American journal of surgery
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The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. ⋯ We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum.
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Effective therapeutic agents for the prevention and treatment of acute kidney injury (AKI) after cardiac surgery remain elusive despite the tremendous advances in surgical techniques, technology, and understanding of disease processes. Recent developments and their effect on the incidence of AKI after cardiac surgery are discussed. ⋯ The definition of AKI has changed, and the focus of interventions has shifted from treatment to prevention to recovery from AKI. Antioxidants and biological agents have been added to classic armaments of hydration and diuretics in addition to tighter metabolic control to prevent AKI. Although the treatment options remain unsatisfactory, a lot of progress nevertheless continues to be made in the prevention and treatment of AKI.
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A systematic analysis was conducted of randomized controlled trials (RCTs) comparing lightweight mesh (LWM) with heavyweight mesh in laparoscopic inguinal hernia repair. ⋯ The use of LWM for laparoscopic inguinal hernia repair is not associated with an increased risk for hernia recurrence. LWM reduces the incidence of chronic groin pain, groin stiffness, and foreign body sensations. Therefore, LWM may routinely be used in laparoscopic inguinal hernia repair. However, high-quality RCTs with longer follow-up periods are required to validate these findings.
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The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth modification (P-POSSUM) are used extensively to predict postoperative mortality and morbidity in general surgery. The aim of this study was to undertake the first systematic review of the predictive value of these models in patients undergoing pancreatic surgery. ⋯ POSSUM overpredicted postoperative morbidity in patients undergoing pancreatic surgery. Both POSSUM and P-POSSUM failed to offer significant predictive value for mortality in pancreatic surgery, and more data collection in large populations undergoing pancreatic surgery are needed.
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The increasing complexity of medical and surgical care often demands comprehensive preoperative work-ups by medical consultants and detailed management recommendations to optimize the patient's medical ailments before surgery. This article aims to review the available evidence and discuss elements of the preoperative medical consultation that are of particular relevance to surgeons. ⋯ Collaborative efforts and adequate communication between the medical and surgical teams are necessary to ensure appropriate patient management before surgery. Although higher-risk patients may require thorough preoperative evaluations, extensive routine investigations may not always be necessary.