Journal of the American College of Surgeons
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CT and ultrasound (US) are increasingly recommended to establish the diagnosis of appendicitis, but population-based rates of misdiagnosis (negative appendectomy [NA]) have not improved over time. The objective of this study was to determine the relationship between CT/US and NA in common practice. ⋯ The rate of NA was unchanged over time despite the introduction and use of CT/US, and this appeared to be related to the inconsistent performance characteristics of the tests. This study cautions against overreliance on CT/US in diagnosing appendicitis and emphasizes the need for test benchmarking in routine practice before establishing protocols for presumed appendicitis.
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Major lower limb amputations continue to be performed at an increasing rate, the major cause being the rising prevalence of adult onset diabetes. It can be demonstrated that a reduction in amputation rate can be achieved at institutes with a higher level of academic and specialty interest, by avoiding errors of management and by newer technical innovations in wound closure. ⋯ Experience confirms that the relationship between high hospital volume, specialty interest, higher level of academic care; avoiding technical errors; and simplifying the methodology, lead to a reduction in need for major amputations. A lower mortality in the patient population at risk is achieved and a reduction in costs, which have risen beyond the 132 billion dollars level, can be expected.
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Biography Historical Article
Medical and surgical care of our four assassinated presidents.
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Randomized Controlled Trial
Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites.
Antiseptic preoperative skin site preparation is used to prepare the operative site before making a surgical incision. The goal of this preparation is a reduction in postoperative wound infection. The most straightforward technique necessary to achieve this goal remains controversial. ⋯ Preoperative preparation of the abdomen with a scrub with povidone-iodine soap followed by a paint with aqueous povidone-iodine can be abandoned in favor of a paint with aqueous povidone-iodine alone. This change will result in reductions in operative times and costs.
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In a previous report, enhanced resource commitment at a Level I trauma center was associated with improved outcomes for most major categories of injured patients, except those with gunshot wounds, which disproportionately affected the young (ages 15 to 24 years). We hypothesized that a primary violence-prevention initiative geared toward changing attitudes about interpersonal conflict among at-risk youths can be effective. ⋯ A multidisciplinary violence-prevention outreach program can produce short-term improvement in beliefs supporting aggression among at-risk youth. Longterm impact of this attitude change needs to be examined in future studies.