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Cooper Williams
Cooper Williams

Kapoors Guide For General Practitioners Pdf 104 ((TOP))

The purpose of these guidelines is to provide evidence-based recommendations about the prevention of VTE for patients undergoing major surgical procedures. The target audience includes patients, surgeons, intensivists, internists, hematologists, general practitioners, hospitalists, other clinicians, pharmacists, and decision makers. Policy makers interested in these guidelines include those involved in developing local, national, or international programs aiming to safely reduce the incidence of VTE and/or to evaluate direct and indirect harms and costs related to VTE and its prevention. This document may also serve as the basis for adaptation by local, regional, or national guideline panels.

Kapoors Guide For General Practitioners Pdf 104

The primary target population of this guideline is patients hospitalized for major surgical procedures that carry a risk for postoperative VTE. This guideline also addresses patients hospitalized following major trauma; most, but not all, subsequently required major surgical procedures. The panel recognized that there are 2 major modalities applied for the prevention of VTE in the postoperative period: pharmacological antithrombotic prophylaxis and mechanical prophylaxis. For evaluation of the pharmacological methods for the prevention of VTE, the panel weighed the benefits and risks of the various options for individual surgical procedures or domains, such as hip or knee arthroplasty, general surgery, or urological or neurosurgical procedures.

The guideline panel determined that the net benefit favored using extended-course antithrombotic prophylaxis over short-term antithrombotic prophylaxis for patients undergoing major surgery based on very low certainty evidence. Given the very low certainty in the evidence of effects this is based upon, there is a critical need for higher-quality studies comparing extended vs short-term prophylaxis using clinically important outcomes in contemporary surgical practices, which are marked by early patient mobilization and shorter hospital stays. There is particularly a need for studies outside the general hip and knee arthroplasty and cancer general surgical settings to confirm the benefits of extended prophylaxis in other settings. There also appears to be a need for further research to determine the optimal duration of extended prophylaxis.

The guideline panel judged that the net benefit did not favor LMWH or UFH prophylaxis for patients undergoing major general surgery. Based on a very low overall certainty in the evidence, the panel determined that the balance of effects did not favor LMWH or UFH. In light of the very low certainty in the evidence, further high-quality comparative studies, using appropriate clinical outcomes, would be of value to add more certainty to this recommendation. However, such comparative studies are not regarded as high priority at this time.

These ASH guidelines stand out by their scope, which includes general issues relevant to any surgical procedure and those related to surgical subspecialties. They make consistent use of high-quality systematic reviews and provide a formal EtD framework for every recommendation, thereby enhancing transparency about the judgments that were made.

For general and abdominal surgery, which includes gastrointestinal, urological, gynecological, bariatric, vascular, plastic, or reconstructive surgery in its scope, the 2012 ACCP guidelines are once again the best known. In the very low risk setting, no specific pharmacological or mechanical prophylaxis is recommended other than early ambulation. At low risk, mechanical prophylaxis (preferably with intermittent pneumatic compression) is suggested over no prophylaxis. For moderate-risk patients, assuming there is no high risk for major bleeding, LMWH, low-dose UFH, and mechanical prophylaxis, preferably with intermittent pneumatic compression devices, are all options. If patients are at high risk for major bleeding complications or if consequences of bleeding are thought to be particularly severe, mechanical prophylaxis (preferably with intermittent pneumatic compression devices) is suggested over no prophylaxis.398

The World Society of Emergency Surgery (WSES) was founded in 2007 with the mission of promoting training and continuing medical education in emergency general surgery and trauma. Since its establishment, the WSES has launched and curated several clinical guidelines for specific topics related to emergency and trauma surgery, which are regularly updated to provide evidence-based guidance to emergency surgeons in their daily practice [1,2,3]. From this perspective, the present manuscript describes the international work conducted by WSES members to build consensus guidelines for the detection and management of one of the most severe complications of cholecystectomy, namely, bile duct injury (BDI).

LC is one of the most common operations a general surgeon performs in elective and emergency settings worldwide. BDI during LC is a severe complication that requires prompt diagnosis and specific treatment to avoid further morbidity and mortality. Practice guidelines have been proposed to prevent BDIs during LC [5], whereas BDI detection, classification, and management, once they occur, remain basically unstandardized. It is critical to have a plan if an injury is detected intraoperatively and to follow a standardized protocol in case of delayed diagnosis during the postoperative period. The present guidelines offer a thorough overview of the current literature about the key aspects of BDI detection and treatment strategies in various clinical situations. They are the results of international and multidisciplinary work promoted by the World Society of Emergency Surgery culminating in a consensus conference where all proposed statements and recommendations were approved by the worldwide contributing experts (a summary of all statements and recommendations is provided in Table 4). We must acknowledge that, despite the large number of publications on the topic, evidence was often derived from retrospective, moderate- to low-quality studies. However, the broad consensus reached by the expert panel allowed proposing recommendations in most cases.


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