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Standards for General Surgery

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https://www.readbyqxmd.com/read/29239925/the-validity-of-training-endoscopic-sinus-and-skull-base-surgery-techniques-on-the-experimental-head-model
#1
Ranko Mladina, Neven Skitarelić, Cemal Cingi, Lei Chen, Nuray Bayar Muluk
OBJECTIVES: The aim of this study was to better understand the usual learning curve in acquiring endonasal endoscopic sinus and skull base surgery (ESSBS) techniques during the novice training on the lamb's head model. METHODS: Ten novices were asked to perform 10 bilateral dissections on the particular lamb's head each. The dissections were uniform, consisted of 10 well-defined steps, beginning from the simple removal of the inferior turbinate, and ending with more complicated procedures like cerebrospinal fluid leak repair, Draf 3 procedure for the frontal sinus and elevation of the nasal septal flap...
December 12, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29239595/explaining-the-absence-of-surgical-procedure-regulation
#2
Jonathan J Darrow
Each year in the United States, surgeons perform approximately 64 million surgical procedures, ranging from tooth extraction to open heart surgery. Yet, notwithstanding the frequency of surgical procedures and their often critical importance to patient health, no state or federal agency either approves the use of new surgical procedures or directly regulates existing procedures. The absence of surgical procedure regulation differs from the regulation of new pharmaceutical products, which can be introduced into interstate commerce only after the Food and Drug Administration (FDA) has reviewed "adequate and well-controlled [clinical] investigations" and concluded the data from those studies sufficiently establish the drug's safety and efficacy...
2017: Cornell Journal of Law and Public Policy
https://www.readbyqxmd.com/read/29236172/the-society-of-european-robotic-gynaecological-surgery-sergs-pilot-curriculum-for-robot-assisted-gynecological-surgery
#3
Peter Rusch, Rainer Kimmig, Fabrice Lecuru, Jan Persson, Jordi Ponce, Michel Degueldre, René Verheijen
PURPOSE: To set forth experiences in the context of the SERGS Pilot Curriculum-the first standardized educational program for robotic use in gynecological surgery-in terms of feasibility, effectiveness and potential for certification. METHODS: The Society of European Robotic Gynecological Surgery (SERGS) outlined a Pilot Curriculum for standardized education in robot-assisted laparoscopic gynecological surgery. Its feasibility and acceptance were checked in the form of a fellowship pilot program conducted at four European Centers of Excellence for robot-assisted surgery...
December 13, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/29233630/higher-risk-of-renal-disease-in-chronic-hepatitis-c-patients-antiviral-therapy-survival-benefit-in-patients-on-hemodialysis
#4
Jonas Söderholm, Charlotta Millbourn, Katharina Büsch, Jan Kövamees, Robert Schvarcz, Karin Lindahl, Annette Bruchfeld
BACKGROUND & AIMS: Several studies have shown that chronic hepatitis C (CHC) infection has a negative impact on kidney function, as well as survival, in patients with chronic kidney disease (CKD) or on hemodialysis (HD). The aim of this nationwide registry study was to describe renal disease in Swedish CHC patients METHODS: In the present study, patients were identified for CHC (B18.2) and CKD (N18) according to the International Classification of Diseases (ICD)-10 in the nationwide Swedish inpatient care day surgery (1997-2013) and non-primary outpatient care (2001-2013) patient registries...
December 9, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/29233486/cetuximab-combined-with-induction-oxaliplatin-and-capecitabine-followed-by-neoadjuvant-chemoradiation-for-locally-advanced-rectal-cancer-swog-0713
#5
Cynthia Gail Leichman, Shannon L McDonough, Stephen R Smalley, Kevin G Billingsley, Heinz-Josef Lenz, Matthew A Beldner, Aram F Hezel, Mario R Velasco, Katherine A Guthrie, Charles D Blanke, Howard S Hochster
BACKGROUND: Neoadjuvant chemoradiation (NCRT) is standard treatment for locally advanced rectal cancer. Pathologic complete response (pCR) has associated with improved survival. In modern phase III trials of NCRT, pCR ranges from 10% to 20%. Cetuximab improves response in KRAS (KRAS proto-oncogene) wild type (wt) metastatic colorectal cancer. S0713 was designed to assess improvement in pCR with additional use of cetuximab with induction chemotherapy and NCRT for locally advanced, KRAS-wt rectal cancer...
October 24, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/29228470/melanoma-patterns-of-care-in-ontario-a-call-for-a-strategic-alignment-of-multidisciplinary-care
#6
Nicole J Look Hong, Stephanie Y Cheng, Nancy N Baxter, Frances C Wright
BACKGROUND AND OBJECTIVES: Variability in melanoma management has prompted concerns about equitable and timely treatment. We investigated patterns of melanoma diagnosis and treatment using population-level data. METHODS: Patients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003-2012) and deterministically linked with administrative databases to identify incidence, disease characteristics, geographic origin, and multimodal treatment within a year of diagnosis...
December 11, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29225156/performance-of-tci-propofol-using-the-schnider-model-for-cardiac-surgery-on-cardiopulmonary-bypass-a-pilot-study
#7
Aaron Kwang Yang Lee, Aaron Yik Hang Kong, Chee Fai Kong
OBJECTIVE: This pilot study aimed to evaluate the performance of target-controlled infusion (TCI) of propofol using the Schnider pharmacokinetic model in patients undergoing cardiac surgery requiring cardiopulmonary bypass. DESIGN: This was a prospective pharmacokinetic study. SETTING: A tertiary care hospital. PARTICIPANTS: This study is comprised of 10 patients, aged between 46 and 81, who underwent elective cardiac surgery requiring the use of cardiopulmonary bypass...
October 4, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29224911/the-hands-and-head-of-a-surgeon-modeling-operative-competency-with-multimodal-epistemic-network-analysis
#8
A R Ruis, Alexandra A Rosser, Cheyenne Quandt-Walle, Jay N Nathwani, David Williamson Shaffer, Carla M Pugh
BACKGROUND: This paper explores a method for assessing intraoperative performance by modeling how surgeons integrate psychomotor, procedural, and cognitive skills to manage errors. METHODS: Audio-video data were collected from general surgery residents (N = 45) performing a simulated laparoscopic ventral hernia repair. Errors were identified using a standard checklist, and speech was coded for elements related to error recognition and management. Epistemic network analysis (ENA) was used to model the integration of error management skills...
December 2, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29222022/do-resident-case-logs-meet-acgme-requirements-a-comparison-between-acute-care-and-elective-cases
#9
Kathryn R Wolf, Zachary A Taylor, Sarah B Placek, Michael W Tsai, Brenton R Franklin, E Matthew Ritter
PURPOSE: Operative experience is at the core of general surgery residency, and recently operative volume requirements for graduating residents were increased. The ACGME has outlined 4 areas of required resident participation and documentation in order for a surgical case to be logged: determination or confirmation of the diagnosis, provision of preoperative care, selection and accomplishment of the operative procedure, and direction of the postoperative care. The purpose of this study was to examine whether general surgery residents are currently meeting the required care participation documentation standard and to examine the effect of acute care vs...
December 5, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/29221278/mitral-valve-repair-versus-replacement-in-elderly-patients-a-systematic-review-and-meta-analysis
#10
Xiaoke Shang, Rong Lu, Mei Liu, Shuna Xiao, Nianguo Dong
Background: Although mitral valve repair (MVP) is generally accepted as the standard treatment for mitral valve disease, in older patients, there is increasing debate about whether MVP is superior to mitral valve replacement (MVR). We, therefore, performed a meta-analysis to compare MVP vs. MVR in the elderly population. Methods: We systematically searched PubMed, the Cochrane Library, and Scopus up to February 2017 and scrutinized the references of relevant literatures...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29220289/osteosarcoma-chondrosarcoma-and-chordoma
#11
Jeremy S Whelan, Lara E Davis
Osteosarcoma (OS), chondrosarcoma, and chordoma are characterized by multiple challenges to the investigator, clinician, and patient. One consequence of their rarity among sarcomas, as well as their biologic and clinical heterogeneity, is that management guidelines are inadequate to inform the range of individual patient-treatment decisions from diagnosis, approaches to surgery, chemotherapy, radiotherapy, treatment of recurrence, palliative care, and quality of survivorship. Of high-grade sarcomas, OSs are among the most curable, with more than two-thirds of patients with localized disease likely to achieve long-term survival...
December 8, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29219935/intrathecal-morphine-for-laparoscopic-segmental-colonic-resection-as-part-of-an-enhanced-recovery-protocol-a-randomized-controlled-trial
#12
Mark V Koning, Aart Jan W Teunissen, Erwin van der Harst, Elisabeth J Ruijgrok, Robert Jan Stolker
BACKGROUND AND OBJECTIVES: Management of postoperative pain after laparoscopic segmental colonic resections remains controversial. We compared 2 methods of analgesia within an Enhanced Recovery After Surgery (ERAS) program. The goal of the study was to investigate whether administration of intrathecal bupivacaine/morphine would lead to an enhanced recovery. METHODS: A single-center, randomized, double-blind controlled trial was performed (NL43488.101.13). Patients scheduled for laparoscopic segmental intestinal resections were considered...
December 6, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29214515/robotic-skills-can-be-aided-by-laparoscopic-training
#13
Daniel G Davila, Melissa C Helm, Matthew J Frelich, Jon C Gould, Matthew I Goldblatt
BACKGROUND: General Surgery is currently the fastest growing specialty with regards to robotic surgical system utilization. Contrary to the experience in laparoscopy, simulator training for robotic surgery is not widely employed partly because robotic surgical simulators are expensive. We sought to determine the effect of a robotic simulation curriculum and whether robotic surgical skills could be derived from those psychomotor skills attained in laparoscopic training. METHODS: Twenty-seven trainees with no prior robotic experience and limited laparoscopy exposure were randomly assigned to one of three training groups: no simulator training, training on a fundamentals of laparoscopic surgery (FLS™) standard box trainer, and training on a robotic computer based simulator (da Vinci Skills Simulator™)...
December 6, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/29214383/evaluation-of-the-effectiveness-and-patients-contentment-with-transanal-haemorrhoidal-artery-dearterialisation-and-mucopexy-thd-for-treatment-of-haemorrhoidal-disease-a-6-year-study
#14
Qurat Ul Ain, Yasir Bashir, Emmanuel Eguare
INTRODUCTION: With high incidence of haemorrhoidal disease and significant complication rates of traditional haemorrhoidectomy procedures, transanal haemorrhoidal artery ligation and mucopexy (THD) emerges as a minimally invasive procedure with superior results. However, it is crucial that effectiveness of results and patient satisfaction be gauged based on post-operative experience, symptomology and recurrence. AIM: Our aim is to provide a long-term analysis of efficacy and patient's satisfaction for the procedure, for the largest patient population, in correlation to presenting symptoms and degree of haemorrhoids...
December 6, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29206070/efficacy-of-platelet-concentrates-in-bone-healing-a-systematic-review-on-animal-studies-part-b-large-size-animal-models
#15
Sabrina Marcazzan, Silvio Taschieri, Roberto Lodovico Weinstein, Massimo Del Fabbro
In the presence of large bone defects, delayed bone union, or nonunion and fractures, bone reconstruction may be necessary. Different strategies have been employed to enhance bone healing among which the use of autologous platelet concentrates (APCs). Due to the high content of platelets and platelet-derived bioactive molecules (e.g., growth factors, antimicrobial peptides), they are promising candidates to enhance bone healing. However, both preclinical and clinical studies produced contrasting results, mainly due to a high heterogeneity in study design, objectives, techniques adopted, and outcomes assessed...
December 5, 2017: Platelets
https://www.readbyqxmd.com/read/29205687/ultrasound-guided-pudendal-nerve-block-in-children-a-new-technique-of-ultrasound-guided-transperineal-approach
#16
Isabelle Gaudet-Ferrand, Pablo De La Arena, Sophie Bringuier, Olivier Raux, Laurent Hertz, Nicolas Kalfa, Chrystelle Sola, Christophe Dadure
BACKGROUND: Transperineal pudendal nerve block guided by nerve stimulator is used in pediatric anesthesia as an alternative to caudal analgesia in perineal surgery. The risk of rectal puncture or intravascular injection is inherent to this blinded technique. We described a new technique of transperineal pudendal nerve block, with ultrasound guidance, to improve safety of the technique. AIMS: The first goal of this study was to describe this new technique and to test its feasibility...
December 5, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29205458/multi-disciplinary-management-of-refractory-insulinomas
#17
Emily Brown, Daniel Watkin, Jonathan Evans, Vincent Yip, Daniel J Cuthbertson
Insulinomas are predominantly benign (~90%), pancreatic neuroendocrine tumours characterised by hyperinsulinaemic hypoglycaemia. They usually present as a small (<2cm), well demarcated, solitary nodule that can arise in any part of the organ. Treatment of sporadic insulinomas is generally aimed at curative surgical resection with special consideration in genetic syndromes. Patients with significant hypoglycaemia can pose a difficult management challenge. In isolated cases where the patient is not medically fit for surgery or with metastatic spread, other treatment options are employed...
December 4, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/29201389/the-feasibility-of-assessing-swallowing-physiology-following-prolonged-intubation-after-cardiovascular-surgery
#18
Stacey A Skoretz, Terrence M Yau, John T Granton, Rosemary Martino
Background: Dysphagia following prolonged intubation after cardiovascular (CV) surgery is common occurring in 67% of patients; however, this population's swallowing physiology has never been prospectively evaluated using standardized methods. Hence, prior to conducting a larger study, our primary objective was to determine the feasibility of assessing swallowing physiology using instrumentation and validated interpretation methods in cardiovascular surgical patients following prolonged intubation...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29201359/rationale-for-and-approach-to-preoperative-opioid-weaning-a-preoperative-optimization-protocol
#19
REVIEW
Heath McAnally
The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit ratio and the nation reels from the grim mortality statistics associated with the opioid epidemic. Patients struggling with chronic pain tend to use opioids and also seek out operative intervention for their complaints, which combination may be leading to increased postoperative "acute-on-chronic" pain and fueling worsened chronic pain and opioid dependence...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29198646/salvage-surgery-for-recurrence-of-laryngeal-and-hypopharyngeal-squamous-cell-carcinoma-a-retrospective-study-from-2005-to-2013
#20
K Pujo, P Philouze, A Scalabre, P Céruse, M Poupart, G Buiret
OBJECTIVES: Salvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure...
November 30, 2017: European Annals of Otorhinolaryngology, Head and Neck Diseases
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