This document discusses evidence-based surgery and how surgeons evaluate the strength of evidence for surgical practices. It covers:
1) Guidelines and secondary sources that surgeons can use to inform evidence-based practice, but notes individual surgeons must also evaluate primary studies.
2) Factors used to evaluate the validity of scientific studies, including internal validity (study quality), external validity (generalizability), and the influence of chance, bias, and confounding.
3) Hierarchies of evidence that rank study designs, with randomized controlled trials considered the strongest, but these systems have limitations and surgeons must make judgments.
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
This document provides an overview of evidence-based practice (EBP) including its definition, importance, evolution, decision-making process, benefits, and misconceptions. It outlines a 5-step approach to EBP: formulating a question, finding evidence, appraising evidence, applying to practice while considering patient values, and evaluating effectiveness. Various resources and levels of evidence are also defined to help practitioners implement EBP and provide the highest quality, cost-effective care.
Stents are hollow tubes used to hold open strictured areas in various parts of the body, usually due to malignancy. There are two main types - simple plastic stents and self-expanding metal stents (SEMS). Plastic stents are used in the biliary tree and pancreas while SEMS can be placed in various areas using a guidewire. Stents are used to relieve obstructive symptoms from cancer and as a bridge to surgery. Complications include perforation, tumour overgrowth, and migration.
Dr. Fadi Alnehlaoui presented on the uses of indocyanine green (ICG) fluorescence in general and oncological surgeries. ICG is a fluorescent dye that is injected intravenously and can help surgeons visualize blood vessels, lymph nodes, and other tissues when used with near-infrared cameras. The summary discusses how ICG fluorescence has been used to help with liver resections, identifying sentinel lymph nodes in breast cancer and other cancers, assessing blood flow in reconstructive surgeries, and aiding various other surgical procedures. In conclusion, ICG fluorescence provides an effective intraoperative imaging technique that is becoming more standard in many surgical specialties.
Conservative breast surgery aims to preserve breast tissue while removing cancerous growths. Dr. Karan R Rawat discusses the challenges and advances in conservative breast surgery techniques as a junior resident in general surgery under the mentorship of Prof. Dr. K.K. Dangayach and Prof. Dr. B.K. Sharma.
1) Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that uses an endoscope passed through natural openings like the mouth, vagina, or anus to perform internal surgery without external incisions.
2) NOTES was first described in animal models in the early 2000s and the first human transgastric cholecystectomy was reported in 2007.
3) While offering advantages over laparoscopy by avoiding external incisions, NOTES faces challenges of developing improved flexible instruments, closing access sites without leaks, and standardizing safe techniques.
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
This document provides an overview of evidence-based practice (EBP) including its definition, importance, evolution, decision-making process, benefits, and misconceptions. It outlines a 5-step approach to EBP: formulating a question, finding evidence, appraising evidence, applying to practice while considering patient values, and evaluating effectiveness. Various resources and levels of evidence are also defined to help practitioners implement EBP and provide the highest quality, cost-effective care.
Stents are hollow tubes used to hold open strictured areas in various parts of the body, usually due to malignancy. There are two main types - simple plastic stents and self-expanding metal stents (SEMS). Plastic stents are used in the biliary tree and pancreas while SEMS can be placed in various areas using a guidewire. Stents are used to relieve obstructive symptoms from cancer and as a bridge to surgery. Complications include perforation, tumour overgrowth, and migration.
Dr. Fadi Alnehlaoui presented on the uses of indocyanine green (ICG) fluorescence in general and oncological surgeries. ICG is a fluorescent dye that is injected intravenously and can help surgeons visualize blood vessels, lymph nodes, and other tissues when used with near-infrared cameras. The summary discusses how ICG fluorescence has been used to help with liver resections, identifying sentinel lymph nodes in breast cancer and other cancers, assessing blood flow in reconstructive surgeries, and aiding various other surgical procedures. In conclusion, ICG fluorescence provides an effective intraoperative imaging technique that is becoming more standard in many surgical specialties.
Conservative breast surgery aims to preserve breast tissue while removing cancerous growths. Dr. Karan R Rawat discusses the challenges and advances in conservative breast surgery techniques as a junior resident in general surgery under the mentorship of Prof. Dr. K.K. Dangayach and Prof. Dr. B.K. Sharma.
1) Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that uses an endoscope passed through natural openings like the mouth, vagina, or anus to perform internal surgery without external incisions.
2) NOTES was first described in animal models in the early 2000s and the first human transgastric cholecystectomy was reported in 2007.
3) While offering advantages over laparoscopy by avoiding external incisions, NOTES faces challenges of developing improved flexible instruments, closing access sites without leaks, and standardizing safe techniques.
1. Locally advanced rectal cancers are defined as T4 or node-positive lesions that cannot be completely resected without a high risk of residual disease. Management involves pre-operative chemotherapy with or without radiation therapy followed by surgery and adjuvant chemotherapy.
2. For resectable stage II/III cancers, pre-operative chemoradiation or radiation followed by surgery and adjuvant chemotherapy improves local control and survival compared to surgery alone.
3. For unresectable T4 cancers, induction chemotherapy and long-course chemoradiation may enable resection. Adjuvant chemotherapy is recommended in all cases.
This document discusses oncoplastic breast surgery techniques. It begins by explaining breast conserving treatment and its goals of providing survival equivalent to mastectomy while achieving low recurrence rates. It then discusses various breast conserving surgery procedures like lumpectomy and quadrantectomy. The document focuses on the compromise between wide excision margins and satisfactory aesthetic results in breast conserving surgery. It also discusses various reconstruction techniques used after breast conserving surgery, including breast implants, fat grafting, flap procedures, and oncoplastic breast reconstruction. The principles and mechanisms of oncoplastic surgery are explained. Techniques for peripheral and central tumors are classified.
1. Oncoplastic breast surgery (OPBS) combines oncological surgery with plastic surgery techniques to allow for wide excision of breast cancer tumors while maintaining the natural shape of the breast.
2. OPBS techniques have evolved since the 1980s and can be used for breast-conserving surgery, post-mastectomy reconstruction, or correction of defects after standard breast-conserving surgery.
3. OPBS is generally indicated for early-stage breast cancers less than 4cm and can extend the use of breast-conserving surgery to larger tumors. Selection depends on factors like excision volume, tumor location, and breast density.
Extra Levator Abdomino Perineal Resection Dr Harsh Shah
This document discusses extralevator abdominoperineal excision (ELAPE) for rectal cancer. It describes how ELAPE aims to improve on conventional abdominoperineal resection (APR) by removing a larger volume of tissue, including the levator muscles, to obtain clear margins. Meta-analyses have found ELAPE results in lower rates of circumferential resection margin involvement, local recurrence, and involved nodes compared to APR. However, ELAPE also increases morbidity risks and requires perineal wound reconstruction. While ELAPE shows potential oncological benefits, more high-quality studies are still needed to prove its superiority over selective approaches.
Information about Low Anterior Resection by Dr Dhaval Mangukiya.
Details of GOAL of LAR, Margins, Reconstructions, Anal Anastomosis, End to Side Colorectal Anastomosis, Stapler Vs Hand Sewn, Intersphincteric Resection, Colonic J pouch Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Single incision laparoscopic Surgery-SILSrkmishra14
World Laparoscopy Hospital is Pioneer in SILS. Single incision laparoscopic surgery (SILS) under direction of Prof. R.K. Mishra is a new technique that has now been utilized in many centers for minimal access surgery. http://www.laparoscopyhospital.com/single_incision_laparoscopic_surgery.html
This document provides information on breast oncoplastic surgery techniques:
- Oncoplastic surgery (OPS) integrates plastic surgery with breast-conserving cancer surgery to allow for wider excisions without compromising breast shape. It ranges from simple reshaping to advanced mammoplasty techniques.
- Key factors in determining the appropriate OPS approach are excision volume, tumor location, breast density, and glandular composition. Excisions over 20% of breast volume or from certain locations risk deformity. OPS allows excision of up to 1000g compared to 80g for standard surgery.
- OPS techniques are classified into Level I involving reshaping and Level II involving skin excision and reshaping using
This document discusses esophageal resection and reconstruction techniques. It covers indications for resection such as carcinoma or injury. Common reconstruction conduits are the stomach, colon, jejunum or combinations. Reconstruction routes include posterior mediastinal, substernal or subcutaneous. Complications can include fistula, stricture or dysfunction. The goal is a viable patient with functional gastrointestinal continuity. Successful reconstruction lasts long, provides nutrition and is done safely with flexibility and a team approach.
The document discusses strategies for performing safe laparoscopic cholecystectomy, including obtaining the critical view of safety, using intraoperative cholangiography to help identify biliary anatomy, and employing bailout techniques such as partial or subtotal cholecystectomy if the critical view cannot be achieved to avoid potential bile duct injuries. It also describes error traps that can lead to injuries and strategies surgeons should follow to promote a culture of safety in laparoscopic cholecystectomy.
Dr. Yajnadatta Sarangi discusses hyperthermic intraperitoneal chemotherapy (HIPEC), which involves delivering chemotherapy intraperitoneally at high temperatures to treat peritoneal metastasis. HIPEC is usually performed along with cytoreductive surgery to remove all visible tumor deposits. It aims to treat microscopic residual disease remaining after surgery. The document discusses the rationale for HIPEC, techniques, indications, contraindications and complications. It presents evidence that HIPEC combined with cytoreductive surgery improves survival outcomes for several cancer types compared to palliative chemotherapy alone.
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
This document discusses the history of biliary injuries and laparoscopic cholecystectomy. It begins with a brief overview of milestones in the history of cholecystectomy and bile duct surgery. It then describes biliary anatomy and variations that can increase risk of injury. The advantages of laparoscopic cholecystectomy are noted but also the increased risk of bile duct injuries compared to open surgery. Risk factors for injuries are discussed including surgeon experience, patient factors like inflammation, and anatomic variations. Techniques for prevention are outlined including obtaining the "critical view of safety" and using intraoperative cholangiography. Classification systems for injuries and approaches to treatment are also summarized. Throughout, the importance of prevention over treatment is emphasized
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is emerging as a new standard treatment for peritoneal surface malignancies. Traditionally, peritoneal carcinomatosis was considered incurable and treated only with palliative chemotherapy. However, CRS-HIPEC aims to remove all visible tumor deposits surgically and then uses heated chemotherapy in the abdominal cavity to target any remaining microscopic disease. Studies show CRS-HIPEC provides significantly longer survival times compared to intravenous chemotherapy alone, with median overall survivals of 16-36 months. Experts indicate CRS-HIPEC should now be considered the standard of care for select patients with peritoneal metastases from conditions like ovarian
This document discusses updates in the management of rectal cancer. It covers the anatomy, risk factors, staging, clinical features, investigations, and various treatment modalities for rectal cancer including surgery, chemotherapy, and radiotherapy. It describes in detail the different surgical procedures like local excision, anterior resection, abdominoperineal resection, and total mesorectal excision. It discusses the importance of clear circumferential resection margins and vascular ligation. Neoadjuvant chemoradiotherapy is emphasized for locally advanced tumors to downstage the cancer before surgery.
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
This document discusses the evolution of breast cancer surgery from radical mastectomy to breast-conserving surgery (BCS). It provides an overview of the key factors to consider when determining eligibility for BCS, including tumor characteristics, family history, genetic factors, and patient age/health status. Multiple studies have shown that BCS followed by radiation therapy provides equivalent survival outcomes to mastectomy for appropriately selected early-stage patients. Surgical challenges include achieving negative margins, maintaining cosmesis, and detecting local recurrence after BCS. Patient selection factors and techniques to help guide BCS are discussed.
1) Cancers of the penis are rare but devastating, accounting for 0.4-0.6% of cancers in men in the US and Europe but up to 10% in some other regions.
2) Risk factors include poor hygiene, phimosis, HPV infection, and lack of circumcision. Over 95% are squamous cell carcinoma.
3) Staging involves physical exam, biopsy, and imaging of lymph nodes and distant organs. Treatment may include organ-sparing surgery or penile amputation depending on size, grade, and extent of invasion.
Acs0826 Molecular And Cellular Mediators Of The Inflammatory Responsemedbookonline
This document discusses the molecular and cellular mediators of the inflammatory response. It describes how neutrophils play a key role in mediating inflammation through the release of reactive oxygen metabolites and proteases that can damage surrounding tissues. Neutrophils adhere to endothelial cells and migrate into tissues via adhesion molecules like selectins, integrins, and immunoglobulins. While neutrophils help fight infection, overactivation can cause excessive tissue damage through increased vascular permeability and parenchymal injury during conditions like reperfusion injury or sepsis. Controlling neutrophil adhesion is important for balancing the benefits of the immune response against potential tissue damage.
Acs0714 Management Of The Patient With Thermal Injuriesmedbookonline
This document discusses the management of patients with thermal injuries. It covers:
- Optimal care requires a multidisciplinary team at a specialized burn center.
- Small burns may be managed as outpatients if proper education is provided. Larger or more complex burns require inpatient care.
- Resuscitation follows the Parkland formula of crystalloid infusion based on percentage of total body surface area burned. Fluid management aims to maintain blood pressure and urine output.
- Proper wound care, pain management, physical therapy and education are essential for recovery from burns.
1. Locally advanced rectal cancers are defined as T4 or node-positive lesions that cannot be completely resected without a high risk of residual disease. Management involves pre-operative chemotherapy with or without radiation therapy followed by surgery and adjuvant chemotherapy.
2. For resectable stage II/III cancers, pre-operative chemoradiation or radiation followed by surgery and adjuvant chemotherapy improves local control and survival compared to surgery alone.
3. For unresectable T4 cancers, induction chemotherapy and long-course chemoradiation may enable resection. Adjuvant chemotherapy is recommended in all cases.
This document discusses oncoplastic breast surgery techniques. It begins by explaining breast conserving treatment and its goals of providing survival equivalent to mastectomy while achieving low recurrence rates. It then discusses various breast conserving surgery procedures like lumpectomy and quadrantectomy. The document focuses on the compromise between wide excision margins and satisfactory aesthetic results in breast conserving surgery. It also discusses various reconstruction techniques used after breast conserving surgery, including breast implants, fat grafting, flap procedures, and oncoplastic breast reconstruction. The principles and mechanisms of oncoplastic surgery are explained. Techniques for peripheral and central tumors are classified.
1. Oncoplastic breast surgery (OPBS) combines oncological surgery with plastic surgery techniques to allow for wide excision of breast cancer tumors while maintaining the natural shape of the breast.
2. OPBS techniques have evolved since the 1980s and can be used for breast-conserving surgery, post-mastectomy reconstruction, or correction of defects after standard breast-conserving surgery.
3. OPBS is generally indicated for early-stage breast cancers less than 4cm and can extend the use of breast-conserving surgery to larger tumors. Selection depends on factors like excision volume, tumor location, and breast density.
Extra Levator Abdomino Perineal Resection Dr Harsh Shah
This document discusses extralevator abdominoperineal excision (ELAPE) for rectal cancer. It describes how ELAPE aims to improve on conventional abdominoperineal resection (APR) by removing a larger volume of tissue, including the levator muscles, to obtain clear margins. Meta-analyses have found ELAPE results in lower rates of circumferential resection margin involvement, local recurrence, and involved nodes compared to APR. However, ELAPE also increases morbidity risks and requires perineal wound reconstruction. While ELAPE shows potential oncological benefits, more high-quality studies are still needed to prove its superiority over selective approaches.
Information about Low Anterior Resection by Dr Dhaval Mangukiya.
Details of GOAL of LAR, Margins, Reconstructions, Anal Anastomosis, End to Side Colorectal Anastomosis, Stapler Vs Hand Sewn, Intersphincteric Resection, Colonic J pouch Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Single incision laparoscopic Surgery-SILSrkmishra14
World Laparoscopy Hospital is Pioneer in SILS. Single incision laparoscopic surgery (SILS) under direction of Prof. R.K. Mishra is a new technique that has now been utilized in many centers for minimal access surgery. http://www.laparoscopyhospital.com/single_incision_laparoscopic_surgery.html
This document provides information on breast oncoplastic surgery techniques:
- Oncoplastic surgery (OPS) integrates plastic surgery with breast-conserving cancer surgery to allow for wider excisions without compromising breast shape. It ranges from simple reshaping to advanced mammoplasty techniques.
- Key factors in determining the appropriate OPS approach are excision volume, tumor location, breast density, and glandular composition. Excisions over 20% of breast volume or from certain locations risk deformity. OPS allows excision of up to 1000g compared to 80g for standard surgery.
- OPS techniques are classified into Level I involving reshaping and Level II involving skin excision and reshaping using
This document discusses esophageal resection and reconstruction techniques. It covers indications for resection such as carcinoma or injury. Common reconstruction conduits are the stomach, colon, jejunum or combinations. Reconstruction routes include posterior mediastinal, substernal or subcutaneous. Complications can include fistula, stricture or dysfunction. The goal is a viable patient with functional gastrointestinal continuity. Successful reconstruction lasts long, provides nutrition and is done safely with flexibility and a team approach.
The document discusses strategies for performing safe laparoscopic cholecystectomy, including obtaining the critical view of safety, using intraoperative cholangiography to help identify biliary anatomy, and employing bailout techniques such as partial or subtotal cholecystectomy if the critical view cannot be achieved to avoid potential bile duct injuries. It also describes error traps that can lead to injuries and strategies surgeons should follow to promote a culture of safety in laparoscopic cholecystectomy.
Dr. Yajnadatta Sarangi discusses hyperthermic intraperitoneal chemotherapy (HIPEC), which involves delivering chemotherapy intraperitoneally at high temperatures to treat peritoneal metastasis. HIPEC is usually performed along with cytoreductive surgery to remove all visible tumor deposits. It aims to treat microscopic residual disease remaining after surgery. The document discusses the rationale for HIPEC, techniques, indications, contraindications and complications. It presents evidence that HIPEC combined with cytoreductive surgery improves survival outcomes for several cancer types compared to palliative chemotherapy alone.
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
This document discusses the history of biliary injuries and laparoscopic cholecystectomy. It begins with a brief overview of milestones in the history of cholecystectomy and bile duct surgery. It then describes biliary anatomy and variations that can increase risk of injury. The advantages of laparoscopic cholecystectomy are noted but also the increased risk of bile duct injuries compared to open surgery. Risk factors for injuries are discussed including surgeon experience, patient factors like inflammation, and anatomic variations. Techniques for prevention are outlined including obtaining the "critical view of safety" and using intraoperative cholangiography. Classification systems for injuries and approaches to treatment are also summarized. Throughout, the importance of prevention over treatment is emphasized
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is emerging as a new standard treatment for peritoneal surface malignancies. Traditionally, peritoneal carcinomatosis was considered incurable and treated only with palliative chemotherapy. However, CRS-HIPEC aims to remove all visible tumor deposits surgically and then uses heated chemotherapy in the abdominal cavity to target any remaining microscopic disease. Studies show CRS-HIPEC provides significantly longer survival times compared to intravenous chemotherapy alone, with median overall survivals of 16-36 months. Experts indicate CRS-HIPEC should now be considered the standard of care for select patients with peritoneal metastases from conditions like ovarian
This document discusses updates in the management of rectal cancer. It covers the anatomy, risk factors, staging, clinical features, investigations, and various treatment modalities for rectal cancer including surgery, chemotherapy, and radiotherapy. It describes in detail the different surgical procedures like local excision, anterior resection, abdominoperineal resection, and total mesorectal excision. It discusses the importance of clear circumferential resection margins and vascular ligation. Neoadjuvant chemoradiotherapy is emphasized for locally advanced tumors to downstage the cancer before surgery.
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
This document discusses the evolution of breast cancer surgery from radical mastectomy to breast-conserving surgery (BCS). It provides an overview of the key factors to consider when determining eligibility for BCS, including tumor characteristics, family history, genetic factors, and patient age/health status. Multiple studies have shown that BCS followed by radiation therapy provides equivalent survival outcomes to mastectomy for appropriately selected early-stage patients. Surgical challenges include achieving negative margins, maintaining cosmesis, and detecting local recurrence after BCS. Patient selection factors and techniques to help guide BCS are discussed.
1) Cancers of the penis are rare but devastating, accounting for 0.4-0.6% of cancers in men in the US and Europe but up to 10% in some other regions.
2) Risk factors include poor hygiene, phimosis, HPV infection, and lack of circumcision. Over 95% are squamous cell carcinoma.
3) Staging involves physical exam, biopsy, and imaging of lymph nodes and distant organs. Treatment may include organ-sparing surgery or penile amputation depending on size, grade, and extent of invasion.
Acs0826 Molecular And Cellular Mediators Of The Inflammatory Responsemedbookonline
This document discusses the molecular and cellular mediators of the inflammatory response. It describes how neutrophils play a key role in mediating inflammation through the release of reactive oxygen metabolites and proteases that can damage surrounding tissues. Neutrophils adhere to endothelial cells and migrate into tissues via adhesion molecules like selectins, integrins, and immunoglobulins. While neutrophils help fight infection, overactivation can cause excessive tissue damage through increased vascular permeability and parenchymal injury during conditions like reperfusion injury or sepsis. Controlling neutrophil adhesion is important for balancing the benefits of the immune response against potential tissue damage.
Acs0714 Management Of The Patient With Thermal Injuriesmedbookonline
This document discusses the management of patients with thermal injuries. It covers:
- Optimal care requires a multidisciplinary team at a specialized burn center.
- Small burns may be managed as outpatients if proper education is provided. Larger or more complex burns require inpatient care.
- Resuscitation follows the Parkland formula of crystalloid infusion based on percentage of total body surface area burned. Fluid management aims to maintain blood pressure and urine output.
- Proper wound care, pain management, physical therapy and education are essential for recovery from burns.
This document provides an overview of acquired immunodeficiency syndrome (AIDS) and approaches to treating human immunodeficiency virus (HIV) infection from a surgical perspective. It discusses the history and pathogenesis of HIV/AIDS, methods for diagnosing HIV infection, classifying patients according to CDC guidelines, and considerations for surgical treatment of HIV-infected patients. Key points addressed include increased risk of infection, renal failure, and cardiac dysfunction in HIV patients; opportunistic infections requiring surgery; and precautions to prevent transmission of HIV to patients and medical personnel in surgical settings.
1) A solitary pulmonary nodule (SPN) is a single radiographically visible lung lesion less than 3 cm in diameter that is completely surrounded by lung tissue.
2) Several factors influence the probability that an SPN is malignant, including increasing age, history of smoking, occupational exposures, and characteristics on CT scans such as size, contour, and growth rate.
3) Evaluation of an SPN involves assessing risk factors for cancer and imaging studies to determine a management plan, which may include follow up scans, PET scans, or tissue sampling depending on probability of malignancy.
This document discusses mechanical ventilation and provides guidance on its use for patients with respiratory failure. It describes the basic principles of ventilation and oxygenation. Various ventilator modes are outlined, including pressure support ventilation (PSV), pressure-controlled ventilation (PCV), and volume-controlled ventilation (VCV). Guidance is given for initial ventilator settings and adjustments based on the patient's condition and oxygen saturation. A lung-protective ventilation strategy is recommended for acute lung injury/acute respiratory distress syndrome. The importance of daily assessments to liberate patients from the ventilator is also emphasized.
This document provides information on evaluating and managing chest wall masses. It discusses:
1) Performing a thorough history, physical exam, and imaging to determine if the mass is primary or secondary.
2) Obtaining a biopsy for masses ≥3cm or if resection would be extensive to determine if the mass is benign or malignant.
3) For benign primary masses, complete resection is usually curative. For malignant primary masses, radical resection with reconstruction is required.
Acs0304 Surgical Management Of Melanoma And Other Skin Cancersmedbookonline
This document discusses the evaluation and management of malignant skin lesions. It recommends that any clinically suspicious lesion undergo biopsy, with excisional biopsy preferred for small lesions and incisional biopsy for large lesions. For confirmed malignancies, further excision with appropriate margins is usually necessary. It then focuses on the two most common types of skin cancer: basal cell carcinoma and squamous cell carcinoma. For basal cell carcinoma, complete surgical excision with a 4mm margin is the main treatment. For squamous cell carcinoma, surgical margins of 6-10mm are recommended depending on risk factors, with lymph node assessment important for high-risk lesions.
This document provides information on evaluating a parotid mass. It begins by classifying parotid masses as nonneoplastic, lymphoepithelial, or neoplastic. The evaluation involves obtaining a clinical history focusing on duration and symptoms. On physical examination, the examiner evaluates the extent of the mass, effects on surrounding areas, and facial nerve function. Imaging may be used to further characterize indeterminate masses. Fine needle aspiration is sometimes used but is controversial. Treatment depends on whether the mass is benign or malignant.
Acs0006 Risk Stratification, Preoperative Testing, And Operative Planningmedbookonline
This document discusses risk stratification, preoperative testing, and operative planning. It outlines tools for assessing surgical risk such as the American Society of Anesthesiologists physical status classification system. Factors that affect cardiac risk are identified, such as smoking, alcohol abuse, and previous cardiovascular disease. Guidelines for preoperative testing are presented, noting the need for selective testing. The importance of identifying clinical risk factors and optimizing modifiable factors is discussed.
1) Soft tissue infections can range from mild to life-threatening and involve skin, subcutaneous tissue, fascia, or muscle. Necrotizing soft tissue infections require urgent surgical debridement in addition to antibiotics.
2) Diagnosis is usually based on history and physical exam, looking for signs of infection severity. Imaging and labs are important when diagnosis is unclear or necrotizing infection is suspected.
3) MRI is the best imaging method, looking for soft tissue gas, edema, or necrosis. Biopsy may be needed to confirm diagnosis or rule out necrotizing infection when MRI is inconclusive.
This summary provides the key details from the document in 3 sentences or less:
Laparoscopic Nissen fundoplication is described as a minimally invasive procedure for gastroesophageal reflux disease. It involves placing 5 trocar ports for instruments and a camera, dissecting the gastrohepatic ligament, wrapping the fundus of the stomach around the lower esophagus, and suturing it in place to create an anti-reflux valve. Proper trocar placement is emphasized to allow adequate exposure and retraction of tissues while avoiding injury to nearby structures like blood vessels.
This document discusses tracheostomy, including:
1) Tracheostomy refers to creating an opening in the trachea, while tracheotomy refers to incising the trachea.
2) Tracheostomy is commonly performed to facilitate prolonged ventilation or provide airway access during head/neck cancer surgery.
3) The procedure involves incising the skin and strap muscles of the neck to access the trachea, through which an opening is made and a tracheostomy tube inserted. Counseling the patient and family on risks is important.
Acs0009 Minimizing Vulnerability To Malpractice Claimsmedbookonline
This document discusses minimizing vulnerability to medical malpractice claims. It begins by noting the adverse malpractice climate with high jury awards and many physicians leaving practice. It then discusses recent tort reforms in Pennsylvania that may be reducing claims, such as damages caps and tougher expert witness standards.
The document outlines personal issues defendant physicians face, noting stresses include allegations of negligence and punitive damages claims. It discusses who brings claims and who is targeted, finding claims are brought for injuries rather than poor care and that targeted physicians are often highly qualified. The document concludes by emphasizing that building trust through open communication, informed consent, accurate records, and educating staff can help reduce claims more than clinical skill alone.
The document discusses considerations for elderly surgical patients. Older patients represent a growing demographic undergoing more procedures. While age alone is a poor indicator of health, the aging process involves physiological changes that reduce cardiac, pulmonary, renal and other organ reserves. Careful preoperative evaluation of functional status is important to assess risks. Perioperative strategies aim to support compromised systems and avoid stressors that can precipitate complications in elderly patients.
This document discusses fungal infections in surgical patients and provides guidance on evaluating and managing patients at risk of Candida infection. Key points:
- Fungal infections are an important cause of morbidity/mortality in surgical settings, especially in critically ill, transplant, and neonatal patients.
- Colonization is distinguished from infection, though colonization is a risk factor. Diagnosis of infection considers culture results and clinical signs/symptoms.
- A diagnostic algorithm is provided to guide evaluation and treatment based on risk factors, culture results, and clinical presentation. Empiric antifungal therapy and source control are recommended for higher-risk situations.
Acs0905 Gynecologic Considerations For The General Surgeonmedbookonline
This document discusses several gynecologic conditions and considerations for general surgeons:
- Gynecologic emergencies like bleeding from ovarian cysts, adnexal torsion, pelvic inflammatory disease, and ectopic pregnancy. Diagnosis and treatment approaches are outlined.
- Outpatient gynecologic problems including evaluating pelvic masses and abnormal uterine bleeding.
- Gynecologic malignancies like ovarian and cervical cancer that some general surgeons may encounter.
- Most conditions can be initially managed conservatively but may require surgery depending on patient stability or response to treatment. Diagnostic tools like ultrasound, CT, and laparoscopy are discussed.
This document discusses breast procedures used to diagnose, stage, and treat breast disease. It covers breast ultrasonography, which can evaluate palpable or mammographically indeterminate breast lesions and guide biopsies. Ductal lavage is described as an investigational method to retrieve breast duct epithelial cells for analysis via a catheter inserted into the duct. Ductoscopy is mentioned as an emerging endoscopic technique to directly visualize the mammary duct lining and biopsy system, currently being evaluated for evaluating nipple discharge, high-risk patients, and determining intraductal disease extent in breast cancer patients. Core needle biopsy is highlighted as the standard minimally invasive biopsy technique replacing excisional biopsy for diagnosis due to being less invasive, costly and exp
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
This document discusses evidence-based laboratory medicine and the need to support clinical decision-making with robust evidence. It notes that while laboratory medicine is perceived as scientific, evidence for many diagnostic tests is limited or flawed. An evidence-based approach can help improve education, guidelines, decision-making and resource allocation. The challenges include a lack of evidence demonstrating the impact of diagnostic tests on patient outcomes. Health technology assessment and outcomes research are important tools to develop high-quality evidence and address the current pressures on healthcare systems.
The document discusses evidence-based nursing practice. It defines evidence-based practice as integrating the best research evidence, clinical expertise, and patient values and needs. The key steps in evidence-based practice are asking questions, acquiring evidence, appraising the evidence, applying it to a patient, and evaluating outcomes. Barriers to evidence-based nursing include lack of time and resources, as well as difficulties interpreting and applying research. Facilitators include administrative support and accessible, clearly written research. Maximizing evidence-based nursing requires overcoming barriers, incorporating different types of evidence, and accounting for issues beyond measurement like patient preferences.
This document reviews instruments for monitoring sedation in intensive care unit (ICU) patients. It finds that while promising objective methods exist, there are no truly validated tools for monitoring ICU sedation. Auditory evoked potentials can only be used for research in deeply sedated patients. Other methods require further development and validation before use in ICUs. Subjective scoring systems based on clinical observation, like the Glasgow Coma Scale modified by Cook and Palma, have proven useful for guiding sedative therapy due to their validity and reliability. Continued research is needed to develop an objective system to improve sedation monitoring and control in ICU patients.
This document discusses evidence-based nursing and its evolution over time. It provides definitions of key terms like evidence-based medicine and evidence-based nursing practice. It also summarizes several models that have been developed to help implement evidence-based practice, including the Stetler Model, Iowa Model, and Star Model. The stages of knowledge transformation in the Star Model are also briefly outlined.
This document describes the Continuous Update Project, a novel approach developed by the World Cancer Research Fund to systematically review mechanistic evidence on diet, nutrition, physical activity and cancer. The approach involves conducting systematic reviews and meta-analyses of both epidemiological and mechanistic studies to make judgements on causal relationships. It emphasizes reproducibility, predefined criteria, and reviews evidence separately from making judgements. The goal is to help identify causal links between exposures and cancer outcomes.
The document discusses evidence based nursing practice. It defines nursing research, evidence, evidence based decision making and evidence based practice. Evidence based nursing practice refers to using the best research evidence, clinical expertise and patient preferences in clinical decision making. The evidence based practice movement started in the 1990s to improve care quality. Models like the Stetler model and Iowa model provide frameworks for evidence based practice. Barriers to evidence based practice include lack of time, skills and research access. Guidelines and systematic reviews are sources of best evidence.
A very vital article that briefly and nicely describes how shpuld evidence be handled in order to evaluate it and make use of the information provided.
L1- INTRO AND PRINCIPLE EVIDENCE-BASED PRACTICE.pdfssuser32d4de
PURPOSE OF THIS COURSE
extend knowledge of research and research processes.
provides an opportunity to examine data collection and data analyses
Appreciate the applicability of research to healthcare professionals
Test bank clinical nursing skills and techniques 9th editionsolahar
This document provides a test bank with multiple choice, multiple response, and completion questions related to Chapter 1 of the 9th Edition of the textbook Clinical Nursing Skills and Techniques. The questions cover topics like the definition of evidence-based practice, developing PICO questions, searching for and appraising evidence, and applying evidence-based practice.
This document provides an overview of evidence-based orthodontics. It defines evidence-based orthodontics as integrating the best available research evidence with clinical expertise and patient values. The need for evidence-based orthodontics is that it allows practitioners to provide the currently best care available to patients. Evidence-based orthodontic practice differs from traditional practice by regularly accessing new evidence, identifying risk factors, and providing continuous, patient-centered, and efficient care. Systematic reviews are used to summarize research evidence in an unbiased manner to inform clinical decision making.
This document provides an overview of evidence-based periodontics. It discusses the need for evidence-based decision making to reduce variations in clinical practice. The advantages of an evidence-based approach are that it is objective, scientifically sound, patient-focused, and incorporates clinical expertise. The process of evidence-based decision making involves framing questions, searching for and appraising evidence from various sources and levels, evaluating outcomes, and implementing decisions. Key aspects include assessing evidence critically and avoiding changes to pre-established hypotheses.
This document provides an introduction to evidence-based practice (EBP) in nursing. It discusses the historical aspects of EBP, noting that while research has increasingly influenced nursing since the 1960s, EBP is still a relatively new phenomenon. The document defines EBP as applying scientific evidence from systematic research to clinical decision making to provide quality patient care. It also addresses what constitutes evidence and discusses some of the challenges and debates around EBP, such as how to handle conflicting evidence or situations where patients do not want EBP. Overall, the document emphasizes that health professionals must continually search for, analyze, and apply the best current evidence in their practice through critical thinking.
This document discusses evidence-based periodontology and decision making. It defines evidence-based periodontology as applying evidence-based healthcare to periodontology by integrating the best available evidence with clinical practice. The document outlines the steps of evidence-based periodontology, including asking questions using the PICO format, searching for and appraising evidence from systematic reviews and clinical practice guidelines, and applying the evidence to clinical decisions. It also discusses tools for critically assessing evidence, such as considering different levels of evidence and ensuring temporality between causes and effects.
This document provides an overview of evidence-based practice (EBP) in healthcare. It defines EBP as integrating the best research evidence, clinical expertise, and patient values and preferences. The key elements of EBP are outlined, including formulating answerable clinical questions using the PICOT format, searching for and appraising evidence, applying evidence to individual patients, and evaluating outcomes. The steps of the EBP process and strategies to bridge the research-practice gap are also summarized. Overall, the document emphasizes that EBP aims to improve clinical decision-making and patient outcomes by basing practices on rigorous research evidence rather than tradition alone.
Here are the key steps a new nurse can take to promote evidence-based practice:
1. Identify a clinical issue or problem on your unit that interests you and has the potential to impact patient outcomes. This could be related to a procedure, treatment, or aspect of care.
2. Conduct a literature search to find the best available evidence on your topic. Search reputable databases like CINAHL, PubMed, and Cochrane.
3. Critically appraise the evidence using an appropriate appraisal tool like CASP to determine the quality and validity of what you find.
4. Synthesize the findings from high quality studies. Determine if a change is warranted based on the evidence.
5
This document discusses evidence-based practice (EBP) in nursing. It defines EBP as integrating the best research evidence, clinical expertise, and patient values and needs. The document outlines the history of EBP beginning in the 1980s and its focus on improving patient outcomes. It also discusses the skills needed for EBP, including critical thinking, information literacy, and communication skills. The five key steps of the EBP process are also summarized: formulating a clinical question, gathering evidence, appraising evidence, integrating evidence with expertise and patient preferences, and evaluating the practice change.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
The document provides guidelines for writing an evidence-based review article. It defines different types of review articles and outlines the key steps, which include: selecting a topic of clinical relevance; conducting a comprehensive literature search of sources like systematic reviews and clinical practice guidelines; evaluating the strength and validity of the evidence; and presenting the information in a standardized format covering introduction, methods, discussion, and references. The discussion section should provide an evidence-based analysis of a topic, acknowledge any controversies, and rate the level of evidence for key statements and recommendations.
1) A preanesthesia evaluation consists of reviewing a patient's medical records, conducting an interview, and performing a physical examination to assess risks and plan anesthetic care.
2) While no controlled trials have directly evaluated the benefits of a preanesthesia evaluation, observational studies link certain medical conditions to postoperative complications, and some studies found the evaluation changed patient care plans.
3) Expert opinion suggests reviewing records before surgery for highly invasive procedures, and on or before the day of surgery for less invasive procedures depending on patient severity and surgical invasiveness. A minimum physical exam includes checking the airway, lungs, and heart.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document provides reference values for many common clinical chemistry analytes measured in various specimens like plasma, serum, urine, and whole blood. The analytes include metabolic panels, lipids, proteins, electrolytes, vitamins, and more. Reference ranges are given in conventional and SI units for each analyte. The purpose is to provide clinicians with the normal expected ranges to interpret laboratory results at the Massachusetts General Hospital.
Acs0904 Urologic Considerations For The General Surgeonmedbookonline
This document discusses urologic considerations for general surgeons. It begins with an overview of genitourinary anatomy, including the kidneys, ureters, bladder, prostate, seminal vesicles, penis, and urethra. It then discusses common urologic injuries general surgeons may encounter, such as those resulting from multiple trauma or iatrogenic injuries during other operations. Urologic malignancies and benign prostatic hyperplasia are also briefly mentioned.
1) The document discusses the management of pregnant patients requiring surgery or experiencing trauma. It notes special considerations for pregnant patients, including physiological changes and the need to care for both mother and fetus.
2) In trauma situations, the initial focus is stabilizing the mother to benefit both patients. Penetrating injuries often directly threaten the fetus while blunt trauma poses less direct risk, usually resulting in placental abruption or preterm labor.
3) Surgical decisions must weigh fetal viability against maternal stability, with non-urgent cases delayed if possible. Monitoring includes fetal heart monitoring and ultrasound to detect issues like abruption.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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