International Journal of Surgery Protocols最新文献

Introduction: Knee arthroplasty also known as the total knee replacement is an orthopedic surgical procedure done to resurface the knee that has been severely damaged by arthritis. After the completion of the surgical procedure, the skin closure is done. The optimal goal of skin closure after the procedure is to promote rapid healing and an acceptable cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty is done by using either of the two widely used sutures i.e., polypropylene (Prolene) sutures or the skin staple sutures. There are no standard guidelines as which type of the suture should be used. The present study aims to compare the incidence of surgical site infections (superficial and deep) for Prolene vs staple sutures in the bilateral knee arthroplasty patients within 6 weeks for superficial and within 90 days for deep infection.

Methods: This study will be conducted as an open blinded, parallel design, equivalence randomized controlled trial. The patients would be selected and randomized in 1:1 ratio to receive either of the two interventions i.e., Prolene or Staples. Patients undergoing unilateral or staged total knee replacement (TKR) were excluded.

Analysis: The normality assessment will be done using Shapiro Wilk test. Cox proportional hazard regression will be used to check the univariate and multi-variable associations of independent variables with the outcome. Both intention to treat analysis and per protocol analysis would be performed.

Ethics and dissemination: All the required approvals will be taken from the ethical review committee. Informed consent will be taken form the patient to enroll him/her in the study. Results of the study will be disseminated to the study participants, public health and clinical professionals and would also be published in a reputable international journal.The trial is registered at clinicaltrials.gov and UIN of the registry is NCT04492852.

Highlights: Post-operative surgical site infections and complications are a major concern nowadays.Skin staples are not widely used as compared to Prolene because they are expensive and not easily available in every hospital.There are no standard guidelines as which type of the suture should be used.The type of sutures is being selected on the orders and wishes of the surgeon at the time of skin closure.

Introduction: Surgical treatment of rotator cuff tears commonly entails reattachment of the ruptured tendon to its bony insertion using suture anchors. Suture anchor design has evolved from solid metal anchors to vented biocomposite anchors with potentially biologic consequences. Few studies have investigated the differences between different modern anchor design and materials, making it difficult to justify their use or cost.

Objective: To compare the rate of bony ingrowth and implant resorption between a coil-type open-architecture biocomposite suture anchor and a vented screw-type biocomposite suture anchor, used for arthroscopic double-row rotator cuff repair.

Methods and analysis: In this retrospective comparative study, a consecutive series of patients who undergo a double row rotator cuff repair using a coil-type open architecture biocomposite suture anchor in the medial row and a vented screw-type biocomposite suture anchor in the lateral row will be included. A sample size calculation demonstrated that 16 participants are required in each group. Primary outcome measures will be bony ingrowth and reabsorption of the suture anchor as measured on computed tomography (CT). Secondary outcomes will include patient reported outcome measures (The American Shoulder and Elbow Surgeons score and The Western Ontario Rotator Cuff questionnaire), range of motion, postoperative tendon integrity, and cyst formation.

Highlights: Open-architecture suture anchors facilitate the release of marrow constituents.The rate of bony ingrowth for coil- and screw-type anchors will be assessed.The difference in functional outcome between the two anchors will be assessed.

Introduction: Postoperative biliary complications in living donor liver transplantation are often difficult to treat, and if treatment is not successful, the patient's QOL is significantly reduced. The frequency of postoperative biliary complications is reported to be higher than that of deceased donor transplantation. In 2013, Lin et al. reported that while biliary reconstruction has traditionally used a surgical surgical loupe (2.5x-4.5x), biliary reconstruction using a surgical microscope (5x-15x) can reduce the incidence of complications. The objective of this study is to clarify the efficacy of biliary reconstruction using surgical microscope in living donor liver transplantation by a multi-facility, randomized comparative study.

Methods and analysis: It is an open-label randomized controlled study in which target patients who meet the registration requirements are randomly allocated to a surgical loupe group and a microscopy group after obtaining their consent (Ratio 1:1). The primary endpoint is an incidence of biliary complications (bile leakage and anastomotic biliary stricture) with Clavien-Dindo class III or higher within 52 weeks following surgery. The secondary endpoint is length of time required for biliary reconstruction using a surgical microscope.

Ethics and dissemination: This study protocol was approved by the institutional review board of Nagasaki University Hospital (No. 20122102-2). The study is registered in UMIN-CTR as UMIN000042011. Written informed consent will be obtained from all participants. The results will be published in a peer-reviewed journal and will be presented at medical meetings.

Highlights: Postoperative biliary complications in living donor liver transplantation are often difficult to treat.Lower incidence of biliary complication following biliary reconstruction using a surgical microscope has been reported.Facilities those use a surgical microscope for biliary reconstruction are limited.The first study to investigate the efficacy of surgical microscope for biliary construction in liver transplantation by randomized controlled trial.

Hydatidosis (Echinococcosis) is a disease caused by infestation of hydatid cysts in any organ of body but mainly liver (70% of cases). Hydatidosis of salivary glands is rare and necessitate computerized tomography for diagnosis while fine needle aspiration remains controversial procedure.

Materials and methods: 6 patients diagnosed with hydatid cysts of parotid glands. These cases were admitted and treated at the maxillofacial surgery Clinic of the "AL-Ramadi" Hospital in Iraq. 5 patients were female and 1 male with age group was between 30-50 years. The patients complained of painless unilateral swelling in parotid region and who were diagnosed hydatid cysts using CT. All cases were treated by superficial parotidectomy with cystectomy and preservation of facial nerve.

Results: All hydatid cysts are CE1- type with no recurrences were reported in any of these cases. The postoperative edema was the most common complication. Other complications were not seen.

Conclusion: parotid hydatid cyst should be included in differential diagnosis of persistent parotid swelling especially those with history of hepatic hydatid cysts. Computerized tomography is the gold imaging that aid in diagnosis and classification of hydatid cysts. Most cases are CE1 type and Eosinophilia is a sign of concern in some patients. Surgical treatment remains the "gold standard" in therapy.

Highlights: Hydatidosis of parotid glands is rare but must be included in differential diagnosis of cystic swelling of salivary glands especially those with history of hepatic hydatid cysts.The hydatid cysts are classified according to morphology on imaging into 5 typesTotal serum bilirubin, eosinophilia and leukocytosis are seenSuperficial parotidectomy with removal of hydatid cysts is the treatment of choice in parotid hydatid cysts.

Background: Oro-motor intervention methods were previously adopted to improve the sucking pattern but there is still a lag in the structured protocol for improving sucking behavior in infants with immature sucking. Thus, this study is aimed to develop a structured protocol for the Oro-motor intervention to improve sucking behavior.

Method: Using the prospective observational study design, neonates with poor suck (producing less than 10 sucks per minute), under NG tube feeding, and maintaining oxygen saturation at room air were included. A total of 6 subjects were enrolled in this study and they were treated with Oro-motor intervention protocol. The Sucking rate and LATCH score were taken as the outcome measures and measured at beginning of intervention and after 2 weeks of intervention.

Result: The mean pre-test and post-test values for sucking rate were is (8.66), (32.5) and LATCH were (4.66), (8.16) respectively. The data collected showed that the protocol framed for Oro-motor intervention was significantly effective in improving quality of feeding among infants with immature sucking behavior.

Conclusion: The structured Oro-motor intervention protocol improves the feeding performance in infants with poor sucking behavior and improves the LATCH score. All the infants included in this study where under nasogastric tube feeding, thus the structured protocol can be considered to be helpful in weaning from NG tube feeding.

Background: Glioblastoma multiforme is the most common and aggressive primary adult brain neoplasm. The current standard of care is maximal safe surgical resection, radiotherapy with concomitant temozolomide, followed by adjuvant temozolomide according to the Stupp protocol. Although the protocol is well adopted in high-income countries (HICs), little is known about its adoption in low- and middle-income countries (LMICs). The aim of this study is to describe a protocol design for a systematic review of published studies outlining the differences in GBM management between HICs and LMICs.

Methods: A systematic review will be conducted. MedLine via Ovid, Embase and Global Index Medicus will be searched from inception to date in order to identify the relevant studies. Adult patients (>18 years) with histologically confirmed primary unifocal GBM will be included. Surgical and chemoradiation management of GBM tumours will be considered. Commentaries, original research, non-peer reviewed pieces, opinion pieces, editorials and case reports will be included.

Results: Primary outcomes will include rates of complications, disability-adjusted life years (DALYs), prognosis, progression-free survival (PFS), overall survival (OS) as well as rate of care abandonment and delay. Secondary outcomes will include the presence of neuro-oncology subspecialty training programs.

Discussion: This systematic review will be the first to compare the current landscape of GBM management in HICs and LMICs, highlighting pertinent themes that may be used to optimise treatment in both financial brackets.

Systematic review registration: The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020215843).

Highlights: Glioblastoma multiforme (GBM) remains the most common primary adult cerebral neoplasm, with an age-adjusted incidence rate of 3.22 per 100,000 population and a 5-year survival rate of 6.8%Despite the well-evidenced efficacy of Stupp protocol, the implementation of this approach bears an institutional and individual financial burden that is particularly notable in low- and middle-income countries (LMICs)This systematic review will be the first to compare the current landscape of GBM management in HICs and LMICs, highlighting pertinent themes that may be used to optimise treatment in both financial brackets.

Background: The practice of antiemetic prophylaxis within the prevention and management of postoperative nausea and vomiting is important for optimal care of surgical patients. The poor practice of antiemetic prophylaxis on postoperative nausea and vomiting prevention come up with complications, reduce patient satisfaction, and increase overall costs. This study aims to assess practice and associated factors of antiemetic prophylaxis among health professionals in referral hospitals of Northwest Ethiopia.

Method and materials: Institutional based cross-sectional study was conducted on 407 health professionals from February 27 to March 30, 2019, in referral Hospitals of Northwest Ethiopia. A stratified random sampling technique was used to select the study participants. A structured questionnaire was used to collect data. Bivariable and multivariable logistic regression was used to identify factors associated with the antiemetic prophylaxis practice level of health professionals on postoperative nausea and vomiting prevention and management. The p-values of < 0.05 were considered statistically significant.

Results: In this study 153 (37.6%) of health professionals were practicing antiemetic prophylaxis. The multivariable logistic regression analysis showed that anesthetists were (AOR: 8.11; 95% CI: 3.27, 20.08) and physicians (AOR: 4.78; 95% CI: 2.46, 9.30) were more likely to give anti-emetic prophylaxis as compared with midwives. Learning in academic classes (AOR: 3.83; 95% CI: 1.46, 10.09), took training (AOR: 6.97; 95% CI: 2.208, 22.021), professionals who said that there are enough anti-emetic drugs available (AOR: 3.10; 95% CI: 1.67, 5.77), professionals, who respond that patients can afford to buy antiemetic's (AOR: 3.56; 95% CI: 1.23, 10.32) were more likely to give anti-emetic prophylaxis as compared to their counterparts.

Conclusions: Less than fifty percent (37.6%) of health Professionals practice antiemetic prophylaxis. Type of Profession, learning, training, availability, and cost of antiemetic drugs were factors significantly affecting the practice of antiemetic prophylaxis.

Highlights: Less than fifty percent of health Professionals practice antiemetic prophylaxis.The availability, drugs affects the practice of antiemetic prophylaxis.The cost of anti-emetics affects the practice of antiemetic prophylaxis.

Background: Provision of education to a person with myocardial infarction and an active family member, who takes care of the patient can prevent or delay the onset of the disease. Telephone tracking is a very useful and inexpensive way to assess the patients' needs and help them with their care problems. This clinical trial (interventional) protocol was conducted over the impact of family-based multimedia education based on the telephone tracking (tele-nursing) to improve the quality of life and self-efficacy in patients with myocardial infarction.

Methods: Two phases are identified to design this study; the first phase includes designing a curriculum by investigating various studies and the panel of experts' opinions. This phase will be conducted in the form of multimedia training and telephone contact. Multimedia training (including audio, video, image, and animation) over the patients' lifestyle, nutrition, and care will be conducted through a one-day workshop in 2-3 hours for patients and one of their active family members. The active family member is defined as the primary caregiver, who spends more time with the patient. The educational course will be conducted at a coordinated date and time in the ward where the patients are hospitalized. The researcher will make telephone calls as the educational intervention and continue the follow-ups once a week for one month. The second phase of the intervention will contain a pre/post-test design along with application of Minnesota quality of life and Scherer general self-efficacy standard questionnaires in the intervention (with training) and control (without training) groups. The target participants will include all patients (and their active family members) admitted to CCUs of hospitals affiliated to Shahrekord University of Medical Sciences.

Discussion: The present study provides useful data for designing a family-based multimedia educational intervention using the telephone-tracking method (tele-nursing) to improve the quality of life and self-efficacy in patients with myocardial infarction. It can also reduce their medical and treatment costs. The strategies of this program could be important and cost effective, and therefore we hope that the success of such a program is a step forward in improving cardiovascular patient's health status.

Highlights: Family-based multimedia educational (tele-nursing) to improve the quality of life and self-efficacy in patients with myocardial infarction.Family-based multimedia educational (tele-nursing) can also reduce their medical and treatment costs.The program is a step forward in improving cardiovascular patient's health status.

Introduction: Para testicular sarcomas are rare mesenchymal tumors that affect patients of all ages. Unlike other sites of sarcoma, they tend to be of lower grade and have a higher propensity for lymphatic spread. Management is hampered by the small number of patients who differ in terms of tumor grade and histology. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. The consensus on the type of surgery and adjuvant treatment is yet to be determined. The local relapse rates in the scrotum and groin after orchidectomy comes out to be 25%-37%, indicating the need for either aggressive surgery or adjuvant treatment. There is a paucity of data identifying the patterns of failure and risk factors for recurrence, which will help clinicians tailor appropriate treatment.

Methods: We aim to perform a systematic review and meta-analysis of the available data in the last 50 years in a methodologically rigorous and transparent manner to identify patterns of failure and high-risk factors for recurrence. The protocol is prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-P) 2015 guidelines. The protocol is registered in the International Prospective Register of Systematic Reviews (CRD42021237134).

Highlights: Para testicular sarcomas are rare mesenchymal tumors that affects patients of all ages. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. A systemic review was performed in 2013 based on survival rates, prognostic factors, and relapse sites on paratesticular sarcomas. However, it lacks a comprehensive review that can guide radiation oncologists to select in which patient's postoperative radiotherapy is warranted and define the target volume based on histopathological type, stage, and grade of the tumor. After 2013, new case series with improved methodology and sample size are published, which adds new information to the literature. In one case series, 22 patients with spermatic cord sarcoma were discussed, while in another study, long-term outcome analysis of 51 patients was discussed, and another study discussed eight patients.