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Safety protocols in surgery

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https://www.readbyqxmd.com/read/28229607/therapeutic-impact-of-colon-capsule-endoscopy-with-pillcam%C3%A2-colon-2-after-incomplete-standard-colonoscopy-a-spanish-multicenter-study
#1
Óscar Nogales, Javier García-Lledó, Marisol Luján, David Nicolás, José Francisco Juanmartiñena, Begoña González-Suárez, Francisco Sánchez Ceballos, Ignacio Couto, José Olmedo, Cristina Garfia, Cristina Carretero, Ignacio Fernández Urién, Sarbelio Rodríguez, Matilde Asteinza, Pilar Olivencia, Ángeles Masedo, Miguel Muñoz-Navas, Beatriz Merino, Cecilia González Asanza
INTRODUCTION: Colon capsule endoscopy (CCE) is an alternative approach for the examination of the colon in patients who refuse colonoscopy or after incomplete colonoscopy (IC). We conducted a study to determine the frequency of complete colonoscopy after IC, the diagnostic yield of CCE, the therapeutic impact of lesions found in CCE, the level of colon cleanliness and the safety of the procedure. METHODS: We performed a prospective, multicenter study involving ten Spanish hospitals...
February 23, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28222779/magnetic-resonance-imaging-for-cerebral-lesions-during-minimal-invasive-mitral-valve-surgery-study-protocol-for-a-randomized-controlled-trial
#2
Cristina Barbero, Davide Ricci, Erik Cura Stura, Augusto Pellegrini, Giovanni Marchetto, Suad ElQarra, Massimo Boffini, Roberto Passera, Maria Consuelo Valentini, Mauro Rinaldi
BACKGROUND: Recent data have highlighted a higher rate of neurological injuries in minimal invasive mitral valve surgery (MIMVS) compared with the standard sternotomy approach; therefore, the role of specific clamping techniques and perfusion strategies on the occurrence of this complication is a matter of discussion in the medical literature. The purpose of this trial is to prospectively evaluate major, minor and silent neurological events in patients undergoing right mini-thoracotomy mitral valve surgery using retrograde perfusion and an endoaortic clamp or a transthoracic clamp...
February 21, 2017: Trials
https://www.readbyqxmd.com/read/28214482/catheter-directed-ultrasound-assisted-thrombolysis-is-a-safe-and-effective-treatment-for-pulmonary-embolism-even-in-high-risk-patients
#3
Kristen A Lee, Andrew Cha, Mark H Kumar, Combiz Rezayat, Clifford M Sales
OBJECTIVE: We sought to assess the early success and safety of catheter-directed, ultrasound-assisted (CDUA) thrombolysis for acute pulmonary embolism (PE) in patients deemed to be "high risk" for thrombolytic therapy. METHODS: A retrospective evaluation of patients who underwent CDUA pulmonary thrombolysis in our practice during 39 months is reported. There were 91 patients considered, all of whom presented with acute PE as diagnosed by computed tomography angiography...
March 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28213593/randomised-double-blind-parallel-group-placebo-controlled-study-to-evaluate-the-analgesic-efficacy-and-safety-of-vvz-149-injections-for-postoperative-pain-following-laparoscopic-colorectal-surgery
#4
Srdjan S Nedeljkovic, Darin J Correll, Xiaodong Bao, Natacha Zamor, Jose L Zeballos, Yi Zhang, Mark J Young, Johanna Ledley, Jessica Sorace, Kristen Eng, Carlyle P Hamsher, Rajivan Maniam, Jonathan W Chin, Becky Tsui, Sunyoung Cho, Doo H Lee
INTRODUCTION: In spite of advances in understanding and technology, postoperative pain remains poorly treated for a significant number of patients. In colorectal surgery, the need for developing novel analgesics is especially important. Patients after bowel surgery are assessed for rapid return of bowel function and opioids worsen ileus, nausea and constipation. We describe a prospective, double-blind, parallel group, placebo-controlled randomised controlled trial testing the hypothesis that a novel analgesic drug, VVZ -149, is safe and effective in improving pain compared with providing opioid analgesia alone among adults undergoing laparoscopic colorectal surgery...
February 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28209144/modified-enhanced-recovery-after-surgery-eras-protocols-for-patients-with-obstructive-colorectal-cancer
#5
Dai Shida, Kyoko Tagawa, Kentaro Inada, Keiichi Nasu, Yasuji Seyama, Tsuyoshi Maeshiro, Sachio Miyamoto, Satoru Inoue, Nobutaka Umekita
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are now well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. However, the efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified. METHODS: We evaluated 122 consecutive resections for obstructive colorectal cancer performed between July 2008 and November 2012 at Tokyo Metropolitan Bokutoh Hospital...
February 16, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28203369/is-endovascular-treatment-with-multilayer-flow-modulator-stent-insertion-a-safe-alternative-to-open-surgery-for-high-risk-patients-with-thoracoabdominal-aortic-aneurysm
#6
Carolline Pinto, George Garas, Leanne Harling, Ara Darzi, Roberto Casula, Thanos Athanasiou
A best evidence topic in cardiothoracic and vascular surgery was written according to a structured protocol. The question addressed was whether endovascular treatment with multilayer flow modulator stents (MFMS) can be considered a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm (TAAA). Altogether 27 papers were identified using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study limitations are tabulated...
March 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28195826/wrong-site-surgery-in-california-2007-2014
#7
Omid Moshtaghi, Yarah M Haidar, Ronald Sahyouni, Afsheen Moshtaghi, Yaser Ghavami, Harrison W Lin, Hamid R Djalilian
Objective The implementation of a universal surgical safety protocol in 2004 was intended to minimize the prevalence of wrong-site surgery (WSS). However, complete elimination of WSS in the operating room continues to be a challenge. The purpose of this study is to evaluate the prevalence and etiology of WSS in the state of California. Study Design A retrospective study of all WSS reports investigated by the California Department of Public Health between 2007 and 2014. Methods Prevalence of overall and specialty-specific WSS, causative factors, and recommendations on further improvement are discussed...
February 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28178003/efficacy-and-safety-of-vedolizumab-for-induction-of-remission-in-inflammatory-bowel-disease-the-israeli-real-world-experience
#8
Uri Kopylov, Yulia Ron, Irit Avni-Biron, Benjamin Koslowsky, Matti Waterman, Saleh Daher, Bella Ungar, Henit Yanai, Nitsan Maharshak, Ofer Ben-Bassat, Lev Lichtenstein, Ariella Bar-Gil Shitrit, Eran Israeli, Doron Schwartz, Eran Zittan, Rami Eliakim, Yehuda Chowers, Shomron Ben-Horin, Iris Dotan
BACKGROUND: Vedolizumab (VDZ) is an anti-integrin monoclonal antibody effective in ulcerative colitis (UC) and Crohn's disease (CD). The aim of this study was to examine the "real world" efficacy and safety of VDZ in a large national patient cohort. METHODS: Patients with inflammatory bowel disease treated with VDZ were prospectively followed for 14 weeks. Patients who completed the induction protocol (week 0/2/6/14) or discontinued the treatment before week 14 for adverse events (AEs) or primary nonresponse were included...
February 7, 2017: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/28177997/outcome-and-salvage-surgery-following-watch-and-wait-for-rectal-cancer-after-neoadjuvant-therapy-a-systematic-review
#9
REVIEW
Joseph C Kong, Glen R Guerra, Satish K Warrier, Robert G Ramsay, Alexander G Heriot
BACKGROUND: Currently there is no reliable test to predict pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer. However, there is increasing interest in using clinical complete response as a surrogate marker, allowing a subset of patients with locally advanced rectal cancer to be allocated into a "watch and wait" pathway. Little is known about the oncological safety of the "watch and wait" approach or the rate of salvage surgery in cases of tumor regrowth...
March 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28166812/efficacy-of-high-intensity-focused-ultrasound-assisted-hepatic-resection-hifu-ar-on-blood-loss-reduction-in-patients-with-liver-metastases-requiring-hepatectomy-study-protocol-for-a-randomized-controlled-trial
#10
Aurélien Dupré, David Pérol, Ellen Blanc, Patrice Peyrat, Valéria Basso, Yao Chen, Jérémy Vincenot, Anthony Kocot, David Melodelima, Michel Rivoire
BACKGROUND: Liver resection is the only potentially curative treatment for colorectal liver metastases (LM). It is considered a safe procedure, but is often associated with blood loss during liver transection. Blood transfusions are frequently needed, but they are associated with increased morbidity and risk of recurrence. Many surgical devices have been developed to decrease blood loss. However, none of them has proven superior to the standard crushing technique. We developed a new, powerful intra-operative high-intensity focused ultrasound (HIFU) transducer which destroys tissue by coagulative necrosis...
February 6, 2017: Trials
https://www.readbyqxmd.com/read/28161928/two-port-pars-plana-anterior-and-central-core-vitrectomy-lam-floaterectomy-in-combination-with-phacoemulsification-and-intraocular-lens-implantation-under-topical-anesthesia-for-patients-with-cataract-and-significant-floaters-results-of-the-first-50-consecutive
#11
Dennis S C Lam, Hiu Ying Leung, Shu Liu, Nishant Radke, Ye Yuan, Vincent Y W Lee
PURPOSE: To study the safety and efficacy of 2-port pars plana anterior and central core vitrectomy (Lam floaterectomy) in combination with phacoemulsification (phaco) and intraocular lens implantation (IOL) for patients with cataract and significant floaters under topical anesthesia. DESIGN: Retrospective review of the first 50 consecutive cases. METHODS: Astandardized treatment protocol was used for patients with cataract and significant (moderate to severe) floaters (duration > 3 months)...
January 2017: Asia-Pacific Journal of Ophthalmology
https://www.readbyqxmd.com/read/28161819/optimizing-resection-of-large-colorectal-polyps
#12
REVIEW
Steven J Heitman, David J Tate, Michael J Bourke
Polypectomy reduces the incidence and mortality of colorectal cancer (CRC). The widespread adoption of CRC screening, more rigorous colonoscopy techniques, and advancements in endoscopic imaging have led to a greater awareness of complex polyps. Whereas surgery was once considered necessary for many large sessile or laterally spreading lesions (LSLs) in the colorectum, the majority can now be removed endoscopically. Endoscopic mucosal resection (EMR) is an established technique for treatment of colorectal LSLs...
February 4, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28161482/evaluation-of-a-standardized-risk-based-venous-thromboembolism-prophylaxis-protocol-in-the-setting-of-thyroid-and-parathyroid-surgery
#13
Ryan Macht, Ivy Gardner, Stephanie Talutis, Pamela Rosenkranz, Gerard Doherty, David McAneny
BACKGROUND: An elevated odds ratio for venous thromboembolism (VTE) prompted the development of a Caprini risk assessment and risk-based prophylaxis protocol for all General Surgery patients. This system includes pre- and post-operative prophylactic heparin as well as extended courses of low molecular weight heparin for high-risk patients. This study evaluates the safety of this chemoprophylaxis program in thyroid and parathyroid surgery. STUDY DESIGN: A retrospective review was conducted of all General Surgery patients undergoing thyroid or parathyroid operations after the implementation of the Caprini prophylaxis protocol...
February 1, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28152148/evaluation-of-a-minimally-disruptive-treatment-protocol-for-frontal-sinus-fractures
#14
Sapna A Patel, Angelique M Berens, Karthik Devarajan, Mark E Whipple, Kris S Moe
Importance: Despite common goals of frontal sinus fracture treatment (restoring forehead contour and creating a safe sinus), there remains significant variability in evaluation and treatment. Objective: To describe our experience with a minimally disruptive treatment protocol for the treatment of frontal sinus fractures. Design, Setting, and Participants: Analysis of prospectively collected data from 2010 through 2015 at a level 1 trauma center...
February 2, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/28143739/phase-ib-safety-two-dose-study-of-multigeneangio-in-patients-with-chronic-critical-limb-ischemia
#15
Moshe Y Flugelman, Moshe Halak, Boris Yoffe, Jacob Schneiderman, Chen Rubinstein, Allan-Isaac Bloom, Eran Weinmann, Ilya Goldin, Victor Ginzburg, Olga Mayzler, Aaron Hoffman, Belly Koren, Diana Gershtein, Michal Inbar, Marina Hutoran, Adili Tsaba
Critical limb ischemia (CLI) is the most severe presentation of peripheral arterial disease. We developed cell-based therapy entailing intra-arterial injection of autologous venous endothelial cells (ECs) modified to express angiopoietin 1, combined with autologous venous smooth muscle cells (SMCs) modified to express vascular endothelial growth factor. This combination promoted arteriogenesis in animal models and was safe in patients with limiting claudication. In an open-label, phase Ib study, we assessed the safety and efficacy of this therapy in CLI patients who failed or were unsuitable for surgery or intravascular intervention...
January 28, 2017: Molecular Therapy: the Journal of the American Society of Gene Therapy
https://www.readbyqxmd.com/read/28129789/short-report-interim-safety-results-for-a-phase-ii-trial-measuring-the-integration-of-stereotactic-ablative-radiotherapy-sabr-plus-surgery-for-early-stage-non-small-cell-lung-cancer-missile-nsclc
#16
David A Palma, Timothy K Nguyen, Keith Kwan, Stewart Gaede, Mark Landis, Richard Malthaner, Dalilah Fortin, Alexander V Louie, Eric Frechette, George B Rodrigues, Brian Yaremko, Edward Yu, A Rashid Dar, Ting-Yim Lee, Al Gratton, Andrew Warner, Aaron Ward, Richard Inculet
: A phase II trial was launched to evaluate if neoadjuvant stereotactic ablative radiotherapy (SABR) before surgery improves oncologic outcomes in patients with stage I non-small cell lung cancer (NSCLC). We report a mandated interim safety analysis for the first 10 patients who completed protocol treatment. Operable patients with biopsy-proven T1-2 N0 NSCLC were eligible. SABR was delivered using a risk-adapted fractionation (54Gy/3 fractions, 55/5 or 60/8). Surgical resection was planned 10 weeks later at a high-volume center (>200 lung cancer resections annually)...
January 27, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/28118549/tight-glycemic-control-in-critically-ill-children
#17
Michael S D Agus, David Wypij, Eliotte L Hirshberg, Vijay Srinivasan, E Vincent Faustino, Peter M Luckett, Jamin L Alexander, Lisa A Asaro, Martha A Q Curley, Garry M Steil, Vinay M Nadkarni
Background In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking. Methods In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4...
February 23, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28094478/fluid-management-in-cardiac-surgery-patients-pitfalls-challenges-and-solutions
#18
Elena Bignami, Marcello Guarnieri, Marco Gemma
Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Many trials on sepsis in a non-cardiac ICU setting show that colloids, in particular hydroxyethyl starches and gelatins, might have a detrimental effect on kidney function, and on major outcomes such as mortality...
January 17, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28088174/feasibility-and-safety-of-dilatational-tracheotomy-using-the-rigid-endoscope-a-multicenter-study
#19
Andreas Nowak, Peter Kern, Sven Koscielny, Taras I Usichenko, Klaus Hahnenkamp, Markus Jungehülsing, Matthias Tittel, Jens Oeken, Eckart Klemm
BACKGROUND: Fiberoptic tracheo-bronchoscopy is the most commonly used procedure for percutaneous dilational tracheotomy (PDT). However, PDT can be associated with major complications, including death. Furthermore it is unclear, whether the tracheal ring fractures may contribute to the development of tracheal stenosis after PDT nor whether tracheal ring fractures can be prevented by using a rigid endoscope for this procedure. The purpose of this study was to evaluate the feasibility of and the incidence of complications for PDT using the rigid tracheotomy endoscope (TED)...
January 14, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28087552/screening-for-atrial-fibrillation-using-economical-and-accurate-technology-safety-a-pilot-study
#20
Mark Lown, Arthur Yue, George Lewith, Paul Little, Mike Moore
INTRODUCTION: Atrial fibrillation (AF) is a cause of stroke and a marker of atherosclerosis and of all patients with stroke, around 17% have AF. The screening and treatment of AF could prevent about 12% of all strokes. Several relatively low-cost devices with good accuracy now exist which can detect AF including WatchBP and AliveCor. However, they can only measure the ECG or pulse over short time periods. Inexpensive devices such as heart rate monitors, which are widely available, can measure heart rate for prolonged periods and may have potential in screening for AF...
January 13, 2017: BMJ Open
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