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Essential Surgical Knowledge

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1843 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/28082010/perioperative-feedback-in-surgical-training-a-systematic-review
#1
REVIEW
Katherine M McKendy, Yusuke Watanabe, Lawrence Lee, Elif Bilgic, Ghada Enani, Liane S Feldman, Gerald M Fried, Melina C Vassiliou
BACKGROUND: Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. METHODS: A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period...
December 26, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/26734967/sigmoid-colectomy-for-acute-diverticulitis-in-immunosuppressed-vs-immunocompetent-patients-outcomes-from-the-acs-nsqip-database
#2
Ahmed Al-Khamis, Jad Abou Khalil, Marie Demian, Nancy Morin, Carol-Ann Vasilevsky, Philip H Gordon, Marylise Boutros
BACKGROUND: The management of acute diverticulitis in immunosuppressed patients is increasingly debated. The appropriate timing and type of operation remains controversial. OBJECTIVE: This study examines the impact of immunosuppression on mortality and morbidity following colectomies for diverticulitis in the emergency and elective settings. DESIGN SETTINGS: With the use of the American College of Surgeons National Surgical Quality Improvement Program database, the outcomes of immunosuppressed compared with immunocompetent patients who underwent colectomy for acute diverticulitis were compared...
February 2016: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28059832/preoperative-disclosure-of-surgical-trainee-involvement-pandora-s-box-or-an-opportunity-for-enlightenment
#3
Brandon M Wojcik, Roy Phitayakorn, Keith D Lillemoe, David C Chang, John T Mullen
No abstract text is available yet for this article.
January 4, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28043693/preoperative-biliary-stenting-versus-operation-first-in-jaundiced-patients-due-to-malignant-lesions-in-the-pancreatic-head-a-meta-analysis-of-current-literature
#4
REVIEW
Florian Scheufele, Stephan Schorn, Ihsan Ekin Demir, Mine Sargut, Elke Tieftrunk, Lenika Calavrezos, Carsten Jäger, Helmut Friess, Güralp Onur Ceyhan
BACKGROUND: Obstructive jaundice is a common presenting symptom among patients with pancreatic cancer. While benefits of preoperative biliary drainage have been suggested by previous studies, recent evidence has shown no significant improvements of preoperative biliary drainage on the postoperative outcome but rather an increase of complications. There is no clear consensus on whether to treat malignant obstructive jaundice with preoperative biliary drainage prior to operative intervention or to proceed directly to resection...
December 30, 2016: Surgery
https://www.readbyqxmd.com/read/27522622/lactic-acidosis-an-update
#5
Jansen Seheult, Gerard Fitzpatrick, Gerard Boran
Lactate is one of the most crucial intermediates in carbohydrate and nonessential amino acid metabolism. The complexity of cellular interactions and metabolism means that lactate can be considered a waste product for one cell but a useful substrate for another. The presence of elevated lactate levels in critically ill patients has important implications for morbidity and mortality. In this review, we provide a brief outline of the metabolism of lactate, the pathophysiology of lactic acidosis, the clinical significance of D-lactate, the role of lactate measurement in acutely ill patients, the methods used to measure lactate in blood or plasma and some of the methodological issues related to interferences in these assays, especially in the case of ethylene glycol poisoning...
August 15, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28045663/caustic-ingestion
#6
REVIEW
Mircea Chirica, Luigi Bonavina, Michael D Kelly, Emile Sarfati, Pierre Cattan
Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation...
October 26, 2016: Lancet
https://www.readbyqxmd.com/read/28054192/five-year-actual-overall-survival-in-resected-pancreatic-cancer-a-contemporary-single-institution-experience-from-a-multidisciplinary-perspective
#7
Vincent J Picozzi, Stephen Y Oh, Alicia Edwards, Margaret T Mandelson, Russell Dorer, Flavio G Rocha, Adnan Alseidi, Thomas Biehl, L William Traverso, William S Helton, Richard A Kozarek
BACKGROUND: Successful surgical resection combined with effective perioperative therapy is essential for maximizing long-term survival for pancreatic adenocarcinoma. PATIENTS AND METHODS: All patients with pancreatic adenocarcinoma who underwent curative resection at our institution from January 2003 to May 2010 were reviewed. Demographic and clinical details were retrospectively collected from medical records and cancer registry data. RESULTS: Overall, 176 patients were included in the analysis (148 with de novo resectable disease and 28 with borderline resectable disease at presentation)...
January 4, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28032576/informing-the-process-of-consent-for-surgery-identification-of-key-constructs-and-quality-factors
#8
N Mark Bagnall, Philip H Pucher, Maximilian J Johnston, Sonal Arora, Thanos Athanasiou, Omar Faiz, Lord Ara Darzi
BACKGROUND: Informed consent is a fundamental requirement of any invasive procedure. Failure to obtain appropriate and informed consent may result in unwanted or unnecessary procedures, as well as financial penalty in case of litigation. The aim of this study was to identify key constructs of the consent process which might be used to determine the performance of clinicians taking informed consent in surgery. METHODS: A multimodal methodology was used. A systematic review was conducted in accordance with PRISMA guidelines to identify evidence-based components of the consent process...
October 7, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/28034499/an-outlook-on-precision-surgery
#9
EDITORIAL
M E Lidsky, M I D'Angelica
No abstract text is available yet for this article.
December 13, 2016: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27914655/crohn-s-disease
#10
REVIEW
Joana Torres, Saurabh Mehandru, Jean-Frédéric Colombel, Laurent Peyrin-Biroulet
Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract, with increasing incidence worldwide. Crohn's disease might result from a complex interplay between genetic susceptibility, environmental factors, and altered gut microbiota, leading to dysregulated innate and adaptive immune responses. The typical clinical scenario is a young patient presenting with abdominal pain, chronic diarrhoea, weight loss, and fatigue. Assessment of disease extent and of prognostic factors for complications is paramount to guide therapeutic decisions...
November 30, 2016: Lancet
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#11
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27973673/prevalence-and-causes-of-attrition-among-surgical-residents-a-systematic-review-and-meta-analysis
#12
Zeyad Khoushhal, Mohamad A Hussain, Elisa Greco, Muhammad Mamdani, Subodh Verma, Ori Rotstein, Andrea C Tricco, Mohammed Al-Omran
Importance: Attrition of residents from general surgery training programs is relatively high; however, there are wide discrepancies in the prevalence and causes of attrition reported among surgical residents in previous studies. Objective: To summarize the estimate of attrition prevalence among general surgery residents. Data Sources: We searched the Medline, EMBASE, Cochrane, PsycINFO, and ERIC databases (January 1, 1946, to October 22, 2015) for studies reporting on the prevalence and causes of attrition in surgical residents, as well as the characteristics and destinations of residents who left general surgery training programs...
December 14, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27931635/complications-of-percutaneous-endoscopic-gastrostomy
#13
REVIEW
Tomas Hucl, Julius Spicak
Percutaneous endoscopic gastrostomy (PEG) has become the method of choice for mid-to long-term enteral feeding. The majority of complications that occur are minor, but the rare major complications may be life threatening. Some complications occur soon after tube placement, others develop later, when the gastrostomy tract has matured. Older patients with comorbidities and infections appear to be at a greater risk of developing complications. Apart from being aware of indications and contraindications, proper technique of PEG placement, including correct positioning of the external fixation device, and daily tube care are important preventive measures...
October 2016: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/27989954/finding-the-evidence-in-real-world-evidence-moving-from-data-to-information-to-knowledge
#14
Richard L Schilsky
No abstract text is available yet for this article.
January 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27979478/risk-factors-for-superficial-surgical-site-infection-after-elective-rectal-cancer-resection-a-multivariate-analysis-of-8880-patients-from-the-american-college-of-surgeons-national-surgical-quality-improvement-program-database
#15
Elie Sutton, Hiromichi Miyagaki, Geoffrey Bellini, H M C Shantha Kumara, Xiaohong Yan, Brett Howe, Amanda Feigel, Richard L Whelan
BACKGROUND: Superficial surgical site infection (sSSI) is one of the most common complications after colorectal resection. The goal of this study was to determine the comorbidities and operative characteristics that place patients at risk for sSSI in patients who underwent rectal cancer resection. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried (via diagnosis and Current Procedural Terminology codes) for patients with rectal cancer who underwent elective resection between 2005 and 2012...
January 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/27965134/national-rise-of-primary-pancreatic-carcinoid-tumors-comparison-to-functional-and-non-functional-pancreatic-neuroendocrine-tumors
#16
Gyulnara G Kasumova, Omidreza Tabatabaie, Mariam F Eskander, Abhishek Tadikonda, Sing Chau Ng, Jennifer F Tseng
BACKGROUND: New guidelines recommend differentiating between carcinoid and pancreatic neuroendocrine tumors (PNETs) during clinical trials. However, little is known about the behavior and incidence of primary pancreatic carcinoid tumors. STUDY DESIGN: Retrospective cohort study utilizing the National Cancer Data Base (NCDB) to identify adults with primary PNETs diagnosed between 2004 and 2013. The Kaplan-Meier method was used to evaluate overall survival and multivariate Cox proportional hazards model was used to assess the hazard of death in resected patients...
December 10, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27884254/troponin-testing-for-clinicians
#17
REVIEW
John E Brush, Sanjay Kaul, Harlan M Krumholz
The analytical performance of troponin assays has improved markedly in the last 2 decades. The variety of assays, their evolution over time, and their critical importance in influencing care, mandates the need for skills in their use. There are 3 critical elements necessary for optimal use of troponin testing in clinical care, as follows: 1) the analytical performance of the assay; 2) the clinical sensitivity and specificity of the test result; and 3) the clinical reasoning for ordering and the proper clinical context for interpreting the test result...
November 29, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27914657/ulcerative-colitis
#18
REVIEW
Ryan Ungaro, Saurabh Mehandru, Patrick B Allen, Laurent Peyrin-Biroulet, Jean-Frédéric Colombel
Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, dysregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings...
November 30, 2016: Lancet
https://www.readbyqxmd.com/read/27915053/american-college-of-surgeons-and-surgical-infection-society-surgical-site-infection-guidelines-2016-update
#19
REVIEW
Kristen A Ban, Joseph P Minei, Christine Laronga, Brian G Harbrecht, Eric H Jensen, Donald E Fry, Kamal M F Itani, E Patchen Dellinger, Clifford Y Ko, Therese M Duane
No abstract text is available yet for this article.
January 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27926563/truth-in-reporting-how-data-capture-methods-obfuscate-actual-surgical-site-infection-rates-within-a-health-care-network-system
#20
Liliana Bordeianou, Christy E Cauley, Donna Antonelli, Sarah Bird, David Rattner, Matthew Hutter, Sadiqa Mahmood, Deborah Schnipper, Marc Rubin, Ronald Bleday, Pardon Kenney, David Berger
BACKGROUND: Two systems measure surgical site infection rates following colorectal surgeries: the American College of Surgeons National Surgical Quality Improvement Program and the Centers for Disease Control and Prevention National Healthcare Safety Network. The Centers for Medicare & Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons. OBJECTIVE: This study aimed to compare database concordance...
January 2017: Diseases of the Colon and Rectum
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