Articles: patients.
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J. Gastrointest. Surg. · Jan 2015
Randomized Controlled Trial Multicenter StudyThe value of drains as a fistula mitigation strategy for pancreatoduodenectomy: something for everyone? Results of a randomized prospective multi-institutional study.
A recent randomized, controlled trial investigating intraperitoneal drain use during pancreatoduodenectomy (PD) had a primary goal of assessing overall morbidity. It was terminated early with findings that routine elimination of drains in PD increases mortality and the severity and frequency of overall complications. Here, we provide a follow-up analysis of drain value in reference to clinically relevant postoperative pancreatic fistula (CR-POPF). ⋯ The results of this analysis suggest that drains diminish the rate and severity of CR-POPF in patients with moderate/high risk, but they could possibly be avoided in the roughly one third of patients with negligible/low risk.
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Randomized Controlled Trial Multicenter Study
Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial.
Can treatment of the symptoms of uncomplicated urinary tract infection (UTI) with ibuprofen reduce the rate of antibiotic prescriptions without a significant increase in symptoms, recurrences, or complications? ⋯ German Federal Ministry of Education and Research (BMBF) No 01KG1105. Patient level data are available from the corresponding author. Patient consent was not obtained but the data are anonymised and risk of identification is low.Trial registration No ClinicalTrialGov Identifier NCT01488955.
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Randomized Controlled Trial Comparative Study
Manual vs Automated Lateral Rotation to Reduce Preventable Pulmonary Complications in Ventilator Patients.
To estimate effect sizes for a trial to compare preventable pulmonary complications (PPCs), turning-related adverse events, mechanical ventilation duration, intensive care unit (ICU) length of stay, and ICU mortality between patients randomized to 2-hourly manual or continuous automated lateral rotation. ⋯ The incidence of PPCs in adult patients receiving mechanical ventilation in a medical-surgical ICU was high. Automated turning decreased PPCs with time but had little effect on secondary outcomes. Safety outcomes were not substantially different between groups. A modest efficacy effect supported reduced PPCs with automated turning to the lateral position.
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Randomized Controlled Trial
Local infiltration analgesia is not improved by postoperative intra-articular bolus injections for pain after total hip arthroplasty.
The effect of postoperative intra-articular bolus injections after total hip arthroplasty (THA) remains unclear. We tested the hypothesis that intra-articular bolus injections administered every 6 hours after surgery during the first 24 hours would significantly improve analgesia after THA. ⋯ Postoperative intra-articular bolus injections of ropivacaine and ketorolac cannot be recommended as analgesic method after THA.
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Randomized Controlled Trial
A cluster randomized trial of a multifaceted quality improvement intervention in Brazilian intensive care units: study protocol.
The uptake of evidence-based therapies in the intensive care environment is suboptimal, particularly in limited-resource countries. Checklists, daily goal assessments, and clinician prompts may improve compliance with best practice processes of care and, in turn, improve clinical outcomes. However, the available evidence on the effectiveness of checklists is unreliable and inconclusive, and the mechanisms are poorly understood. We aim to evaluate whether the use of a multifaceted quality improvement intervention, including the use of a checklist and the definition of daily care goals during multidisciplinary daily rounds and clinician prompts, can improve the in-hospital mortality of patients admitted to intensive care units (ICUs). Our secondary objectives are to assess the effects of the study intervention on specific processes of care, clinical outcomes, and the safety culture and to determine which factors (the processes of care and/or safety culture) mediate the effect of the study intervention on mortality. ⋯ This is a large scale, pragmatic cluster-randomized trial evaluating whether a multifaceted quality improvement intervention, including checklists applied during the multidisciplinary daily rounds and clinician prompting, can improve the adoption of proven therapies and decrease the mortality of critically ill patients. If this study finds that the intervention reduces mortality, it may be widely adopted in intensive care units, even those in limited-resource settings.