Arch Surg Chicago
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Comparative Study
A prospective study of a focused, surgeon-performed ultrasound examination for the detection of occult common femoral vein thrombosis in critically ill patients.
A focused, surgeon-performed ultrasound examination of the common femoral veins is an accurate screening tool for the detection of common femoral vein thrombosis in high-risk, critically ill patients. ⋯ A focused, surgeon-performed ultrasound examination is a rapid and accurate screening method to detect common femoral vein thrombosis in critically ill patients as well as to examine those patients in whom pulmonary embolism is strongly suspected.
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Many surgical intensive care units (SICUs) face bed shortages for acutely ill patients that may result from a large proportion of bed occupation by chronically ill patients. We hypothesized that the introduction of a new intermediate care or step-down unit (SDU) managed by surgically trained intensivists would allow the admission of more acutely ill patients while maintaining satisfactory outcomes. ⋯ Opening an SDU resulted in a significant increase in the overall severity of the SICU population. Creation of an SDU managed by surgically trained intensivists may optimize the use of a hospital's resources, permit the expansion of emergency or tertiary care services, and improve outcomes for critically ill surgical patients.
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Comparative Study Clinical Trial
Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy.
Pancreaticogastrostomy (PG) is associated with a lower relaparotomy rate following pancreaticoduodenectomy (PD) than pancreaticojejunostomy (PJ). ⋯ The PG procedure is a safe method of reconstruction after PD, with a significantly lower rate of PF and relaparotomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of spinal vs general anesthesia via laryngeal mask airway in inguinal hernia repair.
The use of laryngeal mask airway and propofol in inguinal hernia repair results in shorter operative and recovery room times. ⋯ We found no differences between short-acting spinal anesthesia and general anesthesia via laryngeal mask airway with intravenous propofol in efficiency or in early or late outcomes after elective inguinal hernia repair. Surgeon and patient preferences appear to be the most important reasons for selecting an anesthetic technique for individual patients undergoing inguinal hernia repair.
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The success of an educational program in July 1999 that lowered the catheter-related bloodstream infection (CRBSI) rate in our intensive care unit (ICU) 3-fold is correlated with compliance with "best-practice" behaviors. ⋯ Although a previous educational program decreased the CRBSI rate, this was associated with only modest compliance with best practice principles when bedside audits were performed 18 months later. A behavioral intervention improved all identified deficiencies, leading to a nonsignificant decrease in CRBSIs.