International journal of surgery
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There is still significant risk of patients developing surgical site infection (SSI) following orthopaedic surgery due to growing demand for joint surgery in high-risk patients and increasing complexity of procedures. The higher rate of SSI seen in high-risk procedures and also in high-risk patients is of concern as the development of infection can be a very serious complication of orthopaedic surgery and has implications for patient morbidity, length of hospital stay (LOS), resource utilisation and healthcare costs. This article provides an overview of the efficacy of prophylactic and therapeutic application of resorbable gentamicin-containing collagen implants (GCCI) in the prevention of SSI following orthopaedic surgical procedures. ⋯ This review demonstrates that prophylactic use of GCCI can have a positive effect on wound healing in a range of orthopaedic surgical procedures and in high-risk patients. GCCI may also have a role to play in the treatment of osteomyelitis.
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Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. ⋯ It presents the meaning and rationale for each new and updated checklist item providing examples of good reporting and, where possible, references to relevant empirical studies. Several examples of flow diagrams are included. The CONSORT 2010 Statement, this revised explanatory and elaboration document, and the associated website (www.consort-statement.org) should be helpful resources to improve reporting of randomised trials.
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A best evidence topic in ear, nose and throat surgery was written according to a structured protocol. The question addressed was: In patients who are undergoing pinnaplasty for prominent ears, does the use of post-operative head bandages as compared to not using post-operative head bandages improve clinical outcomes? A total of 121 papers were identified using the reported search protocol, of which five articles represented the best evidence to answer the clinical question. ⋯ Four of the five studies concluded that head bandages should not be utilised at all, whereas two of the five studies suggested that there is little reason to use head bandages after the first 24 h post-pinnaplasty. Therefore, the clinical bottom line is that provided the pinnaplasty result is good at time of surgery, there is reasonable evidence to suggest that head bandages have no effect on complications or patient satisfaction, so at best they are unnecessary and at worst, their physical drawbacks may actually outweigh any of their perceived benefits.
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A best evidence topic was written according to a structured protocol. The question addressed was whether early laparoscopic cholecystectomy (ELC) in patients presenting with a short history of acute cholecystitis provides better post-operative outcomes than a delayed laparoscopic cholecystectomy (DLC). A total of 92 papers were found using the reported searches of which 10 represented the best evidence; 3 meta-analyses, 4 randomized control trials, 1 prospective controlled study and 2 retrospective cohort studies were included. ⋯ We conclude that there is strong evidence that early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality. The operating time in ELC can be longer, however the incidence of serious complications (i.e. common bile duct injury), is comparable to the DLC group. Larger randomized studies are required before solid conclusions are reached.
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Review Comparative Study
Enteral vs total parenteral nutrition following major upper gastrointestinal surgery.
A best evidence topic in surgery was written according to a structured protocol. The question addressed was in patients undergoing elective major upper gastrointestinal surgery requiring post-operative nutritional support, does enteral feeding as compared to total parenteral feeding confer any clinical benefits. ⋯ All seven of these papers were randomised controlled trials which demonstrated enteral nutrition to be associated with shorter hospital stay, lower incidence of severe or infectious complications, lower severity of complications and decreased cost as compared to parenteral nutrition. For patients undergoing elective major upper gastrointestinal surgery requiring post-operative nutritional support, enteral feeding should be considered as the most desirable form of post-operative feeding.