Fedmekirurgi i Norge – fritt fram? Sandbu, Rune; Svanevik, Marius
Tidsskrift for den Norske Lægeforening,
2019, Letnik:
139, Številka:
10
Journal Article
To compare clinical failure, recurrent instability, patient-reported outcome measures (PROMs), and return to sport (RTS) between knotted and knotless fixation methods in arthroscopic posterior labral ...repair for isolated posterior shoulder instability (PSI).
Multiple databases were queried according to Preferred Reported Items for Systematic Reviews and Meta-Analyses guidelines for clinical studies with Level I to IV evidence, including knotted and knotless suture anchors for arthroscopic posterior labral repair. Combined anterior and posterior instability, multidirectional instability, SLAP injuries, unspecified repair techniques, majority open procedures, and revision surgery were excluded.
Screening yielded 17 full-text articles reporting on 852 shoulders undergoing posterior labral repair. Recurrent instability ranged from 0% to 21%, and the rate of revision surgery ranged from 0% to 11% in knotted only, 0% in knotless only, and 2.0% to 8.1% in knotted and knotless studies. Six studies with both pre- and postoperative visual analog scale scores and 7 studies with both pre- and postoperative American Shoulder and Elbow Score scores all showed improvement in scores after intervention regardless of repair technique. Thirteen studies reported RTS or duty rates with a minimum of 79%.
Overall recurrent instability after posterior labral repair for isolated PSI was low with improvement in PROMs and favorable RTS rates regardless of fixation method. There was no clear difference in recurrent instability or revision surgery between knotted and knotless fixation methods for isolated posterior labral repair. However, the current literature is predominantly limited by Level III and IV evidence. The quality of literature and lack of standardization on the definition of clinical failure and recurrent instability among surgeons preclude any definitive conclusion regarding one clinically superior fixation method.
Level IV, systematic review of Level III and IV studies.
The SCARE Guidelines were published in 2016 to provide a structure for reporting surgical case reports. Since their publication, SCARE guidelines have been widely endorsed by authors, journal ...editors, and reviewers, and have helped to improve reporting transparency of case reports across a range of surgical specialties. In order to encourage further progress in reporting quality, the SCARE guidelines must themselves be kept up to date. We completed a Delphi consensus exercise to update the SCARE guidelines.
A Delphi consensus exercise was undertaken. All members of the previous Delphi group were invited to participate, in addition to researchers who have previously studied case reports, and editors from the International Journal of Surgery Case Reports. The expert group was sent an online questionnaire where they were asked to rate their agreement with proposed changes to each of the 24 items.
56 people agreed to participate and 45 (80%) invitees completed the survey which put forward modifications to the original guideline. The collated responses resulted in modifications. There was high agreement amongst the expert group.
A modified and improved SCARE checklist is presented, after a Delphi consensus exercise was completed.
The SCARE 2018 Statement: Updating Consensus Surgical CAse REport (SCARE) Guidelines.
•A Delphi consensus exercise to update the SCARE guidelines.•45 (80%) invitees completed the survey and there was high agreement amongst the expert group.•The collated responses resulted in modifications, and a improved SCARE checklist is presented.
Ischemic preconditioning (IPC) is defined as raising tolerance to subsequent ischemic stress by exposing tissues to sub-lethal ischemia. Although many candidates have been suggested, recent studies ...have clearly demonstrated that adenosine-mediated ADORA2B receptor (ADORA2BR) activation is the main mechanism involved in IPC. While the tissue-protective role of this mechanism has been demonstrated in different ischemia/reperfusion (I/R) models, its role in flap surgery-derived I/R damage has not to date been investigated.
To investigate the role of adenosine and ADORA2BR activation in IPC-mediated tissue protection in an epigastric flap model.
Animals were divided into five main groups, all of which were then divided into two subgroups depending on whether or not they were exposed to IPC before the I/R procedure, which consisted of 6 hours of ischemia and 6 days of reperfusion. No drugs were administered in Group 1 (the control group). Animals in Group 2 were pretreated with CD73-inhibitor before IPC application or the ischemic period. Animals in Group 3 were pretreated with adenosine. Animals in Group 4 were pretreated with an ADORA2BR antagonist, and those in Group 5 with an ADORA2BR agonist. After 6 days of reperfusion, tissue survival was evaluated via histological and macroscopic analysis.
IPC application significantly enhanced CD73 expressions and adenosine concentrations (p < 0.01). Flap survivals were increased by IPC in Group 1 (p < 0.05). However, CD73 inhibition blocked this increase (Group 2). In Group 3, adenosine improved flap survival even in the absence of IPC (p < 0.01). While an ADORA2BR antagonist attenuated the tissue-protective effect of IPC (p < 0.01), the ADORA2BR agonist improved flap survival by mimicking IPC in groups 4 and 5.
These results provide pharmacological evidence for a contribution of CD73 enzyme-dependent adenosine generation and signaling through ADORA2BR to IPC-mediated tissue protection. They also suggest for the first time that ADORA2BR agonists may be used as a potential preventive therapy against I/R injury in flap surgeries.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
European trends in epilepsy surgery Baud, Maxime O; Perneger, Thomas; Rácz, Attila ...
Neurology,
07/2018, Letnik:
91, Številka:
2
Journal Article
Recenzirano
Odprti dostop
OBJECTIVEResective surgery is effective in treating drug-resistant focal epilepsy, but it remains unclear whether improved diagnostics influence postsurgical outcomes. Here, we compared practice and ...outcomes over 2 periods 15 years apart.
METHODSSixteen European centers retrospectively identified 2 cohorts of children and adults who underwent epilepsy surgery in the period of 1997 to 1998 (n = 562) or 2012 to 2013 (n = 736). Data collected included patient (sex, age) and disease (duration, localization and diagnosis) characteristics, type of surgery, histopathology, Engel postsurgical outcome, and complications, as well as imaging and electrophysiologic tests performed for each case. Postsurgical outcome predictors were included in a multivariate logistic regression to assess the strength of date of surgery as an independent predictor.
RESULTSOver time, the number of operated cases per center increased from a median of 31 to 50 per 2-year period (p = 0.02). Mean disease duration at surgery decreased by 5.2 years (p < 0.001). Overall seizure freedom (Engel class 1) increased from 66.7% to 70.9% (adjusted p = 0.04), despite an increase in complex surgeries (extratemporal and/or MRI negative). Surgeries performed during the later period were 1.34 times (adjusted odds ratio; 95% confidence interval 1.02–1.77) more likely to yield a favorable outcome (Engel class I) than earlier surgeries, and improvement was more marked in extratemporal and MRI-negative temporal epilepsy. The rate of persistent neurologic complications remained stable (4.6%–5.3%, p = 0.7).
CONCLUSIONImprovements in European epilepsy surgery over time are modest but significant, including higher surgical volume, shorter disease duration, and improved postsurgical seizure outcomes. Early referral for evaluation is required to continue on this encouraging trend.
Bakgrunn: I 2011 ble den nasjonale pasientsikkerhetskampanjen «I trygge hender» lansert. Et av tiltakene var innføring av sjekkliste for trygg kirurgi. Pasienten er en viktig brikke i gjennomgangen ...av sjekklisten og derfor er det viktig å undersøke deres opplevelser. Per i dag er det lite forskning på pasienters erfaringer med sjekklisten. Hensikt: Å få mer kunnskap om hvordan gjennomgangen av sjekklisten oppleves for pasienten. Dette for å belyse hva som kan fremme god bruk av sjekklisten. Metode: Studien har et kvalitativt fenomenologisk design. Syv individuelle semistrukturerte intervju ble gjennomført. Giorgis deskriptive analyse ble benyttet. Resultat: Analysen resulterte i et hovedtema «Trygghet» med to undertemaer «Trygge rammer» og «Mer enn bare en sjekkliste». Informantene var ikke kjent med at sjekklisten ble benyttet, men de opplevde sjekklisten som positiv både for pasienten og det kirurgiske teamet. De ønsket at sjekklisten skulle benyttes, og de ønsket å bli involvert i gjennomgangen. Informantene mente utformingen av sjekklisten var god, at gjennomgangen skapte trygghet og at sjekklisten var en sikkerhet for at alt ble utført korrekt. De opplevde at informasjonen de fikk om sjekklisten var tilstrekkelig. I tillegg så de på sjekklisten som en mulighet for å få og gi informasjon og til å kunne stille spørsmål. De mente også at sjekklisten var der for at pasienten skulle føle seg trygg og at det var en mulighet for det kirurgiske teamet til å bli kjent med pasienten. Konklusjon: Funnene i denne studien tyder på at sjekkliste for trygg kirurgi oppleves som en trygghet for pasientene og at det kan bidra til å øke pasientsikkerheten. Informantene opplevde det også som en trygghet for det kirurgiske teamet, da de får en mulighet til å bli kjent med pasienten. I tillegg kom det frem at pasientene opplevde at sjekklisten hadde flere hensikter enn bedret pasientsikkerhet og teamfølelse. English abstract The Surgical Safety Checklist Provides Security for the Patient – A Qualitative Study Background: In 2011, the national patient safety campaign «In safe hands» was launched. One of the measures was the introduction of a surgical safety checklist. The patient is an important participant in the review of the checklist and therefore it is important to explore their experiences. As of today, there is little research concerning patients’ experiences with the checklist. Purpose: To gain more knowledge about how the patient experiences the review of the checklist and thus to highlight what can promote appropriate use of the checklist. Method: The study has a qualitative phenomenological design. Seven individual semi-structured interviews were conducted. Giorgi’s descriptive analysis was used. Result: The analysis resulted in a main theme «Safety» with two sub-themes «Safe frameworks» and «More than just a checklist». The informants were not aware that the checklist was used, but they experienced the checklist as positive for both the patient and the surgical team. They wanted the checklist to be used and they wanted to be involved in the review. The informants believed that the design of the checklist was good, that the review created security and that the checklist was a guarantee that everything was carried out correctly. They felt that the information they received about the checklist was sufficient. In addition, they regarded the checklist as an opportunity to receive and give information and to be able to ask questions. They also believed that the purpose of checklist was to make the patient feel safe and that it was an opportunity for the surgical team to get to know the patient. Conclusion: The findings in this study suggest that the surgical safety checklist is experienced as a sense of security for the patients and that it can contribute to increased patient safety. The informants also experienced the checklist as a sense of security for the surgical team, as they got an opportunity to get to know the patient. In addition, it appeared that the patients felt that the checklist had more purposes than improved patient safety and team spirit.
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