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Protocols to reduce risk in surgery

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https://www.readbyqxmd.com/read/28107241/polytrauma-patients-with-associated-spine-fractures-an-assessment-of-surgical-intervention-on-patient-outcome
#1
Steven R Niedermeier, Safdar N Khan
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To examine perioperative characteristics among polytraumatized patients with operative, unstable spine fractures with and without concomitant operative long bone injuries. SUMMARY OF BACKGROUND DATA: Treatment of polytrauma patients has delicate and time-sensitive protocols to ensure successful recovery. The literature defines standards for vertebral injury and surgical intervention...
February 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28095728/dental-prophylaxis-and-osteoradionecrosis
#2
C T Chang, S P Liu, C H Muo, C H Tsai, Y F Huang
The aim of this study was to investigate the association of different dental prophylactic modalities and osteoradionecrosis (ORN) and determine the risk of ORN under different timing periods of scaling, with the use chlorhexidine mouth rinse after surgery and with different strategies of fluoride gel application in head and neck cancer (HNC) participants. A cohort of 18,231 HNC participants, including 941 ORN patients and 17,290 matched control cases, were enrolled from a Longitudinal Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) in Taiwan...
January 1, 2017: Journal of Dental Research
https://www.readbyqxmd.com/read/28093920/inspiratory-muscle-training-is-effective-to-reduce-postoperative-pulmonary-complications-and-length-of-hospital-stay-a-systematic-review-and-meta-analysis
#3
Filipa Kendall, José Oliveira, Bárbara Peleteiro, Paulo Pinho, Pedro Teixeira Bastos
PURPOSE: This study systematically review and meta-analyse the effectiveness of inspiratory muscle training (IMT) to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS), both in the preoperative and/or postoperative periods of cardiac, pulmonary, and abdominal surgical patients. Sensitive analysis was performed to examine which patients benefit more from IMT according to methodological features (quality of studies and sample size), patient's characteristics (pulmonary risk stratification, age, and body mass index), type of surgery, period of training, and training protocols (training doses and level of supervision)...
January 17, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28060333/mesenchymal-stromal-cell-culture-and-delivery-in-autologous-conditions-a-smart-approach-for-orthopedic-applications
#4
Luisa Trombi, Serena Danti, Sara Savelli, Stefania Moscato, Delfo D'Alessandro, Claudio Ricci, Stefano Giannotti, Mario Petrini
Human Mesenchymal Stromal Cells (hMSCs) are cultured in vitro with different media. Limits on their use in clinical settings, however, mainly depend on potential biohazard and inflammation risks exerted by xenogeneic nutrients for their culture. Human derivatives or recombinant materials are the first choice candidates to reduce these reactions. Therefore, culture supplements and materials of autologous origin represent the best nutrients and the safest products. Here, we describe a new protocol for the isolation and culture of bone marrow hMSCs in autologous conditions - namely, patient-derived serum as a supplement for the culture medium and fibrin as a scaffold for hMSC administration...
December 8, 2016: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28059919/reducing-readmissions-while-shortening-length-of-stay-the-positive-impact-of-an-enhanced-recovery-protocol-in-colorectal-surgery
#5
Puja M Shah, Lily Johnston, Bethany Sarosiek, Amy Harrigan, Charles M Friel, Robert H Thiele, Traci L Hedrick
BACKGROUND: Hospital readmission rates are an increasingly important quality metric since enactment of the 2012 Hospital Readmissions Reduction Program. The proliferation of enhanced recovery protocols and earlier discharge raises concerns for increased readmission rates. OBJECTIVE: We evaluated the effect of enhanced recovery on readmissions and identified risk factors for readmission. DESIGN: This study involved implementation of a multidisciplinary enhanced recovery protocol...
February 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28054902/novel-goal-directed-hemodynamic-optimization-therapy-based-on-major-vasopressor-during-corrective-cardiac-surgery-in-patients-with-severe-pulmonary-arterial-hypertension-a-pilot-study
#6
Shuwen Li, Qing Ma, Yanwei Yang, Jiakai Lu, Zhiquan Zhang, Mu Jin, Weiping Cheng
INTRODUCTION: Pulmonary arterial hypertension (PAH) is a common and fatal complication of congenital heart disease (CHD). PAH-CHD increases the risk for postoperative complications. Recent evidence suggests that perioperative goal-directed hemodynamic optimization therapy (GDHOT) significantly improves outcomes in surgery patients. Standard GDHOT is based on major solution volume, vasodilators and inotropic therapy, while novel GDHOT is based on major vasopressor and inotropic therapy...
22, 2016: Heart Surgery Forum
https://www.readbyqxmd.com/read/28039238/effect-of-beta-blockers-on-perioperative-outcomes-in-vascular-and-endovascular-surgery-a-systematic-review-and-meta-analysis
#7
S Hajibandeh, S Hajibandeh, S A Antoniou, F Torella, G A Antoniou
BACKGROUND: To investigate the role of perioperative beta-blocker use in vascular and endovascular surgery. METHODS: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (registration number:CRD42016038111). We searched electronic databases to identify all randomized controlled trials and observational studies investigating outcomes of patients undergoing vascular and endovascular surgery with or without perioperative beta blockade...
January 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28011177/correction-of-iron-deficiency-anaemia-in-colorectal-surgery-reduces-perioperative-transfusion-rates-a-before-and-after-study
#8
Edel M Quinn, Ellen Meland, Stacy McGinn, John H Anderson
BACKGROUND: Preoperative anaemia is a risk factor for poorer postoperative outcomes and many colorectal cancer patients have iron-deficiency anaemia. The aim of this study was to assess if a preoperative iron-deficiency anaemia management protocol for elective colorectal surgery patients helps improve detection and treatment of iron-deficiency, and improve patient outcomes. MATERIALS AND METHODS: Retrospective data was collected from 95 consecutive patients undergoing colorectal cancer surgery to establish baseline anaemia correction rates and perioperative transfusion rates...
December 21, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/28009729/impact-of-enhanced-recovery-after-surgery-and-fast-track-surgery-pathways-on-healthcare-associated-infections-results-from-a-systematic-review-and-meta-analysis
#9
Michael C Grant, Dongjie Yang, Christopher L Wu, Martin A Makary, Elizabeth C Wick
OBJECTIVE: The aim of this study was to establish if enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols are associated with reduction in healthcare-associated infection (HAIs). BACKGROUND: Evidence suggests that prevention strategies for HAIs should be multifaceted and transdisciplinary. ERAS and FTS protocols are collaborative approaches to perioperative care which reduce length of stay but may also be an effective strategy for reducing HAIs...
January 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28007690/deep-brain-stimulation-for-tremor-tractographic-versus-traditional-distinct-study-protocol-of-a-randomized-controlled-feasibility-trial
#10
Bastian Elmar Alexander Sajonz, Florian Amtage, Peter Christoph Reinacher, Carolin Jenkner, Tobias Piroth, Jürgen Kätzler, Horst Urbach, Volker Arnd Coenen
BACKGROUND: Essential tremor is a movement disorder that can result in profound disability affecting the quality of life. Medically refractory essential tremor can be successfully reduced by deep brain stimulation (DBS) traditionally targeting the thalamic ventral intermediate nucleus (Vim). Although this structure can be identified with magnetic resonance (MR) imaging nowadays, Vim-DBS electrodes are still implanted in the awake patient with intraoperative tremor testing to achieve satisfactory tremor control...
December 22, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/28003784/pros-and-cons-of-immediately-sequential-bilateral-cataract-surgery-isbcs
#11
REVIEW
Andrzej Grzybowski, Weronika Wasinska-Borowiec, Charles Claoué
Immediately sequential bilateral cataract surgery (ISBCS) is currently a "hot topic" in ophthalmology. There are well-documented advantages in terms of quicker visual rehabilitation and reduced costs. The risk of bilateral simultaneous endophthalmitis and bilateral blindness is now recognized to be minuscule with the advent of intracameral antibiotics and modern management of endophthalmitis. Refractive surprises are rare for normal eyes and with the use of optical biometry. Where a general anesthetic is indicated for cataract surgery, the risk of death from a second anesthetic is much higher than the risk of blindness...
October 2016: Saudi Journal of Ophthalmology: Official Journal of the Saudi Ophthalmological Society
https://www.readbyqxmd.com/read/28000417/a-phase-ii-feasibility-study-of-oral-etoposide-given-concurrently-with-radiotherapy-followed-by-dose-intensive-adjuvant-chemotherapy-for-children-with-newly-diagnosed-high-risk-medulloblastoma-protocol-pog-9631-a-report-from-the-children-s-oncology-group
#12
Adam J Esbenshade, Mehmet Kocak, Linda Hershon, Pierre Rousseau, Jean-Claude Decarie, Susan Shaw, Peter Burger, Henry S Friedman, Amar Gajjar, Albert Moghrabi
BACKGROUND: Children with high-risk medulloblastoma historically have had a poor prognosis. The Children's Oncology Group completed a Phase II study using oral etoposide given with radiotherapy followed by intensive chemotherapy. PROCEDURE: Patients enrolled in the study had high-risk disease defined as ≥1.5 cm(2) of residual disease postsurgery or definite evidence of central nervous metastasis. All patients underwent surgery followed by radiotherapy. During radiation, the patients received oral etoposide (21 days on, 7 off) at an initial dose of 50 mg/m(2) per day (treatment 1), which was reduced to 35 mg/m(2) per day (treatment 2) due to toxicity...
December 21, 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27989343/early-protected-weightbearing-after-ankle-fractures-in-patients-with-diabetes-mellitus
#13
Irina Bazarov, Ruth A Peace, Pieter M Lagaay, Sandeep B Patel, Liisa L Lyon, John M Schuberth
The traditional protocol for treatment after ankle fracture in the diabetic patient involves a period of prolonged non-weightbearing to reduce the incidence of complications. The goal of the present study was to identify the risk factors and complications associated with early protected weightbearing after closed ankle fractures in patients with diabetes. The data from 73 diabetic patients with operatively and nonoperatively treated ankle fractures were retrospectively reviewed. All patients were allowed to begin protected weightbearing in a cast or removable boot at 2 weeks after the index injury or surgery...
January 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/27987219/relative-efficacy-of-tranexamic-acid-and-preoperative-anemia-treatment-for-reducing-transfusions-in-total-joint-arthroplasty
#14
Joseph F Styron, Alison K Klika, Caleb R Szubski, Deborah Tolich, Wael K Barsoum, Carlos A Higuera
BACKGROUND: This study aimed to evaluate the efficacy of a perioperative blood management (PBM) protocol at a large, tertiary hospital at reducing blood transfusions after total hip or knee arthroplasty (THA or TKA). STUDY DESIGN AND METHODS: A retrospective review of the PBM for patients undergoing THA or TKA was performed. Adjusted multiple logistic and Poisson regression models examined the effect of patient characteristics and preoperative, intraoperative, and postoperative factors on the likelihood of transfusion and units transfused...
December 17, 2016: Transfusion
https://www.readbyqxmd.com/read/27982772/deliberate-employment-of-postoperative-hypotension-for-brain-arteriovenous-malformation-surgery-and-the-incidence-of-delayed-postoperative-hemorrhage-a-prospective-cohort-study
#15
Michael Kerin Morgan, Markus Karl Hermann Wiedmann, Nazih N A Assaad, Michael J A Parr, Gillian Z Heller
OBJECTIVE The aim of this study was to examine the impact of deliberate employment of postoperative hypotension on delayed postoperative hemorrhage (DPH) for all Spetzler-Ponce Class (SPC) C brain arteriovenous malformations (bAVMs) and SPC B bAVMs ≥ 3.5 cm in diameter (SPC B 3.5+). METHODS A protocol of deliberate employment of postoperative hypotension was introduced in June 1997 for all SPC C and SPC B 3.5+ bAVMs. The aim was to achieve a maximum mean arterial blood pressure (BP) ≤ 70 mm Hg (with cerebral perfusion pressure > 50 mm Hg) for a minimum of 7 days after resection of bAVMs (BP protocol)...
December 16, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27965919/results-of-protocol-based-perioperative-management-in-off-pump-coronary-artery-bypass-grafting-for-patients-with-non-dialysis-dependent-chronic-kidney-disease
#16
Jeong-Won Kim, Hyung Tae Sim, Jae Suk Yoo, Dong Jin Kim, Kwang Ree Cho
BACKGROUND: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. METHODS: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting...
December 2016: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27955884/pharmacogenetics-guided-analgesics-in-major-abdominal-surgery-further-benefits-within-an-enhanced-recovery-protocol
#17
Anthony J Senagore, Bradley J Champagne, Eslam Dosokey, Justin Brady, Scott R Steele, Harry L Reynolds, Sharon L Stein, Conor P Delaney
OBJECTIVE: Effective, narcotic sparing analgesia is a major component of Enhanced Recovery Protocols (ERP), however the risk of poor analgesia and opioid related side effects (ORADE) remains an issue related to poor outcomes and satisfaction, and is strongly related to the risk of narcotic dependence after surgery. A variety of genes can impact narcotic and non-steroidal (NSAID) drug efficacy including: the CYP family (drug metabolism-narcotics and NSAID), or COMT/ABCB1/OPRM1 (functional receptor and transport activity for analgesia vs side effects)...
November 22, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27928438/laparoscopic-cholecystectomy-in-patients-aged-60-years-and-over-our-experience
#18
Serban D, Branescu C, Savlovschi C, Purcărea Ap, El-Khatib A, Balasescu Sa, Nica A, Dascalu Am, Vancea G, Oprescu Sm, Tudor C
Aim. To analyze the efficiency of laparoscopic cholecystectomy for the population aged 60 years and over admitted with acute cholecystitis, the clinical features and associated pathology presented by these patients and the impact of these factors on the choice of surgical technique. Materials and method. A retrospective study was carried out between February 2010 and February 2015, on patients aged 60 years and over, operated in emergency for acute cholecystitis in our clinic. All data were extracted from the registered medical documents and operatory protocols...
October 2016: Journal of Medicine and Life
https://www.readbyqxmd.com/read/27902493/intravenous-amisulpride-for-the-prevention-of-postoperative-nausea-and-vomiting-two-concurrent-randomized-double-blind-placebo-controlled-trials
#19
Tong J Gan, Peter Kranke, Harold S Minkowitz, Sergio D Bergese, Johann Motsch, Leopold Eberhart, David G Leiman, Timothy I Melson, Dominique Chassard, Anthony L Kovac, Keith A Candiotti, Gabriel Fox, Pierre Diemunsch
BACKGROUND: Two essentially identical, randomized, double-blind, placebo-controlled, parallel-group phase III studies evaluated the efficacy of intravenous amisulpride, a dopamine D2/D3 antagonist, in the prevention of postoperative nausea and vomiting in adult surgical patients. METHODS: Adult inpatients undergoing elective surgery during general anesthesia and having at least two of the four Apfel risk factors for postoperative nausea and vomiting were enrolled at 9 U...
February 2017: Anesthesiology
https://www.readbyqxmd.com/read/27889694/extensive-peritoneal-lavage-after-curative-gastrectomy-for-gastric-cancer-expel-study-protocol-of-an-international-multicentre-randomised-controlled-trial
#20
Guowei Kim, Elya Chen, Amy Yl Tay, Jin San Lee, Janelle Ns Phua, Asim Shabbir, Jimmy By So, Bee Choo Tai
Peritoneal recurrence after gastrectomy for gastric cancer is common and the prognosis is dismal. Recent evidence suggests that extensive peritoneal lavage with large volume of normal saline after surgery before abdominal closure can reduce the risk of peritoneal recurrence and improve overall survival. This study aims to evaluate the benefit of extensive intraoperative peritoneal lavage. This is a prospective, open-label, multicentre randomised controlled trial involving 15 international centres in China, Korea, Japan, Malaysia and Singapore...
November 25, 2016: Japanese Journal of Clinical Oncology
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