Annals of medicine and surgery (2012)
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Ann Med Surg (Lond) · Jun 2014
The effects of QuikClot Combat Gauze on hemorrhage control in the presence of hemodilution and hypothermia.
Hemorrhage is the leading cause of death from trauma. Intravenous (IV) fluid resuscitation in these patients may cause hemodilution and secondary hemorrhage. In addition, hypothermia may interfere with coagulation. ⋯ For subjects achieving hemostasis, up to 5 L of IV fluid was administered or until bleeding occurred, which was defined as >2% total blood volume. The QCG had significantly less hemorrhage than the control (QCG = 30 ± 99 mL; control = 404 ± 406 mL) (p = .004). Further, the QCG group was able to tolerate more resuscitation fluid before hemorrhage (QCG = 4615 ± 1386 mL; control = 846 ± 1836) (p = .000).
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Allogenic blood is a finite resource, with associated risks. Previous studies show intraoperative cell salvage (ICS) can reduce allogenic transfusion rates in orthopaedic surgery. However, there are concerns regarding efficacy and cost-effectiveness of ICS. ⋯ There was no statistically significant difference in age or preoperative Hb between the groups, or in length of hospital stay. In this study, ICS has been shown to be effective in reducing rates and volume of postoperative allogenic transfusion in patients undergoing revision hip surgery at the SGH. However, further work is needed to establish the effect of changing anaesthetic technique on postoperative allogenic transfusion rates.
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Major complications in surgery affect up to 16% of surgical procedures. Over the past 50 years, many patient safety initiatives have attempted to reduce such complications. Since the formation of the National Patient Safety Agency in 2001, there have been major advances in patient safety. ⋯ All patients are placed at risk in the surgical environment. It is crucial that this risk is minimised, whilst optimising the patient's outcome. In this review, recent advances in perioperative patient safety are examined and placed in context.
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Ann Med Surg (Lond) · Jan 2013
Commentary on "duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study".
Decisions about the appropriate termination of resuscitation attempts are among the most important that teams must face, yet there have been very few studies looking into the issue. Many national guidelines refer only to advance decisions to prevent the initiation of resuscitation, such as DNAR orders,(1-3) and yet the decision to continue or abort on-going treatment is a clinical one, which should be evidence based like any other. This observational study(4) is one of the largest to examine the relationship between length of resuscitation efforts in hospital and outcome, and provides novel, powerful, and highly relevant results. ⋯ Exclusions were made for Emergency Departments, operating theatres, postoperative areas, procedure areas, rehabilitation areas, and arrests with area unknown, to avoid the 'distinct circumstances' of arrests in those settings. The median value for each hospital was calculated, and hospitals were divided into quartiles based on median length of resuscitation in non-survivors, with corresponding lengths of 16, 19, 22, and 25 minutes. Median resuscitation times overall were 17 minutes (IQR 10-26), with a breakdown of 12 minutes (IQR 6-21) for immediate survivors and 20 minutes (IQR 14-30) for non-survivors.(4).
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Ann Med Surg (Lond) · Jan 2013
Medical publishing triage - chronicling predatory open access publishers.
This editorial examines the problem of predatory publishers and how they have negatively affected scholarly communication. Society relies on high-quality, peer-reviewed articles for public policy, legal cases, and improving the public health. Researchers need to be aware of how predatory publishers operate and need to avoid falling into their traps. The editorial examines the recent history of predatory publishers and how they have become prominent in the world of scholarly journals.