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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The aim was to summarize the results of all randomized clinical trials (RCTs) comparing percutaneous transluminal angioplasty (PTA) with (supervised) exercise therapy ((S)ET) in patients with intermittent claudication (IC) to obtain the best estimates of their relative effectiveness. ⋯ As IC is a common healthcare problem, defining the optimal treatment strategy is important. A combination of PTA and exercise (SET or ET advice) may be superior to exercise or PTA alone, but this needs to be confirmed.
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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).
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Successful outcome from damage control surgery (DCS) depends as much on elements of resuscitation and non-operative management as on details of the procedure itself. The early management of patients in haemorrhagic shock has undergone substantial revision in the past decade and is now known as 'haemostatic resuscitation'. ⋯ Resuscitation strategies during DCS may be as important as the anatomical repair itself. Recommendations include avoidance of hypothermia, maintenance of a lower than normal blood pressure, and early support of the coagulation system in patients likely to require massive transfusion. Controversies include the optimal ratio of plasma to red blood cells for empirical resuscitation, the ideal role of clotting factor concentrates, and the potential benefit of early, deep anaesthesia. Future research will centre on the complex interaction between the humoral elements of coagulation and the vascular endothelium that regulates perfusion, clotting and integrity of the circulation.