Re: Intensivist supervision of resident-placed central venous catheters decreases the incidence of catheter-related blood stream infections (Adamson Sinjani Muula, 02 May 2008)
The paper by Papadimos et al [1] is timely as it comes at a time when the cost of health care for many patients in the United States is unbearable, and any financial savings are welcome amidst a hurting economy. I commend the authors for using Auto-Regressive Integration Moving Average (ARIMA) analysis to assess if the change in outcome was due to the intervention and not "noise". While the choice of method appears to be appropriate, the reader is left to guess if the assumptions necessary for this method were considered. For instance, it is not known whether the residual variations from the data were or assumed to be normally distributed, to what extent were they independent and whether the authors considered whether there was constant variance [2]. These are important assumptions that, if...
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Adolescent Idiopathic Scoliosis – an indication for surgery? (Hans-Rudolf Weiss, 30 December 2007)
I´d like to thank Evalina Burger for her input regarding my case report published in Patient Safety in Surgery. Indeed, the Risser sign was missing in the case presentation which was grade IV not promising a significant residual growth in relation to this relatively small curve operated on of 28 degrees with a generally benign prognosis. However menarchial status documented here also shows there was little residual growth left before the operation was performed.In an unbiased comment I would have expected a statement that in this benign curve obviously no indication for surgery is given. I would have expected that Dr. Burger to be aware of the fact that the paper cited as reference #5 [1], although being published in Pediatric Rehabilitation, is related to Adolescent Idiopathic...
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Unbiased, evidence-based scientific decision making (Evalina Burger, 20 December 2007)
I read with high interest the case report by Dr. Weiss on a young patient who deteriorated after surgery for adolescent idiopathic scoliosis (AIS). Despite the lack of detailed reporting on parameters which influence the decision making for surgery, such as the Risser sign, I agree with author that the fusion levels selected in this patient were probably inadequate, leading to a residual imbalance. However, the presentation of the discussion appears almost as imbalanced as the patient described in this paper, due to an obvious, unjustified bias by the author against surgery for scoliosis.A large percentage of patients with scoliotic curves of more than 45 degrees will deteriorate without surgery. Spontaneous regression is reported in a small number of patients with AIS. The long-term effect...
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Testicular atrophy- A rare complication which needs special attention (JOHN GRIFSON, 26 November 2007)
Testicular atrophy is a rare complication following hernia surgery.Although the incidence of testicular atrophy is 1% following inguinal herniorraphy,the reported incidence in recurrent hernia surgery is around 5%.Atrophy following inguinal hernia surgery is attributed to the pampniform plexus thrombosis which is inadvertently injured during dissection of a large hernial sac from the chord structures.However in laparoscopic hernia surgery ,a large sac is transected and is rarely dissected.Furthermore the pampniform plexus unite to form the testicular vein in the preperitoneal fat.All these factors significantly lowers the chance of testicular atrophy in laparoscopic hernia surgery. Although the medico legal implications following testicular atrophy are obvious,it still remains unclear...
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Comment on: Moore et al. Patient Safety in Surgery, 1:3
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Re: Intensivist supervision of resident-placed central venous catheters decreases the incidence of catheter-related blood stream infections (Adamson Sinjani Muula, 02 May 2008)
The paper by Papadimos et al [1] is timely as it comes at a time when the cost of health care for many patients in the United States is unbearable, and any financial savings are welcome amidst a hurting economy. I commend the authors for using Auto-Regressive Integration Moving Average (ARIMA) analysis to assess if the change in outcome was due to the intervention and not "noise". While the choice of method appears to be appropriate, the reader is left to guess if the assumptions necessary for this method were considered. For instance, it is not known whether the residual variations from the data were or assumed to be normally distributed, to what extent were they independent and whether the authors considered whether there was constant variance [2]. These are important assumptions that, if... read full comment
Comment on: Papadimos et al. Patient Safety in Surgery, 2:11
Adolescent Idiopathic Scoliosis – an indication for surgery? (Hans-Rudolf Weiss, 30 December 2007)
I´d like to thank Evalina Burger for her input regarding my case report published in Patient Safety in Surgery. Indeed, the Risser sign was missing in the case presentation which was grade IV not promising a significant residual growth in relation to this relatively small curve operated on of 28 degrees with a generally benign prognosis. However menarchial status documented here also shows there was little residual growth left before the operation was performed.In an unbiased comment I would have expected a statement that in this benign curve obviously no indication for surgery is given. I would have expected that Dr. Burger to be aware of the fact that the paper cited as reference #5 [1], although being published in Pediatric Rehabilitation, is related to Adolescent Idiopathic... read full comment
Comment on: Weiss Patient Safety in Surgery, 1:7
Unbiased, evidence-based scientific decision making (Evalina Burger, 20 December 2007)
I read with high interest the case report by Dr. Weiss on a young patient who deteriorated after surgery for adolescent idiopathic scoliosis (AIS). Despite the lack of detailed reporting on parameters which influence the decision making for surgery, such as the Risser sign, I agree with author that the fusion levels selected in this patient were probably inadequate, leading to a residual imbalance. However, the presentation of the discussion appears almost as imbalanced as the patient described in this paper, due to an obvious, unjustified bias by the author against surgery for scoliosis.A large percentage of patients with scoliotic curves of more than 45 degrees will deteriorate without surgery. Spontaneous regression is reported in a small number of patients with AIS. The long-term effect... read full comment
Comment on: Weiss Patient Safety in Surgery, 1:7
Testicular atrophy- A rare complication which needs special attention (JOHN GRIFSON, 26 November 2007)
Testicular atrophy is a rare complication following hernia surgery.Although the incidence of testicular atrophy is 1% following inguinal herniorraphy,the reported incidence in recurrent hernia surgery is around 5%.Atrophy following inguinal hernia surgery is attributed to the pampniform plexus thrombosis which is inadvertently injured during dissection of a large hernial sac from the chord structures.However in laparoscopic hernia surgery ,a large sac is transected and is rarely dissected.Furthermore the pampniform plexus unite to form the testicular vein in the preperitoneal fat.All these factors significantly lowers the chance of testicular atrophy in laparoscopic hernia surgery. Although the medico legal implications following testicular atrophy are obvious,it still remains unclear... read full comment
Comment on: Moore et al. Patient Safety in Surgery, 1:3