The British journal of surgery
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Multicenter Study Comparative Study
Multicentre study of the quality of a large administrative data set and implications for comparing death rates.
The aim was to compare the completeness and accuracy of the English Hospital Episode Statistics (HES) with a 'gold standard' data set for a sample of hospitals and to determine the effect of data quality on comparisons of hospital death rates. ⋯ This study confirmed that HES data can be used effectively to compare mortality between hospitals. Administrative data will be used increasingly for assessing performance and clinicians should accept responsibility to improve coding.
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Hypothermia is commonly used for organ and tissue preservation in multiple clinical settings, but its role in the management of injured patients remains controversial. There is no doubt that temperature modulation is a powerful tool, and hypothermia has been shown to protect cells during ischaemia and reperfusion, decrease organ damage and improve survival. Yet hypothermia is a double-edged sword: unless carefully managed, its induction can be associated with a number of complications. ⋯ Therapeutic hypothermia is a promising life-saving strategy. Appropriate patient selection requires a thorough understanding of how temperature modulation affects various biological mechanisms.
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Traumatic leg amputation commonly affects young, active people and leads to poor long-term outcomes. The aim of this review was to describe common causes of disability and highlight therapeutic interventions that may optimize outcome after traumatic leg amputation. ⋯ Patients who undergo leg amputation after trauma are at risk of poor long-term physical and mental health. Clinicians involved in their care have many opportunities to improve their outcome using a variety of therapeutic variables. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Multicenter Study
Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders.
The American Diabetes Association recently defined remission of type II diabetes as a return to normal measures of glucose metabolism (haemoglobin (Hb) A1c below 6 per cent, fasting glucose less than 5·6 mmol/l) at least 1 year after bariatric surgery without hypoglycaemic medication. A previously used common definition was: being off diabetes medication with normal fasting blood glucose level or HbA1c below 6 per cent. This study evaluated the proportion of patients achieving complete remission of type II diabetes following bariatric surgery according to these definitions. ⋯ Expectations of patients and clinicians may have to be adjusted as regards remission of type II diabetes after bariatric surgery. Focusing on improved glycaemic control rather than remission may better reflect the benefit of this type of surgery and facilitate improved glycaemic control after surgery.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes.
Computed tomography (CT) of injured patients in the radiology department requires potentially dangerous and time-consuming patient transports and transfers. It was hypothesized that CT in the trauma room would improve patient outcome and workflow. ⋯ ISRCTN55332315 (http://www.controlled-trials.com).