Journal of the American College of Surgeons
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Limited data exist for the use of nasogastric decompression after pancreaticoduodenectomy (PD), when postoperative nasogastric tube (NGT) use remains the standard of care. This study seeks to evaluate the effects on patient outcomes of routine vs selective NGT use after PD. ⋯ Routine postoperative nasogastric decompression in patients undergoing PD appears unnecessary in many cases, and can adversely impact postoperative course. Selective NGT usage seems an appropriate treatment strategy.
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Randomized Controlled Trial Multicenter Study Comparative Study
Impact of lipid-lowering medications and low-density lipoprotein levels on 1-year clinical outcomes after coronary artery bypass grafting.
Studies investigating lipid-lowering medication (LLM) use and LDL levels in coronary artery bypass grafting patients are limited. ⋯ Rates of LLM use among veterans post-coronary artery bypass grafting are high. Discharge on LLM might be associated with improved intermediate-term survival. Patients who achieved an LDL target of <100 mg/dL at 1-year did not experience improved 1-year clinical outcomes or graft patency. Longer-term follow-up might reveal differences in cardiac outcomes related to achievement of target LDL levels.
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Due to its complexity, cancer care is increasingly being delivered by multidisciplinary tumor boards (MTBs). Few studies have investigated how best to organize and run MTBs to optimize clinical decision making. We developed and evaluated a multicomponent intervention designed to improve the MTB's ability to reach treatment decisions. ⋯ Multidisciplinary tumor board-delivered treatment is becoming the standard for cancer care worldwide. Our intervention is efficacious and applicable to MTBs and can improve decision making and expedite cancer care.
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Randomized clinical trials (RCTs) are uncommon in pediatric surgical specialties and the quality of reporting is unknown. Our primary purpose was to analyze published surgical RCTs involving children to measure adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. ⋯ Adherence to CONSORT guidelines is low across the spectrum of children's surgical specialties, although significant differences do exist. Future RCTs in children's surgical specialties should specifically focus on areas of low adherence to reporting guidelines.
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Enhanced recovery pathways (ERP) have been well shown to permit early recovery and discharge. The addition of a transversus abdominis plane (TAP) block to a standard pathway may improve these outcomes. We evaluated the addition of a TAP block to an established ERP. ⋯ Transversus abdominis plane blocks with an ERP contribute to a short length of stay after laparoscopic colectomy, without increasing complication or readmission rates.