International journal of surgery
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Randomized Controlled Trial Comparative Study
Postoperative port-site pain after gall bladder retrieval from epigastric vs. umbilical port in laparoscopic cholecystectomy: a randomized controlled trial.
To determine whether gall bladder (GB) retrieval from umbilical port is associated with more pain at port site as compared to GB retrieval from epigastric port in adult patients undergoing four port elective laparoscopic cholecystectomy at a tertiary care hospital. ⋯ Gall bladder retrieval from umbilical port is associated with lower port site pain than GB retrieval from epigastric port in patients undergoing elective laparoscopic cholecystectomy. We recommend umbilical port for gall bladder retrieval.
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Comparative Study
Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly.
Accurate prediction of outcome after emergency surgery in elderly patients may assist decision-making. Many scoring systems require post-operative data (e.g. P-POSSUM) whilst others have failed to gain widespread use. Recent reports suggest that C-reactive protein (CRP) and the neutrophil lymphocyte (N/L ratio) ratio may predict surgical outcome. ⋯ N/L ratio is an easily calculable pre-operative measure that may have utility in the prediction of outcome after emergency abdominal surgery in the elderly. Further work to validate this measure in a larger, prospective setting and determine the underlying mechanisms that mediate outcome are necessary.
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Comparative Study
Functional haemodynamic monitoring: The value of SVV as measured by the LiDCORapid™ in predicting fluid responsiveness in high risk vascular surgical patients.
There is growing evidence that optimal peri-operative fluid management in high-risk surgical patients improves their post-operative outcome. Functional haemodynamic parameters such as SVV (stroke volume variation), PPV (pulse pressure variation) and SPV (systolic pressure variation) have been shown to be superior to CVP (central venous pressure) and ΔCVP in predicting fluid responsiveness. The aim of this study was to determine the accuracy and threshold values of these dynamic parameters using the minimally invasive LiDCORapid™ in high-risk surgical patients. ⋯ Only the SVV was an adequate predictor of fluid responsiveness in this cohort of high risk surgical patients. Whereas PPV and SPV may be obtained from the arterial trace, estimation of the SVV requires a cardiac output monitor which is able to convert an arterial pressure trace into an estimation of stroke volume.
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Clinical handover (handoff, sign out) is frequently implicated as a cause of adverse events in hospitalised patients. Complex social interactions such as handover are subject to the teamwork skills of the participants and there is increasing evidence that the quality of teamwork in handover affects outcome. Teamwork skills have been assessed in one-to-one handovers but the applicability of these measurement tools to healthcare team shift handovers remains unproven. This study aimed to assess the feasibility of measurement of teamwork skills in shift handover and the applicability of adapted teamwork skills rating scales to a shift handover environment. ⋯ Teamwork skills vary widely between handovers and can be consistently scored using both rating scales. It is feasible to use adapted teamwork skill rating scales in shift handover and they appear to measure different constructs to traditional handover measures such as interruptions and communication checklist completion. The assessment of teamwork skills is a necessary complement to the assessment of completeness of information transfer when evaluating the overall quality of handover.
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Change in junior doctors working pattern has brought effective and safe clinical handover into a central role to ensure the patient safety and high quality care. We investigated whether the compliance and quality of clinical handover could be improved through the use of a standardised and structured handover template. ⋯ Implementation of a standardised guideline-based structured handover template and training of junior doctors are likely to improve compliance to agreed standards, promote quality of care, and protect patient safety.