Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Oct 2009
ReviewEvidence-based patient safety advisory: patient assessment and prevention of pulmonary side effects in surgery. Part 1. Obstructive sleep apnea and obstructive lung disease.
Obstructive sleep apnea and obstructive lung disease may increase a patient's risk of perioperative pulmonary complications. This practice advisory provides an overview of the preoperative steps that should be performed to ensure appropriate patient selection and the safety of patients with these conditions. Also discussed are recommendations for perioperative management and strategies for minimizing complications.
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Plast. Reconstr. Surg. · Oct 2009
ReviewEvidence-based patient safety advisory: patient selection and procedures in ambulatory surgery.
Despite the many benefits of ambulatory surgery, there remain inherent risks associated with any surgical care environment that have the potential to jeopardize patient safety. This practice advisory provides an overview of the preoperative steps that should be completed to ensure appropriate patient selection for ambulatory surgery settings. In conjunction, this advisory identifies several physiologic stresses commonly associated with surgical procedures, in addition to potential postoperative recovery problems, and provides recommendations for how best to minimize these complications.
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Plast. Reconstr. Surg. · Oct 2009
ReviewEvidence-based patient safety advisory: malignant hyperthermia.
As more and more routine plastic surgery procedures move from the hospital to outpatient surgery facilities, plastic surgeons must be aware of the risk factors for life-threatening events that might occur in this setting. This awareness includes recognition of the signs and symptoms and the management of a rare but life-threatening condition, malignant hyperthermia. This article reviews the current understanding of the concepts pertinent to malignant hyperthermia diagnosis and treatment in the outpatient setting and current standards and recommendations for physicians and support personnel regarding malignant hyperthermia preparedness in office-based surgery and anesthesia.
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Plast. Reconstr. Surg. · Feb 2009
ReviewSimulation in plastic surgery training and education: the path forward.
Computer-based training simulators have been used extensively, most notably in flight simulation. Over the past 20 years, surgical simulators have been developed, initially for training of minimally invasive surgery and more recently for open surgical simulation. ⋯ The authors believe that a similar training plan should be mandated for plastic surgery, to take advantage of the use of computers, virtual reality, and simulation in the training of plastic surgery residents and to explore the value of this technology for continuing medical education and maintenance of certification. This article gives a brief background and history of surgical simulation and its technology, followed by a detailed description of the three phases of the American College of Surgeons' plan and how the authors propose that each phase be implemented, with modifications as applicable for trainees in plastic surgery.
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As pressure on resources increases, decision makers in health care are increasingly seeking high-quality, scientific evidence to support clinical and health policy choices. Ultimately, legislators will look to develop performance measures based on evidence, rather than on consensus or commonality of practice. ⋯ In doing so, we will challenge the common practice of basing clinical decisions solely on what we are taught, procedures we are most comfortable doing, or procedures that are most financially rewarding. These efforts will not only afford us the best opportunity to provide optimal care to patients but also allow us to demonstrate the inherent quality of our surgical specialty.