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Safety protocols in surgery

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https://www.readbyqxmd.com/read/29349483/surgical-outcomes-of-primary-versus-post-neoadjuvant-chemotherapy-breast-conservation-surgery-a-comparative-study-from-a-developing-country
#1
Gaurav Agarwal, Chaitra Sonthineni, Sabaretnam Mayilvaganan, Anjali Mishra, Punita Lal, Vinita Agrawal
INTRODUCTION: In India and other developing countries, breast conservation surgery (BCS) rates in breast cancer patients are low due to advanced disease at presentation and misconceptions about BCS outcomes. Many patients presenting with large or locally advanced breast cancers (LABC) can be offered post-neoadjuvant chemotherapy (NACT) BCS, safety of which is not as well established as that of primary BCS. This retrospective study compared pathological and surgical outcome parameters in patients undergoing primary and post-NACT BCS...
January 18, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29344678/conservative-antibiotic-treatment-for-acute-uncomplicated-appendicitis-is-feasible
#2
Zvi Steiner, Genady Buklan, Michael Gutermacher, Ita Litmanovitz, Tal Landa, Shmuel Arnon
PURPOSE: Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center's experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria. METHODS: Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA...
January 17, 2018: Pediatric Surgery International
https://www.readbyqxmd.com/read/29344622/barriers-to-and-facilitators-of-implementing-enhanced-recovery-pathways-using-an-implementation-framework-a-systematic-review
#3
Alexander B Stone, Christina T Yuan, Michael A Rosen, Michael C Grant, Lauren E Benishek, Elizabeth Hanahan, Lisa H Lubomski, Clifford Ko, Elizabeth C Wick
Importance: Enhanced recovery pathways (ERPs) have the potential to reduce length of hospital stay, costs, and complications following surgery but can be challenging to implement. Objective: To examine the body of literature on ERPs to assess how authors describe barriers and facilitators of ERP implementation and identify, in aggregate, the best practices that should be considered utilizing the Consolidated Framework for Implementation Research (CFIR) to extract these elements and summarize common barriers and facilitators according to its 5 major domains: (1) intervention characteristics, (2) inner setting, (3) outer setting, (4) characteristics of the individuals, and (5) the process of implementation...
January 17, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29335096/clinically-significant-laser-in%C3%A2-situ-keratomileusis-flap-striae
#4
Avi Wallerstein, Mathieu Gauvin, Eser Adiguzel, Harmanjit Singh, Vasudha Gupta, Mona Harissi-Dagher, Mark Cohen
PURPOSE: To describe the incidence, risk factors, and outcomes before and after irrigation of clinically significant laser in situ keratomileusis (LASIK) flap striae. SETTING: Multisurgeon multicenter standardized protocol practice. DESIGN: Retrospective case-control series. METHODS: Eyes with striae necessitating flap relift and irrigation were identified. Preoperative, intraoperative, and postoperative variables were collected...
December 2017: Journal of Cataract and Refractive Surgery
https://www.readbyqxmd.com/read/29335001/different-clinical-presentation-and-management-of-temporal-bone-fibrous-dysplasia-in-children
#5
REVIEW
Józef Mierzwiński, Justyna Kosowska, Justyna Tyra, Karolina Haber, Maria Drela, Dariusz Paczkowski, Paweł Burduk
BACKGROUND: Fibrous dysplasia is a slowly progressive benign fibro-osseous disorder that involves one or multiple bones with a unilateral distribution in most cases. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. Temporal bone involvement is the least frequently reported type, especially in children. We reviewed available articles regarding fibrous dysplasia with temporal bone involvement in children and added four patients aged 7 to 17 years who were diagnosed and treated in our institution from 2006 to 2017...
January 15, 2018: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29333120/focused-transhepatic-electroporation-mediated-by-hypersaline-infusion-through-the-portal-vein-in-rat-model-preliminary-results-on-differential-conductivity
#6
Clara Pañella, Quim Castellví, Xavier Moll, Rita Quesada, Alberto Villanueva, Mar Iglesias, Dolores Naranjo, Patricia Sánchez-Velázquez, Anna Andaluz, Luís Grande, Antoni Ivorra, Fernando Burdío
Background: Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI) through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE) when applied in a transhepatic fashion. Material and methods: Sprague Dawley (Group A, n = 10) and Athymic rats with implanted hepatic tumour (Group B, n = 8) were employed...
December 2017: Radiology and Oncology
https://www.readbyqxmd.com/read/29331966/effectiveness-and-safety-of-oral-sedation-in-adult-patients-undergoing-dental-procedures-protocol-for-a-systematic-review
#7
Jimmy de Oliveira Araújo, Rogério Heládio Lopes Motta, Cristiane de Cássia Bergamaschi, Caio Chaves Guimarães, Juliana Cama Ramacciato, Natalia Karol de Andrade, Mabel Fernandes Fiqueiró, Luciane Cruz Lopes
INTRODUCTION: The management of anxious patients undergoing dental procedures is still a challenge in clinical practice. Despite a wide variety of drugs for oral sedation in adult patients, there are relatively few systematic reviews that compare the effectiveness and safety of different drugs administered via this route. Thus, this study will evaluate the effectiveness and safety of oral sedation with benzodiazepines and other agents to patients undergoing dental surgical procedures...
January 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29330982/assessment-of-safety-levels-in-operation-rooms-at-two-major-tertiary-care-public-hospitals-of-karachi-safe-surgery-saves-life
#8
Muhammad Saeed Minhas, Muhammad Muzzammil, Jahanzeb Effendi
BACKGROUND: The objectives of this study are to determine the knowledge and attitude towards surgical safety among the health care professionals including surgeons, anaesthetist, hospital administrators, and operation room personnel and raise awareness towards the importance of safe surgery. METHODS: A pilot cross- sectional study of 543 healthcare providers working in the operating rooms and the surgical intensive care units was conducted in two tertiary care hospitals, within a study period of one month...
October 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/29329555/exercise-during-and-after-neoadjuvant-rectal-cancer-treatment-the-exert-trial-study-protocol-for-a-randomized-controlled-trial
#9
Andria R Morielli, Nawaid Usmani, Normand G Boulé, Diane Severin, Keith Tankel, Tirath Nijjar, Kurian Joseph, Alysa Fairchild, Kerry S Courneya
BACKGROUND: Standard treatment for locally advanced rectal cancer includes 5-6 weeks of neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision 6-8 weeks later. NACRT improves local disease control and surgical outcomes but also causes side effects including fatigue, diarrhea, hand-foot syndrome, and physical deconditioning that may impede quality of life (QoL), treatment completion, treatment response, and long-term prognosis. Interventions to improve treatment outcomes and manage side effects that are safe, tolerable and low-cost are highly desirable...
January 12, 2018: Trials
https://www.readbyqxmd.com/read/29318031/para-aortic-lymphadenectomy-in-advanced-stage-cervical-cancer-a-protocol-for-comparing-safety-feasibility-and-diagnostic-accuracy-of-surgical-staging-versus-pet-ct-paldisc-trial
#10
Casper Tax, Karin Abbink, Maroeska M Rovers, Ruud L M Bekkers, Petra L M Zusterzeel
Background: Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29312711/intermittent-chest-tube-clamping-may-shorten-chest-tube-drainage-and-postoperative-hospital-stay-after-lung-cancer-surgery-a-propensity-score-matching-analysis
#11
Shi Yan, Xing Wang, Yaqi Wang, Chao Lv, Yuzhao Wang, Jia Wang, Yue Yang, Nan Wu
Background: Postoperative pleural drainage markedly influences the length of hospital stay and the financial costs of medical care. The safety of chest tube clamping before removal has been documented. This study aims to determine if intermittent chest tube clamping shortens the duration of chest tube drainage and hospital stay after lung cancer surgery. Methods: We retrospectively analyzed 285 consecutive patients with operable lung cancer treated using lobectomy and systematic mediastinal lymphadenectomy...
December 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29304180/the-effect-of-facility-characteristics-on-patient-safety-patient-experience-and-service-availability-for-procedures-in-non-hospital-affiliated-outpatient-settings-a-systematic-review
#12
Nancy F Berglas, Molly F Battistelli, Wanda K Nicholson, Mindy Sobota, Richard D Urman, Sarah C M Roberts
BACKGROUND: Over recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements...
2018: PloS One
https://www.readbyqxmd.com/read/29301556/combined-electroacupuncture-and-auricular-acupuncture-for-postoperative-pain-after-abdominal-surgery-for-gynecological-diseases-study-protocol-for-a-randomized-controlled-trial
#13
Wing Lok Lam, Wing Fai Yeung, Mei Kuen Wong, Chi Wai Cheung, Karen Kar Loen Chan, Hextan Yuen Sheung Ngan, Carlos King Ho Wong, Hai Yong Chen, Lixing Lao
BACKGROUND: Postoperative pain is a major complaint following abdominal surgery for gynecological diseases. Effective postoperative pain control after abdominal surgery is particularly important for patient recovery, mobility, and satisfaction. Acupuncture has been commonly used for pain management. However, its efficacy in postoperative pain control is inconclusive and health economic evaluation is limited. METHODS: A randomized, sham-controlled, patient- and- assessor-blind trial is designed to evaluate the efficacy and safety of acupuncture in managing postoperative pain following abdominal surgery of gynecological diseases...
January 4, 2018: Trials
https://www.readbyqxmd.com/read/29301544/tai-chi-chuan-in-postsurgical-non-small-cell-lung-cancer-patients-study-protocol-for-a-randomized-controlled-trial
#14
Hong Pan, Yingxia Pei, Bingxue Li, Yi Wang, Jie Liu, Hongsheng Lin
BACKGROUND: Impairment of exercise capacity remains a common adverse effect of non-small cell lung cancer (NSCLC) survivors after surgery. Previous research has suggested that Tai Chi Chuan (TCC) offers an exercise capacity benefit in several types of cancers. This is a randomized trial to investigate the efficacy and safety of TCC in postoperative NSCLC patients over an observation period of 3 months and a 9-month follow-up. METHODS/DESIGN: Using a prospective, one center and randomized design, 120 subjects with histologically confirmed stage I-IIIA NSCLC following complete surgical resection will potentially be eligible for this trial...
January 4, 2018: Trials
https://www.readbyqxmd.com/read/29298664/the-prevention-of-delirium-in-elderly-with-obstructive-sleep-apnea-podesa-study-protocol-for-a-multi-centre-prospective-randomized-controlled-trial
#15
Jean Wong, David Lam, Stephen Choi, Mandeep Singh, Naveed Siddiqui, Sanjeev Sockalingam, Frances Chung
BACKGROUND: Delirium is a common problem that occurs in 5-50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway - are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium...
January 3, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29284510/the-napressim-trial-the-use-of-low-dose-prophylactic-naloxone-infusion-to-prevent-respiratory-depression-with-intrathecally-administered-morphine-in-elective-hepatobiliary-surgery-a-study-protocol-and-statistical-analysis-plan-for-a-randomised-controlled-trial
#16
David Cosgrave, Marie Galligan, Era Soukhin, Victoria McMullan, Siobhan McGuinness, Anand Puttappa, Niamh Conlon, John Boylan, Rabia Hussain, Peter Doran, Alistair Nichol
BACKGROUND: Intrathecally administered morphine is effective as part of a postoperative analgesia regimen following major hepatopancreaticobiliary surgery. However, the potential for postoperative respiratory depression at the doses required for effective analgesia currently limits its clinical use. The use of a low-dose, prophylactic naloxone infusion following intrathecally administered morphine may significantly reduce postoperative respiratory depression. The NAPRESSIM trial aims to answer this question...
December 29, 2017: Trials
https://www.readbyqxmd.com/read/29275495/analysis-of-laparoscopic-sleeve-gastrectomy-learning-curve-and-its-influence-on-procedure-safety-and-perioperative-complications
#17
Piotr Major, Michał Wysocki, Jadwiga Dworak, Michał Pędziwiatr, Magdalena Pisarska, Mateusz Wierdak, Anna Zub-Pokrowiecka, Michał Natkaniec, Piotr Małczak, Michał Nowakowski, Andrzej Budzyński
PURPOSE: Laparoscopic sleeve gastrectomy (LSG) has become an attractive bariatric procedure with promising treatment effects yet amount of data regarding institutional learning process is limited. MATERIALS AND METHODS: Retrospective study included patients submitted to LSG at academic teaching hospital. Patients were divided into groups every 100 consecutive patients. LSG introduction was structured along with Enhanced Recovery after Surgery (ERAS) treatment protocol...
December 23, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/29251207/perioperative-outcomes-from-the-prospective-multicenter-least-invasive-fast-track-evar-life-registry
#18
Zvonimir Krajcer, Venkatesh G Ramaiah, Esteban A Henao, D Chris Metzger, Wayne K Nelson, Mohammed M Moursi, Hiranya A Rajasinghe, Raed Al-Dallow, Larry E Miller
PURPOSE: To determine the feasibility, perioperative resource utilization, and safety of a fast-track endovascular aneurysm repair (EVAR) protocol in well-selected patients. METHODS: Between October 2014 and May 2016, the LIFE (Least Invasive Fast-track EVAR) registry ( ClinicalTrials.gov identifier NCT02224794) enrolled 250 patients (mean age 73±8 years; 208 men) in a fast-track EVAR protocol comprised of bilateral percutaneous access using the 14-F Ovation stent-graft, no general anesthesia, no intensive care unit (ICU) admission, and next-day discharge...
December 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/29242018/current-practice-in-cytoreductive-surgery-and-hipec-for-metastatic-peritoneal-disease-spanish-multicentric-survey
#19
Rafael Morales-Soriano, Neus Esteve-Pérez, Juan José Segura-Sampedro, Pedro Cascales-Campos, Pedro Barrios
INTRODUCTION: Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers. AIM OF THE STUDY: To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC...
December 6, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29208819/antibiotic-prophylaxis-in-cataract-surgery-an-evidence-based-approach
#20
REVIEW
Aravind Haripriya
Various protocols are being followed for endophthalmitis prophylaxis in cataract surgery, and this subject continues to be a matter of debate. We summarize the most recent evidence-based studies on this topic with additional stress on intracameral (IC) antibiotic prophylaxis. Here, we discuss several large, international clinical studies which discuss the efficacy, adoption, safety, cost, and newer trends in antibiotic prophylaxis. Majority of these studies report a significant reduction in endophthalmitis rates with IC antibiotic prophylaxis...
December 2017: Indian Journal of Ophthalmology
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