Douglaskeene6308

Objective In gynecologic oncology, minimally invasive surgery using conventional laparoscopy (CL) decreases the incidence of severe morbidity compared to open surgery. In 2005, robot-assisted laparoscopy (RL) was approved for use in gynecology in the US. This study aimed to assess whether RL is superior to CL in terms of morbidity incidence. Methods ROBOGYN-1004 (ClinicalTrials.gov, NCT01247779) was a multicenter, phase III, superiority randomized trial that compared RL and CL in patients with gynecologic cancer requiring minimally invasive surgery. Patients were recruited between 2010 and 2015. LOXO-195 manufacturer The primary endpoint was incidence of severe perioperative morbidity (severe complications during or 6 months after surgery). Results Overall, 369 of 385 patients were included in the as-treated analysis 176 and 193 underwent RL and CL, respectively. The median operating time for RL was 190 (range, 75-432) minutes and for CL was 145 (33-407) minutes (p less then 0.001). The blood loss volumes for the corresponding procedures were 100 (0-2500) and 50 (0-1000) mL (p = 0.003), respectively. The overall rates of conversion to open surgery for the corresponding procedures were 7% (10/176) and 5% (10/193), respectively (p = 0.52). Severe perioperative morbidity occurred in 28% (49/176) and 21% (41/192) of patients who underwent RL and CL, respectively (p = 0.15). At a median follow-up of 25.1 months (range, 0.6-78.2), no significant differences in overall and disease-free survival were observed between the groups. Conclusions RL was not found superior to CL with regard to the incidence of severe perioperative morbidity in patients with gynecologic cancer. In addition, RL involved a longer operating time than CL.Background Online forums have changed traditional sources of seeking help because they provide an anonymous and non-judgemental environment particularly suited for women with post-childbirth problems. Question What support is given to mothers who have posted questions about post-childbirth morbidities? Methods A total of 333 messages posted on a post-childbirth online forum were loaded into NVIVO 12 Pro and were analysed using content and thematic analysis. Content analysis identified the major health problems, and thematic analysis was used for identifying motivations and the support offered. Findings Seventeen different health problems were discussed on posts, with a strong emphasis on pelvic problems, followed by mental health concerns. The key motivation for seeking online help identified using 'typology of advice solicitation' was request for opinion or information (48.85%). The two main support themes were peer to peer support (82%) and normalisation (not always appropriate) of post-childbirth problems (18%). Most of the support offered was emotional (56.9%) followed by practical (22.7%) and informational support (20.4%). Discussion Postpartum adjustment of post-childbirth experiences can be supportive but if ill-informed may provide a barrier to safe and reliable health care. Conclusion We recommend women have access to online forums moderated by healthcare providers who can notify participants when a problem requires support from a relevant health professional opinion.Thymic epithelial neoplasms are rare tumors derived from thymic epithelium that most often present as large anterior mediastinal masses. The vast majority of thymic epithelial neoplasms fall under the diagnostic category of thymoma, with a smaller percentage qualifying for a diagnosis of thymic carcinoma. The ability to render a definitive diagnosis on these tumors is generally hampered by their deep location and close proximity to vital structures, which makes biopsy sampling for histopathologic evaluation difficult. In recent years, the trend in medicine has been to opt for the least invasive procedure to obtain tissue samples that, by definition, implies also obtaining smaller and smaller biopsies, resulting in lesser amounts of tissue available for examination. In the mediastinum, the most common modalities for procuring biopsy samples from mass lesions include fine-needle aspiration, percutaneous core needle biopsy and video-assisted thoracoscopic biopsy. In this review, we will deal only with the role and limitations of percutaneous core biopsies in the interpretation of thymic epithelial neoplasms.Trauma is a major cause of mortality globally, with post-traumatic hemorrhage being the leading cause of death amongst trauma patients. In this paper, the authors review the underlying pathophysiology of trauma-related hemorrhagic shock, specifically the factors which contribute to the development of the acute coagulopathy of trauma shock (ACoTS). We then review the best available evidence for treatment strategies in the pre-hospital setting, as well as the in-hospital setting. Interventions that are strongly supported in the literature include utilization of a well-organized trauma system with direct transport to a designated trauma centre, the early use of tranexamic acid, and damage control orthopaedic surgical techniques and resuscitation protocols. Targeted resuscitation is an evolving field, with use of thromboelastography to guide resuscitation being a particularly promising area. Special trauma populations at particularly high risk are also reviewed, including the geriatric population, as well as unstable pelvic fractures, which are each at increased risk for poor outcomes, and deserve special attention. Major advances have been made in this important area, and ongoing research into the understanding and correction of ACoTS will continue to guide practice.Objective To garner the perceptions of select general surgical trainees of vascular surgical teaching received during their higher specialty training years in the United Kingdom. Design An embedded mixed methods research approach, with a predominantly qualitative research framework, based on phenomenology was used to design a questionnaire and focus group consisting of a purposive criterion-based sample. All responses were analyzed using reflexive thematic analysis by a single researcher. Setting The study setting was the eastern sub-deanery of "Kent, Surrey and Sussex" with 9 district general hospitals and 1 tertiary hospital and 50 higher general surgical trainees. Participants Inclusion criteria were all general surgical trainees in the deanery who had attended vascular surgical teaching and done their vascular rotation over the last 5 years. The exclusion criteria were all trainees currently taking time out of the training programme due to personal or educational reasons, or who were yet to commence their vascular surgical rotation.