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Surgical ethics

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https://www.readbyqxmd.com/read/27909653/magnetic-resonance-imaging-of-the-cervical-spine-under-represents-sagittal-plane-deformity-in-degenerative-myelopathy-patients
#1
Douglas S Weinberg, Arunit J Chugh, Jeremy J Gebhart, Jason D Eubanks
BACKGROUND: In treating patients with cervical myelopathy, surgical approach may be dictated by sagittal balance, highlighting the need for accurate pre-operative assessment. Magnetic Resonance Imaging (MRI) is widely-recognized for its utility in the diagnosis and surgical planning of cervical myelopathy. Plain radiographs (X-rays) are a reliable tool to assess bony alignment. However, they may not always be included in standard pre-operative evaluation, especially in an era of restricted payer-environments...
2016: International Journal of Spine Surgery
https://www.readbyqxmd.com/read/27909568/implementation-of-minimal-invasive-gynaecological-surgery-certification-will-challenge-gynaecologists-with-new-legal-and-ethical-issues
#2
V Tanos, R Socolov, P Demetriou, M Kyprianou, A Watrelot, Y Van Belle, R Campo
The introduction of a certification / diploma program in Minimal Invasive Surgery (MIS) is expected to improve surgical performance, patient's safety and outcome. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA) and the ESHRE Certification for Reproductive Endoscopic Surgery (ECRES) provides a structured learning path, recognising different pillars of competence. In order to achieve a high level of competence a two steps validation is necessary: (a) the individual should be certified of having the appropriate theoretical knowledge and (b) the endoscopic psychomotor skills before entering in the diploma programme reflecting the surgical competence...
June 27, 2016: Facts, Views & Vision in ObGyn
https://www.readbyqxmd.com/read/27909035/randomised-controlled-pilot-study-to-investigate-the-effectiveness-of-thoracic-epidural-and-paravertebral-blockade-in-reducing-chronic-post-thoracotomy-pain-topic-feasibility-study-protocol
#3
Joyce Yeung, Teresa Melody, Amy Kerr, Babu Naidu, Lee Middleton, Kostas Tryposkiadis, Jane Daniels, Fang Gao
INTRODUCTION: Open chest surgery (thoracotomy) is considered the most painful of surgical procedures. Forceful wound retraction, costochondral dislocation, posterior costovertebral ligament disruption, intercostal nerve trauma and wound movement during respiration combine to produce an acute, severe postoperative pain insult and persistent chronic pain many months after surgery is common. Three recent systematic reviews conclude that unilateral continuous paravertebral blockade (PVB) provides analgesia at least equivalent to thoracic epidural blockade (TEB) in the postoperative period, has a lower failure rate, and symptom relief that lasted months...
December 1, 2016: BMJ Open
https://www.readbyqxmd.com/read/27902645/effect-of-nerve-stimulation-use-on-the-success-rate-of-ultrasound-guided-subsartorial-saphenous-nerve-block-a-randomized-controlled-trial
#4
Shaylyn H Montgomery, Colleen M Shamji, Grace S Yi, Cynthia H Yarnold, Stephen J Head, Scott C Bell, Stephan K W Schwarz
BACKGROUND AND OBJECTIVES: Ultrasound-guided subsartorial saphenous nerve block is commonly used to provide complete surgical anesthesia of the foot and ankle in combination with a popliteal sciatic nerve block. However, in part owing to its small caliber and absence of a prominent vascular landmark in the subsartorial plane distal to the adductor canal, the saphenous nerve is more difficult to reliably block than the sciatic nerve in the popliteal fossa. Although the saphenous nerve is a sensory nerve only, neurostimulation can be used to elicit a "tapping" sensation on the anteromedial aspect of the lower leg extending toward the medial malleolus...
November 29, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27884849/access-hd-pilot-a-randomised-feasibility-trial-comparing-catheters-with-fistulas-in-elderly-patients-starting-haemodialysis
#5
Robert Quinn, Pietro Ravani
INTRODUCTION: The selection of the type of vascular access for haemodialysis is an important intervention question. However, only observational studies are available to inform decision-making in this area, and they are at high risk of selection bias. While a clinical trial comparing the effects of the 2 most frequently chosen strategies for haemodialysis access (fistulas and catheters) on patient important and 'hard' clinical end points is needed, the feasibility of such a trial is uncertain...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27884211/plasma-glutamine-levels-before-cardiac-surgery-are-related-to-post-surgery-infections-an-observational-study
#6
Hanneke Buter, Matty Koopmans, Ramses Kemperman, Lilian Jekel, Christiaan Boerma
BACKGROUND: A low plasma glutamine level was found in 34% of patients after elective cardiothoracic surgery. This could be a result of the inflammation caused by surgical stress or the use of extracorporeal circulation (ECC). But it is also possible that plasma glutamine levels were already lowered before surgery and reflect an impaired metabolic state and a higher likelihood to develop complications. In the present study plasma glutamine levels were measured before and after cardiac surgery and we questioned whether there is a relation between plasma glutamine levels and duration of ECC and the occurrence of postoperative infections...
November 25, 2016: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27882550/investigating-interactions-between-epicardial-adipose-tissue-and-cardiac-myocytes-what-can-we-learn-from-different-approaches
#7
REVIEW
Katja Rietdorf, Hilary MacQueen
Heart disease is a major cause of morbidity and mortality throughout the world. Some cardiovascular conditions can be modulated by lifestyle factors such as increased exercise or a healthier diet, but many require surgical or pharmacological interventions for their management. More targeted and less invasive therapies would be beneficial. Recently it has become apparent that epicardial adipose tissue plays an important role in normal and pathological cardiac function, and it is now the focus of considerable research...
November 24, 2016: British Journal of Pharmacology
https://www.readbyqxmd.com/read/27880987/assessing-surgical-research-at-the-teaching-hospital-level
#8
Kate E McBride, Jane M Young, Paul G Bannon, Michael J Solomon
BACKGROUND: To undertake a comprehensive needs assessment to determine the baseline of surgical research activity at a tertiary referral hospital in Sydney, Australia. METHOD: The comprehensive needs assessment comprised three components: a retrospective audit of the hospital ethics committee records to identify surgical research activity; a survey of all 17 surgical departments about the availability of 10 potential research resources and a survey of surgical staff to ascertain perceptions of research culture at the organizational, team and individual levels...
November 23, 2016: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/27878756/imaging-findings-of-adrenal-primitive-neuroectodermal-tumors-a-series-of-seven-cases
#9
Y Zhang, P Cai, M Chen, X Yi, L Li, D Xiao, W Liu, W Li, Y Li
OBJECTIVE: To explore the imaging features of adrenal primitive neuroectodermal tumors (PNETs). MATERIALS AND METHODS: This retrospective study included seven patients with surgically and pathologically confirmed adrenal PNETs. Among them, six underwent computed tomography (CT) scans, and one underwent magnetic resonance imaging. The imaging findings, including size, shape, margin, hemorrhage, calcification, cystic degeneration, regional lymph nodes involvement, tumor thrombus formation and enhancement pattern, were retrospectively analyzed...
November 23, 2016: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/27875647/what-pacemakers-can-teach-us-about-the-ethics-of-maintaining-artificial-organs
#10
Katrina Hutchison, Robert Sparrow
One day soon it may be possible to replace a failing heart, liver, or kidney with a long-lasting mechanical replacement or perhaps even with a 3-D printed version based on the patient's own tissue. Such artificial organs could make transplant waiting lists and immunosuppression a thing of the past. Supposing that this happens, what will the ongoing care of people with these implants involve? In particular, how will the need to maintain the functioning of artificial organs over an extended period affect patients and their doctors and the responsibilities of those who manufacture such devices? Drawing on lessons from the history of the cardiac pacemaker, this article offers an initial survey of the ethical issues posed by the need to maintain and service artificial organs...
November 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27872117/protocol-for-a-multicentre-randomised-feasibility-trial-evaluating-early-surgery-alone-in-low-rectal-cancer-sailor
#11
Dean A Harris, Kymberley Thorne, Hayley Hutchings, Saiful Islam, Gail Holland, Olivia Hatcher, Sarah Gwynne, Ian Jenkins, Peter Coyne, Michael Duff, Melanie Feldman, Des C Winter, Simon Gollins, Phil Quirke, Nick West, Gina Brown, Deborah Fitzsimmons, Alan Brown, John Beynon
INTRODUCTION: There are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT...
November 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27864253/macquarie-surgical-innovation-identification-tool-msiit-a-study-protocol-for-a-usability-and-pilot-test
#12
Brette Blakely, Amanda Selwood, Wendy A Rogers, Robyn Clay-Williams
INTRODUCTION: Medicine relies on innovation to continually improve. However, innovation is potentially risky, and not all innovations are successful. Therefore, it is important to identify innovations prospectively and provide support, to make innovation as safe and effective as possible. The Macquarie Surgical Innovation Identification Tool (MSIIT) is a simple checklist designed as a practical tool for hospitals to identify planned surgical innovations. This project aims to test the usability and pilot the use of the MSIIT in a surgical setting...
November 18, 2016: BMJ Open
https://www.readbyqxmd.com/read/27864247/impact-of-a-pharmacist-delivered-discharge-and-follow-up-intervention-for-patients-with-acute-coronary-syndromes-in-qatar-a-study-protocol-for-a-randomised-controlled-trial
#13
Amani Zidan, Ahmed Awaisu, Nadir Kheir, Ziyad Mahfoud, Rasha Kaddoura, Sumaya AlYafei, Maguy Saffouh El Hajj
INTRODUCTION: Acute coronary syndrome (ACS) is one of the leading causes of morbidity and mortality worldwide. Secondary cardiovascular risk reduction therapy (consisting of an aspirin, a β-blocker, an ACE inhibitor or an angiotensin II receptor blocker and a statin) is needed for all patients with ACS. Less than 80% of patients with ACS in Qatar use this combination after discharge. This study is aimed to evaluate the effectiveness of clinical pharmacist-delivered intervention at discharge and tailored follow-up postdischarge on decreasing hospital readmissions, emergency department (ED) visits and mortality among patients with ACS...
November 18, 2016: BMJ Open
https://www.readbyqxmd.com/read/27861396/surgical-treatments-on-adult-tethered-cord-syndrome-a-retrospective-study
#14
Jun Gao, Xiangyi Kong, Zhimin Li, Tianyu Wang, Yongning Li
To investigate effects of surgical treatment on adult tethered cord syndrome (TCS).A retrospective analysis of 82 adult patients (17 male cases, 82% and 24 female cases, 59%) with TCS treated by surgery was conducted between March, 2005 and December, 2015, with an average age of 31.6 years and average disease course of 6.7 years. All the 82 cases of patients received nerve electrophysiology monitoring assisted microsurgery. After surgery, all patients were followed up for an average of 2.5 years. Surgical effects were evaluated according to Hoffman grading system...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27858187/duodeno-duodenostomy-or-duodeno-jejunostomy-for-duodenal-atresia-is-one-repair-better-than-the-other
#15
Augusto Zani, Jung-Pin Benjamin Yeh, Sebastian K King, Priscilla P L Chiu, Paul W Wales
PURPOSE: The surgical management of neonates with duodenal atresia (DA) involves re-establishment of intestinal continuity, either by duodeno-duodenostomy (DD) or by duodeno-jejunostomy (DJ). Although the majority of pediatric surgeons perform DD repair preferentially, we aimed to analyze the outcome of DA neonates treated with either surgical technique. METHODS: Following ethical approval (REB:1000047737), we retrospectively reviewed the charts of all patients who underwent DA repair between 2004 and 2014...
November 17, 2016: Pediatric Surgery International
https://www.readbyqxmd.com/read/27856651/flat-detector-computed-tomography-pbv-map-in-the-evaluation-of-presurgical-embolization-for-hypervascular-brain-tumors
#16
Li-Li Wen, Xin Zhang, Qing-Rong Zhang, Qi Wu, Shu-Juan Chen, Jin-Long Deng, Kaiyi Huang, Han-Dong Wang
BACKGROUND: Preoperative embolization of hypervascular brain tumors is frequently used to minimize intraoperative bleeding. OBJECTIVE: To explore the efficacy of embolization using flat-detector CT (FDCT) parenchymal blood volume (PBV) maps before and after the intervention. MATERIALS AND METHODS: Twenty-five patients with hypervascular brain tumors prospectively received pre- and postprocedural FDCT PBV scans using a biplane system under a protocol approved by the institutional research ethics committee...
November 17, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27855184/the-influence-of-isoflurane-anaesthesia-on-the-rat-grimace-scale
#17
Amy L Miller, Huw D R Golledge, Matthew C Leach
Over 234,000 rats were used in regulated procedures in the UK in 2014, many of which may have resulted in some degree of pain. When using animals in research, there is an ethical and legal responsibility to alleviate or at least reduce pain to an absolute minimum. To do this, we must be able to effectively assess pain in an accurate and timely manner. The Rat Grimace Scale (RGS) is a pain assessment tool, which is suggested to be both accurate and rapid in pain assessment. Many procedures involve the use of general anaesthesia...
2016: PloS One
https://www.readbyqxmd.com/read/27855106/the-ibra-2-immediate-breast-reconstruction-and-adjuvant-therapy-audit-study-protocol-for-a-prospective-national-multicentre-cohort-study-to-evaluate-the-impact-of-immediate-breast-reconstruction-on-the-delivery-of-adjuvant-therapy
#18
Rajiv Dave, Rachel O'Connell, Tim Rattay, Zoe Tolkien, Nicola Barnes, Joanna Skillman, Paula Williamson, Elizabeth Conroy, Matthew Gardiner, Adrian Harnett, Ciara O'Brien, Jane Blazeby, Shelley Potter, Chris Holcombe
INTRODUCTION: Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes. High-quality evidence, however, is lacking. iBRA-2 is a national prospective multicentre cohort study that aims to investigate the effect of IBR on the delivery of adjuvant therapy. METHODS AND ANALYSIS: Breast and plastic surgery centres in the UK performing mastectomy with or without (±) IBR will be invited to participate in the study through the trainee research collaborative network...
October 7, 2016: BMJ Open
https://www.readbyqxmd.com/read/27849434/less-invasive-phenotype-found-in-isocitrate-dehydrogenase-mutated-glioblastomas-than-in-isocitrate-dehydrogenase-wild-type-glioblastomas-a-diffusion-tensor-imaging-study
#19
Stephen J Price, Kieren Allinson, Hongxiang Liu, Natalie R Boonzaier, Jiun-Lin Yan, Victoria C Lupson, Timothy J Larkin
Purpose To explore the diffusion-tensor (DT) imaging-defined invasive phenotypes of both isocitrate dehydrogenase (IDH-1)-mutated and IDH-1 wild-type glioblastomas. Materials and Methods Seventy patients with glioblastoma were prospectively recruited and imaged preoperatively. All patients provided signed consent, and the local research ethics committee approved the study. Patients underwent surgical resection, and tumor samples underwent immunohistochemistry for IDH-1 R132H mutations. DT imaging data were coregistered to the anatomic magnetic resonance study and reconstructed to provide the anisotropic and isotropic components of the DT...
November 16, 2016: Radiology
https://www.readbyqxmd.com/read/27849121/reproductive-prognosis-in-women-with-endometriosis-after-conservative-surgery-a-single-center-experience
#20
Maria C Cesana, Luisa Ferrari, Paolo Passoni, Serena Polizzi, Federica Brunetti, Rodolfo Milani
BACKGROUND: To evaluate the reproductive prognosis in women subjected to conservative surgical treatment for endometriosis seeking pregnancy during the first three years after surgery. We tried to identify operative findings which negative influences prognosys. METHODS: We retrospectively analysed 140 patients with a diagnosis of endometriosis, based on surgical and histological criteria and without other male or female infertility factors who underwent surgery between 01/2002 and 01/2012...
November 16, 2016: Minerva Ginecologica
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