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Emergency general surgery

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https://www.readbyqxmd.com/read/28647737/trends-in-the-management-of-acute-appendicitis-in-a-single-center-quality-register-cohort-of-5-614-patients
#1
Martin J A Dahlberg, Emil H A Pieniowski, Lennart Å S Boström
Acute appendicitis is one of the most common reasons for emergency surgery. At Stockholm South General Hospital, information on all patients - 15 years or older - undergoing surgery for acute appendicitis is included in a quality register. Data on surgical method, preoperative imaging, hospital stay, intraoperative findings, and 30-day complications were recorded for each patient. From January 2004 to December 2014, 5,614 consecutive patients were registered. The percentage of patients examined with preoperative imaging increased from 30% in 2004 to 93% in 2014...
June 24, 2017: Digestive Surgery
https://www.readbyqxmd.com/read/28647046/assessment-of-emergency-general-surgery-care-based-on-formally-developed-quality-indicators
#2
Angela Ingraham, Avery Nathens, Andrew Peitzman, Allison Bode, Gina Dorlac, Warren Dorlac, Preston Miller, Mahsa Sadeghi, Deena D Wasserman, Karl Bilimoria
BACKGROUND: Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. METHODS: We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators...
June 21, 2017: Surgery
https://www.readbyqxmd.com/read/28645288/a-cohort-study-of-a-general-surgery-electronic-consultation-system-safety-implications-and-impact-on-surgical-yield
#3
Jesus G Ulloa, Marika D Russell, Alice Hm Chen, Delphine S Tuot
BACKGROUND: Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case). METHODS: Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014...
June 23, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28644934/fingertip-injuries-in-children-epidemiology-financial-burden-and-implications-for-prevention
#4
Rachel R Yorlets, Kathleen Busa, Kyle R Eberlin, Mohammad Ali Raisolsadat, Donald S Bae, Peter M Waters, Brian I Labow, Amir H Taghinia
BACKGROUND: Although fingertip injuries are common, there is limited literature on the epidemiology and hospital charges for fingertip injuries in children. This descriptive study reports the clinical features of and hospital charges for fingertip injuries in a large pediatric population treated at a tertiary medical center. METHODS: Our hospital database was queried using International Classification of Diseases, Revision 9 (ICD-9) codes, and medical records were reviewed...
July 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28640104/the-easytube-during-general-anesthesia-for-minor-surgery-a-randomized-controlled-trial
#5
Oliver Robak, Sonia Vaida, Luis Gaitini, Andreas Thierbach, Ricardo Urtubia, Peter Krafft, Michael Frass
BACKGROUND: The EasyTube (EzT) is a supraglottic airway device that is used for emergency airway situations. Ventilation during general anesthesia should also be feasible, but literature on the EzT is scarce. We evaluated the EzT in comparison with the endotracheal tube (ETT) in its use during general anesthesia in a comparative study. METHODS: A total of 400 patients with American Society of Anesthesiologists (ASA) physical status I to II scheduled for minor surgery in 4 centers were randomized for ventilation via the ETT or EzT...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28639296/pathways-to-professionalism-quality-improvement-care-pathways-and-the-interplay-of-standardisation-and-clinical-autonomy
#6
Graham P Martin, David Kocman, Timothy Stephens, Carol J Peden, Rupert M Pearse
Care pathways are a prominent feature of efforts to improve healthcare quality, outcomes and accountability, but sociological studies of pathways often find professional resistance to standardisation. This qualitative study examined the adoption and adaptation of a novel pathway as part of a randomised controlled trial in an unusually complex, non-linear field - emergency general surgery - by teams of surgeons and physicians in six theoretically sampled sites in the UK. We find near-universal receptivity to the concept of a pathway as a means of improving peri-operative processes and outcomes, but concern about the impact on appropriate professional judgement...
June 21, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28638663/acute-abdominal-compartment-syndrome-following-extraperitoneal-bladder-perforation
#7
Ana Licina
Extraperitoneal bladder perforation is a known complication of a commonly performed rigid cystoscopy. If unrecognized, this complication can lead to continuous intra-abdominal fluid leakage with consequent organ function impairment and symptoms. This is the first case report in literature of a transurethral bladder perforation causing an acute abdominal compartment syndrome, which was subsequently managed conservatively with supportive management only. Case Presentation. We describe a clinical course of a 73-year-old Caucasian female whose initial acute presentation involved urinary symptoms...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28632544/improving-outcomes-in-emergency-general-surgery-patients-what-evidence-is-out-there
#8
Geeta Aggarwal, Carol J Peden, Nial F Quiney
No abstract text is available yet for this article.
June 16, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28631455/the-prognostic-importance-of-chronic-end-stage-diseases-in-geriatric-patients-admitted-to-163-italian-icus
#9
Daniele Poole, Stefano Finazzi, Giovanni Nattino, Danilo Radrizzani, Giuseppe Gristina, Paolo Malacarne, Sergio Livigni, Guido Bertolini
BACKGROUND: The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in 5 years (2011-2015) to 163 Italian general ICUs. METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analysed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours...
June 14, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28629581/impact-of-a-teamstepps-trauma-nurse-academy-at-a-level-1-trauma-center
#10
V Kristen Peters, Ellen M Harvey, Andi Wright, Jennifer Bath, Dan Freeman, Bryan Collier
PROBLEM: Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. METHODS: Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers...
June 16, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28628521/experiences-of-acute-pain-in-children-who-present-to-a-healthcare-facility-for-treatment-a-systematic-review-of-qualitative-evidence
#11
Nicole Pope, Mary Tallon, Ruth McConigley, Gavin Leslie, Sally Wilson
BACKGROUND: Pain is a universal and complex phenomenon that is personal, subjective and specific. Despite growing knowledge in pediatric pain, management of children's pain remains sub-optimal and is linked to negative behavioral and physiological consequences later in life. As there is no synthesis of these studies, it was timely to undertake a systematic review. OBJECTIVES: To identify, evaluate and synthesize the existing qualitative evidence on children's experiences of acute pain, including pain management, within a healthcare facility...
June 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28626428/molecular-surgery-concept-from-bench-to-bedside-a-focus-on-trpv1-pain-sensing-neurons
#12
REVIEW
László Pecze, Béla Viskolcz, Zoltán Oláh
"Molecular neurosurgery" is emerging as a new medical concept, and is the combination of two partners: (i) a molecular neurosurgery agent, and (ii) the cognate receptor whose activation results in the selective elimination of a specific subset of neurons in which this receptor is endogenously expressed. In general, a molecular surgery agent is a selective and potent ligand, and the target is a specific cell type whose elimination is desired through the molecular surgery procedure. These target cells have the highest innate sensitivity to the molecular surgery agent usually due to the highest receptor density being in their plasma membrane...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28624064/assessing-written-communication-during-interhospital-transfers-of-emergency-general-surgery-patients
#13
Felicity N R Harl, Megan C Saucke, Caprice C Greenberg, Angela M Ingraham
BACKGROUND: Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. METHODS: We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28623479/fast-calibration-of-electromagnetically-tracked-oblique-viewing-rigid-endoscopes
#14
Xinyang Liu, Christina E Rice, Raj Shekhar
PURPOSE: The oblique-viewing (i.e., angled) rigid endoscope is a commonly used tool in conventional endoscopic surgeries. The relative rotation between its two moveable parts, the telescope and the camera head, creates a rotation offset between the actual and the projection of an object in the camera image. A calibration method tailored to compensate such offset is needed. METHODS: We developed a fast calibration method for oblique-viewing rigid endoscopes suitable for clinical use...
June 16, 2017: International Journal of Computer Assisted Radiology and Surgery
https://www.readbyqxmd.com/read/28623411/-i-am-not-afraid-of-death-a-survey-on-preferences-concerning-neurosurgical-interventions-among-patients-over-75-years
#15
Claudia Unterhofer, Wing Mann Ho, Katrin Wittlinger, Claudius Thomé, Martin Ortler
INTRODUCTION: Treatment decisions in elderly patients with traumatic brain injury (TBI) are mainly determined by trauma severity and patient age. The aim of this study was to explore personal preferences of potential patients regarding life-prolonging neurosurgical interventions by interviewing ambulatory, autonomous elderly people. METHODS: One hundred consecutive patients older than 75 years frequenting the outpatient clinic of the Department of Neurosurgery were interviewed about their attitudes regarding the hypothetical case of an 81-year-old patient with TBI and a space-occupying acute subdural hematoma (aSDH) using a 21-point questionnaire...
June 16, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28622355/anesthetic-action-on-the-transmission-delay-between-cortex-and-thalamus-explains-the-beta-buzz-observed-under-propofol-anesthesia
#16
Meysam Hashemi, Axel Hutt, Darren Hight, Jamie Sleigh
In recent years, more and more surgeries under general anesthesia have been performed with the assistance of electroencephalogram (EEG) monitors. An increase in anesthetic concentration leads to characteristic changes in the power spectra of the EEG. Although tracking the anesthetic-induced changes in EEG rhythms can be employed to estimate the depth of anesthesia, their precise underlying mechanisms are still unknown. A prominent feature in the EEG of some patients is the emergence of a strong power peak in the β-frequency band, which moves to the α-frequency band while increasing the anesthetic concentration...
2017: PloS One
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
#17
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/28617694/the-spectrum-of-general-surgery-interventions-in-pediatric-patients-with-ventricular-assist-devices
#18
Fady Kamel, Holger Buchholz, Bryan Dicken, Jennifer Conway
Ventricular assist devices (VADs) have positively impacted the management of heart failure. However, they come with a range of complications. Although general surgical complications have been assessed in adults with VADs, there is no study to date that has assessed general surgery intervention in the pediatric population. Fifty-two patients who received VADs from 2005 to 2015 at the Stollery Children's Hospital were assessed for general surgery intervention and anticoagulation status at the time of intervention...
June 13, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28614125/development-and-validation-of-a-risk-scale-for-emergence-agitation-after-general-anesthesia-in-children-a-prospective-observational-study
#19
Maai Hino, Takahiro Mihara, Saeko Miyazaki, Toshiyuki Hijikata, Takaaki Miwa, Takahisa Goto, Koui Ka
BACKGROUND: Emergence agitation (EA) is a common complication in children after general anesthesia. The goal of this 2-phase study was (1) to develop a predictive model (EA risk scale) for the incidence of EA in children receiving sevoflurane anesthesia by performing a retrospective analysis of data from our previous study (phase 1) and (2) to determine the validity of the EA risk scale in a prospective observational cohort study (phase 2). METHODS: Using data collected from 120 patients in our previous study, logistic regression analysis was used to predict the incidence of EA in phase 1...
June 12, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28612302/a-simplified-lung-ultrasound-approach-to-detect-increased-extravascular-lung-water-in-critically-ill-patients
#20
Antonio Anile, Jole Russo, Giacomo Castiglione, Giovanni Volpicelli
BACKGROUND: The quantification of B-lines at lung ultrasonography is a valid tool to estimate the extravascular lung water (EVLW) in patients after major cardiac surgery. However, there is still uncertainty about the correlation between B-lines and EVLW in a general population of critically ill. AIM: To evaluate a simplified lung ultrasonographic assessment as a tool to estimate the EVLW in critically ill patients admitted to a polyvalent intensive care unit (ICU)...
December 2017: Critical Ultrasound Journal
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