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Safety protocols in surgery

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https://www.readbyqxmd.com/read/28719890/effect-of-neoadjuvant-nab-paclitaxel-plus-gemcitabine-therapy-on-overall-survival-in-patients-with-borderline-resectable-pancreatic-cancer-a-prospective-multicenter-phase-ii-trial-nac-ga-trial
#1
Ken-Ichi Okada, Toshio Shimokawa, Seiko Hirono, Manabu Kawai, Masayuki Sho, Sohei Satoi, Ippei Matsumoto, Hidetoshi Eguchi, Yoshiaki Murakami, Suguru Yamada, Mariko Doi, Hiroki Yamaue
We conducted a prospective multicenter phase II trial of patients with borderline resectable pancreatic carcinoma to investigate the efficacy of neoadjuvant nab-paclitaxel plus gemcitabine therapy on overall survival (OS). The clinical trial primarily evaluated OS time from the first day of protocol therapy as a primary endpoint. The secondary endpoints were recurrence-free survival from the first day of protocol therapy, safety of the protocol therapy (adverse effect), morbidity based on the Clavien Dindo classification of more than III, response rate, preoperative/postoperative tumor marker (CA 19-9, CEA), rate of normalization, reduction rate of the maximum standardized uptake value on positron emission tomography-computed tomography (limited to institutions where positron emission tomography-computed tomography was available), chemotherapeutic effect grade based on Evans' classification, resection rate, R0 resection rate, surgical data (operative time, blood loss, transfusion, postoperative hospital day), overall morbidity rates (reoperation, rate of readmission, mortality), patient rate in postoperative adjuvant therapy (entry rate, completion rate), dose intensity, quality of life regarding fatigue and malaise assessed by the questionnaire of FACIT-F (Japanese version), and peripheral sensory neuropathy assessed by the questionnaire of the FACT/GOG-NTX subscale (version 4; Japanese version)...
July 19, 2017: Oncology
https://www.readbyqxmd.com/read/28717824/follow-up-after-radical-vaginal-trachelectomy-rvt-patients-problems-and-physicians-difficulties
#2
Dorothee Speiser, Shazia Malik, Malgorzata Lanowska, Anne Bartens, Jens-Uwe Blohmer, Mandy Mangler
PURPOSE: Patients after radical vaginal trachelectomy (RVT) need specific follow-up treatment because their problems differ from those of other gyneco-oncologic patients. Anatomic changes after surgery complicate examinations. Recognition and treatment of these issues require physician's expertise. PATIENTS AND METHODS: We evaluated the follow-up data of 70 patients who underwent RVT for early cervical cancer between 03/2010 and 12/2013. The follow-up interval in the first 2 years was 3 and 6 months in the following 2 years...
July 17, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28715968/applications-of-hyperthermic-intraperitoneal-chemotherapy-for-metastatic-colorectal-cancer
#3
Matthias Hornung, Jens M Werner, Hans J Schlitt
Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) plays a pivotal role in the current treatment of peritoneal carcinomatosis (PC) from colorectal cancer (CRC). Since the first demonstration, benefits for patients and especially an increase in survival have been described. In recent years, feasibility, efficacy and safety of HIPEC have been improved and progress has been made in understanding its oncological mechanism. Areas Covered: In this article, leading publications have been reviewed including clinical trials to describe the clinical presentation of PC due to CRC and present recent evidence of the CRS/HIPEC procedure...
July 18, 2017: Expert Review of Anticancer Therapy
https://www.readbyqxmd.com/read/28707024/experience-of-immediate-ambulation-and-early-discharge-after-tumescent-anesthesia-and-propofol-infusion-in-cosmetic-breast-augmentation
#4
Weiwu Pang, John M Chois, Diana Lambie, Richard Ming-Hui Lin, Zao-Ming Shih
INTRODUCTION: Current cosmetic breast augmentation relies on general anesthesia that normally requires 40 min to total recovery. With experience, the surgical procedure can be completed expediently in 20 min under tumescent anesthesia and propofol full sedation to achieve immediate postoperative ambulation and home discharge readiness, and thus improve patient satisfaction and reduce cost. We retrospectively examined the outcomes of the protocol. MATERIALS AND METHODS: Per protocol, 1200 female patients underwent simple cosmetic breast augmentation accomplished with tumescent anesthesia, immediate mobilization, and early home discharge readiness after surgery...
July 13, 2017: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/28674378/donor-selection-and-prophylactic-strategy-for-venous-thromboembolic-events-in-living-donors-of-liver-transplantation-based-on-results-of-thrombophilia-screening-tests
#5
Hideya Kamei, Yasuharu Onishi, Nobuhiko Kurata, Masatoshi Ishigami, Yasuhiro Ogura
BACKGROUND We reported a strategy of thrombophilia testing-guided venous thromboembolic events (VTE) prophylaxis for living donors of liver transplantation in 2011. The aim of the present study was to evaluate the safety and efficacy of this protocol for VTE prophylaxis. MATERIAL AND METHODS Thrombophilia testing, including protein S (PS), protein C (PC), antithrombin (AT) III, and anti-phospholipid antibody (APLA), was performed in 306 living donor candidates between July 2005 and June 2016. Donors who met any of the criteria of PS <60%, PC <64%, AT-III <70%, and positive APLA were classified into the borderline group and received continuous venous infusion of heparin immediately after surgery, in addition to use of elastic stockings and intermittent pneumatic compression (IPC) until patients were ambulatory...
July 4, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28673310/the-evaluation-of-enhanced-feedback-interventions-to-reduce-unnecessary-blood-transfusions-affinitie-protocol-for-two-linked-cluster-randomised-factorial-controlled-trials
#6
Suzanne Hartley, Robbie Foy, Rebecca E A Walwyn, Robert Cicero, Amanda J Farrin, Jill J Francis, Fabiana Lorencatto, Natalie J Gould, John Grant-Casey, Jeremy M Grimshaw, Liz Glidewell, Susan Michie, Stephen Morris, Simon J Stanworth
BACKGROUND: Blood for transfusion is a frequently used clinical intervention, and is also a costly and limited resource with risks. Many transfusions are given to stable and non-bleeding patients despite no clear evidence of benefit from clinical studies. Audit and feedback (A&F) is widely used to improve the quality of healthcare, including appropriate use of blood. However, its effects are often inconsistent, indicating the need for coordinated research including more head-to-head trials comparing different ways of delivering feedback...
July 3, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28661999/preoperative-site-marking-are-we-adhering-to-good-surgical-practice
#7
Sonia Bathla, Michael Chadwick, Edward J Nevins, Joanna Seward
OBJECTIVES: Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general surgery and opinions of the surgeons, to help guide the formulation and implementation of a regional general surgery preoperative marking protocol. METHODS: A SurveyMonkey questionnaire was designed and distributed to 120 surgeons within the Mersey region, United Kingdom...
June 29, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28660314/nicotine-chewing-gum-for-the-prevention-of-postoperative-ileus-after-colorectal-surgery-a-multicenter-double-blind-randomised-controlled-pilot-study
#8
Daniël P V Lambrichts, Geesien S A Boersema, Buket Tas, Zhouqiao Wu, Wietske W Vrijland, Gert-Jan Kleinrensink, Johannes Jeekel, Johan F Lange, Anand G Menon
PURPOSE: When postoperative ileus is not resolved after 5 days or recurs after resolution, prolonged POI (PPOI) is diagnosed. PPOI increases discomfort, morbidity and hospitalisation length, and is mainly caused by an inflammatory response following intestinal manipulation. This response can be weakened by targeting the cholinergic anti-inflammatory pathway, with nicotine as essential regulator. Chewing gum, already known to stimulate gastrointestinal motility itself, combined with nicotine is hypothesised to improve gastrointestinal recovery and prevent PPOI...
June 28, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28656047/multicenter-phase-2-study-about-the-safety-of-no-antimicrobial-prophylaxis-use-in-low-risk-patients-undergoing-laparoscopic-distal-gastrectomy-for-gastric-carcinoma-ksweet-01-study
#9
Oh Jeong, Mi Ran Jung, Seong Yeob Ryu, Young-Kyu Park, Min Chan Kim, Ki Han Kim, Seung Wan Ryu, In Gyu Kwon, Young Gil Son
BACKGROUND: Recent studies have shown a lower risk of surgical site infections (SSI) after laparoscopic distal gastrectomy compared to open surgery. This is a phase 2 study aiming to determine the incidence of SSI after laparoscopic distal gastrectomy without using antimicrobial prophylaxis (AMP). METHODS: cT1N0 gastric cancers that were subject to laparoscopic distal gastrectomy were enrolled. Based on the unacceptable SSI incidence of ≥12.5% and the target SSI incidence of ≤5%, 105 patients were enrolled with an α of 0...
2017: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/28655398/a-survey-of-pediatric-surgeons-practices-with-enhanced-recovery-after-children-s-surgery
#10
Heather L Short, Natalie Taylor, Mitali Thakore, Kaitlin Piper, Katherine Baxter, Kurt F Heiss, Mehul V Raval
PURPOSE: Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve outcomes in adult abdominal surgical populations. Our purpose was to survey pediatric surgeons' opinions regarding applicability of individual ERAS elements to children's surgery. METHODS: A survey of the American Pediatric Surgical Association was conducted electronically. Using a 5-point Likert scale, respondents rated their willingness to implement 21 adult ERAS elements in an adolescent undergoing elective colorectal surgery...
June 17, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28648840/reducing-fluid-related-complications-during-operative-hysteroscopy-the-use-of-a-new-mandatory-fluid-balance-form
#11
Heli Alkaslassy, Raz Bahar, Hillel Henry Chill, Gilad Karavani, Orna Ben-Yosseff, Asher Shushan
STUDY OBJECTIVE: To examine whether our new reporting system and mandatory fluid-balance form could improve the communication and awareness within the surgical team and therefore the safety of hysteroscopic operations. DESIGN: A case-control study DESIGN: classification: II-2 SETTING: An endoscopic gynecology unit at a tertiary-care university hospital. PATIENTS: Women aged 17-88 (median 43.9) years, who underwent operative hysteroscopy to treat uterine pathology...
June 22, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28619774/protocol-for-a-multicentre-multistage-prospective-study-in-china-using-system-based-approaches-for-consistent-improvement-in-surgical-safety
#12
Xiaochu Yu, Jingmei Jiang, Changwei Liu, Keng Shen, Zixing Wang, Wei Han, Xingrong Liu, Guole Lin, Ye Zhang, Ying Zhang, Yufen Ma, Haixin Bo, Yupei Zhao
INTRODUCTION: Surgical safety has emerged as a crucial global health issue in the past two decades. Although several safety-enhancing tools are available, the pace of large-scale improvement remains slow, especially in developing countries such as China. The present project (Modern Surgery and Anesthesia Safety Management System Construction and Promotion) aims to develop and validate system-based integrated approaches for reducing perioperative deaths and complications using a multicentre, multistage design...
June 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28615506/modified-protocol-for-enhanced-recovery-after-surgery-is-beneficial-for-chinese-cancer-patients-undergoing-pancreaticoduodenectomy
#13
Xiaxing Deng, Xi Cheng, Zhen Huo, Yuan Shi, Zhijian Jin, Haoran Feng, Yue Wang, Chenlei Wen, Hao Qian, Ren Zhao, Weihua Qiu, Baiyong Shen, Chenghong Peng
Radical surgical resection remains the only effective treatment for advanced pancreatic cancer. Effective protocols for recovery from post-operative complications that result in high rates of morbidity and mortality are therefore essential. The enhanced recovery after surgery (ERAS) protocol is an interdisciplinary multimodal concept based on modern anesthesia and analgesia combined with other fast rehabilitation parameters. It was first applied in the field of elective colorectal surgery, and eventually extended to several surgical diseases...
May 23, 2017: Oncotarget
https://www.readbyqxmd.com/read/28608011/safety-of-anticoagulation-interruption-in-patients-undergoing-surgery-or-invasive-procedures-a-systematic-review-and-meta-analyses-of-randomized-controlled-trials-and-non-randomized-studies
#14
Frédérique Hovaguimian, Sabrina Köppel, Donat R Spahn
BACKGROUND: The safety of anticoagulation interruption in patients requiring surgical or invasive procedures remains unclear. We thus performed a systematic review and meta-analyses of randomized controlled trials (RCTs) and non-randomized studies (NRS). METHODS: MEDLINE, Embase and Central databases were searched to March 2017 without date or language restrictions. We considered RCTs and NRS comparing anticoagulation interruption with any anticoagulation (continuation or heparin bridging) in adult surgical patients taking oral anticoagulation...
June 12, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28607855/seri-surgical-scaffold-in-2-stage-breast-reconstruction-2-year-data-from-a-prospective-multicenter-trial
#15
Nolan Karp, Mihye Choi, David A Kulber, Susan Downey, Gloria Duda, Gabriel M Kind, Mark L Jewell, Diane K Murphy, Max R Lehfeldt, Neil Fine
BACKGROUND: Soft-tissue support devices are used during breast reconstruction. This study investigated long-term clinical data following SERI Surgical Scaffold (SERI) implantation, a bioresorbable, silk-derived scaffold for soft-tissue support. METHODS: This was a prospective, multicenter study in 103 subjects who received SERI during stage 1 of 2-stage breast reconstruction with subpectoral tissue expander placement (Natrelle Style 133V; Allergan plc, Dublin, Ireland) followed by subpectoral breast implant placement...
May 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28607676/evaluating-the-quality-improvement-impact-of-the-global-tracheostomy-collaborative-in-four-diverse-nhs-hospitals
#16
Brendan A McGrath, James Lynch, Barbarella Bonvento, Sarah Wallace, Val Poole, Ann Farrell, Cristina Diaz, Sadie Khwaja, David W Roberson
Tracheostomies are predominantly used in Head & Neck Surgery and the critically ill. The needs of these complex patients frequently cross traditional speciality working boundaries and locations and any resulting airway problems can rapidly lead to significant harm. The Global Tracheostomy Collaborative (GTC) was formed in 2012 with the aim of bringing together international expertise in tracheostomy care in order to bring about rapid adoption of best practices and to improve the quality and safety of care to this vulnerable group...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28607648/the-treatment-of-vesicoureteral-reflux-in-children-by-endoscopic-sub-mucosal-intra-ureteral-injection-of-dextranomer-hyaluronic-acid-a-case-series-multi-centre-study
#17
Osama Bawazir
BACKGROUND: Vesicoureteral reflux is a risk factor for progressive renal damage. In addition to long-term antibiotic prophylaxis and open surgical re-implantation, endoscopic sub-mucosal intra-ureteral injection of implant material is a therapeutic alternative that gained a world-wide preference. OBJECTIVE: The aim of this study was to determine the effectiveness and safety of the implant material, dextranomer/hyaluronic acid, in a cohort of Saudi children with vesicoureteral reflux...
April 2017: Electronic Physician
https://www.readbyqxmd.com/read/28601828/colorectal-cancer-with-synchronous-liver-limited-metastases-the-protocol-of-an-inception-cohort-study-cosmic
#18
Ajith K Siriwardena, Anthony K C Chan, Agnieszka M Ignatowicz, James M Mason
INTRODUCTION: Colorectal cancer is the fourth most common cancer in the UK and an important cause of cancer-related death. In 20% of patients, there is metastasis to the liver or beyond at the time of diagnosis. The management of synchronous disease is complex. Conventional surgery removes the colorectal primary first, followed by chemotherapy, with resection of liver metastases as a final step. Advances in the availability and safety of liver surgery, anaesthesia and critical care have made two alternative options feasible...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28601820/axillary-versus-innominate-artery-cannulation-for-antegrade-cerebral-perfusion-in-aortic-surgery-design-of-the-aortic-surgery-cerebral-protection-evaluation-ace-cardiolink-3-randomised-trial
#19
Vinay Garg, Mark D Peterson, Michael Wa Chu, Maral Ouzounian, Roderick Gg MacArthur, John Bozinovski, Ismail El-Hamamsy, F Victor Chu, Ankit Garg, Judith Hall, Kevin E Thorpe, Natasha Dhingra, Hwee Teoh, Thomas R Marotta, David A Latter, Adrian Quan, Muhammad Mamdani, Peter Juni, C David Mazer, Subodh Verma
INTRODUCTION: Neurological injury remains the major cause of morbidity and mortality following open aortic arch repair. Systemic hypothermia along with antegrade cerebral perfusion (ACP) is the accepted cerebral protection approach, with axillary artery cannulation being the most common technique used to establish ACP. More recently, innominate artery cannulation has been shown to be a safe and efficacious method for establishing ACP. Inasmuch as there is a lack of high-quality data comparing axillary and innominate artery ACP, we have designed a randomised, multi-centre clinical trial to compare both cerebral perfusion strategies with regards to brain morphological injury using diffusion-weighted MRI (DW-MRI)...
June 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28597066/effects-of-fat-grafting-containing-stem-cells-in-microstomia-and-microcheilia-derived-from-systemic-sclerosis
#20
Oskar Blezien, Francesco D'Andrea, Giovanni Francesco Nicoletti, Giuseppe Andrea Ferraro
BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disease with multisystem involvement, dominated by a general fibrosis. The early stage of the disease is associated with progressive damage to microcirculation, particularly in the respiratory tract, the gastrointestinal tract and skin. The face assumes a typical appearance characterized by microstomia (reduction of mouth opening) and microcheilia (thinning of the lips). These conditions cause a considerable reduction in performance status of patients...
June 8, 2017: Aesthetic Plastic Surgery
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