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Surgical ethics

Ashok Kumar Saxena, Geetanjali T Chilkoti, Anand K Chopra, Basu Dev Banerjee, Tusha Sharma
BACKGROUND: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. METHODS: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included...
October 2016: Korean Journal of Pain
Christina A Minami, David D Odell, Karl Y Bilimoria
No abstract text is available yet for this article.
October 12, 2016: JAMA Surgery
Larry R Churchill
Moral virtues are the complement to ethical principles. They constitute the elements of character that drive habits and daily routines. Certain virtues are especially important in surgery, shaping surgical practice even when no big decisions are at hand. Eight virtues are described and the work they do is explored: trustworthiness, equanimity, empathy, advocacy, compassion, courage, humility, and hope.
September 17, 2016: Journal of Thoracic and Cardiovascular Surgery
Jacques Balayla
The uterine transplant is an innovative surgical procedure whereby a healthy uterus is transplanted into a woman with uterine factor infertility (UFI) for the purpose of procreation. Twelve uterine transplants have been attempted in the world in the last two decades, and five have led to viable births. While uterine transplantation is still in its experimental stages, it remains unclear whether Canadian centres plan to attempt the procedure in the near future. Herein, I raise several observations that are specific to the Canadian setting and apply the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation to determine whether there is fertile ground for a uterine transplantation program to be adopted in Canada...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Manoj Kumar Sahu, Anuradha Singal, Ramesh Menon, Sarvesh Pal Singh, Alka Mohan, Mala Manral, Divya Singh, V Devagouru, Sachin Talwar, Shiv Kumar Choudhary
BACKGROUND AND OBJECTIVES: Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery...
October 2016: Annals of Cardiac Anaesthesia
Martin Hua, Tristan Boonstra, Patrick J Kelly, Andrew Wilson, Jonathan C Craig, Angela C Webster
OBJECTIVES: The Medical Services Advisory Committee (MSAC) makes recommendations to the Australian Government for funding health technologies under the Medicare Benefits Schedule (MBS). Differences in public, clinical, commercial, and political opinions on health expenditure emphasize the importance of defensible funding decisions. We aimed to evaluate the quality of health technology assessment (HTA) reports over time and among health technologies assessed for MSAC. MAIN OUTCOME MEASURES: A cohort study was performed of HTA reports prepared for MSAC between 1998 and 2013...
October 3, 2016: International Journal of Technology Assessment in Health Care
Marc Dilauro, Matthew D F McInnes, Nicola Schieda, Ania Z Kielar, Raman Verma, Cynthia Walsh, Andrey Vizhul, William Petrcich, Joseph Mamazza
Purpose To evaluate the accuracy of computed tomography (CT) for diagnosis of internal hernia (IH) in patients who have undergone laparoscopic Roux-en-Y gastric bypass and to develop decision tree models to optimize diagnostic accuracy. Materials and Methods This was a retrospective, ethics-approved study of patients who had undergone laparoscopic Roux-en-Y gastric bypass with surgically confirmed IH (n = 76) and without IH (n = 78). Two radiologists independently reviewed each examination for the following previously established CT signs of IH: mesenteric swirl, small-bowel obstruction (SBO), mushroom sign, clustered loops, hurricane eye, small bowel behind the superior mesenteric artery, and right-sided anastomosis...
September 30, 2016: Radiology
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller
Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults...
September 7, 2016: World Journal of Gastroenterology: WJG
Nancy Berlinger, Elizabeth Dietz
Participation in patient safety is one concrete expression of a foundational principle of medical ethics: do no harm. Being an ethical professional requires taking action to prevent harm to patients in health care environments. Checklists and time-outs have become common patient safety tools in the US and other nations. While their use can support ethical practice, recent research has revealed their limitations and has underscored the importance of interpersonal collaboration in developing and using these patient safety tools...
2016: AMA Journal of Ethics
Nicola Di Lorenzo, Livia Cenci, Massimiliano Simi, Claudio Arcudi, Valeria Tognoni, Achille Lucio Gaspari, Pietro Valdastri
BACKGROUND: Minimally invasive surgery (MIS) is rising in popularity generating a revolution in operative medicine during the past few decades. Although laparoscopic techniques have not significantly changed in the last 10 years, several advances have been made in visualization devices and instrumentation. METHODS: Our team, composed of surgeons and biomedical engineers, developed a magnetic levitation camera (MLC) with a magnetic internal mechanism dedicated to MIS...
September 22, 2016: Surgical Endoscopy
Manuel R G Carrapato, Ana M Ferreira, Tuangsit Wataganara
Cesarean sections (CS) have greatly increased and many reasons are often evoked. Safer anesthetics and surgical procedures have rendered CS a popular choice for both professionals and mothers alike. CS on maternal request, for nonmedical reasons, is the subject of scientific, legal and ethical dispute. We shall address the CS issues, primarily, from the pediatrician's point of view. The immediate neonatal problems of the more mature neonate are well recognized. For preterm birth, contradictory results on mid- and long-term outcomes do not confirm the earlier reports on neonatal advantages of CS over vaginal delivery; therefore, their mode of delivery should be based on individual circumstances...
October 16, 2016: Journal of Maternal-fetal & Neonatal Medicine
Lauren Wallace, Nicholas Raison, Faisal Ghumman, Aidan Moran, Prokar Dasgupta, Kamran Ahmed
BACKGROUND: There is a need for new approaches to surgical training in order to cope with the increasing time pressures, ethical constraints, and legal limitations being placed on trainees. One of the most interesting of these new approaches is "cognitive training" or the use of psychological processes to enhance performance of skilled behaviour. Its ability to effectively improve motor skills in sport has raised the question as to whether it could also be used to improve surgical performance...
September 19, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Szilard Szucs, David Jessop, Gabriella Iohom, George D Shorten
BACKGROUND: Fractured neck of femur is a common cause of hospital admission in the elderly and usually requires operative fixation. In a variety of clinical settings, preoperative glucocorticoid administration has improved analgesia and decreased opioid consumption. Our objective was to define the postoperative analgesic efficacy of single dose of dexamethasone administered preoperatively in patients undergoing operative fixation of fractured neck of femur. METHODS: Institutional ethical approval was granted and written informed consent was obtained from each patient...
2016: BMC Anesthesiology
James Anaissie, Faysal A Yafi, Wayne J G Hellstrom
Premature ejaculation (PE) is considered the most common male sexual disorder, affecting up to 75% of men at some point in their lives. While medical management is the mainstay of therapy, surgical options such as dorsal nerve neurectomy (DNN), hyaluronic acid (HA) gel glans penis augmentation, and circumcision have been studied as alternative forms of treatment. Preliminary studies have suggested that DNN and HA gel glans penis augmentation are relatively safe and effective, but due to a lack of large, multicenter, randomized-control trials with long-term follow-up, the International Society of Sexual Medicine (ISSM) has been unable to endorse DNN or HA gel glans penis augmentation as options in the treatment of PE...
August 2016: Translational Andrology and Urology
Ghazi Chammout, Olle Muren, Henrik Bodén, Mats Salemyr, Olof Sköldenberg
BACKGROUND: Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). But controversy still exists regarding using cemented or uncemented stem in these patients. The aim of this study is to compare a cemented and uncemented femoral stem in patients 65-79 years treated surgically with THR for displaced FNF. METHODS/DESIGN: In a single-centre, single-blinded, randomized controlled trial, we will include 140 patients aged 65-79 years with an acute displaced FNF and randomize them in a 1:1 ratio to a cemented tapered or a uncemented tapered hydroxyapatite - coated femoral stem...
2016: BMC Musculoskeletal Disorders
Santiago de la Garza, Vania Phuoc, Steven Throneberry, Jennifer Blumenthal-Barby, Laurence McCullough, John Coverdale
OBJECTIVE: One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. METHODS: PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes...
September 19, 2016: Academic Psychiatry
Karina J Lewis, Leo Ross, Michel W Coppieters, Bill Vicenzino, Annina B Schmid
INTRODUCTION: Carpal tunnel syndrome (CTS) is a prevalent upper limb condition that results in significant individual and socioeconomic costs. Large patient numbers, long outpatient waiting times and traditional referral pathways in public health systems create delays in accessing treatment for this condition. Alternative care pathways aimed at streamlining access to treatment and reducing the need for surgical intervention warrant further investigation. METHODS: A randomised, single-blind controlled clinical trial will be conducted...
2016: BMJ Open
Guy Lin, Tal Marom, David Dagan, Ofer Merin
No abstract text is available yet for this article.
September 8, 2016: World Journal of Surgery
Michael Cheng, Janelle Nassim, Ario Angha, Krisna Srey, Alexander Canales, Chauniqua Kiffin, Yessin Ashmawy, Andrew A Rosenthal
Factor XIII deficiency is a rare inherited coagulopathy. Factor XIII is the last clotting factor in the coagulation cascade to insure strength and stability to fibrin clots. Without this enzyme, the fibrous clot is unstable and nonresistant to fibrinolysis. Gravid women with this congenital disease are especially at risk for complications including miscarriages and hemorrhage without appropriate interventions. We present a case of a woman in her 20s with Factor XIII deficiency who was treated with cryoprecipitate and had a successful normal spontaneous vaginal delivery; subsequently, patient suffered from postpartum hemorrhage and consumptive coagulopathy due to consumption of Factor XIII, requiring emergency surgical intervention...
2016: Case Reports in Obstetrics and Gynecology
Prateek Agarwal, Christina E Sarris, Yehuda Herschman, Nitin Agarwal, Antonios Mammis
Schizophrenia is a chronic and progressive psychiatric disease that remains difficult to manage in the 21st century. Current medical therapies have been able to give reprieve and decrease incidence of psychotic episodes. However, as the disease progresses, patients can become ever more refractory to current pharmaceutical agents and the polypharmacy that is attempted in treatment. Additionally, many of these drugs have significant adverse effects, leaving the practitioner in a difficult predicament for treating these patients...
September 12, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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