ERA

General Surgery

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  1. Treatment of Gastric Cancer With Peritoneal Carcinomatosis by Cytoreductive Surgery and HIPEC: A Systematic Review of Survival, Mortality, and Morbidity [Download]

    Title: Treatment of Gastric Cancer With Peritoneal Carcinomatosis by Cytoreductive Surgery and HIPEC: A Systematic Review of Survival, Mortality, and Morbidity
    Creator: Gill, Richdeep S.
    Description: Gastric cancer with peritoneal carcinomatosis has an extremely poor prognosis, which may be improved with cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC). We systematically reviewed the literature regarding the efficacy of CRS þ HIPEC in these patients. Electronic databases were searched from 2000 to 2010. Following CRS þ HIPEC, overall median survival was 7.9 months and improved to 15 months for patients with completeness of cytoreduction scores of 0/1, however with a 30-day mortality rate of 4.8%. This is the pre-peer reviewed version of the following article: Gill RS, Al-Adra DP, Nagendran J, Campbell S, Shi X, Haase E, Schiller D. Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: A systematic review of survival, mortality, and morbidity.J Surg Oncol. 2011 Jun 28. doi: 10.1002/jso.22017. , which has been published in final form at  http://login.ezproxy.library.ualberta.ca/login?url=http://dx.doi.org/DOI:
    10.1002/jso.22017.
    Subjects: gastric cancer, HIPEC, Articles, cytoreductive surgery, peritoneal carcinomatosis
  2. Providone-Iodine Irrigation of Subcutaneous Tissues May Decrease Surgical Site Infections in Elective Colorectal Operations: A Systematic Review [Download]

    Title: Providone-Iodine Irrigation of Subcutaneous Tissues May Decrease Surgical Site Infections in Elective Colorectal Operations: A Systematic Review
    Creator: Gill, Richdeep S.
    Description: Background: Postoperative wound infection is the most common complication following abdominal surgery and leads to delayed wound healing, prolonged hospital length of stay (LOS), and causes morbidity. Povidone-Iodine (PVI) is a broad-spectrum anti-septic and disinfectant solution, and can be used intra-operatively to irrigate subcutaneous tissues prior to abdominal skin closure. We systematically reviewed the literature regarding the efficacy of intraoperative PVI irrigation of subcutaneous tissues following elective colorectal surgery. Methods: A comprehensive search of electronic databases and various grey literature sources was completed. Unpublished and non-English-language results were included. All clinical controlled trials involving PVI solution in adult colorectal surgery were included. Two independent reviewers assessed the studies for relevance, inclusion, methodological quality and extracted data from the full versions of the manuscripts. Disagreements were resolved by re-extraction or third party adjudication. Data for dichotomous outcomes are reported as relative risks (RR) with 95% confidence intervals (CI). For continuous data, mean differences (MD) are reported with 95% CIs. Results: Five randomized controlled trials (RCTs) involving 205 patients comparing PVI solution or spray to a control group following abdominal fascial closure in elective colorectal or clean-contaminated operations were identified. Pooled results demonstrated a reduction in surgical site infection for patients treated with PVI (RR = 1.97; 95% CI: 1.22 to 3.17) compared to controls. Conclusions: Irrigation of subcutaneous tissues with PVI following abdominal fascial closure is associated with a reduced incidence of surgical site infection. Due to the small number of included trials and patients, additional robust randomized trials are needed.
    Subjects: Providone-Iodine, Colorectal operation, Surgical site infection
    Date Created: 2011/06/01
  3. The Association between Obesity and Colorectal Cancer [Download]

    Title: The Association between Obesity and Colorectal Cancer
    Creator: Whitlock, Kevin
    Description: Obesity has become a major issue for healthcare providers as its prevalence continues to increase throughout the world. The literature suggests that increased body mass index (BMI) is associated with the development of certain cancers such as colorectal cancer (CRC). Consequently, CRC surgeons are now encountering an increasing number of obese patients which may influence the technical aspects and outcomes of surgical treatment. For instance, obese patients present with greater comorbidities preoperatively, which adds increasing complexity and risks to surgical management. Recent literature also suggests that obesity may increase operating time and conversion rates to open colorectal surgery. Postoperative outcomes may also be influenced by obesity; however, this currently remains controversial. There is evidence that survival rates after CRC surgery are not influenced by obesity. In summary, obesity presents challenges to CRC surgeons, and further research will be needed to show how this important characteristic influences the outcomes for CRC patients.
    Subjects: Obesity, Colorectal cancer
    Date Created: 2012
  4. The changing scope of colorectal cancer [Download]

    Title: The changing scope of colorectal cancer
    Creator: White, J.S.
    Subjects: proximal colonic cancers, disease distribution, colorectal cancer
    Date Created: 2002
  5. Endoscopic Revision (StomaphyX) versus Formal Surgical Revision (Gastric Bypass) for Failed Vertical Band Gastroplasty [Download]

    Title: Endoscopic Revision (StomaphyX) versus Formal Surgical Revision (Gastric Bypass) for Failed Vertical Band Gastroplasty
    Creator: Bolton, Johan
    Description: Background: Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx) to RYGB for revision. Methods: A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003-2010. Results: Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB, 47.7 ± 7 kg/m(2) to 35 ± 7 kg/m(2); StomaphyX 43 ± 10 kg/m(2) to 40 ± 9 kg/m(2), P = 0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX. Conclusion: This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.
    Subjects: Endoscopic revision (StomaphyX), Clinical studies, Surgical revision (Gastric Bypass), Failed vertical band gastroplasty
    Date Created: 2013
  6. Motion Pattern Analysis in Proprioceptive Guidance [Download]

    Title: Motion Pattern Analysis in Proprioceptive Guidance
    Creator: Pinzon, David
    Description: • Proprioceptive guidance assists a human operator to perform goal-directed movement by giving kinesthetic feedback. • Proprioceptive guidance enhances motor learning when visual feedback is unreliable, the task has complex kinematics, or is difficult to describe. • These characteristics are present in the surgical and rehabilitation environment, thus making it optimal for training healthcare skills required in Surgery and Rehabilitation. Objectives • We aim to characterize the behavior of proprioceptive guidance in storing information for skill learning. • We hypothesize that a human operator has limited capacity to perceive motor information purely through kinesthetic guidance. • Task performance will degrade once working capacity has reached its limitation.
    Subjects: haptic, proprioceptive guidance, kinesthetic guidance, motor learning
    Date Created: 2015/09/04
  7. The probiotic bacterium Lactobacillus plantarum species 299 reduces intestinal permeability in experimental biliary obstruction [Download]

    Title: The probiotic bacterium Lactobacillus plantarum species 299 reduces intestinal permeability in experimental biliary obstruction
    Creator: White, J.S.
    Description: Aims: Extrahepatic biliary obstruction is associated with the failure of intestinal barrier function, allowing bacteria and other substances from the intestine to enter the circulation and initiate a systemic inflammatory response, causing impairment of organ function. Probiotic bacteria have been shown to have beneficial effects on intestinal barrier function in other conditions, but their effects have never been studied in biliary obstruction. Methods and Results: This study examined the effects of enteral administration of Lactobacillus plantarum species 299 (LP299) in oatmeal fibre compared with sterile oatmeal fibre in water or water alone in an animal model of biliary obstruction. Administration of LP299 was associated with reduced intestinal permeability compared with sterile oatmeal alone (0Æ262 ± 0Æ105% vs 0Æ537 ± 0Æ037%, P = 0Æ019, percentage excretion of 14Carbon), but there was no evidence of reduced endotoxin exposure or blunting of the systemic inflammatory response. Animals receiving sterile oatmeal fibre alone also failed to develop the hyperpermeability after biliary obstruction seen in animals receiving water only (0Æ512 ± 0Æ05% vs 0Æ788 ± 0Æ18%), suggesting that oatmeal itself may have some beneficial effects on intestinal barrier function. Conclusion: Enteral administration of the probiotic bacterium LP299 reduces intestinal hyperpermeability associated with experimental biliary obstruction. Significance and Impact of the Study: This study provides insight to direct further work into the modulation of intestinal barrier function by probiotic bacteria.
    Subjects: intestinal barrier function, biliary obstruction, probiotic
    Date Created: 2006
  8. "A Chance To Show Yourself" - How do Applicants Approach Medical School Admission Essays? [Download]

    Title: "A Chance To Show Yourself" - How do Applicants Approach Medical School Admission Essays?
    Creator: White, J.S.
    Description: Background: Although essay questions are used in the admissions process in many medical schools, there has been little research on how applicants respond to essay questions. Aims: The purpose of this study was to explore how applicants to medical school approach essay questions used in the selection process. Methods: Qualitative analysis was conducted on 240 randomly selected essays written by individuals applying to a single Canadian medical school in 2007 using a modified grounded theory approach to develop a conceptual framework which was checked in interviews with applicants. Results: Three core variables were identified: ‘‘balancing service and reward,’’ ‘‘anticipating the physician role,’’ and ‘‘readiness.’’ We described the overall approach of applicants as ‘‘taking stock,’’ writing about their journeys to the selection process, their experiences of the process itself, and about their anticipated future in medicine. Conclusion: Our findings suggest a disconnect between the approach of the applicants (to ‘‘show themselves’’ and be selected as individuals) and the stated intent of the process (to select applicants based on ‘‘objective’’ criteria). Our findings raise important questions about how applicants represent themselves when applying for medical school and suggest that it is important to understand the applicant’s point of view when developing questions for selection processes.
    Subjects: admissions, medical schools, essay questions
    Date Created: 2011
  9. Exercise interventions for upper-limb dysfunction due to breast cancer treatment [Download]

    Title: Exercise interventions for upper-limb dysfunction due to breast cancer treatment
    Creator: McNeely ML
    Subjects: Joint Diseases, Range of Motion, Articular, Shoulder Joint, Upper Extremity, Lymphedema, Exercise Therapy, Recovery of Function, Randomized Controlled Trials as Topic, Breast Neoplasms, Time Factors, Postoperative Complications
    Date Created: 2010
  10. Exploring Surgeons' Perceptions of the Role of Simulation in Surgical Education: A Needs Assessment [Download]

    Title: Exploring Surgeons' Perceptions of the Role of Simulation in Surgical Education: A Needs Assessment
    Creator: Clark, M.
    Description: Background: The last two decades have seen the adoption of simulation-based surgical education in various disciplines. The current study’s goal was to perform a needs assessment using the results to inform future curricular planning and needs of surgeons and learners. Methods: A survey was distributed to 26 surgeon educators and interviews were conducted with 8 of these surgeons. Analysis of survey results included reliability and descriptive statistics. Interviews were analyzed for thematic content with a constant comparison technique, developing coding and categorization of themes. Results: The survey response rate was 81%. The inter-item reliability, according to Cronbach’s alpha was 0.81 with strongest agreement for statements related to learning new skills, training new residents and the positive impact on patient safety and learning. There was less strong agreement for maintenance of skills, improving team functioning and reducing teaching in the operating room. Interview results confirmed those themes from the survey and highlighted inconsistencies for identified perceived barriers and a focus on acquisition of skills only. Interview responses specified concerns with integrating simulation into existing curricula and the need for more evaluation as a robust educational strategy. Conclusion: The findings were summarized in four themes: 1) use of simulation, 2) integration into curriculum, 3) leadership, and 4) understanding gaps in simulation use. This study exemplifies a mixed-methods approach to planning a surgical simulation program through a general needs assessment.
    Subjects: simulation, surgical education, needs assessment
    Date Created: 2011