The British journal of surgery
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Randomized Controlled Trial Multicenter Study
Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial.
An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial. ⋯ Patients receiving antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery.
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Review
Systematic review of carotid artery procedures and the volume-outcome relationship in Europe.
Hospitals that conduct more procedures on the carotid arteries may achieve better outcomes. In the context of ongoing reconfiguration of UK vascular services, this systematic review was conducted to evaluate the relationship between the volume of carotid procedures and outcomes, including mortality and stroke. ⋯ The evidence from the largest and highest-quality studies included in this review support the centralization of CEA.
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Biography Historical Article
Case study of Berengario da Carpi and Lorenzo de' Medici.
Jacopo Berengario da Carpi (c.1460-c.1530) made several important advances in anatomy, being universally considered the founder of 'animated anatomy' (anatomia animata). In addition to being a famous anatomist, Berengario was also a highly regarded surgeon. One of his famous clients was Lorenzo de' Medici, Duke of Urbino (1492-1519). ⋯ His corpse was exhumed in 1875 and 1947. The casts of his skull made on those occasions are now preserved in the museums of Florence University, and clearly show evidence of the wound. Read more about the stories behind this masterpiece in an essay online.
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Pain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10-50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new-onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety. ⋯ There is a need for more evidence about interventions for CPSP. High-quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.
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Randomized Controlled Trial
Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy.
Major surgery such as oesophagectomy requires a postoperative stay in intensive care. Painful stimuli lead to sleep disturbance and impairment in quality of life. The aim of this study was to evaluate the effect of psychological counselling and sleep adjuvant measures on postoperative quality of sleep and quality of life. ⋯ Perioperative psychological support reduces impairment in quality of life and quality of sleep after oesophagectomy. Registration number: NCT01738620 (http://www.clinicaltrials.gov).