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Surgical ethics

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https://www.readbyqxmd.com/read/28530118/readmission-to-intensive-care-unit-incidence-risk-factors-resource-use-and-outcomes-a-retrospective-cohort-study
#1
Carolina R Ponzoni, Thiago D Corrêa, Roberto R Filho, Ary Serpa Neto, Murillo Sc Assunção, Andreia Pardini, Guilherme Pp Schettino
RATIONALE: Readmission to intensive care unit (ICU) is associated with poor clinical outcomes, increased length of ICU and hospital stay and higher costs. Nevertheless, knowledge on epidemiology of ICU readmissions, risk factors and attributable outcomes are restricted to developed countries. OBJECTIVES: Determine the effect of ICU readmissions on in-hospital mortality, incidence of ICU readmissions, identify predictors of ICU readmissions and hospital mortality and compare resource use and outcomes between readmitted and nonreadmitted patients in a developing country...
May 21, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28529421/should-advertising-by-aesthetic-surgeons-be-permitted
#2
Neeraj Nagpal
Cosmetic, aesthetic and cutaneous surgical procedures require qualified specialists trained in the various procedures and competent to handle complications. However, it also requires huge investments in terms of infrastructure, trained staff and equipment. To be viable advertising is essential to any establishment which provides cosmetic and aesthetic procedures. Business men with deep pockets establish beauty chains which also provide these services and advertise heavily to sway public opinion in their favour...
January 2017: Journal of Cutaneous and Aesthetic Surgery
https://www.readbyqxmd.com/read/28515933/evaluation-of-a-multiprofessional-nonsurgical-obesity-treatment-program-which-parameters-indicated-life-style-changes-and-weight-loss
#3
Pjanic, Roland Müller, Markus Laimer, Niels Hagenbuch, Kurt Laederach, Zeno Stanga
BACKGROUND: According to the current evidence, behavior modifications are an effective part of a non-surgical multiprofessional obesity treatment program (MOTP). The purpose of the present study was to report changes in weight as well in psychological variables during a one year MOTP. We aimed to identify the associations of emotional state and patients' emotion regulation skills with weight change. METHODS: Prospective interventional study. Data of participants attending the one year obesity treatment in either a group or individual structured MOTP were analyzed...
2017: Journal of Eating Disorders
https://www.readbyqxmd.com/read/28511969/the-current-role-of-decompressive-craniectomy-for-severe-traumatic-brain-injury
#4
REVIEW
S Honeybul, K M Ho, C R P Lind, G R Gillett
There is little doubt that decompressive craniectomy can reduce mortality however, the results of a recent study has provided more evidence to inform the debate regarding clinical and ethical concerns that it merely converts death into survival with severe disability or in a vegetative state. The recently published RESCUEicp trial compared last-tier secondary decompressive craniectomy with continued medical management for refractory intracranial hypertension after severe traumatic brain injury. Patients were randomly assigned to decompressive craniectomy with medical therapy or to receive continued medical therapy with the option of adding barbiturates...
May 13, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28501657/effects-of-mentorship-on-graduating-vascular-surgery-trainees
#5
Matthew R Smeds, Cindy Huynh, Carol R Thrush, Mohammed M Moursi, Kwame S Amankwah
OBJECTIVE: Mentorship within surgery, particularly vascular surgery, has not been extensively evaluated. This study sought to examine mentorship experiences in graduating vascular trainees. METHODS: An anonymous electronic survey examining current mentor relationships, ideal characteristics, academic productivity and operative comfort level was emailed to all U.S. graduating 2015 (n=141) and 2016 (n=144) vascular trainees (VTs) during their last year of training...
May 10, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28500021/thoracic-surgery-information-on-the-internet-a-multilingual-quality-assessment
#6
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/28496077/-surgical-training-utilizing-swine-under-general-anesthesia-and-animal-ethics
#7
Yuko Iki, Masafumi Noda, Katsuyoshi Kudoh, Teruko Sueta, Masahiko Kanehira, Takuya Ito, Yasushi Matsuda, Yoshinori Okada, Michiaki Unno
A cross-sectional study is conducted with primary residents attended wet labs at Tohoku University Hospital Advanced Medical Training Center in order to investigate the efficacy of the training, especially focused on the animal ethics. The 41 participants answered questionnaires in regard to non-technical skills, technical skills and ethics before and after the practice. To identify differences in each ethical question between 2 time points, Wilcoxon signed ranks test was used because the data was not normally distributed...
May 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28495809/comparison-of-enteral-versus-intravenous-potassium-supplementation-in-hypokalaemia-in-paediatric-patients-in-intensive-care-post-cardiac-surgery-open-label-randomised-equivalence-trial-eips
#8
Naveed Ur Rehman Siddiqu, Quratulain Merchant, Babar S Hasan, Arjumand Rizvi, Muneer Amanullah, Amina Rehmat, Anwarul Ul Haq
OBJECTIVES: The primary objective was to compare the efficacy of enteral potassium replacement (EPR) and intravenous potassium replacement (IVPR) as first-line therapy. Secondary objectives included comparison of adverse effects and number of doses required to resolve the episode of hypokalaemia. TRIAL DESIGN: The EIPS trial is designed as a randomised, equivalence trial between two treatment arms. STUDY SETTING: The study was conducted at the paediatric cardiac intensive care unit (PCICU) at Aga Khan University Hospital, Karachi...
May 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28494906/the-effect-of-morphine-added-to-bupivacaine-in-ultrasound-guided-transversus-abdominis-plane-tap-block-for-postoperative-analgesia-following-lower-abdominal-cancer-surgery-a-randomized-controlled-study
#9
Fatma Adel El Sherif, Sahar Abdel-Baky Mohamed, Shereen Mamdouh Kamal
OBJECTIVES: Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower abdominal cancer surgery. STUDY DESIGN: Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096. SETTING: Academic medical center...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28487877/preoperative-fasting-among-adult-patients-for-elective-surgery-in-a-kenyan-referral-hospital
#10
George Njoroge, Lucy Kivuti-Bitok, Samuel Kimani
Background. Preoperative fasting (POF) is physiologically and precautionary important during anesthesia and surgery. POF from midnight has been practiced despite the recommended shorter practice. Objective. Assessing preoperative fasting among adult patients scheduled for elective surgery at Kenyatta National Hospital (KNH). Methods. A descriptive cross-sectional study involving 65 surgical patients. A questionnaire of mixed questions on demographics, reasons, source of instructions, opinion on instructions, time, premedication practices, outcome, and complains on NPO was used...
2017: International Scholarly Research Notices
https://www.readbyqxmd.com/read/28487456/deriving-literature-based-benchmarks-for-surgical-complications-in-high-income-countries-a-protocol-for-a-systematic-review-and-meta-analysis
#11
Mary E Brindle, Derek J Roberts, Oluwatomilayo Daodu, Alex Bernard Haynes, Christy Cauley, Elijah Dixon, Claude La Flamme, Paul Bain, William Berry
INTRODUCTION: To improve surgical safety, health systems must identify preventable adverse outcomes and measure changes in these outcomes in response to quality improvement initiatives. This requires understanding of the scope and limitations of available population-level data. To derive literature-based summary estimates of benchmarks of care, we will systematically review and meta-analyse rates of postoperative complications associated with several common and/or high-risk operations performed in five high-income countries (HICs)...
May 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28486898/patient-and-community-attitudes-toward-perioperative-biobanking-and-genomic-research
#12
J Liddell, C Bain, P S Myles
We surveyed hospital patients and clinicians to ascertain their attitudes to the establishment of a perioperative biobank for future genomics research, and whether the requirements for an opt-out approach to consent can be met. We enrolled hospital patients (n=187), patient spouse/family members (n=64), ethics committee members (n=14), and clinical staff (doctors and nurses [n=67]), and unspecified community members (n=10). They were asked to rate and describe their views on medical research and biobanking, the need for individual consent, and the importance of confidentiality...
May 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28484927/ethical-and-legal-considerations-in-the-management-of-an-unbefriended-patient-in-a-vegetative-state
#13
Alexandra Lloyd-Smith Sequeira, Ariane Lewis
BACKGROUND: Patients without surrogates are referred to as "unbefriended." Because these patients do not have representatives to assist with medical decision-making, patient autonomy and self-determination, fundamental concepts of American healthcare, are jeopardized. METHODS: We present a case of an unbefriended patient in a vegetative state and discuss the ethical and legal complications associated with management of unbefriended patients. RESULTS: An unbefriended patient was admitted to our hospital with a cardiac arrest in the setting of an intracerebral hemorrhage...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28474243/-preoperative-fasting-period-of-fluids-in-bariatric-surgery
#14
P Simon, U-C Pietsch, R Oesemann, A Dietrich, H Wrigge
BACKROUND: Aspiration of stomach content is a severe complication during general anaesthesia. The DGAI (German Society for Anesthesiology and Intensive Care Medicine) guidelines recommend a fasting period for liquids of 2 h, with a maximum of 400 ml. Preoperative fasting can affect the patients' recovery after surgery due to insulin resistance and higher protein catabolism as a response to surgical stress. OBJECTIVES: The aim of the study was to compare a liberal fasting regimen consisting of up to 1000 ml of liquids until 2 h before surgery with the DGAI recommendation...
May 4, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28470542/a-comparative-analysis-of-a-disposable-and-a-reusable-pedicle-screw-instrument-kit-for-lumbar-arthrodesis-integrating-hta-and-mcda
#15
Claudia Ottardi, Alessio Damonti, Emanuele Porazzi, Emanuela Foglia, Lucrezia Ferrario, Tomaso Villa, Enrico Aimar, Marco Brayda-Bruno, Fabio Galbusera
OBJECTIVE: Lumbar arthrodesis is a common surgical technique that consists of the fixation of one or more motion segments with pedicle screws and rods. However, spinal surgery using these techniques is expensive and has a significant impact on the budgets of hospitals and Healthcare Systems. While reusable and disposable instruments for laparoscopic interventions have been studied in literature, no specific information exists regarding instrument kits for lumbar arthrodesis. The aim of the present study was to perform a complete health technology assessment comparing a disposable instrument kit for lumbar arthrodesis (innovative device) with the standard reusable instrument...
December 2017: Health Economics Review
https://www.readbyqxmd.com/read/28464906/adjuvant-radiotherapy-after-radical-cystectomy-for-patients-with-muscle-invasive-bladder-cancer-a-phase-ii-trial
#16
Valérie Fonteyne, Piet Dirix, Sara Junius, Elke Rammant, Piet Ost, Gert De Meerleer, Martijn Swimberghe, Karel Decaestecker
BACKGROUND: Neo-adjuvant chemotherapy followed by radical cystectomy with extended pelvic lymph node dissection is considered to be the treatment of choice for patients with muscle invasive bladder cancer (MIBC). Despite this aggressive treatment the outcome is poor and ultimately, 30% of the patients with ≥pT3 tumors develop a pelvic recurrence. We hypothesize that postoperative adjuvant external beam radiotherapy (EBRT) might prevent local and lymph node recurrence and improve disease free- and overall survival as loco-regional recurrence is linked to the development of distant metastasis...
May 2, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28456425/the-position-of-a-written-document-in-preoperative-information-for-pediatric-surgery-a-randomized-controlled-trial-on-parental-anxiety-knowledge-and-satisfaction
#17
M Landier, T Villemagne, A Le Touze, K Braïk, P Meignan, A R Cook, B Morel, H Lardy, A Binet
INTRODUCTION: Preoperative information is a legal and ethical obligation. Very little studies have evaluated the preoperative information method in pediatrics. Having a child operated on is stressful for the parents. Improving information is a way to lower their anxiety. Our study aims to measure the impact of a leaflet, which supports spoken information on parental anxiety, the comprehension-memorization of the information and their satisfaction. MATERIALS & METHODS: Prospective study including 178 patients of outpatient surgery, randomized in two groups: spoken information versus spoken information supported by a leaflet, which is then handed out to the parents...
April 21, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28446925/ethical-legal-and-clinical-aspects-of-live-surgery-in-urology-contemporary-issues-and-a-glimpse-of-the-future
#18
REVIEW
Alin Adrian Cumpanas, Ovidiu Catalin Ferician, Silviu Constantin Latcu, Catalin Pricop, Razvan Tiberiu Bardan
Beside dry and wet lab training, simulators, video tapes, fellowships and clinical visits, live surgery has gained popularity during the last years, being an attraction point at large scientific meetings and at postgraduate courses as well. This type of surgical training raises both ethical and legal issues. Thus, there are professional societies that have banned such meetings, mainly due to safety reasons for the patient. The current article aims to identify and to discuss ethical and legal issues related to the topic, advantages, disadvantages and weak points of this emerging challenge for modern medicine, trying to analyze the issues from all relevant points of view: those of the patient, the surgeon and the session attendant...
2017: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
https://www.readbyqxmd.com/read/28446164/core-information-sets-for-informed-consent-to-surgical-interventions-baseline-information-of-importance-to-patients-and-clinicians
#19
Barry G Main, Angus G K McNair, Richard Huxtable, Jenny L Donovan, Steven J Thomas, Paul Kinnersley, Jane M Blazeby
BACKGROUND: Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient's values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient...
April 26, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28445263/acupuncture-for-enhancing-early-recovery-of-bowel-function-in-cancer-protocol-for-a-systematic-review
#20
Yi-Hua Liu, Yang Ye, Jia-Bin Zheng, Xue-Qian Wang, Ying Zhang, Hong-Sheng Lin
BACKGROUND: Cancer patients undergoing surgical procedure often suffer from bowel dysfunction and postoperative ileus (POI). Cancer management for early recovery of bowel function is still a challenging topic. Acupuncture has been commonly used in a variety of gastrointestinal diseases. The aim of this study is to evaluate the effects of acupuncture therapy to reduce the duration of POI and enhance bowel function in cancer patients. METHODS: We will systematically screen all randomized controlled trials (RCTs) published through electronically and hand searching...
April 2017: Medicine (Baltimore)
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