Morbidity and mortality conferences in general surgery: a narrative systematic review.

Background: In medical and surgical departments around the world, morbidity and mortality conferences (MMC) serve dual roles: they are cornerstones of quality-improvement programs and provide timely opportunities for education within the urgent context of clinical care. Despite the widespread adoption of MMCs, adverse events and preventable errors remain high or incompletely characterized, and opportunities to learn from and adjust to these events are frequently lost. This review examines the published literature on strategies to improve surgical MMCs.

Genicular Artery Embolization for Recurrent Hemarthrosis of the Knee Following Total Knee Arthroplasty: A Single Centre Experience.

Purpose: To retrospectively review the safety and efficacy of genicular artery embolization procedures performed at our institution in patients presenting with recurrent knee hemarthrosis following total knee arthroplasty (TKA).

Materials And Methods: A total of 13 consecutive patients (average age: 68; range 51-84, 62% female) were identified who underwent 14 genicular artery embolization procedures after presenting with recurrent hemarthrosis after TKA. Patient charts were retrospectively reviewed for demographic information, pre-embolization investigations, and details of embolization procedure including complications, technical success, and clinical success.

Psychosocial Influences on Patient Presentations: Considerations for Research and Evaluation at Mass-Gathering Events.

Aim: This review discusses the need for consistency in mass-gathering research and evaluation from a psychosocial perspective.

Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to determine required health resources.

Solar-powered oxygen delivery for the treatment of children with hypoxemia: protocol for a cluster-randomized stepped-wedge controlled trial in Uganda.

Background: Child mortality due to pneumonia is a major global health problem and is associated with hypoxemia. Access to safe and continuous oxygen therapy can reduce mortality; however, low-income countries may lack the necessary resources for oxygen delivery. We have previously demonstrated proof-of-concept that solar-powered oxygen (SPO) delivery can reliably provide medical oxygen remote settings with minimal access to electricity.

The burden of urological disease in Zomba, Malawi: A needs assessment in a sub-Saharan tertiary care center.

Introduction: A large part of the developing world continues to lack access to surgical care. Urology remains one of the least represented surgical subspecialties in global health. To begin understanding the burden of urological illness in sub-Saharan Africa, we sought to characterize all patients presenting to a tertiary care hospital in Malawi with a urological diagnosis or related complaint in the past year.

Ultrasound-guided L5 dorsal ramus block: validation of a novel technique.

Background: Although the value of ultrasound-guided (USG) lumbar medial branch blocks (MBB) has previously been examined in several clinical trials, blocking the L5 dorsal ramus (DR) remains a technical challenge and we sought to examine the accuracy of a novel technique targeting this level.

Methods: In this prospective cohort study, 115 patients scheduled for an L4 MBB and L5 DR block underwent an ultrasound scan to assess their lower spine sonoanatomy. Subjects in whom the necessary landmarks could be visualized underwent a USG L5 DR block using a pivot technique, which involved redirecting a needle from its position on the L5 transverse process after an L4 MBB.

THC intoxication in a 16-month-old child.

A 16-month-old previously healthy child with normal development presented with decreased level of consciousness, apneas, and seizure requiring intubation and treatment for status epilepticus. Investigations revealed no evidence of infection or trauma, normal head CT scan, and urine positive for tetrahydrocannabinol (THC) and negative for other substances. This report outlines the clinical presentation, approach to treatment, and potential seriousness of THC intoxication in young children.

Epinephrine in cardiac arrest: The PARAMEDIC2 trial.

Link:http://www.nejm.org/doi/10.

Cannabis use as a risk factor for causing motor vehicle crashes: a prospective study.

Aim: We conducted a responsibility analysis to determine whether drivers injured in motor vehicle collisions who test positive for Δ-9-tetrahydrocannabinol (THC) or other drugs are more likely to have contributed to the crash than those who test negative.

Design: Prospective case-control study.

Setting: Trauma centres in British Columbia, Canada.

Patient reported outcomes associated with surgical intervention for breast cancer.

Background: Patient reported outcomes (PROs) are an important addition to oncologic breast surgical care. The majority of BREAST-Q PRO literature has been focused on mastectomy with reconstruction (MR), with a paucity of information on more common surgical approaches in practice namely, breast conserving therapy (BCT) and mastectomy (M). This information will help inform patients around decision-making regarding surgical options.

Dose to the dominant intraprostatic lesion using HDR vs. LDR monotherapy: A Phase II randomized trial.

Purpose: To present the dosimetric results of a Phase II randomized trial comparing dose escalation to the MRI-defined dominant intraprostatic lesion (DIL) using either low-dose-rate (LDR) or high-dose-rate (HDR) prostate brachytherapy.

Material And Methods: Patients receiving prostate brachytherapy as monotherapy were randomized to LDR or HDR brachytherapy. Prostate and DILs were contoured on preoperative multiparametric MRI.

Impact of SSO-ASTRO margin guidelines on reoperation rates following breast-conserving surgery.

Background: Re-operation rates following breast-conserving surgery (BCS) for early invasive breast cancer are highly variable, largely due to uncertainty regarding adequate margins. The 2014 SSO-ASTRO guidelines recommended "no ink on tumor" as adequate margins. We evaluated the effect of guideline implementation on re-operation following BCS at our regional cancer center.

Palliative and end-of-life care education in Canadian emergency medicine residency programs: A national cross-sectional survey.

Objectives: Emergency physicians play an important role in providing care at the end-of-life as well as identifying patients who may benefit from a palliative approach. Several studies have shown that emergency medicine (EM) residents desire further training in palliative care. We performed a national cross-sectional survey of EM program directors.

Association of Mortality and Acute Aortic Events With Ascending Aortic Aneurysm: A Systematic Review and Meta-analysis.

Importance: The natural history of ascending aortic aneurysm (AsAA) is currently not well characterized.

Objective: To summarize and analyze existing literature on the natural history of AsAA.

Data Sources: A search of Ovid MEDLINE (January 1, 1946, to May 31, 2017) and Embase (January 1, 1974, to May 31, 2017) was conducted.

Cerebrovascular function in patients with chronic obstructive pulmonary disease: the impact of exercise training.

This study examined cerebral blood flow (CBF) and its regulation before and after a short-term periodized aerobic exercise training intervention in patients with chronic obstructive pulmonary disease (COPD). Twenty-eight patients with COPD (forced expiratory volume in 1 s/forced vital capacity < 0.7 and View Article and Find Full Text PDF

Retrospective evaluation of a clinical decision support tool for effective computed tomography angiography utilization in urgent brain imaging of suspected TIA/minor stroke in the emergency department.

Objectives: The Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization.

Development of intervention-related quality indicators for renal clinical pharmacists using a modified Delphi approach.

Objective: To develop a list of renal Quality Indicator Drug therapy problems (QI-DTPs) that serve to advance renal pharmacy practice to improve patient care.

Methods: Eighteen (18) renal, clinical pharmacists participated in an internet-based three-round modified Delphi survey. Each of the three rounds took approximately 2 weeks to complete.

A theory-informed assessment of the barriers and facilitators to nurse-driven antimicrobial stewardship.

Background: Nurses represent an underused workforce for performing antimicrobial stewardship (AMS) activities. Before engaging nurses in these activities, barriers and facilitators to the targeted behavior change should be identified using a validated model.

Methods: This was a prospective, qualitative, descriptive study to determine the barriers and facilitators to the promotion of intravenous (IV) to oral (PO) antimicrobials by nurses.

Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018.

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care.

Intra-aortic balloon pump: current evidence & future perspectives.

The intra-aortic balloon pump (IABP) is frequently used to support severely compromised ventricles in critically ill patients. Its relatively affordability and ease of insertion has cemented its position as the first line of treatment for hemodynamic support in cardiogenic shock. Accordingly, the current ACC/AHA recommendations maintain a Class 2A for the use of IABP in shock.