Thoracic surgery clinics
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Thoracic surgery clinics · Feb 2013
ReviewLarge-bore and small-bore chest tubes: types, function, and placement.
Chest tubes are placed in the pleural space, either surgically or percutaneously to evacuate abnormal fluid and air. Indications for chest tubes include therapeutic drainage of pleural conditions such as pneumothorax, hemothorax, empyema, chylothorax, and malignant effusions, as well as prophylaxis drainage of air, blood, and other fluids after chest surgery. This article characterizes the types of chest tubes, reviews the basic techniques for insertion, and describes the comparative effectiveness between large-bore and small-bore chest tubes.
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Thoracic surgery clinics · Feb 2013
ReviewAnatomy and pathophysiology of the pleura and pleural space.
Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the hydrostatic and oncotic forces dictates pleural fluid homeostasis. ⋯ Its vessels are closer to the pleural space compared with its visceral counterpart; it contains lymphatic stomata, absent on visceral pleura, which are responsible for a bulk clearance of fluid. The diagnosis and successful treatment of pleural effusions requires a mixture of imaging techniques and pleural fluid analysis.
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Thoracic surgery clinics · Nov 2012
ReviewPsychosocial issues facing lung transplant candidates, recipients and family caregivers.
Although lung transplantation is an accepted treatment for many individuals with severe lung disease, transplant candidates and recipients experience a range of psychosocial stressors that begin at the initiation of the transplant evaluation and continue throughout patients' wait for donor lungs, their perioperative recovery, and their long-term adjustment to posttransplant life. Transplant programs should strive to incorporate evidence-based interventions that aim to improve physical functioning, psychological distress, global quality of life, and medical adherence as well as to integrate symptom management and palliative care strategies throughout the pre- and posttransplantation course.
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Patient safety has been the subject of surgical investigation for the past century. A specific focus on safety and medical errors has incited public attention, government oversight, and research funding. ⋯ A critical analysis of medical errors, their frequency and cause, and outcomes associated with their occurrence has allowed the identification of system-based issues and the implementation of corrective changes to improve these systems. Constant vigilance examining errors and how they occur will allow identification of strategies to reduce errors.
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Thoracic surgery clinics · Nov 2012
ReviewSurviving the intensive care: residual physical, cognitive, and emotional dysfunction.
Patients recovering from critical illness may suffer from physical, psychological, and cognitive problems that have a negative impact on their health-related quality of life. To ensure that patients return as close as possible to their previous physical and mental health, their rehabilitation needs should be assessed and an appropriate program started. Both early mobilization and physical rehabilitation while the patient is still in the intensive care unit and manualized rehabilitation after discharge are beneficial. It is important to assess the rehabilitation needs of patients and target physiotherapy and counseling resources at those patients with the greatest need.