Articles: cations.
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J Laparoendosc Adv Surg Tech A · Apr 2016
Novel Uses of Video to Accelerate the Surgical Learning Curve.
Surgeons are under enormous pressure to continually improve and learn new surgical skills. Novel uses of surgical video in the preoperative, intraoperative, and postoperative setting are emerging to accelerate the learning curve of surgical skill and minimize harm to patients. In the preoperative setting, social media outlets provide a valuable platform for surgeons to collaborate and plan for difficult operative cases. ⋯ Finally, postoperative use of video has provided structure for peer coaching to evaluate and improve surgical skill. Applying these approaches into practice is becoming easier as most of our surgical platforms (e.g., laparoscopic, and endoscopy) now have video recording technology built in and video editing software has become more user friendly. Future applications of video technology are being developed, including possible integration into accreditation and board certification.
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Observational Study
Provider Bias Impacts Tidal Volume Selection and Ventilator Days in Trauma Patients.
The ARDSnet (Acute Respiratory Distress Syndrome Clinical Network) study demonstrated that low tidal volume (Vt) reduces mortality from ARDS. It is unknown whether low Vt is beneficial in at-risk trauma patients. We hypothesized that Vt selection would be low in accordance with ARDSnet criteria and that subsequent outcomes would be improved. ⋯ Trauma patients receiving high Vt were shorter, had higher BMI, and were more likely to be female. The consequences included longer ICU stays and more ventilator days. Formal calculation of PBW and subsequent Vt is advocated.
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As most bariatric procedures are performed by laparoscopy, hospital stay is exceptionally short, despite the habitus of patients and the rather extensive intra-abdominal surgery. To facilitate postoperative mobilization, most patients are given repeated single doses of morphine, a drug with several side effects. We aimed to evaluate the effect of preoperative treatment with a tablet of slow-release morphine (SRM) on postoperative analgesic consumption and length of stay (LOS) in laparoscopic gastric bypass (LGBP). ⋯ Preoperatively administered slow-release morphine significantly reduced the need for postoperative analgesics and shortened hospital stay, without side effects or other complications. At our department, the studied regime is now routinely used in all bariatric surgery and we have started to use the concept in other groups of surgical patients.
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Plast. Reconstr. Surg. · Apr 2016
Comparative StudyWhat Is the Best Way to Measure Surgical Quality? Comparing the American College of Surgeons National Surgical Quality Improvement Program versus Traditional Morbidity and Mortality Conferences.
Morbidity and mortality conferences have played a traditional role in tracking complications. Recently, the American College of Surgeons National Surgical Quality Improvement Program Pediatrics (ACS NSQIP-P) has gained popularity as a risk-adjusted means of addressing quality assurance. The purpose of this article is to report an analysis of the two methodologies used within pediatric plastic surgery to determine the best way to manage quality. ⋯ The ACS NSQIP-P database is able to accurately track complication rates similarly to morbidity and mortality conferences, although it samples only half of all procedures. Although both systems offer value, limitations exist, such as differences in definitions and purpose. Because of the rigor of the ACS NSQIP-P, we recommend that it be expanded to include currently excluded cases and an extension of the study interval.
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Ischemic conditioning induces a series of cellular modifications that may prevent injury from further hypoxic episodes, but there are few data in sepsis. In this randomized controlled study, we evaluated the effects of ischemic conditioning on the microcirculation, organ function, and survival time in an ovine model of septic shock. Sepsis was induced in 14 anesthetized, mechanically ventilated adult sheep by injecting autologous feces into the abdominal cavity. ⋯ Microcirculatory variables were better preserved in the conditioned than in the control group from 6 h after randomization: the median proportion of perfused vessels was 91 (89-93)% versus 89 (86-90)% (P = 0.024) and there was less heterogeneity. Oliguria, hypotension, and death occurred later in the conditioned than in the control group. In this sepsis model, remote ischemic pre- and post-conditioning therefore decreased organ dysfunction, preserved the microcirculation, and prolonged survival.