Archives of surgery (Chicago, Ill. : 1960)
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Randomized Controlled Trial Multicenter Study
Definitive risk factors for anastomotic leaks in elective open colorectal resection.
Anastomotic leaks following elective colorectal resections increase morbidity, mortality, and the need for additional interventions. An accurate understanding of risk factors would potentially reduce anastomotic leaks and/or allow appropriate selection of patients for diverting stomas. ⋯ Significant risk factors for anastomotic leaks include low preoperative serum albumin level, steroid use, male sex, and increased duration of surgery. Appreciation of risk factors provides a rational basis for temporary diversion.
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Comparative Study
Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek.
Considerable concern has been raised about the effects of restricted duty hours on surgical training. However, to our knowledge, the effect of the 80-hour resident workweek on operative outcomes after laparoscopic cholecystectomy has not been well studied. ⋯ At a major public teaching hospital, the bile duct injury rate and the overall complication rate decreased after implementation of the 80-hour workweek.
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Surgical trainees in the United States have a growing interest in both clinical experiences and structured training opportunities in global health. Global health training and exposure can be integrated into a surgical residency program. ⋯ Global health training and exposure for residents can be effectively integrated into an academic surgical residency program through relationships with training programs in low-income countries. Legitimate academic experiences improve the success of these programs. Reciprocity with collaborative partners must be ensured, and sustained commitment and funding remain a great challenge to such programs. The long-term effect on the development of global health careers is yet to be determined.
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Meta Analysis
Meta-analysis of randomized studies evaluating chewing gum to enhance postoperative recovery following colectomy.
To compare outcomes following abdominal surgery with or without the use of chewing gum in the early postoperative period. ⋯ Chewing gum may enhance intestinal recovery following colectomy and reduce the length of hospital stay. Owing to the potential for substantial cost savings, larger-scale, blinded, randomized controlled trials with placebo arms are warranted.
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To determine whether age bias is a factor in triage errors. ⋯ Even when trauma is recognized and acknowledged by EMS, providers are consistently less likely to consider transporting elderly patients to a trauma center. Unconscious age bias, in both EMS in the field and receiving trauma center personnel, was identified as a possible cause.