Patients who exhibit high systemic inflammation after cardiac surgery May benefit most from pre-emptive anti-inflammatory treatments. In this secondary analysis (n 1/4 813) of the randomised, ...double-blind Intraoperative High-Dose Dexamethasone for Cardiac Surgery trial, we set out to develop an inflammation risk prediction model and assess whether patients at higher risk benefit from a single intraoperative dose of dexamethasone (1 mg/kg). Inflammation risk before surgery was quantified from a linear regression model developed in the placebo arm, reLating preoperatively available covariates to peak postoperative C-reactive protein. The primary endpoint was the interaction between inflammation risk and the peak postoperative C-reactive protein reduction associated with dexamethasone treatment. The impact of dexamethasone on the main clinical outcome (a composite of death, myocardial infarction, stroke, renal failure, or respiratory failure within 30 days) was also explored in relation to inflammation risk. Preoperatively available covariates explained a minority of peak postoperative C-reactive protein variation and were not suitable for clinical application (R 1/4 0.058, P 1/4 0.012); C-reactive protein before surgery (excluded above 10 mg/L) was the most predictive covariate (P < 0.001). The anti-inflammatory effect of dexamethasone increased as the inflammation risk increased (-0.689 mg/L per unit predicted peak C-reactive protein, P 1/4 0.002 for interaction). No treatment-effect heterogeneity was detected for the main clinical outcome (P 1/4 0.167 for interaction). Overall, risk predictions from a model of inflammation after cardiac surgery were associated with the degree of peak postoperative C-reactive protein reduction derived from dexamethasone treatment. Future work should explore the impact of this phenomenon on clinical out-comes in larger surgical populations.
Extremely useful as a pocket reference, this handbook features dozens of photographs and covers all facets of general surgery. Each chapter author includes a narrative describing the relevant ...procedure, outlines common pitfalls and offers personal suggestions.
Background: With increasing implementation of enhanced recovery programs (ERPs) in clinical practice, standardised data collection and reporting have become critical in addressing the heterogeneity ...of metrics used for reporting outcomes. Opportunities exist to leverage electronic health record (EHR) systems to collect, analyse, and disseminate ERP data. Objectives: (i) To consolidate relevant ERP variables into a singular data universe; (ii) To create an accessible and intuitive query tool for rapid data retrieval. Method: We reviewed nine established individual team databases to identify common variables to create one standard ERP data dictionary. To address data automation, we used a third-party business intelligence tool to map identified variables within the EHR system, consolidating variables into a single ERP universe. To determine efficacy, we compared times for four experienced research coordinators to use manual, five-universe, and ERP Universe processes to retrieve ERP data for 10 randomly selected surgery patients. Results: The total times to process data variables for all 10 patients for the manual, five universe, and ERP Universe processes were 510, 111, and 76 min, respectively. Shifting from the five-universe or manual process to the ERP Universe resulted in decreases in time of 32% and 85%, respectively. Conclusion: The ERP Universe improves time spent collecting, analysing, and reporting ERP elements without increasing operational costs or interrupting workflow. Implications: Manual data abstraction places significant burden on resources. The creation of a singular instrument dedicated to ERP data abstraction greatly increases the efficiency in which clinicians and supporting staff can query adherence to an ERP protocol.
With the introduction of the European Working Time Directive and changes to doctors' contracts, junior doctors are increasingly expected to cross-cover surgical specialties whilst on-call. Often ...these are specialties in which they have limited, or no, post-graduate experience. Furthermore, this is often out-of-hours, when senior supervision is less readily available. This survival guide, written by junior doctors for junior doctors, provides a concise and easy to read tool for doctors delivering this care. It covers each surgical speciality in turn, addressing speciality specific emergencies; when to admit patients; and when to call for senior help, as well as offering guidance on common referrals and questions, post-operative complications and common medical emergencies in surgical patients. In addition, it outlines key practical skills often required in surgical specialties, providing a summary of necessary skills and tips and tricks for performing them safely and successfully. Lastly, with increasing availability of high-quality Apps and websites, it summarises key online resources available for junior doctors within surgical specialties. This book is the ideal companion for any junior doctor, or member of the multidisciplinary team, involved in the cross-cover of surgical specialties, helping them to deliver high-quality patient care with confidence.
The now classic "Pocket Pasha"--Otolaryngology-Head and Neck Surgery: Clinical Reference Guide--returns for its sixth edition. This universally standard guidebook concisely reviews all aspects of ...otolaryngology including rhinology, laryngology, otology, plastic surgery, sleep medicine, and more. All chapters focus on the key basic science and clinical information to quickly digest the essentials. This "high-yield" book retains a "by residents, for residents" feel while also including expert content useful not only for students and residents but also allied health professionals, primary care providers, and other health providers. The concise, outline format is useful for rapid reading during urgent clinical situations as well as a last-minute refresher before rounds. The guide has proven essential for board review and maintenance of certification exams.
Haunting images Gammeltoft, Tine M
2014., 20140314, 2014, 2014-02-22
eBook
Based on years of careful ethnographic fieldwork in Hanoi, Haunting Images offers a frank and compassionate account of the moral quandaries that accompany innovations in biomedical technology. At the ...center of the book are case studies of thirty pregnant women whose fetuses were labeled “abnormal” after an ultrasound examination. By following these women and their relatives through painful processes of reproductive decision making, Tine M. Gammeltoft offers intimate ethnographic insights into everyday life in contemporary Vietnam and a sophisticated theoretical exploration of how subjectivities are forged in the face of moral assessments and demands. Across the globe, ultrasonography and other technologies for prenatal screening offer prospective parents new information and present them with agonizing decisions never faced in the past. For anthropologists, this diagnostic capability raises important questions about individuality and collectivity, responsibility and choice. Arguing for more sustained anthropological attention to human quests for belonging, Haunting Images addresses existential questions of love and loss that concern us all.
Soft and Stiffness-controllable Robotics Solutions for Minimally Invasive Surgery presents the results of a research project, funded by European Commission, STIFF-FLOP: STIFFness controllable ...Flexible and Learn-able manipulator for surgical Operations. In Minimally Invasive Surgery (MIS), tools go through narrow openings and manipulate soft organs that can move, deform, or change stiffness. There are limitations on modern laparoscopic and robot-assisted surgical systems due to restricted access through Trocar ports, lack of haptic feedback, and difficulties with rigid robot tools operating inside a confined space filled with organs. Also, many control algorithms suffer from stability problems in the presence of unexpected conditions. Yet biological "manipulators", like the octopus arm can manipulate objects while controlling the stiffness of selected body parts and being inherently compliant when interacting with objects. STIFF-FLOP robot is an innovative soft robotic arm that can squeeze through a standard MIS, reconfigure itself and stiffen by hydrostatic actuation to perform compliant force control tasks while facing unexpected situations. Technical topics discussed in the book include:Soft actuatorsContinuum soft manipulatorsControl, kinematics and navigation of continuum manipulatorsOptical sensors for force, torque, and curvatureHaptic feedback and human interface for surgical systemsValidation of soft stiffness controllable robots
