scholarly journals SURGICAL TACTICS IN PATIENTS WITH PENETRATING THORACIC INJURIES

World Science ◽  
2021 ◽  
Author(s):  
Belozоrov Igor ◽  
Kudrevych Oleksandr ◽  
Kosov Eugene ◽  
Rozhkova Olena ◽  
Barsukov Nikita ◽  
...  
Keyword(s):  
Pleural Cavity ◽  
Laboratory Data ◽  
Dynamic Monitoring ◽  
Evidence Based ◽  
Chest Injuries ◽  
Topical Diagnosis ◽  
Lung Injuries ◽  
Surgical Tactics ◽  
Based Medicine

To date, the basis of surgical tactics for chest injuries is the primary surgical treatment of the wound and drainage of the pleural cavity with dynamic monitoring and determination of indications for surgery, based on the amount of blood released by drainage, without any attempts to actively verify the nature of injuries.Treatment of patients on the basis of the so-called "individual approach" and active-waiting tactics, taking into account clinical, radiological and laboratory data, mainly meets the recommendations of the middle of the last century.From the standpoint of evidence-based medicine, thoracoscopy is the most effective method of topical diagnosis of traumatic hemothorax. Videothoracoscopic technologies significantly reduce the incidence of purulent intrapulmonary and pleural complications in penetrating lung injuries. Undoubted advantages of thoracoscopy are: full-fledged revision; accurate diagnosis, which eliminates doubts about the diagnosis and waiting period; determination of indications for drainage, operative thoracoscopy or thoracotomy.

scholarly journals EVALUATION OF THE POSSIBILITY OF USING CORYOLIS VITRATOMYER IN THE DIAGNOSIS OF PULMONARY DAMAGE IN VICTIMS WITH FIRE PENETRATION EARLY WOUNDS

2021 ◽  
pp. 52-55
Author(s):  
E. A. Chernyavsky ◽  
Yu. V. Bunin ◽  
V. V. Negoduyko ◽  
R. M. Mikhailusov ◽  
E. M. Khoroshun ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Gunshot Wounds ◽  
Early Complications ◽  
Video Assisted ◽  
Chest Injuries ◽  
Coriolis Flowmeter ◽  
Lung Injuries ◽  
Pulmonary Damage ◽  
Air Discharge

Summary: The aim of the study was to determine the dependence of the volume of air discharge from the pleural cavity on the choice of surgical treatment in patients with penetrating chest injuries. Materials and methods. Of the 39 observations, video-assisted thoracoscopy (VATS) was performed in 24 patients due to existing hemothorax. Results and their discussion. Among patients with penetrating chest injuries and early complications in the form of isolated pneumothorax on the first day, VATS was performed in three cases, due to increased air discharge from the pleural cavity. On the second and third day, 3 and 1 patient needed PBX, respectively. The article presents the experience of using a Coriolis flowmeter to objectify the diagnosis of lung injuries in victims with gunshot wounds penetrating the chest. Depending on the speed and volume of air discharge from the pleural cavity, the dynamics can be determined by the tactics of treatment. Conclusions: 1. Observation in the dynamics of the rate (

scholarly journals DETERMINATION OF THERAPEUTIC AND DIAGNOSTIC TACTICS IN PENETRATING SHOOTING AND PUNCH-CUTTING INJURIES OF THE CHEST USING SPIRAL COMPUTER TOMOGRAPHY

2020 ◽  
pp. 47-54
Author(s):  
V. V. Boyko ◽  
P. M. Zamyatin ◽  
S. O. Beresnev ◽  
D. P. Zamyatin ◽  
Yu. V. Bunin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spiral Computed Tomography ◽  
Spiral Computed ◽  
Invasive Treatment ◽  
Chest Injuries ◽  
Surgical Tactics ◽  
Conservative And Surgical Treatment ◽  
Spiral Computer Tomography

Summary. The aim of the study was to improve the quality of diagnosis of chest injuries and to optimize surgical tactics through the use of spiral computed tomography. Material and research methods. The work is based on prospective analysis of the results of spiral computed tomography of patients with chest injuries for the period from 2014 to 2020. Results and its discussion. The results of SCT make it possible to objectify the choice of surgical tactics and the most rational type of access. The use of SCT has become expedient for chest injuries both before surgery in patients with stable hemodynamics and in the postoperative period to identify early complications. Conclusions. Based on the study, it was concluded that the use of SCT in patients with chest wounds makes it possible to choose rational treatment tactics, optimal access for surgery and drainage area, as well as apply minimally invasive treatment methods. Conducting CT studies in dynamics allows us to assess the effectiveness of conservative and surgical treatment and promptly make adjustments to the treatment.

scholarly journals Advanced Inferential Medicine℠

2017 ◽  
Author(s):  
Dennis L. Barbour
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Decision ◽  
Treatment Decisions ◽  
Patient Treatment ◽  
Individual Treatment ◽  
Evidence Based ◽  
Prior Beliefs ◽  
Limited Effectiveness ◽  
Based Medicine

Traditional medical inference requires explicit determination of a patient’s ailment prior to deciding the best treatment option. Evidence-based medicine informs these decisions from the outcomes of previous patients with similar ailments who received similar treatments. Precision medicine seeks to expand this nomothetic framework with many more potential diagnoses, the total possible number of which is inherently limited by the number of similar previous patients available for reference. The concept of making patient-care decisions using idiographic information unique to a particular patient may be a familiar concept to practicing clinicians, but it has no formal role within evidence-based medicine. The collective result is constrained inferential capacity of the dominant medical philosophy, leading to limited effectiveness of individual patient treatment decisions. A means of combining nomothetic and idiographic inference to optimize individual treatment outcomes would be a welcome addition to the modern medical armamentarium. Novel idiographic search algorithms informed by nomothetic prior beliefs can construct predictive models about individual patients that provide rigorous clinical decision support. This advanced medical inference framework exploits modern machine learning to generalize the concept of diagnosis and to make effective treatment decisions with or without definitive etiological understanding of a patient’s ailment.

Achieving good health and well-being in Africa by 2030 using multi-state models, survival analysis, statistical methods for evidence-based medicine, diagnosis and determination of risk factors

2020 ◽  
Vol 36 ◽  
pp. 137-145
Author(s):  
Humphrey E. Misiri
Keyword(s):  
Risk Factors ◽  
Sustainable Development ◽  
Statistical Methods ◽  
Evidence Based Medicine ◽  
Well Being ◽  
Good Health ◽  
Evidence Based ◽  
Based Medicine ◽  
Health And Well Being

Seventeen Sustainable Development Goals (SGDs) were adopted by the World Health Organization (WHO) in 2015 for the 2030 Agenda for Sustainable Development. Sustainable Development Goal 3 (SDG3) is ‘Better health and well-being by 2030’. According to WHO, good health in the context of SDG3 is assessed with respect to the level and distribution of individuals’ and communities’ healthy life, conditions that affect health and well-being and risk factors whose presence would affect health and well-being. The overall aim is that each SDG target is achieved by 2030. In 2018 the WHO used statistical methods to assess the state of health in Africa in the context of SDG3. Their analysis revealed successes and shortfalls towards attaining SDG3. Backed by public health and other activities, statistics play an important role in improving the health and well-being of Africa. This paper explains how statistics can be used to help African countries to attain SDG3, in its role in modeling event histories, diagnosis, evidence-based medicine, determination of risk factors of exposures of morbidity and mortality, determination of risk factors of morbidity and mortality, the computation of the level and distribution of vital events, measuring disease frequency and progress, quantification of life expectancy and monitoring and evaluation.

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

The Commitment of the Documentation Service of the Swiss Academy of Medical Sciences for the Impartment of Evidence Based Medicine

Swiss Surgery ◽  
1999 ◽  
Vol 5 (4) ◽  
pp. 183-185
Author(s):  
Bleuer
Keyword(s):  
Evidence Based Medicine ◽  
Cochrane Library ◽  
Evidence Based ◽  
Medical Sciences ◽  
Based Medicine

Die mit dem Aufkommen der elektronischen Medien einhergehende Informationsflut hat die Erwartungen an den Dokumentationsdienst (DOKDI) der Schweizerischen Akademie der Medizinischen Wissenschaften verändert: Insbesondere Evidence Based Medicine (EBM) verlangt nicht nur die Beschaffung von Information, sondern auch eine Selektion hinsichtlich Qualität und Relevanz: Die sich aus der klinischen Situation ergebende Frage fordert eine Antwort, die inhaltlich richtig ist und in der konkreten Situation auch weiterhilft. Dem Ideal, sich durch kritische Lektüre der Originalarbeiten ein Bild über die vorhandene Evidenz für die Richtigkeit eines bestimmten Prozederes zu verschaffen, stehen in der Praxis meist Zeitmangel und methodische Schwierigkeiten im Weg; man wird sich deshalb oft auf die durch andere erarbeitete Evidenz abstützen müssen und z.B. die Cochrane Library konsultieren. Der DOKDI engagiert sich sowohl bei der Erarbeitung von systematischen Übersichtsarbeiten als auch bei der Dissemination der gefundenen Evidenz, indem er seine Erfahrung in der Dokumentation mit elektronischen Medien und die entsprechende Infrastruktur zur Verfügung stellt. Als Ergänzung zu diesen Aktivitäten hat die Akademie einen Grant zur Ausbildung von EBM-Tutoren gesprochen. In einem einwöchigen Kurs in Oxford werden Kliniker zu EBM-Tutoren ausgebildet: Dies wird zukünftig ermöglichen, vermehrt EBM-Workshops in der Schweiz durchzuführen.

Sign in / Sign up

Export Citation Format

Share Document