Хирургия

[Наталья П.]

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The Encyclopedia of Surgery has been written by various experts in the field of surgery and has been written specifically for healthcare students and patients. The Encyclopedia covers 450 surgical procedures and topics such as laser surgery, hysterectomy, endoscopy, cryosurgery, anesthetics, biopsy, angioplasty, medications and postoperative care, and many related subjects. Each entry in the Encyclopedia of Surgery consists of a standardized format which includes the definition, purpose, diagnosis, aftercare, risks, mortality rates, and alternatives.

[Наталья П.]

Заглавие (англ.): Surgical Care at the District Hospital
Заглавие (русс.): Хирургическая помощь в районной больнице
Язык текста: английский
Количество страниц: 400

Часто в небольших районных больницах хирурги сталкиваются с различной патологией: травмой, патологическими родами, острым животом и др. неотложными состояниями. Обычно сложные хирургические операции выполняются в больших больницах, но в случае неотложных состояний хирург районной больницы должен владеть техникой таких операций. Настоящее руководство предназначено специально для таких случаев и содержит рекомендации по оборудованию операционных и хирургических палат, асептике и антисептике, подготовке хирургов, методике проведения отдельных хирургических вмешательств в условиях районной или участковой больницы. Книга полезна практикующим врачам
7 мегабайт
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[Наталья П.]

Руководство
Базовая хирургическая помощь
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Раздел Инфекционный котроль и асептика
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Оборудование
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[Наталья П.]

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Evaluation of acute right lower quadrant pain.
2005

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Evaluation of left lower quadrant pain.

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Evaluation of patients with acute right upper quadrant pain.

[Наталья П.]

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Evidence-based care guideline for prevention of thromboembolism after cavopulmonary anastamosis (bidirectional Glenn and Fontan operations).
Cincinnati Children's Hospital Medical Center

[Наталья П.]

Журнал "Оценка медицинских технологий"
полный текст pdf
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Health Technol Assess. 2006 Nov;10(47):1-186.

Systematic reviews of clinical decision tools for acute abdominal pain.

Liu JL, Wyatt JC, Deeks JJ, Clamp S, Keen J, Verde P, Ohmann C, Wellwood J, Dawes M, Altman DG.

Health Informatics Centre, University of Dundee, UK.

OBJECTIVES: To review for acute abdominal pain (AAP), the diagnostic accuracies of combining decision tools (DTs) and doctors aided by DTs compared with those of unaided doctors. Also to evaluate the impact of providing doctors with an AAP DT on patient outcomes, clinical decisions and actions, what factors are likely to determine the usage rates and usability of a DT and the associated costs and likely cost-effectiveness of these DTs in routine use in the UK.
DESIGN: Electronic databases were searched up to 1 July 2003.
REVIEW METHODS: Data from each eligible study were extracted. Potential sources of heterogeneity were extracted for both questions. For the accuracy review, meta-analysis was conducted. Among studies comparing diagnostic accuracies of DTs with unaided doctors, error rate ratios provided estimates of the differences between the false-negative and false-positive rates of the DT and unaided doctors' performance. Pooled error rate ratios and 95% confidence intervals (CIs) for false-negative rates and false-positive rates were computed. Metaregression was used to explore heterogeneity.
RESULTS: Thirty-two studies from 27 articles, all based in secondary care, were eligible for the review of DT accuracies, while two were eligible for the review of the accuracy of hospital doctors aided by DTs. Sensitivities and specificities for DTs ranged from 53 to 99% and from 30 to 99%, respectively. Those for unaided doctors ranged from 64 to 93% and from 39 to 91%, respectively. Thirteen studies reported false-positive and false-negative rates for both DTs and unaided doctors, enabling a direct comparison of their performance. In random effects meta-analyses, DTs had significantly lower false-positive rates (error rate ratio 0.62, 95% CI 0.46 to 0.83) than unaided doctors. DTs may have higher false-negative rates than unaided doctors (error rate ratio 1.34, 95% CI 0.93 to 1.93). Significant heterogeneity was present. Two studies compared the diagnostic accuracies of doctors aided by DTs to unaided doctors. In a multiarm cluster randomised controlled trial (n = 5193), the diagnostic accuracy of doctors not given access to DTs was not significantly worse (sensitivity 28.4% and specificity 96.0%) than that of three groups of aided doctors (sensitivities of 42.4-47.9%, and specificities of 95.5-96.5%, respectively). In an uncontrolled before-and-after study (n = 1484), the sensitivities and specificities of aided and unaided doctors were 95.5% and 91.5% (p = 0.24) and 78.1% and 86.4% (p < 0.001), respectively. The metaregression of DTs showed that prospective test-set validation at the site of the tool's development was associated with considerably higher diagnostic accuracy than prospective test-set validation at an independent centre [relative diagnostic odds ratio (RDOR) 8.2; 95% CI 3.1 to 14.7]. It also showed that the earlier in the year the study was performed the higher the performance (RDOR 0.88, 0.83 to 0.92), that when developers evaluated their own DT there was better performance than when independent evaluators carried out the study (RDOR = 3.0, 1.3 to 6.8), and that there was no evidence of association between other quality indicators and DT accuracy. The one eligible study of the impact study review, a four-arm cluster randomised trial (n = 5193), showed that hospital admission rates of patients by doctors not allocated to a DT (42.8%) were significantly higher than those by doctors allocated to three combinations of decision support (34.2-38.5%) (p < 0.001). There was no evidence of a difference between perforation rates (p = 0.19) and negative laparotomy rates in the four trial arms (p = 0.46). Usage rates of DTs by doctors in accident and emergency departments ranged from 10 to 77% in the six studies that reported them. Possible determinants of usability include the reasoning method used, the number of items used and the output format. A deterministic cost-effectiveness comparison demonstrated that a paper checklist is likely to be 100-900 times more cost-effective than a computer-based DT, under stated assumptions.
CONCLUSIONS: With their significantly greater specificity and lower false-positive rates than doctors, DTs are potentially useful in confirming a diagnosis of acute appendicitis, but not in ruling it out. The clinical use of well-designed, condition-specific paper or computer-based structured checklists is promising as a way to improve impact on patient outcomes, subject to further research.

[Gallen]

General Surgery CME
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American College of Surgeons 92nd Annual Clinical Congress
ACS 2006 - Highlights of American College of Surgeons 92nd Annual Clinical Congress
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Evidence-Based Perioperative Risk Reduction
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Требуется несложная регистрация.

[брукса]

Думала есть уже ссылка, поискала - вроде не нашла..

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[Наталья П.]

Кохрановский обзор

Routine abdominal drainage for uncomplicated open cholecystectomy

Cochrane Database of Systematic Reviews 2007 Issue 2
Date of Most Recent Substantive Amendment: 16 February 2007

Abstract


Background
Cholecystectomy is the removal of gallbladder and is performed mainly for symptomatic gallstones. Although laparoscopic cholecystectomy is currently preferred over open cholecystectomy for elective cholecystectomy, reports of randomised clinical trials comparing the choice of cholecystectomy (open or laparoscopic) in acute cholecystitis are still being conducted. Drainage in open cholecystectomy is a matter of considerable debate. Surgeons use drains primarily to prevent subhepatic abscess or bile peritonitis from an undrained bile leak. Critics of drain condemn drain use as it increases wound and chest infection.


Objectives
To assess the benefits and harms of routine abdominal drainage in uncomplicated open cholecystectomy.


Search strategy
We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2006.


Selection criteria
We included randomised clinical trials comparing 'no drain' versus 'drain' in patients who had undergone uncomplicated open cholecystectomy (irrespective of language, publication status, and the type of drain). Randomised clinical trials comparing one drain with another were also included.


Data collection and analysis
We collected the data on the characteristics and methodological quality of each trial, number of abdominal collections requiring different treatments, bile peritonitis, wound infection, chest complications, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome, we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis.


Main results
Twenty eight trials involving 3659 patients were included. There were 20 comparisons of 'no drain' versus 'drain' and 12 comparisons of one drain with another. There was no statistically significant difference in mortality, bile peritonitis, total abdominal collections, abdominal collections requiring different treatments, or infected abdominal collections. 'No drain' group had statistically significant lower wound infection (OR 0.61, 95% CI 0.43 to 0.87) and statistically significant lower chest infection (OR 0.59, 95% CI 0.42 to 0.84) than drain group. We found no significant differences between different types of drains.


Authors' conclusions
Drains increase the harms to the patient without providing any additional benefit for patients undergoing open cholecystectomy and should be avoided in open cholecystectomy.



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Plain language summary
Drains increase the harms to patients undergoing open cholecystectomy

Cholecystectomy is the removal of the gallbladder. It is performed mainly in patients having symptomatic gallstones. Drain usage after open cholecystectomy is controversial. The present review includes 28 trials assessing 20 comparisons of 'no drain' versus 'drain' and 12 comparisons of different drain types. The review reports that drains increase the harms to the patient. Drains do not provide any additional benefit for patients undergoing open cholecystectomy and should be avoided in open cholecystectomy. The review found no significant differences between different drain types.

[Наталья П.]

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Inside Surgery is an ambitious attempt to compile an educational guide to the hundreds of surgical procedures that are currently performed across the country. The authors of this Web site also include some tips and tricks to managing surgical patients, as well as some historical notes.

[Наталья П.]

Can J Surg. 2007 Jun;50(3):214-216.

Canadian Association of General Surgeons and American College of Surgeons
Evidence Based Reviews in Surgery.
21. The risk of surgical site infection is reduced with perioperative oxygen.

Brasel K, McRitchie D, Dellinger P.

Objective: Does supplemental perioperative oxygen reduce the risk of surgical wound infection after colorectal surgery?
Design: Randomized controlled trial. Setting: Multicentre trial that included 14 hospitals in Spain.
Patients: 300 patients aged 18-80 years who underwent elective colorectal resection. Patients who had surgery performed laparoscopically or who had minor colon surgery were excluded.
Intervention: Patients were randomly allocated to either 30% or 80% fraction of inspired oxygen (FiO2) intraoperatively and for 6 hours postoperatively. Anesthetic treatment and antibiotic administration were standardized.
Main Outcome Measure: Surgical site infection (SSI) as defined by the Center for Disease Control.
Results: SSI occurred in 35 of 143 patients (24.4%) who were administered 30% FiO2 and in 22 of 148 patients (14.9%) who were administered 80% FiO2 (p = 0.04). The risk of SSI was 39% lower in the 80% group (relative risk [RR], 0.61; 95% confidence interval [CI], 0.38-0.98) versus the 30% FiO2 group.
Conclusions: Patients receiving supplemental oxygen have a significant reduction in risk of surgical site infection.

[Наталья П.]

ACS Surgery, the official textbook of the American College of Surgeons
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[Наталья П.]

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Сайт с информацией для предоперационного обучения пациентов, чтобы улучшить ими понимание их состояния и предстоящего оперативного вмешательства.
Содержит мультипликацию.
Оно же на YouTube
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[Наталья П.]

SSA Surgical Knot Tying Tutorial

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и видеоподборка по завязыванию узлов

[Наталья П.]

CineMed
Surgery videos.
Samples of video-based medical education. General Surgery, Laparoscopy, Bariatrics, Perioperative Nursing, Critical Care Nursing. View our entire catalog at
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