Articles: cations.
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Review Meta Analysis
Meta-analysis of the concordance of histological grade of breast cancer between core needle biopsy and surgical excision specimen.
With the increasing use of neoadjuvant chemotherapy and minimally invasive ablative therapy in breast cancer, pretreatment assessment of tumour grade on core needle biopsy (CNB) is increasingly needed. However, grading on CNB is possibly less accurate than grading based on the surgical excision specimen. A systematic review and meta-analysis of the literature was conducted to derive a reliable estimate of the agreement in tumour grading between CNB and subsequent surgical excision. ⋯ Grading on CNB corresponds moderately with grading based on excision specimens, with underestimation in about one in five patients. Incorrect CNB tumour grading has limited clinical implications, as multiple factors influence decision-making for adjuvant systemic therapy.
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There are few publications about demographics of Emergency Department (ED) burn patient visits. The purpose of this study was to compare ED only burn patients with admitted patients in an urban burn center. This was a retrospective review (1999 to 2014) of a burn unit patient registry. ⋯ Most of the ED-TB only patients (73%) came to the hospital themselves, 23% were transferred from other hospitals, and 2% each, direct from the scene and clinic. In contrast, 53% of admitted patients were transferred from other hospitals, 29% came in on their own, and 11% were brought in direct from the scene, or from the burn clinic (7%), P = .0001. This review suggests that the main reason for non-admission of ED-TB only patients was the severity of injury; ED-TB only patients had a significantly less severe %TBSA (P < .0001), and fewer comorbidities compared to admitted patients.
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Review Meta Analysis
Meta-analysis of negative-pressure wound therapy for closed surgical incisions.
Postoperative wound complications are common following surgical procedures. Negative-pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions. ⋯ Compared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.
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Review Meta Analysis
Effect of Hospital Volume on Surgical Outcomes After Pancreaticoduodenectomy: A Systematic Review and Meta-analysis.
The aim of the study was to evaluate the relationship between hospital volume and outcome after pancreaticoduodenectomy (PD). ⋯ This meta-analysis included studies from different countries with disparate health care systems and provided strong evidence for an inverse association between higher hospital volume and lower mortality after PD. Variations in HVH cutoff values across studies majorly influenced the overall heterogeneity.
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Paroxysmal sympathetic hyperactivity (PSH) is a result of acute brain injury that has been well known for many decades. However, the evidence for management of PSH is almost entirely anecdotal in nature. We reviewed case reports or series of pharmacotherapy management of PSH. ⋯ However, a combination of medications from different classes seems the most effective approach in managing PSH symptoms. There is wide variability in clinical practice with regard to drug choices, dosing, and duration of therapy. Future research needs to be conducted using the new PSH assessment measure to appropriately apply drug management.