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Protocols to reduce risk in surgery

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https://www.readbyqxmd.com/read/29928946/long-term-impact-of-regional-nodal-irradiation-in-patients-with-node-positive-breast-cancer-treated-with-neoadjuvant-systemic-therapy
#1
Shane R Stecklein, Minjeong Park, Diane D Liu, Janeiro J Valle Goffin, Abigail S Caudle, Elizabeth A Mittendorf, Carlos H Barcenas, Sarah Mougalian, Wendy A Woodward, Vicente Valero, Aysegul A Sahin, Wei T Yang, Simona F Shaitelman
BACKGROUND: The impact of regional nodal irradiation (RNI) on locoregional recurrence (LRR) and any disease recurrence (DR) in women with node-positive breast cancer who receive neoadjuvant systemic therapy (NAT) is unknown. METHODS: The impact of RNI on LRR and DR was estimated with the cumulative incidence method in 1289 women with stage II-III breast cancer with cytologically confirmed axillary metastases who received NAT, 1989-2007. Multicovariate Cox regression analysis was performed to examine the effect of RNI after accounting for other predictive and prognostic variables...
June 18, 2018: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/29921685/stepped-wedge-cluster-randomised-controlled-trial-to-assess-the-effectiveness-of-an-optimisation-strategy-for-general-anaesthesia-on-postoperative-morbidity-and-mortality-in-elderly-patients-the-opti-aged-study-a-study-protocol
#2
Serge Molliex, Sylvie Passot, Emmanuel Futier, Marlène Bonnefoi, Florence Rancon, Yannick Lemanach, Bruno Pereira
INTRODUCTION: Elderly patients constitute an increasingly large proportion of the high-risk surgical group. In adult patients, several specific intraoperative approaches such as cardiac output-guided haemodynamic therapy, depth of anaesthesia monitoring (DAM) or lung-protective ventilation (LPV) are designed to reduce postoperative mortality and surgical complications. However, none of these approaches has been specifically performed in the elderly, and no evaluation of a multimodal optimisation strategy for general anaesthesia has been achieved in this population...
June 19, 2018: BMJ Open
https://www.readbyqxmd.com/read/29902831/the-effect-of-antiseptics-in-the-prophylaxis-of-infection-in-orthopaedic-surgery
#3
Martin Lüdemann, Pablo Munoz, Martin Wagner, Uwe Malzahn, Konstantin Horas, Peter Heuschmann, Maximilian Rudert
INTRODUCTION: Over the past decade, the incidence of revision arthroplasty has increased substantially. One of the main reasons for revision arthroplasty is periprosthetic joint infection, often resulting in multiple surgical interventions with variable success and poor clinical outcome. Intraoperative wound irrigation has been proposed to reduce bacterial contamination and thus the risk of periprosthetic infection. However, there is currently no widely accepted recommendation for the use of topical antiseptics within the operative setting for primary implantation...
June 14, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/29890356/laparoscopic-resection-of-cesarean-scar-ectopic-pregnancy-after-unsuccessful-systemic-methotrexate-treatment
#4
L Pirtea, O Balint, C Secosan, D Grigoras, R Ilina
STUDY OBJECTIVE: To present a case of a cesarean scar ectopic pregnancy treated by laparoscopic resection followed by isthmocele repair. DESIGN: Case report SETTINGS: University Gynecology Clinic of the Emergency Clinical City Hospital Timișoara, România. BACKGROUND: Cesarean scar pregnancy is a rare form of ectopic pregnancy. In the last years its prevalence has risen due to the increasing number of cesarean section. An early diagnosis can lead to an early management decreasing the risk of life-threatening complication such as uterine rupture and massive haemorrhage...
June 8, 2018: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/29887176/effectiveness-of-a-patient-blood-management-protocol-on-reduction-of-allogenic-red-blood-cell-transfusions-in-orthopedic-surgery
#5
Mauricio Polanco-García, Ana María Capielo, Xavier Miret, Antonio Chamero, Julio Sainz, Elena Revilla, Antoni Guinjoan, Teresa Arranz
BACKGROUND AND OBJECTIVES: Patient blood management in orthopaedic surgery reduces transfusion risk. The best protocol is unknown. The effectiveness of a protocol based on the Seville Consensus on the reduction of transfusion risk is evaluated and a predictive transfusion equation is proposed in knee surgery. PATIENTS AND METHODS: Cohort study in patients undergoing knee and hip arthroplasty from January 2014 to December 2015 at a second level complexity hospital in Vilafranca del Penedès (Barcelona)...
June 7, 2018: Medicina Clínica
https://www.readbyqxmd.com/read/29880575/standard-wound-management-versus-negative-pressure-wound-therapy-in-the-treatment-of-adult-patients-having-surgical-incisions-for-major-trauma-to-the-lower-limb-a-two-arm-parallel-group-superiority-randomised-controlled-trial-protocol-for-wound-healing-in-surgery
#6
Juul Achten, Karan Vadher, Julie Bruce, Jagdeep Nanchahal, Louise Spoors, James P Masters, Susan Dutton, Jason Madan, Matthew L Costa
INTRODUCTION: Patients with closed high-energy injuries associated with major trauma have surprisingly high rates of surgical site infection in incisions created during fracture fixation. One factor that may reduce the risk of surgical site infection is the type of dressing applied over the closed surgical incision. In this multicentre randomised clinical trial, negative-pressure wound therapy will be compared with standard dressings with outcomes of deep infection, quality of life, pain and disability...
June 7, 2018: BMJ Open
https://www.readbyqxmd.com/read/29880285/a-multimodal-analgesic-protocol-may-reduce-opioid-use-after-third-molar-surgery-a-pilot-study
#7
Caitlin Magraw, Matthew Pham, Timothy Neal, Barry Kendell, Glenn Reside, Ceib Phillips, Raymond P White
OBJECTIVE: This study was designed to assess the number of opioid doses available to patients from filled prescriptions after adoption, in 2017, of a multimodal analgesic protocol that included opioid prescribing to manage postoperative pain. STUDY DESIGN: Data were retrieved from records of the first 24 patients having third molar surgery in 2017 identified from appointment schedules. Inclusion criteria were American Society of Anesthesiologists risk classification I or II, age 18 to 35 years, and at least 2 lower third molars removed...
May 3, 2018: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
https://www.readbyqxmd.com/read/29866735/study-protocol-of-the-randomised-placebo-controlled-globe-trial-gl-p-1-f-o-r-b-ridging-of-hyperglyca-e-mia-during-cardiac-surgery
#8
Abraham H Hulst, Maarten J Visscher, Marc B Godfried, Bram Thiel, Bas M Gerritse, Thierry V Scohy, R Arthur Bouwman, Mark G A Willemsen, Markus W Hollmann, J Hans DeVries, Benedikt Preckel, Jeroen Hermanides
INTRODUCTION: Perioperative hyperglycaemia is common during cardiac surgery and associated with postoperative complications. Although intensive insulin therapy for glycaemic control can reduce complications, it carries the risk of hypoglycaemia. GLP-1 therapy has the potential to lower glucose without causing hypoglycaemia. We hypothesise that preoperative liraglutide (a synthetic GLP-1 analogue) will reduce the number of patients requiring insulin to achieve glucose values<8 mmol l-1 in the intraoperative period...
June 4, 2018: BMJ Open
https://www.readbyqxmd.com/read/29807300/measurement-of-temperature-induced-in-bone-during-drilling-in-minimally-invasive-foot-surgery
#9
Noor Azzizah Omar, John C McKinley
INTRODUCTION: There has been growing interest in minimally invasive foot surgery due to the benefits it delivers in post-operative outcomes in comparison to conventional open methods of surgery. One of the major factors determining the protocol in minimally invasive surgery is to prevent iatrogenic thermal osteonecrosis. The aim of the study is to look at various drilling parameters in a minimally invasive surgery setting that would reduce the risk of iatrogenic thermal osteonecrosis...
February 19, 2018: Foot
https://www.readbyqxmd.com/read/29794717/antifibrinolytic-agents-in-plastic-surgery-current-practices-and-future-directions
#10
Stav Brown, Amy Yao, Peter J Taub
BACKGROUND: Prevention of blood loss is a chief consideration in plastic and reconstructive surgery. The antifibrinolytic drugs tranexamic acid and ε-aminocaproic acid have emerged as promising agents to reduce both perioperative blood loss and transfusion requirements. However, published reports in the plastic surgery literature are lacking. The authors sought to summarize the current knowledge of the use of antifibrinolytics in plastic surgery by reviewing the existing literature for clinical outcomes and recommendations...
June 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29794308/reducing-risk-of-spinal-haematoma-from-spinal-and-epidural-pain-procedures
#11
Harald Breivik, Hilde Norum, Christian Fenger-Eriksen, Seppo Alahuhta, Gísli Vigfússon, Owain Thomas, Michael Lagerkranser
BACKGROUND AND AIMS: Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory...
April 25, 2018: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29786830/blue-light-filtering-intraocular-lenses-iols-for-protecting-macular-health
#12
REVIEW
Laura E Downie, Ljoudmila Busija, Peter R Keller
BACKGROUND: An intraocular lens (IOL) is a synthetic lens that is surgically implanted within the eye following removal of the crystalline lens, during cataract surgery. While all modern IOLs attenuate the transmission of ultra-violet (UV) light, some IOLs, called blue-blocking or blue-light filtering IOLs, also reduce short-wavelength visible light transmission. The rationale for blue-light filtering IOLs derives primarily from cell culture and animal studies, which suggest that short-wavelength visible light can induce retinal photoxicity...
May 22, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29785458/high-resolution-standardization-reduces-delay-due-to-workflow-disruptions-in-laparoscopic-cholecystectomy
#13
Marco von Strauss Und Torney, Sohelia Aghlmandi, Jasmin Zeindler, Debora Nowakowski, Christian A Nebiker, Christoph Kettelhack, Rachel Rosenthal, Raoul A Droeser, Savas D Soysal, Henry Hoffmann, Robert Mechera
BACKGROUND: Optimal resource utilization in high-cost environments like operating theatres is fundamental in today's cost constrained health care systems. Interruptions of the surgical workflow, i.e. microcomplications (MC), lead to prolonged procedure times and higher costs and can be indicative of surgical mistakes. Reducing MC can improve operating room efficiency and prevent intraoperative complications. We, therefore, aimed to evaluate the impact of a high-resolution standardized laparoscopic cholecystectomy protocol (HRSL) on operative time and intraoperative interruptions in a teaching hospital...
May 21, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29782358/neoadjuvant-interdigitated-chemoradiotherapy-using-mesna-doxorubicin-and-ifosfamide-for-large-high-grade-soft-tissue-sarcomas-of-the-extremity-improved-efficacy-and-reduced-toxicity
#14
Mudit Chowdhary, Neilayan Sen, Elizabeth B Jeans, Luke Miller, Marta Batus, Steven Gitelis, Dian Wang, Ross A Abrams
OBJECTIVES: Patients with large, high-grade extremity soft tissue sarcoma (STS) are at high risk for both local and distant recurrence. RTOG 95-14, using a regimen of neoadjuvant interdigitated chemoradiotherapy with mesna, doxorubicin, ifosfamide, and dacarbazine followed by surgery and 3 cycles of adjuvant mesna, doxorubicin, ifosfamide, and dacarbazine, demonstrated high rates of disease control at the cost of significant toxicity (83% grade 4, 5% grade 5). As such, this regimen has not been widely adopted...
May 18, 2018: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/29778738/risk-adapted-therapy-for-young-children-with-medulloblastoma-sjyc07-therapeutic-and-molecular-outcomes-from-a-multicentre-phase-2-trial
#15
Giles W Robinson, Vasilisa A Rudneva, Ivo Buchhalter, Catherine A Billups, Sebastian M Waszak, Kyle S Smith, Daniel C Bowers, Anne Bendel, Paul G Fisher, Sonia Partap, John R Crawford, Tim Hassall, Daniel J Indelicato, Frederick Boop, Paul Klimo, Noah D Sabin, Zoltan Patay, Thomas E Merchant, Clinton F Stewart, Brent A Orr, Jan O Korbel, David T W Jones, Tanvi Sharma, Peter Lichter, Marcel Kool, Andrey Korshunov, Stefan M Pfister, Richard J Gilbertson, Robert P Sanders, Arzu Onar-Thomas, David W Ellison, Amar Gajjar, Paul A Northcott
BACKGROUND: Young children with medulloblastoma have a poor overall survival compared with older children, due to use of radiation-sparing therapy in young children. Radiotherapy is omitted or reduced in these young patients to spare them from debilitating long-term side-effects. We aimed to estimate event-free survival and define the molecular characteristics associated with progression-free survival in young patients with medulloblastoma using a risk-stratified treatment strategy designed to defer, reduce, or delay radiation exposure...
May 16, 2018: Lancet Oncology
https://www.readbyqxmd.com/read/29762314/effectiveness-of-dexmedetomidine-versus-propofol-on-extubation-times-length-of-stay-and-mortality-rates-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#16
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29758039/effects-of-palonosetron-for-prophylaxis-of-postoperative-nausea-and-vomiting-in-high-risk-patients-undergoing-total-knee-arthroplasty-a-prospective-randomized-double-blind-placebo-controlled-study
#17
Jung-Hee Ryu, Young-Tae Jeon, Byunghun Min, Jin-Young Hwang, Hye-Min Sohn
BACKGROUND: The preemptive multimodal pain protocols used in total knee arthroplasty (TKA) often cause emesis postoperatively. We investigated whether palonosetron prophylaxis reduces postoperative nausea and vomiting (PONV) in high-risk patients after TKA. METHODS: We randomized 120 female patients undergoing TKA to receive either palonosetron (0.075 mg, intravenous) or no antiemetic prophylaxis (0.9% saline, control group). All patients were given spinal anesthesia, a continuous femoral nerve block, and fentanyl-based intravenous patient controlled analgesia...
2018: PloS One
https://www.readbyqxmd.com/read/29754385/four-year-evolution-of-a-thrombophylaxis-protocol-in-an-enhanced-recovery-after-surgery-eras-program-recent-results-in-485-patients
#18
Marie-Cécile Blanchet, Vincent Frering, Benoît Gignoux, Yann Matussière, Philippe Oudar, Romain Noël, Alban Mirabaud
"Enhanced recovery after surgery" (ERAS) protocols may reduce morbidity, length of hospital stay (LOS), and costs. During the 4-year evolution of a bariatric ERAS protocol, we found that administration of thrombophylaxis selectively to high-risk morbidly obese patients (assessed postoperatively by Caprini score ≥ 3) undergoing omega loop gastric bypass ("mini" gastric bypass) or sleeve gastrectomy resulted in safe outcomes. Both procedures proved equally effective with this protocol...
May 12, 2018: Obesity Surgery
https://www.readbyqxmd.com/read/29743101/individualized-perioperative-hemodynamic-goal-directed-therapy-in-major-abdominal-surgery-ipegasus-trial-study-protocol-for-a-randomized-controlled-trial
#19
Sandra Funcke, Bernd Saugel, Christian Koch, Dagmar Schulte, Thomas Zajonz, Michael Sander, Angelo Gratarola, Lorenzo Ball, Paolo Pelosi, Savino Spadaro, Riccardo Ragazzi, Carlo Alberto Volta, Thomas Mencke, Amelie Zitzmann, Benedikt Neukirch, Gonzalo Azparren, Marta Giné, Vicky Moral, Hans Otto Pinnschmidt, Oscar Díaz-Cambronero, Maria Jose Alberola Estelles, Marisol Echeverri Velez, Maria Vila Montañes, Javier Belda, Marina Soro, Jaume Puig, Daniel Arnulf Reuter, Sebastian Alois Haas
BACKGROUND: Postoperative morbidity and mortality in patients undergoing surgery is high, especially in patients who are at risk of complications and undergoing major surgery. We hypothesize that perioperative, algorithm-driven, hemodynamic therapy based on individualized fluid status and cardiac output optimization is able to reduce mortality and postoperative moderate and severe complications as a major determinant of the patients' postoperative quality of life, as well as health care costs...
May 9, 2018: Trials
https://www.readbyqxmd.com/read/29743064/patient-directed-self-management-of-pain-padsmap-compared-to-treatment-as-usual-following-total-knee-replacement-a-randomised-controlled-trial
#20
Katherine H O Deane, Richard Gray, Paula Balls, Clare Darrah, Louise Swift, Alan B Clark, Garry R Barton, Sophie Morris, Sue Butters, Angela Bullough, Helen Flaherty, Barbara Talbot, Mark Sanders, Simon T Donell
BACKGROUND: Self-administration of medicines by patients whilst in hospital is being increasingly promoted despite little evidence to show the risks and benefits. Pain control after total knee replacement (TKR) is known to be poor. The aim of the study was to determine if patients operated on with a TKR who self-medicate their oral analgesics in the immediate post-operative period have better pain control than those who receive their pain control by nurse-led drug rounds (Treatment as Usual (TAU))...
May 10, 2018: BMC Health Services Research
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