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Journal and News Scan
This survey of healthcare workers at a German university clinic explored attitudes towards complementary and alternative medicine (CAM). Women were more interested than men (80% vs 20%) and nurses were more interested than physicians (72% vs 57%). Physicians had more concern than nurses about possible adverse effects (52% vs 12%). Almost 3 out of 4 did not feel adequately informed about CAM.
- Recommendations for implementing professionalism and quality policies
- Opportunities to translate current communication and teamwork knowledge into clinical practice
- Recommendations for future action and research opportunities in the physical and safety culture of the OR
Unfortunately , there are lots of stories like this around at the moment. He didn't undergo surgery, he had a stent.
This retrospective study assessed the prognostic significance of the new lung adenocarcinoma classification in patients undergoing resection for small tumors (≤2cm) comparing limited vs lobectomy resections. Histologic subtype with micropapillary component >5% was associated with an increased risk of recurrence in patients operated with limited resections but not lobectomy. This increased risk disappeared when the surgical margin was >1 cm.
This joint statement regarding patient safety advocates a variety of systems to improve outcomes, including checklists, preoperative briefings, postoperative debriefings, and training in communication skills. Nontechnical skills are the key to improvements in safety. Anonymous event reporting and regular training in rare but significant events are also recommended.
The surgical team at Cleveland Clinic have established a checklist, designed to become second nature to residents in training, for checking haemostasis after cardiac surgery. They have tested their process both in a trial mode and then in a service-wide implementation. This is an important part of establishing a plan for reduction of blood use and of re-opening for bleeding.
Bouri and collegues have analysed data from multiple trials of beta blockade prior to non-cardiac surgery. Guidelines for management have been based on these findings. However, exclusion of one report, now discredited, suggests an increase in morbidity rather than a protective effect. They note the increase in the risk of mortality, the primary end-point at 30 days of 27%. These findings indicate the need for further well controlled studies into the use of beta blockers.
In an editorial relating to a published meta-analysis ( Heart doi:10.1136/heartjnl-2013-304262), Hawkes raises the thorny but all too often repeated issue of research fraud. He estimates that in the UK, many deaths may be related to the recommendations regarding the use of β blockers during surgery, based mainly on a study by a now discredited researcher from Holland. There have been many recent and highly publicised instances of research fraud, leading to retractions of multiple peer reviewed papers, potentially impacting on our day to day clinical practice.
This updated meta-analysis comparing bilateral internal mammary artery (BIMA) versus left internal mammary artery (LIMA) for coronary artery bypass grafting includes 27 observational studies and over 79,000 patients and demonstrates an increased long-term survival in patients receiving a BIMA operation versus a LIMA operation.
With increasing access to online information, patients who have seen their purchasing ability decrease or have been turned down by insurance companies are increasingly turning to medical tourism as a realistic option. The article profiles patients such as Michael Shopenn who went to Belgium for his hip replacement. Implications for increasing price transparency, access and quality for patients are also touched upon in this insightful piece.