Surgery
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The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical error and identify opportunities for prevention. ⋯ Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors.
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The aim of this prospective study was to determine whether the change between the initial and subsequent analysis of serum inflammatory markers measured 6 to 10 hours later could improve diagnostic accuracy in appendicitis. ⋯ The cutoff values of the change in total neutrophil count on the first day after onset of symptoms and the change in CRP on the second and third days after onset of symptoms during in-hospital observation may serve as useful parameters to surgeons in differentiating acute appendicitis from other acute abdominal diseases.
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Selective beta adrenergic antagonists are commonly used to reduce myocardial demise in patients at risk for cardiac-related death. The purpose of this study was to examine the hemodynamic and metabolic effects of cardiac selective beta adrenergic blockade in patients. ⋯ Cardiac selective beta adrenergic blockade with esmolol reduces cardiac output in proportion to the percentage decreases in heart rate in moderately severe septic patients without adversely affecting oxygen utilization or hepatic, peripheral blood flow.