Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The identification of all available and relevant study reports is mandatory for a comprehensive assessment of randomised (RCTs) and controlled clinical trials (CCTs) in systematic reviews. Incomplete compilation of health care journals in electronic databases and incorrect indexing of the studies impair the result of a systematic literature search. An additional search in medical journals that are not listed in electronic databases can obtain higher search precision. ⋯ The gap between the number of hand search results and the number of Medline indexed RCTs and CCTs is also reflected in other special medical fields. To ensure completeness of the literature compilation, the hand searching project should be continued.
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Life or extremity threatening injuries have to be diagnosed and treated rapidly by emergency physicians during prehospital care for severely injured patients. The cooperation with other rescue services, the fire brigade and the police must be coordinated and early transportation has to be organized. Rapid sequence intubation by trained personnel for correct indications, such as head injury or severe chest trauma is recommended as well as prehospital chest tube placement in cases of severe or penetrating thoracic injury. ⋯ Ultrasound or near infrared spectroscopy could not be routinely implemented for extended prehospital diagnostic procedures. Transportation to the closest appropriate hospital has to be accomplished as early as possible. Helicopters show positive outcomes if the destination is a level I trauma center, even if secondary alarm calls or more extensive measures prolong the prehospital interval.
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The acute and early phase of polytrauma management is decisive for determining and implementing priority-based operative strategy. The patient's general condition and pattern of injury have to be considered. ⋯ Conceptual damage control surgery is distinguished from early total care. Damage control surgery should be performed only in patients meeting certain instability and risk criteria to avoid additionally burdening their condition.
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Optimal outcome in the treatment of multiple trauma patients requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times with respect to personnel, technical equipment, and emergency room design. The aim is-based on standardized and prioritized clinical pathways and algorithms-to identify and treat not only life-threatening and debilitating but all other injuries in a timely fashion. ⋯ However, many parenchymal lesions of intra-abdominal organs can be managed nonoperatively. Similarly, damage control orthopedics for the initial management of major fractures with initial temporary and minimally invasive fracture stabilization followed by definitive osteosynthesis as soon as the patient has stable organ functions is gaining more acceptance. Maintainance of and improvement in the quality of care requires standardized documentation, regular analysis, and feedback in an internal quality management process as well as participation in an external quality program such as the Trauma Registry of the German Society for Accident Surgery.
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Comparative Study
[A survey of perioperative therapy for elective colon resection in Germany, 2006].
Despite the evidence that fast-track concepts in colon surgery lead to an enhanced recovery rate, there is no information on the prevalence and utilization of such programs in Germany. ⋯ Although there is an evident benefit using fast-track concepts, they are not yet in wide use as a standard procedure. Further efforts have to be made to ensure that the majority of patients will benefit from these concepts.