American journal of surgery
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Precisely because they are at the center of clinical service delivery, physicians, especially surgeons, are the ideal leaders for health care in the 21st century. Although most physicians possess the traits essential for leadership, the vast majority lacks the technical skills necessary for major leadership/management roles that will both change and empower the local healthcare service delivery environment. ⋯ Just like surgical training, these skills too require systematic training. With patients beginning to demand value-added service, it is important for healthcare executives to identify those physicians best suited to serve as leaders within the larger healthcare system and to deliberately nurture their growth in these administrative competencies.
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Although aortoiliac disease remains a common cause of lower extremity ischemia, the efficacy of axillofemoral bypass in this setting remains controversial. This report summarizes our institutional experience with axillofemoral bypass. ⋯ In the setting of diffuse, chronic aortoiliac occlusive disease, long-term patency rates of axillofemoral grafts approach those of aortobifemoral bypass and exceed those quoted for percutaneous transluminal angioplasty, with results that are highly reproducible. Axillofemoral bypass is an excellent option in those patients at prohibitive risk for direct aortic reconstruction or those with limited life expectancy.
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Extracorporeal membrane oxygenation (ECMO) is a supportive therapy used for severe acute respiratory distress syndrome (ARDS). We present outcome, clinical parameters, and complications in a cohort of 245 ARDS patients of whom 62 were treated with ECMO. ⋯ ECMO is a therapeutic option for patients with severe ARDS, likely to increase survival. However, a randomized controlled study proving its benefit is still awaited. Until the development of a causal or otherwise superior therapy ECMO should be used in selected patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Preemptive bupivacaine offers no advantages to postoperative wound infiltration in analgesia for outpatient breast biopsy.
Adequate analgesia is important after surgery and in particular after ambulatory surgery. Preemptive administration of analgesics, ie, prior to commencing surgery, has many theoretical advantages. ⋯ The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing ambulatory breast biopsy.