Surgery
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Randomized Controlled Trial Clinical Trial
Teaching practicing surgeons critical appraisal skills with an Internet-based journal club: A randomized, controlled trial.
The effectiveness of interventions for developing critical appraisal skills in practicing physicians has not been studied, despite the documented importance of reading the literature in caring for patients and in continuing professional development. The objective of this study was to evaluate whether an Internet-based intervention would lead to enhanced critical appraisal skills in practicing surgeons. ⋯ A multifaceted, Internet-based intervention resulted in improved critical appraisal skills of practicing general surgeons.
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Randomized Controlled Trial Clinical Trial
Effects of long-term oxandrolone administration in severely burned children.
Severe burns cause exaggerated catabolism of muscle protein and inhibit bone deposition. Weakness and bony growth arrest interfere with rehabilitation. The purpose of this study was to determine whether oxandrolone administration for 1 year after the burn reverses muscle and bone catabolism in hypermetabolic pediatric burn patients. ⋯ Long-term administration of oxandrolone safely improves LBM, BMC, and BMD in severely burned children.
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Randomized Controlled Trial Clinical Trial
Epidural analgesia improves outcome after multiple rib fractures.
Rib fractures are common and associated with significant pulmonary morbidity. We hypothesized that epidural analgesia would provide superior pain relief, and reduce the risk of subsequent pneumonia. ⋯ The use of epidural analgesia is limited in the trauma population due to numerous exclusion criteria. However, when feasible, epidural analgesia is associated with a decrease in the rate of nosocomial pneumonia and a shorter duration of mechanical ventilation after rib fractures.
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Randomized Controlled Trial Clinical Trial
Insulin decreases hepatic acute phase protein levels in severely burned children.
Severe burn induces the hepatic acute phase response. In this study, we wondered whether continuous insulin treatment decreases acute phase protein levels in the severely burned. ⋯ Continuous insulin treatment decreases acute phase protein levels after a severe burn. The results suggest insulin downregulation of the hepatic acute phase response to injury.
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Randomized Controlled Trial Clinical Trial
Supplemental perioperative fluid administration increases tissue oxygen pressure.
Wound infections are common and serious surgical complications. Wound perfusion delivers oxygen, inflammatory cells, growth factors, and cytokines to injured tissues. Hypoperfused regions experience low oxygen tensions that do not support adequate oxidative killing or wound healing. Clinicians may fail to recognize clinically important hypovolemia because hemodynamic stability and urine output are maintained after peripheral perfusion is compromised. We tested the hypothesis that supplemental fluid administration during and after elective colon resection increases tissue perfusion and tissue oxygen pressure. ⋯ Supplemental perioperative fluid administration significantly increases tissue perfusion and tissue oxygen partial pressure. Optimizing tissue perfusion will require providing more fluid than indicated by normal clinical criteria or use of invasive monitoring to guide treatment. The actual effect of supplemental fluid administration on incidence of wound infection requires further investigation.