The American surgeon
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The American surgeon · Jun 2007
Randomized Controlled Trial Comparative StudyProspective, double-blinded, randomized, placebo-controlled comparison of local anesthetic and nonsteroidal anti-inflammatory drugs for postoperative pain management after laparoscopic surgery.
Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. ⋯ The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.
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The American surgeon · Jun 2007
Comparative StudyInitial chest CT obviates the need for repeat chest radiograph after penetrating thoracic trauma.
The use of serial chest radiographs (CXRs) to evaluate patients with penetrating thoracic trauma is common practice. However, the time interval between these studies and the duration of observation remains uncertain. The purpose of this study was to evaluate whether a noncontrast chest CT is as reliable as a 6-hour CXR for detecting delayed pneumothorax (PTX) after penetrating thoracic trauma. ⋯ There were no delayed findings on CXR provided the CT was negative. The mean time to CT and before disposition was 19 minutes and 8 hours, respectively, with a potential decrease in charges of $313.32 per patient. The use of serial CXRs provided no additional information that was not available on the initial chest CT, allowing for expedited discharge, decompressing overcrowded emergency areas, and reducing the number of patients leaving before completion of their work-up.
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The American surgeon · Jun 2007
How residents think and make medical decisions: implications for education and patient safety.
Medical errors are a major cause of morbidity and mortality, and cognitive errors account for many of these events. This study examined the basic science of the cognitive performance of trainees. We created a low-intensity medical simulator to perform a preliminary study of the ability of residents to recall and process patient information presented verbally. ⋯ More importantly, the reasoning process (forward hypothesis based) of the more experienced residents differed from novices. This preliminary study demonstrates that the cognitive processes used by residents experienced in critical care are quantitatively and qualitatively different from those used by novices. These processes were also associated with far fewer cognitive errors in clinical decision making.
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The American surgeon · Jun 2007
Comparative StudyAbdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: does its use reduce negative appendectomy rates and healthcare costs?
Although acute appendicitis is the most frequent cause of the acute abdomen in the United States, its accurate diagnosis in reproductive-age women remains difficult. Problems in making the diagnosis are evidenced by negative appendectomy rates in this group of 20 per cent to 45 per cent. Abdominal CT scanning has been used in diagnosing acute appendicitis, but its reliability and usefulness remains controversial. ⋯ In the subgroup of reproductive-age women, there was a significant difference in negative appendectomy rates of 17 per cent in the group that received abdominal CT scans versus 42 per cent in the group that did not (P < 0.038). After accounting for the patient and insurance company costs, abdominal CT scan savings averaged $1412 per patient. Abdominal CT scanning is a reliable, useful, and cost-effective test for evaluating right lower quadrant abdominal pain and making the diagnosis of acute appendicitis in reproductive-age women.