World journal of surgery
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World journal of surgery · Feb 2011
Randomized Controlled TrialImpact of low-dose vasopressin on trauma outcome: prospective randomized study.
We previously found that regardless of the animal injury model used resuscitation strategies that minimize fluid administration requirements lead to better outcomes. We hypothesized that a resuscitation regimen that limited the total volume of fluid administered would reduce morbidity and mortality rates in critically ill trauma patients. ⋯ This is the first trial to investigate the impact of vasopressin administration in trauma patients. Infusion of low-dose vasopressin maintained elevated serum vasopressin levels and decreased fluid requirements after injury.
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World journal of surgery · Feb 2011
Randomized Controlled TrialProspective randomized controlled trial to analyze the effects of intermittent pneumatic compression on edema following autologous femoropopliteal bypass surgery.
Patients who undergo autologous femoropopliteal bypass surgery develop postoperative edema in the revascularized leg. The effects of intermittent pneumatic compression (IPC) to treat and to prevent postreconstructive edema were examined in this study. ⋯ Edema following femoropopliteal bypass surgery occurs in all patients. For the prevention and treatment of that edema the use of a class I CS proved superior to treatment with IPC. The use of CS remains the recommended practice following femoropopliteal bypass surgery.
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World journal of surgery · Feb 2011
Randomized Controlled Trial Comparative StudyEffects of virtual reality simulator training method and observational learning on surgical performance.
Virtual reality (VR) simulators and Web-based instructional videos are valuable supplemental training resources in surgical programs, but it is unclear how to optimally integrate them into minimally invasive surgical training. ⋯ Proctored VR training is no more effective than independent training with respect to surgical performance. Therefore, time-consuming human expert feedback during VR training may be unnecessary. Instructional videos, while useful, may not be adequate substitutes for actual observation when trainees are learning minimally invasive surgical procedures.
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World journal of surgery · Jan 2011
Evaluation of trauma and critical care training courses on the knowledge and confidence of participants in Kenya and Zambia.
Trained health-care personnel are essential for improved outcomes for injured and critically ill patients. The highest injury-related mortality is seen in sub-Saharan Africa, where there is a paucity of skilled personnel. Therefore, the College of Surgeons of East, Central, and Southern Africa (COSECSA) along with Emory University provided an acute trauma care (ATC) and fundamental critical care support course (FCCS). This study evaluates the impact of American-derived courses on the knowledge and confidence of participants from resource-limited countries. ⋯ Participants from resource-limited countries benefit from ATC/FCCS courses as demonstrated by increased knowledge and confidence across all topics presented. However, the strongest increase in confidence was in performing life-saving procedures. Therefore, future courses should emphasize essential procedures, reduce didactics, and link knowledge acquisition to skill-based teaching.
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World journal of surgery · Jan 2011
Multicenter StudyOutcomes from prehospital cardiac arrest in blunt trauma patients.
There are few strategies for treating patients who have suffered cardiopulmonary arrest due to blunt trauma (BT-CPA). The aim of this population-based case series observational study was to clarify the outcome of BT-CPA patients treated with a standardized strategy that included an emergency department thoracotomy (EDT) under an emergency medical service (EMS) system with a rapid transportation system. ⋯ In BT-CPA patients, a 20-min resuscitation effort and termination of the effort are thought to be relevant. The initial rhythm is not a prognostic indicator. We believe that the decision on whether to undertake aggressive resuscitation efforts should be made on a case-by-case basis.