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Safety protocols in surgery

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https://www.readbyqxmd.com/read/27902493/intravenous-amisulpride-for-the-prevention-of-postoperative-nausea-and-vomiting-two-concurrent-randomized-double-blind-placebo-controlled-trials
#1
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...
November 30, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27887932/assessing-national-provision-of-care-variability-in-bariatric-clinical-care-pathways
#2
Dana A Telem, Saniea F Majid, Kinga Powers, Eric DeMaria, John Morton, Daniel B Jones
BACKGROUND: The American Society for Metabolic and Bariatric Surgery (ASMBS) Quality Improvement and Patient Safety (QIPS) Committee hypothesized that collecting and sharing clinical pathways could provide a valuable resource to new and existing bariatric programs. OBJECTIVE: To shed light on the variability in practice patterns across the country by analyzing pathways. SETTING: United States Centers of Excellence METHODS: From June 2014 to April 2015, clinical pathways pertaining to preoperative, intraoperative, and postoperative management of bariatric patients were solicited from the ASMBS executive council (EC), QIPS committee members, and state chapter presidents...
August 3, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/27884849/access-hd-pilot-a-randomised-feasibility-trial-comparing-catheters-with-fistulas-in-elderly-patients-starting-haemodialysis
#3
Robert Quinn, Pietro Ravani
INTRODUCTION: The selection of the type of vascular access for haemodialysis is an important intervention question. However, only observational studies are available to inform decision-making in this area, and they are at high risk of selection bias. While a clinical trial comparing the effects of the 2 most frequently chosen strategies for haemodialysis access (fistulas and catheters) on patient important and 'hard' clinical end points is needed, the feasibility of such a trial is uncertain...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27881360/an-observational-registry-of-carotid-endarterectomy-and-carotid-artery-stenting-in-brazil-study-protocol
#4
Edwaldo Edner Joviliano, Winston Bonetti Yoshida, Marcone Lima Sobreira, Regina Moura, Ana Terezinha Guillaumon, Selma Regina De Oliveira Raymundo, Daniel Gustavo Miquelin, Ludvig Hafner, Marcelo Jose Almeida
BACKGROUND: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. CEA has been considered the first-line treatment for carotid stenosis worldwide, and the safety and efficacy of CAS compared to CEA remains in question. OBJECTIVE: The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real-world setting within public university hospitals in Brazil...
November 23, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27878754/efficiency-and-safety-effects-of-applying-eras-protocols-to-bariatric-surgery-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis-of-evidence
#5
REVIEW
Preet Mohinder Singh, Rajesh Panwar, Anuradha Borle, Basavana Goudra, Anjan Trikha, Bart A van Wagensveld, Ashish Sinha
Application of the enhanced recovery after surgery (ERAS) to the bariatric surgical procedures is at its early stages with little consolidated evidence. This meta-analysis evaluates present literature and indicates pathways for development of evidence-based standardized ERAS protocols for bariatric surgery. Comparative trials between ERAS and conventional bariatric surgery published till June 2016 were searched in the medical database. Comparisons were made for length of stay (LOS), readmission, complications (major/minor), and reoperation rates...
November 23, 2016: Obesity Surgery
https://www.readbyqxmd.com/read/27875094/laparoscopic-radical-gastrectomy-for-resectable-advanced-gastric-cancer-within-enhanced-recovery-programs-a-prospective-randomized-controlled-trial
#6
Xia Mingjie, Zhang Luyao, Tang Ze, Zhao YinQuan, Wang Quan
BACKGROUND: Enhanced recovery programs have become an important focus of perioperative management. A few studies have demonstrated the efficacy of an enhanced recovery after surgery (ERAS, which includes optimized pain control, restricted I.V. fluids, early initiation of postoperative oral feeding, and enforced mobilization) protocol in patients undergoing radical gastrectomy. We investigated the feasibility and safety of laparoscopic radical gastrectomy within ERAS programs. METHODS: In this single-center prospective randomized controlled trial conducted between September 2013 and August 2014, 149 consecutive locally advanced gastric cancer patients (T2-4, any N, M0) diagnosed by the CT scanning were allocated to either ERAS group (N = 73) or conventional pathway group (N = 76)...
November 22, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27856288/a-multicenter-randomized-controlled-trial-evaluating-a-connexin43-mimetic-peptide-in-cutaneous-scarring
#7
Christina L Grek, Jade Montgomery, Meenakshi Sharma, A Ravi, J S Rajkumar, Kurtis E Moyer, Robert G Gourdie, Gautam S Ghatnekar
BACKGROUND: The transmembrane protein, connexin43 (Cx43) has key roles in fibrogenic processes including inflammatory signaling and extracellular matrix composition. aCT1 is a Cx43 mimetic peptide that in preclinical studies accelerated wound closure, decreased inflammation and granulation tissue area and normalized mechanical properties following cutaneous injury. PURPOSE: We evaluated the efficacy and safety of aCT1 in the reduction of scar formation in human incisional wounds...
November 14, 2016: Journal of Investigative Dermatology
https://www.readbyqxmd.com/read/27852720/protocol-for-using-mixed-methods-and-process-improvement-methodologies-to-explore-primary-care-receptionist-work
#8
Ian Litchfield, Nicola Gale, Michael Burrows, Sheila Greenfield
INTRODUCTION: The need to cope with an increasingly ageing and multimorbid population has seen a shift towards preventive health and effective management of chronic disease. This places general practice at the forefront of health service provision with an increased demand that impacts on all members of the practice team. As these pressures grow, systems become more complex and tasks delegated across a broader range of staff groups. These include receptionists who play an essential role in the successful functioning of the surgery and are a major influence on patient satisfaction...
November 16, 2016: BMJ Open
https://www.readbyqxmd.com/read/27843040/a-phase-iv-study-of-thromboembolic-and-bleeding-events-following-hip-and-knee-arthroplasty-using-oral-factor-xa-inhibitor
#9
David Gomez, Helen Razmjou, Andrea Donovan, Vikas B Bansal, Jeffrey D Gollish, John J Murnaghan
BACKGROUND: Multiple randomized controlled trials have documented the effectiveness of rivaroxaban in the prevention of venous thromboembolism up to 1-month following total joint arthroplasty. However, the effectiveness and safety of rivaroxaban in the real-world setting, outside of the strict protocols used by randomized clinical trials, are unknown. METHODS: This was a prospective, observational, noninterventional, phase IV study of 3914 consecutive patients who underwent total joint arthroplasty from June 2010 to December 2012...
October 4, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27817153/use-of-fentanyl-iontophoretic-transdermal-system-its-ionsys-%C3%A2-in-the-management-of-patients-with-acute-postoperative-pain-a-case-series
#10
Steven Poplawski, Matthew Johnson, Philip Philips, Leopold H J Eberhart, Tilo Koch, Loretta M Itri
Fentanyl iontophoretic transdermal system (ITS) [IONSYS(®), The Medicines Company, Parsippany, NJ, USA] is a needle-free, patient-controlled, postoperative opioid pain management treatment. It is indicated for the short-term management of acute postoperative pain in adults requiring opioid analgesia in the hospital. The safety and effectiveness of fentanyl ITS for acute postoperative pain management has been demonstrated in a range of surgery and patient types studied in seven phase 3 trials (three placebo-controlled trials and four active-comparator trials)...
December 2016: Pain and Therapy
https://www.readbyqxmd.com/read/27807090/surgical-ablation-of-atrial-fibrillation-a-protocol-for-a-systematic-review-and-meta-analysis-of-randomised-controlled-trials
#11
Graham R McClure, Emilie P Belley-Cote, Rohit K Singal, Iqbal H Jaffer, Nazari Dvirnik, Kevin R An, Gabriel Fortin, Jessica Spence, Richard P Whitlock
INTRODUCTION: Atrial fibrillation (AF) affects 10% of patients undergoing cardiac surgery and is an independent risk factor for all-cause mortality, ischaemic stroke and heart failure. Surgical AF ablation has been shown to significantly improve maintenance of sinus rhythm, however, small to medium size trials conducted to date lack the power required to assess patient-important outcomes such as mortality, stroke, heart failure and health-related quality of life. Moreover, a recent randomised trial (RCT) suggested harm by surgical AF ablation with an almost threefold increase in the requirement for permanent pacemaker postablation...
November 2, 2016: BMJ Open
https://www.readbyqxmd.com/read/27800018/endoscopic-removal-of-a-retained-surgical-sponge-in-a-young-syrian-refugee-after-caesarean-section-a-case-report-with-discussion-of-cultural-and-political-consequences
#12
Johannes Ackermann, Moritz Kanzow, Micaela Mathiak, Ulrich Pecks, Nicolai Maass, Ibrahim Alkatout
BACKGROUND: Inadvertently retained sponges and instruments still constitute a major but preventable complication in surgery. Given the high geographic mobility of patients, the fluctuation of physician-patient contact, and communication problems due to language barriers, the conscientious use of structured safety protocols in clinical routine is an essential aspect of quality in health care. CASE PRESENTATION: We report the case of a 24-year-old refugee from Syria who presented at our gynecological outpatient department with a tumor in the lower abdomen, suspected to be a lump in the ovary or the uterus...
2016: Patient Safety in Surgery
https://www.readbyqxmd.com/read/27795775/-prioperative-adverse-events-critical-reading-of-the-data-registry-used-in-the-surgery-department-of-military-hospital-moulay-ismail-meknes
#13
Hicham Kechna, Omar Ouzzad, Khalid Chkoura, Jaouad Loutid, Moulay Ahmed Hachimi, Sidi Mohamed Hanafi
INTRODUCTION: Despite significant progress made in the field of safety in anesthesia, morbidity (serious or not, completely or partially related to anesthesia) remains common and no health practitioner is immune from accidents. In the current context where priority is given to training programmes, to quality and safety improvement in health care, the occurrence of an anesthesia-related accident in the surgery department is an extremely traumatic event. The fear of prosecution, the emotional context make it difficult to manage...
2016: Pan African Medical Journal
https://www.readbyqxmd.com/read/27786420/outcomes-of-continuous-renal-replacement-therapy-with-regional-citrate-anticoagulation-in-small-children-after-cardiac-surgery-experience-and-protocol-from-a-single-center
#14
Anna Musielak, Alfred Warzywoda, Michał Wojtalik, Bartłomiej Kociński, Paweł Kroll, Danuta Ostalska-Nowicka, Jacek Zachwieja
Patients after a cardiac surgery in cardiopulmonary bypass often present an acute kidney failure. Continuous renal replacement therapy (CRRT) is often required. The aim of this study was to present effectiveness and safety of CRRT with regional citrate anticoagulation (RCA-CRRT) in small children after cardiac surgery. A retrospective analysis was conducted on 15 patients after cardiac surgery and who had RCA-CRRT performed in 2014. The established protocol was followed. Mean time on the RCA-CRRT was 192 h 40 min with the circuit mean lifetime of 43 h 33 min...
October 27, 2016: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/27782950/mid-term-clinical-results-of-co2-laser-assisted-sclerectomy-surgery-class-for-open-angle-glaucoma-treatment
#15
Noa Geffen, Michael Mimouni, Mark Sherwood, Ehud I Assia
PURPOSE: To evaluate the efficacy and safety of CO2 Laser-assisted Sclerectomy Surgery (CLASS) in primary and pseudoexfoliative open-angle glaucoma. MATERIALS AND METHODS: Single-arm, open-label study included data from 9 medical centers located in 7 countries. Subjects underwent nonpenetrating CLASS procedure with a CO2 laser system (IOPtiMate). Intraocular pressure (IOP) and number of medications were measured at baseline, 1, 2, 4, and 6 weeks, and 3, 6, 12, 24, and 36 months...
December 2016: Journal of Glaucoma
https://www.readbyqxmd.com/read/27771314/acute-pain-management-in-morbid-obesity-an-evidence-based-clinical-update
#16
Adele Sandra Budiansky, Michael P Margarson, Naveen Eipe
Increasing numbers of patients with morbid obesity are presenting for surgery, and their acute pain management requires an evidence-based clinical update. The objective of this study was to complete a literature review for acute pain management in morbid obesity and provide an evidence-based clinical update with recommendations. Using standardized search terms, in March 2015, we completed a literature search to determine evidence for different acute pain pharmacologic modalities in morbid obesity. For each modality, the highest level of evidence was ascertained, and recommendations for each pharmacologic modality are presented...
September 19, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/27756258/development-of-oxy111a-a-novel-hypoxia-modifier-as-a-potential-antitumor-agent-in-patients-with-hepato-pancreato-biliary-neoplasms-protocol-of-a-first-ib-iia-clinical-trial
#17
Perparim Limani, Michael Linecker, Philipp Kron, Panagiotis Samaras, Bernhard Pestalozzi, Roger Stupp, Alexander Jetter, Philipp Dutkowski, Beat Müllhaupt, Andrea Schlegel, Claude Nicolau, Jean-Marie Lehn, Henrik Petrowsky, Bostjan Humar, Rolf Graf, Pierre-Alain Clavien
BACKGROUND: Solid tumors, such as hepato-pancreato-biliary cancer, develop tumor hypoxia with tumor growth. Despite advances in surgery, a majority of these patients are in an unresectable condition. At this stage standard cytotoxic chemotherapy regimens are applied with limited success. Novel biological treatment options based on an antiangiogenic mechanism of action neglect other hypoxia mediated mechanisms (e.g. epithelial-mesenchymal transition, Warburg effect, and immunological response) leading to an increased invasiveness with a poor outcome...
October 19, 2016: BMC Cancer
https://www.readbyqxmd.com/read/27754738/noninvasive-electroretinography-assessment-of-intravitreal-sustained-release-methotrexate-microimplants-in-rabbit-eyes
#18
Soumyarwit Manna, James J Augsburger, Zelia M Correa, Marwan F Al-Rjoub, Marepalli B Rao, Rupak K Banerjee
PURPOSE: The purpose of this study is to noninvasively evaluate the safety and toxicity of a chitosan (CS) and polylactic acid (PLA)-based sustained-release methotrexate (MTX) intravitreal microimplant in normal rabbit eyes using electroretinography (ERG). METHODS: PLA-coated CS-based microimplants containing 400 μg of MTX and placebo microimplants (without drug) were surgically implanted in the vitreous of the right and the left eyes, respectively, in each of the 8 New Zealand rabbits using minimally invasive technique...
October 18, 2016: Journal of Ocular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/27753710/implementation-of-the-spanish-national-enhanced-recovery-program-eras-in-bariatric-surgery-a-pilot-study
#19
Jaime Ruiz-Tovar, Pablo Royo, José L Muñoz, Manuel Duran, Elisabeth Redondo, Jose M Ramirez
INTRODUCTION: The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish fast track group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery. PATIENTS AND METHODS: A multicentric prospective pilot study was performed, including 125 consecutive patients undergoing bariatric surgery at 3 Spanish hospitals between January and June 2015, after the Spanish National ERAS protocol in bariatric surgery...
October 7, 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/27745985/multicenter-phase-2-study-of-cisplatin-and-5-fluorouracil-with-concurrent-radiation-therapy-as-an-organ-preservation-approach-in-patients-with-squamous-cell-carcinoma-of-the-cervical-esophagus
#20
Sadamoto Zenda, Takashi Kojima, Ken Kato, Sachiko Izumi, Taijiro Ozawa, Naomi Kiyota, Chikatoshi Katada, Takahiro Tsushima, Yoshinori Ito, Tetsuo Akimoto, Yasuhisa Hasegawa, Miyuki Kanamaru, Hiroyuki Daiko
PURPOSE: To clarify, in a multicenter, single-arm, phase 2 study (UMIN Clinical Trials Registry no. UMIN000001439), the clinical profile of chemoradiotherapy (CRT) for cervical esophageal cancer. PATIENTS AND METHODS: Patients with operable cervical esophageal cancer, excluding candidates for endoscopic resection, were enrolled. Protocol treatment consisted of CRT and adjuvant chemotherapy (CT). First, patients received concurrent CRT with 5-fluorouracil (5-FU) plus cisplatin (CDDP)...
December 1, 2016: International Journal of Radiation Oncology, Biology, Physics
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