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Evidence based surgery

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https://www.readbyqxmd.com/read/28339286/advantages-of-arthroscopic-rotator-cuff-repair-with-a-transosseous-suture-technique-a-prospective-randomized-controlled-trial
#1
Pietro Randelli, Carlo Alberto Stoppani, Carlo Zaolino, Alessandra Menon, Filippo Randelli, Paolo Cabitza
BACKGROUND: Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. PURPOSE: To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1...
March 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28333892/the-effects-of-phacoemulsification-on-intraocular-pressure-and-topical-medication-use-in-patients-with-glaucoma-a-systematic-review-and-meta-analysis-of-3-year-data
#2
James J Armstrong, Tomas Wasiuta, Efstathia Kiatos, Monali Malvankar-Mehta, Cindy M L Hutnik
PURPOSE: For patients with comorbid cataract and primary open-angle glaucoma (POAG), guidance is lacking as to whether cataract extraction and traditional filtering surgery should be performed as a staged or combined procedure. Achieving this guidance requires an evidence-based understanding of the effects of phacoemulsification alone on intraocular pressure (IOP) in patients with POAG. For this reason, a systematic review and meta-analysis was undertaken to synthesize evidence quantifying the effect of phacoemulsification on IOP and the required number of topical glaucoma medications in patients with cataract and POAG...
March 22, 2017: Journal of Glaucoma
https://www.readbyqxmd.com/read/28333542/critical-value-of-anterior-glenoid-bone-loss-that-leads-to-recurrent-glenohumeral-instability-after-arthroscopic-bankart-repair
#3
Sang-Jin Shin, Rag Gyu Kim, Yoon Sang Jeon, Tae Hun Kwon
BACKGROUND: Generally, a glenoid bone loss greater than 20% to 25% is considered critical for poor surgical outcomes after a soft tissue repair. However, recent studies have suggested that the critical value should be lower. PURPOSE: To determine the critical value of anterior glenoid bone loss that led to surgical failure in patients with anterior shoulder instability. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The study included 169 patients with anterior glenoid erosion...
March 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28333394/socket-shield-technique-for-immediate-implant-placement-clinical-radiographic-and-volumetric-data-after-5%C3%A2-years
#4
Daniel Bäumer, Otto Zuhr, Stephan Rebele, Markus Hürzeler
OBJECTIVES: Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues...
March 23, 2017: Clinical Oral Implants Research
https://www.readbyqxmd.com/read/28332062/diagnosis-and-treatment-of-metastases-to-the-thyroid-gland-a-meta-analysis
#5
REVIEW
Patrizia Straccia, Claudia Mosseri, Chiara Brunelli, Esther Diana Rossi, Celestino Pio Lombardi, Alfredo Pontecorvi, Guido Fadda
The thyroid is a rare site of clinically detectable tumor metastases; even though the gland is a highly vascularized structure, the frequency of metastases in the routine practice is less than 0.2% of all thyroid malignancies. The purpose of our meta-analysis is to evaluate the frequency of metastatic diffusion from other primary tumors to the thyroid gland and to suggest the best possible treatment through an evidence-based study. Relevant studies were identified by searching the following databases: PubMed, Scopus, and Web of Science...
March 22, 2017: Endocrine Pathology
https://www.readbyqxmd.com/read/28331607/-simplified-international-recommendations-for-the-implementation-of-patient-blood-management-sir4pbm
#6
Patrick Meybohm, Bernd Froessler, Lawrence T Goodnough, Andrew A Klein, Manuel Muñoz, Michael F Murphy, Toby Richards, Aryeh Shander, Donat R Spahn, Kai Zacharowski
BACKGROUND: More than 30% of the world's population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient blood management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28331239/evaluation-of-a-marker-clip-system-in-sonographically-guided-core-needle-biopsy-for-breast-cancer-localization-before-and-after-neoadjuvant-chemotherapy
#7
R Schulz-Wendtland, P Dankerl, M R Bani, P A Fasching, K Heusinger, M P Lux, S M Jud, C Rauh, C M Bayer, M G Schrauder, M W Beckmann, M Uder, B Brehm, C R Loehberg
Introduction The placement of intramammary marker clips has proven to be helpful for tumor localization in patients undergoing neoadjuvant chemotherapy and breast-conserving surgery. The purpose of our study was to investigate the feasibility of using a clip marker system for breast cancer localization and its influence on the imaging assessment of treatment responses after neoadjuvant chemotherapy. Patients and Methods Between March and June 2015, a total of 25 patients (n = 25), with a suspicion of invasive breast cancer with diameters of at least 2 cm (cT2), underwent preoperative sonographically guided core needle biopsy using a single-use breast biopsy system (HistoCore™) and intramammary clip marking using a directly adapted clip system based on the established O-Twist Marker™, before their scheduled preoperative neoadjuvant chemotherapy...
February 2017: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/28331172/an-anti-coagulation-conundrum-implantation-of-total-artificial-heart-in-a-patient-with-heparin-induced-thrombocytopenia-type-ii
#8
Theodore J Cios, Yuliana Salamanca-Padilla, Dmitri Guvakov
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication of heparin administration. It can present a major clinical dilemma for physicians caring for patients requiring life-saving urgent or emergent cardiac surgery. Studies have been published examining the use of alternative anticoagulants for patients undergoing cardiopulmonary bypass (CPB), however, evidence does not clearly support any particular approach. Presently, there are no large-scale, prospective randomized studies examining the impact of alternative anticoagulants on clinical outcomes for HIT-positive patients requiring cardiac surgery...
March 23, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28329292/surgical-septal-myectomy-or-alcohol-septal-ablation-which-approach-offers-better-outcomes-for-patients-with-hypertrophic-obstructive-cardiomyopathy
#9
Shi Sum Poon, Mark Field, Dhiraj Gupta, Duke Cameron
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether surgical septal myectomy (SM) is more beneficial than alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy. Altogether 218 articles were found using the reported search, of which 15 studies represented the best evidence to answer the clinical question. There were 14 observational studies and 1 meta-analysis study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these articles are tabulated...
February 28, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28329149/prediction-of-long-term-cognitive-decline-following-postoperative-delirium-in-older-adults
#10
Elizabeth E Devore, Tamara G Fong, Edward R Marcantonio, Eva M Schmitt, Thomas G Travison, Richard N Jones, Sharon K Inouye
Background: Increasing evidence suggests that postoperative delirium may result in long-term cognitive decline among older adults. Risk factors for such cognitive decline are unknown. Methods: We studied 126 older participants without delirium or dementia upon entering the Successful AGing After Elective Surgery (SAGES) study, who developed postoperative delirium and completed repeated cognitive assessments (up to 36 months of follow-up). Pre-surgical factors were assessed preoperatively and divided into nine groupings of related factors ("domains")...
March 15, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28328756/pectoralis-and-serratus-fascial-plane-blocks-each-provide-early-analgesic-benefits-following-ambulatory-breast-cancer-surgery-a-retrospective-propensity-matched-cohort-study
#11
Faraj W Abdallah, David MacLean, Caveh Madjdpour, Tulin Cil, Anuj Bhatia, Richard Brull
BACKGROUND: Pectoralis and serratus blocks have been described recently for use in breast surgery, but evidence supporting their analgesic benefits is limited. This cohort study evaluates the benefits of adding a pectoralis or serratus block to conventional opioid-based analgesia (control) in patients who underwent ambulatory breast cancer surgery at Women's College Hospital between July 2013 and May 2015. We tested the joint hypothesis that adding a pectoralis or serratus block reduced postoperative in-hospital (predischarge) opioid consumption and nausea and vomiting (PONV)...
March 21, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28327892/safety-and-efficacy-of-tachosil-absorbable-fibrin-sealant-patch-compared-with-current-practice-for-the-prevention-of-cerebrospinal-fluid-leaks-in-patients-undergoing-skull-base-surgery-a-randomized-controlled-trial
#12
Bernard George, Christian Matula, Lars Kihlström, Enrique Ferrer, Vilhelm Tetens
BACKGROUND: Cerebrospinal fluid (CSF) leakage associated with incomplete sealing of the dura mater is a major complication of intradural procedures. OBJECTIVE: To compare the efficacy and safety of adjunctive TachoSil (Takeda Pharma A/S, Roskilde, Denmark) with current practice for the prevention of postoperative CSF leaks in patients undergoing elective skull base surgery involving dura mater closure. METHODS: Patients were intraoperatively randomized to TachoSil or current practice immediately before primary dura closure by suturing ± duraplasty...
March 11, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28327273/factors-affecting-orthopedic-residency-selection-a-cross-sectional-survey
#13
Jason Strelzow, Robert Petretta, Henry M Broekhuyse
BACKGROUND: Annually, orthopedic residency programs rank and recruit the best possible candidates. Little evidence exists identifying factors that potential candidates use to select their career paths. Recent literature from nonsurgical programs suggests hospital, social and program-based factors influence program selection. We sought to determine what factors influence the choice of an orthopedic career and a candidate's choice of orthopedic residency program. METHODS: We surveyed medical student applicants to orthopedic programs and current Canadian orthopedic surgery residents (postgraduate year [PGY] 1-5)...
April 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28326464/meningiomas-in-pregnancy-timing-of-surgery-and-clinical-outcomes-as-observed-in-104-cases-and-establishment-of-a-best-management-strategy
#14
REVIEW
Yosef Laviv, Ahmed Bayoumi, Anand Mahadevan, Brett Young, Myles Boone, Ekkehard M Kasper
BACKGROUND: There is a strong correlation between the level of circulating female sex hormones and the parturient growth of meningiomas. As a result, rapid changes in meningioma size occur during pregnancy, putting both the mother and fetus at risk. Large, symptomatic meningiomas require surgical resection, regardless of the status of pregnancy. However, the preferred timing of such complex intervention is a matter of debate. The rarity of this clinical scenario and the absence of prospective trials make it difficult to reach evidence-based conclusions...
March 22, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28325701/evaluation-of-flexor-pollicis-longus-tendon-attrition-using-color-doppler-imaging-after-volar-plate-fixation-for-distal-radius-fracture
#15
Yoshitaka Tanaka, Hiroyuki Gotani, Koichi Yano, Kosuke Sasaki, Yoshitaka Hamada
PURPOSE: Early diagnosis of attritional wear of the flexor pollicis longus (FPL) tendon is essential in preventing subsequent tendon rupture. There are currently few objective methods of assessing FPL attrition. We hypothesized that color Doppler imaging could visibly detect FPL tendon attrition, and analyzed our results. METHODS: We evaluated ultrasound imaging of the contact between the FPL tendon and a volar locking plate using the real-time B-mode and Doppler waveforms of the FPL tendon using the continuous Doppler wave mode in 40 patients who underwent fixation of the distal volar locking plate for distal radius fracture...
March 18, 2017: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
https://www.readbyqxmd.com/read/28324327/lumbar-disc-replacement-surgery-successes-and-obstacles-to-widespread-adoption
#16
REVIEW
Stephan N Salzmann, Nicolas Plais, Jennifer Shue, Federico P Girardi
PURPOSE OF REVIEW: Lumbar disc replacement has been a surgical alternative to fusion surgery for the treatment of lumbar degenerative disc disease (DDD) for many years. Despite enthusiasm after the approval of the first devices, implantation rates have remained low, especially in the USA. The goal of this review is to provide a general overview of lumbar disc replacement in order to comprehend the successes and obstacles to widespread adoption. RECENT FINDINGS: Although a large amount of evidence-based data including satisfactory long-term results is available, implantation rates in the USA have not increased in the last decade...
March 21, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28324142/a-phase-ii-study-of-partial-and-subtotal-thymectomy-for-thymoma-jart02
#17
Motoki Yano, Yoshitaka Fujii, Junji Yoshida, Tomoki Utsumi, Hiroyuki Shiono, Motoshi Takao, Masayuki Tanahashi, Yushi Saito
BACKGROUND: We believe the merit of preservation of a part of the thymus following surgery for thymoma. We evaluated the efficacy of partial or subtotal thymectomy for early-stage thymoma in the prospective study. METHODS: The Japanese Association for Research on the Thymus conducted a multiple institutional study of thymectomy for thymoma localized in the thymus without total thymectomy. Patients without autoimmune disease who had an anterior mediastinal tumor that had been clinically diagnosed as an early-stage thymoma were enrolled in the study...
March 21, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28322617/clinicians-views-on-management-and-terminology-for-papillary-thyroid-microcarcinoma-a-qualitative-study
#18
Brooke Nickel, Juan P Brito, Alexandra Barratt, Susan Jordan, Ray Moynihan, Kirsten McCaffery
BACKGROUND: There is growing acceptance that the increase in thyroid cancer incidence is in part a result of overdiagnosis of small low-risk papillary microcarcinomas (PMCs) with indolent clinical course. Although surgery is the cornerstone treatment for patients with PMCs, recent management guidelines are shifting toward inclusion of more conservative treatments such as active surveillance. There is little evidence on clinicians' experience in managing PMC patients and their attitudes toward treatment options, including their willingness to accept a nonsurgical option...
March 21, 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/28321553/enhanced-recovery-after-surgery-eras-%C3%A2-in-individuals-with-diabetes-a-systematic-review
#19
Zaina Albalawi, Michael Laffin, Leah Gramlich, Peter Senior, Finlay A McAlister
BACKGROUND: Prevalence of diabetes in surgical patients is 10-40%. It is well recognized that they have higher rates of complications, and longer stays in hospital compared to patients without diabetes. Enhanced recovery after surgery (ERAS) is an evidence-based multimodal surgical care pathway that improves postoperative complications and length of stay in patients without diabetes. This review evaluates the evidence on whether individuals with diabetes would benefit from ERAS implementation...
March 20, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28321549/a-preoperative-medical-history-and-physical-should-not-be-a-requirement-for-all-cataract-patients
#20
Oliver D Schein, Peter J Pronovost
Cataract surgery poses minimal systemic medical risk, yet a preoperative general medical history and physical is required by the Centers for Medicare and Medicaid Services and other regulatory bodies within 1 month of cataract surgery. Based on prior research and practice guidelines, there is professional consensus that preoperative laboratory testing confers no benefit when routinely performed on cataract surgical patients. Such testing remains commonplace. Although not yet tested in a large-scale trial, there is also no evidence that the required history and physical yields a benefit for most cataract surgical patients above and beyond the screening performed by anesthesia staff on the day of surgery...
March 20, 2017: Journal of General Internal Medicine
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