Archives of surgery (Chicago, Ill. : 1960)
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Dissection of subnipple tissue to spare the entire skin envelope of the breast (total skin-sparing mastectomy) is a feasible option in appropriately selected patients and yields an excellent final cosmetic outcome. ⋯ Total skin-sparing mastectomy is a viable surgical option in selected patients with breast neoplasm and those who choose prophylactic mastectomy, and may increase the willingness of women to consider mastectomy to reduce their risk of breast cancer.
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To determine if a change in trauma designation from level II (L2) to level I (L1) in the same institution reduces mortality. ⋯ The significant reduction in mortality of trauma patients with severe or specific injuries after the change to a higher trauma level designation may justify direct triage of these patients to L1 facilities, when available.
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Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients.
Timely diagnosis and treatment of adrenal insufficiency (AI) dramatically reduces mortality in trauma patients. We sought to identify risk factors and populations with a high risk of developing AI. ⋯ Exposure to etomidate is a modifiable risk factor for the development of AI in this sample of critically injured patients. The use of etomidate for procedural sedation and rapid-sequence intubation in this patient population should be reevaluated.
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To assess whether structured team briefings improve operating room communication. ⋯ Interprofessional checklist briefings reduced the number of communication failures and promoted proactive and collaborative team communication.
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Review
Unexpected intraoperative patient death: the imperatives of family- and surgeon-centered care.
Conveying to family members that their loved one has unexpectedly died during an operation is perhaps the most stressful task a surgeon must perform. The loss of a patient's life precipitates enormous personal and professional anxiety and stress on a surgeon: profound grief, damage to self-esteem, loss of self-confidence and reputation, and the specter of litigation. Most surgeons feel unskilled in such a setting, yet how they communicate-what they say and how they say it-is extremely important for everyone involved. Two distinct, but interactive, phases of response are relevant when communicating with a family before and after an unexpected death of their loved one: a proactive phase ("CARE") intended to establish a positive therapeutic relationship, and a reactive phase ("SHARE") intended to respond to the crisis in a compassionate and respectful manner and to ensure self-care for the physician.