Journal of the American College of Surgeons
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Clinical signs and symptoms such as swelling, pain, and redness are unreliable markers of deep vein thrombosis (DVT). Because of this venous duplex scanning (VDS) has been heavily used in DVT detection. The purpose of this study was to determine if a combination of D-dimer testing and pretest clinical score could reduce the use of VDS in symptomatic patients with suspected DVT. ⋯ A combination of D-dimer testing and clinical probability score may be effective in avoiding unnecessary VDS in suspected symptomatic DVT in the low and moderate PCP patients. The need for VDS could be reduced by 23% despite a relatively high prevalence of DVT.
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While specialty-level evaluations evolve from traditional examinations to objective structured clinical examination-like assessments, a broader range of competencies are tested; consequently, examiners are forced to integrate results when making a determination of competency. The aim of this study was to describe how experts weigh relative performances on specific components of a comprehensive examination to make decisions of overall competency. ⋯ Performance on the SOE section of a multicompetency examination is markedly associated with the final determination of competency. These results have implications for the design and implementation of comprehensive specialty-level assessments.
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For patients who suffer from severe chronic pancreatitis, total pancreatectomy can alleviate pain, and islet autotransplantation (IAT) might preserve endocrine function and circumvent the complications of diabetes. Factors that determine success after this operation have not been clearly defined. ⋯ The likelihood of glycemic control after IAT is related to both patient characteristics and islet cell mass. Based on these data, more islet cells may be required for insulin independence than previously thought.
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Comparative Study
Resuscitation with pressors after traumatic brain injury.
The purpose of the study was to compare initial resuscitation with arginine vasopressin (AVP), phenylephrine (PE), or isotonic crystalloid fluid alone after traumatic brain injury and vasodilatory shock. ⋯ To correct vasodilatory shock after traumatic brain injury, a resuscitation strategy that combined either phenylephrine or arginine vasopressin plus crystalloid was superior to either fluid alone or pressor alone.
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Practice Guideline Guideline
Drug-assisted intubation in the prehospital setting.