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https://www.readbyqxmd.com/read/28431425/the-association-of-frailty-with-outcomes-and-resource-use-after-emergency-general-surgery-a-population-based-cohort-study
#1
Daniel I McIsaac, Husein Moloo, Gregory L Bryson, Carl van Walraven
BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28431424/sleep-disordered-breathing-postoperative-delirium-and-cognitive-impairment
#2
Enoch W K Lam, Frances Chung, Jean Wong
Sleep-disordered breathing (SDB) is highly prevalent in the general population and has been associated with cognitive impairment in older individuals. Delirium is an acute decline in cognitive function and attention that often occurs after surgery, especially in older individuals. Several recent studies suggest an association between SDB and postoperative delirium. The aim of this systematic review is to examine the current literature on SDB, postoperative delirium, and cognitive impairment and to discuss the pathophysiology and perioperative considerations...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28431416/caring-for-critically-injured-children-an-analysis-of-56-pediatric-damage-control-laparotomies
#3
Miguel A Villalobos, Joshua P Hazelton, Rachel L Choron, Lisa Capano-Wehrle, Krystal Hunter, John P Gaughan, Steven E Ross, Mark J Seamon
BACKGROUND: Injury is the leading cause of death in children under 18 years. Damage control principles have been extensively studied in adults but remain relatively unstudied in children. Our primary study objective was to evaluate the use of damage control laparotomy (DCL) in critically injured children. METHODS: An American College of Surgeons-verified Level 1 trauma center review (1996-2013) of pediatric trauma laparotomies was undertaken. Exclusion criteria included: age older than 18 years, laparotomy for abdominal compartment syndrome or delayed longer than 2 hours after admission...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28427474/assessment-of-surgical-antimicrobial-prophylaxis-in-orthopaedics-and-traumatology-surgical-unit-of-a-tertiary-care-teaching-hospital-in-addis-ababa
#4
Nitsuh Alemayehu Argaw, Kibruyisfawe Zewdie Shumbash, Alemseged Ayele Asfaw, Segewkal Hawaze
BACKGROUND: Prophylactic antimicrobials have a starring role in prevention of surgical site infection. This study assesses the practice of surgical antimicrobial prophylaxis (SAP) and development of surgical site infection (SSI) based on patient chart review in patients who underwent surgery in the Orthopaedics and Traumatology Surgical Unit of Tikur Anbesa Specialized Hospital (TASH). RESULTS: Majority of the patients 144 (72%) were males. 108 (54%) of the surgical wounds were clean and 63 (31%) were clean contaminated...
April 20, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28427073/surgical-management-and-techniques
#5
Marco Codenotti, Lorenzo Iuliano, Gisella Maestranzi
Technical advancements have substantially extended the indications for surgery in diabetic retinopathy (DR) during the last 40 years, from the traditional indications including non-clearing vitreous hemorrhage, traction retinal detachment (RD), and traction-rhegmatogenous RD, to epiretinal membrane (ERM), vitreomacular traction, diffuse macular edema, neovascular glaucoma, and anterior hyaloid fibrovascular proliferation. The goals of vitreoretinal surgery in DR are multiple: clearing media opacities, release of traction (anteroposterior and/or tangential), segmentation and/or removal of traction bands, peeling of ERMs, hemostasis, laser photocoagulation, and tamponade of retinal breaks with gas or silicone oil...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28423960/the-role-of-molecular-diagnostic-testing-in-the-management-of-thyroid-nodules
#6
Maureen D Moore, Suraj Panjwani, Katherine D Gray, Brendan M Finnerty, Rasa Zarnegar, Thomas J Fahey
Fine needle aspiration (FNA) with cytologic examination remains the standard of care for investigation of thyroid nodules. However, as many as 30% of FNA samples are cytologically indeterminate for malignancy, which confounds clinical management. To reduce the burden of repeat diagnostic testing and unnecessary surgery, there has been extensive investigation into molecular markers that can be detected on FNA specimens to more accurately stratify a patient's risk of malignancy. Areas Covered: In this review, the authors discuss recent evidence and progress in molecular markers used in the diagnosis of thyroid cancer highlighting somatic gene alterations, molecular technologies and microRNA analysis...
April 19, 2017: Expert Review of Molecular Diagnostics
https://www.readbyqxmd.com/read/28422408/prevention-of-the-osmotic-demyelination-syndrome-after-liver-transplantation-a-multidisciplinary-perspective
#7
J F Crismale, K A Meliambro, S DeMaria, D B Bronster, S Florman, T D Schiano
The osmotic demyelination syndrome (ODS) is a serious neurologic condition that occurs in the setting of rapid correction of hyponatremia. It presents with protean manifestations, from encephalopathy to the "locked-in" syndrome. ODS can complicate liver transplantation (LT), and its incidence may increase with the inclusion of serum sodium as a factor in the Model for End-Stage Liver Disease score. A comprehensive understanding of risk factors for the development of ODS in the setting of LT, along with recommendations to mitigate the risk of ODS, are necessary...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28422282/analysis-of-circulating-mir-1-mir-23a-and-mir-26a-in-atrial-fibrillation-patients-undergoing-coronary-bypass-artery-grafting-surgery
#8
Andre Feldman, Dalmo Antonio Ribeiro Moreira, Carlos Gun, Hui-Tzu Lin Wang, Mario Hiroyuki Hirata, Juliana de Freitas Germano, Gabriela Guimarães Sousa Leite, Pedro Farsky
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. From a pathophysiological point of view, a myriad of factors such as trauma, atrial dilation, ischemia, mechanical myopericarditis, autonomic imbalance, loss of connexins, AF nest remodeling, inflammation, sutures, and dysfunction caused by postextracorporeal circulation can contribute to postoperative atrial fibrillation (POAF) resulting in a longer hospital stay and consequently higher cost. Recent studies showed that short fragments of RNA, called microRNA (miRNA), can contribute to the development of several cardiovascular diseases, including AF...
May 2017: Annals of Human Genetics
https://www.readbyqxmd.com/read/28421875/three-dimensional-printing-and-its-applications-in-otorhinolaryngology-head-and-neck-surgery
#9
Trevor D Crafts, Susan E Ellsperman, Todd J Wannemuehler, Travis D Bellicchi, Taha Z Shipchandler, Avinash V Mantravadi
Objective Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology-head and neck surgery, discusses future innovations, and explores the financial impact of these advances...
November 1, 2016: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28420664/the-uk-cardiac-and-vascular-surgery-interventional-anaemia-response-caviar-study-protocol-for-an-observational-cohort-study-to-determine-the-impact-and-effect-of-preoperative-anaemia-management-in-cardiac-and-vascular-surgical-patients
#10
Marisa Chau, Toby Richards, Caroline Evans, Anna Butcher, Timothy Collier, Andrew Klein
INTRODUCTION: Preoperative anaemia is linked to poor postsurgical outcome, longer hospital stays, greater risk of complications and mortality. Currently in the UK, some sites have developed anaemia clinics or pathways that use intravenous iron to correct iron deficiency anaemia prior to surgery as their standard of care. Although intravenous iron has been observed to be effective in a variety of patient settings, there is insufficient evidence in its use in cardiac and vascular patients...
April 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28420629/dexamethasone-versus-standard-treatment-for-postoperative-nausea-and-vomiting-in-gastrointestinal-surgery-randomised-controlled-trial-dreams-trial
#11
(no author information available yet)
Objectives To determine whether preoperative dexamethasone reduces postoperative vomiting in patients undergoing elective bowel surgery and whether it is associated with other measurable benefits during recovery from surgery, including quicker return to oral diet and reduced length of stay.Design Pragmatic two arm parallel group randomised trial with blinded postoperative care and outcome assessment.Setting 45 UK hospitals.Participants 1350 patients aged 18 or over undergoing elective open or laparoscopic bowel surgery for malignant or benign pathology...
April 18, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28419812/defining-quality-in-head-and-neck-reconstruction
#12
Peter M Vila, Jason T Rich, Shaun C Desai
Microvascular free flap reconstruction has now become the standard of care in the reconstruction of selected head and neck defects. Although uncommon, flap failure is a catastrophic event that results in significant patient morbidity, extended length of hospitalization, and increased cost. However, there is currently no gold standard for measuring the quality of a reconstructive center. Structure and process outcomes have recently been developed, but outcome measures are still lacking. Areas for future research include preoperative nutrition, preoperative flap planning, intraoperative fluid management, appropriate thromboembolism prophylaxis, consistent perioperative antibiotic regimens, skilled ancillary staff, and clear outcome measures for performance measurement...
April 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28419206/short-term-preoperative-exercise-therapy-does-not-improve-long-term-outcome-after-lung-cancer-surgery-a-randomized-controlled-study%C3%A2
#13
Wolfram Karenovics, Marc Licker, Christoph Ellenberger, Michel Christodoulou, John Diaper, Chetna Bhatia, John Robert, Pierre-Olivier Bridevaux, Frédéric Triponez
OBJECTIVES: Poor aerobic fitness is a potential modifiable risk factor for long-term survival and quality of life in patients with lung cancer. This randomized trial evaluates the impact of adding rehabilitation (Rehab) with high-intensity interval training (HIIT) before lung cancer surgery to enhance cardiorespiratory fitness and improve long-term postoperative outcome. METHODS: Patients with operable lung cancer were randomly assigned to usual care (UC, n  = 77) or to intervention group (Rehab, n  = 74) that entailed HIIT that was implemented only preoperatively...
April 17, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28419035/clinical-practice-guidelines-decrease-unnecessary-echocardiograms-before-hip-fracture-surgery
#14
Chris Adair, Eric Swart, Rachel Seymour, Joshua Patt, Madhav A Karunakar
BACKGROUND: Preoperative assessment of geriatric patients with a hip fracture may include transthoracic echocardiography (TTE), which increases resource utilization and cost and may delay surgery. The purpose of this study was to evaluate preoperative TTE utilization at a single institution in order to determine (1) how often TTE is ordered in accordance with clinical practice guidelines (CPGs), (2) how frequently TTE reveals cardiac disease that may alter medical or anesthesia management, and (3) whether following CPGs reduces unnecessary TTE utilization without potentially missing important disease...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28418817/virtual-mapping-of-the-frontal-recess-guiding-safe-and-efficient-frontal-sinus-surgery
#15
Neil S Patel, Amy C Dearking, Erin K O'Brien, John F Pallanch
Objective To define relationships between the frontal sinus opening, ostia of other frontal recess cells, and endoscopic landmarks and to develop a clinically useful framework to guide frontal sinus surgery. Study Design Retrospective review. Setting Tertiary care academic referral center. Methods Adult patients with computed tomography (CT) without sinonasal pathology were included. Virtual endoscopy (using OsiriX) and corresponding CT reconstructions were used to identify all visible ostia in the frontal recess and characterize their positions in spaces between the uncinate/agger nasi (U), bulla ethmoidalis (EB), and middle turbinate (MT)...
April 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28418577/prospective-assessment-of-sleep-quality-before-and-after-primary-total-joint-replacement
#16
Blaine T Manning, Sean M Kearns, Daniel D Bohl, Tori Edmiston, Scott M Sporer, Brett R Levine
Sleep disruption is a common, yet rarely addressed, complaint among patients who have undergone total joint arthroplasty (TJA). This study assessed sleep quality before and after primary TJA. A total of 105 patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) prospectively completed questionnaires during the preoperative, early postoperative, and late postoperative periods. The survey included the Epworth Sleepiness Scale, current sleeping habits, and patient perspectives of sleep quality and duration...
April 18, 2017: Orthopedics
https://www.readbyqxmd.com/read/28418509/association-of-preoperative-calcium-and-calcitriol-therapy-with-postoperative-hypocalcemia-after-total-thyroidectomy
#17
Anne K Maxwell, David C Shonka, Derek J Robinson, Paul A Levine
Importance: Hypocalcemia is the most common complication after total thyroidectomy and can result in prolonged hospital admissions and increased hospital charges. Objective: To determine the effectiveness of preoperative calcium and calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. Design, Setting, and Participants: A retrospective cohort study was conducted at a tertiary care center in 65 patients undergoing total thyroidectomy by a single surgeon...
April 13, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28417683/tracheostomy-for-severe-pediatric-obstructive-sleep-apnea-indications-and-outcomes
#18
Christopher J Rizzi, Julian D Amin, Amal Isaiah, Tulio A Valdez, Anita Jeyakumar, Suzanne E Smart, Kevin D Pereira
Objectives (1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure. Study Design Case series with chart review. Setting Four tertiary care academic children's hospitals. Subjects and Methods Twenty-nine children aged <18 years from January 1, 2010, to December 31, 2015, who underwent tracheostomy for severe OSA, defined as an apnea-hypopnea index (AHI) >10, were included in the study...
April 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28417506/the-effect-of-intraoperative-hypothermia-upon-blood-transfusion-needs-and-length-of-stay-among-gastrointestinal-system-cancer-surgery
#19
V B Poveda, A S Nascimento
This cross-sectional study was performed to evaluate the relationship between intraoperative body temperature and the need for blood transfusion and length of stay in the post-anaesthetic care unit (PACU) or in the intensive care unit (ICU) among 79 patients undergoing elective oncology surgery of the digestive system. There was a statistically significant correlation between a lower temperature during surgery and medical diagnosis (p = .009), the use of bupivacaine anaesthesia (p = .016), anaesthesia time (p = ...
April 18, 2017: European Journal of Cancer Care
https://www.readbyqxmd.com/read/28417167/gene-expression-levels-of-gamma-glutamyl-hydrolase-in-tumor-tissues-may-be-a-useful-biomarker-for-the-proper-use-of-s-1-and-tegafur-uracil-leucovorin-in-preoperative-chemoradiotherapy-for-patients-with-rectal-cancer
#20
Sotaro Sadahiro, T Suzuki, A Tanaka, K Okada, G Saito, H Miyakita, T Ogimi, H Nagase
PURPOSE: Preoperative chemoradiotherapy (CRT) using 5-fluorouracil (5-FU)-based chemotherapy is the standard of care for rectal cancer. The effect of additional chemotherapy during the period between the completion of radiotherapy and surgery remains unclear. Predictive factors for CRT may differ between combination chemotherapy with S-1 and with tegafur-uracil/leucovorin (UFT/LV). METHODS: The subjects were 54 patients with locally advanced rectal cancer who received preoperative CRT with S-1 or UFT/LV...
April 17, 2017: Cancer Chemotherapy and Pharmacology
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