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Emergency general surgery

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https://www.readbyqxmd.com/read/27912036/failure-to-redose-antibiotic-prophylaxis-in-long-surgery-increases-risk-of-surgical-site-infection
#1
Nongyao Kasatpibal, Joanne D Whitney, E Patchen Dellinger, Bala G Nair, Kenneth C Pike
BACKGROUND: Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk. METHODS: A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome...
December 2, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27909654/bone-substitutes-and-expanders-in-spine-surgery-a-review-of-their-fusion-efficacies
#2
Abhijeet Kadam, Paul W Millhouse, Christopher K Kepler, Kris E Radcliff, Michael G Fehlings, Michael E Janssen, Rick C Sasso, James J Benedict, Alexander R Vaccaro
STUDY DESIGN: A narrative review of literature. OBJECTIVE: This manuscript intends to provide a review of clinically relevant bone substitutes and bone expanders for spinal surgery in terms of efficacy and associated clinical outcomes, as reported in contemporary spine literature. SUMMARY OF BACKGROUND DATA: Ever since the introduction of allograft as a substitute for autologous bone in spinal surgery, a sea of literature has surfaced, evaluating both established and newly emerging fusion alternatives...
2016: International Journal of Spine Surgery
https://www.readbyqxmd.com/read/27909567/ovarian-reserve-may-be-compromised-after-adnexal-surgery-are-we-sufficiently-fertility-focused-in-our-surgical-training
#3
G S Kalra, S Campbell, G Nargund
There is a general trend towards delay in childbearing age amongst women. The ovarian reserve clearly falls with increasing age and the impact is greater with advancing age, particularly from late 30s. Presence of other risk factors can increase the risk of subfertility. A large number of women are exposed to pelvic surgery for various reasons, both elective and emergency. There is evidence that some of the pelvic surgery performed around ovaries and tubes has a negative impact on the ovarian reserve and in turn may cause a decline in woman's ability to conceive...
June 27, 2016: Facts, Views & Vision in ObGyn
https://www.readbyqxmd.com/read/27908808/emergency-hybrid-approach-to-ruptured-femoral-pseudoaneurysm-in-hiv-positive-intravenous-drug-abusers
#4
Maurizio Domanin, Giovanni Romagnoni, Silvia Romagnoli, Antonio Rolli, Livio Gabrielli
PURPOSE: Chronic traumatism of the common femoral artery due to intravenous injection in drug abusers, in association with local infections and arterial wall weakening caused by HIV, can lead to the development of pseudoaneurysms. Rupture of pseudoaneurysm is a dramatic event in such patients and its correction is difficult and controversial. Most of the cases reported describe open surgical elective options, that consist in ligation, repair or substitution of the damaged arterial segment, employing when possible biological grafts...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27907982/learners-perspective-where-and-when-pre-residency-trainees-learn-more-to-achieve-their-core-clinical-competencies
#5
Eusang Ahn, Ducksun Ahn, Young-Mee Lee
PURPOSE: While it is known that effective clinical education requires active involvement of its participants, regular feedback, communication skills and interprofessional training, limited studies have been conducted in Korea that demonstrate how pre-residency trainees acquire their core clinical skills. This is a cross-sectional study of interns and students across a third-tier university hospital in Korea to examine where and when they acquire core clinical skills. METHODS: A total of 74 students and 91 interns were asked to participate in a closed-ended questionnaire, and 50 participants (20 students and 30 interns) were involved in semistructured individual interviews...
December 2016: Korean Journal of Medical Education
https://www.readbyqxmd.com/read/27904169/lean-umbilical-cord-a-case-report
#6
N Rippinger, M Elsässer, P Sinn, C Sohn, H Fluhr
The "lean" umbilical cord (also known as thin-cord syndrome) is a comparatively rare anomaly of the umbilical cord, which has seldom been described in the medical literature. We report on a 35-year-old women who presented to us at 29 + 4 weeks gestation with vaginal bleeding and cervical incompetence subsequently complicated not only by premature rupture of membranes but also acute placental insufficiency requiring emergency caesarean section under general anaesthesia at 31 + 2 weeks gestation. At surgery no obvious cause for the acute placental insufficiency - such as placental abruption, cord prolapse or true knot of the umbilical cord - was found...
November 2016: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/27901329/comparing-incidence-of-emergence-delirium-between-sevoflurane-and-desflurane-in-children-following-routine-otolaryngology-procedures
#7
Jeremy N Driscoll, Brian M Bender, Carlos A Archilla, Carol M Klim, J Hossain, George Mychaskiw, Julie L Wei
BACKGROUND: Emergence delirium (ED) is a state of aggressive agitation that can occur temporarily in the process of emerging from anesthesia in children exposed to volatile or intravenous anesthetics. Emergence delirium is typically assessed using the published and validated pediatric emergence delirium (PAED) scale. Due to some variation in properties between sevoflurane and desflurane for maintenance of anesthesia after standard sevoflurane induction, we designed a prospective study to examine potential differences in emergence behavior and incidence of ED in children undergoing elective ear-nose-throat (ENT) surgery...
November 30, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27898431/improving-outcome-of-trauma-patients-by-implementing-patient-blood-management
#8
Christoph Füllenbach, Kai Zacharowski, Patrick Meybohm
PURPOSE OF REVIEW: Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy. RECENT FINDINGS: Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy...
November 24, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27895842/postoperative-outcome-of-caesarean-sections-and-other-major-emergency-obstetric-surgery-by-clinical-officers-and-medical-officers-in-malawi
#9
Garvey Chilopora, Caetano Pereira, Francis Kamwendo, Agnes Chimbiri, Eddie Malunga, Staffan Bergström
BACKGROUND: Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. METHODS: During a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation...
September 2016: Malawi Medical Journal: the Journal of Medical Association of Malawi
https://www.readbyqxmd.com/read/27895441/a-retrospective-analysis-of-postoperative-patients-admitted-to-the-intensive-care-unit
#10
S Uzman, Y Yilmaz, M Toptas, I Akkoc, Y G Gul, H Daskaya, Y Toptas
BACKGROUND: The aim of this retrospective study was to evaluate postoperative patients admitted to the intensive care unit (ICU) and to describe their characteristics and outcomes. METHODS: We performed a retrospective chart review of 1,756 postoperative patients admitted to the ICU of a tertiary referral hospital from January 2008 to December 2012. For each patient we recorded: demographic data, reason for admission to the ICU, duration of mechanical ventilation, elective versus emergency surgery, type of anaesthesia, American Society of Anesthesiologists (ASA) physical status, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score (GCS), and outcome...
January 2016: Hippokratia
https://www.readbyqxmd.com/read/27895055/role-of-agents-for-reversing-the-effects-of-target-specific-oral-anticoagulants
#11
REVIEW
Tanya R Riley, Mary L Gauthier-Lewis, Chelsea K Sanchez, Janine S Douglas
PURPOSE: The available clinical data on target-specific oral anticoagulant (TSOAC) reversal agents that are currently in development or have been approved by the Food and Drug Administration (FDA) are reviewed. SUMMARY: The development of TSOACs such as dabigatran, rivaroxaban, edoxaban, and apixaban has presented benefits and new challenges. One of the main challenges associated with the use of TSOACs is the lack of suitable agent-specific reversal agents. Several treatment options for the management of life-threatening bleeding events associated with TSOAC use, such as fresh frozen plasma, prothrombin complex concentrates, and recombinant coagulation factor VIIa, have been used, with inconsistent results...
November 28, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27893639/surgical-rescue-the-next-pillar-of-acute-care-surgery
#12
Matthew E Kutcher, Jason L Sperry, Matthew R Rosengart, Deepika Mohan, Marcus K Hoffman, Matthew D Neal, Louis H Alarcon, Gregory A Watson, Juan Carlos Puyana, Graciela M Bauzá, Vaishali D Schuchert, Anisleidy Fombona, Tianhua Zhou, Samuel Zolin, Robert D Becher, Timothy R Billiar, Raquel M Forsythe, Brian S Zuckerbraun, Andrew B Peitzman
BACKGROUND: The evolving field of Acute Care Surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of 'surgical rescue' in the practice of Acute Care Surgery (ACS). METHODS: A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure...
November 23, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27893575/variations-in-burn-excision-and-grafting-a-survey-of-the-american-burn-association
#13
Jacqueline S Israel, David G Greenhalgh, Angela L Gibson
It is unknown whether variations in burn care affect outcomes or affect the success of emerging therapeutics. The purpose of this study was to assess burn surgeons' preferences in excision and grafting to determine if surgical technique affects outcomes. A 71-item survey evaluating skin grafting techniques was emailed to members of the American Burn Association in July and August 2015. The survey was anonymous and voluntary. Relationships between variables were evaluated using Fisher's exact test. A P-value of ≤...
November 15, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/27886968/defining-communication-improvement-needs-in-general-surgery-an-analysis-of-pages-communications-patterns-and-content%C3%A2
#14
Julie Hallet, David Wallace, Abraham El-Sedfy, Najma Ahmed, Andrew J Smith, Avery B Nathens, Lesley Gotlib Conn, Natalie G Coburn
OBJECTIVE: To describe patterns of pages communication to general surgery (GS) residents, identify the need for and develop strategies to improve interprofessional communication. DESIGN: Retrospective cohort study. SETTING: General surgery (GS) service at a tertiary care academic institution, Sunnybrook Health Sciences Centre, in Toronto, Ontario, Canada. PARTICIPANTS: All pages sent to GS residents over 4 weeks at an academic institution...
November 2016: Journal of Surgical Education
https://www.readbyqxmd.com/read/27885240/incidence-and-characteristics-of-needlestick-injuries-among-medical-trainees-at-a-community-teaching-hospital-a-cross-sectional-study
#15
Ben Ouyang, Lucy Dx Li, Joanne Mount, Alainna J Jamal, Lauren Berry, Carmine Simone, Marcus Law, R W Melissa Tai
ObjectivesThis field study aimed to determine the incidence and distribution of needlestick injuries among medical trainees at a community teaching hospital in Toronto, Canada.MethodsThe study was performed during the 2013-2015 academic years at Toronto East General Hospital (TEGH), a University of Toronto-affiliated community-teaching hospital during the 2013-2015 academic years. Eight-hundred and forty trainees, including medical students, residents, and post-graduate fellows, were identified and invited via email to participate in an anonymous online fluidsurveys...
November 22, 2016: Journal of Occupational Health
https://www.readbyqxmd.com/read/27879967/the-influence-of-luts-medical-treatment-on-bph-surgery-do-we-operate-too-late
#16
Fabrizio Presicce, Cosimo DE Nunzio, Mauro Gacci, Roman Sosnowsky, Riccardo Lombardo, Francesco Porpiglia, Andrea Tubaro
BACKGROUND: To systematically collect the available evidence on the influence of Lower Urinary Tract Symptoms (LUTS) medical treatment on BPH surgery. EVIDENCE ACQUISITION: A systematic literature search January 1990 until June 2016 was performed by combining the following MESH terms: Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, male, medical treatment surgical treatment, deferred/postponed treatment/intervention, early intervention/treatment. Each article title and abstract was reviewed for relevance and appropriateness with regards to the topic of this review...
November 23, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
https://www.readbyqxmd.com/read/27877032/pulmonary-complications-after-abdominal-surgery-in-patients-with-mild-to-moderate-chronic-obstructive-pulmonary-disease
#17
Tae Hoon Kim, Jae Seung Lee, Sei Won Lee, Yeon-Mok Oh
Postoperative pulmonary complications (PPCs) are one of the most important causes of postoperative morbidity and mortality after abdominal surgery. Although chronic obstructive pulmonary disease (COPD) has been considered a risk factor for PPCs, it remains unclear whether mild-to-moderate COPD is a risk factor. This retrospective cohort study included 387 subjects who underwent abdominal surgery with general anesthesia in a tertiary referral hospital. PPCs included pneumonia, pulmonary edema, pulmonary thromboembolism, atelectasis, and acute exacerbation of COPD...
2016: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/27875598/results-of-the-2016-national-resident-matching-program%C3%A2-1986-2016-a-comparison-of-family-medicine-e-roads-and-other-select-specialties
#18
Stanley M Kozakowski, Alexandra Travis, Ashley Bentley, Gerald Fetter
This article is a continuation in a series of national studies conducted by the American Academy of Family Physicians that reports the performance of family medicine and other primary care specialties in the National Residency Matching Program® (NRMP) Main Residency Match, hereafter called the Match. Match data from 1986-2016 were analyzed to compare the numbers of positions offered and filled in family medicine, other primary care specialties, emergency medicine, diagnostic radiology, ophthalmology, anesthesiology, and dermatology (E-ROAD), and other select specialties...
November 2016: Family Medicine
https://www.readbyqxmd.com/read/27871517/guidelines-for-preoperative-investigations-for-elective-surgery-at-queen-elizabeth-hospital-effects-on-practices-outcomes-and-costs
#19
Judith Nicholls, Pamela S Gaskin, Justin Ward, Yasodananda K Areti
STUDY OBJECTIVE: We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. DESIGN: A prospective study. SETTING: Queen Elizabeth Hospital, Barbados. PATIENTS: Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27870669/operating-room-efficiency-benefits-of-an-orthopaedic-traumatologist-at-a-level-ii-trauma-center
#20
Peter L Althausen, Justin R Kauk, Steven Shannon, Minggen Lu, Timothy J O'Mara, Timothy J Bray
OBJECTIVES: Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. DESIGN: Retrospective review...
December 2016: Journal of Orthopaedic Trauma
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