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Standards for General Surgery

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https://www.readbyqxmd.com/read/28531789/do-picu-patients-meet-technical-criteria-for-performing-indirect-calorimetry
#1
Megan R Beggs, Gonzalo Garcia Guerra, Bodil M K Larsen
BACKGROUND & AIMS: Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown...
October 2016: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/28529196/the-usage-of-mock-oral-examinations-for-program-improvement
#2
Shari L Meyerson, Stuart Lipnick, Edward Hollinger
OBJECTIVE: Mock oral examinations are often used to prepare residents for the American Board of Surgery certifying examination. Another potential use of these examinations is to identify programmatic weaknesses. Results from a multi-institutional mock oral examination were evaluated to determine if specific areas of weakness within each of the participating programs could be identified to facilitate program development. DESIGN: A mock oral examination was administered annually consisting of 3 examination rooms per resident with 3 cases in each room...
May 18, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28527646/high-dose-amino-acid-administration-achieves-an-anabolic-response-in-type-2-diabetic-patients-that-is-independent-of-glycaemic-control-a-randomized-clinical-trial
#3
Chelsia Gillis, Patricia S Roque, Jürgen Bläss, Albert Urwyler, Harald Schepperle, Guido Kunz, Thomas Peters, Thomas Schricker, Linda Wykes, Andrea Kopp Lugli
BACKGROUND & AIMS: Surgical stress provokes protein catabolism and hyperglycaemia that is enhanced in patients with type 2 diabetes (T2DM), and increases perioperative morbidity. This study hypothesized that perioperative administration of high dose intravenous (IV) amino acids (AA) will augment protein balance in T2DM patients receiving tight plasma glucose control via continuous IV insulin compared to standard plasma glucose control via subcutaneous (SC) insulin sliding scale. METHODS: Eighteen patients with well-controlled T2DM (HbA1C% < 7...
May 3, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28526647/clipping-versus-coiling-in-anterior-circulation-ruptured-intracranial-aneurysms-a-meta-analysis
#4
REVIEW
George Fotakopoulos, Eleni Tsianaka, Kostas Fountas, Demosthenes Makris, Michael Spyrou, Juha Hernesniemi
BACKGROUND: The treatment plan with open surgical or endovascular repair in anterior circulation ruptured intracranial aneurysms must be taken on the basis of its special characteristics OBJECTIVE: To evaluate the possible superiority on outcomes, studying operative mortality (Op-Mo), permanent neurologic deficit (PND), late mortality (La-Mo) and need for re-intervention (re-iter), after open surgical and endovascular repair in anterior circulation ruptured intracranial aneurysms. METHODS: This Meta-Analysis included articles that compared outcomes of the two methods, published in full text form (last search performed on 06 December 2016)...
May 16, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28524791/sagittal-craniosynostosis-a-utility-outcomes-study
#5
Victoria Kuta, P Daniel McNeely, Simon Walling, Michael Bezuhly
OBJECTIVE Sagittal craniosynostosis results in a characteristic scaphocephalic head shape that is typically corrected surgically during a child's 1st year of life. The authors' objective was to determine the potential impact of being born with sagittal craniosynostosis by using validated health state utility assessment measures. METHODS An online utility assessment was designed to generate health utility scores for scaphocephaly, monocular blindness, and binocular blindness using standardized utility assessment tools, namely the visual analog scale (VAS) and the standard gamble (SG) and time trade-off (TTO) tests...
May 19, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28522786/pilonidal-sinus-finding-the-righttrack-for-treatment
#6
Wojciech Hap, Ewelina Frejlich, Julia Rudno-Rudzińska, Krzysztof Kotulski, Krzysztof Kurnol, Katarzyna Hap, Adam Skalski, Wojciech Kielan
Pilonidal cyst is a troublesome condition affecting usually young people. It significantly influences quality of life and causes low self-esteem. Despite its known pathophysiology and numerous therapeutic methods available, pilonidal cysts still constitute a significant problem in general surgery. A large number of surgical techniques indicates the lack of a single method that ensures therapeutic success, and frequent complications cause both patient's dissatisfaction and frustration of the operator. In many cases, therapy is based on methods developed in a given healthcare center and their efficacy is usually not scientifically verified...
February 28, 2017: Polski Przeglad Chirurgiczny
https://www.readbyqxmd.com/read/28512853/derivation-and-validation-of-the-append-score-an-acute-appendicitis-clinical-prediction-rule
#7
Hinetamatea Mikaere, Irene Zeng, Melanie Lauti, Malsha Kularatna, Andrew D MacCormick
BACKGROUND: Although many clinical prediction rules (CPRs) for appendicitis exist, none have been developed for a New Zealand population presenting with right iliac fossa (RIF) pain. The aim of this study was to derive and validate an appendicitis CPR for our population. METHOD: This is a retrospective review of all patients from December 2010 to February 2012 of at least 15 years of age presenting to the general surgery service with RIF pain. Patient data were divided into derivation and validation groups...
May 16, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28509820/impact-of-preoperative-opioid-use-on-total-knee-arthroplasty-outcomes
#8
Savannah R Smith, Jennifer Bido, Jamie E Collins, Heidi Yang, Jeffrey N Katz, Elena Losina
BACKGROUND: There is growing concern about the use of opioids prior to total knee arthroplasty (TKA), and research has suggested that preoperative opioid use may lead to worse pain outcomes following surgery. We evaluated the pain relief achieved by TKA in patients who had and those who had not used opioids use before the procedure. METHODS: We augmented data from a prospective cohort study of TKA outcomes with opioid-use data abstracted from medical records. We collected patient-reported outcomes and demographic data before and 6 months after TKA...
May 17, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28509808/implementing-patient-information-for-gynae-oncology-patients-at-a-tertiary-referral-health-service
#9
Vicki Campbell, Kate Kynoch, Jacinta Tolmie, Carolyn Donges
AIM: To ensure that gynae-oncology surgical patients receive relevant written information, in their preferred format, and at a time that suits them, according to the best available evidence. METHODS: This project utilized an audit and feedback design and was conducted over a 9-month period from August 2015 to May 2016. Twenty-nine patients were audited prior to two strategies being implemented. The first strategy was a standardized e-mail letter to all patients (containing links to surgical information, cancer support websites and a short video introducing hospital staff, and the second was a discharge information sheet detailing wound care, signs of complications, actions to take and follow-up instructions...
May 15, 2017: International Journal of Evidence-based Healthcare
https://www.readbyqxmd.com/read/28506475/a-novel-perfused-porcine-simulator-for-teaching-aortic-anastomosis-increases-resident-interest-in-vascular-surgery
#10
Peter B Bartline, Jennie O'Shea, James M McGreevy, Michelle T Mueller
OBJECTIVE: This report describes a novel simulator, euthanized pigs on cardiopulmonary bypass, and validates this simulator with a controlled trial in general surgery residents learning aortic anastomosis. We evaluated this novel simulator with the following hypothesis: our porcine perfused simulator is as good as or better than the standard rubber tubing, low-fidelity models used for vascular anastomotic training. METHODS: Euthanized pigs were placed on cardiopulmonary bypass, creating a perfused, ex vivo model on which to perform surgical procedures...
May 12, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28505682/-implementation-of-a-laparoscopic-simulation-training-in-undergraduate-medical-education-the-l%C3%A3-beck-toolbox-curriculum
#11
Tilman Laubert, Michael Thomaschewski, Paul Auerswald, Markus Zimmermann, Linda Brüheim, Tobias Keck, Claudia Benecke
Background Simulation-based training has become increasingly relevant in minimally invasive surgery (MIS). It is unclear whether or not the established Lübeck Toolbox (LTB) Curriculum for the acquisition of basic MIS skills can be implemented to supplement standard undergraduate education in surgery and how it would be accepted. Materials und Methods Since 04/2015, students at the medical school of the University of Lübeck have had the option to complete the highly standardized and validated LTB Curriculum...
May 15, 2017: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/28505233/addition-of-droperidol-to-prophylactic-ondansetron-and-dexamethasone-in-children-at-high-risk-for-postoperative-vomiting-a-randomized-controlled-double-blind-study
#12
N Bourdaud, C François, O Jacqmarcq, M-L Guye, J Jean, C Studer, C Engrand-Donal, J-M Devys, F Boutin, E Guyot, N Bouazza, J-M Treluyer, G A Orliaguet
Background: : The combination of dexamethasone (DEX), ondansetron (OND) and droperidol (DRO) is efficacious in preventing postoperative nausea and vomiting in adults, but has not been well assessed in children. Methods: : Children undergoing elective surgery under general anaesthesia and considered at high risk for postoperative vomiting (POV) were randomly assigned to receive a combination of DEX, OND and placebo (Group A) or a combination of DEX, OND and DRO (Group B)...
May 15, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28500021/thoracic-surgery-information-on-the-internet-a-multilingual-quality-assessment
#13
Myles Davaris, Stephen Barnett, Robert Abouassaly, Nathan Lawrentschuk
BACKGROUND: Previous data suggest that quality of Internet information regarding surgical conditions and their treatments is variable. However, no comprehensive analysis of website quality exists for thoracic surgery. OBJECTIVE: The aim of this study was to quantify website quality in a multilingual setting using an international standard for assessment. METHODS: Health On the Net (HON) principles may be applied to websites using an automated toolbar function...
May 12, 2017: Interactive Journal of Medical Research
https://www.readbyqxmd.com/read/28498176/effectiveness-of-haloperidol-prophylaxis-in-critically-ill-patients-with-a-high-risk-of-delirium-a-systematic-review
#14
Eduardo Santos, Daniela Cardoso, Hugo Neves, Madalena Cunha, Manuel Rodrigues, João Apóstolo
BACKGROUND: Delirium is associated with increased intensive care unit and hospital length of stay, prolonged duration of mechanical ventilation, unplanned removal of tubes and catheters, and increased morbidity and mortality. Prophylactic treatment with low-dose haloperidol may have beneficial effects for critically ill patients with a high risk of delirium. OBJECTIVES: To identify the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk for delirium...
May 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28494088/peripheral-nerve-blocks-for-hip-fractures
#15
REVIEW
Joanne Guay, Martyn J Parker, Richard Griffiths, Sandra Kopp
BACKGROUND: Various nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017. OBJECTIVES: This review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards...
May 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28492821/risk-associated-with-complications-and-mortality-after-urgent-surgery-vs-elective-and-emergency-surgery-implications-for-defining-quality-and-reporting-outcomes-for-urgent-surgery
#16
Matthew G Mullen, Alex D Michaels, J Hunter Mehaffey, Christopher A Guidry, Florence E Turrentine, Traci L Hedrick, Charles M Friel
Importance: Given the current climate of outcomes-driven quality reporting, it is critical to appropriately risk stratify patients using standardized metrics. Objective: To elucidate the risk associated with urgent surgery on complications and mortality after general surgical procedures. Design, Setting, and Participants: This retrospective review used the American College of Surgeons National Surgery Quality Improvement Program database to capture all general surgery cases performed at 435 hospitals nationwide between January 1, 2013, and December 31, 2013...
May 10, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28489642/pupillary-reflex-for-evaluation-of-thoracic-paravertebral-block-a-prospective-observational-feasibility-study
#17
Baptiste Duceau, Mélanie Baubillier, Gaëlle Bouroche, Aline Albi-Feldzer, Christian Jayr
BACKGROUND: Although thoracic paravertebral block (TPVB) is recommended in major breast surgery, there is no gold standard to assess the success of TPVB. Pupillary dilation reflex (PDR) is the variation of the pupillary diameter after a noxious stimulus. The objective was to evaluate the feasibility of recording the PDR to assess analgesia in an anesthetized thoracic dermatome after TPVB. METHODS: This prospective, observational, single-center study included 32 patients requiring breast surgery under general anesthesia and TPVB...
May 4, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28488238/trans-oral-miniature-x-ray-radiation-delivery-system-with-endoscopic-optical-feedback
#18
Axel Boese, Fredrick Johnson, Till Ebert, Ali Mahmoud-Pashazadeh, Christoph Arens, Michael Friebe
PURPOSE: Surgery, chemo- and/or external radiation therapy are the standard therapy options for the treatment of laryngeal cancer. Trans-oral access for the surgery reduces traumata and hospitalization time. A new trend in treatment is organ-preserving surgery. To avoid regrowth of cancer, this type of surgery can be combined with radiation therapy. Since external radiation includes healthy tissue surrounding the cancerous zone, a local and direct intraoral radiation delivery would be beneficial...
May 9, 2017: International Journal of Computer Assisted Radiology and Surgery
https://www.readbyqxmd.com/read/28486890/efficacy-and-safety-of-ultra-rapid-iron-polymaltose-infusion-during-general-anaesthesia
#19
R M Browning, N Alakeson, E J O'Loughlin
To assess the efficacy and safety of ultra rapid (15 minute) infusion of iron polymaltose to iron deficient patients during general anaesthesia, we performed a prospective, interventional non-randomised study on 99 adult patients with iron deficiency with or without anaemia presenting for surgery under general anaesthesia. Over 15 minutes during the maintenance phase of anaesthesia, patients were given iron polymaltose, 500 mg if not anaemic, or 1,000 mg if anaemic. Haemodynamic stability, immediate or delayed iron-related side-effects and efficacy at six weeks were assessed...
May 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28486288/the-comprehensive-complication-index-cci%C3%A2-added-value-and-clinical-perspectives-3-years-down-the-line
#20
Pierre-Alain Clavien, Diana Vetter, Roxane D Staiger, Ksenija Slankamenac, Tarun Mehra, Rolf Graf, Milo Alan Puhan
OBJECTIVE: To explore the added value of the comprehensive complication index (CCI) to standard assessment of postoperative morbidity, and to clarify potential controversies for its application. BACKGROUND: The CCI was introduced about 3 years ago as a novel metric of postoperative morbidity, integrating in a single formula all complications by severity, ranging from 0 (uneventful course) to 100 (death). It remains unclear, how often the CCI adds to standard reporting of complications and how to apply it in complex postoperative courses...
June 2017: Annals of Surgery
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