Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction

Background:

Use of self-expanding metallic stents (SEMS) as a bridge to surgery has been suggested as an alternative management for acute malignant left-sided colonic obstruction, as emergency surgery has a high risk of morbidity and mortality. This meta-analysis evaluated high-quality evidence comparing preoperative SEMS with emergency surgery.

Results:

Four RCTs with 234 patients were included..........Three trials were stopped prematurely, one because the emergency surgery group had a significantly increased anastomotic leak rate, and two others because of stent-related complications and increased 30-day morbidity following SEMS management.......

Evaluation of laparoscopic management of gynecologic emergencies by residents

Framework Needed for Research Ethics Review During Public Health Emergencies

Note: discussion with particular reference to SARS (2003).

blog author's opinion: the most interesting/important comment in the article might be the following, as below. The larger question is the resulting action.

"Provide guidance and education on the important differences between public health research and practice to foster consistency in application of the differences and on how to recognize when projects proposed during emergencies cross the line from practice to research."

Why do patients with cancer visit the emergency department near the end of life? - CMAJ

Note: full access (pdf)
"Between 2002 and 2005 in Ontario, 91 561 patients died of cancer and were included in our cohort."

"...The other highly ranked diagnoses that were common to both periods were abdominal pain, dyspnea, pneumonia, malaise and fatigue, and pleural effusion. A notable difference between the two time periods was the rank of cardiac arrest, which ranked 16th among diagnoses made for visits during the final two weeks but 61st among those made for visits during the final six months. Palliative care, dehydration and altered level of consciousness ranked much higher for the final two-week period than for the six-month period. No specific code exists for pain-related crisis...".

"Clinical descriptions of patients or families as no longer “coping” at home are common."