International journal of surgery
-
In order to examine the reporting quality of urological RCTs, the initial objectives of this study were to evaluate the degree to which RCTs involving urological surgical techniques (as the intervention) published in the years 2000-2003 complied with the CONSORT statement, and to assess trends and patterns of compliance. Following our initial findings in urology, we extended the methodology to a number of other specialties to assess whether our findings in urology could be generalised to other surgical disciplines. ⋯ Clinical research teams conducting RCTs in urology and other surgical disciplines demonstrate poor compliance with the CONSORT statement. We would recommend that trials should be registered at their outset and that urological and other surgical journals to consider supporting the CONSORT statement and to have compliance 'hard-wired' into their submission, editorial and peer-review processes. Since it seems the best researchers are unable to produce an RCT results which enable surgical techniques to be critically assessed, there is a need for education about the CONSORT statement and its importance at all levels of surgical training. We believe that an open debate is needed on the possible role of other research designs, such as tracker studies. Whether this study actually raises the question of how appropriate RCTs are to surgical techniques, we leave to the reader.
-
Injuries to the duodenum--prognosis correlates with body Injury Severity Score: a prospective study.
Duodenal injury is an important hollow viscus injury in the abdomen. The study analysed the factors related to the outcome of duodenal injuries presenting to the unit. ⋯ M:F ratio was 9:2. Median age was 33 years. All were operated by a senior registrar or senior. Seven out of 23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Duodenal injury severity was graded according to American Association for Surgery of Trauma-Organ Injury Scale (AAST-OIS). Seventeen/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18 h. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs were required for 3/23 patients. Five patients died. Duodenum-related mortality was zero. The mortality was related to body Injury Severity Score >45. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Adverse prognostic factors towards morbidity was injury-operation lag >18 h.
-
Elderly patients are vulnerable to complications of intravenous fluid overload, however daily monitoring of fluid balance in this population has been highlighted as sub optimal by the NCEPOD. We compare current practice in fluid balance monitoring and intravenous fluid prescribing for elderly patients in a London District General Hospital to guidelines for fluid management in children issued by the National Patient Safety Agency. ⋯ Initial and daily weights are non-invasive parameters of fluid balance that are infrequently monitored in elderly patients receiving intravenous fluids. We propose that all elderly patients should be weighed (1) on admission to the Emergency Department, (2) prior to commencement of intravenous fluids and (3) on a regular basis, preferably daily, for the duration of intravenous fluid administration. For immobile patients, strict fluid input-output charts should be maintained as a surrogate index of changes in daily weight. We encourage consistent and accurate documentation of these non-invasive parameters on the fluid prescription charts.
-
The pre-operative staging in oesophageal cancer is often challenging and underestimation of the extent of the disease may lead to unnecessary surgery. ⋯ FDG-PET is more accurate than CT in defining N and M status. It can result in a reduction of unnecessary surgery in a significant number of patients. The combined PET-CT scan as a single imaging modality is expected to further improve diagnostic accuracy of FDG-PET.