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Savadjian AJ, Taicher BM, La JO, Podgoreanu M, Miller TE, McCartney S, Raghunathan K, Shah N, Mamoun N. Reduce intraoperative albumin utilisation in cardiac surgical patients: a quality improvement initiative. BMJ Open Qual 2024; 13:e002726. [PMID: 38663929 PMCID: PMC11043756 DOI: 10.1136/bmjoq-2023-002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Albumin continues to be used routinely by cardiac anaesthesiologists perioperatively despite lack of evidence for improved outcomes. The Multicenter Perioperative Outcomes Group (MPOG) data ranked our institution as one of the highest intraoperative albumin users during cardiac surgery. Therefore, we designed a quality improvement project (QIP) to introduce a bundle of interventions to reduce intraoperative albumin use in cardiac surgical patients. METHODS Our institutional MPOG data were used to analyse the FLUID-01-C measure that provides the number of adult cardiac surgery cases where albumin was administered intraoperatively by anaesthesiologists from 1 July 2019 to 30 June 2022. The QIP involved introduction of the following interventions: (1) education about appropriate albumin use and indications (January 2021), (2) email communications reinforced with OR teaching (March 2021), (3) removal of albumin from the standard pharmacy intraoperative medication trays (April 2021), (4) grand rounds presentation discussing the QIP and highlighting the interventions (May 2021) and (5) quarterly provider feedback (starting July 2021). Multivariable segmented regression models were used to assess the changes from preintervention to postintervention time period in albumin utilisation, and its total monthly cost. RESULTS Among the 5767 cardiac surgery cases that met inclusion criteria over the 3-year study period, 16% of patients received albumin intraoperatively. The total number of cases that passed the metric (albumin administration was avoided), gradually increased as our interventions went into effect. Intraoperative albumin utilisation (beta=-101.1, 95% CI -145 to -56.7) and total monthly cost of albumin (beta=-7678, 95% CI -10712 to -4640) demonstrated significant decrease after starting the interventions. CONCLUSIONS At a single academic cardiac surgery programme, implementation of a bundle of simple and low-cost interventions as part of a coordinated QIP were effective in significantly decreasing intraoperative use of albumin, which translated into considerable costs savings.
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Affiliation(s)
- André J Savadjian
- Anesthesiology, Duke University Health System, Durham, North Carolina, USA
| | - Brad M Taicher
- Anesthesiology, Duke University Health System, Durham, North Carolina, USA
| | - Jong Ok La
- Duke Molecular Physiology Institute, Duke University Hospital, Durham, North Carolina, USA
| | - Mihai Podgoreanu
- Anesthesiology, Duke University Health System, Durham, North Carolina, USA
| | - Timothy E Miller
- Anesthesiology, Duke University Health System, Durham, North Carolina, USA
| | - Sharon McCartney
- Anesthesiology, Duke University Health System, Durham, North Carolina, USA
| | | | - Nirav Shah
- University of Michigan, Ann Arbor, Michigan, USA
| | - Negmeldeen Mamoun
- Anesthesiology, Duke University Health System, Durham, North Carolina, USA
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Lu Y, Fang PP, Yu YQ, Cheng XQ, Feng XM, Wong GTC, Maze M, Liu XS. Effect of Intraoperative Dexmedetomidine on Recovery of Gastrointestinal Function After Abdominal Surgery in Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2128886. [PMID: 34648009 PMCID: PMC8517746 DOI: 10.1001/jamanetworkopen.2021.28886] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Postoperative ileus is common after abdominal surgery, and small clinical studies have reported that intraoperative administration of dexmedetomidine may be associated with improvements in postoperative gastrointestinal function. However, findings have been inconsistent and study samples have been small. Further examination of the effects of intraoperative dexmedetomidine on postoperative gastrointestinal function is needed. OBJECTIVE To evaluate the effects of intraoperative intravenous dexmedetomidine vs placebo on postoperative gastrointestinal function among older patients undergoing abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS This multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at the First Affiliated Hospital of Anhui Medical University in Hefei, China (lead site), and 12 other tertiary hospitals in Anhui Province, China. A total of 808 participants aged 60 years or older who were scheduled to receive abdominal surgery with an expected surgical duration of 1 to 6 hours were enrolled. The study was conducted from August 21, 2018, to December 9, 2019. INTERVENTIONS Dexmedetomidine infusion (a loading dose of 0.5 μg/kg over 15 minutes followed by a maintenance dose of 0.2 μg/kg per hour) or placebo infusion (normal saline) during surgery. MAIN OUTCOMES AND MEASURES The primary outcome was time to first flatus. Secondary outcomes were postoperative gastrointestinal function measured by the I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) scoring system, time to first feces, time to first oral feeding, incidence of delirium, pain scores, sleep quality, postoperative nausea and vomiting, hospital costs, and hospital length of stay. RESULTS Among 808 patients enrolled, 404 were randomized to receive intraoperative dexmedetomidine, and 404 were randomized to receive placebo. In total, 133 patients (60 in the dexmedetomidine group and 73 in the placebo group) were excluded because of protocol deviations, and 675 patients (344 in the dexmedetomidine group and 331 in the placebo group; mean [SD] age, 70.2 [6.1] years; 445 men [65.9%]) were included in the per-protocol analysis. The dexmedetomidine group had a significantly shorter time to first flatus (median, 65 hours [IQR, 48-78 hours] vs 78 hours [62-93 hours], respectively; P < .001), time to first feces (median, 85 hours [IQR, 68-115 hours] vs 98 hours [IQR, 74-121 hours]; P = .001), and hospital length of stay (median, 13 days [IQR, 10-17 days] vs 15 days [IQR, 11-18 days]; P = .005) than the control group. Postoperative gastrointestinal function (as measured by the I-FEED score) and delirium incidence were similar in the dexmedetomidine and control groups (eg, 248 patients [72.1%] vs 254 patients [76.7%], respectively, had I-FEED scores indicating normal postoperative gastrointestinal function; 18 patients [5.2%] vs 12 patients [3.6%] had delirium on postoperative day 3). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, the administration of intraoperative dexmedetomidine reduced the time to first flatus, time to first feces, and length of stay after abdominal surgery. These results suggest that this therapy may be a viable strategy to enhance postoperative recovery of gastrointestinal function among older adults. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR1800017232.
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Affiliation(s)
- Yao Lu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pan-Pan Fang
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yong-Qi Yu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin-Qi Cheng
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao-Mei Feng
- Department of Anesthesiology, University of Utah, Salt Lake City
| | | | - Mervyn Maze
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco
| | - Xue-Sheng Liu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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Matuszewski PE, Abbenhaus E, Chen AT, Karunakar M. The Effect of Rotation on Intraoperative Fluoroscopic Evaluation of Hindfoot Alignment and How to Help Prevent Error. Bull Hosp Jt Dis (2013) 2020; 78:250-254. [PMID: 33207146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Restoration of hindfoot alignment correlates with improved clinical and biomechanical outcomes after fracture care and reconstruction. Intraoperative assessment of alignment with fluoroscopy is challenging. This study was designed to determine the effect of rotation on the measurement of hindfoot alignment and to determine if any radiographic landmarks can be utilized to help surgeons identify appropriate rotation during intraoperative imaging. METHODS Ten unmatched cadaveric limbs that had been disarticulated at mid-tibia were used and placed supine in a radiolucent jig. Fluoroscopic images were obtained with the C-arm positioned at 45°. Images were obtained in sequential rotational adjustments from 12° of internal rotation to 12° of external rotation. The location of the fibula relative to the base of the fifth metatarsal was measured on images and recorded as an interval percentage overlap (0% to 50%, 50% to 100%, and greater than 100%). Hindfoot alignment was recorded by measuring the angle between the tibial and calcaneal axis. RESULTS Varus and valgus hindfoot alignment demon-strated a linear relationship to leg rotation (r2 = 0.998, p < 0.001). In these uninjured cadaveric specimens, 8° to 15° of internal rotation relative to the medial border of the foot produced a normal valgus angle (0° to 5°). Using 50% to 100% overlap of the fibula over the fifth metatarsal base as a radiographic test was a reliable indicator of predicted measurement, with 89% sensitivity and 99% specificity. CONCLUSIONS The measurement of hindfoot alignment changes with foot rotation. Use of the fibula overlap of the fifth metatarsal base may be a helpful tool to judge appro-priate rotation intraoperatively.
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Lanitis S, Peristeraki S, Chortis P, Gkanis V, Sourtse G, Badagionis M, Kontos M. The value of the intraoperative assessment of the SLN via frozen section in the post Z0011 era. J Gynecol Obstet Hum Reprod 2020; 50:101991. [PMID: 33238218 DOI: 10.1016/j.jogoh.2020.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Sentinel node (SN) assessment via frozen section (FS) has declined since the publication of Z0011 which modified the management of a specific group of patients with positive SN. The risk of misleading the surgeons to a preventable ALND and the cost are among the main factors for that. The aim of our study is to assess the value of FS in the post Z0011. MATERIAL AND METHODS 244 patients out of 434 were eligible for an upfront SLNB. Based on the final histology and the clinical data we selected the eligible for breast conserving surgery patients (55.4%). 78 patients had positive SN and 26 of them fulfilled the criteria of Z0011. We assessed the false negative findings, the impact on the management and the indications and value of FS in the post Z0011 era. RESULTS Overall, there were 12 FN cases out of which 7 were macrometastases (8.97%). Only in one case there were > 2 positive LN and 3 patients needed mastectomy. The remaining cases fulfilled the criteria of Z0011 and needed no further surgery hence in 96.1% of the cases the axillary status was correctly assessed via FS and the reoperation rate was 1.2%. On the contrary, if FS was not used, at least 21.3% of the patents would have needed reoperation based on the today's guidelines. DISCUSSION We believe FS is still valuable and may spare a significant percentage of patients from a second operation (SNB) without leading to axillary overtreatment if used wisely.
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Affiliation(s)
- Sophocles Lanitis
- 2nd surgical Department and unit of Surgical Oncology, "Korgialenio - Benakio", Red Cross Athens General Hospital, 1 Athanasaki and Erythrou st., Athens, 11526, Greece.
| | - Styliani Peristeraki
- 2nd surgical Department and unit of Surgical Oncology, "Korgialenio - Benakio", Red Cross Athens General Hospital, 1 Athanasaki and Erythrou st., Athens, 11526, Greece
| | - Panagiotis Chortis
- 2nd surgical Department and unit of Surgical Oncology, "Korgialenio - Benakio", Red Cross Athens General Hospital, 1 Athanasaki and Erythrou st., Athens, 11526, Greece
| | - Vasileios Gkanis
- 2nd surgical Department and unit of Surgical Oncology, "Korgialenio - Benakio", Red Cross Athens General Hospital, 1 Athanasaki and Erythrou st., Athens, 11526, Greece
| | - Gionous Sourtse
- 2nd surgical Department and unit of Surgical Oncology, "Korgialenio - Benakio", Red Cross Athens General Hospital, 1 Athanasaki and Erythrou st., Athens, 11526, Greece
| | - Miltiadis Badagionis
- 2nd surgical Department and unit of Surgical Oncology, "Korgialenio - Benakio", Red Cross Athens General Hospital, 1 Athanasaki and Erythrou st., Athens, 11526, Greece
| | - Michalis Kontos
- 1st surgical Department Laiko Hospital, University of Athens, 17 Agiou Thoma, Athens, 11527, Greece
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Abstract
Much anticipation awaits the results of the SOUND trial, (Gentilini and Veronesi in Breast 21:678-681, 2012) which may prove the futility of performing sentinel node biopsy (SNB) in low-risk breast cancer patients. However, do we really not know the answer to the questions that the SOUND trial poses already? Consideration must be taken of the very much overlooked trials predating the sentinel node era, which risk stratified patients according to the absence of palpable lymphadenopathy and without dependence upon ultrasound imaging (clinically negative axilla). This automatically selects a low-risk group of patients for axillary disease (low axillary burden) and the relevance of these critical trials is discussed.
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Affiliation(s)
- M Ahmed
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, 9th Floor (East), Pond Street, London, NW3 2QG, UK.
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Lindahl SB. Intraoperative Irrigation: Fluid Administration and Management Amidst Conflicting Evidence. AORN J 2020; 111:495-507. [PMID: 32343379 DOI: 10.1002/aorn.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgeons use irrigation during open cavity procedures to improve their view of the patient's anatomy and to reduce the patient's risk of infection. However, there are no standard guidelines that recommend a specific type of fluid, additive, or volume of irrigation to use during open procedures. Intraoperative hypothermia can occur if irrigation fluids have not been warmed or have cooled before use, causing adverse patient outcomes. In addition, failing to manage (eg, measure and document) fluid volume accurately may affect clinical decision making and cause other complications. Perioperative personnel should evaluate new technologies that may improve the efficiency and accuracy of irrigation temperature and volume measurements. More research is needed to develop standardized practice guidelines for intraoperative irrigation and fluid management.
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Abstract
Intra-operative fluid therapy (IFT) is the cornerstone of peri-operative management as it may significantly influence the treatment outcome. Therefore, we sought to evaluate nationwide clinical practice regarding IFT in Poland.A cross-sectional, multicenter, point-prevalence study was performed on April 5, 2018, in 31 hospitals in Poland. Five hundred eighty-seven adult patients undergoing non-cardiac surgery were investigated. The volume and type of fluids transfused with respect to the patient and procedure risk were assessed.The study group consisted of 587 subjects, aged 58 (interquartile range [IQR] 40-67) years, including 142 (24%) American Society of Anesthesiology Physical Status (ASA-PS) class III+ patients. The median total fluid dose was 8.6 mL kg h (IQR 6-12.5), predominantly including balanced crystalloids (7.0 mL kg h, IQR 4.9-10.6). The dose of 0.9% saline was low (1.6 mL kg h, IQR 0.8-3.7). Synthetic colloids were used in 66 (11%) subjects. The IFT was dependent on the risk involved, while the transfused volumes were lower in ASA-PS III+ patients, as well as in high-risk procedures (P < .05).The practice of IFT is liberal but is adjusted to the preoperative risk. The consumption of synthetic colloids and 0.9% saline is low.
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Lin Y, Zhou C, Liu Z, Wu K, Chen S, Wang W, Chen Y, Wang H. Room Temperature Versus Warm Irrigation Fluid Used for Patients Undergoing Arthroscopic Shoulder Surgery: A Systematic Review and Meta Analysis. J Perianesth Nurs 2020; 35:48-53. [PMID: 31564621 DOI: 10.1016/j.jopan.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/09/2019] [Accepted: 06/15/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to analyze whether warm irrigation fluid could reduce postoperative adverse effects in patients undergoing arthroscopic shoulder surgery compared with room temperature irrigation fluid. DESIGN A systematic review and meta-analysis of clinical trials was performed. METHODS A computerized search of electronic databases was performed. The inclusion criteria were studies comparing the clinical effects of room temperature and warm irrigation fluid on patients undergoing arthroscopic shoulder surgery. FINDINGS Warm irrigation fluid reduced the degree of core body temperature drop and the incidence of hypothermia. A statistically lower incidence of shivering also occurred in the warm irrigation fluid group. CONCLUSIONS The use of warm irrigation fluid better maintains core body temperature and reduces incidence of shivering than room temperature irrigation fluid. Therefore, warm irrigation fluid is a better choice for arthroscopic shoulder surgery.
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Affiliation(s)
- Youbin Lin
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Chunbin Zhou
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhaoyong Liu
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Kezhou Wu
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shubiao Chen
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Weihao Wang
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yelong Chen
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hu Wang
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
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Velasco D, Simonovich SD, Krawczyk S, Roche B. Barriers and Facilitators to Intraoperative Alternatives to Opioids: Examining CRNA Perspectives and Practices. AANA J 2019; 87:459-467. [PMID: 31920199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Opioids are the mainstay of intraoperative pain control, but they have several deleterious effects. Alternative medications and strategies to opioids, while effective in producing intraoperative analgesia, are underutilized by anesthesia providers. The purpose of this study was to examine and describe Certified Registered Nurse Anesthetists' perspectives and practices on administering opioids vs nonopioid or opioid-sparing strategies ("opioid alternatives") to treat intraoperative pain. A qualitative study design using semistructured interviews was conducted (N = 12). Study participants described their perspectives and practices on treating intraoperative pain. Two key themes emerged: (1) barriers to intraoperative opioid-alternative administration and (2) facilitators to intraoperative opioid-alternative administration. Barriers expressed by study participants included opioid superiority, inconsistent analgesic effects of intraoperative opioid alternatives, limited experience with opioid alternatives, limited resources on opioid alternatives, negative experiences with intraoperative opioid-alternative administration, and patient comorbidities. Facilitators expressed by study participants included the adverse effects of opioids, institutional policy and procedures, positive experiences with opioid-alternative administration, and regional anesthesia superiority. This study highlights the importance of improving education, training, and institutional policies in support of opioid-alternative medications and strategies to treat intraoperative pain and better prevent opioid addiction and abuse.
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Affiliation(s)
- David Velasco
- is a graduate of North-shore School of Nurse Anesthesia and is currently in clinical practice at Franciscan St Anthony in Crown Point, Indiana
| | - Shannon D Simonovich
- is an assistant professor at DePaul University School of Nursing, Chicago, Illinois
| | - Susan Krawczyk
- is a faculty member at North-Shore University HealthSystem, School of Nurse Anesthesia, in Evanston, Illinois, and a clinical CRNA at Loyola University HealthSystem in Maywood, Illinois
| | - Bernadette Roche
- is a faculty member at North-Shore University HealthSystem, School of Nurse Anesthesia, and adjunct associate professor of nursing at DePaul University School of Nursing
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Baker L, Park L, Gilbert R, Martel A, Ahn H, Davies A, McIsaac DI, Saidenberg E, Tinmouth A, Fergusson DA, Martel G. Guidelines on the intraoperative transfusion of red blood cells: a protocol for systematic review. BMJ Open 2019; 9:e029684. [PMID: 31213453 PMCID: PMC6586075 DOI: 10.1136/bmjopen-2019-029684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/22/2019] [Accepted: 05/09/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION A significant proportion of red blood cell (RBC) transfusions are administered intraoperatively; yet there is limited evidence to guide transfusion decisions in this setting. The objective of this systematic review is to explore the availability, quality and content of clinical practice guidelines (CPGs) reporting on the indication for allogenic RBC transfusion during surgery. METHODS Major electronic databases (MEDLINE, EMBASE and CINAHL), guideline clearinghouses and Google Scholar, will be systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative allogenic RBC transfusion. Characteristics of eligible guidelines will be reported in a summary table. The AGREE II instrument will be used to appraise the quality of identified guidelines. Recommendations advising on indications for intraoperative RBC transfusion will be manually extracted and presented to allow for comparison of similarities and/or discrepancies in the literature. ETHICS AND DISSEMINATION The results of this systematic review will be disseminated through relevant conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER CRD42018111487.
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Affiliation(s)
- Laura Baker
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Lily Park
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Gilbert
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Andre Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Hilalion Ahn
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandra Davies
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Elianna Saidenberg
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Division of Hematology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alan Tinmouth
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Division of Hematology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Guillaume Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
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Salgado-Filho MF, Morhy SS, Vasconcelos HDD, Lineburger EB, Papa FDV, Botelho ESL, Fernandes MR, Daher M, Bihan DL, Gatto CST, Fischer CH, Silva AAD, Galhardo Júnior C, Neves CB, Fernandes A, Vieira MLC. [Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology]. Braz J Anesthesiol 2018; 68:1-32. [PMID: 28867150 PMCID: PMC9391779 DOI: 10.1016/j.bjan.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 01/22/2023]
Abstract
Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.
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Affiliation(s)
- Marcello Fonseca Salgado-Filho
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil.
| | - Samira Saady Morhy
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Henrique Doria de Vasconcelos
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Universidade Federal do Vale da São Francisco (Univasf), Petrolina, PE, Brasil; Jonhs Hopkins University, Baltimore, EUA
| | - Eric Benedet Lineburger
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Hospital São José, Criciúma, SC, Brasil
| | - Fabio de Vasconcelos Papa
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Takaoka Anestesia, São Paulo, SP, Brasil
| | - Eduardo Souza Leal Botelho
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | - Marcelo Ramalho Fernandes
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil; Hospital Copa Star, Rio de Janeiro, RJ, Brasil
| | - Maurício Daher
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brasil
| | - David Le Bihan
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil; Hospital do Rim e Hipertensão, São Paulo, SP, Brasil; Grupo Dasa, São Paulo, SP, Brasil
| | - Chiara Scaglioni Tessmer Gatto
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto do Coração (Incor), São Paulo, SP, Brasil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Cláudio Henrique Fischer
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alexander Alves da Silva
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; São Paulo Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brasil
| | - Carlos Galhardo Júnior
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil
| | - Carolina Baeta Neves
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alexandre Fernandes
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | - Marcelo Luiz Campos Vieira
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; Instituto do Coração (Incor), São Paulo, SP, Brasil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
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12
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Khalifa MA, Salama S, Vogel RI, Klein ME, Richter J, Pulver T, Mullany SA, Winterhoff B. Assessment of the Intraoperative Consultation Service Rendered by General Pathologists in a Scenario Where a Well-Defined Decision Algorithm Is Followed. Am J Clin Pathol 2017; 147:322-326. [PMID: 28395052 DOI: 10.1093/ajcp/aqw223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Intraoperative consultation (IOC) remains an area of general practice even within subspecialized pathology departments. This study assesses the IOCs rendered in a general pathology setting where surgeons integrate these results in a well-defined algorithm, developed with the input of specialized pathologists. METHODS The surgical decisions to perform lymphadenectomy in patients with endometrial adenocarcinoma operated on at our institution between January 2003 and June 2015 as a result of the IOC assessment of tumor size, histologic grade, and depth of invasion in the hysterectomy specimen were analyzed. RESULTS Frozen section (FS) was examined in 801 cases. In comparison to permanent section analysis, FS International Federation of Gynecology and Obstetrics (FIGO) grade had an overall accuracy of 0.95 (95% confidence interval [CI], 0.93-0.98). The FS depth of invasion had an overall accuracy of 0.92 (95% CI, 0.89-0.94). FIGO grade was not documented in 47.8%, the depth of myometrial invasion in 45.2%, and tumor size in 41.8% of the pathology reports. CONCLUSIONS The high omission rate of the needed parameters by the general pathologists would question their overall understanding of the paradigm shift intended by this algorithm. Possible explanations of this phenomenon and potential solutions are discussed.
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Affiliation(s)
| | - Sherine Salama
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Molly E Klein
- From the Department of Laboratory Medicine and Pathology
| | - James Richter
- From the Department of Laboratory Medicine and Pathology
| | - Tanya Pulver
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Sally A Mullany
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Boris Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
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El Boghdady M, Tang B, Tait I, Alijani A. The effect of a simple intraprocedural checklist on the task performance of laparoscopic novices. Am J Surg 2016; 214:373-377. [PMID: 27773378 DOI: 10.1016/j.amjsurg.2016.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical checklists are used for error reduction. Checklists are infrequently applied during procedures and have been limited to lists of procedural steps as aid memoires. We aimed to study the effect of a self-administered checklist on the laparoscopic task performance of novices during a standardized task. METHODS Twenty novices were randomized into 2 equal groups, those receiving paper feedback (control group) and those receiving paper feedback and the checklist (checklist group). Subjects performed laparoscopic double knots, repeated over 5 separate stages. Human reliability assessment technique was used for error analysis. RESULTS 2,341 errors were detected during the 5 stages. During the first stage, the errors were not significantly different between the 2 groups. The checklist group committed significantly fewer errors as compared with the control group during all the later 4 stages (P < .01). CONCLUSIONS The simple intraprocedural checklist significantly improved the laparoscopic task performance and the learning curve of laparoscopic novices.
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Affiliation(s)
- Michael El Boghdady
- Cuschieri Skills Centre, Ninewells Hospital and Medical School, University of Dundee, Level 5, Dundee, UK.
| | - Benjie Tang
- Cuschieri Skills Centre, Ninewells Hospital and Medical School, University of Dundee, Level 5, Dundee, UK
| | - Iain Tait
- Cuschieri Skills Centre, Ninewells Hospital and Medical School, University of Dundee, Level 5, Dundee, UK
| | - Afshin Alijani
- Cuschieri Skills Centre, Ninewells Hospital and Medical School, University of Dundee, Level 5, Dundee, UK
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14
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Füßinger MA, Duttenhoefer F, Bittermann G, Schmelzeisen R. [Intraoperative quality management modalities in head and neck surgery]. HNO 2016; 64:650-7. [PMID: 27435274 DOI: 10.1007/s00106-016-0203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immediate intraoperative control via suitable imaging techniques is necessary to achieve the best possible surgical outcome. Intraoperative imaging increases patient safety, offers the surgeon direct support in challenging anatomic regions, and affords the possibility of direct correction with a reduced rate of corrective surgery. The procedures are based on cone beam computed tomography (CBCT), endoscopy, or navigation-assisted surgery. This article describes available intraoperative quality management modalities for fracture management and tumor treatment in the field of head and neck surgery.
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Affiliation(s)
- M A Füßinger
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - F Duttenhoefer
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - G Bittermann
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - R Schmelzeisen
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
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15
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Abstract
Between 2002 and 2005, we made 343 intraoperative frozen section diagnoses with a telepathology system, which connected a neurosurgical department to our department of pathology. An expert neuropathologist performed at least one brief gross examination, and this was followed by a smear preparation and a frozen section slide for each case. Frozen section diagnosis lasted on average 26.1 min, calculated from the beginning of gross examination until the surgeon was given the diagnosis. The majority of cases (283 or 83%) were diagnosed in 15–40 min. The mean time needed for macroscopic examination was 3.0 min, time for staining 4.2 min, smear diagnosis took 5.4 min and time for histological diagnosis 10.7 min. Telemicroscopy of a smear slide took 11 times longer compared with light microscopy, and telemicroscopy of a frozen section slide took 16 times longer than with light microscopy. In 6% of cases, the telepathology software posed technical problems, which delayed the time of diagnosis, but not by more than 4 min. We were able to render a diagnosis in all cases (system reliability 100%). After eliminating sampling errors (i.e. cases with no diagnostic material in the frozen section slides and/or in smear preparations), the diagnostic accuracy for telepathology was 97.9%.
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Affiliation(s)
- G Hutarew
- Department of Pathology, St John's Hospital of the Salzburg State Clinics and Paracelsus Medical University Salzburg PMU, Austria.
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Putnam LR, Levy SM, Blakely ML, Lally KP, Wyrick DL, Dassinger MS, Russell RT, Huang EY, Vogel AM, Streck CJ, Kawaguchi AL, Calkins CM, St Peter SD, Abbas PI, Lopez ME, Tsao K. A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough? J Pediatr Surg 2016; 51:639-44. [PMID: 26590473 DOI: 10.1016/j.jpedsurg.2015.10.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/21/2015] [Accepted: 10/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Surgical wound classification (SWC) is widely utilized for surgical site infection (SSI) risk stratification and hospital comparisons. We previously demonstrated that nearly half of common pediatric operations are incorrectly classified in eleven hospitals. We aimed to improve multicenter, intraoperative SWC assignment through targeted quality improvement (QI) interventions. METHODS A before-and-after study from 2011-2014 at eleven children's hospitals was conducted. The SWC recorded in the hospital's intraoperative record (hospital-based SWC) was compared to the SWC assigned by a surgeon reviewer utilizing a standardized algorithm. Study centers independently performed QI interventions. Agreement between the hospital-based and surgeon SWC was analyzed with Cohen's weighted kappa and chi square. RESULTS Surgeons reviewed 2034 cases from 2011 (Period 1) and 1998 cases from 2013 (Period 2). Overall SWC agreement improved from 56% to 76% (p<0.01) and weighted kappa from 0.45 (95% CI 0.42-0.48) to 0.73 (95% CI 0.70-0.75). Median (range) improvement per institution was 23% (7-35%). A dose-response-like pattern was found between the number of interventions implemented and the amount of improvement in SWC agreement at each institution. CONCLUSIONS Intraoperative SWC assignment significantly improved after resource-intensive, multifaceted interventions. However, inaccurate wound classification still commonly occurred. SWC used in SSI risk-stratification models for hospital comparisons should be carefully evaluated.
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Affiliation(s)
- Luke R Putnam
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA
| | - Shauna M Levy
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA
| | - Martin L Blakely
- Vanderbilt Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin P Lally
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA
| | - Deidre L Wyrick
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Melvin S Dassinger
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert T Russell
- Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - Eunice Y Huang
- Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adam M Vogel
- St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christian J Streck
- MUSC Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Akemi L Kawaguchi
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA; Children's Hospital Los Angeles, Keck Medical Center of USC, Los Angeles, CA, USA
| | - Casey M Calkins
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shawn D St Peter
- Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Paulette I Abbas
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Monica E Lopez
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - KuoJen Tsao
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA.
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Candinas D, Gloor B, Fridén T, Andrén-Sandberg Å. [Patient safety in the operating room is not just a matter of cutting correctly. Social interaction, psychological factors and organization does also play a role]. Lakartidningen 2015; 112:DMPZ. [PMID: 26485131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Daniel Candinas
- Inselspital, Bern - Surgery Bern, Sweden Inselspital, Bern - Surgery Bern, Sweden
| | - Beat Gloor
- Inselspital - Surgery Bern, Switzerland Inselspital - Surgery Bern, Switzerland
| | - Thomas Fridén
- Inspektionen för vård och omsorg - Stockholm, Sweden Inspektionen för vård och omsorg - Stockholm, Sweden
| | - Åke Andrén-Sandberg
- Karolinska Universitetssjukhuset - Gastrocentrum kirurgi Stockholm, Sweden Karolinska Universitetssjukhuset - Gastrocentrum Stockholm, Sweden
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18
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Sichkar SY, Afukov II, Stepanenko SM. [EPIDURAL ANALGESIA FOR INTRAOPERATIVE AND POSTOPERATIVE CARE IN NEWBORNS]. Anesteziol Reanimatol 2015; 60:65-70. [PMID: 26415302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anesthesia care in newborns has to be complex, balanced and safe. Nowadays epidural analgesia (EA) in neonates during intra- and postoperative period is widely used in Russia. Modern EA techniques imply the installation of a catheter into epidural space at lumbar or thoracic level as well as different approach to local anesthetics dosage. Newborns have special anatomy, physiology and pharmacodynamics which have to be taken in mind when EA is used. At the present moment Ropivacine (2 mg/ml) is approved for peripheral nerve blocks in newborns.
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Enochsson L, Sandblom G, Österberg J, Thulin A, Hallerbäck B, Persson G. [GallRiks 10 years. Quality registry for gallstone surgery have improved health care]. Lakartidningen 2015; 112:DCE6. [PMID: 25689007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Swedish Registry for cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) (GallRiks) is a validated register with high coverage. The registry started on May 1, 2005 and serves as a base for audit on gallstone disease treatment and also provides a database for clinical research. The aim of this study is to present an overview of the clinical consequences and implementations in patient care that GallRiks research may have contributed to during a 10-year period. Results from studies on GallRiks data have reduced the use of antibiotic and thromboembolic prophylaxis as well as showed the importance of intraoperative cholangiography. Furthermore, the studies on GallRiks data have most probably changed the treatment strategies in ERCP. Studies on GallRiks data have changed and improved the management of patients in Sweden who undergo gallstone surgery or ERCP.
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Affiliation(s)
- Lars Enochsson
- Center for Digestive Diseases - Department of Upper Abdominal Surgery Stockholm, Sweden Center for Digestive Diseases - Department of Upper Abdominal Surgery Stockholm, Sweden
| | - Gabriel Sandblom
- Center for Digestive Diseases - Department of Surgery Stockholm, Sweden Gatrocentrum - Karolinska Universitetssjukhuset Stockholm, Sweden
| | - Johanna Österberg
- Mora Lasarett - Department of Surgery Mora, Sweden Mora Lasarett - Department of Surgery Mora, Sweden
| | - Anders Thulin
- Hallands sjukhus, Halmstad - Department of Surgery Halmstad, Sweden Hallands sjukhus, Halmstad - Department of Surgery Halmstad, Sweden
| | - Bengt Hallerbäck
- Norra Älvsborgs Länssjukhus - Department of Surgery Trollhättan, Sweden Norra Älvsborgs Länssjukhus - Department of Surgery Trollhättan, Sweden
| | - Gunnar Persson
- Länssjukhuset Ryhov - Department of Surgery Jönköping, Sweden
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Della Rocca G, Vetrugno L, Tripi G, Deana C, Barbariol F, Pompei L. Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach? BMC Anesthesiol 2014; 14:62. [PMID: 25104915 PMCID: PMC4124502 DOI: 10.1186/1471-2253-14-62] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/14/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fluid management in the perioperative period has been extensively studied but, despite that, "the right amount" still remains uncertain. The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today. DISCUSSION In the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is. The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence. SUMMARY An intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy. Finally, we propose a rational approach currently used at our institution.
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Affiliation(s)
- Giorgio Della Rocca
- Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy
| | - Luigi Vetrugno
- Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy
| | - Gabriella Tripi
- Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy
| | - Cristian Deana
- Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy
| | - Federico Barbariol
- Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy
| | - Livia Pompei
- Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy
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21
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Strøm C, Rasmussen LS. [Anaesthesia for elderly patients]. Ugeskr Laeger 2013; 175:2406-2410. [PMID: 24630194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Elderly surgical patients comprise a heterogeneous population, especially due to extreme variability in the aging process and the prevalence of chronic disease. Providing anaesthesia can be challenging as the sensitivity to anaesthetic agents is generally increased. Careful preoperative assessment is mandatory but can be difficult, and intraoperative care must be tailored to the extent of organ failure. The aim of this review is to highlight some specific concerns that must be addressed in the perioperative management of elderly patients.
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Affiliation(s)
- Camilla Strøm
- Anæstesi- og operationsklinikken, HovedOrtoCentret, Rigshospitalet, Blegdamsvej 9, 2100 København Ø.
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Leung A, Luu S, Regehr G, Murnaghan ML, Gallinger S, Moulton CA. "First, do no harm": balancing competing priorities in surgical practice. Acad Med 2012; 87:1368-1374. [PMID: 22914525 DOI: 10.1097/acm.0b013e3182677587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To explore surgeons' perceptions of the factors that influence their intraoperative decision making, and implications for professional self-regulation and patient safety. METHOD Semistructured interviews were conducted with 39 academic surgeons from various specialties at four hospitals associated with the University of Toronto Faculty of Medicine. Purposive and theoretical sampling was performed until saturation was achieved. Thematic analysis of the transcripts was conducted using a constructivist grounded-theory approach and was iteratively elaborated and refined as data collection progressed. A preexisting theoretical professionalism framework was particularly useful in describing the emergent themes; thus, the analysis was both inductive and deductive. RESULTS Several factors that surgeons described as influencing their decision making are widely accepted ("avowed," or in patients' best interests). Some are considered reasonable for managing multiple priorities external to the patient but are not discussed openly ("unavowed," e.g., teaching pressures). Others are actively denied and consider the surgeon's best interests rather than the patient's ("disavowed," e.g., reputation). Surgeons acknowledged tension in balancing avowed factors with unavowed and disavowed factors; when directly asked, they found it difficult to acknowledge that unavowed and disavowed factors could lead to patient harm. CONCLUSIONS Some factors that are not directly related to the patient enter into surgeons' intraoperative decision making. Although these are probably reasonable to consider within "real-world" practice, they are not sanctioned in current patient care constructs or taught to trainees. Acknowledging unavowed and disavowed factors as sources of pressure in practice may foster critical self-reflection and transparency when discussing surgical errors.
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Affiliation(s)
- Annie Leung
- University of Toronto Faculty of Medicine, Department of Surgery, Wilson Centre, University Health Network and University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
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Lauscher P, Mirakaj V, Rosenberger P, Meier J. [Practical guidelines for blood transfusions in Germany]. Anasthesiol Intensivmed Notfallmed Schmerzther 2012; 47:410-6; quiz 417. [PMID: 22744855 DOI: 10.1055/s-0032-1316483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
During the last decades drug safety of blood- and plasma products have been raised significantly. Moreover, since 2008 the usage of blood- and plasma products was determined in a clinical practice guideline for blood- and plasma products by the Bundesärztekammer. This document underlays a current update and exists in it's actual 4. revision. Aim oft the manuscript presented is to summarize the content of these clinical practice guidelines concerning the most important points like indications for transfusion (physiological and hb-bound transfusion triggers), the right choice of red blood cell concentrate, and the most common side effects.
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Affiliation(s)
- Patrick Lauscher
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikums Tübingen, Germany.
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Dhatariya K, Levy N, Kilvert A, Watson B, Cousins D, Flanagan D, Hilton L, Jairam C, Leyden K, Lipp A, Lobo D, Sinclair-Hammersley M, Rayman G. NHS Diabetes guideline for the perioperative management of the adult patient with diabetes. Diabet Med 2012; 29:420-33. [PMID: 22288687 DOI: 10.1111/j.1464-5491.2012.03582.x] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery.
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Affiliation(s)
- K Dhatariya
- Norfolk and Norwich University Hospitals, Norwich, UK.
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25
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Chatelain D, Shildknecht H, Trouillet N, Brasseur E, Darrac I, Regimbeau JM. Intraoperative consultation in digestive surgery. A consecutive series of 800 frozen sections. J Visc Surg 2012; 149:e134-42. [PMID: 22342769 DOI: 10.1016/j.jviscsurg.2012.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To assess indications and quality of frozen sections in digestive surgery. PATIENTS AND METHODS All the frozen sections from the department of digestive surgery from Amiens hospital performed between 01/07/2006 and 01/07/2010 were assessed. Assessment of frozen section forms, reading of pathology reports, and reviewing of frozen section slides were performed. RESULTS Eight hundred frozen sections were performed in 349 patients. From one to 14 surgical specimens were sent for frozen section (mean 2.3). Frozen sections were performed in 77% of the cases for cancer surgery (n=268), most of the time pancreatic surgery (28.4%) and liver surgery (24.6%). Frozen sections were performed in 69% of the cases for diagnosis, in 29% of the cases to assess surgical margins and in 2% of the cases to assess if tissue specimen was appropriate for pathological diagnosis. Frozen sections were sent all days of the week (except Saturday and Sunday), during all the year, between 8 H 30 and 17 H 15. Thirty-seven percent of the cases were sent between 12 H and 14 H. Response time was 15 minutes (3 to 57 minutes). Rate of differed diagnoses was 2%. Rate of discordant diagnoses was 3.4%. CONCLUSION Frozen section is a rapid and accurate tool in digestive surgery. Local adjustment of the organization of the Pathology Department could enhance the rapidity and the quality of pathology diagnoses.
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Affiliation(s)
- D Chatelain
- Service d'anatomie pathologique, CHU d'Amiens, université de Picardie-Jules-Verne, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. II. The intra-operative period. Blood Transfus 2011; 9:189-217. [PMID: 21527082 PMCID: PMC3096863 DOI: 10.2450/2011.0075-10] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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27
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Abstract
The challenges to prospective randomized controlled trials have necessitated the exploration of observational data sets that support research into the predictors and modulators of preoperative adverse events. The primary purpose and design of quality improvement databases is quality assessment and improvement at the local, regional, or national level. However, these data can also provide the opportunity to robustly study specific questions related to patient outcomes with no additional clinical risk to the patient. The virtual explosion of anesthesia-related registries has opened seemingly limitless opportunities for outcomes research in addition to generating hypothesis for more rigorous prospective analysis.
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Affiliation(s)
- Satya Krishna Ramachandran
- Department of Anesthesiology, University of Michigan Medical School, 1 H427 University Hospital Box 0048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0048, USA.
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Benning A, Dixon-Woods M, Nwulu U, Ghaleb M, Dawson J, Barber N, Franklin BD, Girling A, Hemming K, Carmalt M, Rudge G, Naicker T, Kotecha A, Derrington MC, Lilford R. Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase. BMJ 2011; 342:d199. [PMID: 21292720 PMCID: PMC3033437 DOI: 10.1136/bmj.d199] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2010] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting NHS hospitals in England. PARTICIPANTS Nine hospitals participating in SPI2 and nine matched control hospitals. INTERVENTION The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. RESULTS One of the scores (organisational climate) showed a significant (P = 0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P = 0.010) and 12 hour (2.4, 1.1 to 5.0; P = 0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P = 0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P = 0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P = 0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P = 0.760 and P = 0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P = 0.652 and P = 0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P = 0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. CONCLUSIONS Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.
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Affiliation(s)
- Amirta Benning
- School of Health and Population Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK
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29
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Belov IV, Komarov RN, Stepanenko AB, Gens AP, Stogniĭ NI. [Surgical treatment of the aortic dissection type B: analysis of 15 years' experience]. Khirurgiia (Mosk) 2011:14-17. [PMID: 21983528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
65 patients with the aortic dissection type B were operated on in the period 1995-2010. The proximal local aortic prosthetics proved to be the method of choice in treatment of such patients. The method allowed the reduction of the hospital lethality on 5,7 ± 3,9% and considerably decrease the overall hospital stay.
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MESH Headings
- Aortic Dissection/pathology
- Aortic Dissection/physiopathology
- Aortic Dissection/surgery
- Aorta, Abdominal/pathology
- Aorta, Thoracic/pathology
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/physiopathology
- Aortic Aneurysm, Abdominal/surgery
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/surgery
- Blood Loss, Surgical/physiopathology
- Blood Loss, Surgical/prevention & control
- Blood Vessel Prosthesis/standards
- Blood Vessel Prosthesis Implantation/methods
- Blood Vessel Prosthesis Implantation/mortality
- Blood Vessel Prosthesis Implantation/standards
- Female
- Hospital Mortality
- Humans
- Intraoperative Care/methods
- Intraoperative Care/standards
- Male
- Middle Aged
- Risk Adjustment
- Survival Rate
- Time Factors
- Treatment Outcome
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30
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Kriger AG, Zviagin AA, Korolev SV, Zhukov AO, Kochatkov AV, Bozh'eva EI, Ikramov RZ, Berelavichus SV, Kozlov IA, Kolygin AV, Akhtanin EA. [Surgical treatment of the unformed intestinal fistulae]. Khirurgiia (Mosk) 2011:4-13. [PMID: 21983527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Treatment results of 5 patients with unformed intestinal fistulae are represented. High unformed intestinal fistulae are acknowledged to be completely unsuitable for conservative treatment and should be operated on. Complex treatment should include complete parenteral feeding, adequate fecal diversion with the use of aspirational drainage. Surgical treatment must be y the increase of fistula discharge or absence of fistula formation. Low intestinal fistulae should better be surgically dissected after their organization, otherwise urgent surgery is to be performed by complications development, such as purulent leakage into the abdominal cavity or severe wound infection.
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31
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Tsar'kov PV, Fedorov DN, Kravchenko AI, Istranov AL, Danilov MA, Tulina IA. [The combined abdomenotranssacral access for the extralevator rectum extirpation]. Khirurgiia (Mosk) 2011:43-50. [PMID: 21606921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Technique of the extralevator abdomenoperineal rectum extirpation with the use of the combined abdomenotranssacral access is thoroughly described in the article. The radicality of the procedure and the immediate results has been evaluated in 27 patients with the lower ampullary rectum and anal canal cancer. The average blood loss was 625±288 (300-3500) ml. The soft tissue defect was replaced with the use of unilateral rotated gluteus maximus muscle (n=21), bilateral rotated gluteus maximus muscle (n=6). Tumor-free resection line was registered by the morphological investigation of the resected tissues in 25 cases. Long-term results (13.2±3.1) (2-22 months)) were obtained in 24 patients. The obtained results of the postoperative morbidity and survival rates allow to consider the described method as a safe and appropriate surgical procedure.
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32
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Sazhin AV, Mosin SV, Kodzhoglian AA, Mirzoian AT, Laĭpanov BK, Iuldoshev AR. [Principles of diagnostics and treatment of chronic appendicitis]. Khirurgiia (Mosk) 2011:32-38. [PMID: 21606919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Treatment results of 101 patients, operated on with the diagnosis of the chronic appendicitis, were analyzed. Of them, 55 had periodic right iliac pain syndrome, the rest 46 had a history of appendicular abscess or infiltrate. 58 patients were operated on laparoscopically, the rest had traditional open appendectomy. The use of ultrasound and roentgen diagnostics proved to be non-effective. The reliable laparoscopic symptoms of chronic appendicitis were singled out. The laparoscopy provided the correct diagnosis in 93.3% of patients and allowed avoiding the groundless appendectomy in 31.2%. The intraoperative ultrasound is helpful in questionable cases. The diagnostic and treatment algorithm for chronic appendicitis, based on laparoscopic methods, was worked out.
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Schreiber D, Rineer J, Sura S, Teper E, Nabhani T, Han P, Schwartz D, Choi K, Rotman M. Radical prostatectomy for cT3-4 disease: an evaluation of the pathological outcomes and patterns of care for adjuvant radiation in a national cohort. BJU Int 2010; 108:360-5. [PMID: 21087395 DOI: 10.1111/j.1464-410x.2010.09875.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Schreiber
- Department of Radiation Oncology, State University of New York-Downstate, Brooklyn, NY 11209, USA.
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34
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Gottsäter A, Mätzsch T. [Large variations in carotid surgery. A questionnaire to surgical units shows different procedures]. Lakartidningen 2010; 107:1698-1701. [PMID: 20701149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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35
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Sierro C, Iglesias JF, Eeckhout E, Vogt P. [Pre-operative cardiac assessment in non-cardiac surgery: a frequent dilemma simplified by a decision tree]. Rev Med Suisse 2010; 6:1117-1121. [PMID: 20572354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In patients undergoing non-cardiac surgery, cardiac events are the most common cause of perioperative morbidity and mortality. It is often difficult to choose adequate cardiologic examinations before surgery. This paper, inspired by the guidelines of the European and American societies of cardiology (ESC, AHA, ACC), discusses the place of standard ECG, echocardiography, treadmill or bicycle ergometer and pharmacological stress testing in preoperative evaluations. The role of coronary angiography and prophylactic revascularization will also be discussed. Finally, we provide a decision tree which will be helpful to both general practitioners and specialists.
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Affiliation(s)
- C Sierro
- Service de cardiologie, CHUV, Lausanne.
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36
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Sazhin AV, Tiagunov AE, Pervova EV, Aleksandrov AN, Rogov KA, Zlotnikova AD, Zhdanov AM. [General surgical procedures in patients with electrical pacemaker]. Khirurgiia (Mosk) 2010:9-16. [PMID: 21164416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Work of the implanted electric pacemaker (EP) was assessed in 99 patients, aged 62.4±9.6 years, during non-cardiological surgery. Inhibition of the EP stimuli was registered in 9 (9.1%) patients, short episodes of uneffective stimulation with synchronization disturbation--in 2 (2%) patients and change of stimulation regimen was registered in the same number of patients by electocoagulation. Episodes of myopotential inhibition not assotiated with electrocoagulation was registered in 4 cases. The ascertained rhythm disturbances require a thorough preoperative check-up, intraoperative ECG control and short use of monopolar electrocoagulation.
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MESH Headings
- Aged
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/therapy
- Cardiac Pacing, Artificial/adverse effects
- Cardiac Pacing, Artificial/methods
- Electrocoagulation/adverse effects
- Electrocoagulation/methods
- Electrocoagulation/mortality
- Electrodes, Implanted/adverse effects
- Electrodes, Implanted/statistics & numerical data
- Equipment Failure Analysis
- Female
- Humans
- Intraoperative Care/instrumentation
- Intraoperative Care/standards
- Intraoperative Complications/etiology
- Intraoperative Complications/mortality
- Intraoperative Complications/prevention & control
- Male
- Middle Aged
- Monitoring, Intraoperative/standards
- Pacemaker, Artificial/adverse effects
- Pacemaker, Artificial/statistics & numerical data
- Risk
- Surgical Procedures, Operative/adverse effects
- Surgical Procedures, Operative/mortality
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37
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Berger MS. Defining and achieving excellence in surgical neuro-oncology. Clin Neurosurg 2010; 57:10-14. [PMID: 21280488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Mitchel S Berger
- University of California at San Francisco, San Francisco, California, USA
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38
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Rutka JT. Excellence in clinical neurosurgery: practice and judgment make perfect. Clin Neurosurg 2010; 57:69-78. [PMID: 21280497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- James T Rutka
- The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumour Research Centre, The University of Toronto, Toronto, Ontario, Canada
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39
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Zarivchatskiĭ MF. [The system of intraoperative and perioperative safety in surgical treatment of benign diseases of the thyroid gland]. Vestn Khir Im I I Grek 2010; 169:77-79. [PMID: 20387612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The system of safe interventions on the thyroid gland was developed on the basis of experiences with surgical treatment of 2255 patients with diffuse toxic goiter, 437--with nodular toxic goiter, 1377--with nodular nontoxic goiter, 123--with autoimmune thyroiditis and 937--with recurrent goiter. The system includes measures in the preoperative period, those during operation and the postoperative rehabilitation of the patients. This system allowed shortening of the period of preoperative preparation, decrease of blood loss, and less number of postoperative complications.
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Kalson NS, Mulgrew E, Cook G, Lovell ME. Does the number of trauma lists provided affect care and outcome of patients with fractured neck of femur? Ann R Coll Surg Engl 2009; 91:292-5. [PMID: 19220949 PMCID: PMC2749390 DOI: 10.1308/003588409x391839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Delay in surgery for fractured neck of femur is associated with increased mortality; it is recommended that patients with fractured neck of femur are operated within 48 h. North West hospitals provide dedicated trauma lists, as recommended by the British Orthopaedic Association, to allow rapid access to surgery. We investigated trauma list provision by each trust and its effects on the time taken to get neck of femur patients to surgery and patient survival. PATIENTS AND METHODS The number of trauma lists provided by 13 acute trusts was determined by telephone interview with the theatre manager. Data on operating delays, reasons for delay and 30-day mortality were obtained from the Greater Manchester and Wirral fractured neck of femur audit. RESULTS A total of 883 patients were included in the audit (35-126 per hospital). Overall, 5-15 trauma lists were provided each week, and 80% of lists were consultant-led. Of patients, 31.8% were operated on within 24 h and 36.9% were delayed more than 48 h; 37.7% of delays were for non-medical reasons. The 30-day mortality rates varied between 5-19% (mean, 11.8%). There were no significant relationships between the number of trauma lists and these variables. When divided into hospitals with > 10 lists per week (n = 6) and those with < 10 lists per week (n = 7) there were no significant differences in 48-h delay, non-medical delay or mortality. However, 24-h delay showed a trend to be lower in those with > 10 lists (34.6% of patients versus 28.9%; P = 0.09). CONCLUSIONS Most trusts provided at least one dedicated daily list. This study shows that extra lists may enable trusts to cope better with fractured neck of femur but do not change mortality.
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Affiliation(s)
- NS Kalson
- Department of Orthopaedics, Wythenshawe HospitalManchester, UK
| | - E Mulgrew
- Department of Orthopaedics, Wythenshawe HospitalManchester, UK
| | - G Cook
- Clinical Effectiveness Unit, Stepping Hill Hospital, Stockport NHS Foundation TrustStockport, UK
| | - ME Lovell
- Department of Orthopaedics, Wythenshawe HospitalManchester, UK
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Apovian CM, Cummings S, Anderson W, Borud L, Boyer K, Day K, Hatchigian E, Hodges B, Patti ME, Pettus M, Perna F, Rooks D, Saltzman E, Skoropowski J, Tantillo MB, Thomason P. Best practice updates for multidisciplinary care in weight loss surgery. Obesity (Silver Spring) 2009; 17:871-9. [PMID: 19396065 PMCID: PMC2859198 DOI: 10.1038/oby.2008.580] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The objective of this study is to update evidence-based best practice guidelines for multidisciplinary care of weight loss surgery (WLS) patients. We performed systematic search of English-language literature on WLS, patient selection, and medical, multidisciplinary, and nutritional care published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. A total of 150 papers were retrieved from the literature search and 112 were reviewed in detail. We made evidence-based best practice recommendations from the most recent literature on multidisciplinary care of WLS patients. New recommendations were developed in the areas of patient selection, medical evaluation, and treatment. Regular updates of evidence-based recommendations for best practices in multidisciplinary care are required to address changes in patient demographics and levels of obesity. Key factors in patient safety include comprehensive preoperative medical evaluation, patient education, appropriate perioperative care, and long-term follow-up.
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Affiliation(s)
- Caroline M Apovian
- Department of Endocrinology, Diabetes, and Nutrition, Boston University Medical Center, Boston, Massachusetts, USA.
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42
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Cox PBWB, Dejong CHC, Maessen JMC, Teeuwen JHFA, Tijink H, Marcus MAE. [Quicker recovery from elective colon surgery: anaesthesiological aspects of the fast-track programme]. Ned Tijdschr Geneeskd 2009; 153:B377. [PMID: 19785828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A multidisciplinary approach for patients who will undergo colonic resection was introduced in 2006 and 2007 in 26 Dutch hospitals, following several other European centres. This approach aims to place the patient in an optimal metabolic state before operation, with subsequent rapid mobilisation and resumption of oral intake of liquids and solid food. The surgeon, anaesthetist, and nursing staff collaborate in this approach, each taking responsibility for specific tasks. The anaesthesiological tasks consist of withholding preoperative intake of drink and food, appropriate pain reduction, perioperative fluid balance management, use of inotropic and vasopressor drugs, prevention of post-operative nausea and vomiting, and addressing possible immunological consequences of surgery.
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Affiliation(s)
- P B W Boris Cox
- Academisch Ziekenhuis, Afd. Anesthesiologie en Pijnbestrijding, Maastricht, The Netherlands.
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43
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Kin N, Yamada Y. [Ideal intraoperative management to prevent perioperative complications]. Kyobu Geka 2008; 61:630-635. [PMID: 20715400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Anesthesiologists can contribute considerably to prevent both intra- and post-operative complications. Intraoperative transesophageal echocardiography can be utilized to visualize potential hazards at various stages in cardiac surgery; aortic and venous cannulation, left ventricular vent tube insertion and removal of residual air in cardiac chambers. Near infrared spectroscopy is employed for early detection of cerebral ischemia. A more than 20 percent of decrease from the preoperative baseline probably indicates cerebral ischemia and prompts some measures to improve cerebral oxygenation. Separate lung ventilation can be offered by using a combination of a normal endotracheal tube and a bronchial blocker instead of a double lumen tube in order to avoid a tube exchange at the end of operation which is sometimes difficult and dangerous. Intraoperative awareness should be avoided by administering additional sedatives especially at a rewarming phase of cardiopulmonary bypass. Intraoperative shivering causes excessive oxygen demands and should be prevented by giving enough amounts of muscle relaxants. Temperature and glucose controls are also important to decrease surgery-related morbidity and mortality. A premature cease of rewarming by cardiopulmonary bypass and extra heating after bypass may well be considered. High thoracic epidural anesthesia is possibly beneficial to reduce patients' stress, improve postoperative pulmonary function and hasten recovery.
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Affiliation(s)
- Nobuhide Kin
- Department of Anesthesiology, The University of Tokyo, Tokyo, Japan
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Nejc D, Pasz-Walczak G, Piekarski J, Pluta P, Sek P, Bilski A, Durczynski A, Berner A, Jastrzebski T, Jeziorski A. 94% accuracy of intraoperative imprint touch cytology of sentinel nodes in skin melanoma patients. Anticancer Res 2008; 28:465-469. [PMID: 18383886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED The aim of the present study was to assess whether the reliability of imprint touch cytology (ITC) of sentinel nodes in skin melanoma patients allows intraoperative decisions regarding simultaneous radical lymphadenectomy to be made. PATIENTS AND METHODS The results of ITC of sentinel nodes were compared with the results of standard histopathological and immunohistochemical examinations. RESULTS A total of 148 sentinel nodes were identified in 98 lymph node groups in 85 skin melanoma patients. ITC revealed the presence of metastases in 7 out of 16 melanoma-positive sentinel nodes (sensitivity, 43.7%). There were no false-positive results of ITC of sentinel nodes (specificity, 100%). The negative predictive value of ITC was 93.6%, the positive predictive value was 100%, and the accuracy of the method was 93.9%. CONCLUSION ITC of sentinel nodes is a reliable method. There was no risk of overtreatment due to false-positive results of sentinel node ITC in our study. High accuracy of the method warrants its clinical use.
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Affiliation(s)
- Dariusz Nejc
- Department of Surgical Oncology, Medical University of Lodz, Poland
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45
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Bassett K, Smith SW, Cardiff K, Bergman K, Aghajanian J, Somogyi E. Nurse anaesthetic care during cataract surgery: a comparative quality assurance study. Can J Ophthalmol 2007; 42:689-94. [PMID: 17891197 DOI: 10.3129/i07-125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND We studied whether a new model of nurse-provision of conscious sedation for cataract surgery maintained patient satisfaction and safety. METHODS We prospectively and non-randomly studied 106 patients who had outpatient cataract surgery on a day when an anaesthetist was present at the UBC, Vancouver Hospital Eye Care Centre, and 105 patients with no anaesthetist, but instead a surgical suite nurse trained to give conscious sedation was present. Questionnaires determined patient perception of well-being, pain, and anxiety before surgery, before discharge, at 48 hours and at 6 weeks postoperative. Hospital records and a surgeon questionnaire were used to determine complications. Ophthalmology records were used to determine visual acuity (preoperative and at 6 weeks). RESULTS No anaesthetic complications were reported in either group and there were no significant differences in surgical complications. Patient responses to assessments of discomfort, well-being, and anxiety, preoperatively and postoperatively, were very similar on the nurse days and anaesthetist days. INTERPRETATION Conscious sedation of cataract surgery patients can be safely and effectively provided by a trained nurse for selected patients. This nursing role is likely replicable in similar operating room settings.
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Affiliation(s)
- Ken Bassett
- British Columbia Centre for Epidemiologic and International Ophthalmology, Department of Ophthalmology, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.
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46
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Abstract
Patient safety and quality of care are inextricably linked. Surgery encompasses such a wide spectrum of diagnosis, treatment, postoperative care, and outpatient follow-up of so many illnesses that quality improvement and patient safety opportunities are numerous and potentially overwhelming. The study of error can be applied across all components of the care process, and offers many points of study to improve patient safety. A fundamental premise is that appropriate and safely delivered health care is less expensive. In our current climate, this emphasis on quality and safety will remain a high priority. Surgeon leadership at all levels is key to our professional viability.
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Affiliation(s)
- Michael H McCafferty
- Department of Surgery, Section of Colorectal Surgery, University of Louisville, 550 South Jackson Street, Louisville, Kentucky 40202, USA
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Intraoperative neurophysiological monitoring and interpretation. Clin Privil White Pap 2007;:1-12. [PMID: 17526128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Suojaranta-Ylinen RT, Roine RO, Vento AE, Niskanen MM, Salmenperä MT. Improved neurologic outcome after implementing evidence-based guidelines for cardiac surgery. J Cardiothorac Vasc Anesth 2007; 21:529-34. [PMID: 17678779 DOI: 10.1053/j.jvca.2006.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A high incidence of neurologic complications was observed in the year 2001 in cardiac surgical patients in this department. This article attempts to show the impact of changing and optimizing management protocols on the incidence of neurologic morbidity after cardiac surgery. DESIGN An observational study of cardiac surgical patients. SETTING University hospital. PARTICIPANTS All cardiac surgical patients treated postoperatively in the cardiac surgical ICU in 2001 (n = 1,165, control group) and in 2003 (n = 1,222, intervention group) were evaluated. INTERVENTIONS A quality improvement program started at the beginning of 2002, based on the Task Force Committee Guidelines, included surgical and cardiopulmonary bypass recommendations as well as peri- and postoperative care (eg, use of epiaortic echo and strict perfusion protocol, avoidance of hyperthermia and hyperglycemia, and minimization of cerebral edema). RESULTS The number of neurologic complications decreased from 78 (6.7%) in 2001 to 33 (2.7%) in 2003 (p < 0.01), and corresponding numbers for ICU mortality were 44 (3.8%) and 24 (2.0%) (p < 0.01). The length of ICU stay also decreased (3.2 +/- 4.5 days in 2001 v 2.9 +/- 5.5 days in 2003, p < 0.001). In 2001, patients with neurologic complications consumed 853 ICU patient days (23% of all ICU patient days) and, in 2003, 549 (15% of all ICU patient days). According to logistic regression analysis that included 11 independent variables (treatment year, EuroSCORE, diabetes mellitus, history of stroke, and 7 different types of surgery), treatment in 2003 was independently associated with decreased risk for neurologic complications (odds ratio 0.30, 95% confidence intervals 0.19-0.47, p < 0.001). CONCLUSIONS The occurrences of neurologic complications, mortality, and ICU resource consumption by this patient group decreased after implementation of an optimized management protocol and evidence-based guidelines.
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Abstract
PURPOSE OF REVIEW Interest in stress-induced insulin resistance has increased during the past 5 years. Relevant clinical and mechanistic investigations during the past year will be reviewed. RECENT FINDINGS Recent trials of intensive insulin therapy in intensive care units have brought attention to a high incidence of hypoglycemic episodes with such treatment. The clinical relevance of such hypoglycemia has been shown to be minor, however. Furthermore, animal and in-vitro work further supports the finding that glucose control, rather than glycemia-independent effects of insulin, is the primary mechanism of action of intensive insulin therapy. In elective surgery, cohort studies show an association between intraoperative hyperglycemia and postoperative morbidity. Beneficial effects of preoperative oral carbohydrate treatment on immunocompetence and cardiac contractility have been demonstrated. Laparoscopic segmental colectomy was associated with considerably attenuated derangements in glucose metabolism compared with conventional, open surgery. SUMMARY Better methods of insulin dosing and administration and glucose monitoring are warranted to further minimize the risks of intensive insulin therapy. In elective surgery, perioperative measures such as preoperative oral carbohydrate treatment and laparoscopic techniques attenuate metabolic and other physiological derangements and such methods should be integrated into perioperative care protocols to minimize morbidity and enhance recovery.
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Affiliation(s)
- Mattias Soop
- Karolinska Institute, CLINTEC, Karolinska University Hospital, Huddinge, Sweden
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Clyne CA, Shah A, Yarlagadda R, Migeed M, Kluger J. Catheter ablation for atrial fibrillation: Hartford Hospital experience. Conn Med 2007; 71:69-76. [PMID: 17393897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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