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Effect of specialization on surgery safety

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https://www.readbyqxmd.com/read/29205995/volume-and-health-outcomes-evidence-from-systematic-reviews-and-from-evaluation-of-italian-hospital-data
#1
Laura Amato, Danilo Fusco, Anna Acampora, Katia Bontempi, Alessandro Cesare Rosa, Paola Colais, Fabio Cruciani, Mariangela D'Ovidio, Francesca Mataloni, Silvia Minozzi, Zuzana Mitrova, Luigi Pinnarelli, Rosella Saulle, Salvatore Soldati, Chiara Sorge, Simona Vecchi, Martina Ventura, Marina Davoli
BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care». There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions...
September 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/29179761/efficacy-and-safety-of-the-xingnao-kaiqiao-acupuncture-technique-via-intradermal-needling-to-treat-postoperative-gastrointestinal-dysfunction-of-laparoscopic-surgery-study-protocol-for-a-randomized-controlled-trial
#2
Wenli Zhao, Jinting Li, Yuling Wang, Jing Liu, Ying Chen, Guang Zhao, Ye Zhao, Huaien Bu, Yiider Tseng, Xuemin Shi
BACKGROUND: Xingnao Kaiqiao acupuncture involves needling of the Neiguan (PC6), Renzhong (DU26), and Sanyinjiao (SP6) acupoints. The technique has a significant clinical effect in many neurological diseases. In the present report, we have developed a protocol for a scientific trial to analyze whether Xingnao Kaiqiao can be used to treat gastrointestinal dysfunction after laparoscopic surgery. In this context, we intend to execute a double-blind, randomized controlled trial to assess the efficacy and safety of Xingnao Kaiqiao acupuncture via intradermal needling...
November 28, 2017: Trials
https://www.readbyqxmd.com/read/29178185/case-series-of-outcomes-of-a-standardized-surgical-approach-for-placenta-percreta-for-prevention-of-ureteral-lesions
#3
David Atallah, Malak Moubarak, Malek Nassar, Bernard Kassab, Michel Ghossain, Nadine El Kassis
OBJECTIVE: To report the outcomes of women with placenta percreta who were surgically treated by a specialized technique based on gynecologic oncology experience, and to demonstrate its safety in preventing ureteral lesions and reducing blood loss. METHODS: In the present retrospective study, data from patients with placenta percreta radically treated at Hôtel-Dieu de France, Beirut, Lebanon, between December 2012 and January 2017 were reviewed. Demographic, pathology, and delivery data, medical history, per-operative and postoperative information, and neonatal data were assessed...
November 27, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/29115962/bridging-the-human-resource-gap-in-surgical-and-anesthesia-care-in-low-resource-countries-a-review-of-the-task-sharing-literature
#4
REVIEW
Tigistu Ashengo, Alena Skeels, Elizabeth J H Hurwitz, Eric Thuo, Harshad Sanghvi
Task sharing, the involvement of non-specialists (non-physician clinicians or non-specialist physicians) in performing tasks originally reserved for surgeons and anesthesiologists, can be a potent strategy in bridging the vast human resource gap in surgery and anesthesia and bringing needed surgical care to the district level especially in low-resource countries. Although a common practice, the idea of assigning advanced tasks to less-specialized workers remains a subject of controversy. In order to optimize its benefits, it is helpful to understand the current task sharing landscape, its challenges, and its promise...
November 7, 2017: Human Resources for Health
https://www.readbyqxmd.com/read/29073928/safety-of-tubal-ligation-by-minilaparotomy-provided-by-clinical-officers-versus-assistant-medical-officers-study-protocol-for-a-noninferiority-randomized-controlled-trial-in-tanzanian-women
#5
Mark A Barone, Zuhura Mbuguni, Japhet Ominde Achola, Carmela Cordero, Joseph Kanama, Projestine S Muganyizi, Jamilla Mwanga, Caitlin Shannon, Leopold Tibyehabwa
BACKGROUND: Female sterilization by tubal ligation is a safe, extremely effective, and permanent way to limit childbearing. It is the most popular modern contraceptive method worldwide. The simplest way to provide tubal ligation is by a procedure called minilaparotomy, generally performed with the client under local anesthesia with systemic sedation and analgesia. In Tanzania, unmet need for family planning is high and has declined little in the past decade. Access to tubal ligation is limited throughout the country, in large part because of a lack of trained providers...
October 26, 2017: Trials
https://www.readbyqxmd.com/read/28827901/applied-research-on-laparoscopic-simulator-in-the-resident-surgical-laparoscopic-operation-technical-training
#6
Shangxi Fu, Xiao Liu, Li Zhou, Meisheng Zhou, Liming Wang
The purpose of this study was to estimate the effects of surgical laparoscopic operation course on laparoscopic operation skills after the simulated training for medical students with relatively objective results via data gained before and after the practice course of laparoscopic simulator of the resident standardized trainees. Experiment 1: 20 resident standardized trainees with no experience in laparoscopic surgery were included in the inexperienced group and finished simulated cholecystectomy according to simulator videos...
August 2017: Indian Journal of Surgery
https://www.readbyqxmd.com/read/28718878/deep-brain-and-cortical-stimulation-for-epilepsy
#7
REVIEW
Mathieu Sprengers, Kristl Vonck, Evelien Carrette, Anthony G Marson, Paul Boon
BACKGROUND: Despite optimal medical treatment, including epilepsy surgery, many epilepsy patients have uncontrolled seizures. Since the 1970s interest has grown in invasive intracranial neurostimulation as a treatment for these patients. Intracranial stimulation includes both deep brain stimulation (DBS) (stimulation through depth electrodes) and cortical stimulation (subdural electrodes). This is an updated version of a previous Cochrane review published in 2014. OBJECTIVES: To assess the efficacy, safety and tolerability of DBS and cortical stimulation for refractory epilepsy based on randomized controlled trials (RCTs)...
July 18, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28700011/how-does-practice-improve-the-skills-of-medical-students-during-consecutive-training-courses
#8
Erzsebet Vanyolos, Istvan Furka, Iren Miko, Aida Viszlai, Norbert Nemeth, Katalin Peto
Purpose: To follow-up the development of medical students in taking a stitch using two different bench models, and to assess their performance with regards to gender, handedness, prior recreational activities and interest in surgery. Methods: The study was performed during the compulsory basic (n=152) and the consecutive elective course (n=27). Students took simple interrupted stitches into synthetic and biopreprate models in the classroom and in the operating room...
June 2017: Acta Cirúrgica Brasileira
https://www.readbyqxmd.com/read/28666699/perioperative-pain-management-an-update-for-obstetrician-gynecologists
#9
REVIEW
Georgine Lamvu, Jessica Feranec, Emily Blanton
The opioid epidemic in the United States is unprecedented and continues to worsen. Many opioid abusers obtain their pills through legitimate prescriptions, directly or indirectly, from a medical provider. While practitioners have a responsibility to treat pain, it is now becoming clear that aggressive opioid prescription practices contribute to an epidemic of abuse. The medical community has to balance the unintended consequences of opioid misuse and abuse with the need to provide adequate pain control. Additionally, providers are being held accountable by the legal system and professional organizations for their prescribing practices...
June 27, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28655529/telementoring-and-telesurgery-for-minimally-invasive-procedures
#10
REVIEW
Andrew J Hung, Jian Chen, Ankeet Shah, Inderbir S Gill
PURPOSE: Tremendous interest and need lie at the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery given its endoscopic optics and mechanized instrument movement. We review the present status, current challenges and future promise of telemedicine in endoscopic and minimally invasive surgery with a focus on urological applications. MATERIALS AND METHODS: Two paired investigators screened PubMed(®), Scopus(®) and Web of Science(®) databases for all full text English language articles published between 1995 and 2016 using the key words "telemedicine," "minimally invasive surgical procedure," "robotic surgical procedure," "education" and "distance...
June 26, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28525415/effects-of-collagenase-digestion-and-stromal-vascular-fraction-supplementation-on-volume-retention-of-fat-grafts
#11
Jonathan B Olenczak, Scott A Seaman, Kant Y Lin, Angela Pineros-Fernandez, Catherine E Davis, Lisa S Salopek, Shayn M Peirce, Patrick S Cottler
OBJECTIVE: The use of autologous fat as a soft tissue filler has increased over the past decade in both reconstructive and aesthetic surgeries. Enhancement of autologous fat grafts with the addition of the stromal vascular fraction (SVF) has been reported to improve long-term volume retention. Stromal vascular fraction is most commonly isolated using enzymatic digestion, but it is unknown what effect the digestion process has on the adipocytes and SVF cells that comprise the graft. Some clinicians have reported use of enzymatically digested fat grafts to alter the physical properties of the tissue in specialized applications...
June 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28456730/usefulness-of-pbpk-modeling-in-incorporation-of-clinical-conditions-in-personalized-medicine
#12
REVIEW
Niloufar Marsousi, Jules A Desmeules, Serge Rudaz, Youssef Daali
Personalized medicine aims to determine the most adequate treatment and dose regimen to obtain the maximum efficacy and minimum side effect by taking into account patients' characteristics. For numerous reasons, one being ethical and methodological hurdles in including specific populations in clinical trials, innovative methods for optimization of drugs safety and efficacy in such patients have received increasing interest recently. Physiological-based pharmacokinetic (PBPK) modeling has emerged as a promising approach in designing adequate clinical trials and quantifying anticipated changes in unknown clinical situations...
April 26, 2017: Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28452912/effects-of-a-brief-team-training-program-on-surgical-teams-nontechnical-skills-an-interrupted-time-series-study
#13
Brigid M Gillespie, Emma Harbeck, Evelyn Kang, Catherine Steel, Nicole Fairweather, Kriengsak Panuwatwanich, Wendy Chaboyer
BACKGROUND: Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. METHODS: Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program...
April 27, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28360973/endoluminal-solutions-to-bariatric-surgery-complications-a-review-with-a-focus-on-technical-aspects-and-results
#14
REVIEW
Raquel Souto-Rodríguez, María-Victoria Alvarez-Sánchez
Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications...
March 16, 2017: World Journal of Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28272086/effectiveness-and-safety-of-surgical-excision-in-the-treatment-of-digital-mucoid-cysts
#15
Galina Balakirski, Christoph Loeser, Jens M Baron, Edgar Dippel, Laurenz Schmitt
BACKGROUND: Digital mucoid cysts have a tendency for recurrence after operative intervention. Several procedures are in use. OBJECTIVE: Retrospective evaluation for effectiveness, safety and patient satisfaction by using a questionnaire after treatment for digital mucoid cysts with targeted surgical excision and closure by flap-design. MATERIALS AND METHODS: All patients treated with surgical excision for digital mucoid cysts at the Dermatology Department of the Ludwigshafen City Hospital between 2007 and 2011 were evaluated using a specially designed questionnaire...
July 2017: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
https://www.readbyqxmd.com/read/28072800/modified-percutaneous-lumbar-foraminoplasty-and-percutaneous-endoscopic-lumbar-discectomy-instrument-design-technique-notes-and-5-years-follow-up
#16
Zhen-Zhou Li, Shu-Xun Hou, Wei-Lin Shang, Ke-Ran Song, Hong-Liang Zhao
BACKGROUND: Conventional percutaneous endoscopic lumbar discectomy (PELD) with an "inside-outside" technique has 4.3% - 10.3% surgical failure rate, especially in central herniated discs (HDs), migrated HDs, and axillary type HDs. PELD with foraminoplasty has been used for complex HDs. Percutaneous lumbar foraminoplasty (PLF), which is performed with a trephine or bone reamer introduced over a guidewire without a protective working cannula in the original Tessys technique, can quickly cut the hypertrophied bony structure under fluoroscopic guidance, and risk injury to the exiting and traversing nerve roots...
January 2017: Pain Physician
https://www.readbyqxmd.com/read/27924508/ultrasonography-guided-percutaneous-nephrolithotomy-with-chinese-one-shot-tract-dilation-technique-based-on-stimulated-diuresis-a-report-of-67-cases
#17
Ying Shi, Hua-Geng Liang, Xiong Yang, Bo Hai, Liang Wang, Yi-Fei Xing, Wen Ju, Fu-Qing Zeng, Xiao-Ping Zhang, Wen-Cheng Li
The safety and effectiveness of a novel Chinese one-shot dilation technique based on stimulated diuresis for percutaneous nephrolithotomy (PCNL) were investigated. After the feasibility of the Chinese one-shot dilation based on stimulated diuresis was verified by an animal study, this technique was applied in the clinical practice. A total of 67 patients in our department underwent the modified PCNL from July 2014 to June 2015. After the renal infundibulum was distended by stimulated diuresis, the kidney was punctured under the ultrasonographic guidance via the fornix of the target calyx...
December 2016: Journal of Huazhong University of Science and Technology. Medical Sciences
https://www.readbyqxmd.com/read/27921198/-metabolic-surgery-or-conservative-measures-as-therapy-of-obese-type%C3%A2-2%C3%A2-diabetics
#18
REVIEW
Udo Jahn, Thomas Schubert, Sibylle Schlepp, Heinz Jürgen Deuber
After bariatric surgery there are some favourable effects on comorbidities of obesity as glucose and lipid metabolism besides weight loss. Therefore surgical measures targeting at improvement of such metabolic disorders especially diabetes type 2 has been called "metabolic surgery". The complexity of its underlying metabolic mechanisms is not yet clear, but restriction of energy and weight loss (maintenance) seem to be the cornerstones.Risks of these procedures which are drawn of the established methods of bariatric surgery are reported to be relatively low in qualified centers...
June 2017: Wiener Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27731885/transfusion-thresholds-and-other-strategies-for-guiding-allogeneic-red-blood-cell-transfusion
#19
REVIEW
Jeffrey L Carson, Simon J Stanworth, Nareg Roubinian, Dean A Fergusson, Darrell Triulzi, Carolyn Doree, Paul C Hebert
BACKGROUND: There is considerable uncertainty regarding the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients. Blood is a scarce resource, and in some countries, transfusions are less safe than others because of a lack of testing for viral pathogens. Therefore, reducing the number and volume of transfusions would benefit patients. OBJECTIVES: The aim of this review was to compare 30-day mortality and other clinical outcomes in participants randomized to restrictive versus liberal red blood cell (RBC) transfusion thresholds (triggers) for all conditions...
October 12, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27695249/the-use-of-intraoperative-computed-tomography-navigation-in-pituitary-surgery-promises-a-better-intraoperative-orientation-in-special-cases
#20
Stefan Linsler, Sebastian Antes, Sebastian Senger, Joachim Oertel
OBJECTIVE: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. MATERIALS AND METHODS: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated...
October 2016: Journal of Neurosciences in Rural Practice
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