Journal of the American College of Surgeons
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Multicenter Study Clinical Trial
Acute kidney injury network staging in geriatric postoperative acute kidney injury patients: shortcomings and improvements.
The incidence of acute kidney injury (AKI) is rising, particularly among the elderly. However, the optimal risk stratification scheme for these patients is unknown. The Acute Kidney Injury Network (AKIN) classification application in geriatric patients has not been previously confirmed. ⋯ This is the first study to demonstrate the poor applicability of the AKIN classification in the prediction of in-hospital mortality in geriatric postoperative AKI patients. Consideration of late dialysis status may enhance the discriminative power of AKIN in this specific population.
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Randomized Controlled Trial
Selecting patients for acute normovolemic hemodilution during hepatic resection: a prospective randomized evaluation of nomogram-based allocation.
Acute normovolemic hemodilution (ANH) decreases transfusion rates but adds to the complexity of anesthetic management during hepatectomy. A randomized controlled trial was conducted to determine if selecting patients for ANH using a transfusion nomogram improves management and resource use compared with selection using extent of resection. ⋯ Although allocation of intraoperative management using a transfusion nomogram did not improve appropriate management overall, it more effectively identified low blood loss cases and reduced ANH use in patients least likely to benefit.
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Clinical Trial
Implementation of an interactive virtual-world simulation for structured surgeon assessment of clinical scenarios.
A novel simulation technology has emerged through the use of online 3-dimensional virtual worlds in which it is feasible to create virtual patients. This study establishes the face, content and construct validity of online 3-dimensional virtual patients in Second Life (a 3-dimensional virtual world accessible via the Internet). ⋯ This novel form of simulation demonstrated high face and content validity. Performance assessed in managing a series of virtual patients varies with different levels of surgical training. This simulation can be used to differentiate among these levels and can be implemented as a unique form of assessment.
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Randomized Controlled Trial Comparative Study
Effectiveness of an oxidized cellulose patch hemostatic agent in thyroid surgery: a prospective, randomized, controlled study.
This single-blinded, prospective, randomized controlled trial compared the efficacy and safety of an oxidized cellulose patch (Surgicel [Johnson and Johnson]) with conventional procedures for achieving hemostasis in thyroid surgery. ⋯ Routine use of an oxidized cellulose hemostatic agent has no advantage over conventional hemostasis and is potentially harmful in thyroid surgery.