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Standards for General Surgery

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https://www.readbyqxmd.com/read/29054303/cost-savings-of-standardization-of-thoracic-surgical-instruments-the-process-of-lean
#1
Kyle H Cichos, Paul L Linsky, Benjamin Wei, Douglas J Minnich, Robert J Cerfolio
BACKGROUND: Our objective is to show the effect that standardization of surgical trays has on the number of instruments sterilized and on cost. METHODS: We reviewed our most commonly used surgical trays with the 3 general thoracic surgeons in our division and agreed upon the least number of surgical instruments needed for mediastinoscopy, video-assisted thoracoscopic surgery, robotic thoracic surgery, and thoracotomy. RESULTS: We removed 59 of 79 instruments (75%) from the mediastinoscopy tray, 45 of 73 (62%) from the video-assisted thoracoscopic surgery tray, 51 of 84 (61%) from the robotic tray, and 50 of 113 (44%) from the thoracotomy tray...
October 17, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29053675/transcanalicular-diode-laser-assisted-dacryocystorhinostomy-for-the-treatment-of-primary-acquired-nasolacrimal-duct-obstruction
#2
Joel M Mor, Yongwei Guo, Konrad R Koch, Ludwig M Heindl
Today's gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity...
October 13, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29050058/-ambulant-anesthesia-limits-and-possibilities
#3
Harald Hofer, Frank Vescia
The number of operations carried out on an outpatient basis is increasing in Germany. This trend has been observed for years. The prerequisite is an infrastructure that is in line with guidelines. The competence of the anesthetist must not be restricted to that of a standard specialist anesthetist, but the physician should have experience in ambulatory anesthesia. Well-adjusted comorbidities of the patient are generally not a contraindication for an outpatient procedure. The heavily overweight patient can also be operated on an outpatient basis if he is compliant, comorbidities are well adjusted and intensive postoperative care is ensured...
October 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29049244/isolated-heptadactylia-a-case-report-of-central-polydactyly-of-the-foot
#4
Nicolas Piette, Pierre-Yves Zambelli, Daniel N'Dele
RATIONALE: Heptadactylia is a rare congenital disorder from the polydactyly family. Polydactyly is generally classified into 3 major groups: preaxial (medial ray), postaxial (lateral ray), and central polydactyly. Most common cases are related to preaxial or postaxial polydactyly. The rarity of central polydactyly can be explained in 3 ways. First, central polydactyly with duplication appearing on metatarsal is pretty uncommon. Second, the duplication appears isolated on the foot. Polydactyly is mostly associated with other physical defects or others duplications...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29049141/review-of-setting-performance-standards-for-technical-and-nontechnical-competence-in-general-surgery-by-szasz-p-bonrath-em-louridas-m-fesco-ab-howe-b-fehr-a-ott-m-mack-la-harris-ka-grantcharov-tp-in-ann-surg-266-1-7-2017-and-beyond-measure-twice-new-performance
#5
https://www.readbyqxmd.com/read/29048703/a-pilot-study-on-the-efficacy-and-safety-of-a-minimally-invasive-surgical-and-anesthetic-approach-for-ventricular-assist-device-implantation
#6
Jonida Bejko, Demetrio Pittarello, Gianclaudio Falasco, Guido Di Gregorio, Vincenzo Tarzia, Giulio Rizzoli, Dario Gregori, Gino Gerosa, Tomaso Bottio
BACKGROUND: The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assist device implantation. METHODS: 68 patients (50.4 ± 17.1 years old) were supported with the HeartWare® HVAD (32 patients) and the Jarvik 2000 VAD (36 patients) between January 2010 and August 2016. Two surgical techniques were applied: a minimally invasive approach with the aid of paravertebral-block (mini-invasive group, 41 patients) and a standard-surgical-approach with the aid of general anesthesia (27 patients)...
October 16, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29046621/applying-a-statistical-method-in-transvaginal-ultrasound-training-lessons-from-the-learning-curve-cumulative-summation-test-lc-cusum-for-endometriosis-mapping
#7
Vered H Eisenberg, Juan L Alcazar, Nissim Arbib, Eyal Schiff, Reuven Achiron, Motti Goldenberg, David Soriano
BACKGROUND: Methods available for assessing the learning curve, such as a predefined number of procedures or direct mentoring are lacking. Our aim was to describe the use of a statistical method to identify the minimal training length of an experienced sonographer, newly trained in deep infiltrating endometriosis (DIE) mapping by evaluating the learning curve of transvaginal ultrasound (TVUS) in the preoperative assessment of endometriosis. METHODS: A retrospective study in a tertiary referral center for endometriosis...
2017: Gynecological Surgery
https://www.readbyqxmd.com/read/29038762/clinical-outcomes-of-residual%C3%A2-or%C3%A2-recurrent-nasopharyngeal-carcinoma-treated-with-endoscopic-nasopharyngectomy-plus-chemoradiotherapy-or-with-chemoradiotherapy-alone-a-retrospective-study
#8
Jingjin Weng, Jiazhang Wei, Jinyuan Si, Yangda Qin, Min Li, Fei Liu, Yongfeng Si, Jiping Su
BACKGROUND: Local residual and recurrent nasopharyngeal carcinoma (NPC) generally shows treatment failure after standard radiotherapy with or without concurrent chemotherapy. Whether endoscopic nasopharyngectomy might provide an additional therapeutic advantage remains controversial. Therefore, we retrospectively compared the clinical prognoses of patients with residual or recurrent NPC treated with endoscopic nasopharyngectomy combined with chemoradiotherapy (CRT) with those of patients treated with CRT alone...
2017: PeerJ
https://www.readbyqxmd.com/read/29038724/idiopathic-granulomatous-mastitis-dilemmas-in-diagnosis-and-treatment
#9
Rahim Mahmodlou, Niloofar Dadkhah, Fariba Abbasi, Jafar Nasiri, Rohollah Valizadeh
BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory disease of the breast. Due to its uncommon etiology, diagnosis and treatment is still unknown. Selection of a standard method for diagnosing idiopathic granulomatous mastitis is sophisticated. In view of non-definitive clinical and imaging finding, histopathology is the cornerstone of definitive diagnosis. OBJECTIVE: To determine and help solve the dilemma of treatment and diagnosis of idiopathic granulomatous mastitis...
September 2017: Electronic Physician
https://www.readbyqxmd.com/read/29038032/feasibility-of-sacrocolpopexy-by-outpatient-laparoscopic-surgery
#10
Valentin Keller, Caroline Rambault, Christophe Binelli, Gaëtan Gombaud, Aubert Agostini, Vincent Villefranque
INTRODUCTION: Sacrocolpopexy (SP) is a common intervention that is most often performed by laparoscopy. This intervention usually involves standard hospitalization. Evaluation of whether this procedure can be safely carried out by outpatient hospitalization (OH) is of considerable relevance. The aim of our study was hence to evaluate the feasibility of SP by OH. PATIENTS AND METHODS: This was an observational multicenter study that included women who underwent SP by OH...
October 13, 2017: Journal of gynecology obstetrics and human reproduction
https://www.readbyqxmd.com/read/29033272/graduating-surgical-residents-lack-competence-in-critical-care-ultrasound
#11
Renuka Tripu, Margaret H Lauerman, Daniel Haase, Syeda Fatima, Jacob Glaser, Cassandra Cardarelli, Thomas M Scalea, Sarah Murthi
OBJECTIVE: Ultrasound provides accessible imaging for bedside diagnostics and procedural guidance, but may lead to misdiagnosis in untrained users. The main objective of this study was to determine observed and self-perceived competence with critical care ultrasound in graduated general surgery residents. DESIGN: The design of this study was a retrospective review. Ultrasound training program records were reviewed for number of prior ultrasound examinations performed, self-perceived competence, observed competence on faculty examinations, and intended future use of individual critical care ultrasound examinations...
October 13, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/29030932/a-prospective-audit-of-pain-profiles-following-general-and-urological-surgery-in-children
#12
Caroline A Wilson, David Sommerfield, Thomas F E Drake-Brockman, Claudia Lagrange, Anoop Ramgolam, Britta S von Ungern-Sternberg
BACKGROUND: Postoperative pain is frequently undertreated in children both in hospital and at home following discharge. Pain has both short- and long-term consequences for children, their families, and the healthcare system. A greater understanding of procedure-specific postoperative pain trajectories is required to improve pain management. AIM: To determine the duration and severity of acute postoperative pain experienced by children undergoing 8 different general and urological procedures (primary outcomes)...
November 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29027853/intraoperative-test-stimulation-versus-stereotactic-accuracy-as-a-surgical-end-point-a-comparison-of-essential-tremor-outcomes-after-ventral-intermediate-nucleus-deep-brain-stimulation
#13
Tsinsue Chen, Zaman Mirzadeh, Kristina M Chapple, Margaret Lambert, Virgilio G H Evidente, Guillermo Moguel-Cobos, Srivadee Oravivattanakul, Padma Mahant, Francisco A Ponce
OBJECTIVE Ventral intermediate nucleus deep brain stimulation (DBS) for essential tremor is traditionally performed with intraoperative test stimulation and conscious sedation, without general anesthesia (GA). Recently, the authors reported retrospective data on 17 patients undergoing DBS after induction of GA with standardized anatomical coordinates on T1-weighted MRI sequences used for indirect targeting. Here, they compare prospectively collected data from essential tremor patients undergoing DBS both with GA and without GA (non-GA)...
October 13, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29026234/compliance-with-the-guide-for-commissioning-oral-surgery-an-audit-and-discussion
#14
O Modgill, A Shah
Introduction The Guide for commissioning oral surgery and oral medicine published by NHS England (2015) prescribes the level of complexity of oral surgery and oral medicine investigations and procedures to be carried out within NHS services. These are categorised as Level 1, Level 2, Level 3A and Level 3B. An audit was designed to ascertain the level of oral surgery procedures performed by clinicians of varying experience and qualification working in a large oral surgery department within a major teaching hospital...
October 13, 2017: British Dental Journal
https://www.readbyqxmd.com/read/29022095/laparoscopic-portoenterostomy-for-biliary-atresia-single-center-experience-and-review-of-literatures
#15
Joel Cazares, Hiroyuki Koga, Hiroshi Murakami, Hiroki Nakamura, Geoffrey Lane, Atsuyuki Yamataka
AIM: The aim of this report was to present the laparoscopic portoenterostomy (LapPE) procedure developed by the Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine (JLapPE). We also attempted to obtain an understanding of the current status of laparoscopic portoenterostomy in the world as reported in the English literature to compare with our experience. METHODS: There were 22 BA patients who had JLapPE between 2009 and 2016...
October 11, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/29019127/dige-saturation-labeling-for-scarce-amounts-of-protein-from-formalin-fixed-paraffin-embedded-ffpe-tissue
#16
Paul Dowling
In this chapter, we describe the utility of difference gel electrophoresis (DIGE) as a proteomics platform for the global detection of expressed proteins in formalin-fixed paraffin-embedded (FFPE) tissues and its use for biomarker discovery/identification of proteins that may contribute to cancer development and progression. Formalin fixation and paraffin embedding of tissue is the standard processing methodology practiced in pathology laboratories worldwide, resulting in a highly stable form of tissue that is easily stored due to its inherent stability at room temperature...
2018: Methods in Molecular Biology
https://www.readbyqxmd.com/read/29017476/the-relationship-between-preoperative-american-society-of-anesthesiologists-physical-status-classification-scores-and-functional-recovery-following-hip-fracture-surgery
#17
Li-Huan Chen, Jersey Liang, Min-Chi Chen, Chi-Chuan Wu, Huey-Shinn Cheng, Hsiu-Ho Wang, Yea-Ing Lotus Shyu
BACKGROUND: Little is known about the relationship of the American Society of Anesthesiologists Physical Status Classification scores (ASA scores) on patient outcomes following hip fracture surgery in Asian countries. Therefore, this study explored the association of patients' preoperative ASA scores on trajectories of recovery in physical functioning and health outcomes during the first year following postoperative discharge for older adults with hip-fracture surgery in Taiwan. METHODS: The data for this study was generated from three prior studies...
October 10, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28993121/evaluating-surgical-residents-patient-centered-communication-skills-practical-alternatives-to-the-apprenticeship-model
#18
Anna Newcomb, Amber W Trickey, Elena Lita, Jonathan Dort
OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to assess communication skills and provide feedback to residents. We aimed to develop a feasible data collection process that generates objective clinical performance information to guide training activities, inform ACGME milestone evaluations, and validate assessment instruments. DESIGN: Residents care for patients in the surgical clinic and in the hospital, and participate in a communication curriculum providing practice with standardized patients (SPs)...
October 6, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28991122/peripheral-nerve-blocks-for-hip-fractures-a-cochrane-review
#19
Joanne Guay, Martyn J Parker, Richard Griffiths, Sandra L Kopp
BACKGROUND: This review focuses on the use of peripheral nerve blocks as preoperative analgesia, as postoperative analgesia, or as a supplement to general anesthesia for hip fracture surgery and tries to determine if they offer any benefit in terms of pain on movement at 30 minutes after block placement, acute confusional state, myocardial infarction/ischemia, pneumonia, mortality, time to first mobilization, and cost of analgesic. METHODS: Trials were identified by computerized searches of Cochrane Central Register of Controlled Trials (2016, Issue 8), MEDLINE (Ovid SP, 1966 to 2016 August week 1), Embase (Ovid SP, 1988 to 2016 August week 1), and the Cumulative Index to Nursing and Allied Health Literature (EBSCO, 1982 to 2016 August week 1), trials registers, and reference lists of relevant articles...
October 4, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28991116/incidence-and-operative-factors-associated-with-discretional-postoperative-mechanical-ventilation-after-general-surgery
#20
Juliet J Ray, Meredith Degnan, Krishnamurti A Rao, Jonathan P Meizoso, Charles A Karcutskie, Danielle B Horn, Luis Rodriguez, Richard P Dutton, Carl I Schulman, Roman Dudaryk
BACKGROUND: Mechanical ventilation after general surgery is associated with worse outcomes, prolonged hospital stay, and increased health care cost. Postoperatively, patients admitted to the intensive care unit (ICU) may be categorized into 1 of 3 groups: extubated patients (EXT), patients with objective medical indications to remain ventilated (MED), and patients not meeting these criteria, called "discretional postoperative mechanical ventilation" (DPMV). The objectives of this study were to determine the incidence of DPMV in general surgery patients and identify the associated operative factors...
October 4, 2017: Anesthesia and Analgesia
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