Canadian journal of surgery. Journal canadien de chirurgie
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Intraoperative spinal cord and nerve root monitoring is used to identify an insult to the neural elements with the goal of preventing injury. There are 2 major categories of monitoring: evoked potentials (somatosensory evoked potentials and motor evoked potentials) and electromyography. The availability of intraoperative neuromonitoring and the indications for use vary widely. In this study, we aimed to document the current practices and opinions of Canadian spine surgeons with regards to intraoperative spinal monitoring. ⋯ The availability of spinal monitoring in Canada is variable. Most surgeons believe that it is an important adjunct to improve patient safety.
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Supine anteroposterior (AP) chest radiography is an insensitive test for detecting posttraumatic pneumothoraces (PTXs). Computed tomography (CT) often identifies occult pneumothoraces (OPTXs) not diagnosed by chest radiography. All previous literature describes the epidemiology of OPTX in patients with blunt polytrauma. Our goal was to identify the frequency of OPTXs in patients with penetrating trauma. ⋯ Up to 17% of all PTXs in patients injured by penetrating mechanisms will be missed by standard trauma chest radiographs. This increases to nearly 80% with supine AP chest radiographs. Upright chest radiography detects 92% of all PTXs and is available to most patients without spinal trauma. The frequency of tube thoracostomy use in patients with overt PTXs is significantly higher than for OPTXs in blunt and penetrating trauma.
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Comparative Study
Anterior opening wedge high tibial osteotomy: the effect of increasing posterior tibial slope on ligament strain.
Although a previous study showed that anterior opening wedge high tibial osteotomy (HTO) for sagittal plane correction induced no increased strain in the anterior cruciate ligament (ACL), we hypothesized that other ligamentous restraints of the knee may be subjected to increased strain. ⋯ Increasing the posterior slope via HTO did not increase strain in the PCL, MCL or LCL.
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Operating rooms are expensive to run, and hospitals strive to be efficient. The purpose of this study was to evaluate an initiative to improve starting on time in the operating room in an academic pediatric hospital. ⋯ A targeted, multifaceted and multidisciplinary approach can increase the percentage of operations that begin on time in a pediatric hospital.
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Delays in the operating room have a negative effect on its efficiency and the working environment. In this prospective study, we analyzed data on perioperative system delays. ⋯ Delays frequently occur in the operating room and have a major effect on patient flow and resource utilization. Thorough documentation of perioperative delays provides a basis for the development of solutions for improving operating room efficiency and illustrates the principles underlying the causes of operating room delays across surgical disciplines.