over the next 40 years. These patients are at increased risk for hip fractures and will pose a burden to providers in the near future. In order to provide high value care, providers will need to maintain positive outcomes, mitigate complications, and reduce overall cost burdens. This study was designed to investigate the safety and efficacy of a patient transfer protocol between a large academic medical center and a single specialty orthopaedic institution...
December 2017: Bulletin of the Hospital for Joint Diseases
https://www.readbyqxmd.com/read/29150418/immune-enhancing-formulas-for-patients-with-cancer-undergoing-esophagectomy-systematic-review-protocol
#18
Astrid Naranjo, Elizabeth Isenring, Laisa Teleni
BACKGROUND: Adult patients with an esophageal cancer can potentially be compromised with postoperative leaks or fistulae if patients' nutritional status is in a vulnerable stage. Currently in Australia, there is a growing need for clinicians to know whether use of immune-enhancing formulas (IEFs) containing Arg, omega-3, and RNA are a cost-effective approach compared with isonitrogenous-isocaloric formulas to reduce postoperative infectious complications in esophagectomy patients. Since IEFs may carry higher costs, this has led to inconsistencies in practice among clinicians and hospitals...
November 17, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/29127739/renal-haemodynamics-and-oxygenation-during-and-after-cardiac-surgery-and-cardiopulmonary-bypass
#19
REVIEW
Roger G Evans, Yugeesh R Lankadeva, Andrew D Cochrane, Bruno Marino, Naoya Iguchi, Michael Z L Zhu, Sally G Hood, Julian A Smith, Rinaldo Bellomo, Bruce S Gardiner, Chang-Joon Lee, David W Smith, Clive N May
Acute kidney injury (AKI) is a common complication following cardiac surgery performed on cardiopulmonary bypass (CPB) and has important implications for prognosis. The aetiology of cardiac surgery-associated AKI is complex, but renal hypoxia, particularly in the medulla, is thought to play at least some role. There is strong evidence from studies in experimental animals, clinical observations and computational models, that medullary ischaemia and hypoxia occurs during CPB. There are no validated methods to monitor or improve renal oxygenation during CPB, and thus possibly decrease the risk of AKI...
November 11, 2017: Acta Physiologica
https://www.readbyqxmd.com/read/29121664/does-preoperative-mechanical-prophylaxis-have-additional-effectiveness-in-preventing-postoperative-venous-thromboembolism-in-elderly-patients-with-hip-fracture-retrospective-case-control-study
#20
Ji-Hoon Nam, Dae-Hwan Kim, Je-Hyun Yoo, Ji-Hyo Hwang, Jun-Dong Chang
BACKGROUND: Elderly patients undergoing hip fracture surgery (HFS) are at increased risk of postoperative venous thromboembolism (VTE). To reduce this risk, combined postoperative mechanical and chemical thromboprophylaxis has been routinely performed after HFS in these patients. This retrospective case-control study was conducted to evaluate the additional effectiveness of preoperative mechanical thromboprophylaxis for the prevention of VTE following HFS in elderly patients. METHODS: Of 539 consecutive patients aged 70 years or older undergoing HFS, 404 (control group) did not receive preoperative mechanical thromboprophylaxis, while 135 (study group) received mechanical thromboprophylaxis using an intermittent pneumatic compression device and graduated compression stockings from the time of admission until surgery...
2017: PloS One
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