International journal of surgery
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With the use of decompressive craniectomy for traumatic brain injury (TBI) come a corresponding number of cranioplasties. TBI causes dynamic processes to commence or change during the period from injury to recovery; hence, the role of the timing of surgical intervention should be emphasized. ⋯ The timing of cranioplasty following posttraumatic craniectomy was not related to the neurological outcomes of TBI. Despite the limitations of the retrospective design, the analyses provide preliminary information to elucidate the question.
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It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or 'tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs. ⋯ There is an increasing drive to improve the clinical role of the MDT within cancer care. This study demonstrates the main barriers that MDTs face in deciding on and, importantly, implementing a management plan. Further research should prospectively evaluate interventions to enhance translation of MDT decision-making into cancer care and thus to expedite and improve care.
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Randomized Controlled Trial Clinical Trial
Ramosetron vs. ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy: prospective, randomized, and double-blind study.
Up to 75% of the patients undergoing laparoscopic cholecystectomy develop postoperative nausea and vomiting (PONV). Both ramosetron, a serotonin subtype 3 (5-HT3) antagonist, and dexamethasone are effective for PONV prophylaxis following laparoscopic cholecystectomy but their combined effect has not been investigated. We investigated the efficacy and tolerance of ramosetron alone and ramosetron with dexamethasone for PONV prophylaxis after laparoscopic cholecystectomy. ⋯ In patients undergoing laparoscopic cholecystectomy, the combined use of ramosetron and dexamethasone was more effective than ramosetron alone for reducing the need for rescue antiemetics and pain control following the procedure.
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Meta Analysis
Safety and impact on diagnostic accuracy of early analgesia in suspected acute appendicitis: a meta-analysis.
The safety of early analgesia in patients suspected to have acute appendicitis (AA) is still controversial. ⋯ Early analgesia with opiates in suspected AA might influence the approach to treatment, but does not appear to alter diagnostic accuracy or surgical outcome. To support our findings, further trials on larger sample sizes from different age groups and both genders are needed.
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Chronic pelvic pain (CPP), a common gynaecological presentation, may be due to bladder pain syndrome (BPS) or the co-existence of BPS and endometriosis, known as the 'evil twins syndrome'. ⋯ Almost two thirds of women presenting with CPP have BPS. Large variations in prevalence may be due to variable study selection and quality. Clinicians need to actively investigate patients for BPS, a condition that appears to co-exist with endometriosis.