The British journal of surgery
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Multicenter Study Comparative Study Clinical Trial
Open or endovascular revascularization in the treatment of acute lower limb ischaemia.
Consensus is lacking regarding intervention for patients with acute lower limb ischaemia (ALI). The aim was to study amputation-free survival in patients treated for ALI by either primary open or endovascular revascularization. ⋯ Primary endovascular treatment for ALI appeared to reduce mortality compared with open surgery, without any difference in the risk of amputation.
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Multicenter Study
Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation.
The prognostic equivalence between mastectomy and breast-conserving surgery (BCS) followed by radiotherapy was shown in pivotal trials conducted decades ago. Since then, detection and treatment of breast cancer have improved substantially and recent retrospective analyses point towards a survival benefit for less extensive breast surgery. Evidence for the association of such survival data with locoregional recurrence rates is largely lacking. ⋯ The present data support the superiority of BCS with postoperative radiotherapy over mastectomy without radiotherapy. The axillary recurrence rate differed significantly, and could be one contributing factor in a complex explanatory model.
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Multicenter Study Observational Study
Preoperative oral care and effect on postoperative complications after major cancer surgery.
Improving patients' oral hygiene is an option for preventing postoperative pneumonia that may be caused by aspiration of oral and pharyngeal secretions. Whether preoperative oral care by a dentist can decrease postoperative complications remains controversial. A retrospective cohort study was undertaken to assess the association between preoperative oral care and postoperative complications among patients who underwent major cancer surgery. ⋯ Preoperative oral care by a dentist significantly reduced postoperative complications in patients who underwent cancer surgery.
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Multicenter Study
Best-practice care pathway for improving management of mastitis and breast abscess.
Surgical subspecialization has resulted in mastitis and breast abscesses being managed with unnecessary admission to hospital, prolonged inpatient stay, variable antibiotic prescribing, incision and drainage rather than percutaneous aspiration, and loss to specialist follow-up. The objective was to evaluate a best-practice algorithm with the aim of improving management of mastitis and breast abscesses across a multisite NHS Trust. The focus was on uniformity of antibiotic prescribing, ultrasound assessment, admission rates, length of hospital stay, intervention by aspiration or incision and drainage, and specialist follow-up. ⋯ A standardized approach to mastitis and breast abscess reduced undesirable practice variation, with sustained improvements in process and patient outcomes.
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Pragmatic Clinical Trial
Effectiveness of a multidisciplinary patient care bundle for reducing surgical-site infections.
Surgical-site infection (SSI) is associated with significant healthcare costs. To reduce the high rate of SSI among patients undergoing colorectal surgery at a cancer centre, a comprehensive care bundle was implemented and its efficacy tested. ⋯ Meaningful reductions in SSI can be achieved by implementing a multidisciplinary care bundle at a hospital-wide level.