SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Annals of surgery

80

Laparoscopic sleeve gastrectomy (LSG) is performed almost as often in Europe as laparoscopic Roux-Y-Gastric Bypass (LRYGB). We present the 3-year interim results of the 5-year prospective, randomized trial comparing the 2 procedures (Swiss Multicentre Bypass Or Sleeve Study; SM-BOSS).

Concepts: Randomized controlled trial

53

To determine if preoperative intravenous (IV) iron improves outcomes in abdominal surgery patients.

Concepts: Randomized controlled trial

32

The aim of this study was to develop and internally validate a triage score that can identify trauma patients at the scene who would potentially benefit from helicopter emergency medical services (HEMS).

Concepts: Illness, Ambulance, Emergency medical services, Emergency medicine, Paramedic, Emergency medical technician, Emergency physician, R Adams Cowley

32

To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.

Concepts: Randomized controlled trial, Surgery, Pharmaceutical industry

30

: To evaluate the long-term impact of the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hour limits on residents' perception of education.

Concepts: Psychology, Learning, School, United Nations, Medical education in the United States

29

To examine how surgeons use the “fix-it” model to communicate with patients before high-risk operations.

Concepts: Hospital, Physician, Cognition, Decision theory

29

To explore high-stakes surgical decision making from the perspective of seniors and surgeons.

Concepts: Decision making, Surgery

29

: The purpose of this study was to identify patient, clinical, and surgical factors that may predispose patients to anastomotic leak (AL) after large bowel surgery.

Concepts: Colon, Defecation

28

: Though histological grade is known to have a major prognostic impact in metastatic mucinous appendiceal adenocarcinomas, the prognostic impact of grade in localized disease, and the validity of the American Joint Committee on Cancer AJCC Staging Manual 7th edition’s decision to combine moderately and poorly differentiated mucinous adenocarcinomas into a single mucinous high-grade category, is not known.

Concepts: Cancer, Disease, Breast cancer, Lung cancer, Cancer staging, Testicular cancer, AJCC staging system, American Joint Committee on Cancer

28

OBJECTIVE:: To identify clinical hallmarks associated with recovery of gastrointestinal transit. BACKGROUND:: Impaired gastrointestinal transit or postoperative ileus largely determines clinical recovery after abdominal surgery. However, validated clinical hallmarks of gastrointestinal recovery to evaluate new treatments and readiness for discharge from the hospital are lacking. METHODS:: Gastric emptying and colonic transit were scintigraphically assessed from postoperative day 1 to 3 in 84 patients requiring elective colonic surgery and were compared with clinical parameters. The clinical hallmark that best reflected recovery of gastrointestinal transit was validated using data from a multicenter trial of 320 segmental colectomy patients. RESULTS:: Seven of 84 patients developed a major complication with paralytic ileus characterized by total inhibition of gastrointestinal motility and were excluded from further analysis. In the remaining patients, recovery of colonic transit (defined as geometric center of radioactivity ≥2 on day 3), but not gastric emptying, was significantly correlated with clinical recovery (ρ = -0.59, P < 0.001). Conversely, the combined outcome measure of tolerance of solid food and having had defecation (SF + D) (area under the curve = 0.9, SE = 0.04, 95% CI = 0.79-0.95, P < 0.001), but not time to first flatus, best indicated recovery of gastrointestinal transit with a positive predictive value of 93% (95% CI = 78-99). Also in the main clinical trial, multiple regression analysis revealed that SF + D best predicted the duration of hospital stay. CONCLUSIONS:: Our data indicate that the time to SF + D best reflects recovery of gastrointestinal transit and therefore should be considered as primary outcome measure in future clinical trials on postoperative ileus.(Netherlands National Trial Register, number NTR1884 and NTR222).

Concepts: Regression analysis, Clinical trial, Digestive system, Prediction, Pharmaceutical industry, Clinical research, Ileus, Multicenter trial