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Safety protocols in surgery

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https://www.readbyqxmd.com/read/29158011/extended-adjuvant-intermittent-letrozole-versus-continuous-letrozole-in-postmenopausal-women-with-breast-cancer-sole-a-multicentre-open-label-randomised-phase-3-trial
#1
Marco Colleoni, Weixiu Luo, Per Karlsson, Jacquie Chirgwin, Stefan Aebi, Guy Jerusalem, Patrick Neven, Erika Hitre, Marie-Pascale Graas, Edda Simoncini, Claus Kamby, Alastair Thompson, Sibylle Loibl, Joaquín Gavilá, Katsumasa Kuroi, Christian Marth, Bettina Müller, Seamus O'Reilly, Vincenzo Di Lauro, Andrea Gombos, Thomas Ruhstaller, Harold Burstein, Karin Ribi, Jürg Bernhard, Giuseppe Viale, Rudolf Maibach, Manuela Rabaglio-Poretti, Richard D Gelber, Alan S Coates, Angelo Di Leo, Meredith M Regan, Aron Goldhirsch
BACKGROUND: In animal models of breast cancer, resistance to continuous use of letrozole can be reversed by withdrawal and reintroduction of letrozole. We therefore hypothesised that extended intermittent use of adjuvant letrozole would improve breast cancer outcome compared with continuous use of letrozole in postmenopausal women. METHODS: We did the multicentre, open-label, randomised, parallel, phase 3 SOLE trial in 240 centres (academic, primary, secondary, and tertiary care centres) in 22 countries...
November 17, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/29152553/oncological-outcomes-of-sequential-intravesical-gemcitabine-and-docetaxel-in-patients-with-non-muscle-invasive-bladder-cancer
#2
Niv Milbar, Max Kates, Meera R Chappidi, Filippo Pederzoli, Takahiro Yoshida, Alexander Sankin, Phillip M Pierorazio, Mark P Schoenberg, Trinity J Bivalacqua
Background: Bacillus Calmette-Guérin (BCG) unresponsive/relapsing patients with non-muscle invasive bladder cancer (NMIBC) who prefer bladder preservation over radical cystectomy (RC) or those who do not qualify for surgery may be offered intravesical therapies. Gemcitabine (GEM) combined with Docetaxel (DOCE) has been offered at Johns Hopkins Hospital (JHH). Objective: To evaluate experience with GEM/DOCE, to confirm safety of the regimen, to identify populations that may benefit most, and to consider the appropriate endpoints for judging efficacy of second line therapies...
October 27, 2017: Bladder Cancer
https://www.readbyqxmd.com/read/29151009/risk-stratification-triage-and-implementation-of-an-expedited-hip-fracture-treatment-protocol-is-it-safe-and-effective
#3
William Zelenty, Richard Yoon, Lorraine Hutzler, Nirmal Tejwani, Joseph Bosco
INTRODUCTION: The population of patients in the USA over the age of 65 is expected to significantly increase over the next 40 years. These patients are at increased risk for hip fractures and will pose a burden to providers in the near future. In order to provide high value care, providers will need to maintain positive outcomes, mitigate complications, and reduce overall cost burdens. This study was designed to investigate the safety and efficacy of a patient transfer protocol between a large academic medical center and a single specialty orthopaedic institution...
December 2017: Bulletin of the Hospital for Joint Diseases
https://www.readbyqxmd.com/read/29150478/early-versus-late-application-of-subthalamic-deep-brain-stimulation-to-parkinson-s-disease-patients-with-motor-complications-elass-protocol-of-a-multicentre-prospective-and-observational-study
#4
Lulu Jiang, Wai Sang Poon, Elena Moro, Wenbiao Xian, Chao Yang, Xian Lun Zhu, Jing Gu, Xiaodong Cai, Jinlong Liu, Vincent Mok, Yanmei Liu, Shaohua Xu, Qiyu Guo, Wanru Chen, Ling Chen
INTRODUCTION: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established surgical treatment for Parkinson's disease (PD). However, there is currently no consensus on the best timing for this surgery. The aim of our study is to compare the therapeutic efficacy of bilateral STN DBS in patients with PD with early and late motor complications. METHODS AND ANALYSIS: 200 patients with PD will be enrolled in this multicentre, prospective, observational study, and will be followed up for 4 years...
November 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29150418/immune-enhancing-formulas-for-patients-with-cancer-undergoing-esophagectomy-systematic-review-protocol
#5
Astrid Naranjo, Elizabeth Isenring, Laisa Teleni
BACKGROUND: Adult patients with an esophageal cancer can potentially be compromised with postoperative leaks or fistulae if patients' nutritional status is in a vulnerable stage. Currently in Australia, there is a growing need for clinicians to know whether use of immune-enhancing formulas (IEFs) containing Arg, omega-3, and RNA are a cost-effective approach compared with isonitrogenous-isocaloric formulas to reduce postoperative infectious complications in esophagectomy patients. Since IEFs may carry higher costs, this has led to inconsistencies in practice among clinicians and hospitals...
November 17, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/29150228/surgeons-perceptions-of-the-causes-of-preventable-harm-in-arterial-surgery-a-mixed-methods-study
#6
Rachael Lear, Anthony D Godfrey, Celia Riga, Christine Norton, Charles Vincent, Colin D Bicknell
BACKGROUND: System factors contributing to preventable harm in vascular patients have not been previously reported in detail. The aim of this exploratory mixed-methods study was to describe vascular surgeons' perceptions of factors contributing to adverse events (AEs) in arterial surgery. A secondary aim was to report recommendations to improve patient safety. METHODS: Vascular consultants/registrars working in the British National Health Service were questioned about the causes of preventable AEs through survey and semi-structured interview (response rates 77% and 83%, respectively)...
November 15, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29145879/allogeneic-mesenchymal-stem-cell-as-induction-therapy-to-prevent-both-delayed-graft-function-and-acute-rejection-in-deceased-donor-renal-transplantation-study-protocol-for-a-randomized-controlled-trial
#7
Qipeng Sun, Liangqing Hong, Zhengyu Huang, Ning Na, Xuefeng Hua, Yanwen Peng, Ming Zhao, Ronghua Cao, Qiquan Sun
BACKGROUND: Using kidneys from deceased donors is an available strategy to meet the growing need of grafts. However, higher incidences of delayed graft function (DGF) and acute rejection exert adverse effects on graft outcomes. Since ischemia-reperfusion injury (IRI) and ongoing process of immune response to grafts are the major causes of DGF and acute rejection, the optimal induction intervention should possess capacities of both repairing renal structure injury and suppressing immune response simultaneously...
November 16, 2017: Trials
https://www.readbyqxmd.com/read/29124343/anatomical-landmarks-of-mandibular-interforaminal-region-related-to-dental-implant-placement-with-3d-cbct-comparison-between-edentulous-and-dental-mandibles
#8
Elif Sener, Erinc Onem, Gulcan Coskun Akar, Figen Govsa, Mehmet Asim Ozer, Yelda Pinar, Ali Mert, B Guniz Baksi Sen
BACKGROUND: Anterior mandibular (interforaminal) region is important in implant applications as it serves a basis for neurovascular bedding and holds the prosthesis for patients. Treatment planning for dental implant patients is often complicated by the unknown extent of the anterior loop of the neurovascular bundle. Anatomical structures including mandibular incisive canal (MIC) and lingual foramen (LF) should also be examined as part of the detailed analysis for their neurovascular structures...
November 9, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/29122527/implementation-of-enhanced-recovery-programs-for-bariatric-surgery-results-from-the-francophone-large-scale-database
#9
Anissa Deneuvy, Karem Slim, Maxime Sodji, Pierre Blanc, Denis Gallet, Marie-Cécile Blanchet
BACKGROUND: The feasibility, safety, and efficacy of programs for enhanced recovery after bariatric surgery (ERABS) are now well established. However, data concerning their large-scale implementation remain insufficient. OBJECTIVES: The objective of the present study was to review the multicenter implementation of ERABS SETTING: This retrospective analysis of a prospective database was conducted in 15 Groupe francophone de Rehabilitation Améliorée après ChirurgiE centers from data from March 2014 to January 2017...
October 4, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/29122306/carmustine-wafer-implantation-for-high-grade-gliomas-evidence-based-safety-efficacy-and-practical-recommendations-from-the-neuro-oncology-club-of-the-french-society-of-neurosurgery
#10
REVIEW
A Roux, F Caire, J Guyotat, P Menei, P Metellus, J Pallud
There is a growing body of evidence that carmustine wafer implantation during surgery is an effective therapeutic adjunct to the standard combined radio-chemotherapy regimen using temozolomide in newly diagnosed and recurrent high-grade glioma patient management with a statistically significant survival benefit demonstrated across several randomized clinical trials, as well as prospective and retrospective studies (grade A recommendation). Compelling clinical data also support the safety of carmustine wafer implantation (grade A recommendation) in these patients and suggest that observed adverse events can be avoided in experienced neurosurgeon hands...
November 6, 2017: Neuro-Chirurgie
https://www.readbyqxmd.com/read/29114614/preoperative-radiation-dose-escalation-for-rectal-cancer-using-a-concomitant-boost-strategy-improves-tumor-downstaging-without-increasing-toxicity-a-matched-pair-analysis
#11
Jillian R Gunther, Awalpreet S Chadha, Ui Sup Shin, In Ja Park, Kiran V Kattepogu, Jonathan D Grant, David C Weksberg, Cathy Eng, Scott E Kopetz, Prajnan Das, Marc E Delclos, Harmeet Kaur, Dipen M Maru, John M Skibber, Miguel A Rodriguez-Bigas, Y Nancy You, Sunil Krishnan, George J Chang
Purpose: Pathologic complete response to neoadjuvant chemoradiation therapy (CRT) is associated with improved outcomes for patients with locally advanced rectal cancer (LARC). Increased response rates have been reported with higher radiation doses, but these studies often lack long-term outcome and/or toxicity data. We conducted a case-control analysis of patients with LARC who underwent definitive CRT to determine the efficacy and safety of intensified treatment with a concomitant boost (CB) approach...
July 2017: Advances in Radiation Oncology
https://www.readbyqxmd.com/read/29111154/robot-assisted-partial-nephrectomy-5-yr-oncological-outcomes-at-a-single-european-tertiary-cancer-center
#12
Mihai Dorin Vartolomei, Deliu Victor Matei, Giuseppe Renne, Valeria Maria Tringali, Nicolae Crisan, Gennaro Musi, Francesco Alessandro Mistretta, Andrea Russo, Gabriele Cozzi, Giovani Cordima, Stefano Luzzago, Antonio Cioffi, Ettore Di Trapani, Michele Catellani, Maurizio Delor, Danilo Bottero, Ciro Imbimbo, Vincenzo Mirone, Matteo Ferro, Ottavio de Cobelli
BACKGROUND: Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. OBJECTIVE: The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center...
October 27, 2017: European Urology Focus
https://www.readbyqxmd.com/read/29108701/impact-of-potassium-iodide-on-thyroidectomy-for-graves-disease-implications-for-safety-and-operative-difficulty
#13
Reese W Randle, Maria F Bates, Kristin L Long, Susan C Pitt, David F Schneider, Rebecca S Sippel
BACKGROUND: Potassium iodide often is prescribed prior to thyroidectomy for Graves' disease, but the effect of potassium iodide on the ease and safety of thyroidectomy for Graves' is largely unknown. METHODS: We conducted a prospective, cohort study of patients with Graves' disease undergoing thyroidectomy. For the first 8 months, no patients received potassium iodide; for the next 8 months, potassium iodide was added to the preoperative protocol for all patients...
November 3, 2017: Surgery
https://www.readbyqxmd.com/read/29092758/navigation-guided-resection-of-maxillary-tumours-the-accuracy-of%C3%A2-computer-assisted-surgery-in-terms-of-control-of-resection-margins%C3%A2-a-feasibility-study
#14
Achille Tarsitano, Francesco Ricotta, Gennaro Baldino, Giovanni Badiali, Angelo Pizzigallo, Valerio Ramieri, Piero Cascone, Claudio Marchetti
INTRODUCTION: Surgical treatment of maxillary tumours is often highly complex. The three-dimensional anatomy of the mid-face renders both correct intraoperative orientation and adequate oncological safety difficult to obtain. Recently, computer-assisted techniques and intraoperative navigation have been applied to oncological surgery treating head and neck cancer. However, only a few studies have explored whether preoperative virtual resection planning and intraoperative control of resection margins allow assessment of the surgical margins of the tumour...
September 30, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29090018/incidence-root-cause-and-outcomes-of-unintentionally-retained-intraabdominal-surgical-sponges-a-retrospective-case-series-from-two-hospitals-in-togo
#15
Boyodi Tchangai, Mazamaesso Tchaou, Iroukora Kassegne, Kpatekana Simlawo
BACKGROUND: The term gossypiboma refers to a sponge that has been forgotten in the surgical field. It is the most common retained surgical item, and constitutes a continuing problem for surgical safety. We performed a hospital-based study to examine their incidence, root cause, and outcomes, as an effort toward improving prevention. METHODS: This retrospective study covered 10 years (2006-2015) and included surgically confirmed cases of abdominal gossypibomas occurring after 45,011 abdominal and gynaecological operations in 2 public hospitals in Lome (Togo)...
2017: Patient Safety in Surgery
https://www.readbyqxmd.com/read/29081374/enhanced-recovery-after-surgery-for-pancreaticoduodenectomy-review-of-current-evidence-and-trends
#16
REVIEW
Xiequn Xu, Chaoji Zheng, Yupei Zhao, Weiyun Chen, Yuguang Huang
Pancreaticoduodenectomy (PD) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with PD by utilizing ERAS. Guidelines for perioperative care after PD were published in 2013, but these recommendations could even change in one year. The purpose of this review is to examine the current evidence for ERAS in preoperative, intraoperative and post-operative setting of care for PD patients and to propose ERAS evidence-based protocol for patients undergoing PD...
October 25, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/29075986/a-practical-method-for-prevention-of-readmission-for-symptomatic-hyponatremia-following-transsphenoidal-surgery
#17
William T Burke, David J Cote, Sherry I Iuliano, Hasan A Zaidi, Edward R Laws
INTRODUCTION: Patients undergoing transsphenoidal pituitary surgery (TSS) are at risk for several serious complications, including the syndrome of inappropriate antidiuretic hormone and subsequent hyponatremia. OBJECTIVE: In this study, we examined the effect of 1 week of post-discharge fluid restriction to 1.0 L daily on rates of post-operative readmission for hyponatremia. METHODS: We retrospectively analyzed all patients undergoing TSS from 2008 to 2014 and prospectively recorded patient data from 2015 to 2017...
October 26, 2017: Pituitary
https://www.readbyqxmd.com/read/29073928/safety-of-tubal-ligation-by-minilaparotomy-provided-by-clinical-officers-versus-assistant-medical-officers-study-protocol-for-a-noninferiority-randomized-controlled-trial-in-tanzanian-women
#18
Mark A Barone, Zuhura Mbuguni, Japhet Ominde Achola, Carmela Cordero, Joseph Kanama, Projestine S Muganyizi, Jamilla Mwanga, Caitlin Shannon, Leopold Tibyehabwa
BACKGROUND: Female sterilization by tubal ligation is a safe, extremely effective, and permanent way to limit childbearing. It is the most popular modern contraceptive method worldwide. The simplest way to provide tubal ligation is by a procedure called minilaparotomy, generally performed with the client under local anesthesia with systemic sedation and analgesia. In Tanzania, unmet need for family planning is high and has declined little in the past decade. Access to tubal ligation is limited throughout the country, in large part because of a lack of trained providers...
October 26, 2017: Trials
https://www.readbyqxmd.com/read/29061632/neoadjuvant-s-1-with-concurrent-radiotherapy-followed-by-surgery-for-borderline-resectable-pancreatic-cancer-study-protocol-for-an-open-label-multicentre-prospective-phase-ii-trial-jaspac05
#19
Shinichiro Takahashi, Izumi Ohno, Masafumi Ikeda, Tatsushi Kobayashi, Tetsuo Akimoto, Motohiro Kojima, Masaru Konishi, Katsuhiko Uesaka
INTRODUCTION: Borderline resectable pancreatic cancer (BRPC) can involve the portal vein, superior mesenteric vein, superior mesenteric artery, coeliac axis or hepatic artery, and has a high probability of positive surgical margins and poor prognosis after resection. Neoadjuvant chemoradiation is expected to provide substantial local control and prolong survival in patients with BRPC. METHODS AND ANALYSIS: This open-label, multicentre, prospective phase II trial will assess S-1 with concurrent radiotherapy as preoperative treatment for BRPC...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29049615/current-trends-in-management-of-submental-liposis-a-pooled-analysis-and-survey
#20
Sagar Patel, Russell Kridel
Importance: Since its approval by the US Food and Drug Administration for treatment of moderate to severe submental liposis in April 2015, deoxycholic acid (Kybella) has received significant media attention as a novel aesthetic treatment. Four phase 3 clinical trials have published data demonstrating the safety and efficacy of the drug compared with placebo; however, no study has juxtaposed the product with submental liposuction. Objective: To evaluate the efficacy of injectable deoxycholic acid in the treatment of isolated submental liposis...
October 19, 2017: JAMA Facial Plastic Surgery
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