Surgical List Order

Repeating the same procedure leads to time savings and greater efficiency. Time of procedure had been linked to outcome and fewer complications (although there must be fast and bad surgeons!). The effects are modest but add up, so switching between different procedures on the list may seem like adding variety but it may be worth considering repeating the same procedure where possible.

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Medical News weekly

Epidiolex (cannabidiol) approved for rare epilepsy in US link

15% high schoolers report at least one sports related concussion  link

Maternal diabetes, Type 1 predominantly linked to increased autism link in offspring  link

C  Difficile infections decreasing in Canada link

Tamsulosin did not significantly increase the renal stone passage rate  link

Latest osteoporosis screening guidelines  link

 

ARDS Recruitment Maneuver

A meta-analysis has findings that are at odds with some previous work on recruitment maneuvers in ARDS. “Recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU and hospital stay. Further studies are required to know the clinical benefits of recruitment maneuver without PEEP titration in ARDS patients”.

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Complications and Mortality

A study on complications associated with mortality in the NSQIP database identified the most serious complications and concluded: “The most common causes of attributable mortality (attributable deaths per million patients) were bleeding (n = 368), respiratory failure (n = 358), septic shock (n = 170), and renal failure (n = 88). Some complications, such as urinary tract infection and pneumonia, were associated with attributable mortality only in older patients”.

20% of all 30-day mortality is independently attributable to a postoperative complication. Unplanned intubation, septic shock, and bleeding are associated with the greatest number of years of life lost.These are clearly areas to focus on especially in younger patients.

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