Rosenthalagerskov0766

INTRODUCTION Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. METHODS Retrospective cohort including patients ≥18 years old with BMI≥35kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. RESULTS Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed .29% less EWL% per each extra year of life (P=.019), and .93% more EWL% per each extra HOMA-IR point (P=.004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P=.050), and 2% more chance of success per each additional HOMA-IR point (P=.038). CONCLUSIONS There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes. selleck compound INTRODUCTION The role of advanced life support (ALS) versus basic life support (BLS) in blunt trauma is controversial. Previous studies have shown no mortality benefit with ALS for penetrating trauma but the blunt population has mostly remained unaddressed. METHODS A retrospective cohort study was conducted at a Level 1 trauma center comparing outcomes in blunt trauma patients managed by ALS versus BLS from July 1, 2014 to December 31, 2014. Both Injury Severity Score (ISS) and select Abbreviated Injury Score (AIS) were used to determine differences in mortality, length of stay (LOS) and complications based on mode of transportation, prehospital time, and number of prehospital interventions. RESULTS 698 total patients were identified. Mortality and complications were grossly higher in ALS patients (p = 0.01 and  less then  0.001, respectively). When accounting for ISS and AIS there was no difference in mortality (p= less then 0.001-0.003). Prehospital interventions did not increase prehospital time (p = 0.7) but did correlate with increased mortality (p  less then  0.001). CONCLUSION There is no mortality advantage for blunt trauma patients managed by ALS versus BLS. This Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) document illustrates and defines the overall nomenclature associated with type B aortic dissection. The contents describe a new classification system for practical use and reporting that includes the aortic arch. Chronicity of aortic dissection is also defined along with nomenclature in patients with prior aortic repair and other aortic pathologic processes, such as intramural hematoma and penetrating atherosclerotic ulcer. Complicated vs uncomplicated dissections are clearly defined with a new high-risk grouping that will undoubtedly grow in reporting and controversy. Follow-up criteria are also discussed with nomenclature for false lumen status in addition to measurement criteria and definitions of aortic remodeling. Overall, the document provides a facile framework of language that will allow more granular discussions and reporting of aortic dissection in the future. BACKGROUND In surgical patients undergoing general anaesthesia, coughing at the time of extubation is common and can result in potentially dangerous complications. We performed a systematic review and meta-analysis to assess the efficacy and safety of i.v. lidocaine administration during the perioperative period to prevent cough and other airway complications. METHODS We searched Medical Literature Analysis and Retrieval System, Excerpta Medica database, and Cochrane Central Register of Controlled Trials for RCTs comparing the perioperative use of i.v. lidocaine with a control group in adult patients undergoing surgery under general anaesthesia. The RCTs were assessed using risk-of-bias assessment, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS In 16 trials (n=1516), the administration of i.v. lidocaine compared with placebo or no treatment led to large reductions in post-extubation cough (risk ratio [RR] 0.64; 95% confidence interval [CI] 0.48-0.86) and in postoperative sore throat at 1 h (RR 0.46; 95% CI 0.32-0.67). There was no difference in incidence of laryngospasm (risk difference [RD] 0.02; 95% CI -0.07 to 0.03) or incidence of adverse events related to the use of lidocaine. CONCLUSIONS The use of i.v. lidocaine perioperatively decreased airway complications, including coughing and sore throat. There was no associated increased risk of harm. Modern healthcare is delivered by interprofessional teams, and good leadership of these teams is integral to safe patient care. Good leadership in the operating theatre has traditionally been considered as authoritative, confident and directive, and stereotypically associated with men. We argue that this may not be the best model for team-based patient care and promote the concept of inclusive leadership as a valid alternative. Inclusive leadership encourages all team members to contribute to decision-making, thus engendering more team cohesion, information sharing and speaking up, and ultimately enhancing team effectiveness. However, the relational behaviours associated with inclusive leadership are stereotypically associated with women and may not in fact be recognised as leadership. In this article we provide evidence on the advantages of inclusive leadership over authoritative leadership and explore gender stereotypes and obstacles that limit the recognition of inclusive leadership. We propose that operating teams rise above gender stereotypes of leadership.